Portal hypertension(PH)plays an important role in the natural history of cirrhosis,and is associated with several clinical consequences.The introduction of transjugular intrahepatic portosystemic shunts(TIPS)in the 19...Portal hypertension(PH)plays an important role in the natural history of cirrhosis,and is associated with several clinical consequences.The introduction of transjugular intrahepatic portosystemic shunts(TIPS)in the 1980s has been regarded as a major technical advance in the management of the PH-related complications.At present,polytetrafluoroethylene-covered stents are the preferred option over traditional bare metal stents.TIPS is currently indicated as a salvage therapy in patients with bleeding esophageal varices who fail standard treatment.Recently,applying TIPS early(within 72 h after admission)has been shown to be an effective and life-saving treatment in those with high-risk variceal bleeding.In addition,TIPS is recommended as the second-line treatment for secondary prophylaxis.For bleeding gastric varices,applying TIPS was able to achieve hemostasis in more than 90%of patients.More trials are needed to clarify the efficacy of TIPS compared with other treatment modalities,including cyanoacrylate injection and balloon retrograde transvenous obliteration of gastric varices.TIPS should also be considered in bleeding ectopic varices and refractory portal hypertensive gastropathy.In patients with refractory ascites,there is growing evidence that TIPS not only results in better control of ascites,but also improves long-term survivalin appropriately selected candidates.In addition,TIPS is a promising treatment for refractory hepatic hydrothorax.However,the role of TIPS in the treatment of hepatorenal and hepatopulmonary syndrome is not well defined.The advantage of TIPS is offset by a risk of developing hepatic encephalopathy,the most relevant postprocedural complication.Emerging data are addressing the determination the optimal time and patient selection for TIPS placement aiming at improving long-term treatment outcome.This review is aimed at summarizing the published data regarding the application of TIPS in the management of complications related to PH.展开更多
Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferre...Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.展开更多
In India</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the problem of infertility is growing and in the last 5 years</span><s...In India</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the problem of infertility is growing and in the last 5 years</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> it has gone up to 20%</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">30%. This ongoing prospective clinical study brings forth a novel, innovative, effective, simple, affordable, easily performed outpatient procedure (OP) and a promising therapeutic method in rejuvenating the Ageing Ovaries and Thin Endometrium, with autologous Platelet Rich Plasma (PRP). This clinical study proves to give a better result in rejuvenating Ovary and treating the Thin Endometrium. This pilot study include</span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> five women (28</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">44 years) with Poor Ovarian Response (POR), Premature Ovarian Insufficiency (POI) and Perimenopause and Thirty-nine women (22</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">43</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">years.) with recurrent implantation failure due to Thin Endometrium were subjected to autologous PRP instillation under Ultrasound Guidance, and Hysteroscopic guided PRP. After PRP</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> a significant output was obtained, with improved Anti Mullerian Hormone (AMH) and Antral Follicle Count (AFC) and out of five women three women conceived by Intra Cytoplasmic Sperm Injection (ICSI). PRP injected in women with Poor Ovarian Response found successful ovarian rejuvenation within 1</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">3 months and had a 60% of pregnancy rate, PRP into the endometrium had 53.8% successful pregnancies. We have not encountered any complications.展开更多
文摘Portal hypertension(PH)plays an important role in the natural history of cirrhosis,and is associated with several clinical consequences.The introduction of transjugular intrahepatic portosystemic shunts(TIPS)in the 1980s has been regarded as a major technical advance in the management of the PH-related complications.At present,polytetrafluoroethylene-covered stents are the preferred option over traditional bare metal stents.TIPS is currently indicated as a salvage therapy in patients with bleeding esophageal varices who fail standard treatment.Recently,applying TIPS early(within 72 h after admission)has been shown to be an effective and life-saving treatment in those with high-risk variceal bleeding.In addition,TIPS is recommended as the second-line treatment for secondary prophylaxis.For bleeding gastric varices,applying TIPS was able to achieve hemostasis in more than 90%of patients.More trials are needed to clarify the efficacy of TIPS compared with other treatment modalities,including cyanoacrylate injection and balloon retrograde transvenous obliteration of gastric varices.TIPS should also be considered in bleeding ectopic varices and refractory portal hypertensive gastropathy.In patients with refractory ascites,there is growing evidence that TIPS not only results in better control of ascites,but also improves long-term survivalin appropriately selected candidates.In addition,TIPS is a promising treatment for refractory hepatic hydrothorax.However,the role of TIPS in the treatment of hepatorenal and hepatopulmonary syndrome is not well defined.The advantage of TIPS is offset by a risk of developing hepatic encephalopathy,the most relevant postprocedural complication.Emerging data are addressing the determination the optimal time and patient selection for TIPS placement aiming at improving long-term treatment outcome.This review is aimed at summarizing the published data regarding the application of TIPS in the management of complications related to PH.
文摘Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.
文摘In India</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the problem of infertility is growing and in the last 5 years</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> it has gone up to 20%</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">30%. This ongoing prospective clinical study brings forth a novel, innovative, effective, simple, affordable, easily performed outpatient procedure (OP) and a promising therapeutic method in rejuvenating the Ageing Ovaries and Thin Endometrium, with autologous Platelet Rich Plasma (PRP). This clinical study proves to give a better result in rejuvenating Ovary and treating the Thin Endometrium. This pilot study include</span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> five women (28</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">44 years) with Poor Ovarian Response (POR), Premature Ovarian Insufficiency (POI) and Perimenopause and Thirty-nine women (22</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">43</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">years.) with recurrent implantation failure due to Thin Endometrium were subjected to autologous PRP instillation under Ultrasound Guidance, and Hysteroscopic guided PRP. After PRP</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> a significant output was obtained, with improved Anti Mullerian Hormone (AMH) and Antral Follicle Count (AFC) and out of five women three women conceived by Intra Cytoplasmic Sperm Injection (ICSI). PRP injected in women with Poor Ovarian Response found successful ovarian rejuvenation within 1</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">-</span><span style="font-size:10pt;font-family:""> </span><span style="font-family:Verdana;">3 months and had a 60% of pregnancy rate, PRP into the endometrium had 53.8% successful pregnancies. We have not encountered any complications.
