1576
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Gravante G. Thermal ablation for unresectable liver tumours, time to move forward? World J Gastrointest Surg 2010; 2:1-5. [PMID: 21160826 PMCID: PMC2999191 DOI: 10.4240/wjgs.v2.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 12/09/2009] [Accepted: 12/16/2009] [Indexed: 02/06/2023] Open
Abstract
Even with the advent of laparoscopic techniques for liver tumours, classic resections still represent a major undertaking for numerous liver lesions. The avoidance of surgery using ablative techniques has been the aim for over 20 years. Large volumes can now be rapidly treated with low morbidity with the many technical developments and modifications of the delivery probes. Despite these advances recurrences rates remain high with all of the presently available techniques. The biological and pathophysiological basis underlying may help explain their limitations and are important in understanding where they may be appropriately applied and ways in which they may be improved in the future.
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1577
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Chugay P, Choi J, Dong XD. Jejunal diverticular disease complicated by enteroliths: Report of two different presentations. World J Gastrointest Surg 2010; 2:26-9. [PMID: 21160831 PMCID: PMC2999198 DOI: 10.4240/wjgs.v2.i1.26] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 10/24/2009] [Accepted: 10/31/2009] [Indexed: 02/06/2023] Open
Abstract
Jejunal diverticula are quite rare. Furthermore, small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention. In this manuscript, we report two presentations of jejunal diverticulum with complications from enteroliths followed by a review of the literature. The first case was that of a 79-year-old male who presented with abdominal pain and was found, on computed tomography (CT) scan, to have evidence of intestinal perforation. A laparotomy showed that he had perforated jejunal diverticulitis. The second case was that of an 89-year-old female who presented with recurrent episodes of bowel obstruction. A laparotomy showed that she had an enterolith impacted in her jejunum in the presence of significant diverticular disease. Although a rare entity, familiarity with jejunal diverticular disease, its complications, and its management, should be part of every surgeon’s base of knowledge when considering abdominal pathology.
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1578
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Kang NS, Qin DP. Cancer-like foreign-body in rectum wall: A case report. World J Gastrointest Surg 2010; 2:32-4. [PMID: 21160833 PMCID: PMC2999196 DOI: 10.4240/wjgs.v2.i1.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 08/12/2009] [Accepted: 08/19/2009] [Indexed: 02/06/2023] Open
Abstract
Foreign bodies in the rectum wall, whose most common causes are aberrant sexual activity and intake of small fishbone fragments by mistake, usually have a clear history, presenting an acute upset. However, chronic presence of a foreign-body can result in inflammatory reaction and stromal proliferation, and can even accelerate the occurrence and deterioration of tumors through different mechanisms, such as reactive oxygen species. Foreign bodies in the rectum wall may induce complications and lead to misdiagnosis. Colonoscopy and biopsy pathology are one of the most trusted techniques for diagnosis.
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1579
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Shimoyama S. Pharmacogenetics of irinotecan: An ethnicity-based prediction of irinotecan adverse events. World J Gastrointest Surg 2010; 2:14-21. [PMID: 21160829 PMCID: PMC2999195 DOI: 10.4240/wjgs.v2.i1.14] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 12/16/2009] [Accepted: 12/23/2009] [Indexed: 02/06/2023] Open
Abstract
Irinotecan is now regarded as the most active drug for the treatment of colorectal cancer. However, one of the most difficult issues oncologists face is deciding the optimal dose for an individual patient, as each individual shows different outcomes even at the same dose with regard to treatment related adverse events, ranging from no toxicity to a lethal event. Inherited genetic polymorphism of a single gene or multiple genes (haplotype or linkage disequilibrium) involved in SN-38 glucuronidation, a predominant route of irinotecan detoxification, is now recognized as a significant factor that can alter the incidence of side effects. Attempts to explore such inherited genetic variability have been focused on elucidating interindividual as well as interethnic differences. Genotyping studies in relation to adverse events in an individual or in a group of similar ethnicity should contribute to establishing individual-oriented or ethnicity-oriented irinotecan treatment regimens. This review highlights current single- or multi-tired approaches for the elucidation of genetic predispositions of patients to severe toxicities, especially among Asians. The purpose of this is to contribute to minimizing toxicity by dose modifications, with the consequent aim of maximizing dose intensity and efficacy, an ultimate goal of irinotecan-individualized therapy.
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1580
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Theisen J, Krause B, Peschel C, Schmid R, Geinitz H, Friess H. Early response evaluation and prediction in neoadjuvant-treated patients with esophageal cancer. World J Gastrointest Surg 2009; 1:30-7. [PMID: 21160793 PMCID: PMC2999119 DOI: 10.4240/wjgs.v1.i1.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 11/03/2009] [Accepted: 11/10/2009] [Indexed: 02/06/2023] Open
Abstract
Since the introduction of multimodal therapy regimens, the prognosis of esophageal cancer has improved. There is undoubtedly true for patients with surgically resected tumors in the case of a response to neoadjuvant chemotherapy or chemoradiation. Important conclusions can be drawn from this regarding the indication for perioperative therapies, the radicality of surgery, or the surgical indications. Thus, most of the current research in this field is aimed at the early identification of this subset of patients, at the beginning of, or even before, neoadjuvant treatment. Conventional staging tools have failed to predict responses to neoadjuvant therapy. However, molecular imaging methods, e.g. positron emission tomography (PET)-scans, have shown promising results in the early selection of responders and non-responders during the course of neoadjuvant therapy, allowing physicians to alter the treatment plan accordingly. Even more desirable is the identification of potential responders before the start of neoadjuvant therapy. Preliminary molecular data on biopsy specimens demonstrate the possibility of early response prediction in these patients. We present the current knowledge on response evaluation and prediction in esophageal cancer and draw conclusions for future clinical practice and studies in this review.
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1581
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Shrikhande SV, Barreto SG. Surgery for gallbladder cancer: The need to generate greater evidence. World J Gastrointest Surg 2009; 1:26-9. [PMID: 21160792 PMCID: PMC2999113 DOI: 10.4240/wjgs.v1.i1.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 10/30/2009] [Accepted: 11/06/2009] [Indexed: 02/06/2023] Open
Abstract
The outcomes for gallbladder cancer remain largely dismal to this day. Overall, the low incidence of gallbladder cancer around the world coupled with an even lower number of patients amenable to surgery at the time of presentation, has precluded the generation of evidence-based guidelines for the management of this cancer. However, while the incidence of the cancer may be decreasing in some parts of the world, in other countries such as India, Japan and Chile, gallbladder cancer continues to affect a sizeable population of patients. As such, there is a growing need to define what constitutes an adequate surgery for each stage of this cancer, based on sound evidence. This editorial provides a broad overview of the existing problems in the management of gallbladder cancer and appeals for multi-institutional studies aimed at answering some of the pertinent questions on the surgical management of gallbladder cancer.
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1582
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Chamuleau RA. Future of bioartificial liver support. World J Gastrointest Surg 2009; 1:21-5. [PMID: 21160791 PMCID: PMC2999112 DOI: 10.4240/wjgs.v1.i1.21] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 10/28/2009] [Accepted: 11/04/2009] [Indexed: 02/06/2023] Open
Abstract
Many different artificial liver support systems (biological and non-biological) have been developed, tested pre-clinically and some have been applied in clinical trials. Based on theoretical considerations a biological artificial liver (BAL) should be preferred above the non-biological ones. However, clinical application of the BAL is still experimental. Here we try to analyze which hurdles have to be taken before the BAL will become standard equipment in the intensive care unit for patients with acute liver failure or acute deterioration of chronic liver disease.
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1583
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Velanovich V. Gastroesophageal reflux disease and the airway-essentials for the surgeon. World J Gastrointest Surg 2009; 1:8-10. [PMID: 21160788 PMCID: PMC2999107 DOI: 10.4240/wjgs.v1.i1.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 10/24/2009] [Accepted: 11/01/2009] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) has many protean manifestations. Some of the most vexing have to do with the airway. GERD affects the tracheobronchial tree directly, leading to aspiration pneumonia and asthma, or exacerbating existing pulmonary disease, such as asthma or chronic obstructive pulmonary disease. In addition to the respiratory manifestation of GERD, there are unique pharyngeal and laryngeal manifestations. These include voice hoarseness, throat-clearing, chronic cough, globus, and “post-nasal drip”. Linking these symptoms to GERD is challenging and frequently the diagnosis is that of exclusion. Despite proton pump inhibitor therapy being the mainstay of treatment, with anti-reflux surgery being reserved for intractable cases, there is no definitive evidence of the superiority of either.
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1584
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Ma LS. What is the purpose of launching World Journal of Gastrointestinal Surgery? World J Gastrointest Surg 2009; 1:1-2. [PMID: 21160785 PMCID: PMC2999108 DOI: 10.4240/wjgs.v1.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 08/13/2009] [Accepted: 08/20/2009] [Indexed: 02/06/2023] Open
Abstract
The first issue of World Journal of Gastrointestinal Surgery (WJGS), whose preparatory work was initiated on September 27, 2008, will be published on November 30, 2009. The WJGS Editorial Board has now been established and consists of 328 distinguished experts from 35 countries. Our purpose of launching WJGS is to publish peer-reviewed, high-quality articles via an open-access online publishing model, thereby acting as a platform for communication between peers and the wider public, and maximizing the benefits to editorial board members, authors and readers.
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1585
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Privitera A, Milkhu CS, Datta V, Rodriguez-Justo M, Windsor A, Cohen CR. Actinomycosis of the sigmoid colon: A case report. World J Gastrointest Surg 2009; 1:62-4. [PMID: 21160798 PMCID: PMC2999117 DOI: 10.4240/wjgs.v1.i1.62] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 09/15/2009] [Accepted: 09/22/2009] [Indexed: 02/06/2023] Open
Abstract
Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species. The ileo-cecal region is most commonly affected, while the left side of the colon is more rarely involved. The infection has a tendency to infiltrate adjacent tissues and is therefore rarely confined to a single organ. Presentation may vary from non specific symptoms and signs to an acute abdomen. A computed tomography scan is helpful in identifying the inflammatory process and the organs involved. It also allows visual guidance for percutaneous drainage of abscesses, thus aiding diagnosis. Culture is difficult because of the anaerobic character and slow growth of actinomycetes. Colonoscopy is usually normal, but may shows signs of external compression. Preoperative diagnosis is rare and is established only in less than 10% of cases. In uncomplicated disease, high dose antibiotic therapy is the mainstay of treatment. Surgery is often performed because of a difficulty in diagnosis. Surgery and antibiotics are required in the case of complicated disease. Combined medical and surgical treatment achieves a cure in about 90% of cases. The authors report a case of sigmoid actinomycosis where diagnosis was made from the histology, and a review of the literature is presented.
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1586
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Noguchi H. Pancreatic islet transplantation. World J Gastrointest Surg 2009; 1:16-20. [PMID: 21160790 PMCID: PMC2999120 DOI: 10.4240/wjgs.v1.i1.16] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 11/10/2009] [Accepted: 11/17/2009] [Indexed: 02/06/2023] Open
Abstract
Type 1 diabetes mellitus is an autoimmune disease, which results in the permanent destruction of β-cells of the pancreatic islets of Langerhans. While exogenous insulin therapy has dramatically improved the quality of life, chronic diabetic complications develop in a substantial proportion of subjects and these complications generally progress and worsen over time. Although intensive insulin therapy has proven effective to delay and sometimes prevent the progression of complications such as nephropathy, neuropathy or retinopathy, it is difficult to achieve and maintain long term in most subjects. Reasons for this difficulty include compliance issues and the increased risk of severe hypoglycemic episodes, which are generally associated with intensification of exogenous insulin therapy. Clinical studies have shown that transplantation of pancreas or purified pancreatic islets can support glucose homeostasis in type 1 diabetic patients. Islet transplantation carries the special advantages of being less invasive and resulting in fewer complications compared with the traditional pancreas or pancreas-kidney transplantation. However, islet transplantation efforts have limitations including the short supply of donor pancreata, the paucity of experienced islet isolation teams, side effects of immunosuppressants and poor long-term results. The purpose of this article is to review recent progress in clinical islet transplantation for the treatment of diabetes.
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1587
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Ribeiro MA. Liver regeneration, stem cells and beyond. World J Gastrointest Surg 2009; 1:6-7. [PMID: 21160787 PMCID: PMC2999123 DOI: 10.4240/wjgs.v1.i1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 11/10/2009] [Accepted: 11/17/2009] [Indexed: 02/06/2023] Open
Abstract
Studies of the liver regenerative process have gained prominence in the last few years, especially with the interest in stem cell therapy. The regenerative capacity of the liver, its mechanisms and the role of stem cells will be discussed in this editorial as well as the role of artificial tissues and organs aiming to produce a new liver based on the current literature.
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1588
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Fonseca AZ, Ribeiro MAF, Frazão M, Costas MC, Spinelli L, Contrucci O. Esophagectomy for a traumatic esophageal perforation with delayed diagnosis. World J Gastrointest Surg 2009; 1:65-7. [PMID: 21160799 PMCID: PMC2999122 DOI: 10.4240/wjgs.v1.i1.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 07/16/2009] [Accepted: 07/23/2009] [Indexed: 02/07/2023] Open
Abstract
Esophageal perforations are rare, and traumatic perforations are even more infrequent. Due to the rarity of this condition and its nonspecific presentation, the diagnosis and treatment of this type of perforation are delayed in more than 50% of patients, which leads to a high mortality rate. An 18-year-old male patient was brought to the emergency room with a penetrating neck injury, caused by a gunshot wound. He was taken to the operating room and underwent surgical exploration of the neck and a chest tube was inserted to treat the hemo- and pneumothorax. During the procedure, a 2 cm lesion was detected in the esophagus, and the patient underwent a primary repair. A contrast leakage into his right hemithorax was noticed on the 4th postoperative day; he was submitted to new surgery, and a subtotal esophagectomy and jejunostomy were performed. He was discharged from the hospital in good condition 20 d after the last procedure. The discussion around this topic focuses on the importance of the timing of diagnosis and the subsequent treatment. In early diagnosed patients, more conservative therapeutics should be performed, such as primary repair, while in those with delayed diagnosis, the patient should be submitted to more aggressive and definitive treatment.
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1589
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Kharbutli B, Velanovich V. Gastrointestinal symptomatic outcomes of laparoscopic and open gastrectomy. World J Gastrointest Surg 2009; 1:56-8. [PMID: 21160796 PMCID: PMC2999106 DOI: 10.4240/wjgs.v1.i1.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 08/25/2009] [Accepted: 09/02/2009] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the laparoscopic and the open gastrectomy approaches for short term morbidity, length of hospital stay and also long term gastrointestinal symptoms.
METHODS: Patients who have undergone gastrectomy had their medical records reviewed for demographic data, type of gastrectomy, short term morbidity, and length of hospital stay. Patients were contacted and asked to complete the Gastrointestinal Symptom Rating Scale (GSRS). The GSRS measures three domains of GI symptoms: Dyspepsia Syndrome (DS) for the foregut (best score 0, worse score 15), indigestion syndrome (IS) for the midgut (best score 0, worse score 12), and bowel dysfunction syndrome (BDS) for the hindgut (best score 0, worse score 16). Statistical analysis was done using the Mann-Whitney U-test.
RESULTS: We had complete data on 32 patients: 7 laparoscopic and 25 open. Of these, 25 had a gastroenteric anastomosis and 6 did not. The table shows the results as medians with interquartile range. Laparoscopic gastrectomy had a better score than open gastrectomy in the DS domain (0 vs 1, P = 0.02), while gastrectomy without anastomosis had a better score than gastrectomy with anastomosis in the IS domain (0 vs 1, P = 0.05).
CONCLUSION: Patients have little adverse gastrointestinal symptoms and preserve good gastrointestinal function after undergoing any type of gastrectomy. Laparoscopic approach had better dyspepsia and foregut symptoms. Performing an anastomosis led to mild adverse midgut and indigestion effects
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1590
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Munkholm-Larsen S, Cao CQ, Yan TD. Malignant peritoneal mesothelioma. World J Gastrointest Surg 2009; 1:38-48. [PMID: 21160794 PMCID: PMC2999110 DOI: 10.4240/wjgs.v1.i1.38] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 07/27/2009] [Accepted: 08/04/2009] [Indexed: 02/06/2023] Open
Abstract
Malignant mesothelioma is a highly aggressive neoplasm. The incidence of malignant mesothelioma is increasing worldwide. Diffuse malignant peritoneal mesothelioma (DMPM) represents one-fourth of all mesotheliomas. Association of asbestos exposure with DMPM has been observed, especially in males. The great majority of patients present with abdominal pain and distension, caused by accumulation of tumors and ascitic fluid. In the past, DMPM was considered a pre-terminal condition; therefore attracted little attention. Patients invariably died from their disease within a year. Recently, several prospective trials have demonstrated a median survival of 40 to 90 mo and 5-year survival of 30% to 60% after combined treatment using cytoreductive surgery and perioperative intraperitoneal chemotherapy. This remarkable improvement in survival has prompted new search into the medical science related to DMPM, a disease previously ignored as uninteresting. This review article focuses on the key advances in the epidemiology, diagnosis, staging, treatments and prognosis of DMPM that have occurred in the past decade.
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1591
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Biscione FM. Rates of surgical site infection as a performance measure: Are we ready? World J Gastrointest Surg 2009; 1:11-5. [PMID: 21160789 PMCID: PMC2999116 DOI: 10.4240/wjgs.v1.i1.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 08/25/2009] [Accepted: 09/01/2009] [Indexed: 02/06/2023] Open
Abstract
With the introduction of quality assurance in health care delivery, there has been a proliferation of research studies that compare patient outcomes for similar conditions among many health care delivery facilities. Since the 1990s, increasing interest has been placed in the incorporation of clinical adverse events as quality indicators in hospital quality assurance programs. Adverse post-operative events, and very especially surgical site infection (SSI) rates after specific procedures, gained popularity as hospital quality indicators in the 1980s. For a SSI rate to be considered a valid indicator of the quality of care, it is essential that a proper adjustment for patient case mix be performed, so that meaningful comparisons of SSI rates can be made among surgeons, institutions, or over time. So far, a significant impediment to developing meaningful hospital-acquired infection rates that can be used for intra- and inter-hospital comparisons has been the lack of an adequate means of adjusting for case mix. This paper discusses what we have learned in the last years regarding risk adjustment of SSI rates for provider performance assessment, and identifies areas in which significant improvement is still needed.
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1592
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Shivathirthan N, Maheshwari G, Kamath D, Haldar P. Enterolithiasis complicating eosinophilic enteritis: A case report and review of literature. World J Gastrointest Surg 2009; 1:68-70. [PMID: 21160800 PMCID: PMC2999105 DOI: 10.4240/wjgs.v1.i1.68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 06/01/2008] [Accepted: 06/08/2008] [Indexed: 02/06/2023] Open
Abstract
We report a case of eosinophilic enteritis involving the proximal small bowel, a relatively rare entity, presenting unusually as enteroliths in a 68-year-old man with complaints of anemia, malena and abdominal pain. The disease if diagnosed in the initial stages responds well to medical treatment but if associated with complications or misdiagnosed, surgical modality is the treatment of choice. In our case, the patient presented with enteroliths and strictures. Resection and anastomosis of the small bowel containing stones was carried out. Histopathology confirmed the diagnosis as eosinophilic enteritis.
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1593
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Marik PE. Glycemic control in critically ill patients: What to do post NICE-SUGAR? World J Gastrointest Surg 2009; 1:3-5. [PMID: 21160786 PMCID: PMC2999109 DOI: 10.4240/wjgs.v1.i1.3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/09/2009] [Accepted: 11/16/2009] [Indexed: 02/06/2023] Open
Abstract
Until recently, stress hyperglycemia was considered to be a beneficial adaptive response, with raised blood glucose providing a ready source of fuel for the brain, skeletal muscle, heart and other vital organs at a time of increased metabolic demand. Following the Leuven Intensive Insulin Therapy Trial in 2001, tight glycemic control became rapidly adopted as the standard of care in intensive care units (ICU’s) throughout the world. However, four randomized controlled studies and the recently published NICE-SUGAR study have subsequently been unable to replicate the findings of the Leuven Intensive Insulin Therapy Trial. This paper offers an explanation for these discordant findings, and provides a practical approach to glucose control in the ICU.
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1594
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Parsi MA. Peroral cholangioscopy-assisted guidewire placement for removal of impacted stones in the cystic duct remnant. World J Gastrointest Surg 2009; 1:59-61. [PMID: 21160797 PMCID: PMC2999114 DOI: 10.4240/wjgs.v1.i1.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 07/19/2009] [Accepted: 07/26/2009] [Indexed: 02/06/2023] Open
Abstract
It is well known that impacted biliary stones are difficult to remove endoscopically. Among the many factors associated with failure of endoscopic therapy for removal of bile duct stones, impaction ranks high. One of the reasons behind failure of endoscopic therapy in such cases is that the impacted stone often does not allow passage of a guidewire. Recent introduction of a novel single-operator cholangioscopy system has made it possible for a single endoscopist to use cholangioscopy for evaluation and treatment of a wide variety of biliary disorders. This cholangioscopy system was used for placement of a guidewire in the cystic duct remnant with subsequent removal of an impacted stone which had prevented passage of a guidewire by conventional means.
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1595
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Ikeda Y, Kanda T, Kosugi SI, Yajima K, Matsuki A, Suzuki T, Hatakeyama K. Gastric cancer surgery for patients with liver cirrhosis. World J Gastrointest Surg 2009; 1:49-55. [PMID: 21160795 PMCID: PMC2999121 DOI: 10.4240/wjgs.v1.i1.49] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 11/12/2009] [Accepted: 11/19/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To elucidate the influence of liver cirrhosis (LC) on the prognosis of patients with gastric cancer (GC). METHODS Of the 1347 GC patients who underwent curative gastrectomy for GC between January 1984 and June 2007, 25 patients (21 men and 4 women with a median age of 67 years; range 54-77 years) with LC were enrolled in this study. Using the Child-Pugh classification, 15 patients were evaluated as grade A and 10 patients as grade B. No grade C patient underwent gastrectomy in this series. Clinical outcomes, including postoperative morbidity and survival, were retrospectively analyzed based on medical records and surgical files. RESULTS There was no significant difference in operative blood loss and perioperative blood transfusion between the two groups. The most common postoperative complication was intractable ascites, which was the single postoperative morbidity noted more frequently in grade B patients (40.0%) than in grade A patients (6.7%) with statistical significance (P = 0.041). Operative mortality due to hepatic failure was seen in one grade A patient. Three patients had hepatocellular carcinoma (HCC) at presentation and two patients developed HCC after surgery. Overall 5-year survival rate was 58.9% in patients with early GC and 33.3% in patients with advanced GC (P = 0.230). GC-specific 5-year survival rate of early GC patients was 90.0% while that of advanced GC patients was 58.3% (P = 0.010). Four patients with early GC died of uncontrolled HCC, of which two were synchronous and two metachronous. CONCLUSION The risk of postoperative intractable ascites is high, particularly in grade B patients. Early detection and complete control of HCC is vital to improve a patient's prognosis.
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