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Diabetic ketoacidosis: Treatment in the intensive care unit or general medical/surgical ward?

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World Journal of Diabetes 2017年第2期8卷 40-44页

作者： Yamely Mendez Salim Surani Joseph Varon Dorrington Medical Associates Facultad de Medicina Universidad Autónoma de Tamaulipas Tampico Department of Pulmonary Critical Care and Sleep Medicine Texas A and M University Department of Medicine University of North Texas Department of Critical Care Medicine Founda-tion Surgical Hospital of Houston

Diabetic ketoacidosis(DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit(ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin. In some institutions, DKA is treated in the emergency department and general medical/surgical wards to avoid ICU overcrowding.

关键词： Diabetic ketoacidosis Diabetes Hyperosmolar non-ketotic state Clinical outcomes Serum ketones

Corticosteroid-free immunosuppression in liver transplantation: An evidence-based review

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World Journal of Gastroenterology 2014年第31期20卷 10703-10714页

作者： George Sgourakis Georgia Dedemadi 2~(nd) surgical Department and surgical Oncology unit "Korgialenio-Benakio" Red Cross Hospital surgical Department of "Amalia Fleming" general Hospital

Thirty-six randomized controlled trials and two metaanalyses were reviewed. With respect to adult patients undergoing first orthotopic liver transplantation(OLT), steroid replacement resulted in fewer cases of overall acute rejection in the corticosteroid free-immunosuppression arm. Initial steroid administration for two weeks and early tacrolimus monotherapy is a feasible immunosuppression regimen without steroid replacement, although further investigations are needed in view of chronic rejections. No significant differences were noted between the treatment groups in terms of patient and graft survival independently of steroid replacement. Renal insufficiency, de novo hypertension, neurological disorders and infectious complications did not differ significantly among steroid and steroidfree groups. Diabetes mellitus, cholesterol levels and cytomegalovirus infection are more frequent in patients within the steroid group. With respect to diabetes mellitus and hypercholesterolemia, the difference was independent of steroid replacement. In relation to transplanted hepatitis C virus patients, mycophenolate mofetil does not appear to have a significant antiviral effect despite early reports. Male gender of donors and recipients, living donors, cold ischemia times, acute rejection, and early histological recurrence were related to the development of advanced hepatitis. There is sufficient scientific clinical evidence advocating avoidance of the ab initio use of steroids in OLT.

关键词： Meta-analysis Evidence based Hepatitis C virus recurrence Liver transplantation Steroid withdrawal Orthotopic liver transplantation

Splenic lymphangiomatosis showing rapid growth during lactation:A case report

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World Journal of Gastroenterology 2010年第9期16卷 1155-1157页

作者： Rosalia Patti Emilio Iannitto Gaetano Di Vita general Surgery unit Department of Surgical and Oncological SciencesUniversity of Palermo Haematological Division University of Palermo

Splenic lymphangiomatosis is a very rare condition that,from 1990 to date,has been described only nine *** the present report,we describe the first case of splenic lymphangiomatosis with rapid growth during lactation in a 35-year-old *** also underline the difficultly in making an accurate preoperative diagnosis,despite more modern imaging *** splenectomy was considered to be the treatment needed,both to make a definitive diagnosis and to exclude the presence of malignancy.

关键词： Lymphangiomatosis Spleen Lactation

Dual loop(Roux en Y) reconstruction with isolated gastric limb reduces delayed gastric emptying after pancreatico-duodenectomy

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World Journal of Gastrointestinal Surgery 2019年第2期11卷 93-100页

作者： Offir Ben-Ishay Reem Abu Zhaya Yoram Kluger surgical Oncology unit Division of General Surgery Rambam Health Care Campus

BACKGROUND Single loop reconstruction(SLR) was routine in our institution for patients undergoing pancreatico-duodenectomy(PD). Roux-en Y reconstruction with an isolated gastric limb(RIGL) recently became the reconstruction of *** To evaluate the impact of RIGL on incidence and severity of delayed gastric emptying(DGE).METHODS This is a single institution, retrospective analysis of patients undergoing PD. All patients undergoing PD from July 2010 through December 2016 were included in the study. Outcome of RIGL were compared to SLR. Primary measure of outcome included incidence and severity of DGE. Secondary measures of outcome were overall complications and postoperative *** One hundred and seventy-nine patients were included in the study. Fifty-two had RIGL, 127 had SLR. Overall complication rate was 40.2%, patients in the RIGL group experienced lower rates of DGE(15.4% vs 59.1%, P = 0.001). Other patient related outcomes were also significantly reduced: day of nasogastric tube removal(3 vs 5, P < 0.001), regain of normal diet(8 vs 9, P < 0.001). On multivariate analysis RIGL was associated independently with reduced rates of DGE(P < 0.001, OR 0.14)CONCLUSION The current study shows that RIGL reduces the rate of DGE after PD. Further prospective randomized controlled trials are required to affirm the current data.

关键词： Pancreaticoduodenectomy Delayed gastric emptying Complications Roux en Y

Rare cystic liver lesions: A diagnostic and managing challenge

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World Journal of Gastroenterology 2013年第43期19卷 7603-7619页

作者： Andreas Bakoyiannis Spiros Delis Charina Triantopoulou Christos Dervenis First surgical Department-HPB surgical unit Konstantopouleion Agia Olga General Hospital14233 AthensGreece Radiology Department Konstantopouleion Agia Olga General Hospital14233 AthensGreece

Cystic formations within the liver are a frequent finding among *** the common cystic lesions,like simple liver cysts,rare cystic liver lesions like cystadenocarcinoma should also be considered in the differential *** knowledge of each entity’s nature and course are key elements to successful *** search in PubMed,Cochrane Database,and international published literature regarding rare cystic liver lesions was carried *** our research are included not only primary rare lesions like cystadenoma,hydatid cyst,and polycystic liver disease,but also secondary ones like metastasis from gastrointestinal stromal tumors ***-to date knowledge regarding diagnosis and management of rare cystic liver lesions is provided.A diagnostic and therapeutic algorithm is also *** need for a multidisciplinary approach by a team including radiologists and surgeons familiar with liver cystic entities,diagnostic tools,and treatment modalities is *** with cystic liver lesions must be carefully evaluated by a multidisciplinary team,in order to receive the most appropriate treatment,since many cystic liver lesions have a malignant potential and evolution.

关键词： Liver cyst Cystic tumor Hepatic lesion Gastrointestinal stromal tumors Metastases Cystadenoma Cystadenocarcinoma Hydatid cyst Polycystic liver disease Caroli Echinococcus

Giant appendiceal mucocele: Report of a case and brief review

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World Journal of Gastroenterology 2005年第30期11卷 4761-4763页

作者： Bernardino Rampone Franco Roviello Daniele Marrelli Enrico Pinto Department of general Surgery and surgical Oncology

Mucocele of the appendix is a rare lesion, characterized by distension of the lumen due to accumulation of mucoid substance. This disease is often asymptomatic and pre-operative diagnosis is rare. If untreated, one type of mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and to histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadenocarcinoma. In this paper, we report a case of a 51-year-old woman with a mobile, painless mass in the right lower quadrant of abdomen caused by a giant appendiceal mucocele. Imaging showed a larger tubular, cystic structure extending below from the inferior wall of the cecum. Surgery revealed a giant retro-cecal appendix measuring 17 cm in length and 4 cm in diameter. The final pathologic diagnosis was mucocele caused by mucinous cystadenoma.

关键词： Appendix Mucocele Pseudomyxoma peritonei surgical treatment

Treatment of Helicobacter pylori in surgical practice:A randomised trial of triple versus quadruple therapy in a rural district general hospital

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World Journal of Gastroenterology 2008年第24期14卷 3855-3860页

作者： Siok Siong Ching Sivakumaran Sabanathan Lloyd R Jenkinson Clinical Research Fellow in general Surgery Leeds General Infirmary Department of Surgery Ysbyty Gwynedd

AIM: To compare a lansoprazole-based triple versus quadruple therapy for Helicobacter pylori (H pylori) eradication with emphasis on side effect prof ile,patient compliance and eradication rate at a rural district general hospital in Wales,united Kingdom. METHODS: One hundred one patients with H pylori infection were included in the study. Patients were randomised to receive triple therapy comprising of lansoprazole 30 mg,amoxycillin 1 g,clarithromycin 500 mg,all b.d. (LAC),or quadruple therapy comprising of lansoprazole 30 mg b.d.,metronidazole 500 mg t.d.s.,bismuth subcitrate 240 mg b.d.,and tetracycline chloride 500 mg q.d.s. (LMBT). Cure was defi ned as a negative 13C urea breath test 2 mo after treatment. RESULTS: Seven patients were withdrawn after randomisation. Fifty patients were assigned to LAC group and 44 to LMBT group. The intention-to-treat cure rates were 92% and 91%,whereas the per-protocol cure rates were 92% and 97%,respectively. Side effects were common,with 56% experiencingmoderate to severe symptoms in the LAC group and 59% in the LMBT group. Symptoms of vomiting,diarrhoea and black stools were significantly more common in the LMBT group. Patient compliance was 100% for triple therapy and 86% for quadruple therapy (P < 0.01). One-third of patients in both groups were still taking acid-reducing medications at six-month follow-up. CONCLUSION: One-week triple and quadruple therapies have similar intention-to-treat eradication rates. Certain side effects are more common with quadruple therapy,which can compromise patient compliance. Patient education or modifi cations to the regimen are alternative options to improve compliance of the quadruple regimen.

关键词： Helicobacter pylori Triple therapy Quadruple therapy Side effects Treatment compliance Eradication rate

Three-dimensional models:from cell culture to Patient-Derived Organoid and its application to future liposarcoma research

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Oncology Research 2025年第1期33卷 1-13页

作者： SAYUMI TAHARA SYDNEY RENTSCH FERNANDA COSTAS CASAL DE FARIA PATRICIA SARCHET ROMA KARNA FEDERICA CALORE RAPHAEL E.POLLOCK Department of Surgery Division of Surgical OncologyThe James Comprehensive Cancer CenterThe Ohio State University Wexner Medical CenterColumbusOH 43210USA Department of Cancer Biology and Genetics The James Comprehensive Cancer CenterThe Ohio State University Wexner Medical CenterColumbusOH 43210USA

Liposarcoma is one of the most common soft tissue sarcomas,however,its occurrence rate is still rare compared to other *** to its rarity,in vitro experiments are an essential approach to elucidate liposarcoma *** cell culture-based research(2D cell culture)is still playing a pivotal role,while several shortcomings have been recently under *** vivo,mouse models are usually adopted for pre-clinical analyses with expectations to overcome the issues of 2D cell ***,they do not fully recapitulate human dedifferentiated liposarcoma(DDLPS)***,three-dimensional(3D)culture systems have been the recent research focus in the cell biology field with the expectation to overcome at the same time the disadvantages of 2D cell culture and in vivo animal models and fill in the gap between *** the liposarcoma rarity,we believe that 3D cell culture techniques,including 3D cell cultures/co-cultures,and Patient-Derived tumor Organoids(PDOs),represent a promising approach to facilitate liposarcoma investigation and elucidate its molecular mechanisms and effective therapy *** this review,we first provide a general overview of 3D cell cultures compared to 2D cell *** then focus on one of the recent 3D cell culture applications,Patient-Derived Organoids(PDOs),summarizing and discussing several PDO ***,we discuss the current and future applications of PDOs to sarcoma,particularly in the field of liposarcoma.

关键词： Cell culture Liposarcoma Patient-Derived Organoid(PDO) Spheroid Three-dimensional(3D)cell culture

Refining selection criteria to further increase survival benefit in liver transplantation for unresectable colorectal liver metastases

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Hepatobiliary Surgery and Nutrition 2020年第4期9卷 490-492页

作者： Matteo Serenari Matteo Ravaioli general Surgery and Transplant unit Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly

Liver transplantation(LT)for hepatocellular carcinoma(HCC)was characterized in its early experience by high recurrence rates due to extensive tumor burden(1).Only after the adoption of Milan criteria(2),LT was recognized as a standard treatment for HCC(3).Besides HCC,other hepatic malignancies were proposed to be treated in the past with LT but due to the poor results observed(4),these indications were *** them,colorectal liver metastases(CRLM)were considered an absolute contraindication until recently.

关键词： colorectal metastases absolute