Id: 3527114 combined endoscopic/percutaneous rendezvous for biliary continuity … cerb the leak when traditional methods fail

CBD transection or partial resection is a severe iatrogenic injury that requires surgical reconstruction and exploration. Herein, we have reported a novel combined PTC and endoscopic rendezvous technique to achieve biliary continuity in these patients. A 65-year-old female presented with abdominal pain to an outside facility a few days after elective cholecystectomy performed for symptomatic cholelithiasis. She was found to have elevated troponin levels consistent with a non-ST elevation myocardial infarction and a CT scan showed free peritoneal fluid concerning for bile leak.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Sunday, May 23, 2021 Source Type: research

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AbstractChronic thromboembolic pulmonary hypertension is an underdiagnosed condition. Patients typically present with the symptoms of right heart failure. Diagnosis is usually done by radionuclide ventilation/perfusion (VQ) scan, high-quality multidetector computed tomography (CT) or pulmonary angiography at expert centers. Pulmonary endarterectomy remains the corner stone in management of chronic thromboembolic pulmonary hypertension. Deep hypothermic circulatory arrest is commonly used for the operation at most centers. In-hospital mortality ranges from 1.7 to 14.2%. Pulmonary hemorrhage, reperfusion lung injury, and rig...
Source: Indian Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
ConclusionsWe established the feasibility of initiating and managing patients in a monthly text-based symptom-monitoring program. The provision of smartphones and patient navigation were unique and vital components of this program.
Source: Quality of Life Research - Category: Health Management Source Type: research
ConclusionsInformatics solutions can generate timely, tailored office reports including PROs and predictive analytics. Patients successfully complete the pre-visit PRO assessments and clinicians and patients value the report to support shared surgical decisions.
Source: Quality of Life Research - Category: Health Management Source Type: research
ConclusionMultilevel IS frameworks are necessary for PROM/PREM implementation given the complexity. In cross-study comparisons, barriers to PROM/PREM implementation were consistent across patient populations and care settings, but enablers were context specific, suggesting the need for tailored implementation strategies based on clinic resources. Theoretically guided studies are needed to clarify how, why, and in what circumstances IS principles lead to successful PROM/PREM integration and sustainability.
Source: Quality of Life Research - Category: Health Management Source Type: research
ConclusionThis study was the preparatory phase for a future trial on a method to stimulate setting specific goals. The future trial would provide a thorough understanding of the quality of person-defined goals.
Source: Quality of Life Research - Category: Health Management Source Type: research
Discussion:This ECG is Aslanger's pattern, and the angiogram is exactly what you expect with this ECG pattern, including the inferior OMI attributed to circumflex (more often than RCA).This pattern was recently published in J Electrocardiology: Aslanger and others (including Smith).  A new electrocardiographic pattern indicating inferior myocardial infarction.  https://pubmed.ncbi.nlm.nih.gov/32526537/This newly recognized ECG pattern is defined as:(1) any STE in III (with reciprocal STD in aVL), but not in other inferior leads, (2) STD in any of leads V4 to V6, (but not in V2) with a positive...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
In this study, approximately 10% of Transient STEMI had no culprit found:Early or late intervention in patients with transient ST ‐segment elevation acute coronary syndrome: Subgroup analysis of the ELISA‐3 trialOne must use all available data, including the ECG, to determine what happened.Final Diagnosis?If the troponin remained under the 99% reference, then it would be unstable angina.  If it rose above that level before falling, it would be acute myocardial injury due to ischemia, which is, by definition, acute MI.  If that is a result of plaque rupture, then it is a type I MI.  The clinical presentat...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
One of our graduates, Rochelle Zarzar, who is now an education fellow, sent me this from one of the hospitals she works at now:An elderly woman presented with chest pain.  She had been nauseous the night before and did not feel well, then awoke 2 hours prior with chest pain.She had had a completely normal angiogram 3 months prior.Here is that angiogram report:The left main coronary artery is normal.Left anterior descending is a type 3 vessel and is normal.Left circumflex is nondominant and normal.The right coronary artery is dominant and normal.The nurses immediately recorded an ECG.  This was 2 hours after the o...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
ConclusionSpontaneously regressive epigastric pain with a normal physical and biology/ECG should not necessarily reassure the physician, in particular if patients have cardiovascular risk factors. A POCUS should be considered for these patients.
Source: Critical Ultrasound Journal - Category: Radiology Source Type: research
An 87-year-old woman presented to the emergency department with abdominal distension and feculent vomiting. She had significant comorbidities including recent pulmonary embolism, myocardial infarction, and atrial fibrillation. She also had a history of cholecystitis and cholangitis, but because of her comorbidities and age, her complicated gallstone disease had been managed nonsurgically. She had no change in bowel habit, weight loss, or per rectal bleeding. On examination, she had marked abdominal distension and vague generalized pain but no signs of peritonitis, and per rectal examination showed no masses.
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Electronic Image of the Month Source Type: research
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