检索结果-南通市图书馆

Colorectal surgeon consensus with diverticulitis clinical practice guidelines

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Surgery 2017年第11期9卷 224-232页

作者： Javariah Siddiqui Assad Zahid Jonathan Hong Christopher John Young Discipline of Surgery University of Sydney Department of Colorectal Surgery Royal Prince Alfred Hospital

AIM To determine the application of clinical practice guidelines for the current management of diverticulitis and colorectal surgeon specialist consensus in Australia and New *** A survey was distributed to 205 colorectal surgeons in Australia and New Zealand, using 22 hypothetical clinical *** The response rate was 102(50%). For 19 guidelinebased scenarios, only 11(58%) reached consensus(defined as > 70% majority opinion) and agreed with guidelines; while 3(16%) reached consensus and did not agree with guidelines. The remaining 5(26%) scenarios showed community equipoise(defined as less than/equal to 70% majority opinion). These included diagnostic imaging where CT scan was contraindicated, management options in the failureof conservative therapy for complicated diverticulitis, surgical management of Hinchey grade 3, proximal extent of resection in sigmoid diverticulitis and use of oral mechanical bowel preparation and antibiotics for an elective colectomy. The consensus areas not agreeing with guidelines were management of simple diverticulitis, management following the failure of conservative therapy in uncomplicated diverticulitis and follow-up after an episode of complicated diverticulitis. Fifty-percent of rural/regional based surgeons would perform an urgent sigmoid colectomy in failed conservative therapy of diverticulitis compared to only 8% of surgeons city-based(Fisher's exact test P = 0.016). In right-sided complicated diverticulitis, a greater number of those in practice for more than ten years would perform an ileocecal resection and ileocolic anastomosis(79% vs 41%, P < 0.0001).CONCLUSION While there are areas of consensus in diverticulitis management, there are areas of community equipoise for future research, potentially in the form of RCTs.

关键词： Diverticulitis Clinical practice guidelines Consensus

Changes of macrophage migration-inhibitory factor in acute myocardial infarction:pathophysiological significance and clinical implication

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

中国病理生理杂志 2012年第11期 2000-2001页

作者： David WHITE William CHAM Andrew TAYLOR Stephen DUFFY Anthony DART Experimental Cardiology Laboratory Baker IDI Heart and Diabetes Institute alfred Heart Centre Alfred HospitalMelbourneVictoria 3004Australia

AIM:The pro-inflammatory cytokine macrophage migration-inhibitory factor(MIF)is known to play a key role in a number of inflammatory ***,its change in the setting of acute myocardial infarct(MI)and significance in act... 详细信息

关键词： MIF

How should immunomodulators be optimized when used as combination therapy with anti-tumor necrosis factor agents in the management of inflammatory bowel disease?

同方期刊数据库评论

在线全文

同方期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2015年第40期21卷 11331-11342页

作者： Mark G Ward Peter M Irving Miles P Sparrow Department of Gastroenterology The Alfred Hospital Department of Gastroenterology Guy’s and St. Thomas’ NHS Foundation Trust

In the last 15 years the management of inflammatory bowel disease has evolved greatly,largely through the increased use of immunomodulators and,especially,anti-tumor necrosis factor(anti-TNF) biologic agents. Within this time period,confidence in the use of anti-TNFs has increased,whilst,especially in recent years,the efficacy and safety of thiopurines has been questioned. Yet despite recent concerns regarding the risk: benefit profile of thiopurines,combination therapy with an immunomodulator and an anti-TNF has emerged as the recommended treatment strategy for the majority of patients with moderate-severe disease,especially those who are recently diagnosed. Concurrently,therapeutic drug monitoring has emerged as a means of optimizing the dosage of both immunomodulators and antiTNFs. However the recommended therapeutic target levels for both drug classes were largely derived from studies of monotherapy with either agent,or studies underpowered to analyze outcomes in combination therapy patients. It has been assumed that these target levels are applicable to patients on combination therapy also,however there are few data to support this. Similarly,the timing and duration of treatment with immunomodulators when used in combination therapy remains unknown. Recent attention,including post hoc analyses of the pivotal registration trials,has focused on the optimization of anti-TNF agents,when used as either monotherapy or combination therapy. This review will instead focus on how best to optimize immunomodulators when used in combination therapy,including an evaluation of recent data addressing unanswered questions regarding the optimal timing,dosage and duration of immunomodulator therapy in combination therapy patients.

关键词： Inflammatory bowel disease Thiopurines Drug monito

Liquid biopsies for liquid tumors: emerging potential of circulating free nucleic acid evaluation for the management of hematologic malignancies

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Cancer Biology & Medicine 2016年第2期13卷 215-225页

作者： Jay Hocking Sridurga Mithraprabhu Anna Kalff Andrew Spencer Myeloma Research Group Australian Center for Blood Diseases Monash University Malignant Haematology & Stem Cell Transplantation Service Alfred Hospital

Circulating free nucleic acids; cell free DNA and circulating micro-RNA, are found in the plasma of patients with hematologic and solid malignancies at levels higher than that of healthy individuals. In patients with hematologic malignancy cell free DNA reflects the underlying tumor mutational profile, whilst micro-RNAs reflect genetic interference mechanisms within a tumor and potentially the surrounding microenvironment and immune effector cells. These circulating nucleic acids offer a potentially simple, non-invasive, repeatable analysis that can aid in diagnosis, prognosis and therapeutic decisions in cancer treatment.

关键词： Circulating nucleic acids DNA miRNA hematologic malignancy biopsy

Hepatocellular carcinoma in central Sydney :a 10yearreview of patients seen in a medical oncology department

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 1999年第6期5卷 483-487页

作者： Desmond Yip 1, Michael Findlay 2, Michael Boyer 1 and Martin H. Tattersall 3 Royal Prince alfred hospital 澳大利亚 Wellington Cancer Centre 新西兰 University of Sydney 澳大利亚

AIM To report a single Australian oncology unit′s experience with the management of patients with hepatocellular carcinoma (HCC), in the context of a literature review of the current management issues. METHODS Retrospective case record review of 76 patients with diagnosis of HCC referred to the unit between 1984 and 1995. RESULTS Sixty three patients had adequate records for analysis. Thirty six (56%) were migrants with half from Southeast Asia. Twenty four patients had a documented viral aetiology. Nine (14%) of 51 patients with pathological confirmation of HCC had normal alpha fetoprotein levels. Median survival of the 20 patients managed palliatively was 5 weeks compared to 16 weeks for the cohort overall. Surgery in 16 patients rendered all initially disease free with a median survival of 88 weeks. Chemoembolisation induced tumor responses in 5 of the 11 patients so treated. Systemic chemotherapy and tamoxifen treatment caused tumor response in two of 12 and one of 25 respectively. CONCLUSION Prolonged survival of patients with HCC depends on early detection of small tumors suitable for surgical resection. Other active treatments are palliative in intent and have limited success. In addition to tumor response and survival duration, the toxicities of therapies and the overall quality of life of patients need to be considered as important outcomes. Viral hepatitis prevention and screening of individuals at risk are strategies that are important for HCC management in communities where the disease is endemic.

关键词： carcinoma, hepatocellular liver neoplasms survival/rate Australia

Congenital peritoneal encapsulation: A review and novel classification system

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2019年第19期25卷 2294-2307页

作者： Aneesh Dave James Mc Mahon Assad Zahid Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney Medical School Edward Ford Building the University of Sydney

Congenital peritoneal encapsulation(CPE) is a very rare, congenital condition characterised by the presence of an accessory peritoneal membrane which encases a variable extent of the small bowel. It is unclear how CPE develops,however it is currently understood to be a result of an aberrant adhesion in the peritoneal lining of the physiological hernia in foetal mid-gut development. The condition was first described in 1868, and subsequently there have been only 45 case reports of the phenomenon. No formal, systematised review of CPE has yet been performed, meaning the condition remains poorly understood,underdiagnosed and mismanaged. Diagnosis of CPE remains clinical with important adjuncts provided by imaging and diagnostic laparoscopy. Two thirds of patients present with abdominal pain, likely secondary to sub-acute bowel obstruction. A fixed, asymmetrical distension of the abdomen and differential consistency on abdominal palpation are more specific clinical features present in approximately 10% of cases. CPE is virtually undetectable on plain imaging, and is only detected on 40% of patients with computed tomography scan. Most patients will undergo diagnostic laparotomy to confirm the *** of CPE includes both medical management of the critically-unstable patient and surgical laparotomy, partial peritonectomy and *** following prompt surgical treatment is excellent, with a majority of patients being symptom free at follow up. This review summarises the current literature on the aetiology, diagnosis and treatment of this rare disease. We also introduce a novel classification system for encapsulating bowel diseases, which may distinguish CPE from the commoner, more morbid conditions of abdominal cocoon and encapsulating peritoneal sclerosis.

关键词： Congenital Encapsulation Peritoneum Cocoon Sclerosis

Hepatic portal venous gas: Physiopathology, etiology, prognosis and treatment

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastroenterology 2009年第29期15卷 3585-3590页

作者： Bassam Abboud Jad El Hachem Thierry Yazbeck Corinne Doumit Department of General Surgery Hotel-Dieu de France Hospital Boulevard Alfred Naccache Beirut 16-6830 Lebanon

Hepatic portal venous gas (HPVG), an ominous radiologic sign, is associated in some cases with a severe underlying abdominal disease requiring urgent operative intervention. HPVG has been reported with increasing frequency in medical literature and usually accompanies severe or lethal conditions. The diagnosis of HPVG is usually made by plain abdominal radiography, sonography, color Doppler flow imaging or computed tomography (CT) scan. Currently, the increased use of CT scan and ultrasound in the inpatient setting allows early and highly sensitive detection of such severe illnesses and also the recognition of an increasing number of benign and non-life threatening causes of HPVG. HPVG is not by itself a surgical indication and the treatment depends mainly on the underlying disease. The prognosis is related to the pathology itself and is not influenced by the presence of HPVG. Based on a review of the literature, we discuss in this paper the pathophysiology, risk factors, radiographic findings, management, and prognosis of pathologies associated with HPVG.

关键词： Hepatic portal venous gas Bowel ischemia/necrosis Diverticulitis Gastric pathologies Ulcerativecolitis Abdominal computed tomography scan Crohn'sdisease Liver transplantation Chemotherapy

Associations between Bodyweight and Clinical Outcome in Patients Post-Fontan Procedure: A Systematic Review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Congenital Heart Disease 2022年第6期17卷 617-639页

作者： Emma Payne Thomas Wilson Marjan Haghighi Zoe McCallum Yves d’Udekem Julian Ayer The University of Sydney SydneyAustralia The University of Melbourne MelbourneAustralia The Royal Children’s hospital MelbourneAustralia The Royal Prince alfred hospital SydneyAustralia The Children’s National hospital WashingtonUSA

Background: Patients born with a single ventricle circulation commonly experience growth failure in early life,which is associated with adverse outcomes in infancy. However, associations between bodyweight or weight trajectoryand clinical outcome post-Fontan procedure are yet to be determined. Methods: On the 1st of July 2021, asystematic review was performed in MEDLINE, EMBASE, the Cochrane Library, and Scopus of studies of patientswith clinical outcome data post-Fontan procedure and association with bodyweight. Quality of studies was evaluatedby Newcastle–Ottawa scale for cohort studies and Joanna Briggs Institute tool for cross-sectional ***: Of 527 studies that underwent title and abstract screening, 15 were selected for final review. An increasedrisk of adverse post-Fontan outcomes was found for low weight patients, consistent with findings in *** there is some evidence to suggest increased mortality in overweight adult patients, studies are conflictingas to whether overweight status is associated with increased heart failure. Increased BMI is associated with diminishedexercise capacity and deceased physiological functioning. Negative weight trajectory is associated withadverse outcomes in the peri-Fontan period, whereas a positive weight trajectory is associated with increased Fontanfailure in adulthood. Abnormal BMI (high or low) is associated with increased heart failure and poorer performancein quality-of-life scores. Conclusions: Bodyweight is a modifiable risk factor for poor clinical outcomein patients with a single ventricle circulation. Recognizing associations between bodyweight and Fontan pathophysiologymay help to define patient-centered exercise and diet interventions that minimize patient morbidityand mortality.

关键词： Fontan bodyweight congenital heart disease single ventricle

Intraocular lens exchange-removing the optic intact

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

International Journal of Ophthalmology(English edition) 2016年第6期9卷 925-928页

作者： Matthew Hao Lee Diane Lesley Webster Department of Ophthalmology Alfred HospitalMelbourneVIC 3004Australia Royal Victorian Eye and Ear hospital East MelbourneVIC3002Australia

Current practice for intraocular lens （IOL） exchange is to cut the optic of the posterior chamber intraocular lens （PCIOL） prior to removing it. Great care must be taken during this maneuver to avoid a posterior capsular tear. Removing the haptics from the fibrosed capsule can also be hazardous, as it may result in zonular stress and dehiscence. A technique is described for performing foldable （one-piece acrylic） IOL removal without cutting the optic. Careful visco-dissection of the haptics with a low viscosity ophthalmic viscosurgical device （OVD） in the fibrosed peripheral capsular tunnel avoids zonular or capsular stress. Internal wound enlargement permits foldable IOL removal in one piece, whilst preserving a self-sealing sutureless corneal wound. This technique may enhance the safety and efficacy of foldable IOL exchange.

关键词： intraocular lens exchange viscodissection posterior capsular tear