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简介：Aim:Tostudytheadvantageofexcisionofthedistalsymptomaticuretericstumpswiththeretroperitoneallaparoscopicapproach.Methods:Fourpatientswhohadfailedtosettletheirsymptomswiththeinitialconservativemanagementwereincludedinthestudy.Allunderwentexcisionofthedistalsymptomaticuretericstumpswiththeretroperitoneallaparoscopicapproachandthenreceivedprophylacticantibiotics.Results:Wehaveachievedbetterresultsthanthosereportedintheliteratureintermsofoperatingtime(mean1h45min),bloodloss(＜10mL),postoperativerecovery(within12h)andhospitalstay(＜48h).Conclusion:Retroperitoneallaparoscopicexcisionisasafe,simpleandeffectivemethodinthemanagementofsymptomaticuretericstumps.

简介：Hypertensionisaleadingriskfactorforcardiovasculardisease,theleadingcauseofdeathandmorbidityinoursocietyandonaglobalscale.Majorcomponentsofcardiovasculardiseaseincludestroke,coronaryarterydisease,heartfailure,andchronickidneydisease,inallofwhichhypertensionplaysamajorrole.Theriskofthesecomplicationsincreasesdirectlyandlinearlywithsystolicbloodpressurestartingat115mmHg.Althoughusuallyasymptomatic,hypertensionisreadilydetectableonphysicalexaminationandisamenabletobothlifestylemodificationandpharmacologictreatmentinmostpatients.However,largeproportionsofthehypertensivepopulationremainundetectedandundertreated.Numerousguidelineshavebeenissuedduringthepastfewdecadestopromotedetectionandoptimaltherapy.Despitetheincreaseinriskwithsystolicbloodpressuregreaterthan115mmHg,thegenerallyacceptedthresholdfordiagnosisandtreatmenthasbeensystolicbloodpressuregreaterthan139mmHganddiastolicbloodpressuregreaterthan80mmHgbecauseuntilrecentlytreatmenttolowerlevelshasbeenassociatedwithanunfavorablerelationbetweenclinicalbenefitandharm.Inthepastseveralyears,newguidelines,advisories,commentaries,andclinicaltrialshaveprovidedevidenceforapotentialchangeincurrentrecommendationsforthemanagementofhypertension.Inthisregard,thelong-awaitedeighthreportoftheJointNationalCommitteeonthePrevention,Detection,Evaluation,andTreatmentofHighBloodPressurerecommendedpatientsolderthan60yearsbetreatedtoasystolicbloodpressureoflessthan150mmHg,whichhasgeneratedconsiderablecontroversyandcaution.ThestrikingfindingsoftheSystolicBloodPressureInterventionTrial(SPRINT)havereceivedconsiderableattentionbecauseofthedemonstrationthatintensivetherapytoatargetsystolicbloodpressurebelow120mmHgdecreasescardiovascularmortalityandmorbiditymorethanlessintensivetreatmenttoatargetsystolicbloodpressurebelow140mmHg

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简介：Dizzinessaffectsaleutone-thirdofindividualsovertheageof65years,andisoneofthemostconmlonreasonsfortheelderlytoconsulttheirgeneralpractitioner.Syncopeaffectsatleast20%ofthepopulationatmlnetimeandaccountsforabout6%ofgeneralmedicaladmissionsintheUK.Recurrentsymptomsareparticulas-lydisablingbecausetheyaffectanindividual'sabilitytoworkandtodrive,increasesusceptibilitytofallsandassociateinju-rim,andreduceindependenceintheelderly.

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简介：Objective:Tosummarizesurgicaltreatmentsandtheircorrespondingcurativeeffectsonsciaticnerveinjuries.Methods:Surgicaltreatmentsonsciaticnerveinjurywereperformedin28patientsfromJanuary1990toJuly2000.Thetreatmentsincludedneurolysis,neurolysispluspartialnerveanastomosis,nerveanastomosisandnervetransplantation.ThecurativeeffectwasevaluatedaccordingtoSunderlandcriteria.Results:Of28cases,22patientswerefollowedupwithafollow-upperiodof13monthsto5years(average30months).Of22nerves,7wereexcellent,5good,7fairand3poor,withanexcellencerateof54.5%.

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简介：Thispaperreviewscurrentrecommendationsontheappropriateevaluationandmanagementofcardiacarrhythmiasinthepregnantpatient.Mostarrhythmiasduringpregnancyarebenignandrequirenointervention.Whenrequired,thedecisiontotreatshouldbebasedonsymptomseverityandtheassociatedrisktomotherandfetusposedbypotentiallyrecurringarrhythmiaepisodesthroughoutthepregnancy.Anytreatmentstrategyinthispatientpopulationhasinherentrisktobothmotherandunbornchild.Beforetheinitiationofanyintervention,documentationofaclinicalarrhythmiaandcorrelationwithclinicalsymptomsshouldbeobtained.Thereisnoroleforempirictherapy.

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简介：Necrotizingpancreatitisisanuncommonyetseriouscomplicationofacutepancreatitiswithmortalityratesreportedupto15%thatreach30%incaseofinfection.Traditionallyopensurgicaldebridementwastheonlytoolinourdisposaltomanagethisseriousclinicalentity.Thisapproachishoweverassociatedwithpooroutcomes.Managementhasnowshiftedawayfromopensurgicaldebridementtoamoreconservativemanagementandminimallyinvasiveapproaches.Contemporaryapproachtopatientswithnecrotizingpancreatitisand/orinfectiouspancreatitisissummarizedinthe3Ds:Delay,DrainandDebride.Patientscanbemanagedintheintensivecareunitandanyinterventionshouldbedelayed.Percutaneousdrainagecanbeutilizedfirstandearlyinthecourseofthedisease,followedbyendoscopicdrainageorvideoassistedretroperitoneoscopicdrainageifnecrosectomyisdeemednecessary.Opensurgeryisnowlessfrequentlyperformedandshouldbereservedforcasesrefractorytoanyotherapproach.Themanagementofnecrotizingpancreatitisthereforerequiresamultidisciplinarydynamicmodelofapproachratherthanbeingasurgicaldisease.

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