Pediatric Gastroenterology
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Biological and Histological Assessment of the Hepatoportoenterostomy Role in Biliary Atresia As a Stand-Alone Procedure Or As a Bridge Toward Liver Transplantation
medicina Article Biological and Histological Assessment of the Hepatoportoenterostomy Role in Biliary Atresia as a Stand-Alone Procedure or as a Bridge toward Liver Transplantation Raluca-Cristina Apostu 1, Vlad Fagarasan 1 , Catalin C. Ciuce 1, Radu Drasovean 1 , Dan Gheban 2, Radu Razvan Scurtu 1,*, Alina Grama 3, Ana Cristina Stefanescu 3, Constantin Ciuce 1 and Tudor Lucian Pop 3 1 Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babes Street, 400000 Cluj-Napoca; First Surgical Clinic, Emergency County Hospital, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania; [email protected] or [email protected] (R.-C.A.); [email protected] (V.F.); [email protected] (C.C.C.); [email protected] (R.D.); [email protected] (C.C.) 2 Department of Pathology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babes Street, 400000 Cluj-Napoca; 4 th Pediatric Clinic, Emergency Clinical Hospital for Children, 68 Motilor Street, 400000 Cluj-Napoca, Romania; [email protected] 3 Department of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babes Street, 400000 Cluj-Napoca; 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; [email protected] (A.G.); [email protected] (A.C.S.); [email protected] (T.L.P.) * Correspondence: [email protected]; Tel.: +40-744-704-012 Abstract: Background and objectives: In patients with biliary atresia (BA), hepatoportoenterostomy (HPE) is still a valuable therapeutic tool for prolonged survival or a safer transition to liver transplantation. Citation: Apostu, R.-C.; Fagarasan, V.; The main focus today is towards efficient screening programs, a faster diagnostic, and prompt treatment. -
Iron Dysregulation in Movement Disorders
Neurobiology of Disease 46 (2012) 1–18 Contents lists available at SciVerse ScienceDirect Neurobiology of Disease journal homepage: www.elsevier.com/locate/ynbdi Review Iron dysregulation in movement disorders Petr Dusek a,c, Joseph Jankovic a,⁎, Weidong Le b a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA b Parkinson's Disease Research Laboratory, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA c Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic article info abstract Article history: Iron is an essential element necessary for energy production, DNA and neurotransmitter synthesis, myelination Received 9 November 2011 and phospholipid metabolism. Neurodegeneration with brain iron accumulation (NBIA) involves several genetic Revised 22 December 2011 disorders, two of which, aceruloplasminemia and neuroferritinopathy, are caused by mutations in genes directly Accepted 31 December 2011 involved in iron metabolic pathway, and others, such as pantothenate-kinase 2, phospholipase-A2 and fatty acid Available online 12 January 2012 2-hydroxylase associated neurodegeneration, are caused by mutations in genes coding for proteins involved in phospholipid metabolism. Phospholipids are major constituents of myelin and iron accumulation has been linked Keywords: Iron to myelin derangements. Another group of NBIAs is caused by mutations in lysosomal enzymes or transporters Neurodegeneration such as ATP13A2, mucolipin-1 and possibly also β-galactosidase and α-fucosidase. Increased cellular iron uptake Dystonia in these diseases may be caused by impaired recycling of iron which normally involves lysosomes. -
USMLE and COMLEX II
USMLE and COMLEX II CE / CK Review General Surgery Northwestern Medical Review www.northwesternmedicalreview.com Lansing, Michigan 2014-2015 1. Northwestern Medical Review Acute Abdomen 4. What is the most common confirmatory physical 1. Your patient is a 45-year-old woman who is finding for peritonitis? presented with the complaint of severe abdominal ________________________________________ pain. You made the initial diagnosis of acute abdomen based on her history and examination. To determine the exact etiology, you want to 5. In a stable patient who is suspected of having perform a laparotomy on the patient. Before acute abdomen what is the next best course of ordering the procedure you re-evaluate the findings action? more thoroughly and come to the conclusion that you should NOT perform laparotomy on the A. Administering opiate analgesics patient. Which of the following clinical suspicions B. Laparotomy and/or findings was the CONTRAINDICATION to the laparotomy procedure on this patient? C. Serial abdominal exams D. Abdominal CT scan A. Suspicion of bacterial peritonitis E. Serial abdominal exams and CT scan B. Presence of acute right lower quadrant abdominal pain 6. What would you do if the above patient were to C. History indicating that the abdominal pain is become unstable? chronic D. Presence of a palpable abdominal mass ________________________________________ E. Alvarado score of 9 ________________________________________ 7. What are the top-tested causes of acute abdomen that do not require laparotomy? 2. What is acute abdomen? -
Review Article Pruritus in Systemic Diseases: a Review of Etiological Factors and New Treatment Modalities
Hindawi Publishing Corporation e Scientific World Journal Volume 2015, Article ID 803752, 8 pages http://dx.doi.org/10.1155/2015/803752 Review Article Pruritus in Systemic Diseases: A Review of Etiological Factors and New Treatment Modalities Nagihan Tarikci, Emek Kocatürk, Fule Güngör, IlteriG OLuz Topal, Pelin Ülkümen Can, and Ralfi Singer Department of Dermatology, Okmeydanı Training and Research Hospital, 34384 Istanbul, Turkey Correspondence should be addressed to Emek Kocaturk;¨ [email protected] Received 20 February 2015; Revised 11 June 2015; Accepted 16 June 2015 Academic Editor: Uwe Wollina Copyright © 2015 Nagihan Tarikci et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pruritus is the most frequently described symptom in dermatology and can significantly impair the patient’s quality of life. In 10–50% of adults with persistent pruritus, it can be an important dermatologic clue for the presence of a significant underlying systemic disease such as renal insufficiency, cholestasis, hematologic disorder, or malignancy (Etter and Myers, 2002; Zirwas and Seraly, 2001). This review describes the presence of pruritus in different systemic diseases. It is quite important to discover the cause of pruritus for providing relief for the patients experiencing substantial morbidity caused by this condition. 1. Pruritus Endocrinal Disorders. Thyroid diseases, diabetes mellitus. Pruritus is a topic that has caused a great deal of controversy Paraneoplastic Diseases. Lymphomas and solid organ tumors. because it is difficult to characterize and define. Various indirect definitions proposed include a sensation which provokes the desire to scratch or an uneasy sensation of 2. -
Value of 48- Or 72-Hr Urine Collections in Performing the Schilling Test
VALUE OF 48- OR 72-HR URINE COLLECTIONS IN PERFORMING THE SCHILLING TEST Edward B. Silberstein Radioisotope Laboratory, Cincinnati General Hospital, Cincinnati, Ohio In 21 % of 71 consecutive, normal Schilling serum vitamin B,2 levels less than 50 pg/mI, and tests evaluated in the Radioisotope Laboratory patients with abnormal vitamin B12 absorption as of the Cincinnati General Hospital, normal 57Co measured by a whole-body counter (6—10). cyanocobalamin excretion (greater than 8% of The test was performed, as previously described a test dose of 0.5 @g)was not achieved until 48— (5), with 0.5 @gof 57Co-cyanocobalamin, 1 @@Ci/ 72 hr. it is recommended that the vitamin B,2 @Lg;however, instead of a single day's collection, adsorption test, as described by Schilling, be serial 24-hr urines were collected for 48—72 hr with altered to routinely include at least a 48-hr additional “flushing―doses of 1 mg of cyanoco urine collection. balamin given intramuscularly at the beginning of the second and third days of the test. Each individual in this study produced at least 500 ml of urine per The Schilling test remains an important diagnos 24 hr with creatinine content exceeding 15 mg/kg tic procedure in the study of patients with megalo body weight if volume was under 500 ml to prove blastic anemia and/or peripheral neuropathy. In the that a full day's collection was made (1 1) . The 72-hr original description of the vitamin B,2 absorption collection was made if there was azotemia (BUN test by Schilling ( 1) , a 24-hr urine collection was exceeding 25 mg% ) or in any patient older than obtained after the oral administration of radioactive 65 years. -
Report from the Inaugural Australian Pruritus Symposium, Sydney, Australia, August 10, 2013
Acta Derm Venereol 2014; 94: 123 LETTER TO THE EDITOR Report from the Inaugural Australian Pruritus Symposium, Sydney, Australia, August 10, 2013 Frank Brennan1 and Dedee F. Murrell2* 1Palliative Medicine, Calvary Hospital, 91 Rocky Point Road, and 2Department of Dermatology, St George Hospital, University of New South Wales, Gray St, Kogarah, Sydney, NSW 2217 Australia. *E-mail: [email protected] Accepted Aug 28, 2013; Epub ahead of print Oct 24, 2013 Sir, on the mechanisms and management of opioid-induced The inaugural Australian symposium on pruritus was itch. Frank Brennan spoke on uraemic pruritus, Paul Gray, convened at St George Hospital, Sydney on August 10, a Pain Specialist with a particular interest in burns spoke 2013. The co-conveners were Professor Dedee Murrell, on the phenomenon of post-burns pruritus and Craig Le- Executive Vice President of the International Society of wis, Medical Oncologist surveyed the symptom of itch Dermatology (ISD) and Dr Frank Brennan, Palliative and its management in cancer medicine. Medicine Physician. The impetus behind the symposium A feature of the day was an interview with a patient was the recognition of two facts. Firstly, the significant in front of the symposium participants. The patient developments in the understanding of the pathophysio- presented with a challenging combination of pruritus logy of pruritus in recent years and, secondly, the paucity secondary to a life-long history of atopy and, in later of education and understanding by colleagues across years, uraemic pruritus. Connie Katelaris surveyed the multiple disciplines of those developments. Given that history and immunological results of the patient and the symptom of pruritus manifests in many diseases the made clinical recommendations. -
Gastroenterostomy and Vagotomy for Chronic Duodenal Ulcer
Gut, 1969, 10, 366-374 Gut: first published as 10.1136/gut.10.5.366 on 1 May 1969. Downloaded from Gastroenterostomy and vagotomy for chronic duodenal ulcer A. W. DELLIPIANI, I. B. MACLEOD1, J. W. W. THOMSON, AND A. A. SHIVAS From the Departments of Therapeutics, Clinical Surgery, and Pathology, The University ofEdinburgh The number of operative procedures currently in Kingdom answered a postal questionnaire. Eight had vogue in the management of chronic duodenal ulcer died since operation, and three could not be traced. The indicates that none has yet achieved definitive status. patients were questioned particularly with regard to Until recent years, partial gastrectomy was the eating capacity, dumping symptoms, vomiting, ulcer-type dyspepsia, diarrhoea or other change in bowel habit, and favoured operation, but an increasing awareness of a clinical assessment was made based on a modified its significant operative mortality and its metabolic Visick scale. The mean time since operation was 6-9 consequences, along with Dragstedt and Owen's years. demonstration of the effectiveness of vagotomy in Thirty-five patients from this group were admitted to reducing acid secretion (1943), has resulted in the hospital for a full investigation of gastrointestinal and widespread use of vagotomy and gastric drainage. related function two to seven years following their The success of duodenal ulcer surgery cannot be operation. Most were volunteers, but some were selected judged only on low stomal (or recurrent) ulceration because of definite complaints. There were more females rates; the other sequelae of gastric operations must than males (21 females and 14 males). The following be considered. -
Pathophysiology, Diagnosis, and Management of Pediatric Ascites
INVITED REVIEW Pathophysiology, Diagnosis, and Management of Pediatric Ascites ÃMatthew J. Giefer, ÃKaren F. Murray, and yRichard B. Colletti ABSTRACT pressure of mesenteric capillaries is normally about 20 mmHg. The pediatric population has a number of unique considerations related to Intestinal lymph drains from regional lymphatics and ultimately the diagnosis and treatment of ascites. This review summarizes the physio- combines with hepatic lymph in the thoracic duct. Unlike the logic mechanisms for cirrhotic and noncirrhotic ascites and provides a sinusoidal endothelium, the mesenteric capillary membrane is comprehensive list of reported etiologies stratified by the patient’s age. relatively impermeable to albumin; the concentration of protein Characteristic findings on physical examination, diagnostic imaging, and in mesenteric lymph is only about one-fifth that of plasma, so there abdominal paracentesis are also reviewed, with particular attention to those is a significant osmotic gradient that promotes the return of inter- aspects that are unique to children. Medical and surgical treatments of stitial fluid into the capillary. In the normal adult, the flow of lymph ascites are discussed. Both prompt diagnosis and appropriate management of in the thoracic duct is about 800 to 1000 mL/day (3,4). ascites are required to avoid associated morbidity and mortality. Ascites from portal hypertension occurs when hydrostatic Key Words: diagnosis, etiology, management, pathophysiology, pediatric and osmotic pressures within hepatic and mesenteric capillaries ascites produce a net transfer of fluid from blood vessels to lymphatic vessels at a rate that exceeds the drainage capacity of the lym- (JPGN 2011;52: 503–513) phatics. It is not known whether ascitic fluid is formed predomi- nantly in the liver or in the mesentery. -
American Cancer Society Flufobt Program Implementation Guide for Primary Care Practices
Health Care Solutions From the American Cancer Society American Cancer Society FluFOBT Program Implementation Guide for Primary Care Practices EIGHTY BY 2018 Reaching 80% screened for colorectal cancer by 2018 Table of Contents Introduction ................................................................................................................................. 2 Background Information and Education .................................................................................... 3 Why Have a FluFOBT Program? .................................................................................................. 4 Colorectal Cancer Screening Eligibility ...................................................................................... 5 Colorectal Cancer Screening Recommendations ....................................................................... 6 Patient Education ......................................................................................................................... 8 How to Set Up Your FluFOBT Program .................................................................................... 10 Staff Training for Your FluFOBT Program ................................................................................ 16 Summary ..................................................................................................................................... 19 Appendix A: FluFOBT Components and Logic Model ............................................................ 20 Appendix B: Colorectal Cancer Screening Recommendations -
Clinical Acute Abdominal Pain in Children
Clinical Acute Abdominal Pain in Children Urgent message: This article will guide you through the differential diagnosis, management and disposition of pediatric patients present- ing with acute abdominal pain. KAYLEENE E. PAGÁN CORREA, MD, FAAP Introduction y tummy hurts.” That is a simple statement that shows a common complaint from children who seek “M 1 care in an urgent care or emergency department. But the diagnosis in such patients can be challenging for a clinician because of the diverse etiologies. Acute abdominal pain is commonly caused by self-limiting con- ditions but also may herald serious medical or surgical emergencies, such as appendicitis. Making a timely diag- nosis is important to reduce the rate of complications but it can be challenging, particularly in infants and young children. Excellent history-taking skills accompanied by a careful, thorough physical exam are key to making the diagnosis or at least making a reasonable conclusion about a patient’s care.2 This article discusses the differential diagnosis for acute abdominal pain in children and offers guidance for initial evaluation and management of pediatric patients presenting with this complaint. © Getty Images Contrary to visceral pain, somatoparietal pain is well Pathophysiology localized, intense (sharp), and associated with one side Abdominal pain localization is confounded by the or the other because the nerves associated are numerous, nature of the pain receptors involved and may be clas- myelinated and transmit to a specific dorsal root ganglia. sified as visceral, somatoparietal, or referred pain. Vis- Somatoparietal pain receptors are principally located in ceral pain is not well localized because the afferent the parietal peritoneum, muscle and skin and usually nerves have fewer endings in the gut, are not myeli- respond to stretching, tearing or inflammation. -
Tc. Süleyman Demirel Üniversitesi Sosyal Bilmler Enstitüsü Tarih Anabilim Dali
TC. SÜLEYMAN DEMİREL ÜNİVERSİTESİ SOSYAL BİLMLER ENSTİTÜSÜ TARİH ANABİLİM DALI ORTAÇAĞ ANADOLU’SUNDA İSTANBUL İLE AFYONKARAHİSAR ARASINDAKİ ASKERİ YOL GÜZERGÂHLARI Seda EDİZ 1130204513 YÜKSEK LİSANS TEZİ DANIŞMAN Doç. Dr. Abdullah BAKIR ISPARTA-2019 (Ediz, Seda, Ortaçağ Anadolu’sunda İstanbul ile Afyonkarahisar Arasındaki Askeri Yol Güzergâhları, Yüksek Lisans Tezi, Isparta, 2018) ÖZET Yapılan bu tez çalışmasında İstanbul-Afyonkarahisar arasındaki askeri yol güzergahları ve bu iki şehir arasında kalan bölgenin tarihi coğrafyası hakkında bilgiler verilmektedir. Bu bağlamda öncelikle Eski Çağda bölgenin tarihi coğrafyası ve bu dönemde gerçekleşmiş, söz konusu saha üzerinden yapılan veya bu yollardan geçen savaşlar ele alınmıştır. Ardından Orta Çağda gerçekleşen Bizans Selçuklu mücadeleleri sırasında kullanılan yol güzergahları değerlendirilmiş sonrasında ise I., II., ve III. Haçlı Seferleri esnasında kullanılan yol güzergahları ana kaynaklar ve topografik eserler yardımı ile incelenmeye alınmıştır. Çalışmada konunun aydınlatılmasına yardımcı olması açısından söz konusu sahanın tarihi coğrafyası, Bithynia, Mysia, Troas, Aiolis, Lydia, Ionia ve Phrygia olacak şekilde sırasıyla ele alınmıştır. Tarihi coğrafya incelendikten sonra Eski Çağda bölgeden geçen askeri yol güzergahını kullanmış orduların savaşlarına kronolojik olarak yer verilmiştir. Öncelikle Pers kral yolu değerlendirilmiş ardından, Pers Kralı Kserkses’in Yunanistan Seferi (MÖ. 481-480) sırasında Anadolu’da izlediği yol güzergahı ve savaş esnasında yaşanan olaylara yer verilmiştir. -
2016 Essentials of Dermatopathology Slide Library Handout Book
2016 Essentials of Dermatopathology Slide Library Handout Book April 8-10, 2016 JW Marriott Houston Downtown Houston, TX USA CASE #01 -- SLIDE #01 Diagnosis: Nodular fasciitis Case Summary: 12 year old male with a rapidly growing temple mass. Present for 4 weeks. Nodular fasciitis is a self-limited pseudosarcomatous proliferation that may cause clinical alarm due to its rapid growth. It is most common in young adults but occurs across a wide age range. This lesion is typically 3-5 cm and composed of bland fibroblasts and myofibroblasts without significant cytologic atypia arranged in a loose storiform pattern with areas of extravasated red blood cells. Mitoses may be numerous, but atypical mitotic figures are absent. Nodular fasciitis is a benign process, and recurrence is very rare (1%). Recent work has shown that the MYH9-USP6 gene fusion is present in approximately 90% of cases, and molecular techniques to show USP6 gene rearrangement may be a helpful ancillary tool in difficult cases or on small biopsy samples. Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors, 5th edition. Mosby Elsevier. 2008. Erickson-Johnson MR, Chou MM, Evers BR, Roth CW, Seys AR, Jin L, Ye Y, Lau AW, Wang X, Oliveira AM. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion. Lab Invest. 2011 Oct;91(10):1427-33. Amary MF, Ye H, Berisha F, Tirabosco R, Presneau N, Flanagan AM. Detection of USP6 gene rearrangement in nodular fasciitis: an important diagnostic tool. Virchows Arch. 2013 Jul;463(1):97-8. CONTRIBUTED BY KAREN FRITCHIE, MD 1 CASE #02 -- SLIDE #02 Diagnosis: Cellular fibrous histiocytoma Case Summary: 12 year old female with wrist mass.