The gut microbiome is a complex microbial community,recognized for its potential role in physiology,health,and disease.The available evidence supports the role of gut dysbiosis in pancreatic disorders,including acute ...The gut microbiome is a complex microbial community,recognized for its potential role in physiology,health,and disease.The available evidence supports the role of gut dysbiosis in pancreatic disorders,including acute pancreatitis(AP).In AP,the presence of gut barrier damage resulting in increased mucosal permeability may lead to translocation of intestinal bacteria,necrosis of pancreatic and peripancreatic tissue,and infection,often accompanied by multiple organ dysfunction syndrome.Preserving gut microbial homeostasis may reduce the systemic effects of AP.A growing body of evidence suggests the possible involvement of the gut microbiome in various pancreatic diseases,including AP.This review discusses the possible role of the gut microbiome in AP.It highlights AP treatment and supplementation with prebiotics,synbiotics,and probiotics to maintain gastrointestinal microbial balance and effectively reduce hospitalization,morbidity and mortality in an early phase.It also addresses novel therapeutic areas in the gut microbiome,personalized treatment,and provides a roadmap of human microbial contributions to AP that have potential clinical benefit.展开更多
AIM: To compare the surgical outcomes between laparoscopic liver resection(LLR) and open liver resection(OLR) as a curative treatment in patients with hepatocellular carcinoma(HCC). METHODS: A Pub Med database search ...AIM: To compare the surgical outcomes between laparoscopic liver resection(LLR) and open liver resection(OLR) as a curative treatment in patients with hepatocellular carcinoma(HCC). METHODS: A Pub Med database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as "laparoscopy", "hepatectomy", and "hepatocellular carcinoma". A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection. RESULTS: Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival(OS) rates, but disease-free survival(DFS) rates were higher in the laparoscopic arm. CONCLUSION: LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.展开更多
Gastrointestinal arterio-venous malformations are a known cause of gastrointestinal bleeding. We present a rare case of persistent rectal bleeding due to a rectal arterio-portal venous fistula in the setting of portal...Gastrointestinal arterio-venous malformations are a known cause of gastrointestinal bleeding. We present a rare case of persistent rectal bleeding due to a rectal arterio-portal venous fistula in the setting of portal hypertension secondary to portal vein thrombosis. The portal hypertension was initially surgically treated with splenectomy and a proximal splenorenal shunt. However, rectal bleeding persisted even after surgery, presenting us with a diagnostic dilemma. The patient was re-evaluated with a computed tomography mesenteric angiogram which revealed a rectal arterio-portal fistula. Arterio-portal fistulas are a known but rare cause of portal hypertension, and possibly the underlying cause of continued rectal bleeding in this case. This was successfully treated using angiographic localizationand super-selective embolization of the rectal arterioportal venous fistula via the right internal iliac artery. The patient subsequently went on to have a full term pregnancy. Through this case report, we hope to high-light awareness of this unusual condition, discuss the diagnostic workup and our management approach.展开更多
Living donor liver transplant(LDLT)is a major surgi-cal undertaking.Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation....Living donor liver transplant(LDLT)is a major surgi-cal undertaking.Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation.Computed tomography(CT)and magnetic resonance imaging(MRI)are currently the imaging modalities of choice in pre-operative evaluation.These cross-sec-tional imaging techniques can reveal the vascular and biliary anatomy,assess the hepatic parenchyma and perform volumetric analysis.Knowledge of the broad indications and contraindications to qualify as a recipi-ent for LDLT is essential for the radiologist reporting scans in a pre-transplant patient.Similarly,awareness of the various anatomical variations and pathological states in the donor is essential for the radiologist to generate a meaningful report of his/her observations.CT and MRI have largely replaced invasive techniques such as catheter angiography,percutaneous cholan-giography and endoscopic retrograde cholangiopan-creatography.In order to generate a meaningful report based on these pre-operative imaging scans,it is also mandatory for the radiologist to be aware of the sur-geon’s perspective.We intend to provide a brief over-view of the common surgical concepts of LDLT and give a detailed description of the minimum that a radiologist is expected to seek and report in CT and MR scans per-formed for LDLT related evaluation.展开更多
基金Lee Foundation Microbiome Education Grant,No.N:176-000-054-001.
文摘The gut microbiome is a complex microbial community,recognized for its potential role in physiology,health,and disease.The available evidence supports the role of gut dysbiosis in pancreatic disorders,including acute pancreatitis(AP).In AP,the presence of gut barrier damage resulting in increased mucosal permeability may lead to translocation of intestinal bacteria,necrosis of pancreatic and peripancreatic tissue,and infection,often accompanied by multiple organ dysfunction syndrome.Preserving gut microbial homeostasis may reduce the systemic effects of AP.A growing body of evidence suggests the possible involvement of the gut microbiome in various pancreatic diseases,including AP.This review discusses the possible role of the gut microbiome in AP.It highlights AP treatment and supplementation with prebiotics,synbiotics,and probiotics to maintain gastrointestinal microbial balance and effectively reduce hospitalization,morbidity and mortality in an early phase.It also addresses novel therapeutic areas in the gut microbiome,personalized treatment,and provides a roadmap of human microbial contributions to AP that have potential clinical benefit.
文摘AIM: To compare the surgical outcomes between laparoscopic liver resection(LLR) and open liver resection(OLR) as a curative treatment in patients with hepatocellular carcinoma(HCC). METHODS: A Pub Med database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as "laparoscopy", "hepatectomy", and "hepatocellular carcinoma". A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection. RESULTS: Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival(OS) rates, but disease-free survival(DFS) rates were higher in the laparoscopic arm. CONCLUSION: LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.
文摘Gastrointestinal arterio-venous malformations are a known cause of gastrointestinal bleeding. We present a rare case of persistent rectal bleeding due to a rectal arterio-portal venous fistula in the setting of portal hypertension secondary to portal vein thrombosis. The portal hypertension was initially surgically treated with splenectomy and a proximal splenorenal shunt. However, rectal bleeding persisted even after surgery, presenting us with a diagnostic dilemma. The patient was re-evaluated with a computed tomography mesenteric angiogram which revealed a rectal arterio-portal fistula. Arterio-portal fistulas are a known but rare cause of portal hypertension, and possibly the underlying cause of continued rectal bleeding in this case. This was successfully treated using angiographic localizationand super-selective embolization of the rectal arterioportal venous fistula via the right internal iliac artery. The patient subsequently went on to have a full term pregnancy. Through this case report, we hope to high-light awareness of this unusual condition, discuss the diagnostic workup and our management approach.
文摘Living donor liver transplant(LDLT)is a major surgi-cal undertaking.Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation.Computed tomography(CT)and magnetic resonance imaging(MRI)are currently the imaging modalities of choice in pre-operative evaluation.These cross-sec-tional imaging techniques can reveal the vascular and biliary anatomy,assess the hepatic parenchyma and perform volumetric analysis.Knowledge of the broad indications and contraindications to qualify as a recipi-ent for LDLT is essential for the radiologist reporting scans in a pre-transplant patient.Similarly,awareness of the various anatomical variations and pathological states in the donor is essential for the radiologist to generate a meaningful report of his/her observations.CT and MRI have largely replaced invasive techniques such as catheter angiography,percutaneous cholan-giography and endoscopic retrograde cholangiopan-creatography.In order to generate a meaningful report based on these pre-operative imaging scans,it is also mandatory for the radiologist to be aware of the sur-geon’s perspective.We intend to provide a brief over-view of the common surgical concepts of LDLT and give a detailed description of the minimum that a radiologist is expected to seek and report in CT and MR scans per-formed for LDLT related evaluation.
