ABSTRACT
Background: Sufficient distension of the GI lumen is needed for safe advancement of endoscopes and for careful visualization of the mucosa. Carbon dioxide [CO2] has been proposed as an alternative to room air for insufflation
Aim of the Study: To assess the merits and demerits of the use CO2 insufflation for endoscopy in terms of safety and efficacy
Methods: Electronic and manual searches were combined to search RCTs [Randomized controlled trials]. After methodological quality assessment and data extraction, the efficacy and safety of CO2 insufflation were systematically assessed
Results: Ten RCTs met the eligibility criteria and included in the present study; six of which on colonoscopy, two on endoscopic retrograde cholangiopancreatography [ERCP] and two on double-balloon enteroscopy [DBE]. Postprocedural pain was assessed. Overall, pain was lower in the CO2 insufflation group compared with the air group. Two RCTs found decreased flatus in the CO2 group compared with the air group, and 3 RCTs showed there was decreased bowel distention on abdominal radiography in the CO2 group compared with the air group. Moreover, CO2 insufflation revealed no consistent advantages in the RCTs of DBE, yet it was still indicated safe as air insufflation in stomach/ oesophagus endoscopic submucosal dissection. PCO2 level showed no significant variation during these procedures
Conclusion: CO2 insufflation is proven to be associated with decreased postprocedural pain, flatus, and bowel distention. CO2 insufflation also appears to be safe in patients without severe underlying pulmonary disease
ABSTRACT
Background: Heavy alcohol consumption is an inevitable cause of alcoholic liver disease with a high chance to progress to Alcoholic Liver Cirrhosis. Alcohol could damage the function of body organs and could cause cancer. Liver damage due to excessive alcohol consumption is usually presented as fatty liver [build-up of fats in the liver], steatohepatitis, fibrosis, alcoholic cirrhosis, and hepatocellular carcinoma. When liver fibrosis progresses, it will ultimately end up as alcoholic cirrhosis
Objective of the Study: This article was intended to explore and investigate the possible optimal diagnosis and management of Alcoholic liver cirrhosis
Methods: We searched the medical literatures to retrieve studies for the review till 30 November 2017. Electronic search in the scientific database from 1965 to 2017- [Medline, Embase. The Cochrane Library websites were searched for English Publications [both reprint requests and by searching the database]. Data extracted included authors, country, year of publication, characteristics of patients, pathophysiology, risk factors, clinical manifestations, different diagnostic approaches and treatment modalities
Conclusion: Absolute abstinence remains the foundation for any treatment of any acute or chronic Alcoholic Liver Disease. It's also important to understand that no treatment will cure cirrhosis or repair scarring in the liver that has already occurred and the only resort would be liver transplantation which is also debatable provided the complications it carries along. Nevertheless, timely diagnosis of alcoholic cirrhosis in people with alcoholic liver disease is the cornerstone for evaluation of prognosis or choosing treatment strategies such as nutritional and medical support and lifestyle change
ABSTRACT
Background: Heavy alcohol consumption is an inevitable cause of alcoholic liver disease with a high chance to progress to Alcoholic Liver Cirrhosis. Alcohol could damage the function of body organs and could cause cancer. Liver damage due to excessive alcohol consumption is usually presented as fatty liver [build-up of fats in the liver], steatohepatitis, fibrosis, alcoholic cirrhosis, and hepatocellular carcinoma. When liver fibrosis progresses, it will ultimately end up as alcoholic cirrhosis
Objective of the Study: This article was intended to explore and investigate the possible optimal diagnosis and management of Alcoholic liver cirrhosis
Methods: We searched the medical literatures to retrieve studies for the review till 30 November 2017. Electronic search in the scientific database from 1965 to 2017- [Medline, Embase. The Cochrane Library websites were searched for English Publications [both reprint requests and by searching the database] .Data extracted included authors, country, year of publication, characteristics of patients, pathophysiology, risk factors, clinical manifestations, different diagnostic approaches and treatment modalities
Conclusion: Absolute abstinence remains the foundation for any treatment of any acute or chronic Alcoholic Liver Disease. It's also important to understand that no treatment will cure cirrhosis or repair scarring in the liver that has already occurred and the only resort would be liver transplantation which is also debatable provided the complications it carries along. Nevertheless, timely diagnosis of alcoholic cirrhosis in people with alcoholic liver disease is the cornerstone for evaluation of prognosis or choosing treatment strategies such as nutritional and medical support and lifestyle change
ABSTRACT
Purpose: The Purpose of this study is to detect differences between the values of dynamic coracohumeral distance [CHD] measured using ultrasonography [USG] in different shoulder rotations and to investigate its correlation with subscapularis tear
Methods:We prospectively enrolled consecutive patients [n = 84] who were scheduled to have arthroscopic rotator cuff repair. Patients with a history of previous shoulder surgery or shoulder fracture and patients with external rotation less than 30 were excluded from the study. Dynamic coracohumeral distance was measured utilizing ultrasonography in 3 different shoulder positions: external rotation, neutral and internal rotation. We assessed the intrarater reliability with 3 times repetition of measurement. Patients were divided into one of 3 groups according to arthroscopic findings: intact subscapularis, partial-thickness tear, and full-thickness tear of the subscapularis. The control group [n = 12] included patients without rotator cuff tears from the outpatient clinic. Subgroup analysis according to the presence of dynamic subcoracoid stenosis, defined as a coracohumeral distance less than 6 mm measured in internal rotation was performed to find the clinical effect of dynamic subcoracoid stenosis
Results: A partial-thickness tear of the subscapularis tendon was present in 30 patients [35.7%] and a full-thickness tear in 13 patients [15.5%] among 84 patients. The CHD was maximum in external rotation and the narrowest in internal rotation. There were no statistical differences in the CHDs between groups with different subscapularis tear status. According to the presence of dynamic subcoracoid stenosis, patients with dynamic subcoracoid stenosis had a significantly higher incidence of partial-thickness subscapularis tear than those without stenosis [P = 0.018]
Conclusions: The coracohumeral distance values were narrowest in shoulder internal rotation, which is thought to be the pathogenic position. We could not confirm the correlation between coracohumeral distance and subscapularis tear. However, patients who have dynamic subcoracoid stenosis had significantly higher incidence of subscapularis tear than others without dynamic stenosis