Clinical practice guidelines for the management of biliary tract cancers 2019: the 3rd English edition / 中华消化外科杂志

The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as grade 1 (strong) or grade 2 (weak) according to the concepts of the grading of recommendations assessment, development, and evaluation system. The 31 CQs covered the six topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, and (6) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.

Vasoespasmo cerebral en hemorragia subaracnoidea debida a ruptura de aneurisma / Cerebral vasospasm in subarachnoid hemorrhage due to a ruptured aneurysm

El pronóstico de la hemorragia subaracnoidea depende de una serie de factores, pero principalmente de la cantidad de sangre derramada y el eventual resangrado, que determinan el estado general del paciente y conducen al espasmo arterial. El lugar de la ruptura, la presión intracreneana, eventualmente un hematoma intracerebral, también participan en la determinación de ese pronóstico, así como la edad del paciente y otras enfermedades que coincidentemente éste pueda padecer. La cirugía precoz, clipando el aneurisma y evacuando coágulos, puede evitar en buena medida al resangrado y al espasmo. El LCR escaso o carente de una cantidad de dispositivos metabólicos que en el resto del organismo impiden la producción de radicales libres, los que a su vez producen la preoxidación de lípidos, causa muy probable del espasmo arterial. A la cirugía precoz pueden agregarse medicamentos que protejan al cerebro de la isquemia, drogas recolectoras de radicales libres y otras que disminuyan su producción, antagonistas del calcio, etc