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| 1 | Pathophysiological consequences of obstructive jaundice and perioperative management显示文摘Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management.Data sources: A Pub Med was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated.Results: The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier,the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production(TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders,nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma,albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.Conclusion: The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy. | Efstathios T Pavlidis Theodoros E Pavlidis | 2018 | Hepatobiliary & Pancreatic Diseases International2018，17，1： | 63 |
| 2 | Pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome: Pathogenesis, clinical manifestations, diagnosis,treatment, and outcomes显示文摘Hepatic sinusoidal obstruction syndrome (HSOS) can be caused by the intake of pyrrolizidine alkaloids (PAs). To date, PAs-induced HSOS has not been extensively studied. In view of the difference in etiology of HSOS between the West and China, clinical profiles, imaging findings, treatment, and outcomes of HSOS associated with hematopoietic stem cell transplantation or oxaliplatin might be hardly extrapolated to PAs-induced HSOS. Reactive metabolites derived from PAs form pyrrole-protein adducts that result in toxic destruction of hepatic sinusoidal endothelial cells. PAs-induced HSOS typically manifests as painful hepatomegaly, ascites, and jaundice. Laboratory tests revealed abnormal liver function tests were observed in most of the patients with PAs-induced HSOS. In addition, contrast computed tomography and magnetic resonance imaging scan show that patients with PAs-induced HSOS have distinct imaging features, which reveal that radiological imaging provides an effective noninvasive method for the diagnosis of PAs-induced HSOS. Liver biopsy and histological examination showed that PAs-induced HSOS displayed distinct features in acute and chronic stages. Therapeutic strategies for PAs-induced HSOS include rigorous fluid management, anticoagulant therapy, glucocorticoids, transjugular intrahepatic portosystemic shunt, liver transplantation, etc. The aim of this review is to describe the pathogenesis, clinical profiles, diagnostic criteria, treatment, and outcomes of PAs-induced HSOS. | Xiao-Qian Yang Jin Ye Xin Li Qian Li Yu-Hu Song | 2019 | World Journal of Gastroenterology2019，25，28： | 29 |
| 3 | Accurate definition and management of idiopathic sclerosing encapsulating peritonitis显示文摘AIM: To review the literature on idiopathic sclerosing encapsulating peritonitis(SEP), also known as abdominal cocoon syndrome. METHODS: The Pub Med, MEDLINE, Google Scholar, and Google databases were searched using specific key words to identify articles related to idiopathic SEP. These key words were 'sclerosing encapsulating peritonitis,' 'idiopathic sclerosing encapsulating peritonitis,' 'abdominal cocoon,' and 'abdominal cocoon syndrome.' The search included letters tothe editor, case reports, review articles, original articles, and meeting presentations published in the English-language literature from January 2000 to May 2014. Articles or abstracts containing adequate information about age, sex, symptom duration, initial diagnosis, radiological tools, and surgical approaches were included in the study. Papers with missing or inadequate data were excluded. RESULTS: The literature search yielded 73 articles on idiopathic(primary) SEP published in 23 countries. The four countries that published the greatest number of articles were India(n = 21), Turkey(n = 14), China(n = 8) and Nigeria(n = 3). The four countries that reported the greatest number of cases were China(n = 104; 53.88%), India(n = 35; 18.13%), Turkey(n = 17; 8.80%) and Nigeria(n = 5; 2.59%). The present study included 193 patients. Data on age could be obtained for 184 patients(range: 7-87 years; mean ± SD, 34.7 ± 19.2 years), but were unavailable for nine patients. Of the 184 patients, 122 were male and 62 were female; sex data could not be accessed in the remaining nine patients. Of the 149 patients whose preoperative diagnosis information could be obtained, 65(43.6%) underwent operations for abdominal cocoon, while the majority of the remaining patients underwent operations for a presumed diagnosis of intestinal obstruction and/or abdominal mass. Management information could be retrieved for 115 patients. Of these, 68 underwent excision + adhesiolysis(one laparoscopic); 24 underwent prophylactic appendectomy in addition to excision + adhesiolysis. Twenty patients underwent various resection and repair techniques along with excision + adhesiolysis. The remaining three patients were managed with antituberculosis therapy(n = 2) and immunosuppressive therapy(n = 1). CONCLUSION: Idiopathic SEP is a rare disorder characterized by frequently recurring bouts of intestinal obstruction. Surgical therapy is the gold standardmanagement strategy. | Sami Akbulut | 2015 | World Journal of Gastroenterology2015，21，2： | 29 |
| 4 | Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention显示文摘Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast followthrough and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. 'Good' surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients. | Fausto Catena Salomone Di Saverio Federico Coccolini Luca Ansaloni Belinda De Simone Massimo Sartelli Harry Van Goor | 2016 | World Journal of Gastrointestinal Surgery2016，8，3： | 28 |
| 5 | Ginsenoside Rb1,a Panoxadiol Saponin against Oxidative Damage and Renal Interstitial Fibrosis in Rats with Unilateral Ureteral Obstruction显示文摘Objective:To investigate the possible protective effect and mechanism of ginsenoside Rb1 against oxidative damage and renal interstitial fibrosis on rats with unilateral ureteral obstruction(UUO). Methods:In total,80 male rats were randomly divided into 4 groups,20 in each group:the sham operated group (SOR),UUO group,UUO with ginsenoside Rb1 treatment group(treated with intraperitoneal injection of 50 mg/ kg daily) and UUO with Losartan treatment group(as the positive control,treated with 20 mg/kg by ga... | 谢席胜 刘衡川 杨满 左川 邓尧 樊均明 | 2009 | Chinese Journal of Integrative Medicine2009，15，2： | 25 |
| 6 | 督导式护理干预在肠梗阻导管治疗肠梗阻中临床应用效果研究显示文摘肠梗阻(intestinal obstruction)由肠内异物堵塞及肠肌痉挛等引起,是常见的外科急腹症之一,目前对急性肠梗阻的诊断还比较困难,并且肠梗阻的病情发展快,患者的病死率较高。肠梗阻按照病因可以分为机械性肠梗阻、动力性肠梗阻和血运性肠梗阻,其中机械性肠梗阻的发病率最高,在肠梗阻的治疗中最为常见,它是由肠外、肠内和肠壁的各种机械性因素引起的肠内容物通过障碍。 | 万丽 陈玉梅 | 2017 | 山西医药杂志2017，46，6： | 20 |
| 7 | Metabonomic phenotype and identification of “heart blood stasis obstruction pattern” and “qi and yin deficiency pattern” of myocardial ischemia rat models显示文摘The traditional Chinese medicine concepts of 'Xinxueyuzuzheng (heart blood stasis obstruction pattern)' and 'Qiyinliangxuzheng (qi and yin deficiency pattern)' for myocardial ischemia rat models were constructed in the present study. Endogenous metabolites in rat plasma were analyzed using the GC/TOF-MS-based metabonomic method. Significant metabolic differences were observed between the control and two model groups, and the three groups were distinguished clearly by pattern recognition. Compared with those of the control, the levels of hydroxyproline, threonic acid, glutamine and citric acid were strikingly up or down-regulated in model rats. The metabolites contributing most to the classification between the two 'pattern' rats were identified, such as valine, serine, threonine, ornithine, hydroxyproline, lysine, 2-hydroxybutanoic acid, 3-hydroxybutanoic acid, galactofuranose and inositol. These compounds were indicated as the potential biomarkers. The results suggested that the two 'patterns' are involved in dysfunction in oxidative stress, energy metabolism and amino acid metabolism. These findings also provided the substantial foundation for exploring the scientific connotation of these two 'Zhengxing (pattern types)' of myocardial ischemia, and 'Bianzheng (pattern identification)'. | YAN Bei1, A JiYe1, HAO HaiPing1, WANG GuangJi1, ZHU XuanXuan2, 3, ZHA WeiBin1, LIU LinSheng1, GUAN EnZe3, ZHANG Ying1, GU ShengHua1, HUANG Qing1 & ZHENG YuanTing1 1Key Laboratory of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing 210009, China 2Pharmacological Laboratory of Clinical Research Institute, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029, China 3College of Pharmacy, Nanjing University of Traditional Chinese Medicine, Nanjing 210029, China | 2009 | Science China(Life Sciences)2009，52，11： | 19 |
| 8 | Fecal microbiota transplantation and prednisone for severe eosinophilic gastroenteritis显示文摘Eosinophilic gastroenteritis is a rare disease of unknown etiology.It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations.We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man.The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital.Then he was misdiagnosed as having Crohn’s disease in another university teaching hospital.Finally,the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn’s disease by fecal microbiota transplantation.Physical examination revealed a slight distended abdomen with diffuse tenderness.Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%,as well as eosinopenia,monocytopenia and lymphocytopenia.Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon.We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations.The patient was treated by fecal microbiota transplantation combined with oral prednisone,and was free from gastrointestinal symptoms at the time when we reported his disease.This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis. | Yi-Xuan Dai Chuan-Bing Shi Bo-Ta Cui Min Wang Guo-Zhong Ji Fa-Ming Zhang | 2014 | World Journal of Gastroenterology2014，20，43： | 18 |
| 9 | Bezoar-induced small bowel obstruction: Clinical characteristics and diagnostic value of multi-slice spiral computed tomography显示文摘AIM: To determine the possible predisposing factors of bezoar-induced small bowel obstruction(b I-Sb O) and to discuss the diagnostic value of multi-slice spiral computed tomography,particularly contrast-enhanced scanning,in this condition.METHODS: A total of 35 b I-Sb O cases treated at our hospital from January 2007 to December 2013 were retrospectively analysed.Complete clinical and computed tomography(CT) data of the patients were available and confirmed by surgery.SbO was clinically diagnosed on the basis of clinical manifestations.Of the 35 patients,18 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT and 17 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT combined with contrastenhanced examination.Original images were processed using a GE ADW4.3 workstation to obtain MPR,CPR,MIP and CTA images.The images of all patients were evaluated by two abdominal imaging experts.The main analytical contents of planar scanning included intestinal bezoar conditions,changes in the intestinal wall and changes in peri-intestinal conditions.Vascular hyperaemia and arterial blood supply conditions at a specific obstruction site and the distal end of the obstruction site were evaluated through contrastenhanced examination.RESULTS: The proportion of males to females among the 35 cases was 1:1.69(13:22); median age was 63.3 years.The following cases were observed: 29(82.8%) cases occurred in autumn and winter and showed a history of consuming high amounts of persimmon and hawthorn; 19(54.3%) cases revealed a history of gastrointestinal surgery; 19 exhibited incomplete dentition,with missing partial or whole posterior teeth; 26 suffered from obstruction at the ileum.A total of 51 bezoars were found in these patients,of whom 16(45.7%) had multiple bezoars.CT planar scanning of bezoars showed lumps with mottled gas inside the intestinal cavity.Furthermore,9 cases of bezoars had envelopes and 11 cases were accompanied with thickening of the distal wall of the obstructed bowel.Scanning of 17 cases was enhanced; the results revealed that the mesenteric blood vessels at the obstruction site and the proximal site were dilated,and a total of 7 cases were accompanied with distal vascular dilation and intestinal wall thickening.CONCLUSION: b I-Sb O exhibits regional and seasonal characteristics.CT planar and contrast-enhanced scanning can be applied to diagnose and observe vascular conditions in obstructed zones. | Pei-Yuan Wang Xia Wang Lin zhang Hai-Fei Li Liang Chen Xu Wang bin Wang | 2015 | World Journal of Gastroenterology2015，21，33： | 18 |
| 10 | Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction显示文摘AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent(PS) or nasobiliary catheter(NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedurerelated adverse events, stent/catheter dysfunction(occlusion or migration of PS/NBC, developmentof cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution(bilirubin level < 3.0 mg/d L) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.RESULTS: In total, 419 patients were included in the study(PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients(46%), bile duct cancer in 172(41%), gallbladder cancer in three(1%), and ampullary cancer in 50(12%). The median serum total bilirubin was 7.8 mg/d L and 324 patients(77%) had ≥ 3.0 mg/d L. During the median time to surgery of 29 d [interquartile range(IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio(SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method(PS or NBC).CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored. | Naoki Sasahira Tsuyoshi Hamada Osamu Togawa Ryuichi Yamamoto Tomohisa Iwai Kiichi Tamada Yoshiaki Kawaguchi Kenji Shimura Takero Koike Yu Yoshida Kazuya Sugimori Shomei Ryozawa Toshiharu Kakimoto Ko Nishikawa Katsuya Kitamura Tsunao Imamura Masafumi Mizuide Nobuo Toda Iruru Maetani Yuji Sakai Takao Itoi Masatsugu Nagahama Yousuke Nakai Hiroyuki Isayama | 2016 | World Journal of Gastroenterology2016，22，14： | 18 |
| 11 | Surgery in biliary lithiasis: from the traditional “open” approach to laparoscopy and the“rendezvous” technique显示文摘BACKGROUND:According to the current literature, biliary lithiasis is a worldwide-diffused condition that affects almost 20% of the general population. The rate of common bile duct stones(CBDS) in patients with symptomatic cholelithiasis is estimated to be 10% to 33%, depending on patient's age.Compared to stones in the gallbladder, the natural history of secondary CBDS is still not completely understood. It is not clear whether an asymptomatic choledocholithiasis requires treatment or not. For many years, open cholecystectomy with choledochotomy and/or surgical sphincterotomy and cleaning of the bile duct were the gold standard to treat both pathologies. Development of both endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic surgery,together with improvements in diagnostic procedures, influenced new approaches to the management of CBDS in association with gallstones.DATA SOURCES:We decided to systematically review the literature in order to identify all the current therapeutic options for CBDS. A systematic literature search was performed independently by two authors using Pub Med, EMBASE, Scopus and the Cochrane Library Central.RESULTS:The therapeutic approach nowadays varies greatly according to the availability of experience and expertise in each center, and includes open or laparoscopic common bile duct exploration, various combinations of laparoscopic cholecystectomy and ERCP and combined laparoendoscopic rendezvous.CONCLUSIONS:Although ERCP followed by laparoscopic cholecystectomy is currently preferred in the majority of hospitals worldwide, the optimal treatment for concomitant gallstones and CBDS is still under debate, and greatly varies among different centers. | Giuseppe Tarantino Paolo Magistri Roberto Ballarin Giacomo Assirati Antonio Di Cataldo Fabrizio Di Benedetto | 2017 | Hepatobiliary & Pancreatic Diseases International2017，16，6： | 18 |
| 12 | Enhanced recovery after surgery vs conventional care in emergency colorectal surgery显示文摘AIM:To investigate the feasibility and beneficial effects of enhanced recovery after surgery(ERAS) programme in the setting of emergency colorectal surgery.METHODS:Between January 2011 and October 2013,patients undergoing emergency resection for obstructing colorectal cancer at the Faculty of Medicine Siriraj Hospital,Bangkok,Thailand using ERAS programme were compared with those using conventional care(1:2 ratio). They were matched for their age,gender,ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity score,and type of surgery. Primary outcomes were length of hospital stay and postoperative morbidity. Secondary outcomes included gastrointestinal recovery,30-d readmission,and time interval from surgery to chemotherapy.RESULTS:Twenty patients treated with ERAS programme were compared with 40 patients receiving conventional postoperative care.Median of hospital stay was shorter in the ERAS group:5.5 d(range:3-16)vs 7.5 d(range:5-25),P=0.009.The ERAS group had a non-significant reduction in the incidence of postoperative complication(25%vs 48%,P=0.094).No 30-d mortality and readmission occurred.Patients with ERAS programme had a shorter time to first flatus(1.6 d vs 2.8 d,P<0.001)and time to resumption of normal diet(3.5 d vs 5.5 d,P=0.002).Time interval between operation and initiation of adjuvant chemotherapy was significantly shorter in the ERAS group(37 d vs 49 d,P=0.009).CONCLUSION:The ERAS programme in the setting of emergency colorectal surgery was safe and feasible.It achieved significantly shorter hospitalisation and faster recovery of bowel function. | Varut Lohsiriwat | 2014 | World Journal of Gastroenterology2014，20，38： | 16 |
| 13 | Palliative treatment for incurable malignant colorectal obstructions: A meta-analysis显示文摘AIM:To perform a meta-analysis of palliative stent placement vs palliative surgical decompression for management of incurable malignant colorectal obstructions.METHODS:The databases of Medline,Web of Science,Embase,and the Cochrane Central Register of Controlled Trials were searched from their inception to July 2012 for studies(prospective,retrospective,randomized controlled trials,and case-control trials)designed as comparative analyses of patients with incurable malignant colorectal obstructions treated by selfexpanding metallic stents(SEMS)or palliative surgery.No language restrictions were imposed.The main outcome measures were hospital stay,intensive care unit admission,clinical success rate,30-d mortality,stoma formation,complications,and overall survival time.The data extraction was conducted by two investigators working independently and using a standardized form.The Mantel-Haenszel 2method was used to estimate the pooled risk ratios with 95%CI under a fixed-effects model;when statistical heterogeneity existed in the pooled data(as evaluated by Q test and I2statistics,where P<0.10 and I2<25%indicated heterogeneity),a random-effects model was used.RESULTS:Thirteen relevant articles,representing837 patients(SEMS group,n=404;surgery group,n=433),were selected for analysis.Compared to the surgery group,the SEMS group showed lower clinical success(99.8%vs 93.1%,P=0.0009)but shorter durations of hospital stay(18.84 d vs 9.55 d,P<0.00001)and time to initiation of chemotherapy(33.36 d vs15.53 d,P<0.00001),and lower rate of stoma formation(54.0%vs 12.7%,P<0.00001).Additionally,the SEMS group experienced a significantly lower rate of30-d mortality(4.2%vs 10.5%,P=0.01).Stent-related complications were not uncommon and included perforation(10.1%),migration(9.2%),and occlusion(18.3%).Surgery-related complications were slightly less common and included wound infection(5.0%)and anastomotic leak(4.7%).The rate of total complications was similar between these two groups(SEMS:34.0%vs surgery:38.1%,P=0.60),but the surgeryrelated complications occurred earlier than stent-related complications(rate of early complications:33.7%vs13.7%,P=0.03;rate of late complications:32.3%vs12.7%,P<0.0001).The overall survival time of SEMSand surgery-treated patients was not significantly different(7.64 mo vs 7.88 mo).CONCLUSION:SEMS is less effective than surgery for palliation of incurable malignant colorectal obstructions,but is associated with a shorter time to chemotherapy and lower 30-d mortality. | Xiao-Dan Zhao Bao-Bao Cai Ri-Sheng Cao Rui-Hua Shi | 2013 | World Journal of Gastroenterology2013，19，33： | 15 |
| 14 | Acute appendicitis: Epidemiology, treatment and outcomesanalysis of 16544 consecutive cases显示文摘AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA) in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants) from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17,54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92.Mortality was < 0.0001%.Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48% of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results. | Marco Ceresoli Alberto Zucchi Niccolò Allievi Asaf Harbi Michele Pisano Giulia Montori Arianna Heyer Gabriela E Nita Luca Ansaloni Federico Coccolini | 2016 | World Journal of Gastrointestinal Surgery2016，8，10： | 14 |
| 15 | Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract显示文摘Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number(agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography(US) is typically the first imaging performed as it is easily available, noninvasive and radiation free used both antenatally and postnatally. Computed tomography(CT) and magnetic resonance imaging(MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management. | Subramaniyan Ramanathan Devendra Kumar Maneesh Khanna Mahmoud Al Heidous Adnan Sheikh Vivek Virmani Yegu Palaniappan | 2016 | World Journal of Radiology2016，8，2： | 13 |
| 16 | Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome显示文摘Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Ab-dominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of 'recurrent characteristics of the complaints' that can be learned by a careful history, may be helpful in diagnosis. | Yener Uzunoglu Fatih Altintoprak Omer Yalkin Yasemin Gunduz Guner Cakmak Orhan V Ozkan Fehmi Celebi | 2014 | World Journal of Clinical Cases2014，2，11： | 13 |
| 17 | Enteral stents for the management of malignant colorectal obstruction显示文摘Colorectal cancer(CRC) is the 3rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient's quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may beused to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient's condition for curative surgical intervention. An overall complication rate(major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects. | Jeremy Kaplan Anna Strongin Douglas G Adler Ali A Siddiqui | 2014 | World Journal of Gastroenterology2014，20，37： | 13 |
| 18 | Treatment of a patient with obstructive jaundice and extrahepatic portal hypertension显示文摘BACKGROUND:Recurrence of inflammation in the extrahepatic bile duct can lead to bile duct stenosis, obstructive jaundice and cavernous transformation of the portal vein.The latter can develop into extrahepatic portal hypertension(PHT).It is difficult to establish the correct method for treating these conditions. METHODS:At another hospital,a 51-year-old man developed PHT as a result of endoscopic retrograde cholangiopancreatography and endoscopic nasobiliary drainage to relieve cholelithiasis and obstructive jaundice. We dealt with the biliary tract obstruction through percutaneous transhepatic cholangial drainage(PTCD), followed by selective devascularization and a shunt operation 2 weeks after the disappearance of jaundice. Three months after cholecystojejunostomy,there were no obvious changes around the bile duct. RESULT:The patient recovered uneventfully and was discharged 14 days after operation. CONCLUSION:For this patient,surgery in stages was the best choice.The most suitable method to decrease jaundice is PTCD. | Xu, Qing Gu, Lei Wu, Zhi-Yong | 2009 | Hepatobiliary & Pancreatic Diseases International2009，8，4： | 12 |
| 19 | Comparison of endoscopic stenting for malignant biliary obstruction: A single-center study显示文摘AIM: To evaluate the efficacy and safety of single-step endoscopic placement of self-expandable metallic stents(SEMS) for treatment of obstructive jaundice.METHODS: A retrospective study was performed among 90 patients who underwent transpapillary biliary metallic stent placement for malignant biliary obstruction(MBO) between April 2005 and October 2012. The diagnosis of primary disease and MBO was based on abdominal ultrasound, computed tomography, magnetic resonance imaging, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography with brush cytology, biopsy, and/or a combination of these modalities. The type of SEMS(covered or non-covered, 8 mm or 10 mm in diameter) was determined by the endoscopist. Ninety patients were divided into two groups: group 1(49 patients) who underwent a singlestep SEMS placement and group 2(41 patients) who underwent a two-step SEMS placement. The technical success rate, complication rate, stent patency, and patient survival rate were compared between the groups. In addition, to identify the clinical prognostic factors associated with patient survival, the following variables were evaluated in Cox-regression analysis: gender, age, etiology of MBO(pancreatic cancer or nonpancreatic cancer), clinical stage(Ⅳb; with distant metastases or Ⅳa >; without distant metastases), chemotherapy(with or without), patency of the stent, and the use of single-step or two-step SEMS. RESULTS: Immediate technical success was achieved in 93.9%(46/49) in group 1 and in 95.1%(39/41) in group 2, with no significant difference(P = 1.0). Similarly, there was no difference in the complication rates between the groups(group 1, 4.1% and group 2, 4.9%; P = 0.62). Stent failure was observed in 10 cases in group 1(20.4%) and in 16 cases in group 2(39.0%). The patency of stent and patient survival revealed no difference between the two groups with Kaplan-Meier analysis, with a mean patency of 111 ± 17 d in group 1 and 137 ± 19 d in group 2(P = 0.91), and a mean survival of 178 ± 35 d in group 1 and 222 ± 23 d in group 2(P = 0.57). On the contrary, the number of days of hospitalization associated with first-time SEMS placement in group 1 was shorter when compared with that number in group 2(28 vs 39 d; P < 0.05). Multivariate analysis revealed that a clinical stage of Ⅳa >(P = 0.0055), chemotherapy(P = 0.0048), and no patency of the stent(P = 0.011) were independent prognostic factors associated with patient survival.CONCLUSION: Our results showed that single-step endoscopic metal stent placement was safe and effective for treating obstructive jaundice secondary to various inoperable malignancies. | Ryuichi Yamamoto Masatomo Takahashi Yasuyo Osafune Katsuya Chinen Shingo Kato Sumiko Nagoshi Koji Yakabi | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，9： | 12 |
| 20 | Nasogastric tube syndrome induced by an indwelling long intestinal tube显示文摘The nasogastric tube(NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome(NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube. | Naoki Sano Masayoshi Yamamoto Kentaro Nagai Keiichi Yamada Nobuhiro Ohkohchi | 2016 | World Journal of Gastroenterology2016，22，15： | 11 |
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