Application value of superior mesenteric vascular right approach in duodenum-preserving pancreatic head resection for chronic pancreatitis with pancreatic head stones / 中华消化外科杂志

Objective To investigate the application value of superior mesenteric vascular right approach in duodenum-preserving pancreatic head resection for chronic pancreatitis with pancreatic head stones.Methods The retrospective descriptive study was conducted.The clinical data of 3 chronic pancreatitis patients with pancreatic head stones who were admitted to the Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2015 to May 2017 were analyzed.All the 3 patients underwent Beger procedure via superior mesenteric vascular fight approach,dissecting the posterior tunnel of pancreatic neck and gradually cutting off the pancreatic neck close to the right side of superior mesenteric vein.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) postoperative pathological examination situations;(4) follow-up situations.Follow-up was performed by outpatient examination up to December 2017,including abdominal pain,diarrhea,chills,fever,jaundice,blood glucose,liver function and tumor marker examination,and residual or recurrent stones by ultrasound,CT or MRI examination.Measurement data were represented as average (range).Results (1) Surgical situations:all the 3 patients underwent successful Beger procedure via superior mesenteric vascular right approach,including 1 combined with choledochal cyst resection,without perioperative death.The operation time,time of cutting off pancreatic neck and volume of intraoperative blood loss of 3 patients were 400 minutes (range,360-480 minutes),20 minutes (range,15-25 minutes) and 117 mL (range,50-200 mL)respectively.(2) Postoperative situations:time of initial out-of-bed activity,time to anal exsufflation and time for drinking intake were 4 days (range,3-5 days),3 days (range,2-3 days) and 3 days (range,2-4 days).One patient complicated with pancreatic fistula and gastroplegia was improved by abdominal drainage and symptomatic treatment and discharged with drainage-tube at 30 days postoperatively and removed drainage-tube at 47 days postoperatively.One patient with pancreatic fistula was improved by abdominal drainage and symptomatic treatment and discharged with drainage-tube at 28 days postoperatively and removed drainage-tube at 48 days postoperatively.One patient recovered steadily without complications and discharged at 13 days postoperatively after removal of drainage-tube.(3) Postoperative pathological examination showed that 3 patients were diagnosed as chronic pancreatitis complicated with stones of pancreatic head,including 1 along with choledochal cyst and mild atypical hyperplasia.(4) Follow-up situations:3 patients were followed up for 17-27 months with good general conditions and without abdominal pain,diarrhea,chills,fever or jaundice.Blood glucose was controlled well,and liver function and tumor marker were normal.There was no sign of residual and recurrent stones.Conclusion Beger procedure via superior mesenteric vascular right approach for chronic pancreatitis complicated with pancreatic head stones is safe and effective.

Diagnoses and Approaches of Soft Tissue Tumors for Orthopaedic Non-Oncologists / 대한정형외과학회잡지

Soft tissue tumors are classified into benign and malignant on the basis of the patient's age, medical history, physical examination, pathological and radiologic examination. We have to caution against misdiagnosis of malignant tumor which can delay the treatment time. Lipoma, schwannoma, hemangioma, and ganglion cysts are common benign tumors, usually of small size and are often located in the superficial layer. Although it may be suspected as a benign tumor, performing contrast-enhanced magnetic resonance maging is preferably advantageous. Liposarcoma and undifferentiated pleomorphic sarcoma, the most common malignant soft tissue tumors, usually occur after middle age; rhabdomyosarcoma is usually presented in children and synovial sarcoma often occurs at a younger age. The magnetic resonance (MR) signal intensity of lipoma shows uniformity with subcutaneous fat, sarcoma should be suspected if it has a contrast-enhanced and non-fat-suppressed part. The MR signals of ganglion cysts show homogeneous and same signal intensity with joint fluid and urine, while the liquid containing sarcoma, like synovial sarcoma, is characterized by heterogeneous signal intensity and contrast enhancement. If surgery is performed, an incision should be made in the longitudinal direction of the limb and the excised tumor should be sent for pathology analysis. When the macroscopic finding of the tumor during surgery is different from the expected diagnosis, the operation should cease with biopsy only or the small superficial tumor can be excised widely if possible. The transfer should be considered unless you can be sure of a benign tumor in hands and feet of children. When diagnosed as malignant tumors, patients should be provided with sufficient information that can lead them to a musculoskeletal tumor specialist.

Inclusión social de los vendedores que ejercen actividades laborales del sector informal en el centro histórico de barranquilla / Social inclusion of street vendors engaged in labor activities in barranquilla's historic center

This study provides an assessment of the politics involved in the inclusion of street vendors as having the right to be considered part of an informal labor force in the downtown area of Barranquilla. Quantitative and qualitative methods were applied to evaluate the collected data. The areas of analysis were as follows: informal stationary vendors located in the comercial sector and Barranquilla's labor policies and directives regarding such labor. In conclusion, despite the local government's approach to include informal street vendors as part of the labor force with their corresponding labor and political social rights, many of these do not take part in any of the programs earmarked as benefits of such due to lack of awareness of such programs.

El presente estudio permitió evaluar, desde el enfoque de derechos, la gestión de la política de inclusión social que se desarrolla en el contexto de los vendedores que laboran de manera informal en el Centro Histórico del distrito de Barranquilla (Colombia). Para la recolección de la información, se utilizaron técnicas cuantitativas y cualitativas. Las unidades de análisis fueron dos: los vendedores estacionarios ubicados en el sector informal y los directivos/administrativos de la Alcaldía Distrital. En conclusión, se estableció que a pesar de que la Alcaldía enmarca su plan de gobierno en el enfoque social de derechos, los vendedores no participan en todos los programas, por ello, se amerita la inclusión de este grupo mediante el diseño de una política social que en realidad los haga partícipes de estos derechos.