This document describes the medical history and treatment of a 50-year-old female patient who presented with right upper quadrant pain and was diagnosed with cholelithiasis. She underwent an open cholecystectomy but was later readmitted with signs of bile duct injury, which was repaired during a second surgery. The patient was discharged after the drainage from her bile duct decreased sufficiently over a two week follow up period.
Bile duct injury during laparoscopic cholecystectomyEaswar Moorthy
1. Bile duct injuries during laparoscopic cholecystectomy can occur due to misidentification of structures or improper surgical techniques.
2. It is important to clearly identify the junction of the cystic duct and gallbladder using cues like the "elephant trunk sign" and Rouviere's sulcus, and obtain the "critical view of safety" to help prevent bile duct injuries.
3. If there is uncertainty in the anatomy, performing an intraoperative cholangiogram can help reduce the risk of bile duct injury. Early recognition of bile duct injuries through imaging and prompt repair by a specialist, often involving hepaticojejunostomy, can lead to the best outcomes.
This document discusses the history of biliary injuries and laparoscopic cholecystectomy. It begins with a brief overview of milestones in the history of cholecystectomy and bile duct surgery. It then describes biliary anatomy and variations that can increase risk of injury. The advantages of laparoscopic cholecystectomy are noted but also the increased risk of bile duct injuries compared to open surgery. Risk factors for injuries are discussed including surgeon experience, patient factors like inflammation, and anatomic variations. Techniques for prevention are outlined including obtaining the "critical view of safety" and using intraoperative cholangiography. Classification systems for injuries and approaches to treatment are also summarized. Throughout, the importance of prevention over treatment is emphasized
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
This document describes the medical history and treatment of a 50-year-old female patient who presented with right upper quadrant pain and was diagnosed with cholelithiasis. She underwent an open cholecystectomy but was later readmitted with signs of bile duct injury, which was repaired during a second surgery. The patient was discharged after the drainage from her bile duct decreased sufficiently over a two week follow up period.
Bile duct injury during laparoscopic cholecystectomyEaswar Moorthy
1. Bile duct injuries during laparoscopic cholecystectomy can occur due to misidentification of structures or improper surgical techniques.
2. It is important to clearly identify the junction of the cystic duct and gallbladder using cues like the "elephant trunk sign" and Rouviere's sulcus, and obtain the "critical view of safety" to help prevent bile duct injuries.
3. If there is uncertainty in the anatomy, performing an intraoperative cholangiogram can help reduce the risk of bile duct injury. Early recognition of bile duct injuries through imaging and prompt repair by a specialist, often involving hepaticojejunostomy, can lead to the best outcomes.
This document discusses the history of biliary injuries and laparoscopic cholecystectomy. It begins with a brief overview of milestones in the history of cholecystectomy and bile duct surgery. It then describes biliary anatomy and variations that can increase risk of injury. The advantages of laparoscopic cholecystectomy are noted but also the increased risk of bile duct injuries compared to open surgery. Risk factors for injuries are discussed including surgeon experience, patient factors like inflammation, and anatomic variations. Techniques for prevention are outlined including obtaining the "critical view of safety" and using intraoperative cholangiography. Classification systems for injuries and approaches to treatment are also summarized. Throughout, the importance of prevention over treatment is emphasized
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
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Fettleber und NASH. Metabolische Fettleber.
Definition Fettleber. Häufigkeit und klinische Zeichennostik der Fettleber
Sonographie der Fettleber und anderer Leberveränderungen
Bildgebende Diagnostik der Fettleber wie CT.
Molekulare Pathogenese der Fettleber.
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Häufigkeit und Histologie der Fettleberhepatitis.
Für die adjuvante Bestrahlung nach brusterhaltender Operation empfiehlt die Deutsche Gesellschaft für Radioonkologie (DEGRO):
Primärmaßnahme ist natürlich die Entfernung eines verdächtigen Knotens.
Bei Verdacht auf Lyphknotenbefall ist neben der Resektion Lymphektomien
dieser oft eine anschließende adjuvante Strahlentherapie.
Standard für alle Patientinnen ohne Einschränkungen ist die konventionelle Fraktionierung mit sequenziellem Boost (Bestrahlung der ganzen Brust mit 50 Gy in 25 bis 28 Fraktionen, anschließend Boost bis 60/66 Gy mit fünf bis acht weiteren Fraktionen). Die Gesamtbehandlungszeit beträgt sechs bis sieben Wochen.
Alternativ kann die Bestrahlung der ganzen Brust auch hypofraktioniert durchgeführt werden (mit circa 16 Fraktionen und Einzeldosen von circa 2,66 Gy). Der Boost erfolgt dann wie bei konventioneller Fraktionierung sequenziell. Diese Therapie kommt nach der aktuellen S3-Leitlinie infrage bei älteren Patientinnen, die prognostisch günstige Tumoren haben (Durchmesser < 5 cm, kein lokoregionaler Lymphknotenbefall) und keine Chemotherapie erhalten. Die Gesamtbehandlungszeit beträgt viereinhalb bis fünf Wochen.
Quelle : Deutsches Ärzteblatt.
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Update 2014: Vorhofflimmern - T. Autenrieth, MetzingenKlin-RT
Vortrag im Rahmen des Reutlinger Update Innere Medizin 2014 - 28. & 29. November 2014. Eine jährliche Fortbildungsveranstaltung der Bezirksärztekammer Südwürttemberg, der Kreisärzteschaft Reutlingen und der Kreiskliniken Reutlingen GmbH für Ärztinnen und Ärzte.
The document discusses several studies by Dubecz et al. on trends in adenocarcinoma (adeno-CA) incidence and esophageal cancer (EC) cure and resection rates in the modern era. It notes increasing adeno-CA incidence rates over time, higher rates in white men, stage-by-stage incidence data, and modern cure rates for localized and regional EC from resection. Resection rates for non-metastatic EC in the US are presented from several data sources, along with median lymph nodes removed and percentage of patients with adequate lymph node dissection.
Stent Presentation at STS 2009 San franciscodubeczattila
This study evaluated the use of self-expanding metal stents, plastic stents, and hybrid stents to treat 133 patients with malignant and benign esophageal diseases over an 8-year period at a single institution. Stent placement was successful in relieving obstruction in 91% of patients with a median hospital stay of 1 day. Complications included migration in 9.7% of cases, impaction in 13% requiring endoscopic disimpaction, and tumor ingrowth in 5.2% of uncovered metal stents. Stent placement was found to be a generally safe, quick, and reliable procedure for palliating malignant esophageal obstructions.
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Definition Fettleber. Häufigkeit und klinische Zeichennostik der Fettleber
Sonographie der Fettleber und anderer Leberveränderungen
Bildgebende Diagnostik der Fettleber wie CT.
Molekulare Pathogenese der Fettleber.
Diagnosen bei Leberwerterhöhungen
Verschiedenartiger Anstieg der Leberfunktionsparameter.
Häufigkeit und Histologie der Fettleberhepatitis.
Für die adjuvante Bestrahlung nach brusterhaltender Operation empfiehlt die Deutsche Gesellschaft für Radioonkologie (DEGRO):
Primärmaßnahme ist natürlich die Entfernung eines verdächtigen Knotens.
Bei Verdacht auf Lyphknotenbefall ist neben der Resektion Lymphektomien
dieser oft eine anschließende adjuvante Strahlentherapie.
Standard für alle Patientinnen ohne Einschränkungen ist die konventionelle Fraktionierung mit sequenziellem Boost (Bestrahlung der ganzen Brust mit 50 Gy in 25 bis 28 Fraktionen, anschließend Boost bis 60/66 Gy mit fünf bis acht weiteren Fraktionen). Die Gesamtbehandlungszeit beträgt sechs bis sieben Wochen.
Alternativ kann die Bestrahlung der ganzen Brust auch hypofraktioniert durchgeführt werden (mit circa 16 Fraktionen und Einzeldosen von circa 2,66 Gy). Der Boost erfolgt dann wie bei konventioneller Fraktionierung sequenziell. Diese Therapie kommt nach der aktuellen S3-Leitlinie infrage bei älteren Patientinnen, die prognostisch günstige Tumoren haben (Durchmesser < 5 cm, kein lokoregionaler Lymphknotenbefall) und keine Chemotherapie erhalten. Die Gesamtbehandlungszeit beträgt viereinhalb bis fünf Wochen.
Quelle : Deutsches Ärzteblatt.
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Grunddiagnostik einfacher Arterienverschlüsse,
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A 29-year-old woman had been chronically treated for Crohn's disease for years based on a biopsy suggesting a mild case. However, during a surgery, a retained surgical sponge was discovered in her small intestine that had been there since a previous surgery, causing her symptoms. A review of previous samples found threads from the sponge. It is believed the sponge had migrated through her intestines without causing an open wound. Her true diagnosis was misdiagnosed Crohn's disease due to the retained foreign body.
The document summarizes WHO's perspective on proposed reforms to Hungary's health insurance system. The WHO has two main concerns: 1) There is no logical link between the problems identified in Hungary's system and the solution of introducing competitive private health insurance. 2) Analyzing the system using labels like "Beveridge" and "Bismarck" is outdated and misleading. The WHO believes the reforms will greatly increase costs without clear benefits and that Hungary should learn from countries with similar systems rather than those proposed as models.
Gallengangverletzungen Nach Cholezystektomie 2007 öCk Graz Final
1. Gallengangsverletzungen nach Cholezystektomie Attila Dubecz, BHA. von Rahden, R. Stadlhuber K. Emmanuel, HJ. Stein Universitätsklinik für Chirurgie , Paracelsus Privatuniversität Salzburg 48. Österreich ischer Chirurgen k ongress, 7.-9. Juni. 2007 Graz
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4. Eigene Daten n=2850 Cholezystektomien 1999-2006 2422 laparos kopisch 428 offen 46 Gallengang s verletzungen: 1.6%