Differentiating Crohn's disease(CD) and intestinal tuberculosis(ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammato...Differentiating Crohn's disease(CD) and intestinal tuberculosis(ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical(diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic(longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic(caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic(positive stain/culture for acid fast-bacillus in ITB), radiologic(long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus(AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However,these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy(ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.展开更多
Visceral artery aneurysms(VAAs) include aneurysms of the splanchnic circulation and those of the renal artery.Their diagnosis is clinically important because of the associated high mortality and potential complication...Visceral artery aneurysms(VAAs) include aneurysms of the splanchnic circulation and those of the renal artery.Their diagnosis is clinically important because of the associated high mortality and potential complications.Splenic,superior mesenteric,gastroduodenal,hepatic and renal arteries are some of the common arteries affected by VAAs.Though surgical resection and anastomosis still remains the treatment of choice in some of the cases,especially cases involving the proximal arteries,increasingly endovascular treatment is being used for more distal vessels.We present a pictorial review of various intra-abdominal VAAs and their endovascular management.展开更多
AIM: To assess the prognostic significance of cathepsin L, a cysteine protease that degrades the peri-tumoral tissue, in patients with pancreatic cancer.
Wealthy nations must do much more,much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental...Wealthy nations must do much more,much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis.They will meet again at the biodiversity summit in Kunming,China,and the climate conference(Conference of the Parties(COP)26)in Glasgow,UK.Ahead of these pivotal meetings,we-the editors of health journals worldwide-call for urgent action to keep average global temperature increases below 1.5°C,halt the destruction of nature and protect health.展开更多
AIM:To report our experience in the surgical management of severe injuries of the gastrointestinal tract due to corrosive ingestion.METHODS:A retrospective review of patients who underwent emergency surgery for severe...AIM:To report our experience in the surgical management of severe injuries of the gastrointestinal tract due to corrosive ingestion.METHODS:A retrospective review of patients who underwent emergency surgery for severe gastrointestinal injuries following corrosive ingestion between 1983 and 2010 was carried out.Data was extracted from a prospectively maintained esophageal disease database.Severe corrosive injuries were defined as full thickness necrosis with perforation of the esophagus or the stomach(with or without involvement of the adjacent viscera) with resultant mediastinitis or peritonitis.RESULTS:Between 1983 and 2010,209 patients with corrosive injury of the esophagus were managed.Of these,13(6.2%) patients underwent emergency surgery for severe corrosive injury.The median age of the patients was 22 years and the median interval between ingestion of the corrosive substance and surgery was 24 h.The surgical procedures done included esophagogastrectomy alone(n = 6),esophagogastrectomy withduodenectomy(n = 4),esophagogastrectomy with pancreaticoduodenectomy(n = 1),esophagogastrectomy with splenectomy(n = 1) and distal gastrectomy with duodenectomy(n = 1).Two patients died in the postoperative period and one after discharge awaiting the second surgery.The factors significantly predictive of mortality following such an injury included renal failure at the time of initial presentation,presence of metabolic acidosis,delay of more than 24 h between corrosive ingestion and surgery,and corrosive induced adjacent organ injury(pancreatic)(P < 0.001,0.02,0.005 and 0.015 respectively).Ten patients underwent subsequent surgery for restoration of the alimentary tract continuity with a colonic pull-up(n = 8) and gastrojejunostomy(n = 1).In one patient,the attempted colon pull-up failed due to extensive scarring of the mesocolon.The median follow up(following restoration of continuity of the gastrointestinal tract) was 36.5 mo.One patient developed dysphagia due to a stricture at the anastomotic site,which was successfully managed by dilatation.Another patient developed severe aspiration,necessitating laryngeal inlet closure and permanent tracheostomy,and 3 patients complained of occasional regurgitation.CONCLUSION:Management of severe corrosive injury involves prompt resuscitation and urgent surgical debridement.Although the subsequent restoration of continuity may be complicated and may not always be possible,long term outcomes are acceptable in the majority.展开更多
The International Committee of Medical Journal Editors （ICMJE） believes that there is an ethical obligation to responsibly share data generated by interventional clinical trials because participants have put themsel...The International Committee of Medical Journal Editors （ICMJE） believes that there is an ethical obligation to responsibly share data generated by interventional clinical trials because participants have put themselves at risk. In a growing consensus, many funders around the world - foundations, government agencies, and industry - now mandate data sharing. Here, we outline ICMJE＇s proposed requirements to help meet this obligation. We encourage feedback on the proposed requirements. Anyone can provide feedback at www. icmje.org by April 18, 2016.展开更多
Wealthy nations must do much more,much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental...Wealthy nations must do much more,much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis.They will meet again at the biodiversity summit in Kunming,China,and the climate conference(Conference of the Parties(COP)26)in Glasgow,UK.Ahead of these pivotal meetings,we-the editors of health journals worldwide-call for urgent action to keep average global temperature increases below 1.5℃,halt the destruction of nature and protect health.展开更多
Wealthy nations must do much more,much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental...Wealthy nations must do much more,much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis.They will meet again at the biodiversity summit in Kunming,China,and the climate conference(Conference of the Parties(COP)26)in Glasgow,UK.Ahead of these pivotal meetings,we-the editors of health journals worldwide-call for urgent action to keep average global temperature increases below 1.5℃,halt the destruction of nature and protect health.展开更多
文摘Differentiating Crohn's disease(CD) and intestinal tuberculosis(ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical(diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic(longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic(caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic(positive stain/culture for acid fast-bacillus in ITB), radiologic(long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus(AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However,these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy(ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.
文摘Visceral artery aneurysms(VAAs) include aneurysms of the splanchnic circulation and those of the renal artery.Their diagnosis is clinically important because of the associated high mortality and potential complications.Splenic,superior mesenteric,gastroduodenal,hepatic and renal arteries are some of the common arteries affected by VAAs.Though surgical resection and anastomosis still remains the treatment of choice in some of the cases,especially cases involving the proximal arteries,increasingly endovascular treatment is being used for more distal vessels.We present a pictorial review of various intra-abdominal VAAs and their endovascular management.
基金Supported by Grants from Indian Council of Medical Research,New Delhi and Council of Scientific and Industrial Research,New Delhi
文摘AIM: To assess the prognostic significance of cathepsin L, a cysteine protease that degrades the peri-tumoral tissue, in patients with pancreatic cancer.
文摘Wealthy nations must do much more,much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis.They will meet again at the biodiversity summit in Kunming,China,and the climate conference(Conference of the Parties(COP)26)in Glasgow,UK.Ahead of these pivotal meetings,we-the editors of health journals worldwide-call for urgent action to keep average global temperature increases below 1.5°C,halt the destruction of nature and protect health.
文摘AIM:To report our experience in the surgical management of severe injuries of the gastrointestinal tract due to corrosive ingestion.METHODS:A retrospective review of patients who underwent emergency surgery for severe gastrointestinal injuries following corrosive ingestion between 1983 and 2010 was carried out.Data was extracted from a prospectively maintained esophageal disease database.Severe corrosive injuries were defined as full thickness necrosis with perforation of the esophagus or the stomach(with or without involvement of the adjacent viscera) with resultant mediastinitis or peritonitis.RESULTS:Between 1983 and 2010,209 patients with corrosive injury of the esophagus were managed.Of these,13(6.2%) patients underwent emergency surgery for severe corrosive injury.The median age of the patients was 22 years and the median interval between ingestion of the corrosive substance and surgery was 24 h.The surgical procedures done included esophagogastrectomy alone(n = 6),esophagogastrectomy withduodenectomy(n = 4),esophagogastrectomy with pancreaticoduodenectomy(n = 1),esophagogastrectomy with splenectomy(n = 1) and distal gastrectomy with duodenectomy(n = 1).Two patients died in the postoperative period and one after discharge awaiting the second surgery.The factors significantly predictive of mortality following such an injury included renal failure at the time of initial presentation,presence of metabolic acidosis,delay of more than 24 h between corrosive ingestion and surgery,and corrosive induced adjacent organ injury(pancreatic)(P < 0.001,0.02,0.005 and 0.015 respectively).Ten patients underwent subsequent surgery for restoration of the alimentary tract continuity with a colonic pull-up(n = 8) and gastrojejunostomy(n = 1).In one patient,the attempted colon pull-up failed due to extensive scarring of the mesocolon.The median follow up(following restoration of continuity of the gastrointestinal tract) was 36.5 mo.One patient developed dysphagia due to a stricture at the anastomotic site,which was successfully managed by dilatation.Another patient developed severe aspiration,necessitating laryngeal inlet closure and permanent tracheostomy,and 3 patients complained of occasional regurgitation.CONCLUSION:Management of severe corrosive injury involves prompt resuscitation and urgent surgical debridement.Although the subsequent restoration of continuity may be complicated and may not always be possible,long term outcomes are acceptable in the majority.
文摘The International Committee of Medical Journal Editors （ICMJE） believes that there is an ethical obligation to responsibly share data generated by interventional clinical trials because participants have put themselves at risk. In a growing consensus, many funders around the world - foundations, government agencies, and industry - now mandate data sharing. Here, we outline ICMJE＇s proposed requirements to help meet this obligation. We encourage feedback on the proposed requirements. Anyone can provide feedback at www. icmje.org by April 18, 2016.
文摘Wealthy nations must do much more,much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis.They will meet again at the biodiversity summit in Kunming,China,and the climate conference(Conference of the Parties(COP)26)in Glasgow,UK.Ahead of these pivotal meetings,we-the editors of health journals worldwide-call for urgent action to keep average global temperature increases below 1.5℃,halt the destruction of nature and protect health.
文摘Wealthy nations must do much more,much faster.The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis.They will meet again at the biodiversity summit in Kunming,China,and the climate conference(Conference of the Parties(COP)26)in Glasgow,UK.Ahead of these pivotal meetings,we-the editors of health journals worldwide-call for urgent action to keep average global temperature increases below 1.5℃,halt the destruction of nature and protect health.
