AIM: To systematically review these minimally invasive approaches to infected pancreatic necrosis. METHODS: We used the MEDLINE database to investigate studies between 1996 and 2010 with greater than 10 patients that ...AIM: To systematically review these minimally invasive approaches to infected pancreatic necrosis. METHODS: We used the MEDLINE database to investigate studies between 1996 and 2010 with greater than 10 patients that examined these techniques. Using a combination of Boolean operators, reports were retrieved addressing percutaneous therapy (341 studies), endoscopic necrosectomy (574 studies), laparoscopic necrosectomy via a transperitoneal approach (148 studies), and retroperitoneal necrosectomy (194 studies). Only cohorts with at least 10 or more patients were included. Non-English papers, letters, animal studies, duplicate series and reviews without original data were excluded, leaving a total of 27 studies for analysis. RESULTS: Twenty-seven studies with 947 patients total were examined (eight studies on percutaneous approach; ten studies on endoscopic necrosectomy; two studies on laparoscopic necrosectomy via a transperitoneal approach; five studies on retroperitoneal necrosectomy; and two studies on a combined percutaneous-retroperitoneal approach). Success rate, complications, mortality, and number of procedures were outcomes that were included in the review. We found that most published reports were retrospective in nature, and thus, susceptible to selection and publication bias. Few reports examined these techniques in a comparative, prospective manner. CONCLUSION: Each minimally invasive approach though was found to be safe and feasible in multiple reports. With these new techniques, treatment of infected pancreatic necrosis remains a challenge. We advocate a multidisciplinary approach to this complex problem with treatment individualized to each patient.展开更多
A 78-year-old woman presented with fever, severe abdominal pain, and distension.She had been institutionalized for depression and senile dementia.Laboratory examinations disclosed a leucocytosis(WBC:12 500/μL) and el...A 78-year-old woman presented with fever, severe abdominal pain, and distension.She had been institutionalized for depression and senile dementia.Laboratory examinations disclosed a leucocytosis(WBC:12 500/μL) and elevated levels of serum C-reactive protein(2.8 mEq/L).Diagnosis of acute cecal volvulus was made from a"coffee bean sign"on an abdominal computed tomography and a"beak sign"on a gastrographin enema.An emergent laparotomy confirmed the diagnosis and an ileo-colectomy with primary anastomosis was carried out.The patient recovered after intensive respiratory care and fluid therapy, and then returned to her former institution.A review of Japanese literature disclosed that:(1) a marked increase of aged patients with mental disability presenting with cecal volvulus,(2) adoption of ileo-colectomy as the standard surgical procedure, and(3) improved survival of the patients, were observed in the last decade.展开更多
Tujia dance is an advanced, special form of human aesthetic activities. The so-called aesthetic, simply put, is to feel, and understand the objective things or phenomena presented by the United States itself： specifi...Tujia dance is an advanced, special form of human aesthetic activities. The so-called aesthetic, simply put, is to feel, and understand the objective things or phenomena presented by the United States itself： specifically, it refers to the people in their social practice and objective process of historical things or phenomena occur and construct a special performance relationship. There are basically three kinds of relationships of man and objective things or phenomena： firstly, cognitive relation of science; Secondly, ethical norms relations; thirdly, aesthetic performance relationship. Focus on the relationship between the performances of the aesthetic object vivid sense of the expressive form of regularity is the unity and purpose, with freedom. The essence of aesthetic is liberty. Art aesthetic and general aesthetic are different, mainly because of its aesthetic objects, which is based on works of art as an aesthetic object. General aesthetic contemplation of beauty of reality, the reality of objective things or phenomena, not as people practice the original object mad the object of knowledge exists. In social practice, they first form a rational understanding of relationships and will practice relationship. On this basis, when the society develops to the degree of no direct utilitarian attitude, practical attitude towards the object of an object only when there has been more mature, purely aesthetic relationship. The beauty of art is different from the reality beauty, which is produced and existed as an aesthetic object.展开更多
文摘AIM: To systematically review these minimally invasive approaches to infected pancreatic necrosis. METHODS: We used the MEDLINE database to investigate studies between 1996 and 2010 with greater than 10 patients that examined these techniques. Using a combination of Boolean operators, reports were retrieved addressing percutaneous therapy (341 studies), endoscopic necrosectomy (574 studies), laparoscopic necrosectomy via a transperitoneal approach (148 studies), and retroperitoneal necrosectomy (194 studies). Only cohorts with at least 10 or more patients were included. Non-English papers, letters, animal studies, duplicate series and reviews without original data were excluded, leaving a total of 27 studies for analysis. RESULTS: Twenty-seven studies with 947 patients total were examined (eight studies on percutaneous approach; ten studies on endoscopic necrosectomy; two studies on laparoscopic necrosectomy via a transperitoneal approach; five studies on retroperitoneal necrosectomy; and two studies on a combined percutaneous-retroperitoneal approach). Success rate, complications, mortality, and number of procedures were outcomes that were included in the review. We found that most published reports were retrospective in nature, and thus, susceptible to selection and publication bias. Few reports examined these techniques in a comparative, prospective manner. CONCLUSION: Each minimally invasive approach though was found to be safe and feasible in multiple reports. With these new techniques, treatment of infected pancreatic necrosis remains a challenge. We advocate a multidisciplinary approach to this complex problem with treatment individualized to each patient.
文摘A 78-year-old woman presented with fever, severe abdominal pain, and distension.She had been institutionalized for depression and senile dementia.Laboratory examinations disclosed a leucocytosis(WBC:12 500/μL) and elevated levels of serum C-reactive protein(2.8 mEq/L).Diagnosis of acute cecal volvulus was made from a"coffee bean sign"on an abdominal computed tomography and a"beak sign"on a gastrographin enema.An emergent laparotomy confirmed the diagnosis and an ileo-colectomy with primary anastomosis was carried out.The patient recovered after intensive respiratory care and fluid therapy, and then returned to her former institution.A review of Japanese literature disclosed that:(1) a marked increase of aged patients with mental disability presenting with cecal volvulus,(2) adoption of ileo-colectomy as the standard surgical procedure, and(3) improved survival of the patients, were observed in the last decade.
文摘Tujia dance is an advanced, special form of human aesthetic activities. The so-called aesthetic, simply put, is to feel, and understand the objective things or phenomena presented by the United States itself： specifically, it refers to the people in their social practice and objective process of historical things or phenomena occur and construct a special performance relationship. There are basically three kinds of relationships of man and objective things or phenomena： firstly, cognitive relation of science; Secondly, ethical norms relations; thirdly, aesthetic performance relationship. Focus on the relationship between the performances of the aesthetic object vivid sense of the expressive form of regularity is the unity and purpose, with freedom. The essence of aesthetic is liberty. Art aesthetic and general aesthetic are different, mainly because of its aesthetic objects, which is based on works of art as an aesthetic object. General aesthetic contemplation of beauty of reality, the reality of objective things or phenomena, not as people practice the original object mad the object of knowledge exists. In social practice, they first form a rational understanding of relationships and will practice relationship. On this basis, when the society develops to the degree of no direct utilitarian attitude, practical attitude towards the object of an object only when there has been more mature, purely aesthetic relationship. The beauty of art is different from the reality beauty, which is produced and existed as an aesthetic object.
