Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone features.In recent years,variable m...Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone features.In recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse events.In this review,we outline a stepwise approach in CBD stone management.As first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical lithotripsy.On the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence.As discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions.Furthermore,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management option.In addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed.In conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.展开更多
Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating...Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating to small bowel, colonic and colorectal anastomotic techniques were reviewed. ?eferences from these articles were also reviewed, and relevant articles obtained. Either a stapled or sutured gastrointestinal tract anastomosis is acceptable in most situations. The available evidence suggests that in the following situations, however, particular anastomotic techniques may result in fewer complications: A stapled side-to-side ileocolic anastomosis is preferable following a right hemicolectomy for cancer. A stapled side-to-side anastomosis is likely also preferable after an ileocolic resection for Crohn’s disease. Colorectal anastomoses can be sutured or stapled with similar results, although the incidence of strictures is higher following stapled anas-tomoses. Following reversal of loop ileostomy there is some evidence to suggest that a stapled side-to-side anastomosis or sutured enterotomy closure (rather than spout resection and sutured anastomosis) results in fewer complications. Non-randomised data has indi-cated that small bowel anastomoses are best sutured in the trauma patient. This article reviews the theory,practice and evidence base behind the various gastro-intestinal anastomoses to help the practising general surgeon make evidence based operative decisions.展开更多
Exogenous gene suture was used to achieve peripheral nerve anastomoses to probe into the feasibility that the sites of anastomoses of nerves directly transfer gene and thus enable gene to be expressed at the sites of ...Exogenous gene suture was used to achieve peripheral nerve anastomoses to probe into the feasibility that the sites of anastomoses of nerves directly transfer gene and thus enable gene to be expressed at the sites of anastomoses under the condition that perfect nerve anastomoses are ensured. PCMVβ plasmid containing cytomegalovirus promoter (CMV promoter) and Escherichia coli (E.coli) β Galactosidase (β Gal) structural gene (lacZ gene) was conducted. A soaked medical 8 0nylon suture was used to perform epineurial repair of rabbit sciatic nerve. In the control group a suture soaked in sucrose PBS was used, while in the experimental group a suture soaked in PCMVβ plasmid solution was applied. The sites of anastomoses of nerves by stages were taken out, and β Gal histochemical staining was performed and β Gal enzyme activity was assayed with 5 bromo 4 chloro 3 indolyl β D galactoside. Results showed that the sites of anastomoses of nerves were taken out 2 days, 7 days, 14 days and 30 days respectively after the operation. The β Gal histochemical stains at the sites of anastomoses showed no indigo positive cells at different stages in the control group, whereas displayed indigo positive cells in the experimental group. In the control group, no β Gal enzyme activity was detected at different stages after operation, but in the experimental group, β Gal enzyme activity could be detected from the 3rd day to the 30th day after operation. It was concluded that by using exogenous gene suture, exogenous gene could be transferred to the sites of peripheral nerve and expressed the exogenous gene expression products with bioactivity, which provided the feasibility of using gene therapy to accelerate the recovery of nerve function.展开更多
We comment on a study titled“Feasibility and safety of"bridging"pancreaticogastrostomy for pancreatic trauma in Landrace pigs”in which ten pigs were randomized to either experimental“bridging”pancreatico...We comment on a study titled“Feasibility and safety of"bridging"pancreaticogastrostomy for pancreatic trauma in Landrace pigs”in which ten pigs were randomized to either experimental“bridging”pancreaticogastrostomy(PG)or a control group with a routine mucosa-to-mucosa PG.At six months anastomoses had strictured and closed in both groups.The authors concluded that“bridging”PG is feasible and safe in damage control surgery during the early stage of pancreatic injury.In this letter we comment on the study design,specifically leaving a 2 cm gap between the pancreatic stump and the stomach and highlight the complexity of performing pancreatic anastomoses following trauma pancreaticoduodenectomy as to our experience in a high volume trauma centre.Our data emphasize that pancreatic anastomoses in trauma are complex procedures with significant postoperative morbidity and are best managed collaboratively by trauma and hepatopancreaticobiliary surgical teams with the required technical skills.展开更多
The CycloneTM System (Castlewood Surgical, Inc., Concord, MA) is a novel device that facilitates the attachment of the saphenous vein onto the ascending aorta for the purpose of creating a bypass graft during a corona...The CycloneTM System (Castlewood Surgical, Inc., Concord, MA) is a novel device that facilitates the attachment of the saphenous vein onto the ascending aorta for the purpose of creating a bypass graft during a coronary artery bypass grafting (CABG) operation. It allows the surgeon to perform a hand-sewn anastomosis with no disruption of the intima of the aorta, and no need for partial clamping. During a 36-month period 109 CABG operations were performed, and the CycloneTM System (and its predecessor, the HexalonTM) was utilized to create 138 proximal anastomoses. This study demonstrates that this is a safe and effective method of creating a clampless, no-touch proximal anastomoses during off-pump CABG.展开更多
BACKGROUND Anastomosing hemangioma(AH)is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract.Due to the lack of specific clinical and radiologic manifestations,it is easily misdi...BACKGROUND Anastomosing hemangioma(AH)is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract.Due to the lack of specific clinical and radiologic manifestations,it is easily misdiagnosed preoperatively.Here,we report a case of AH arising from the left renal vein that was discovered incidentally and confirmed pathologically,and then describe its imaging characteristics from a radiologic point of view and review its clinicopathologic features and treatment.CASE SUMMARY A 74-year-old woman was admitted to our department for a left retroperitoneal neoplasm measuring 2.6 cm×2.0 cm.Her laboratory data showed no significant abnormalities.A non-contrast-enhanced computed tomography(CT)scan showed a heterogeneous density in the neoplasm.Non-contrast-enhanced magnetic resonance imaging(MRI)revealed a heterogeneous hypointensity on T1-weighed images and a heterogeneous hyperintensity on T2-weighed images.On contrastenhanced CT and MRI scans,the neoplasm presented marked septal enhancement in the arterial phase and persistent enhancement in the portal phase,and its boundary with the left renal vein was ill-defined.Based on these clinical and radiological manifestations,the neoplasm was initially considered to be a neurogenic neoplasm in the left retroperitoneum.Finally,the neoplasm was completely resected and pathologically diagnosed as AH.CONCLUSION AH is an uncommon benign hemangioma.Preoperative misdiagnoses are common not only because of a lack of specific clinical and radiologic manifestations but also because clinicians lack vigilance and diagnostic experience in identifying AH.AH is not exclusive to the urogenital parenchyma.We report the first case of this neoplasm in the left renal vein.Recognition of this entity in the left renal vein can be helpful in its diagnosis and distinction from other neoplasms.展开更多
Although anastomosing fluvial rivers are given much attention recently by some research workers because the result channel sandstone of which is one typical primary reservoirs of petroleum and natural gas, of which th...Although anastomosing fluvial rivers are given much attention recently by some research workers because the result channel sandstone of which is one typical primary reservoirs of petroleum and natural gas, of which the flood plains and the interchannel wetlands are pay zones where coals had formed, the comprehension of anastomosing river is some extent limited at present. Some researchers regard that the anastomosing river river and the anabranched river are the same kind of rivers. In this paper, the sedimentary, geomorphic and hydraulic characteristics and the main controlling factors of anastomosing fluvial system are summarized systematically. Some of the characteristics are compared with others fluvial rivers. Humid climate is suitable to form anastomosing channel systems, in arid semiarid regions anastomosing river maybe develop if many befitting factors combine together. The authors of the paper think that anastomosing river is one typical channel pattern and is dissimilar to anabranched channel pattern.展开更多
The Laramie River after flowing in a north direction through southeast Wyoming’s Laramie Basin abruptly turns in an east direction to flow across the north-to-south oriented Laramie Range in a bedrock-walled canyon a...The Laramie River after flowing in a north direction through southeast Wyoming’s Laramie Basin abruptly turns in an east direction to flow across the north-to-south oriented Laramie Range in a bedrock-walled canyon and eventually reaches the lower elevation Great Plains and southeast-oriented North Platte River. The North Laramie River, Bluegrass Creek, and North Sybille/Sybille Creek also flow from the Laramie Basin in separate bedrock-walled valleys into the Laramie Range before eventually joining the Laramie River. Bedrock-walled through valleys link the various Laramie Range stream and river crossing valleys and detailed topographic maps were used to determine how this anastomosing bedrock-walled canyon complex and the large escarpment-surrounded Goshen Hole basin (located just to the east of the anastomosing canyon complex) originated. Map evidence shows multiple streams of water must have diverged in the Laramie Basin from the north-oriented Laramie River to enter the Laramie Range before converging in or east of the Laramie Range and also shows how present day through valleys enabled diverging and converging streams of water to cross the Laramie Range. The anastomosing bedrock-walled valley complex studied here extends from north of the North Laramie River valley to south of the North Sybille/Sybille Creek valley. Large volumes of water flowing from the Laramie Basin to the Great Plains are interpreted to have eroded the anastomosing canyon complex and the “downstream” Goshen Hole escarpment-surrounded basin. Headward erosion of the north-oriented Sybille and Chugwater Creek valleys across large sheets of east-oriented water are interpreted to have left the Goshen Hole escarpment-surrounded basin as a large abandoned headcut. A water source was not determined, although a continental ice sheet that deeply eroded and warped the North American continent is considered to be a possible source.展开更多
Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical,morphological,and immunohistochemical features.This article summarizes the clinical and pathologic...Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical,morphological,and immunohistochemical features.This article summarizes the clinical and pathological features of primary renal angiosarcoma and anastomosing haemangioma of the kidney including epidemiology,genetics,and prognosis.Renal anastomosing haemangiomas are benign neoplasms characterized by anastomosing capillary-sized vascular channels.These tumours are rare,with about 75 cases reported in the literature.Most anastomosing haemangiomas are found incidentally on ultrasound,computed tomography,or magnetic resonance imaging.Common symptoms include abdominal pain,haematuria,and abdominal mass.Renal anastomosing haemangiomas are characterized by recurrent mutations in GNAQ and GNA14 genes.The prognosis of anastomosing haemangioma is excellent.Primary renal angiosarcomas are malignant tumours showing endothelial differentiation.To date,76 cases have been described in the literature.Primary renal angiosarcomas are frequently symptomatic.The clinical features of renal angiosarcomas are similar to those of renal anastomosing haemangiomas,including abdominal pain,haematuria,and abdominal mass.Angiogenesis-related genes and vascular-specific receptor tyrosine kinases such as KDR,TIE1,SNRK,TEK,and FLT1 are upregulated in angiosarcomas.Primary renal angiosarcomas are highly aggressive neoplasms with a poor prognosis despite surgical treatment,chemotherapy,radiotherapy,or targeted therapy.展开更多
Detailed topographic maps of drainage divides surrounding the Jefferson County, Montana, Boulder River drainage basin were analyzed to determine the nature of drainage systems that preceded today’s Boulder River drai...Detailed topographic maps of drainage divides surrounding the Jefferson County, Montana, Boulder River drainage basin were analyzed to determine the nature of drainage systems that preceded today’s Boulder River drainage system and how the Boulder River drainage system evolved from those earlier drainage systems. The Boulder River studied here drains in a north, east, and south direction to the Jefferson River, which at Three Forks, Montana joins the north-oriented Madison and Gallatin Rivers to form the north-oriented Missouri River. The North American east-west Continental Divide surrounds the Boulder River drainage basin western half and mountainous drainage divides with the Jefferson and Missouri Rivers surround the drainage basin’s eastern half. More than 25 deep mountain passes are notched into these drainage divides and provide evidence of the regional drainage system that preceded the present day Boulder River drainage system. Analysis of pass elevations and of orientations of valleys leading in opposite directions from those mountain passes shows that prior to Boulder River drainage system development immense volumes of south-oriented water moving in anastomosing complexes of diverging and converging channels flowed across the Boulder River drainage basin area and that the Boulder River drainage system evolved as deeper channels progressively captured flow from shallower channels. While not documented in detail crustal warping probably raised Boulder River drainage basin areas relative to adjacent valleys and basins as capture events took place. A water source was not determined, but may have been from a large North American continental ice sheet, although Boulder River drainage basin evolution probably occurred while mid Tertiary sediments were filling adjacent valleys and basins.展开更多
Drainage divides along a southern Laramie Range crest area and in the nearby southeast Wyoming Gangplank area (as observed on detailed topographic maps) suggest present-day drainage routes in the Cheyenne Tablelands r...Drainage divides along a southern Laramie Range crest area and in the nearby southeast Wyoming Gangplank area (as observed on detailed topographic maps) suggest present-day drainage routes in the Cheyenne Tablelands region originated as headward erosion of south-oriented valleys (now the downstream Lodgepole, Crow, and Lone Tree Creek valleys) from an actively eroding northeast-oriented South Platte River valley captured flood flow in the south half of a large east-oriented anastomosing channel complex while headward erosion of a north-oriented valley (now the downstream Horse Creek valley) from the southeast-oriented North Platte River valley captured the north half of the same large anastomosing channel complex. The Gangplank, which today serves as a low gradient ramp of Tertiary Ogallala Formation sediments leading from the Great Plains to the Laramie Range erosion surface, is located along the Crow Creek-Lone Tree Creek drainage divide and low points along that divide (referred to here as divide crossings) suggest, prior to headward erosion of what is now its south-oriented downstream Lone Tree Creek valley, upstream east-oriented Lone Tree Creek drainage routes were intertwined with east-oriented Crow Creek drainage routes, which today flow much further in an east direction (than east-oriented upstream Lone Tree Creek drainage routes) before also turning in a south direction to reach the South Platte River. The ability of the commonly accepted regional geomorphology paradigm to explain this topographic map evidence is then compared with a fundamentally different and new regional geomorphology paradigm’s ability to explain the same evidence. While both paradigms offer possible explanations the new paradigm, which requires headward erosion of the valleys to have occurred as massive continental ice sheet melt water floods crossed the region, explains much more of the drainage system evidence and also permits much more detailed explanations.展开更多
AIM:To report our experience with single-port laparoscopic surgery(SPLS)for sigmoid volvulus(SV).METHODS:Between October 2009 and April 2013,10patients underwent SPLS for SV.SPLS was performed transumbilically or thro...AIM:To report our experience with single-port laparoscopic surgery(SPLS)for sigmoid volvulus(SV).METHODS:Between October 2009 and April 2013,10patients underwent SPLS for SV.SPLS was performed transumbilically or through a predetermined stoma site.Conventional straight and rigid-type laparoscopic instruments were used.After intracorporeal,segmental resection of the affected sigmoid colon,the specimen was extracted through the single-incision site.Patientdemographics and perioperative data were analyzed.RESULTS:SPLS for SV was successful in all 10 patients(4,resection and primary anastomosis;6,Hartmann’s procedure).The median operative time and postoperative hospitalization period were 168(range,85-315)min and 6.5(range,4-29)d,respectively.No intraoperative complications were noted;there were 2 postoperative complications,including 1 anastomotic leak.CONCLUSION:SPLS was a safe and feasible therapeutic approach for SV,when performed by a surgeon experienced in conventional laparoscopic surgery.展开更多
We report a case of acute type B aortic dissection complicated by coarctation of aorta in 35-year-old women. Computed tomography angiography (CTA) showed a short segment aortic narrowing with diameter of 9.2 mm a smal...We report a case of acute type B aortic dissection complicated by coarctation of aorta in 35-year-old women. Computed tomography angiography (CTA) showed a short segment aortic narrowing with diameter of 9.2 mm a small intimal tear, a true lumen, a false lumen, a markedly thick mural thrombus and pleural effusion. Open surgical procedure was performed and the aortic coarctation (CoA) and aortic dissection were resected and a 24-mm prosthetic graft was anastomosed. No pseudo aneurysms were present at the anastomosis sites on the follow up CTA.展开更多
Anastomosing hemangioma is a type of tumor lesion of benign behavior scarcely documented, it has been observed in renal parenchyma, testicles, ovaries and adrenal glands, it is usually prone to perirenal and renal med...Anastomosing hemangioma is a type of tumor lesion of benign behavior scarcely documented, it has been observed in renal parenchyma, testicles, ovaries and adrenal glands, it is usually prone to perirenal and renal medullary adipose tissue. In this case report, we present an anastomosed hemangioma in the right kidney of a 33-year-old woman, with previous coexistence of breast cancer, in which an unusual behavior was detected, with characteristics of vascular lesion, in this case we report: The classic conditions, its heterogeneous nature and the vascular alterations that presents in different imaging modalities.展开更多
Endoscopic ultrasound(EUS)has both diagnostic and therapeutic clinical applications.This review article focuses on recent advances in two commonly performed procedures:EUS-guided tissue acquisition and EUS-guided drai...Endoscopic ultrasound(EUS)has both diagnostic and therapeutic clinical applications.This review article focuses on recent advances in two commonly performed procedures:EUS-guided tissue acquisition and EUS-guided drainage.There is a shift from acquiring aspirates for cytology to obtaining tissue cores for histological diagnoses and molecular analyses.There is growing interest and research about artificial intelligence in EUS.Artificial intelligence may potentially be useful to guide clinical decision making if biopsy results are non-diagnostic.The range of EUS-guided drainage procedures has expanded.EUS-guided drainage of walled-off pancreatic fluid collections is an accepted first line treatment option.EUS-guided palliative drainage of malignant biliary obstruction after unsuccessful endoscopic retrograde cholangiopancreatography(ERCP)is now an accepted alternative to percutaneous transhepatic biliary drainage.EUS-guided gallbladder drainage for management of acute cholecystitis is now a preferred option over percutaneous cholecystostomy for non-surgical candidates.Other EUS-created gastrointestinal anastomoses such as EUS-guided gastroenterostomy in the context of gastric outlet obstruction,and EUS-directed transgastric ERCP for Roux-en-Y gastric bypass are now technically feasible,but further prospective randomized studies are needed to establish the actual clinical impact.展开更多
Feto-fetal transfusion syndrome(FFTS)severely affects monochorionic(MC)multiple pregnancies and affects 1 in 1600 pregnancies overall.The number of increasing disputed obstetrics cases in China is related to unavailab...Feto-fetal transfusion syndrome(FFTS)severely affects monochorionic(MC)multiple pregnancies and affects 1 in 1600 pregnancies overall.The number of increasing disputed obstetrics cases in China is related to unavailability of prompt diagnosis of FFTS.We present here a woman with a MC triplet pregnancy with intrauterine fetal death at 33 weeks of gestation due to FFTS.Subsequent pathological anatomy showed that the MC placenta contained vascular anastomoses,including arterio-arterial anastomosis and arterio-venous anastomosis.These anastomoses led to unidirectional blood flow with the absence of adequate compensatory counter-transfusion and bi-directional flow.When encountering such challenging conditions,medical practitioners should discreetly compare the fetuses’characteristics with features of placental blood vessels and consult morphological and pathological findings.Furthermore,they should perform ultrasound examinations,particularly focussing on fetal size differences and the maximum vertical pocket in the diagnosis of FFTS,especially in MC multiple pregnancies with abdominal symptoms.展开更多
The anastomosing fluvial system was considered as the same term of the braided fluvial system. Smith and others have recognized the difference between them. They described the anastomosing fluvial system as 'a low...The anastomosing fluvial system was considered as the same term of the braided fluvial system. Smith and others have recognized the difference between them. They described the anastomosing fluvial system as 'a low energy complex of several interconnected channels of variable sinuosity crossing a wetland and forming many elongate vegetated islands', and established a depositional model of anastomosing fluvial system based on their展开更多
The anastomosing river that is present within the First Great Bend of the Yellow River is different from other sand-bedded rivers of this type because it contains gravel-bedded materials. It is therefore important to ...The anastomosing river that is present within the First Great Bend of the Yellow River is different from other sand-bedded rivers of this type because it contains gravel-bedded materials. It is therefore important to determine whether, or not, the specific characteristics of this anastomosing river are similar to those seen in sand-bedded forms, including the characteristics of erosion and deposition, and the stability of channel and interchannel wetlands. Four Landsat images from 1990, 2001, 2013, and 2016 alongside two Google Earth(GE) images from 2011 and 2013 were utilized in this study in tandem with field sampling and observations to select a 12 km main channel length section of the Qihama reach anastomosing river. This section was then used to determine variations in channel planform and sedimentary characteristics over a 26 year period. The results of this study show that this gravel-bedded anastomosing river has exhibited a high degree of stability overall, and that there has been no obvious channel and wetland bank erosion and deposition. Data also show that over the 26 years of this study, anastomosing belt area increased by 2.43%, while the ratio of land to water area remained almost equal. The number of wetlands has also increased along this river section at a rate as high as 62.16% because of the fragmentation of some small interchannel examples, while the talweg has alternately migrated to either the left or right over long periods of time at a relatively stable rate. Indeed, as a result of the migration of this line, there has been significant turnover in the number of islands within the main channel while bank shift has occurred at a rate of about 5 m/yr. The numerous anastomosing channels within this river section remained very stable over the course of this study, characterized by a mean annual migration rate of just 1 m/yr, while the sediments in bank columnar sections are mainly composed of fine sands or silts with a relatively high clay content. The sediment grain-size distribution curve for this river section contains multiple peaks, distinct from the muddy sediments within bank columnar sections from sand-bedded anastomosing rivers. The dense vegetation within riparian and interchannel wetlands alongside this river reach has also protected anastomosing channels from erosion and maintainedtheir stability, a key feature of this gravel-bedded system.展开更多
文摘Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone features.In recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse events.In this review,we outline a stepwise approach in CBD stone management.As first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical lithotripsy.On the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence.As discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions.Furthermore,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management option.In addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed.In conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.
文摘Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating to small bowel, colonic and colorectal anastomotic techniques were reviewed. ?eferences from these articles were also reviewed, and relevant articles obtained. Either a stapled or sutured gastrointestinal tract anastomosis is acceptable in most situations. The available evidence suggests that in the following situations, however, particular anastomotic techniques may result in fewer complications: A stapled side-to-side ileocolic anastomosis is preferable following a right hemicolectomy for cancer. A stapled side-to-side anastomosis is likely also preferable after an ileocolic resection for Crohn’s disease. Colorectal anastomoses can be sutured or stapled with similar results, although the incidence of strictures is higher following stapled anas-tomoses. Following reversal of loop ileostomy there is some evidence to suggest that a stapled side-to-side anastomosis or sutured enterotomy closure (rather than spout resection and sutured anastomosis) results in fewer complications. Non-randomised data has indi-cated that small bowel anastomoses are best sutured in the trauma patient. This article reviews the theory,practice and evidence base behind the various gastro-intestinal anastomoses to help the practising general surgeon make evidence based operative decisions.
基金a grant from the ScientificCommittee of Hebei Province(No.982 76 110 1)
文摘Exogenous gene suture was used to achieve peripheral nerve anastomoses to probe into the feasibility that the sites of anastomoses of nerves directly transfer gene and thus enable gene to be expressed at the sites of anastomoses under the condition that perfect nerve anastomoses are ensured. PCMVβ plasmid containing cytomegalovirus promoter (CMV promoter) and Escherichia coli (E.coli) β Galactosidase (β Gal) structural gene (lacZ gene) was conducted. A soaked medical 8 0nylon suture was used to perform epineurial repair of rabbit sciatic nerve. In the control group a suture soaked in sucrose PBS was used, while in the experimental group a suture soaked in PCMVβ plasmid solution was applied. The sites of anastomoses of nerves by stages were taken out, and β Gal histochemical staining was performed and β Gal enzyme activity was assayed with 5 bromo 4 chloro 3 indolyl β D galactoside. Results showed that the sites of anastomoses of nerves were taken out 2 days, 7 days, 14 days and 30 days respectively after the operation. The β Gal histochemical stains at the sites of anastomoses showed no indigo positive cells at different stages in the control group, whereas displayed indigo positive cells in the experimental group. In the control group, no β Gal enzyme activity was detected at different stages after operation, but in the experimental group, β Gal enzyme activity could be detected from the 3rd day to the 30th day after operation. It was concluded that by using exogenous gene suture, exogenous gene could be transferred to the sites of peripheral nerve and expressed the exogenous gene expression products with bioactivity, which provided the feasibility of using gene therapy to accelerate the recovery of nerve function.
文摘We comment on a study titled“Feasibility and safety of"bridging"pancreaticogastrostomy for pancreatic trauma in Landrace pigs”in which ten pigs were randomized to either experimental“bridging”pancreaticogastrostomy(PG)or a control group with a routine mucosa-to-mucosa PG.At six months anastomoses had strictured and closed in both groups.The authors concluded that“bridging”PG is feasible and safe in damage control surgery during the early stage of pancreatic injury.In this letter we comment on the study design,specifically leaving a 2 cm gap between the pancreatic stump and the stomach and highlight the complexity of performing pancreatic anastomoses following trauma pancreaticoduodenectomy as to our experience in a high volume trauma centre.Our data emphasize that pancreatic anastomoses in trauma are complex procedures with significant postoperative morbidity and are best managed collaboratively by trauma and hepatopancreaticobiliary surgical teams with the required technical skills.
文摘The CycloneTM System (Castlewood Surgical, Inc., Concord, MA) is a novel device that facilitates the attachment of the saphenous vein onto the ascending aorta for the purpose of creating a bypass graft during a coronary artery bypass grafting (CABG) operation. It allows the surgeon to perform a hand-sewn anastomosis with no disruption of the intima of the aorta, and no need for partial clamping. During a 36-month period 109 CABG operations were performed, and the CycloneTM System (and its predecessor, the HexalonTM) was utilized to create 138 proximal anastomoses. This study demonstrates that this is a safe and effective method of creating a clampless, no-touch proximal anastomoses during off-pump CABG.
基金the People’s Livelihood Science and Technology Innovation Project of the Bureau of Science and Technology of Jiaxing City,No.2019AD32201。
文摘BACKGROUND Anastomosing hemangioma(AH)is a rare subtype of benign hemangioma that is most commonly found in the genitourinary tract.Due to the lack of specific clinical and radiologic manifestations,it is easily misdiagnosed preoperatively.Here,we report a case of AH arising from the left renal vein that was discovered incidentally and confirmed pathologically,and then describe its imaging characteristics from a radiologic point of view and review its clinicopathologic features and treatment.CASE SUMMARY A 74-year-old woman was admitted to our department for a left retroperitoneal neoplasm measuring 2.6 cm×2.0 cm.Her laboratory data showed no significant abnormalities.A non-contrast-enhanced computed tomography(CT)scan showed a heterogeneous density in the neoplasm.Non-contrast-enhanced magnetic resonance imaging(MRI)revealed a heterogeneous hypointensity on T1-weighed images and a heterogeneous hyperintensity on T2-weighed images.On contrastenhanced CT and MRI scans,the neoplasm presented marked septal enhancement in the arterial phase and persistent enhancement in the portal phase,and its boundary with the left renal vein was ill-defined.Based on these clinical and radiological manifestations,the neoplasm was initially considered to be a neurogenic neoplasm in the left retroperitoneum.Finally,the neoplasm was completely resected and pathologically diagnosed as AH.CONCLUSION AH is an uncommon benign hemangioma.Preoperative misdiagnoses are common not only because of a lack of specific clinical and radiologic manifestations but also because clinicians lack vigilance and diagnostic experience in identifying AH.AH is not exclusive to the urogenital parenchyma.We report the first case of this neoplasm in the left renal vein.Recognition of this entity in the left renal vein can be helpful in its diagnosis and distinction from other neoplasms.
文摘Although anastomosing fluvial rivers are given much attention recently by some research workers because the result channel sandstone of which is one typical primary reservoirs of petroleum and natural gas, of which the flood plains and the interchannel wetlands are pay zones where coals had formed, the comprehension of anastomosing river is some extent limited at present. Some researchers regard that the anastomosing river river and the anabranched river are the same kind of rivers. In this paper, the sedimentary, geomorphic and hydraulic characteristics and the main controlling factors of anastomosing fluvial system are summarized systematically. Some of the characteristics are compared with others fluvial rivers. Humid climate is suitable to form anastomosing channel systems, in arid semiarid regions anastomosing river maybe develop if many befitting factors combine together. The authors of the paper think that anastomosing river is one typical channel pattern and is dissimilar to anabranched channel pattern.
文摘The Laramie River after flowing in a north direction through southeast Wyoming’s Laramie Basin abruptly turns in an east direction to flow across the north-to-south oriented Laramie Range in a bedrock-walled canyon and eventually reaches the lower elevation Great Plains and southeast-oriented North Platte River. The North Laramie River, Bluegrass Creek, and North Sybille/Sybille Creek also flow from the Laramie Basin in separate bedrock-walled valleys into the Laramie Range before eventually joining the Laramie River. Bedrock-walled through valleys link the various Laramie Range stream and river crossing valleys and detailed topographic maps were used to determine how this anastomosing bedrock-walled canyon complex and the large escarpment-surrounded Goshen Hole basin (located just to the east of the anastomosing canyon complex) originated. Map evidence shows multiple streams of water must have diverged in the Laramie Basin from the north-oriented Laramie River to enter the Laramie Range before converging in or east of the Laramie Range and also shows how present day through valleys enabled diverging and converging streams of water to cross the Laramie Range. The anastomosing bedrock-walled valley complex studied here extends from north of the North Laramie River valley to south of the North Sybille/Sybille Creek valley. Large volumes of water flowing from the Laramie Basin to the Great Plains are interpreted to have eroded the anastomosing canyon complex and the “downstream” Goshen Hole escarpment-surrounded basin. Headward erosion of the north-oriented Sybille and Chugwater Creek valleys across large sheets of east-oriented water are interpreted to have left the Goshen Hole escarpment-surrounded basin as a large abandoned headcut. A water source was not determined, although a continental ice sheet that deeply eroded and warped the North American continent is considered to be a possible source.
文摘Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical,morphological,and immunohistochemical features.This article summarizes the clinical and pathological features of primary renal angiosarcoma and anastomosing haemangioma of the kidney including epidemiology,genetics,and prognosis.Renal anastomosing haemangiomas are benign neoplasms characterized by anastomosing capillary-sized vascular channels.These tumours are rare,with about 75 cases reported in the literature.Most anastomosing haemangiomas are found incidentally on ultrasound,computed tomography,or magnetic resonance imaging.Common symptoms include abdominal pain,haematuria,and abdominal mass.Renal anastomosing haemangiomas are characterized by recurrent mutations in GNAQ and GNA14 genes.The prognosis of anastomosing haemangioma is excellent.Primary renal angiosarcomas are malignant tumours showing endothelial differentiation.To date,76 cases have been described in the literature.Primary renal angiosarcomas are frequently symptomatic.The clinical features of renal angiosarcomas are similar to those of renal anastomosing haemangiomas,including abdominal pain,haematuria,and abdominal mass.Angiogenesis-related genes and vascular-specific receptor tyrosine kinases such as KDR,TIE1,SNRK,TEK,and FLT1 are upregulated in angiosarcomas.Primary renal angiosarcomas are highly aggressive neoplasms with a poor prognosis despite surgical treatment,chemotherapy,radiotherapy,or targeted therapy.
文摘Detailed topographic maps of drainage divides surrounding the Jefferson County, Montana, Boulder River drainage basin were analyzed to determine the nature of drainage systems that preceded today’s Boulder River drainage system and how the Boulder River drainage system evolved from those earlier drainage systems. The Boulder River studied here drains in a north, east, and south direction to the Jefferson River, which at Three Forks, Montana joins the north-oriented Madison and Gallatin Rivers to form the north-oriented Missouri River. The North American east-west Continental Divide surrounds the Boulder River drainage basin western half and mountainous drainage divides with the Jefferson and Missouri Rivers surround the drainage basin’s eastern half. More than 25 deep mountain passes are notched into these drainage divides and provide evidence of the regional drainage system that preceded the present day Boulder River drainage system. Analysis of pass elevations and of orientations of valleys leading in opposite directions from those mountain passes shows that prior to Boulder River drainage system development immense volumes of south-oriented water moving in anastomosing complexes of diverging and converging channels flowed across the Boulder River drainage basin area and that the Boulder River drainage system evolved as deeper channels progressively captured flow from shallower channels. While not documented in detail crustal warping probably raised Boulder River drainage basin areas relative to adjacent valleys and basins as capture events took place. A water source was not determined, but may have been from a large North American continental ice sheet, although Boulder River drainage basin evolution probably occurred while mid Tertiary sediments were filling adjacent valleys and basins.
文摘Drainage divides along a southern Laramie Range crest area and in the nearby southeast Wyoming Gangplank area (as observed on detailed topographic maps) suggest present-day drainage routes in the Cheyenne Tablelands region originated as headward erosion of south-oriented valleys (now the downstream Lodgepole, Crow, and Lone Tree Creek valleys) from an actively eroding northeast-oriented South Platte River valley captured flood flow in the south half of a large east-oriented anastomosing channel complex while headward erosion of a north-oriented valley (now the downstream Horse Creek valley) from the southeast-oriented North Platte River valley captured the north half of the same large anastomosing channel complex. The Gangplank, which today serves as a low gradient ramp of Tertiary Ogallala Formation sediments leading from the Great Plains to the Laramie Range erosion surface, is located along the Crow Creek-Lone Tree Creek drainage divide and low points along that divide (referred to here as divide crossings) suggest, prior to headward erosion of what is now its south-oriented downstream Lone Tree Creek valley, upstream east-oriented Lone Tree Creek drainage routes were intertwined with east-oriented Crow Creek drainage routes, which today flow much further in an east direction (than east-oriented upstream Lone Tree Creek drainage routes) before also turning in a south direction to reach the South Platte River. The ability of the commonly accepted regional geomorphology paradigm to explain this topographic map evidence is then compared with a fundamentally different and new regional geomorphology paradigm’s ability to explain the same evidence. While both paradigms offer possible explanations the new paradigm, which requires headward erosion of the valleys to have occurred as massive continental ice sheet melt water floods crossed the region, explains much more of the drainage system evidence and also permits much more detailed explanations.
文摘AIM:To report our experience with single-port laparoscopic surgery(SPLS)for sigmoid volvulus(SV).METHODS:Between October 2009 and April 2013,10patients underwent SPLS for SV.SPLS was performed transumbilically or through a predetermined stoma site.Conventional straight and rigid-type laparoscopic instruments were used.After intracorporeal,segmental resection of the affected sigmoid colon,the specimen was extracted through the single-incision site.Patientdemographics and perioperative data were analyzed.RESULTS:SPLS for SV was successful in all 10 patients(4,resection and primary anastomosis;6,Hartmann’s procedure).The median operative time and postoperative hospitalization period were 168(range,85-315)min and 6.5(range,4-29)d,respectively.No intraoperative complications were noted;there were 2 postoperative complications,including 1 anastomotic leak.CONCLUSION:SPLS was a safe and feasible therapeutic approach for SV,when performed by a surgeon experienced in conventional laparoscopic surgery.
文摘We report a case of acute type B aortic dissection complicated by coarctation of aorta in 35-year-old women. Computed tomography angiography (CTA) showed a short segment aortic narrowing with diameter of 9.2 mm a small intimal tear, a true lumen, a false lumen, a markedly thick mural thrombus and pleural effusion. Open surgical procedure was performed and the aortic coarctation (CoA) and aortic dissection were resected and a 24-mm prosthetic graft was anastomosed. No pseudo aneurysms were present at the anastomosis sites on the follow up CTA.
文摘Anastomosing hemangioma is a type of tumor lesion of benign behavior scarcely documented, it has been observed in renal parenchyma, testicles, ovaries and adrenal glands, it is usually prone to perirenal and renal medullary adipose tissue. In this case report, we present an anastomosed hemangioma in the right kidney of a 33-year-old woman, with previous coexistence of breast cancer, in which an unusual behavior was detected, with characteristics of vascular lesion, in this case we report: The classic conditions, its heterogeneous nature and the vascular alterations that presents in different imaging modalities.
文摘Endoscopic ultrasound(EUS)has both diagnostic and therapeutic clinical applications.This review article focuses on recent advances in two commonly performed procedures:EUS-guided tissue acquisition and EUS-guided drainage.There is a shift from acquiring aspirates for cytology to obtaining tissue cores for histological diagnoses and molecular analyses.There is growing interest and research about artificial intelligence in EUS.Artificial intelligence may potentially be useful to guide clinical decision making if biopsy results are non-diagnostic.The range of EUS-guided drainage procedures has expanded.EUS-guided drainage of walled-off pancreatic fluid collections is an accepted first line treatment option.EUS-guided palliative drainage of malignant biliary obstruction after unsuccessful endoscopic retrograde cholangiopancreatography(ERCP)is now an accepted alternative to percutaneous transhepatic biliary drainage.EUS-guided gallbladder drainage for management of acute cholecystitis is now a preferred option over percutaneous cholecystostomy for non-surgical candidates.Other EUS-created gastrointestinal anastomoses such as EUS-guided gastroenterostomy in the context of gastric outlet obstruction,and EUS-directed transgastric ERCP for Roux-en-Y gastric bypass are now technically feasible,but further prospective randomized studies are needed to establish the actual clinical impact.
基金supported by the National Natural Science Foundation of China[grant number 81373249],[grant num-ber 81571855]Mittal Student Innovation Test Plan of Cen-tral South University[grant number MX2016447]Student Innovation Test Plan of Central South University[grant number CX2016343],[grant number YC2016714].
文摘Feto-fetal transfusion syndrome(FFTS)severely affects monochorionic(MC)multiple pregnancies and affects 1 in 1600 pregnancies overall.The number of increasing disputed obstetrics cases in China is related to unavailability of prompt diagnosis of FFTS.We present here a woman with a MC triplet pregnancy with intrauterine fetal death at 33 weeks of gestation due to FFTS.Subsequent pathological anatomy showed that the MC placenta contained vascular anastomoses,including arterio-arterial anastomosis and arterio-venous anastomosis.These anastomoses led to unidirectional blood flow with the absence of adequate compensatory counter-transfusion and bi-directional flow.When encountering such challenging conditions,medical practitioners should discreetly compare the fetuses’characteristics with features of placental blood vessels and consult morphological and pathological findings.Furthermore,they should perform ultrasound examinations,particularly focussing on fetal size differences and the maximum vertical pocket in the diagnosis of FFTS,especially in MC multiple pregnancies with abdominal symptoms.
文摘The anastomosing fluvial system was considered as the same term of the braided fluvial system. Smith and others have recognized the difference between them. They described the anastomosing fluvial system as 'a low energy complex of several interconnected channels of variable sinuosity crossing a wetland and forming many elongate vegetated islands', and established a depositional model of anastomosing fluvial system based on their
基金National Natural Science Foundation of China,No.41571005,No.41271027
文摘The anastomosing river that is present within the First Great Bend of the Yellow River is different from other sand-bedded rivers of this type because it contains gravel-bedded materials. It is therefore important to determine whether, or not, the specific characteristics of this anastomosing river are similar to those seen in sand-bedded forms, including the characteristics of erosion and deposition, and the stability of channel and interchannel wetlands. Four Landsat images from 1990, 2001, 2013, and 2016 alongside two Google Earth(GE) images from 2011 and 2013 were utilized in this study in tandem with field sampling and observations to select a 12 km main channel length section of the Qihama reach anastomosing river. This section was then used to determine variations in channel planform and sedimentary characteristics over a 26 year period. The results of this study show that this gravel-bedded anastomosing river has exhibited a high degree of stability overall, and that there has been no obvious channel and wetland bank erosion and deposition. Data also show that over the 26 years of this study, anastomosing belt area increased by 2.43%, while the ratio of land to water area remained almost equal. The number of wetlands has also increased along this river section at a rate as high as 62.16% because of the fragmentation of some small interchannel examples, while the talweg has alternately migrated to either the left or right over long periods of time at a relatively stable rate. Indeed, as a result of the migration of this line, there has been significant turnover in the number of islands within the main channel while bank shift has occurred at a rate of about 5 m/yr. The numerous anastomosing channels within this river section remained very stable over the course of this study, characterized by a mean annual migration rate of just 1 m/yr, while the sediments in bank columnar sections are mainly composed of fine sands or silts with a relatively high clay content. The sediment grain-size distribution curve for this river section contains multiple peaks, distinct from the muddy sediments within bank columnar sections from sand-bedded anastomosing rivers. The dense vegetation within riparian and interchannel wetlands alongside this river reach has also protected anastomosing channels from erosion and maintainedtheir stability, a key feature of this gravel-bedded system.
