Pancreatic trauma is rare compared to other abdominal solid organ injuries,accounting for 0.2%-0.3% of all trauma patients. Moreover, this type of injury may frequently be overlooked or not readily appreciated on init...Pancreatic trauma is rare compared to other abdominal solid organ injuries,accounting for 0.2%-0.3% of all trauma patients. Moreover, this type of injury may frequently be overlooked or not readily appreciated on initial clinical examinations and investigations. The organ injury scale determines the severity of the trauma. Nonetheless, there are conflicting recommendations for the best strategy in severe cases. Overall, conservative management of induced severe traumatic pancreatitis is adequate. Modern imaging modalities such as ultrasound scanning and computed tomography scanning can detect injuries in fewer than 60% of patients. However, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography(ERCP) have diagnostic accuracies approaching 90%-100%. Thus, management options include ERCP and stent placement or distal pancreatectomy in cases of complete gland transection and wide drainage only for damage control surgery, which can prevent mortality but increases the risk of morbidity. In the majority of cases, surgical intervention is not required and should be reserved for only severe grade Ⅲ to grade Ⅴ injuries.展开更多
BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastom...BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage,with detrimental effects on patient postoperative outcomes.Despite the investigation of several factors and the invention of protective materials,the ideal agent to prevent anastomotic leaks is yet to be determined.AIM To study the effect of platelet rich plasma(PRP)on the healing of bowel anastomoses.METHODS A systematic literature search was performed in PubMed,EMBASE,and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.RESULTS Eighteen studies were eligible with a total population of 712 animals including rats(14 studies),rabbits(2 studies)and pigs(2 studies).No postoperative complications were reported following PRP application.Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention,such as intraperitoneal chemotherapy or peritonitis.Similar results were reported by ten studies in terms of tissue hydroxyproline levels.One study reported significant increase in collagen deposition in PRP groups.PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy(6 studies).CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes,especially in animal models having an underlying condition affecting the normal healing process.PRP application seems to augment the normal healing process under these circumstances.However,further studies are needed to investigate the potential role of PRP on bowel anastomosis healing,especially in clinical settings.展开更多
Coronavirus disease 2019(COVID-19)causes acute microvascular thrombosis in both venous and arterial structures which is highly associated with increased mortality.The mechanisms leading to thromboembolism are still un...Coronavirus disease 2019(COVID-19)causes acute microvascular thrombosis in both venous and arterial structures which is highly associated with increased mortality.The mechanisms leading to thromboembolism are still under investigation.Current evidence suggests that excessive complement activation with severe amplification of the inflammatory response(cytokine storm)hastens disease progression and initiates complement-dependent cytotoxic tissue damage with resultant prothrombotic complications.The concept of thromboinflammation,involving overt inflammation and activation of the coagulation cascade causing thrombotic microangiopathy and end-organ damage,has emerged as one of the core components of COVID-19 pathogenesis.The complement system is a major mediator of the innate immune response and inflammation and thus an appealing treatment target.In this review,we discuss the role of complement in the development of thrombotic microangiopathy and summarize the current data on complement inhibitors as COVID-19 therapeutics.展开更多
文摘Pancreatic trauma is rare compared to other abdominal solid organ injuries,accounting for 0.2%-0.3% of all trauma patients. Moreover, this type of injury may frequently be overlooked or not readily appreciated on initial clinical examinations and investigations. The organ injury scale determines the severity of the trauma. Nonetheless, there are conflicting recommendations for the best strategy in severe cases. Overall, conservative management of induced severe traumatic pancreatitis is adequate. Modern imaging modalities such as ultrasound scanning and computed tomography scanning can detect injuries in fewer than 60% of patients. However, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography(ERCP) have diagnostic accuracies approaching 90%-100%. Thus, management options include ERCP and stent placement or distal pancreatectomy in cases of complete gland transection and wide drainage only for damage control surgery, which can prevent mortality but increases the risk of morbidity. In the majority of cases, surgical intervention is not required and should be reserved for only severe grade Ⅲ to grade Ⅴ injuries.
文摘BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage,with detrimental effects on patient postoperative outcomes.Despite the investigation of several factors and the invention of protective materials,the ideal agent to prevent anastomotic leaks is yet to be determined.AIM To study the effect of platelet rich plasma(PRP)on the healing of bowel anastomoses.METHODS A systematic literature search was performed in PubMed,EMBASE,and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.RESULTS Eighteen studies were eligible with a total population of 712 animals including rats(14 studies),rabbits(2 studies)and pigs(2 studies).No postoperative complications were reported following PRP application.Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention,such as intraperitoneal chemotherapy or peritonitis.Similar results were reported by ten studies in terms of tissue hydroxyproline levels.One study reported significant increase in collagen deposition in PRP groups.PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy(6 studies).CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes,especially in animal models having an underlying condition affecting the normal healing process.PRP application seems to augment the normal healing process under these circumstances.However,further studies are needed to investigate the potential role of PRP on bowel anastomosis healing,especially in clinical settings.
文摘Coronavirus disease 2019(COVID-19)causes acute microvascular thrombosis in both venous and arterial structures which is highly associated with increased mortality.The mechanisms leading to thromboembolism are still under investigation.Current evidence suggests that excessive complement activation with severe amplification of the inflammatory response(cytokine storm)hastens disease progression and initiates complement-dependent cytotoxic tissue damage with resultant prothrombotic complications.The concept of thromboinflammation,involving overt inflammation and activation of the coagulation cascade causing thrombotic microangiopathy and end-organ damage,has emerged as one of the core components of COVID-19 pathogenesis.The complement system is a major mediator of the innate immune response and inflammation and thus an appealing treatment target.In this review,we discuss the role of complement in the development of thrombotic microangiopathy and summarize the current data on complement inhibitors as COVID-19 therapeutics.
