The relationship between gallbladder status and recurrent biliary complications in patients with choledocholithiasis following endoscopic treatment

AbstractBackgroundEndoscopic methods are currently the treatment of choice for patients with common bile duct (CBD) stones, but subsequent management of the intact gallbladder for patients following endoscopic treatment is still controversial. The primary aim of this study was to discover the association between gallbladder status and recurrent biliary complications for patients with CBD stones after endoscopic treatment. Additionally, we also sought to determine risk factors for recurrent biliary complications in these patients.MethodsThe records of 1625 patients with CBD stones following endoscopic treatment were reviewed. A total of 681 patients were enrolled and subsequently categorized into four groups: Group 1 (n = 201), calculous gallbladder; Group 2 (n = 140), acalculous gallbladder; Group 3 (n = 175), elective cholecystectomy after endoscopic treatment; and Group 4 (n = 165), prior cholecystectomy. The basic demographics and recurrent biliary complications during follow-up among these four groups were analyzed by Chi-square test, ANOVA, Kaplan-Meier analysis, and log-rank test.ResultsDuring the median follow-up period of 34 months, 133 patients (20%) with recurrent biliary complications were identified. The recurrence rates of Groups 1, 2, 3, and 4 were 29%, 11%, 15%, and 19%, respectively. Kaplan-Meier analysis showed that patients with calculous gallbladder had a significantly higher rate of recurrent biliary complication. In multivariate analysis, patients with a history of cirrhosis, juxta-papillary diverticulum, calculous gallbladder, CBD size ≥1.5 cm, and endoscopic management with endoscopic sphincterotomy were at a higher risk for developing biliary complications (p = 0.029, p = 0.039, p < 0.001, p = 0.002, p = 0.021, respectively.)ConclusionPatients with cholecystolithiasis and CBD stones had a higher incidence of recurrent biliary complications. For some of these patients, elective cholecystectomy following endoscopic treatment may be considered. However, routine elective cholecystectomy in patients with normal gallbladder is not appropriate because of the low recurrence of biliary complications. Whether gallbladder function affects the biliary clearance and biliary complications requires further research

Characterization of cracking within thermal spray deposits by an acoustic emission method: extended abstract

Four-point bend tests with in situ acoustic emission (AE) were used to study the cracking behavior of alumina-3 % titania materials prepared by gas- and water-stabilized plasma technologies (GSP and WSP, respectively). Catastrophic failure was observed for GSP-sprayed samples while WSP-sprayed samples exhibited microcracking before failure. The amplitude and energy distributions were also investigated, and it was determined that the percentage of macrocracks for GSP-sprayed samples is much larger than for WSP-sprayed samples. The processing effects, which induced differences in microstructure, may account for the differences in AE responses

Cherry-picking restaurant reservation customers

This study first identifies the mismatch between size and value when a restaurant that receives booking requests from customer parties elects to cherry-pick among the intending parties, and second proposes that SPM (average spending per person per minute) is a better indicator for evaluating any intending party's real value. The results obtained through discrete-event simulation techniques confirm that the proposed SPM policy outperforms policies based on party size and traditional first-come-first-served practices and the alternative recommendation is that focus should rest on more profitable strategies that improves SPM value rather than simply on going for size, that is, looking only for larger or smaller parties

Emergency Endoscopic Variceal Ligation versus Somatostatin for Acute Esophageal Variceal Bleeding

Endoscopic variceal ligation and somatostatin are widely used for treating acute esophageal variceal bleeding. This study compared the efficacy, safety, and survival of both therapies. Methods: Acute esophageal variceal bleeding patients were randomized to undergo emergency ligation or receive a bolus of 250 μg somatostatin plus infusion at 250 μg/hour for 48 hours and undergo ligation subsequently. Results: Three (4.8%) of 62 patients in the ligation group and 20 (31.7%) of 63 patients in the somatostatin group encountered treatment failure (p = 0.0001). Transfusion requirements were 4.7 ± 3.2 units in the ligation group and 6.9 ± 7.3 units in the somatostatin group (p = 0.03). Hospital stay was 7.7 ± 4.0 days in the ligation group and 10.2 ± 9.9 days in the somatostatin group (p = 0.07). Adverse effects occurred in the ligation group (20 episodes) and the somatostatin group (27 episodes) (p = 0.2). The 42-day mortality rates were 5 patients (8.1%) in the ligation group and 3 patients (4.8%) in the somatostatin group (p = 0.5). Conclusion: Emergency ligation was superior to somatostatin in treating acute esophageal variceal bleeding, with fewer requirements of transfusion and a tendency toward shorter hospital stay. The adverse effects and 42-day mortality rates were similar between both treatments

Nodular Regenerative Hyperplasia of the Liver

Nodular regenerative hyperplasia (NRH), characterized by diffuse hepatic micronodular transformation in groups without fibrous septa between the nodules, is a rare benign liver lesion that has many synonyms in previous literature. Pathologic evaluation is the mainstay of accurate diagnosis. Treatment is focused on its underlying conditions and complications of portal hypertension. A 39-year-old man visited our hospital due to right upper quadrant pain and a palpable liver mass. Magnetic resonance examination revealed a slightly hyperintense tumor on T2-weighted images, and focal nodular hyperplasia was diagnosed by the radiologists. Atypical radiologic findings could not yield an accurate diagnosis. Surgical intervention was therefore performed. Pathologic examination of the resected liver tumor confirmed the diagnosis of NRH. We conclude that NRH should be included in the differential diagnosis of benign liver tumor

Porosity measurement and densification of plasma sprayed alumina-titania deposits

Abstract not available