ABSTRACT
INTRODUCTION AND IMPORTANCE: Gallbladder volvulus is a rare surgical disease with clinical manifestations similar to acute acalculous cholecystitis. Diagnosing gallbladder volvulus is critical as delayed surgical intervention in gallbladder volvulus is associated with high morbidity and mortality. CASE PRESENTATION: A 62-year-old male patient presented to our outpatient department for right upper quadrant pain of one-month duration. Taking into consideration the patient's clinical symptoms, laboratory results, and imaging findings, we diagnosed the patient with acute acalculous cholecystitis and started intravenous antibiotics. After 3 days, the clinical progress was unfavorable, laparoscopic cholecystectomy was performed, and the final diagnosis of gallbladder was done intraoperatively. The postoperative course was uneventful, and the patient was discharged on the second day after surgery. CLINICAL DISCUSSION: The cause of gallbladder volvulus may be related to abnormal embryological development, resulting in a long mesentery gallbladder and consequently leading to a floating gallbladder. Patients with gallbladder volvulus often do not exhibit specific signs, and the symptoms typically resemble those of acute acalculous cholecystitis. Once gallbladder volvulus is diagnosed, the surgical intervention must be conducted immediately. CONCLUSION: Gallbladder volvulus is a relatively rare and challenging condition to diagnose. It should be considered in cases of acute acalculous cholecystitis, especially in elderly, thin patients who do not respond to antibiotic treatment. Cholecystectomy is the definitive treatment for gallbladder volvulus. In particular, laparoscopic surgery should be chosen initially.
ABSTRACT
BACKGROUND: Surgical drainage for chronic pancreatitis patients with a normal-sized pancreatic head remains controversial. Both Frey and extended Partington procedures could be used, but the level of evidence is weak. METHOD: The object of this prospective cohort study was to assess the mid-term results concerning pain, quality of life, and pancreatic function of surgical drainage (Frey or extended Partington procedure) in patients with painful chronic pancreatitis and a normal-sized pancreatic head. RESULTS: Fifty-nine patients (Frey procedure: 14 cases; extended Partington procedure: 45 cases) were enrolled in the study with a median length of follow-up of 16 months. The effective and complete pain relief rate was 85% and 58%, respectively. The Izbicki score decreased from 53.4 preoperatively to 8.8 postoperatively. The general 12-Item Short Form Health Survey (SF-12) score increased from 45.2 to 75.4. The pancreatic insufficiency did not change significantly postoperatively. At three months after surgery, the complete pain relief and Izbicki score were more favorable in the Frey group than in the extended Partington group. CONCLUSION: Both Frey and extended Partington procedures resulted in excellent pain relief and quality of life improvement and did not worsen pancreatic function. The Frey procedure could yield a more favorable result in the early postoperative period.
ABSTRACT
Objective: Major depressive disorder (MDD) is a major public health problem due to MDD's increasing incidence among adults worldwide. While selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, are considered to be the most effective treatment for MDD, the adverse effects of SSRIs should not be neglected. The aim of this research was to evaluate the effectiveness of acupuncture as a complement to paroxetine systematically for improving quality of life (QoL) for patients with MDD. Methods and Materials: Chinese and English electronic databases were searched, randomized controlled clinical studies were collected, data entry was managed, and a meta-analysis was performed to evaluate the QoL of the patients pre and post treatment. Results: There were 5 studies included in the review, in which the researchers compared the QoL of patients with MDD treated with: paroxetine + acupuncture (both electroacupuncture and traditional acupuncture) or paroxetine alone. In all aspects-including physical health, psychologic health, social relationships, and environment-patients treated with the combination therapy experienced a significant improvements in QoL compared the patients treated with the single therapy. Conclusions: Using acupuncture as a complementary treatment improved QoL in patients with MDD.
