简介：Theuseoflaparoscopyhasbeenestablishedinimprovingperioperativeandpostoperativeoutcomesforpatientswithsimpleappendicitis.Laparoscopicappendectomyisassociatedwithlesswoundpain,lesswoundinfection,ashorterhospitalstay,andfasteroverallrecoverywhencomparedtotheopenappendectomyforuncomplicatedcases.Inthepasttwodecades,theuseoflaparoscopyforthetreatmentofperforatedappendicitistotaketheadvantagesofminimallyinvasivenesshasincreased.Thisarticlereviewedtheprevalence,approaches,safetydisclaimers,perioperativeandpostoperativeoutcomesofthelaparoscopicappendectomyinthetreatmentofpatientswithperforatedappendicitis.Specialissuesincludingtheconversion,intervalappendectomy,laparoscopicapproachforelderlyorobesepatientarealsodiscussedtodefinetheroleoflaparoscopictreatmentforpatientswithperforatedappendicitis.

简介：背景：测试的HIV-1genotypic和phenotypic危险性(通用终端)优化antiretroviral选择，但是它幸存上的效果是未知的。客观：评估在通用终端和幸存之间的协会。设计：队学习。设定：10个美国HIV诊所。病人：为通过2005从1999看见的通用终端(血浆HIVRNA水平>1000copies/mL)合格的2699个感染HIV的病人。大小：人口统计的特征，临床的因素，通用终端使用，所有原因死亡，和为有幸存的通用终端的协会的粗略、调整的危险比率(HR)。结果：病人们被跟随为一3.3年中部；(34%)915有通用终端。把通用终端有的病人比那些降低死亡率(2.0对2.7死亡每100人年)。在标准考克斯模型，通用终端与改进幸存被联系(调整HR，0.69[95%CI，0.51～0.94]；P=0.017)在为临床的后续的人口统计的特征，CD4⁺房间计数，HIVRNA水平，和紧张控制以后。在亚群分析，通用终端与改进幸存被联系因为2107高度活跃的antiretroviral治疗(HAART)经历了病人(2.2对3.2死亡每为有没有通用终端的通用终端对那些的病人的100人年；调整HR，0.60[CI，0.43～0.82]；P=0.002)并且为921个三倍的antiretroviral班富有经验病人(2.1对3.1死亡每100人年；调整HR，0.61[CI0.40到0.93]；P=0.022)。边缘的结构的模型支持了在通用终端之间的协会并且在全面的队改进了幸存(调整HR，0.54；P=0.001)并且在HAART富有经验的组(调整HR，0.56；P=0.003)。限制：通用终端的使用没被使随机化。剩余惊讶可以存在。结论：通用终端的使用独立地在HAART富有经验的病人之中与改进幸存被联系。

简介：Recentfindingsinthepathophysiologyandmonitoringofhemostasisinpatientswithendstageliverdiseasehavemajorimpactoncoagulationmanagementduringlivertransplantation.Thereisincreasingevidence,thatthechangesinbothcoagulationfactorsandplateletcountregularlyobservedinpatientswithlivercirrhosiscannotbeinterpretedasareliableindicatorofdiffusebleedingrisk.Instead,adifferentiatedviewonhemostasishasledtotheconceptofarebalancedcoagulationsystemWhileitisimportanttorecognizethatprocoagulantfactorsarereducedinlivercirrhosis,itisalsoevidentthatsynthesisofanticoagulantfactorsandfibrinolyticproteinsproducedintheliverisalsodiminished.Similarly,thedecreasedplateletcountmaybecounterbalancedbyincreasedplateletaggregabilitycausedbyhighlyactivevonWillebrandmultimeres.Thecoagulationsystemisthereforstatedtoberebalanced.Whileundernormal＂unstressed＂conditionsdiffusebleedingisrarelyobserved,howeverbothdiffusebleedingorthrombusformationmayoccurwhencompensationmechanismsareexhausted.Whilemostpatientspresentingforlivertransplantationhaveseverecirrhosis,liverfunctionandthusproductionofpro-andanticoagulantfactorscanbepreservedespeciallyincholestaticliverdisease.Duringlivertransplantation,profoundchangesinthehemostasissystemcanoccur.Surgicalbleedingcanleadtodiffusebleedingascoagulationfactorsandplateletsarealreadyreduced.Ischemiaandtissuetraumacanleadtoalterationsofhemostasiscomparabletotraumainducedcoagulopathy.Afurthercommondisturbanceoftenstartingwiththereperfusionofthetransplantedorganishyperfibrinolysiswhichcaneventuallyprecipitatecompleteconsumptionoffibrinogenandanendogenousheparinizationbyglycocalyxshedding.Moreover,thromboticeventsinlivertransplantationsarenotuncommonandcontributetoincreasedmortality.Besidesconventionallaboratorymethods,bed-sidemonitoringofhemostasis（e.g.,thrombelastography,thrombe

简介：AIM:ToevaluatetheefficacyandsafetyofN-butyl-2-cyanoacrylateintreatingacutebleedingofgastricvaricesinchildren.METHODS:Theretrospectivestudyincluded21childrenwith47episodesofactivegastricvaricealbleedingwhoweretreatedbyendoscopicinjectionofN-butyl-2-cyanoacrylateatAsanMedicalCenterChildren’sHospitalbetweenAugust2004andDecember2011.Toreducetheriskofembolism,eachinjectionconsistedof0.1-0.5mLof0.5mLN-butyl-2-cyanoacrylatedilutedwith0.5or0.8mLLipiodol.Theprimaryoutcomewasincidenceofhemostasisaftervaricealobliterationandthesecondaryoutcomewascomplicationoftheprocedure.RESULTS:The21patientsexperienced47episodesofactivegastricvaricealbleeding,includingrebleeding,forwhichtheyreceivedatotalof52cyanoacrylateinjections.Following42bleedingepisodes,hemostasiswasachievedafteroneinjectionandfollowingfivebleedingepisodesitwasachievedaftertwoinjections.Themeanvolumeofeachsinglealiquotofcyanoacrylateinjectedwas0.3±0.1mL(range:0.1-0.5mL).Injectionachievedhemostasisin45of47(95.7%)episodesofacutegastricvaricealbleeding.Elevenpatients(52.4%)developedrebleedingevents,withthemeandurationofhemostasisbeing11.1±11.6mo(range:1.0-39.2mo).Notreatment-relatedcomplicationssuchasdistalembolismwerenotedwiththeexceptionofabdominalpaininonepatient(4.8%).Amongfourmortalities,onepatientdiedofvaricealrebleeding.CONCLUSION:Endoscopicvaricealobliterationusingasmallvolumeofaliquotswithrepeatedcyanoacrylateinjectionwasaneffectiveandsafeoptionforthetreatmentofgastricvaricesinchildren.

简介：胰腺的假包囊(PP)是被纤维组织衬里并且可以包含坏死的碎片或血的胰腺的分泌物的集合。包括经皮、内视镜或外科的途径的干预基于假包囊的尺寸，地点，症状和复杂并发症。与先进成像系统和照相机的可获得性，更好止血的设备和优秀laparoscopic技术，很假的包囊能被腹腔镜检查发现并且设法。我们与对laparoscopic胰囊肿胃吻合术顺从的胰腺的假包囊描述一个30岁的男病人的一个盒子。一个切口通过前面的胃的墙被做用一个超声的联盟者在与假包囊的靠近的接触暴露以后的胃的墙激活的解剖刀。然后，另一个切口被做让胰囊肿胃吻合术获得完全、没有障碍的排水。病人在手术以后恢复了很好并且在6瞬间后续期间是没有症状的，建议laparoscopic胰囊肿胃吻合术是打开为PP的最低限度地侵略的管理的胰囊肿胃吻合术的一种安全、有效的选择。

简介：Livermetastasessynchronouslyormetachronouslyoccurinapproximately50%ofcolorectalcancerpatients.Multimodalitycomprehensivetreatmentisthebesttherapeuticstrategyforthesepatients.However,theoptimalpatternofmultimodalitytherapyisstillcontroversial,anditraisesseveralsignificantconcerns.Liverresectionisthemostimportanttreatmentforcolorectallivermetastases.ThedefinitionofresectabilityhasshiftedtofocusonthecompletionofR0resectionandnormalliverfunctionmaintenance.Theroleofneoadjuvantandadjuvantchemotherapystillneedstobeclarified.Themanagementofeitherprogressionorcompleteremissionduringneoadjuvantchemotherapyischallenging.Theoptimalsequencingofsurgeryandchemotherapyinsynchronouscolorectallivermetastasespatientsisstillunclear.Conversionalchemotherapy,portalveinembolization,two-stageresection,andtumorablationareeffectiveapproachestoimproveresectabilityforinitiallyunresectablepatients.Severaltechnicalissuesandconcernsrelatedtothesemethodsneedtobefurtherexplored.Forpatientswithdefinitelyunresectableliverdisease,thenecessityofresectingtheprimarytumorisstilldebatable,andevaluatingandpredictingtheefficacyoftargetedtherapydeservefurtherinvestigation.Thisreviewdiscussesdifferentpatternsandimportantconcernsofmultidisciplinarytreatmentofcolorectallivermetastases.

简介：AIM:Toevaluatetheshort-andlong-termoutcomesofliverresectionforcaudatelobehepatocellularcarcinoma(HCC).METHODS:Weretrospectivelyanalyzed114consecutivepatientswithHCC,originatingfromthecaudatelobe,whounderwentresectionbetweenJanuary2001andJanuary2007.Univariateandmultivariateanalyseswereperformedonseveralclinicopathologicvariablestodeterminethefactorsaffectinglong-termoutcomeandintrahepaticrecurrence.RESULTS:Overallmortalityandmorbiditywere0%and18%,respectively.Afteramedianfollow-upof31mo(interquartilerange,11-66mo),tumorrecurrencehadoccurredin76patients(66.7%).The1-,3-,and5-yeardisease-freesurvivalrateswere65.7%,38.1%,and18.4%,respectively.The1-,3-,and5-yearoverallsurvivalrateswere76.1%,54.7%,and31.8%,respectively.Univariateanalysisshowedthatsubsegmentallocationofthetumor(45.7%vs16.2%,P=0.01),livercirrhosis(12.3%vs47.9%,P=0.03),surgicalmargin(18.5%vs54.6%,P=0.04),vascularinvasion(37.9%vs23.2%,P=0.04)andextendedcaudateresection(42.1%vs15.4%,P=0.04)wererelatedtopoorerlong-termsurvival.Multivariateanalysisshowedthatonlysubsegmentallocationofthetumor,livercirrhosisandsurgicalmarginweresignificantindependentprognosticfactors.CONCLUSION:HepatectomywasaneffectivetreatmentforHCCinthecaudatelobe.Thesubsegmentallocationofthetumor,livercirrhosisandsurgicalmarginaffectedlong-termsurvival.

简介：Medicaltherapyfortype2diabetesmellitusisineffectiveinthelongtermduetotheprogressivenatureofthedisease,whichrequiresincreasingmedicationdosesandpolypharmacy.Conversely,bariatricsurgeryhasemergedasacost-effectivestrategyforobesediabeticindividuals;ithaslowcomplicationratesandresultsindurableweightloss,glycemiccontrolandimprovementsinthequalityoflife,obesity-relatedco-morbidityandoverallsurvival.Thefindingthatglucosehomeostasiscanbeachievedwithaweightloss-independentmechanismimmediatelyafterbariatricsurgery,especiallygastricbypass,hasledtotheparadigmofmetabolicsurgery.However,theprimaryfocusofmetabolicsurgeryisthealterationofthephysio-anatomyofthegastrointestinaltracttoachieveglycemiccontrol,metaboliccontrolandcardio-metabolicriskreduction.Todate,metabolicsurgeryisstillnotwelldefined,asitisusedmostfrequentlyforlessobesepatientswithpoorlycontrolleddiabetes.Themechanismofglycemiccontrolisstillincompletelyunderstood.Publishedresearchfindingsonmetabolicsurgeryarepromising,butmanyaspectsstillneedtobedefined.Thispaperexaminestheproposedmechanismofdiabetesremission,theefficacyofdifferenttypesofmetabolicprocedures,thedurabilityofglucosecontrol,andtherisksandcomplicationsassociatedwiththisprocedure.Weproposeatailoredapproachfortheselectionoftheidealmetabolicprocedurefordifferentgroupsofpatients,consideringtheindicationsandprognosticfactorsfordiabetesremission.

简介：Neuroendocrinetumors(NET)areaheterogeneousgroupofcancers,withindolentbehavior.Themostcommonprimaryoriginisthegastro-intestinaltractbutcanalsoappearinthelungs,kidneys,adrenals,ovariesandotherorgans.Ingeneral,NETisusuallydiscoveredinthemetastaticphase(40%-80%).Theliveristhemostcommonorganinvolvedwhenmetastasesoccur(40%-93%),followedbybone(12%-20%)andlung(8%-10%).Anumberofdifferenttherapeuticoptionsareavailableforthetreatmentofhepaticmetastasesincludingsurgicalresection,transplantation,ablation,trans-arterialchemoembolization,chemotherapyandsomatostatinanalogues.Recently,moleculartargetedtherapieshavebeenused,usuallyincombinationwithothertreatmentoptions,toimproveoutcomesinpatientswithmetastases.ThisarticleemphasizesontheroleofsurgeryinthetreatmentoflivermetastasesfromNET.

简介：Schwannomasareneurogenictumorsthatarisefromtheneuralsheathsofperipheralnerves.Thesetumorscanbelocatedinanyareaofthehumanbody;themostcommonlocationsarethehead,neck,trunkandextremities.Pancreaticschwannomasareveryrare.Overthepast40years,only67casesofpancreaticschwannomashavebeenreportedintheEnglishliterature.Herewepresentacaseofpancreaticschwannomaina62-year-oldmale.Thetumorwasrevealedbyultrasoundandcomputedtomographyintheneckandbodyofthepancreas.Anaccuratediagnosiswasdifficulttoobtainpreoperatively.Thepatientconsentedtotheperformanceofalaparotomy,andthemasswasfoundintheneckandbodyofthepancreasandsuccessfullytreatedusingaspleenpreservingdistalpancreatectomywithsplenicarteryandveinpreservation.Theprocedurehasonlybeenreportedinoneothercaseofpancreaticschwannoma;herewepresentthesecondreportedcase.Macroscopically,thetumorwaswellcircumscribed,gray-whiteincolorand3.3cm×2.8cminsize.Microscopically,thetumorcellswerespindle-shapedandhadapalisadingarrangementwithnoatypia,whichareresultscompatiblewithabenigntumor.Bothhypercellularandhypocellularareaswerevisible.Immunohistochemically,thetumorcellswerestronglypositiveforS-100protein.Thetumorwasdefinitivelydiagnosedasaschwannomaofthepancreaticneckandbody.Thepatientwasfollowedfor72moandhasbeendoingwellwithoutanycomplications.

简介：导致放射的胃炎是胃肠的流血的一个很少发生的原因。从放射治疗产生是严肃的复杂并发症的。起始的损害是胃的mucosa的表示特性地尖锐的发炎。我们介绍了一个46岁的男病人，出血性的胃炎为hepatocellular癌的变形retroperitoneal淋巴节点由外部放射疗法导致了。内视镜的考试在胃和十二指肠的灯泡的整个muscosa与毛细管扩张显示出弥漫的edematoushyperemicmucosa。有活跃流着的多重出血性的补丁在窦上被发现。反秘书治疗为hemostasis被开始，但是melena仍然发生了离开并且在上。最后，他被氢化尼松治疗成功地对待。我们强烈因此争论赞成perdnisolone治疗有效地与导致放射的出血性的胃炎对待病人。

简介：肝炎B病毒(HBV)感染是使世界范围的3.5亿个人担心的一个全球公共健康问题。有长期的肝炎B(CHB)的个人在开发肝肝硬化，肝的补偿不全和hepatocellular癌的增加的风险。为了维持，无法发现的病毒的负担减少长期的感染复杂并发症。没有治疗，根除HBV感染。当前的药是昂贵的，与不利事件被联系，并且具有有限功效。当前的指南试着标准化临床的实践。不过，争吵与CHB关于无征状的病人的管理留下，并且什么是肝炎Be抗原(HBeAg)与正常丙氨酸aminotransferase积极是病毒的负担的截止价值区分HBeAg否定的CHB病人和不活跃的搬运人。我们详细讨论DNA水平为什么独自不是足够的开始CHB的治疗。

简介：

简介：Gastrointestinaltoxicities(GIT),includingoralmucositis,nauseaandvomiting,anddiarrhea,arecommonsideeffectsofchemotherapyandtargetedagentsinpatientswithadvancedcolorectalcancerandpancreaticcancer.Beingoftenunderreported,itisstilldifficulttopreciselyestablishtheirburdenintermsofbothpatient’squalityoflifeandcancercarecosts.Moreover,withtheuseofmoreintensiveupfrontcombinationregimens,thefrequencyofthesetoxicitiesisrapidlygrowingwithapotentialnegativeeffectalsoonpatient’soutcome,asaresultofdosereductions,delaysorevendiscontinuationofactivetreatments.Thus,identifyingpatientsathigherriskofdevelopingGITaswellasanoptimalmanagementareparamountinordertoimprovepatient’scomplianceandoutcome.Afterthedescriptionofthemaintreatment-inducedGIT,wediscussthecurrentknowledgeonthepathophysiologyofthesesideeffectsandcommentthescalescommonlyusedtoassessandgradethem.WethenprovideacriticalupdateonGITincidencebasedontheresultsofkeyrandomizedtrialsconductedinpatientswithmetastaticcolorectalcancerandadvancedpancreaticcancer.

简介：瞄准：在试验性的老鼠在生物化学、组织病理学说的变化，氧化压力，和细菌的易位(BT)上调查allopurinol和高比重的氧(HBO)治疗的单个、联合的效果尖锐胰腺炎(AP)。方法：85只Sprague-Dawley老鼠在学习被包括。85只老鼠中的十五个被用作控制(假冒，组我)。AP在留下经由管内牛磺胆酸盐注入被导致七十只老鼠。幸存到尖锐引起坏死胰腺炎的正式就职的老鼠被使随机化进四个组。组II独自收到了saline，组IIIallopurinol，加HBO的组IVallopurinol和组VHBO。浆液淀粉酶层次，氧化压力参数，BT和组织病理学说的分数是坚定的。结果：浆液淀粉酶层次在与组II相比的组III，IV和V是更低的(974+/-110，384+/-40，851+/-56，和1664+/-234U/L，分别地P<0.05，为所有)。联合揭示的二种处理选择显著地降低median[25-75百分位数]组织病理学说的分数什么时候与单个政府相比(13[12.5-15]在allopurinol组，9.5[7-11.75]在HBO组，并且6[4.5-7.5]在联合的组，P<0.01)。氧化压力标记在与控制相比的所有处理组显著地更好。进胰和mes伤寒淋巴结的细菌的易位在与组II相比的组III，IV和V是更低的(54%，23%，50%对为到胰的易位的100%，并且62%，46%，58%对为到mes伤寒淋巴节点的易位的100%，分别地P<0.05为所有)。结论：当在试验性的老鼠AP独立管理了时，现在的学习证实HBO和allopurinol处理的利益。这些处理选择的联合看起来更有效地阻止胰腺的损害参数的前进。

简介：AIM:Toevaluatetherelationshipbetweenthiopu-rineS-methyltransferase(TPMT)polymorphismsandthiopurine-inducedadversedrugreactions(ADRs)ininflammatoryboweldisease(IBD).METHODS:EligiblearticlesthatcomparedthefrequencyofTPMTpolymorphismsamongthiopurine-tolerantand-intolerantadultIBDpatientswereincluded.StatisticalanalysiswasperformedwithReviewManager5.0.Sub-analysis/sensitivityanalysiswasalsoperformed.RESULTS:Ninestudiesthatinvestigatedatotalof1309participantsmetourinclusioncriteria.Theinci-denceofTPMTgenemutationwasincreased2.93-fold(95%CI:1.68-5.09,P=0.0001)and5.93-fold(95%CI:2.96-11.88,P<0.00001),respectively,inIBDpatientswiththiopurine-inducedoverallADRsandbonemarrowtoxicity(BMT),comparedwithcontrols.TheORforTPMTgenemutationinIBDpatientswiththiopurine-inducedhepatotoxicityandpancreatitiswas1.51(95%CI:0.54-4.19,P=0.43)and1.02(95%CI:0.26-3.99,P=0.98)vscontrols,respectively.CONCLUSION:Thismeta-analysissuggeststhattheTPMTpolymorphismsareassociatedwiththiopurine-inducedoverallADRsandBMT,butnotwithhepatotoxicityandpancreatitis.

简介：瞄准：评估影响多囊肝疾病的非侵略、侵略的治疗的结果的因素。方法：有到2006年6月的从1986年7月的完全的后续的病人的临床的文件的分析。结果：41个病人(男性，7；女性，34)，11.9年变老的47.8+/-，和5.7+/-6.7年后续，被学习。硷性磷酸酯酶(AP)举起(15%病人)与侵略治疗的要求被联系(信息技术，P=0.005)。信息技术率是更高的在比非征兆的病人征兆(65.4%对14.3%，P=0.002)，并且在拿神经质的代替治疗(HRT)的女人(P=0.001)。包囊复杂并发症(CC)是更经常的(22%)在征兆的病人组织(P=0.023)。有身体质量的病人索引(BMI)>(59%)25在它以后有一个趋势到复杂并发症(P=0.075)。腹的疼痛为信息技术(78%)是最普通的症状(56%)和指示。十九个病人(46%)要求了第一种信息技术：12开的开窗术()，4laparoscopic开窗术(LF)和有肝的切除术(FHR)的3开窗术。三要求了第二种信息技术，并且一个人要求了第三个过程。复杂并发症在32%由于第一种信息技术被发现(16.7%，LF25%，FHR66.7%)，并且在在66.7%的第二种信息技术(100%)。后续死亡率是0。结论：症状，提高的AP，和CC的存在与信息技术要求被联系。HRT与症状和信息技术要求的存在被联系。有BMI>的病人25有一个趋势产生信息技术复杂并发症。复杂并发症的比例在FHR和秒信息技术组是更高的。RS是更经常的在以后。

简介：INTRODUCTIONInChina,liverfibrosisinmostpatientsresultedfromthevirusesofhepatitisB.Bothanti-virusandanti-fibrosisshouldbeconsideredindesigningaprogramforthetreatmentofliverfibrosis.Therefore,40casesofliverfibrosisduetohepatitisBweretreatedbyusingIFN-α1andtraditionalmedicinalpreparationsfromFebruary1994toApril1996.Goodcurativeeffectwasachieved.