Surgery, Gastroenterology and Oncology

Read article While idiopathic intracranial hypertension (IIH) is more commonly recognized as a disorder of adults, it affects children of all ages and can have distinctive characteristics when presenting in the prepubertal age group. It is characterized by raised intracranial pressure (ICP) in the absence of brain parenchymal lesion, vascular malformations, hydrocephalus, or central nervous system (CNS) infection. The diagnosis is usually confirmed by a high opening pressure of cerebrospinal fluid (CSF) with exclusion of secondary causes of intracranial hypertension.
Objectives: The p....[more]

Read article Background: The therapeutic index for tacrolimus (Tac) is relatively narrow and can vary postoperatively in pancreas transplantation (PancTx) recipients secondary to various factors. We hypothesised that intra-patient Tac variability (%Coefficient of Variance; Tac %CoV) after PancTx would influence early patient outcomes.

Methods: 45 pancTx recipients in our centre between 2009-2014 were retrospectively reviewed. The %CoV was calculated using their inpatient Tac levels [(standard deviation Tac trough level mean Tac trough level) x 100]. Patients were then separ....[more]

Read article Introduction: Prophylactic antifibrinolytics are recommended for patients at risk to develop significant hyperfibrinolysis during liver transplantation, identified by the preoperative thromboelastometry. Even with this approach, postreperfusion hyperfibrinolysis is frequent, often leading to increased bleeding and transfusion requirements.The aim of this study was to assess hyperfibrinolysis and to predict postreperfusion hyperfibrinolysis based on preoperative standard coagulation tests (SCTs) and thromboelastometry in liver transplant patients without an indication for antif....[more]

Read article Purpose: The aim of this study is to describe the role of the percutaneous biliary drainage (PTBD) in the managament of patients with hepatic cholangiocarcinoma (CC) and also to assess outcomes and complications after PTBD procedures.

Methods and Materials: 225 consecutive patients with biliary obstruction managed by PTBD were included. All cases were performed by four consultant interventional radiologist between January 2014 and March 2016. Demografic data, patients history, the radiological data base, laboratory test from and following intervention, procedur....[more]

Read article Hepatocellular carcinoma (HCC) is the fifth most frequent cancer worldwide and in most cases it evolves on a cirrhotic liver, which requires a complex treatment strategy that includes different options. We present the case of a 62 years old patient, suffering from chronic HBV and HDV hepatitis, which was found, in 2011 with a 7 cm HCC located in the sixth segment of the liver and resected. Within less than a year, tumor relapse was detected (multiple nodules in the remaining sixth segment).
Systemic chemotherapy (Sorafenib) started being administered and two TACE procedures were....[more]

Read article Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. It is a rare condition that causes significant morbidity and mortality and often occurs in the elderly with significant comorbidities .
Individual diagnostic and treatment strategies are required for optimal management and outcome. We describe a case of Bouveret's Syndrome in an elderly patient who was managed successfully through surgery.