Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children.

UNLABELLED: Upper gastrointestinal bleeding (UGIB) remains a common disease affecting 100 to 170 per 100 000 adults per year and causing thereby a significant burden to healthcare resources. Despite the improvements in the management of this disorder, the associated mortality ranges from 5 to 14%. Since the general management of UGIB is not uniform, the main objective of this work is to provide guidelines for the care of adults and children presenting with bleeding caused by gastro-duodenal ulcer or variceal rupture. METHODS: In the absence of evidence-based recommendations, these guidelines were proposed after expert opinions reconciliation and graded accordingly. They are based on the published literature up to September 2010 and graded according to the class of evidence. RESULTS: The current guidelines for the management of UGIB include recommendations for the diagnostic process, general supportive care, pharmacological therapy aiming at bleeding control, specific and endoscopic treatment of acute bleeding and follow-up for both gastro-duodenal ulcers and portal hypertension-induced bleeding.

Laparoscopic living donor hepatectomy for pediatric liver transplantation.

Living donor liver transplantation is a well established modality, especially for pediatric transplantation with excellent early graft function and long-term results. Left lateral sectionectomy through open approach is a well-standardized procedure. Considering our acquired experience in both laparoscopic liver resection and standard open surgery for live donation in pediatric and adult patients, we decided to offer, for the first time in Belgium, a laparoscopic approach for the left lateral sectionectomy to a young mother. The patient was a child 6-months old,affected by biliary atresia and rapidly deteriorating while waiting on a deceased donor liver graft. Surgical technique and key-points of this procedure in the living donor are hereby discussed.

Pelvic physiotherapy in genuine stress incontinence.

In a prospective cohort study, the effect of pelvic physiotherapy on genuine stress incontinence, factors that influence therapy outcome, and patients' attitudes toward physiotherapy were studied. The study group consisted of 52 ambulatory and mentally fit Caucasian women (mean age, 53 years), suffering from genuine stress incontinence and who had no contraindications for surgery. They had physiotherapy twice weekly for ten weeks. The aim of physiotherapy was strengthening the pelvic floor muscles under control of digital vaginal palpation. Therapy outcome was assessed by a questionnaire and by the patients' self-monitoring urinary diary recording pad changes (52) and number of leakage episodes (35) before treatment and at end of therapy. The questionnaire also served to determine how patients appreciated physiotherapy. Physiotherapy had a low cure rate (+/- 25%) but a high improvement rate causing a decreased demand for surgery. At follow-up (mean 14 months) its beneficial effect was maintained. To date, only 10 patients (19%) have undergone surgery. Severity of symptoms was the only limiting factor. We conclude that every woman with urinary stress incontinence is a potential candidate for physiotherapy but surgical treatment as an option must remain open. Overall, physiotherapy was well accepted since episodes of urinary incontinence were less frequent and therefore bearable; however, changes in patients' behavior play a role.