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Correlated with such hepatic-systemic factors as cirrhosis, inflammation and immunity, portal vein thrombosis (PVT) is common in perioperative period of liver transplantation (LT) recipients.It affects negatively surgical procedures and outcomes due to its insidious onset and atypical clinical symptoms.With continuous improvements of LT techniques and refining of medical imaging, researchers have gained further insights into the pathophysiological processes, screening, diagnoses, evaluations, classifications and perioperative managements of PVT.This review focused upon perioperative managements of LT recipients with PVT to enhance the clinical problem-solving capability and long-term patient survival.
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Pancreatic ductal adenocarcinoma is a highly invasive malignant tumor of the digestive system with an extremely poor prognosis. Leukemia inhibitory factor is an important member of the interleukin-6 family and can regulate multiple physiological processes such as cell differentiation, growth, and renewing. This article reviews the mechanism of action of leukemia inhibitory factor in pancreatic ductal adenocarcinoma and the research advances in leukocyte inhibitory factor-targeted therapy based on literature evidence, and the analysis shows that leukemia inhibitory factor plays an important role in the progression, immune escape, and chemotherapy resistance of pancreatic ductal adenocarcinoma and may gradually become a potential biomarker and therapeutic target for pancreatic ductal adenocarcinoma.
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At present, there is still a lack of comprehensive diagnosis and treatment criteria for pancreatic exocrine insufficiency around the world. Pancreatic surgeons often ignore or misjudge pancreatic exocrine insufficiency secondary to pancreatic cancer, and as a result, pancreatic exocrine insufficiency is not adequately treated, which greatly affects the quality of life of patients with pancreatic cancer. This article summarizes the latest research advances in the pathogenesis, typical symptoms, and diagnostic methods of pancreatic exocrine insufficiency, as well as pancreatic enzyme replacement therapy in different stages of pancreatic cancer. It is pointed out that pancreatic enzyme replacement therapy can significantly improve the quality of life of patients with different stages of pancreatic cancer.
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Objective To evaluate appropriate timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatie gallbladder drainage (PTGD) for the treatment of acute cholecystitis (AC).Methods To compare the clinical data of 74 patients with acute cholecystitis who underwent laparoscopic cholecystectomy at different time after PTGD,Including the degree of gallbladder inflammation,operation time,intraoperative blood loss,the rate of conversion to laparotomy,length of stay and total cost.74 cases were divided into 3 groups,group 1 (n =31),operated within 4 w,group 2 (n =22),between 4 and 8 w,group 3 (n =21),after 8 w.Results Group 2 was better than group 1 and group 3 in operation time,blood loss,length of stay and total cost,the difference was statistically significant (P ＜ 0.05).Conclusion Laparoscopic cholecystectomy performed after 4-8 weeks PTGD is the best time in terms of less risk of operation,shorter hospital stay,lower cost,and better quality of life.
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With the continuous improvement of various imaging techniques, the morbidity of polypoid lesions in gallbladder is increasing year by year. However, owing to the lack of effective means of diagnosis before undergoing the surgery, there is a large number of patients who do not have definite indications of surgery for prophylactic cholecystectomy. Therefore, this text will carry out a comprehensive narration of the imaging features, epidemiological characteristics and pathological types about the polypoid lesions in gallbladder, summarizing the experience of diagnosis and treatment of the disease, helping the option in clinical treatments.
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ObjectiveTo retrospectively analyze the distribution of artery involvement above the aortic arch and differences incidence of cerebral ischemic in patients with Takayasu’s arteritis (TA) by color Doppler flow imaging (CDFI).MethodsA total of 84 cases (aged from 11 to 70 years old, median age 39 years old) continuous observed from August 2005 to June 2013 were included in this study. All patients were detected by CDFI and confirmed by digital subtraction angiography (DSA) and clinical examination. The distribution of the involved arteries were analyzed.ResultsA total of 924 vessels (84 patients) was detected, 352 (38.1%) arteries involved inflammatory lesions. The prevalence rate of female was higher than male (92.9% and 7.1%) significantly. The symptoms of cerebral ischemic included dizziness, syncope, TIA, amaurosis etc. The involvement rate of common carotid artery (CCA) was the highest (94.0%), followed by the subclavian arterythe (SA) (82.1%). The detecting rate of bilateral CCA was higher than that of bilateral SA, 75% and 50% (χ2=15.732,P=0.003), respectively. The rate of combined lesions of CCA and SA were higher in left (64.3%) than the right 56% (χ2=12.777,P=0.001). Most patients had multiple vascular (≥ 3 vessels) diseases (69.1%). No significant difference was found in the incidence of cerebral ischemia symptoms in patients with bilateral CCA or SA lesions (74.6% with78.6%) (χ2=0.219,P=0.411). No significant difference was found inthe patients with left or right CCA combined with SA lesions (76.5% with 76.4% ,χ2=1.230, P=0.602) also. The incidence of cerebral ischemia for greater than 3 vessel disease was significantly higher than less vessels (69.1% with 30.9%) (χ2=6.674,P=0.010).ConclusionThe study in the distribution of aortic arch vascular lesion for the patients with Takayasu arteritis by CDFI is valuable for the early detection and treatment of vascular lesions, and decresing the incidence of ischemic cerebrovascular disease.
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Objective To summarize the clinical experiences of liver transplantation.Methods Of the nine patients, four operation was standard orthotopic liver transplantation,the latter five were the piggyback liver transplantation.The immunosuppressive protocols included methylprednisolone FK506 and mycophenolatemofeti. Meanwhile intravenous antihepatitis B immunoglobulin and Lamivudine were used to prevent hepatitis B recurrence.Results All patients were cured.Conclusion Liver transplantation can be employed for liver disease both cirrhosis and carcinoma as a conventional surgery.It is an effective way for the treatment of no metastatic liver carcinoma.The immunosuppressive protocols included methylprednisolone FK506 and mycophenolatemofeti,it can prevent immune rejection.
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Objective To investigate the effectiveness of choledochoscopy and duodenoscopy in the treatment of residual calculus of the intrahepatic bile duct. Methods Clinical data of 573 cases of choledochoscopy and 36 cases of duodenoscopy from February 1985 to June 2004 were analyzed. Results Stones were completely removed under choledochoscope by way of T-tube sinus tract in 96.02% of patients (507/528) and by way of subcutaneous blind loop in 84.62% of patients (22/26). Percutaneous transhepatic choledochoscope placement was successfully conducted in 84.21% of patients (16/19) and stones were completely removed in 78.95% of the patients (15/19). The success rate of duodenoscopic cholangiography was 91.67% (33/36) and stones were completely removed under duodenoscope in 80.56% of patients (29/36). Conclusions Treatment of residual and recurrent calculus of the intrahepatic bile duct by choledochoscopy and duodenoscopy is effective and convenient.