BACKGROUND： Definitive therapy for gallstone pancreatitis requires eradication of gallstones with cholecystectomy and common bile duct （CBD） clearance. Current guidelines rec- ommend this be done within the same ad...BACKGROUND： Definitive therapy for gallstone pancreatitis requires eradication of gallstones with cholecystectomy and common bile duct （CBD） clearance. Current guidelines rec- ommend this be done within the same admission and prefer- ably by laparoscopic cholecystectomy and CBD exploration. We report our experience of laparoscopic single-stage manage- ment with cholecystectomy and intraoperative cholangiogram followed by laparoscopic bile duct exploration （LBDE） when necessary performed at three different stages.展开更多
Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft survival.Pre-emptive LDKT,prior to requirement for renal replacement therapy(RRT),...Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft survival.Pre-emptive LDKT,prior to requirement for renal replacement therapy(RRT),provides further advantages,due to uraemia and dialysis avoidance.There are a number of potential barriers and opportunities to promoting pre-emptive LDKT.Significant infrastructure is needed to deliver robust programmes,which varies based on socio-economic standards.National frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education programmes.Focus on other programme’s components,including deceased kidney transplantation and RRT,can also hamper uptake.LDKT programmes are designed to provide maximal benefit to the recipient,which is specifically true for pre-emptive transplantation.Health care providers need to be educated to maximize early LDKT referral.Equitable access for varying population groups,without socioeconomic bias,also requires prioritisation.Cultural barriers,including religious influence,also need consideration in developing successful outcomes.In addition,the benefit of pre-emptive LDKT needs to be emphasised,and opportunities provided to potential donors,to ensure timely and safe work-up processes.Recipient education and preparation for pre-emptive LDKT needs to ensure increased uptake.Awareness of the benefits of pre-emptive transplantation require prioritisation for this population group.We recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure success.Education regarding preemptive LDKT should be the norm for patients approaching ESRD,appropriate for the patient’s cultural needs and physical status.Pre-emptive transplantation maximize benefit to potential recipients,with the potential to occur within successful service delivery.To fully embrace preemptive transplantation as the norm,investment in infrastructure,increased awareness,and donor and recipient support is required.展开更多
The antiphospholipid syndrome(APS)is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosi...The antiphospholipid syndrome(APS)is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis,fetal loss,thrombocytopenia,leg ulcers,livedo reticularis,chorea,and migraine.We document a previously unreported case of a 37-year-old female in whom APS was first manifested by infarction and cecal perforation following cesarean section.At laparotomy the underlying cause of colonic perforation was not clear and after resection of the affected bowel an ileo-colostomy was performed.The diagnosis of APS was established during post-operative hospital stay and the patient was commenced on warfarin.Eventually,she made a full recovery and had her stoma reversed after 4 mo.Pregnancy poses an increased risk of complications in women with APS and requires a more aggressive approach to the obstetric care.This should include full anticoagulation in the puerperium and frequent doppler ultrasound monitoring of uterine and umbilical arteries to detect complications such as preeclampsia and placental insufficiency.展开更多
Pancreatic cancer is a highly devastating disease with high mortality rates.Even patients who undergo potential curative surgery have a high risk for recurrence.The incidence of depression and anxiety are higher in pa...Pancreatic cancer is a highly devastating disease with high mortality rates.Even patients who undergo potential curative surgery have a high risk for recurrence.The incidence of depression and anxiety are higher in patients with cancer than the general population.However,patients with pancreatic cancer are at most of risk of both depression and anxiety and there seems to be a biological link.In some patients,depression seems to be a precursor to pancreatic cancer.In this article we discuss the biological link between depression anxiety and hepatobiliary malignancies and discuss treatment strategies.展开更多
文摘BACKGROUND： Definitive therapy for gallstone pancreatitis requires eradication of gallstones with cholecystectomy and common bile duct （CBD） clearance. Current guidelines rec- ommend this be done within the same admission and prefer- ably by laparoscopic cholecystectomy and CBD exploration. We report our experience of laparoscopic single-stage manage- ment with cholecystectomy and intraoperative cholangiogram followed by laparoscopic bile duct exploration （LBDE） when necessary performed at three different stages.
文摘Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft survival.Pre-emptive LDKT,prior to requirement for renal replacement therapy(RRT),provides further advantages,due to uraemia and dialysis avoidance.There are a number of potential barriers and opportunities to promoting pre-emptive LDKT.Significant infrastructure is needed to deliver robust programmes,which varies based on socio-economic standards.National frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education programmes.Focus on other programme’s components,including deceased kidney transplantation and RRT,can also hamper uptake.LDKT programmes are designed to provide maximal benefit to the recipient,which is specifically true for pre-emptive transplantation.Health care providers need to be educated to maximize early LDKT referral.Equitable access for varying population groups,without socioeconomic bias,also requires prioritisation.Cultural barriers,including religious influence,also need consideration in developing successful outcomes.In addition,the benefit of pre-emptive LDKT needs to be emphasised,and opportunities provided to potential donors,to ensure timely and safe work-up processes.Recipient education and preparation for pre-emptive LDKT needs to ensure increased uptake.Awareness of the benefits of pre-emptive transplantation require prioritisation for this population group.We recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure success.Education regarding preemptive LDKT should be the norm for patients approaching ESRD,appropriate for the patient’s cultural needs and physical status.Pre-emptive transplantation maximize benefit to potential recipients,with the potential to occur within successful service delivery.To fully embrace preemptive transplantation as the norm,investment in infrastructure,increased awareness,and donor and recipient support is required.
文摘The antiphospholipid syndrome(APS)is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis,fetal loss,thrombocytopenia,leg ulcers,livedo reticularis,chorea,and migraine.We document a previously unreported case of a 37-year-old female in whom APS was first manifested by infarction and cecal perforation following cesarean section.At laparotomy the underlying cause of colonic perforation was not clear and after resection of the affected bowel an ileo-colostomy was performed.The diagnosis of APS was established during post-operative hospital stay and the patient was commenced on warfarin.Eventually,she made a full recovery and had her stoma reversed after 4 mo.Pregnancy poses an increased risk of complications in women with APS and requires a more aggressive approach to the obstetric care.This should include full anticoagulation in the puerperium and frequent doppler ultrasound monitoring of uterine and umbilical arteries to detect complications such as preeclampsia and placental insufficiency.
文摘Pancreatic cancer is a highly devastating disease with high mortality rates.Even patients who undergo potential curative surgery have a high risk for recurrence.The incidence of depression and anxiety are higher in patients with cancer than the general population.However,patients with pancreatic cancer are at most of risk of both depression and anxiety and there seems to be a biological link.In some patients,depression seems to be a precursor to pancreatic cancer.In this article we discuss the biological link between depression anxiety and hepatobiliary malignancies and discuss treatment strategies.
