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Visceral Medicine

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https://www.readbyqxmd.com/read/30182025/surgery-of-cystic-tumors-of-the-pancreas-why-when-and-how
#1
REVIEW
Jan G D'Haese, Jens Werner
The management of cystic pancreatic neoplasms has increasingly gained clinical attention due to their frequent incidental detection by cross-sectional imaging and their potential for progression to pancreatic cancer. Surgical resection is warranted for all mucinous cystic neoplasms, solid pseudopapillary neoplasms, and main-duct intraductal papillary mucinous neoplasms since these lesions harbor a major risk for malignant transformation. For branch-duct IPMN (BD-IPMN), the risk for malignancy is considerably lower so that some lesions may be safely followed while others require surgical resection...
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30182024/pancreatic-cystic-neoplasms-different-types-different-management-new-guidelines
#2
REVIEW
Lianne Scholten, Nadine C M van Huijgevoort, Jeanin E van Hooft, Marc G Besselink, Marco Del Chiaro
Pancreatic cystic neoplasms (PCN) include different types of cysts with various biological behavior. The most prevalent PCN are intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), and serous cystic neoplasm (SCN). Management of PCN should focus on the prevention of malignant progression, while avoiding unnecessary morbidity of surgery. This requires specialized centers with dedicated multidisciplinary PCN teams. The malignant potential of PCN varies enormously between the various types of PCN...
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30140689/fatal-case-of-spontaneous-rectus-sheath-hematoma-caused-by-anticoagulant-and-steroid-therapy-during-hospital-admission
#3
Ivan Romic, Goran Pavlek, Marko Mance, Marijan Romic, Trpimir Moric
Background: Rectus sheath hematoma (RSH) is a rare but potentially dangerous clinical entity that requires medical supervision. Case Report: Here we discuss one such case which describes the fatal course of spontaneous RSH during hospital admission. Conclusion: Usually, RSH presents as a minimal abdominal wall swelling with self-limiting course but in the case of hematoma and size progression, specific conservative or invasive measures are necessary to prevent serious complications including hypovolemic shock and death...
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30140688/the-ongoing-challenge-of-acute-mesenteric-ischemia
#4
REVIEW
Bernd Luther, Apostolos Mamopoulos, Christian Lehmann, Ernst Klar
Background: The lethality of acute mesenteric ischemia (AMI) remains quite high with 50-70%. The main reasons for that are the fact that AMI is rarely taken into consideration by the differential diagnosis of acute abdomen, the time-consuming diagnostic process, and the lack of a standardized therapeutic concept. The present interdisciplinary review aims to increase awareness among physicians and to help improve clinical outcomes. Methods: This clinical therapeutic review is based on author expertise as well as a selective literature survey in PubMed based on the term 'mesenteric ischemia', combined with the terms 'arterial', 'clinical presentation', 'diagnosis', 'therapy', 'surgery', and 'interventional radiology'...
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30140687/diagnostic-and-treatment-algorithms-of-pancreatic-cystic-tumors
#5
Jens Werner, Orlin Belyaev, Carlos Fernández-Del Castillo, Philippe Lévy, Matthias Löhr, Julia Mayerle, Waldemar Uhl
No abstract text is available yet for this article.
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30140686/surveillance-of-cystic-lesions-of-the-pancreas-whom-and-how-to-survey
#6
REVIEW
Stefano Andrianello, Massimo Falconi, Roberto Salvia, Stefano Crippa, Giovanni Marchegiani
The sudden prevalence increase of pancreatic cystic neoplasms (PCN) related to the use of cross-sectional imaging has raised several concerns. Even if there is a tangible risk of progression towards pancreatic cancer (PC), surgical resection cannot be offered to all patients due to the high risk of morbidity and mortality. Available guidelines are useful tools to identify patients at higher risk for harboring cancer thanks to their sensitivity. Because of their low specificity, however, such a risk is often overestimated...
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30140685/management-algorithm-for-cystic-pancreatic-lesions
#7
REVIEW
Georg Beyer, Elisabetta Goni, Marlies Köpke, Jan G D'Haese, Jens Werner, Jörg Schirra, Julia Mayerle
Cystic pancreatic lesions are common findings in an aging society due to an increasing availability of high-resolution cross-sectional imaging. Although the overall prevalence of malignancy and the rate of malignant conversion are low, especially mucinous pancreatic cystic lesions such as intraductal papillary mucinous neoplasm and mucinous cystic neoplasm harbor significant malignant potential depending on their morphology and size. Recently updated guidelines recommend sophisticated algorithms for initial workup and surveillance based on individual characteristics of the cystic lesion and the patient, thus weighing the lifetime risk for malignancy against the adverse event rate of potentially curative surgery in the light of number and location of cystic lesions, age of the patient, comorbidities, and the resulting life expectancy as well as the effect of repeated follow-up examinations on the patient's quality of life...
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30140684/the-role-of-endoscopic-ultrasound-in-the-diagnosis-of-cystic-lesions-of-the-pancreas
#8
REVIEW
Philippe Lévy, Vinciane Rebours
A precise diagnosis of the nature of pancreatic cystic neoplasm (PCN) is crucial since it determines the patients in need of rapid surgical resection as well as those who can be followed up, and, accordingly, the frequency and modalities of surveillance. Endoscopic ultrasound (EUS) and especially fine needle aspiration (FNA) are invasive methods, with specific adverse events occurring in 2.7-5%. Thus, they should only be used as a third-line tool in the absence of characteristic radiographic features on computed tomography (CT) scan and magnetic resonance imaging (MRI)...
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30140683/radiological-workup-of-cystic-neoplasms-of-the-pancreas
#9
REVIEW
Thomas L Bollen, Frank J Wessels
Pancreatic cystic lesions are being detected with increasing frequency because of increased use and improved quality of cross-sectional imaging techniques. Pancreatic cystic lesions encompass non-neoplastic lesions (such as pancreatitis-related collections) and neoplastic tumors. Common cystic pancreatic neoplasms include serous cystadenomas, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and solid pseudopapillary tumors. These cystic pancreatic neoplasms may have typical morphology, but at times show overlapping imaging features on cross-sectional examinations...
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30140682/cyst-fluid-biomarkers-diagnosis-and-prediction-of-malignancy-for-cystic-lesions-of-the-pancreas
#10
REVIEW
Aadhithya Raman, Anne Marie Lennon
Pancreatic cysts are common, and are identified in 2-13% of individuals undergoing cross-sectional imaging. Intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) are pancreatic cysts which are precursors to pancreatic adenocarcinoma. Currently available tools are imperfect at differentiating IPMNs and MCNs from other, benign types of pancreatic cysts. The role of molecular markers in the evaluation of pancreatic cysts and the identification of cysts with high-grade dysplasia or invasive adenocarcinoma is reviewed...
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/30140681/cystic-lesions-of-the-pancreas
#11
EDITORIAL
Julia Mayerle, Jens Werner
No abstract text is available yet for this article.
July 2018: Visceral Medicine
https://www.readbyqxmd.com/read/29888246/long-term-outcomes-after-surgery-for-appendiceal-mucinous-tumours
#12
Audrius Dulskas, Tomas Poskus, Eligijus Poskus, Kestutis Strupas
Background: Appendiceal mucinous tumour (AMT) is a very uncommon disease. We aimed to evaluate preoperative and postoperative characteristics as well as long-term outcomes of patients with appendiceal mucinous adenomas and peritoneal pseudomyxoma (PMP). Methods: A consecutive cohort of patients diagnosed with AMT were included in the study. Tumour recurrence and the development of PMP was diagnosed based on the patients' complaints, physical examination, imaging studies, and biopsy results...
April 2018: Visceral Medicine
https://www.readbyqxmd.com/read/29888245/current-concepts-of-inguinal-hernia-repair
#13
REVIEW
Ferdinand Köckerling, Maarten P Simons
With more than 20 million patients annually, inguinal hernia repair is one of the most often performed surgical procedures worldwide. The lifetime risk to develop an inguinal hernia is 27-43% for men and 3-6% for women. In spite of all advances, 11% of all patients suffer from a recurrence and 10-12% from chronic pain following primary inguinal hernia repair. By developing evidence-based guidelines and recommendations, the international hernia societies aim to improve the outcome of inguinal hernia repair due to standardization of care...
April 2018: Visceral Medicine
https://www.readbyqxmd.com/read/29888244/functional-diagnosis-in-upper-and-lower-gastrointestinal-diseases-relevance-for-conservative-interdisciplinary-and-surgical-therapies
#14
Mark Fox, Henriette Heinrich, Silvana Perretta, Daniel Steinemann
No abstract text is available yet for this article.
April 2018: Visceral Medicine
https://www.readbyqxmd.com/read/29888243/high-resolution-anorectal-manometry-new-insights-in-the-diagnostic-assessment-of-functional-anorectal-disorders
#15
REVIEW
Henriette Heinrich, Benjamin Misselwitz
Functional anorectal disorders such as faecal incontinence (FI), functional anorectal pain, and functional defecation disorders (FDD) are highly prevalent and represent a high socioeconomic burden. Several tests of anorectal function exist in this setting; however, high-resolution anorectal manometry (HR-ARM) is a new tool that depicts pressure all along the anal canal and can assess rectoanal coordination. HR-ARM is used in the diagnosis of FI and especially FDD although data in health is still sparse, and pressure phenomena seen during simulated defecation, such as dyssynergia, are highly prevalent in health...
April 2018: Visceral Medicine
https://www.readbyqxmd.com/read/29888242/before-and-after-anorectal-surgery-which-information-is-needed-from-the-functional-laboratory
#16
REVIEW
Maria Witte, Frank Schwandner, Ernst Klar
Background: Anorectal surgery covers a wide spectrum of surgery. Diagnostic workup of anorectal disease is based on clinical examination with basic functional tests followed by more elaborate diagnostic tests. Since the incidence of anorectal disorders increases with age, more patients will present in outpatient clinics, thus underlining the relevance of this topic. Methods: A PubMed literature search was performed using the terms 'anal incontinence', 'anal and rectal surgery', 'functional diagnostics', and combinations of these terms...
April 2018: Visceral Medicine
https://www.readbyqxmd.com/read/29888241/medical-therapy-of-constipation-current-standards-and-beyond
#17
REVIEW
Viola Andresen, Peter Layer
Chronic constipation is a very common medical problem with relevant impact on the patients' quality of life. Modern definitions recognize constipation as a polysymptomatic disorder, including various aspects of disturbed defecation. Current guidelines recommend a stepwise approach in the management of chronic constipation. Isolated or concomitant evacuation disorders should be identified and may need differential/additional treatment. Baseline measures include lifestyle components and bulking agents. The next step recommends treatment with conventional laxatives...
April 2018: Visceral Medicine
https://www.readbyqxmd.com/read/29888240/before-and-after-esophageal-surgery-which-information-is-needed-from-the-functional-laboratory
#18
REVIEW
Ines Gockel, Sebastian Murad Rabe, Stefan Niebisch
Background: Indications for benign esophageal surgery and postoperative follow-up need to be highly elaborated with differentiated and structured algorithms, based on objective functional workup in the esophageal laboratory. Functional outcome is of utmost interest and has to be driven by the need for comprehensive but purposeful diagnostic methods. Methods: Preoperative diagnostic workup procedures by the functional laboratory include 24-h pH-monitoring, impedance testing, and high-resolution manometry (HRM) - in addition to upper gastrointestinal endoscopy and barium swallow/timed barium esophagogram...
April 2018: Visceral Medicine
https://www.readbyqxmd.com/read/29888239/medical-therapy-of-gastroesophageal-reflux-disease-beyond-proton-pump-inhibitors-where-are-we-heading
#19
REVIEW
Herbert Koop
Proton pump inhibitors (PPI) have greatly improved the treatment of gastroesophageal reflux disease. However, recent investigations have revealed that reflux symptoms persist in a substantial number of patients. Therefore, treatment strategies beyond PPI are urgently required. One such strategy may involve more reliable acid suppression, e.g., with new acid inhibitory drugs. Furthermore, the rapid appearance of an acidic compartment in the proximal stomach after a meal, which is largely responsible for postprandial heartburn, requires a specific kind of therapy in addition to PPI which still needs to be established...
April 2018: Visceral Medicine
https://www.readbyqxmd.com/read/29888238/what-is-the-impact-of-high-resolution-manometry-in-the-functional-diagnostic-workup-of-gastroesophageal-reflux-disease
#20
REVIEW
Jutta Keller
International guidelines agree that high-resolution esophageal manometry (HRM) is an integral part of the diagnostic evaluation of patients with refractory reflux symptoms and should be performed before antireflux surgery. Its most important goal is to explore differential diagnoses, in particular major esophageal motility disturbances, that may be responsible for symptoms. HRM additionally provides insights into all relevant pathomechanisms of gastroesophageal reflux disease (GERD): It can reveal important information on the morphology and function of the esophagogastric junction (EGJ), the presence of a hiatus hernia, transient lower esophageal sphincter relaxations, and dysmotility of the esophageal body...
April 2018: Visceral Medicine
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