Hopkins General Surgery Review Manual
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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. -
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. -
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. -
Intrahepatic Cysts in Biliary Atresia Aftersuccessful
Arch Dis Child: first published as 10.1136/adc.59.3.274 on 1 March 1984. Downloaded from 274 Sinaasappel, den Ouden, Luyendijk, and Degenhart The reason for the patient's persistent vomiting in 3 Menke JA, Stallworth RE, Bindstadt DH, Strano AJ, the first five months of life may well have been Wallace SE. Medication bezoar in a neonate. Am J Dis Child 1982;136:72-3. a slower development of his antireflux mechanism, 4 Metlay LA, Klionsky BC. An unusual gastric bezoar in a but we have not been able to confirm this newborn: polystyrene resin and candida albicans. J Pediatr hypothesis. 1983;102:121-3. 5 Portuguez-Malavasi A, Aranda JV. Antacid bezoar in a newborn. Pediatrics 1979;63:679- 80. References 6 Hewitt GJ, Benham ES. A complication of gaviscon in' a neonate-'the gavisconoma'. Aust Paediatr J 1976;12:47-8. O'Brien D, Rodgerson DO, Ibbott FA. Laboratory manual of pediatric micro- and ultramicro biochemical techniques. 4th ed. Correspondence to Dr M Sinaasappel, Department of Paediatrics, New York: Harper & Row, 1968:231. Gastro-enterological Division, Erasmus University and University 2 Schreiner RL, Lemons JA, Gresham EL. A new complication Hospital, Rotterdam, The Netherlands. of nutritial management of the low-birth-weight infant. Pediat- rics 1979;63:683-4. Received 7 November 1983 Intrahepatic cysts in biliary atresia after successful hepatoportoenterostomy S SAITO, T NISHINA, AND Y TSUCHIDA Department ofPaediatric Surgery, University of Tokyo, Japan SUMMARY A patient with an unusual association of dilated and cord like portions of the extrahepatic biliary atresia and two intrahepatic cysts is reported. -
The Reliability and Reproducibility of the Schilling Test in Primary Malabsorptive Disease and After Partial Gastrectomy
Gut: first published as 10.1136/gut.4.1.32 on 1 March 1963. Downloaded from Gut, 1963, 4, 32 The reliability and reproducibility of the Schilling test in primary malabsorptive disease and after partial gastrectomy J. F. ADAMS AND E. JUNE CARTWRIGHT From the Western Infirmary, Glasgow EDITORIAL SYNOPSIS A study of the reproducibility and reliability of the Schilling test in patients with primary malabsorptive disease and after partial gastrectomy is reported. The value of the test was assessed by repeated tests in each patient. Consistently normal or abnormal results were obtained in only one of the seven patients with primary malabsorptive disease and in only two of the eight patients who had undergone partial gastrectomy. From these results it is concluded that the result of a single test may be of little clinical value. Assessment of the results suggests that the mean value for a series of Schilling tests may give some indication of value clinically about the capacity to absorb radioactive vitamin B12 at the time of the tests at least in patients who have undergone partial gastrectomy. The significance of the findings is discussed, particularly in relation to the aetiology of post-gastrectomy megaloblastic anaemia. http://gut.bmj.com/ Absorption tests using radioactive vitamin B12 may ml. water; two hours later 1,000 ptg. vitamin B12 was given be of considerable value in establishing a precise intramuscularly and urine was collected for the subsequent diagnosis in conditions in which anaemia results 24 hours. The radioactivity in a 450 ml. aliquot was from malabsorption. It is obviously important to measured as described by Adams and Seaton (1961) and the total urinary radioactivity expressed as a percentage appreciate the limitations of such tests. -
Deep Neck Infections 55
Deep Neck Infections 55 Behrad B. Aynehchi Gady Har-El Deep neck space infections (DNSIs) are a relatively penetrating trauma, surgical instrument trauma, spread infrequent entity in the postpenicillin era. Their occur- from superfi cial infections, necrotic malignant nodes, rence, however, poses considerable challenges in diagnosis mastoiditis with resultant Bezold abscess, and unknown and treatment and they may result in potentially serious causes (3–5). In inner cities, where intravenous drug or even fatal complications in the absence of timely rec- abuse (IVDA) is more common, there is a higher preva- ognition. The advent of antibiotics has led to a continu- lence of infections of the jugular vein and carotid sheath ing evolution in etiology, presentation, clinical course, and from contaminated needles (6–8). The emerging practice antimicrobial resistance patterns. These trends combined of “shotgunning” crack cocaine has been associated with with the complex anatomy of the head and neck under- retropharyngeal abscesses as well (9). These purulent col- score the importance of clinical suspicion and thorough lections from direct inoculation, however, seem to have a diagnostic evaluation. Proper management of a recog- more benign clinical course compared to those spreading nized DNSI begins with securing the airway. Despite recent from infl amed tissue (10). Congenital anomalies includ- advances in imaging and conservative medical manage- ing thyroglossal duct cysts and branchial cleft anomalies ment, surgical drainage remains a mainstay in the treat- must also be considered, particularly in cases where no ment in many cases. apparent source can be readily identifi ed. Regardless of the etiology, infection and infl ammation can spread through- Q1 ETIOLOGY out the various regions via arteries, veins, lymphatics, or direct extension along fascial planes. -
A New Look at Vitaminb
A new look at vitaminB 18 The Nurse Practitioner • Vol. 34, No. 11 www.tnpj.com 2.5 CONTACT HOURS 12 deficiency By Sandra M. Nettina, APRN-BC, ANP, MSN ona Abraham is a 78-year-old widow who sees you for refill of her arthritis and antihypertensive med- M ications. She recently relocated from another state to be closer to her daughter, although she lives in her own “se- nior” apartment. Through history taking, you learn that she has a long history of osteoarthritis, mild hypertension requir- ing medication for the past 5 years, and occasional gastroe- sophageal reflux. Surgical history includes appendectomy as a teenager, a ventral hernia repair after her last child was born, and right knee arthroscopy about 5 years ago. Her medications include triamterene/hydrochlorthiazide 37.5/25 mg daily, acetaminophen 650 mg (2) twice daily , cal- cium citrate 600 mg/vitamin D 400 international units twice daily, omeprazole 20 mg daily p.r.n for heartburn, and hy- drocodone/acetaminophen 5/325 mg every 6h p.r.n. for severe pain. You perform a physical exam, discuss healthy diet and physical activity, order serum electrolytes and creatinine, refill her prescriptions, and advise her to schedule a follow-up ap- pointment in 3 months for preventative screening. You are about to conclude the visit and leave the room when Mrs. Abra- ham asks if she can get a vitamin B12 shot now. You question her about her need for B12 and Mrs. Abraham states she never knew how her previous primary care provider knew she had a vitamin B12 deficiency, but monthly shots have helped boost her energy over the past year. -
Effect of Prior Radiopharmaceutical Administration on Schilling Test Performance: Analysis and Recommendations
CASE REPORTS Effect of Prior Radiopharmaceutical Administration on Schilling Test Performance: Analysis and Recommendations Lionel S. Zuckier, Michael Stabin, Borys R. Krynyckyi, Pat Zanzonico and Barbara Binkert Department of Nuclear Medicine, Albert Einstein College of Medicine, Bronx, New York; Radiation Internal Dose Information Center; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee; and the Department of Radiology, New York Hospital-Cornell Medical Center, New York, New York period in the Grampian Health Board Area in Scotland, inter Previously administered diagnostic and therapeutic radiopharma- ference by previously administered radiopharmaceuticals was ceuticals may interfere with performance of the Schilling test for suspected in five cases involving three radionuclides (67Ga and prolonged periods of time. Additionally, presence of confounding 75Se twice each; I3ll once) (3). radionuclides in the urine may not be suspected if baseline urine The International Committee for Standardization in Hema- measurements have not been performed before the examination. Methods: We assumed that a spurious contribution of counts tology has recommended that immediately before any B12 corresponding to 1% of the administered Schilling dose would absorption test, pretest baseline radioactivity measurements begin to contribute clinically significant interference. Based on the should be performed, such as a 12-hr control urine sample in the typical amounts of radiopharmaceuticals administered, spectra of case of the Schilling test (9). As supported by a recent survey of commonly used radionuclides and best available pharmacokinetic hospitals performing the dual-isotope Schilling test (8), it models of biodistribution and excretion, we estimated the interval appears that this time-consuming suggestion is not commonly required for 24-hr urinary excretion of diagnostic and therapeutic implemented and is recommended in only one (¡0) of three radiopharmaceuticals to drop below this threshold of significant interference. -
American Surgical Association
AMERICAN SURGICAL ASSOCIATION Program of the 131st Annual Meeting Boca Raton Resort & Club Boca Raton, Florida Thursday, April 14th Friday, April 15th Saturday, April 16th 2011 Table of Contents Officers and Council ....................................................................2 Committees ..................................................................................3 Foundation Trustees.....................................................................5 Representatives ............................................................................6 Future Meetings ...........................................................................7 General Information.....................................................................8 Continuing Medical Education Accreditation Information........10 AMERICAN Program Committee Disclosure List..........................................13* SURGICAL Faculty Disclosure List...............................................................13* Author Disclosure List...............................................................14* ASSOCIATION Discussant Disclosure List.........................................................22* Schedule-at-a-Glance.................................................................24 Program Outline.........................................................................26 Program Program Detail and Abstracts.....................................................41 of the Alphabetical Directory of Fellows.............................................94* 131st Annual -
Vitamin B12 (Cobalamin) Deficiency in Elderly Patients
Review Synthèse Vitamin B12 (cobalamin) deficiency in elderly patients Emmanuel Andrès, Noureddine H. Loukili, Esther Noel, Georges Kaltenbach, Maher Ben Abdelgheni, Anne E. Perrin, Marie Noblet-Dick, Frédéric Maloisel, Jean-Louis Schlienger, Jean-Frédéric Blicklé Abstract and these should be excluded as causes of cobalamin defi- ciency before a diagnosis is made. To obtain cutoff points VITAMIN B12 OR COBALAMIN DEFICIENCY occurs frequently (> 20%) of cobalamin serum levels, patients with known complica- among elderly people, but it is often unrecognized because the tions are compared with age-matched control patients clinical manifestations are subtle; they are also potentially serious, without complications. Because different patient popula- particularly from a neuropsychiatric and hematological perspec- tions have been studied, several serum concentration defin- tive. Causes of the deficiency include, most frequently, food- itions have emerged.5–7 Varying test sensitivities and speci- cobalamin malabsorption syndrome (> 60% of all cases), perni- ficities result from the lack of a precise “gold standard.” cious anemia (15%–20% of all cases), insufficent dietary intake The definitions of cobalamin deficiency used in this review and malabsorption. Food-cobalamin malabsorption, which has are shown in Box 1. Based in part on the work of Klee7 and only recently been identified as a significant cause of cobalamin in part on our own work,8 they are calculated for elderly pa- deficiency among elderly people, is characterized by the inability to release cobalamin from food or a deficiency of intestinal cobal- tients. The first definition is simpler to interpret, but it re- amin transport proteins or both. We review the epidemiology and quires that blood samples be drawn on 2 separate days. -
Copyright © ESPGHAN and NASPGHAN. All Rights Reserved
Journal of Pediatric Gastroenterology and Nutrition, Publish Ahead of Print DOI : 10.1097/MPG.0000000000002836 Cholangitis in Patients with Biliary Atresia Receiving Hepatoportoenterostomy: A National Database Study Katherine Cheng, M.D.1 Jean P. Molleston, M.D.2 William E. Bennett, Jr., M.D., M.S.2,3 1. Department of Pediatrics, 2. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 3. Section of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, USA Abstract: Introduction: Biliary atresia (BA) is a progressive form of liver disease in the neonatal period usually requiring hepatoportoenterostomy (HPE). Cholangitis is a common sequelae of HPE, but data about which patients are at risk for this complication are limited. Objective: To determine risk factors associated with cholangitis in a large retrospective cohort after HPE. Methods: The Pediatric Health Information System (PHIS) was queried for BA (ICD-9 975.61) and HPE (ICD-9-CM 51.37) admissions from 2004-2013. We performed univariate Copyright © ESPGHAN and NASPGHAN. All rights reserved. analysis and linear regression with dependent variables of ≥ 2 or ≥ 5 episodes of cholangitis, and independent variables of age at time of HPE, race, ethnicity, gender, insurance, ursodeoxycholic acid (UDCA) use, steroid use, presence of esophageal varices (EV), and portal hypertension (PH). Results: We identified 1,112 subjects with a median age at HPE of 63 days and median number of cholangitis episodes of 2 within 2 years. On multiple regression analysis, black race (OR 1.51, p = 0.044) and presence of PH (OR 2.24, p < 0.001) were associated with increased risk of ≥ 2 episodes of cholangitis, while HPE at > 90 days was associated with less risk (OR 0.46, p = 0.001). -
Micronutrient Deficiencies As a Result of Bariatric Surgery
MICRONUTRIENT DEFICIENCIES AS A RESULT OF BARIATRIC SURGERY By Ashlie Lewis A Senior Project submitted In partial fulfillment of the requirements for the degree of Bachelor of Science in Nutrition Food Science and Nutrition Department California Polytechnic State University San Luis Obispo, CA June 2010 ABSTRACT The most effective method of sustainable weight loss in obese patients is bariatric surgery. However, micronutrient deficiencies that can result after bariatric surgery can cause health problems that may outweigh its benefits. Micronutrient deficiencies are most common in patients who undergo Roux-en-Y gastric bypass or biliopancreatic diversion with or without duodenal switch. The majority of vitamin B12 and folate deficiencies studies showed significant prevalence rates in their patient populations. Most concluded that routine oral B12 supplementation was ineffective at resolving deficiency; very high oral doses (> 350 µg) or intramuscular injections of crystalline B12 were typically required. Studies of iron deficiency after bariatric surgery found high prevalence rates due to inadequate oral supplementation, which can lead to the need for parenteral supplementation. Calcium and vitamin D deficiency studies also showed high prevalence rates of deficiency, which is important to address as deficiency can result in metabolic bone disease. Overall, the need for lifelong supplementation and follow up, early detection of deficiencies, patient education, and more aggressive supplementation regiments were emphasized to increase quality of life in bariatric surgery patients. Future research in bariatric surgery studies should include long-term health outcomes, patient education on required supplementation, and more aggressive supplementation regimens. Introduction Throughout the past several decades, prevalence of overweight and obesity in the United States has steadily increased.