The 21^(st) century has started with several innovations in the medical sciences,with wide applications in health care management.This development has taken in the field of medicines(newer drugs/molecules),various too...The 21^(st) century has started with several innovations in the medical sciences,with wide applications in health care management.This development has taken in the field of medicines(newer drugs/molecules),various tools and technology which has completely changed the patient management including abdominal surgery.Surgery for abdominal diseases has moved from maximally invasive to minimally invasive(laparoscopic and robotic)surgery.Some of the newer medicines have its impact on need for surgical intervention.This article focuses on the development of these emerging molecules,tools,and technology and their impact on present surgical form and its future effects on the surgical intervention in gastroenterological diseases.展开更多
Objective:Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease.Despite its success,approximately 10%of patients may experience persistent biliary symptoms,leading to t...Objective:Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease.Despite its success,approximately 10%of patients may experience persistent biliary symptoms,leading to the post-cholecystectomy syndrome.A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome.The objective of this study was to shed light on the clinical manifestations,evaluation,therapeutic strategies,and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.Methods:This was a retrospective study,conducted over a five-year period(January 2017 to December 2022)at Apollo Hospitals in South India.All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included.The following data were collected:patient demographics,symptoms,preoperative investigations,intraoperative details and post operative outcomes.Results:In total,36 patients were included and analysed.The majority of patients were male(25,69.4%),with a mean age of 50.7±12.1 years.The most common presentation was pain in the upper abdomen or right upper quadrant region(24,66.7%).The laparoscopic approach was attempted in all patients,with a success rate of 94.4%.Two patients required conversion to open surgery.Cholecystoenteric fistula to the colon was observed in one patient.Choledocholithiasis was observed in 7 patients(19.4%),and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.Conclusion:Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection.Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy,a complex procedure associated with certain risks.This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.展开更多
Diaphragm eventration is the permanent elevation of a hemidiaphragm and can be due to congenital or acquired causes.It is a rather uncommon condition in adults and causes a spectrum of symptoms,ranging from asymptomat...Diaphragm eventration is the permanent elevation of a hemidiaphragm and can be due to congenital or acquired causes.It is a rather uncommon condition in adults and causes a spectrum of symptoms,ranging from asymptomatic incidental findings on imaging to life-threatening respiratory distress.Asymptomatic patients do not require any treatment,but plication is the conventional,well-known method for treating symptomatic patients.Management varies depending on the symptoms.In this article,we discuss two rare cases of diaphragmatic eventration that were treated with minimal access surgery.展开更多
Liver transplantation(LT)in patients with hepatocellular carcinoma(HCC)and chronic liver disease(CLD)is limited by factors such as tumor size,number,portal venous or hepatic venous invasion and extrahepatic disease.Al...Liver transplantation(LT)in patients with hepatocellular carcinoma(HCC)and chronic liver disease(CLD)is limited by factors such as tumor size,number,portal venous or hepatic venous invasion and extrahepatic disease.Although previously established criteria,such as Milan or UCSF,have been relaxed globally to accommodate more potential recipients with comparable 5-year outcomes,there is still a subset of the population that has advanced HCC with or without portal vein tumor thrombosis without detectable extrahepatic spread who do not qualify or are unable to be downstaged by conventional methods and do not qualify for liver transplantation.Immune checkpoint inhibitors(ICI)such as atezolizumab,pembrolizumab,or nivolumab have given hope to this group of patients.We completed a comprehensive literature review using PubMed,Google Scholar,reference citation analysis,and CrossRef.The search utilized keywords such as'liver transplant','HCC','hepatocellular carcinoma','immune checkpoint inhibitors','ICI','atezolizumab',and'nivolumab'.Several case reports have documented successful downstaging of HCC using the atezolizumab/bevacizumab combination prior to LT,with acceptable early outcomes comparable to other criteria.Adverse effects of ICI have also been reported during the perioperative period.In such cases,a 1.5-month interval between ICI therapy and LT has been suggested.Overall,the results of downstaging using combination immunotherapy were encouraging and promising.Early reports suggested a potential ray of hope for patients with CLD and advanced HCC,especially those with multifocal HCC or branch portal venous tumor thrombosis.However,prospective studies and further experience will reveal the optimal dosage,duration,and timing prior to LT and evaluate both short-and long-term outcomes in terms of rejection,infection,recurrence rates,and survival.展开更多
Extensive vascular network and proximity to the gastrointestinal tract make the liver susceptible to abscess formation.While pyogenic liver abscesses account for the majority of liver abscesses in the Western world,am...Extensive vascular network and proximity to the gastrointestinal tract make the liver susceptible to abscess formation.While pyogenic liver abscesses account for the majority of liver abscesses in the Western world,amebic liver abscesses are more prevalent in tropical and developing nations.Most liver abscesses heal without complications.However,various vascular complications can occur in these patients,including compression of the inferior vena cava,thrombosis of the portal vein and/or hepatic veins,hepatic artery pseudoaneurysm,direct rupture into major vessels or the pericardium,and biliovascular fistula.These compli-cations can present significant clinical challenges due to the potential for hae-morrhage,ischemia,and systemic embolism,thereby increasing the risk of morbidity and mortality.Mechanical compression,flow stasis,inflammation,endothelial injury,and direct invasion are some of the proposed mechanisms that can cause vascular complications in the setting of a liver abscess.For the diag-nosis,thorough assessment,and therapeutic planning of vascular complications,more sophisticated imaging techniques such as multidetector computed tomo-graphy angiography or magnetic resonance angiography may be necessary.Although most vascular complications resolve with abscess treatment alone,additional interventions may be required based on the nature,severity,and course of the complications.This article aims to provide a systematic update on the spectrum of vascular complications of liver abscesses,offering insights into their pathogenesis,diagnosis,and management strategies.展开更多
Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. It is predominantly idiopathic (with an unknown cause) in India and mostly due to alcohol in the West. Diabetes that occur secondary to...Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. It is predominantly idiopathic (with an unknown cause) in India and mostly due to alcohol in the West. Diabetes that occur secondary to chronic pancreatitis (T3c Diabetes) is often brittle, and is difficult to attain normoglycemia with conventional treatment requiring multiple doses of insulin. Mild and severe model of CP was induced in mice by repeated intraperitoneal injections of cerulein and L-arginine respectively with an intent to study islet dysfunction and develop therapeutic strategy in animal models of CP. Dietary intervention of epigallocatechin-3-gallate (EGCG) was tested in both the models of CP for its beneficial effects on insulin secretory functions. Pancreata collected upon euthanasia were used to study alterations in the morphology of pancreatic parenchyma and inflammation by staining with H&E and fibrotic changes by Masson’s trichrome and picrosirius staining. Insulin secretory functions of islets were evaluated to test the efficacy of the dietary intervention on β-cell functions. Intraperitoneal glucose tolerance test was performed to monitor the glucose homeostasis before and after the dietary intervention. Both the models resulted in CP with dispersed acini, inflammation and fibrosis. The loss of acini and extent of fibrosis was more in L-arginine model. 2-fold improvement in glucose-stimulated insulin secretory functions of islets was observed with 0.5% EGCG dietary intervention in cerulein model of CP and 1.6-fold in L-arginine model of CP. A further improvement in insulin secretion by 3.2-fold was observed with additional dietary supplements like N-acetyl cysteine, curcumin in combination with EGCG. Our results thus demonstrate and highlight the therapeutic potential of dietary green tea (EGCG) supplementation in reversing islet dysfunction and improving glucose homeostasis in experimental chronic pancreatitis in mice.展开更多
BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary...BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.展开更多
A 67-year old man was presented with a 6-mo history of recurrent right lower quadrant abdominal pain. On physical examination, a vague mass was palpable in the right lumbar region. His routine laboratory tests were no...A 67-year old man was presented with a 6-mo history of recurrent right lower quadrant abdominal pain. On physical examination, a vague mass was palpable in the right lumbar region. His routine laboratory tests were normal. Ultrasonography showed a hypoechoic lesion in the right lumbar region anterior to the right kidney with internal echoes and fluid components. Abdominal contrast-enhanced computed tomography （CECT） showed a well-defined hypodense cystic mass lesion lateral to the ascending colon/caecum, not communicating with the lumen of colon/caecum. After complete open excision of the cystic mass lesion, gross pathologic examination revealed a turgid cystic dilatation of appendiceal remnant filled with the mucinous material. On histopathological examination, mucinous cyst adenoma of appendix was confirmed. We report this rare unusual late complication of mucocele formation in the distal viable appendiceal remnant, which was leftover following incomplete retrograde appendectomy. This unusual complication is not described in the literature and we report it in order to highlight the fact that a high index of clinical and radiological suspicion is essential for the diagnosis of mucocele arising from a distal viable appendiceal remnant in a patient who has already undergone appendectomy presenting with recurrent abdominal pain.展开更多
Adult stem cells represent the self-renewing progenitors of numerous body tissues, and they are currently classified according to their origin and differentiation ability. In recent years, the research on stem cells h...Adult stem cells represent the self-renewing progenitors of numerous body tissues, and they are currently classified according to their origin and differentiation ability. In recent years, the research on stem cells has expanded enormously and holds therapeutic promises for many patients suffering from currently disabling diseases. This paper focuses on the possible use of stem cells in the two main clinical settings in gastro-enterology, i.e., hepatic and intestinal diseases, which have a strong impact on public health worldwide. Despite encouraging results obtained in both regenerative medicine and immunemediated conditions,further studies are needed to fully understand the biology of stem cellsand carefully assess their put ativeonco- genicproperties.Moreover,there searchonstemcellsarousesferventethical,socialandpoliticaldebate.TheItalianSocietyofGastroenterologysponsoredaworkshoponstemcellsheldinVeronaduringtheⅩⅥCongressoftheFederationofItalianSocietiesofDigestiveDiseases(March 6-9,2010).Here,we report on the issues discussed,including liver and intestinal diseases that may benefit from stemcell therapy,the biology of hepatic and intestinal tissue repair,and stem cell usage inclinical trials.展开更多
Applying indocyanine green(ICG)fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines.The research in this field is nascent and fragmented,necessitating academic ef...Applying indocyanine green(ICG)fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines.The research in this field is nascent and fragmented,necessitating academic efforts to gain a comprehensive understanding.The present review aims to integrate diverse perspectives and recent advances in its application in gastrointestinal surgery.The relevant articles were selected by using the appropriate keyword search in PubMed.The angiography and cholangiography property of ICG fluorescence is helpful in various hepatobiliary disorders.In gastroesophageal and colorectal surgery,the lymphangiography and angiography property of ICG is applied to evaluate bowel vascularity and guide lymphadenectomy.The lack of objective parameters to assess ICG fluorescence has been the primary limitation when ICG is used to evaluate bowel perfusion.The optimum dose and timing of ICG administration need to be standardized in some new application areas in gastrointestinal surgery.Binding tumor-specific ligands with fluorophores can potentially widen the fluorescence application to detect primary and metastatic gastrointestinal tumors.The narrative review outlines prior contributions,limitations,and research opportunities for future studies across gastrointestinal sub-specialty.The findings of the present review would be helpful for scholars and practitioners to explore and progress in this exciting domain of gastrointestinal surgery.展开更多
BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.Therefore,assessmen...BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.Therefore,assessment of lymphatic dysfunction in cirrhosis patients with refractory ascites(RA)can be crucial as it would call for using different strategies for fluid mobilization.AIM To assessing the magnitude,spectrum,and clinical associations of lymphatic dysfunction in liver cirrhosis patients with RA.METHODS This observational study included 155 consecutive cirrhosis patients with RA.The presence of clinical signs of lymphedema,such as peau d’orange appearance and positive Stemmer sign,intestinal lymphangiectasia(IL)on duodenal biopsy seen as dilated vessels in the lamina propria with strong D2-40 immunohistochemistry,and chylous ascites were used to diagnose the overt lymphatic dysfunctions.RESULTS A total of 69(44.5%)patients out of 155 had evidence of lymphatic dysfunction.Peripheral lymphedema,found in 52(33.5%)patients,was the most common manifestation,followed by IL in 42(27.0%)patients,and chylous ascites in 2(1.9%)patients.Compared to patients without lymphedema,those with lymphedema had higher mean age,median model for end-stage liver disease scores,mean body mass index,mean ascitic fluid triglyceride levels,and proportion of patients with hypoproteinemia(serum total protein<5 g/dL)and lymphocytopenia(<15%of total leukocyte count).Patients with IL also had a higher prevalence of lymphocytopenia and hypoproteinemia(28.6%vs.9.1%,P=0.004).Seven(13%)patients with lymphedema had lower limb cellulitis compared to none in those without it.On multivariate regression analysis,factors independently associated with lymphatic dysfunction included obesity[odds ratio(OR):4.2,95%confidence intervals(95%CI):1.1–15.2,P=0.027],lymphocytopenia[OR:6.2,95%CI:2.9–13.2,P<0.001],and hypoproteinemia[OR:3.7,95%CI:1.5–8.82,P=0.003].CONCLUSION Lymphatic dysfunction is common in cirrhosis patients with RA.Significant indicators of its presence include hypoproteinemia and lymphocytopenia,which are likely due to the loss of lymphatic fluid from the circulation.Future efforts to mobilize fluid in these patients should focus on methods to improve lymphatic drainage.展开更多
Gastric stump carcinoma,also known as remnant gastric carcinoma,is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition.Enterogastric reflux and preexisting risk factor...Gastric stump carcinoma,also known as remnant gastric carcinoma,is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition.Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma.The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases.The tumor location is predominantly at the anastomotic site towards the stomach.However,it can occur anywhere in the remnant stomach.The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer.Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome.However,recent advances in diagnostic and therapeutic strategies have improved outcomes.Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes,thereby providing novel therapeutic targets.Also,reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis,staging,and treatment of these tumors.The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.展开更多
Objective:The laparoscopic approach is becoming the standard of care for many surgical disorders.However,in the case of hydatid cysts,laparoscopic management is challenging due to the risk of spillage of hydatid fluid...Objective:The laparoscopic approach is becoming the standard of care for many surgical disorders.However,in the case of hydatid cysts,laparoscopic management is challenging due to the risk of spillage of hydatid fluid,which can cause an anaphylactic reaction and recurrence.Here,we report our initial experience with laparoscopic partial pericystectomy of hydatid cysts using long ribbon gauze to decrease intra-operative spillage.Method:This was a retrospective study(between January 2010 and December 2021)in the Department of Surgical Gastroenterology,Sanjay Gandhi Postgraduate Institute of Medical Science,a tertiary care referral center in northern India.Here,we have included 37 consecutive patients with hydatid cysts of the liver and spleen.Diagnosis was made by laboratory and imaging findings(abdominal sonography or contrast enhanced CT scans).All patients were managed with laparoscopic partial pericystectomy.Intraoperatively,a betadine-soaked long ribbon gauze,high-pressure suction canula,and an endo-bag were used in all patients.The collected data included patient demography,location,size,and number of cysts,WHO type,operative time,blood loss,postoperative complications,hospital stay and follow-up.Result:In our series,the mean age was 38.4±13.6 years,15(40.5%)were men and 22(59.5%)were women.The right lobe of the liver was the most commonly affected site(21,56.8%).The mean operative time was 80.0±32.0 min,and intraoperative blood loss was 23.6±11.5 mL.Bile leak was present in 6(16.2%)patients.There was no mortality.The hospital stay was 5(3,9)days,and no recurrence was observed at a median follow-up of 36 months.Conclusion:Laparoscopic partial pericystectomy using this technique is safe in the management of hydatid cysts.Simply,proper packing and safe removal of soaked gauzes can minimize the incidence of postoperative complications and recurrence.展开更多
Artificial intelligence(AI)has been used in various fields of day-to-day life and its role in medicine is immense.Understanding of oncology has been improved with the introduction of AI which helps in diagnosis,treatm...Artificial intelligence(AI)has been used in various fields of day-to-day life and its role in medicine is immense.Understanding of oncology has been improved with the introduction of AI which helps in diagnosis,treatment planning,management,prognosis,and follow-up.It also helps to identify high-risk groups who can be subjected to timely screening for early detection of malignant conditions.It is more important in pancreatic cancer as it is one of the major causes of cancer-related deaths worldwide and there are no specific early features(clinical and radiological)for diagnosis.With improvement in imaging modalities(computed tomography,magnetic resonance imaging,endoscopic ultrasound),most often clinicians were being challenged with lesions that were difficult to diagnose with human competence.AI has been used in various other branches of medicine to differentiate such indeterminate lesions including the thyroid gland,breast,lungs,liver,adrenal gland,kidney,etc.In the case of pancreatic cancer,the role of AI has been explored and is still ongoing.This review article will focus on how AI can be used to diagnose pancreatic cancer early or differentiate it from benign pancreatic lesions,therefore,management can be planned at an earlier stage.展开更多
Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily...Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.展开更多
Gallbladder cancer(GBC)is one of the commonest biliary malignancies seen in India,Argentina,and Japan.The disease has dismal outcome as it is detected quite late due to nonspecific symptoms and signs.Early detection i...Gallbladder cancer(GBC)is one of the commonest biliary malignancies seen in India,Argentina,and Japan.The disease has dismal outcome as it is detected quite late due to nonspecific symptoms and signs.Early detection is the only way to improve the outcome.There have been several advances in basic as well as clinical research in the hepatobiliary and pancreatic diseases in the West and other developed countries but not enough has been done in GBC.Therefore,it is imp-ortant and the responsibility of the countries with high burden of GBC to find solutions to the many unanswered questions like etiopathogenesis,early diagn-osis,treatment,and prognostication.As India being one of the largest hubs for GBC in the world,it is important to know how the country has progressed on GBC.In this review,we will discuss the outcome of the publications from India highlighting the work and the developments taken place in past several decades both in basic and clinical research.展开更多
BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality.Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce,with international inve...BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality.Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce,with international investigative algorithms,relying heavily on computed tomography(CT),having limited availability in this setting.AIM To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness(FT)necrosis and mortality.METHODS A retrospective analysis of a prospective corrosive injury registry(March 1,2017–October 31,2023)was performed to include all adult patients with acute corrosive ingestion managed at a single,academic referral centre in Cape Town,South Africa.Patient demographics,corrosive ingestion details,initial investigations,management,and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs(ROC AUC)were used to identify factors predictive of FT necrosis and 30-day mortality.RESULTS One-hundred patients were included,with a mean age of 32 years(SD:11.2 years)and a male predominance(65.0%).The majority(73.0%)were intentional suicide attempts.Endoscopy on admission was the most frequent initial investigation performed(95 patients),while only 17 were assessed with CT.Seventeen patients had full thickness necrosis at surgery,of which eleven underwent emergency resection and six were palliated.Thirty-day morbidity and mortality were 27.0%and 14.0%,respectively.Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8%and 91.0%,respectively.Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%.Multivariate analyses with ROC AUC showed admission endoscopy findings,CT findings,and blood gas findings(pH,base excess,lactate),to all have significant predictive value for full thickness necrosis,with endoscopy proving to have the best predictive value(AUC 0.850).CT and endoscopy findings were the only factors predictive of early mortality,with CT performing better than endoscopy(AUC 0.798 vs 0.759).CONCLUSION Intentional corrosive injuries result in devastating morbidity and mortality.Locally,early endoscopy remains the mainstay of severity assessment,but referral for CT imaging should be considered especially when blood gas findings are abnormal.展开更多
Circular RNAs(circRNAs),a new star of noncoding RNAs,are a group of endogenous RNAs that form a covalently closed circle and occur widely in the mammalian genome.Most circRNAs are conserved throughout species and fre-...Circular RNAs(circRNAs),a new star of noncoding RNAs,are a group of endogenous RNAs that form a covalently closed circle and occur widely in the mammalian genome.Most circRNAs are conserved throughout species and fre-quently show stage-specific expression during various stages of tissue develop-ment.CircRNAs were a mystery discovery,as they were initially believed to be a product of splicing errors;however,subsequent research has shown that ci-rcRNAs can perform various functions and help in the regulation of splicing and transcription,including playing a role as microRNA(miRNA)sponges.With the application of high throughput next-generation technologies,circRNA hotspots were discovered.There are emerging indications that explain the association of circRNAs with human diseases,like cancers,developmental disorders,and in-flammation,and circRNAs may be a new potential biomarker for the diagnosis and treatment outcome of various diseases,including cancer.After the discoveries of miRNAs and long noncoding RNAs,circRNAs are now acting as a novel re-search entity of interest in the field of RNA disease biology.In this review,we aim to focus on major updates on the biogeny and metabolism of circRNAs,along with their possible/established roles in major human diseases.展开更多
Colorectal diseases are increasing due to altered lifestyle,genetic,and environmental factors.Colonoscopy plays an important role in diagnosis.Advances in colonoscope(ultrathin scope,magnetic scope,capsule)and technol...Colorectal diseases are increasing due to altered lifestyle,genetic,and environmental factors.Colonoscopy plays an important role in diagnosis.Advances in colonoscope(ultrathin scope,magnetic scope,capsule)and technological gadgets(Balloon assisted scope,third eye retroscope,NaviAid G-EYE,dye-based chromoendoscopy,virtual chromoendoscopy,narrow band imaging,i-SCAN,etc.)have made colonoscopy more comfortable and efficient.Now in-vivo microscopy can be performed using confocal laser endomicroscopy,optical coherence tomography,spectroscopy,etc.Besides developments in diagnostic colonoscopy,therapeutic colonoscopy has improved to manage lower gastrointestinal tract bleeding,obstruction,perforations,resection polyps,and early colorectal cancers.The introduction of combined endo-laparoscopic surgery and robotic endoscopic surgery has made these interventions feasible.The role of artificial intelligence in the diagnosis and management of colorectal diseases is also increasing day by day.Hence,this article is to review cutting-edge developments in endoscopic principles for the management of colorectal diseases.展开更多
AIM:To evaluate the ability of endoscopic ultrasound(EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.METHODS:A multicenter study was conducted and included 222 patients who und...AIM:To evaluate the ability of endoscopic ultrasound(EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.METHODS:A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass(n=121) or lymph node(n=101).The classification as benign or malignant,based on the real time elastography pattern,was compared with the classif ication based on the B-mode EUS images and with the fi nal diagnosis obtained by EUS-guided fi ne needle aspiration(EUS-FNA) and/or by surgical pathology.An interobserver study was performed.RESULTS:The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%,respectively,compared to 92.3% and 68.9%,respectively,for the conventional B-mode images.The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%,respectively,compared to 78.6% and 50.0%,respectively,for the B-mode images.The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.CONCLUSION:EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity,specificity and accuracy.It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.展开更多
文摘The 21^(st) century has started with several innovations in the medical sciences,with wide applications in health care management.This development has taken in the field of medicines(newer drugs/molecules),various tools and technology which has completely changed the patient management including abdominal surgery.Surgery for abdominal diseases has moved from maximally invasive to minimally invasive(laparoscopic and robotic)surgery.Some of the newer medicines have its impact on need for surgical intervention.This article focuses on the development of these emerging molecules,tools,and technology and their impact on present surgical form and its future effects on the surgical intervention in gastroenterological diseases.
基金The study was approved by the institutional review board and the approval number is AMH-C-S-042/07-23.
文摘Objective:Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease.Despite its success,approximately 10%of patients may experience persistent biliary symptoms,leading to the post-cholecystectomy syndrome.A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome.The objective of this study was to shed light on the clinical manifestations,evaluation,therapeutic strategies,and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.Methods:This was a retrospective study,conducted over a five-year period(January 2017 to December 2022)at Apollo Hospitals in South India.All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included.The following data were collected:patient demographics,symptoms,preoperative investigations,intraoperative details and post operative outcomes.Results:In total,36 patients were included and analysed.The majority of patients were male(25,69.4%),with a mean age of 50.7±12.1 years.The most common presentation was pain in the upper abdomen or right upper quadrant region(24,66.7%).The laparoscopic approach was attempted in all patients,with a success rate of 94.4%.Two patients required conversion to open surgery.Cholecystoenteric fistula to the colon was observed in one patient.Choledocholithiasis was observed in 7 patients(19.4%),and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.Conclusion:Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection.Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy,a complex procedure associated with certain risks.This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.
文摘Diaphragm eventration is the permanent elevation of a hemidiaphragm and can be due to congenital or acquired causes.It is a rather uncommon condition in adults and causes a spectrum of symptoms,ranging from asymptomatic incidental findings on imaging to life-threatening respiratory distress.Asymptomatic patients do not require any treatment,but plication is the conventional,well-known method for treating symptomatic patients.Management varies depending on the symptoms.In this article,we discuss two rare cases of diaphragmatic eventration that were treated with minimal access surgery.
文摘Liver transplantation(LT)in patients with hepatocellular carcinoma(HCC)and chronic liver disease(CLD)is limited by factors such as tumor size,number,portal venous or hepatic venous invasion and extrahepatic disease.Although previously established criteria,such as Milan or UCSF,have been relaxed globally to accommodate more potential recipients with comparable 5-year outcomes,there is still a subset of the population that has advanced HCC with or without portal vein tumor thrombosis without detectable extrahepatic spread who do not qualify or are unable to be downstaged by conventional methods and do not qualify for liver transplantation.Immune checkpoint inhibitors(ICI)such as atezolizumab,pembrolizumab,or nivolumab have given hope to this group of patients.We completed a comprehensive literature review using PubMed,Google Scholar,reference citation analysis,and CrossRef.The search utilized keywords such as'liver transplant','HCC','hepatocellular carcinoma','immune checkpoint inhibitors','ICI','atezolizumab',and'nivolumab'.Several case reports have documented successful downstaging of HCC using the atezolizumab/bevacizumab combination prior to LT,with acceptable early outcomes comparable to other criteria.Adverse effects of ICI have also been reported during the perioperative period.In such cases,a 1.5-month interval between ICI therapy and LT has been suggested.Overall,the results of downstaging using combination immunotherapy were encouraging and promising.Early reports suggested a potential ray of hope for patients with CLD and advanced HCC,especially those with multifocal HCC or branch portal venous tumor thrombosis.However,prospective studies and further experience will reveal the optimal dosage,duration,and timing prior to LT and evaluate both short-and long-term outcomes in terms of rejection,infection,recurrence rates,and survival.
文摘Extensive vascular network and proximity to the gastrointestinal tract make the liver susceptible to abscess formation.While pyogenic liver abscesses account for the majority of liver abscesses in the Western world,amebic liver abscesses are more prevalent in tropical and developing nations.Most liver abscesses heal without complications.However,various vascular complications can occur in these patients,including compression of the inferior vena cava,thrombosis of the portal vein and/or hepatic veins,hepatic artery pseudoaneurysm,direct rupture into major vessels or the pericardium,and biliovascular fistula.These compli-cations can present significant clinical challenges due to the potential for hae-morrhage,ischemia,and systemic embolism,thereby increasing the risk of morbidity and mortality.Mechanical compression,flow stasis,inflammation,endothelial injury,and direct invasion are some of the proposed mechanisms that can cause vascular complications in the setting of a liver abscess.For the diag-nosis,thorough assessment,and therapeutic planning of vascular complications,more sophisticated imaging techniques such as multidetector computed tomo-graphy angiography or magnetic resonance angiography may be necessary.Although most vascular complications resolve with abscess treatment alone,additional interventions may be required based on the nature,severity,and course of the complications.This article aims to provide a systematic update on the spectrum of vascular complications of liver abscesses,offering insights into their pathogenesis,diagnosis,and management strategies.
文摘Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. It is predominantly idiopathic (with an unknown cause) in India and mostly due to alcohol in the West. Diabetes that occur secondary to chronic pancreatitis (T3c Diabetes) is often brittle, and is difficult to attain normoglycemia with conventional treatment requiring multiple doses of insulin. Mild and severe model of CP was induced in mice by repeated intraperitoneal injections of cerulein and L-arginine respectively with an intent to study islet dysfunction and develop therapeutic strategy in animal models of CP. Dietary intervention of epigallocatechin-3-gallate (EGCG) was tested in both the models of CP for its beneficial effects on insulin secretory functions. Pancreata collected upon euthanasia were used to study alterations in the morphology of pancreatic parenchyma and inflammation by staining with H&E and fibrotic changes by Masson’s trichrome and picrosirius staining. Insulin secretory functions of islets were evaluated to test the efficacy of the dietary intervention on β-cell functions. Intraperitoneal glucose tolerance test was performed to monitor the glucose homeostasis before and after the dietary intervention. Both the models resulted in CP with dispersed acini, inflammation and fibrosis. The loss of acini and extent of fibrosis was more in L-arginine model. 2-fold improvement in glucose-stimulated insulin secretory functions of islets was observed with 0.5% EGCG dietary intervention in cerulein model of CP and 1.6-fold in L-arginine model of CP. A further improvement in insulin secretion by 3.2-fold was observed with additional dietary supplements like N-acetyl cysteine, curcumin in combination with EGCG. Our results thus demonstrate and highlight the therapeutic potential of dietary green tea (EGCG) supplementation in reversing islet dysfunction and improving glucose homeostasis in experimental chronic pancreatitis in mice.
文摘BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.
文摘A 67-year old man was presented with a 6-mo history of recurrent right lower quadrant abdominal pain. On physical examination, a vague mass was palpable in the right lumbar region. His routine laboratory tests were normal. Ultrasonography showed a hypoechoic lesion in the right lumbar region anterior to the right kidney with internal echoes and fluid components. Abdominal contrast-enhanced computed tomography （CECT） showed a well-defined hypodense cystic mass lesion lateral to the ascending colon/caecum, not communicating with the lumen of colon/caecum. After complete open excision of the cystic mass lesion, gross pathologic examination revealed a turgid cystic dilatation of appendiceal remnant filled with the mucinous material. On histopathological examination, mucinous cyst adenoma of appendix was confirmed. We report this rare unusual late complication of mucocele formation in the distal viable appendiceal remnant, which was leftover following incomplete retrograde appendectomy. This unusual complication is not described in the literature and we report it in order to highlight the fact that a high index of clinical and radiological suspicion is essential for the diagnosis of mucocele arising from a distal viable appendiceal remnant in a patient who has already undergone appendectomy presenting with recurrent abdominal pain.
文摘Adult stem cells represent the self-renewing progenitors of numerous body tissues, and they are currently classified according to their origin and differentiation ability. In recent years, the research on stem cells has expanded enormously and holds therapeutic promises for many patients suffering from currently disabling diseases. This paper focuses on the possible use of stem cells in the two main clinical settings in gastro-enterology, i.e., hepatic and intestinal diseases, which have a strong impact on public health worldwide. Despite encouraging results obtained in both regenerative medicine and immunemediated conditions,further studies are needed to fully understand the biology of stem cellsand carefully assess their put ativeonco- genicproperties.Moreover,there searchonstemcellsarousesferventethical,socialandpoliticaldebate.TheItalianSocietyofGastroenterologysponsoredaworkshoponstemcellsheldinVeronaduringtheⅩⅥCongressoftheFederationofItalianSocietiesofDigestiveDiseases(March 6-9,2010).Here,we report on the issues discussed,including liver and intestinal diseases that may benefit from stemcell therapy,the biology of hepatic and intestinal tissue repair,and stem cell usage inclinical trials.
文摘Applying indocyanine green(ICG)fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines.The research in this field is nascent and fragmented,necessitating academic efforts to gain a comprehensive understanding.The present review aims to integrate diverse perspectives and recent advances in its application in gastrointestinal surgery.The relevant articles were selected by using the appropriate keyword search in PubMed.The angiography and cholangiography property of ICG fluorescence is helpful in various hepatobiliary disorders.In gastroesophageal and colorectal surgery,the lymphangiography and angiography property of ICG is applied to evaluate bowel vascularity and guide lymphadenectomy.The lack of objective parameters to assess ICG fluorescence has been the primary limitation when ICG is used to evaluate bowel perfusion.The optimum dose and timing of ICG administration need to be standardized in some new application areas in gastrointestinal surgery.Binding tumor-specific ligands with fluorophores can potentially widen the fluorescence application to detect primary and metastatic gastrointestinal tumors.The narrative review outlines prior contributions,limitations,and research opportunities for future studies across gastrointestinal sub-specialty.The findings of the present review would be helpful for scholars and practitioners to explore and progress in this exciting domain of gastrointestinal surgery.
文摘BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.Therefore,assessment of lymphatic dysfunction in cirrhosis patients with refractory ascites(RA)can be crucial as it would call for using different strategies for fluid mobilization.AIM To assessing the magnitude,spectrum,and clinical associations of lymphatic dysfunction in liver cirrhosis patients with RA.METHODS This observational study included 155 consecutive cirrhosis patients with RA.The presence of clinical signs of lymphedema,such as peau d’orange appearance and positive Stemmer sign,intestinal lymphangiectasia(IL)on duodenal biopsy seen as dilated vessels in the lamina propria with strong D2-40 immunohistochemistry,and chylous ascites were used to diagnose the overt lymphatic dysfunctions.RESULTS A total of 69(44.5%)patients out of 155 had evidence of lymphatic dysfunction.Peripheral lymphedema,found in 52(33.5%)patients,was the most common manifestation,followed by IL in 42(27.0%)patients,and chylous ascites in 2(1.9%)patients.Compared to patients without lymphedema,those with lymphedema had higher mean age,median model for end-stage liver disease scores,mean body mass index,mean ascitic fluid triglyceride levels,and proportion of patients with hypoproteinemia(serum total protein<5 g/dL)and lymphocytopenia(<15%of total leukocyte count).Patients with IL also had a higher prevalence of lymphocytopenia and hypoproteinemia(28.6%vs.9.1%,P=0.004).Seven(13%)patients with lymphedema had lower limb cellulitis compared to none in those without it.On multivariate regression analysis,factors independently associated with lymphatic dysfunction included obesity[odds ratio(OR):4.2,95%confidence intervals(95%CI):1.1–15.2,P=0.027],lymphocytopenia[OR:6.2,95%CI:2.9–13.2,P<0.001],and hypoproteinemia[OR:3.7,95%CI:1.5–8.82,P=0.003].CONCLUSION Lymphatic dysfunction is common in cirrhosis patients with RA.Significant indicators of its presence include hypoproteinemia and lymphocytopenia,which are likely due to the loss of lymphatic fluid from the circulation.Future efforts to mobilize fluid in these patients should focus on methods to improve lymphatic drainage.
文摘Gastric stump carcinoma,also known as remnant gastric carcinoma,is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition.Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma.The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases.The tumor location is predominantly at the anastomotic site towards the stomach.However,it can occur anywhere in the remnant stomach.The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer.Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome.However,recent advances in diagnostic and therapeutic strategies have improved outcomes.Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes,thereby providing novel therapeutic targets.Also,reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis,staging,and treatment of these tumors.The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.
文摘Objective:The laparoscopic approach is becoming the standard of care for many surgical disorders.However,in the case of hydatid cysts,laparoscopic management is challenging due to the risk of spillage of hydatid fluid,which can cause an anaphylactic reaction and recurrence.Here,we report our initial experience with laparoscopic partial pericystectomy of hydatid cysts using long ribbon gauze to decrease intra-operative spillage.Method:This was a retrospective study(between January 2010 and December 2021)in the Department of Surgical Gastroenterology,Sanjay Gandhi Postgraduate Institute of Medical Science,a tertiary care referral center in northern India.Here,we have included 37 consecutive patients with hydatid cysts of the liver and spleen.Diagnosis was made by laboratory and imaging findings(abdominal sonography or contrast enhanced CT scans).All patients were managed with laparoscopic partial pericystectomy.Intraoperatively,a betadine-soaked long ribbon gauze,high-pressure suction canula,and an endo-bag were used in all patients.The collected data included patient demography,location,size,and number of cysts,WHO type,operative time,blood loss,postoperative complications,hospital stay and follow-up.Result:In our series,the mean age was 38.4±13.6 years,15(40.5%)were men and 22(59.5%)were women.The right lobe of the liver was the most commonly affected site(21,56.8%).The mean operative time was 80.0±32.0 min,and intraoperative blood loss was 23.6±11.5 mL.Bile leak was present in 6(16.2%)patients.There was no mortality.The hospital stay was 5(3,9)days,and no recurrence was observed at a median follow-up of 36 months.Conclusion:Laparoscopic partial pericystectomy using this technique is safe in the management of hydatid cysts.Simply,proper packing and safe removal of soaked gauzes can minimize the incidence of postoperative complications and recurrence.
文摘Artificial intelligence(AI)has been used in various fields of day-to-day life and its role in medicine is immense.Understanding of oncology has been improved with the introduction of AI which helps in diagnosis,treatment planning,management,prognosis,and follow-up.It also helps to identify high-risk groups who can be subjected to timely screening for early detection of malignant conditions.It is more important in pancreatic cancer as it is one of the major causes of cancer-related deaths worldwide and there are no specific early features(clinical and radiological)for diagnosis.With improvement in imaging modalities(computed tomography,magnetic resonance imaging,endoscopic ultrasound),most often clinicians were being challenged with lesions that were difficult to diagnose with human competence.AI has been used in various other branches of medicine to differentiate such indeterminate lesions including the thyroid gland,breast,lungs,liver,adrenal gland,kidney,etc.In the case of pancreatic cancer,the role of AI has been explored and is still ongoing.This review article will focus on how AI can be used to diagnose pancreatic cancer early or differentiate it from benign pancreatic lesions,therefore,management can be planned at an earlier stage.
文摘Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.
文摘Gallbladder cancer(GBC)is one of the commonest biliary malignancies seen in India,Argentina,and Japan.The disease has dismal outcome as it is detected quite late due to nonspecific symptoms and signs.Early detection is the only way to improve the outcome.There have been several advances in basic as well as clinical research in the hepatobiliary and pancreatic diseases in the West and other developed countries but not enough has been done in GBC.Therefore,it is imp-ortant and the responsibility of the countries with high burden of GBC to find solutions to the many unanswered questions like etiopathogenesis,early diagn-osis,treatment,and prognostication.As India being one of the largest hubs for GBC in the world,it is important to know how the country has progressed on GBC.In this review,we will discuss the outcome of the publications from India highlighting the work and the developments taken place in past several decades both in basic and clinical research.
文摘BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality.Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce,with international investigative algorithms,relying heavily on computed tomography(CT),having limited availability in this setting.AIM To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness(FT)necrosis and mortality.METHODS A retrospective analysis of a prospective corrosive injury registry(March 1,2017–October 31,2023)was performed to include all adult patients with acute corrosive ingestion managed at a single,academic referral centre in Cape Town,South Africa.Patient demographics,corrosive ingestion details,initial investigations,management,and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs(ROC AUC)were used to identify factors predictive of FT necrosis and 30-day mortality.RESULTS One-hundred patients were included,with a mean age of 32 years(SD:11.2 years)and a male predominance(65.0%).The majority(73.0%)were intentional suicide attempts.Endoscopy on admission was the most frequent initial investigation performed(95 patients),while only 17 were assessed with CT.Seventeen patients had full thickness necrosis at surgery,of which eleven underwent emergency resection and six were palliated.Thirty-day morbidity and mortality were 27.0%and 14.0%,respectively.Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8%and 91.0%,respectively.Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%.Multivariate analyses with ROC AUC showed admission endoscopy findings,CT findings,and blood gas findings(pH,base excess,lactate),to all have significant predictive value for full thickness necrosis,with endoscopy proving to have the best predictive value(AUC 0.850).CT and endoscopy findings were the only factors predictive of early mortality,with CT performing better than endoscopy(AUC 0.798 vs 0.759).CONCLUSION Intentional corrosive injuries result in devastating morbidity and mortality.Locally,early endoscopy remains the mainstay of severity assessment,but referral for CT imaging should be considered especially when blood gas findings are abnormal.
文摘Circular RNAs(circRNAs),a new star of noncoding RNAs,are a group of endogenous RNAs that form a covalently closed circle and occur widely in the mammalian genome.Most circRNAs are conserved throughout species and fre-quently show stage-specific expression during various stages of tissue develop-ment.CircRNAs were a mystery discovery,as they were initially believed to be a product of splicing errors;however,subsequent research has shown that ci-rcRNAs can perform various functions and help in the regulation of splicing and transcription,including playing a role as microRNA(miRNA)sponges.With the application of high throughput next-generation technologies,circRNA hotspots were discovered.There are emerging indications that explain the association of circRNAs with human diseases,like cancers,developmental disorders,and in-flammation,and circRNAs may be a new potential biomarker for the diagnosis and treatment outcome of various diseases,including cancer.After the discoveries of miRNAs and long noncoding RNAs,circRNAs are now acting as a novel re-search entity of interest in the field of RNA disease biology.In this review,we aim to focus on major updates on the biogeny and metabolism of circRNAs,along with their possible/established roles in major human diseases.
文摘Colorectal diseases are increasing due to altered lifestyle,genetic,and environmental factors.Colonoscopy plays an important role in diagnosis.Advances in colonoscope(ultrathin scope,magnetic scope,capsule)and technological gadgets(Balloon assisted scope,third eye retroscope,NaviAid G-EYE,dye-based chromoendoscopy,virtual chromoendoscopy,narrow band imaging,i-SCAN,etc.)have made colonoscopy more comfortable and efficient.Now in-vivo microscopy can be performed using confocal laser endomicroscopy,optical coherence tomography,spectroscopy,etc.Besides developments in diagnostic colonoscopy,therapeutic colonoscopy has improved to manage lower gastrointestinal tract bleeding,obstruction,perforations,resection polyps,and early colorectal cancers.The introduction of combined endo-laparoscopic surgery and robotic endoscopic surgery has made these interventions feasible.The role of artificial intelligence in the diagnosis and management of colorectal diseases is also increasing day by day.Hence,this article is to review cutting-edge developments in endoscopic principles for the management of colorectal diseases.
文摘AIM:To evaluate the ability of endoscopic ultrasound(EUS) elastography to distinguish benign from malignant pancreatic masses and lymph nodes.METHODS:A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass(n=121) or lymph node(n=101).The classification as benign or malignant,based on the real time elastography pattern,was compared with the classif ication based on the B-mode EUS images and with the fi nal diagnosis obtained by EUS-guided fi ne needle aspiration(EUS-FNA) and/or by surgical pathology.An interobserver study was performed.RESULTS:The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%,respectively,compared to 92.3% and 68.9%,respectively,for the conventional B-mode images.The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%,respectively,compared to 78.6% and 50.0%,respectively,for the B-mode images.The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.CONCLUSION:EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity,specificity and accuracy.It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.
