scholarly journals Perihepatic Abscess due to a Liver Suture with Pledgets Used to Treat a Penetrating Liver Injury

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Hazuki Koguchi ◽  
Kimihiko Kusashio ◽  
Akihiro Fujita ◽  
Nao Yamamoto
Keyword(s):  
Liver Injury ◽  
Good Condition ◽  
Bile Leakage ◽  
Purulent Discharge ◽  
Duodenal Perforation ◽  
Emergency Laparotomy ◽  
Case Presentation ◽  
The Past ◽  
Liver Injuries ◽  
Selective Nonoperative Management

Background. Selective nonoperative management has become the standard for liver injuries. Accordingly, we cannot perform surgery for liver injuries as frequently as in the past. This report is aimed at sharing a valuable experience of postoperative complications after surgery for a liver injury. Case Presentation. A 40-year-old man was stabbed in his abdomen and underwent an emergency laparotomy for a severe liver injury. Five months after the operation, he developed fever, and purulent discharge was observed from an abdominal fistula. He was diagnosed with a perihepatic abscess and duodenal perforation due to the pledgets used for the operation. He underwent a second surgery to remove the pledgets and the abscess cavity for infection control and was discharged in good condition. Conclusion. The intra-abdominal environment should be considered contaminated due to bile leakage in surgeries following liver injury. Furthermore, nonabsorbable agents should not be used in these contaminated areas.

scholarly journals The Evolution of Liver Injury Diagnosis and Treatment in the Past 50 Years

2014 ◽  
Vol 3 (3) ◽  
pp. 124-131
Author(s):  
Charles E Lucas
Keyword(s):  
Liver Injury ◽  
Liver Tissue ◽  
Median Sternotomy ◽  
Operative Therapy ◽  
Diagnosis And Treatment ◽  
Current Therapy ◽  
Hepatic Veins ◽  
Artery Ligation ◽  
The Past ◽  
Liver Injuries

ABSTRACT Background During the past 50 years many changes have occurred in treating liver injury. Nonoperative therapy (NOT) for blunt penetrating injuries is now common. Study design This report highlights the current therapy of liver injury. Results Complications of NOT include early rebleeding requiring prompt operative intervention; intrahepatic hematoma which becomes infected necessitating drainage; bile peritoneum requiring exploration and drainage; and hemobilia requiring embolization, hepatotomy with ligation, or resection. Operative exposure through a midline incision which can be extended as a median sternotomy is preferred. Prehepatic and intrahepatic packs are helpful. Full mobilization of the right and left triangular ligaments augments exposure. Hemostasis for both blunt and penetrating, usually, is obtained by hepatorrhaphy using the 2’ blunt tipped needle swedged onto a 2-O chromic suture. Through-and-through injuries may require hepatotomy with intrahepatic ligation of cross-linking vessels. Locally destructive wounds may require nonanatomic debridement to the point of healthy liver tissue which is then sutured. Formal segmentectomy, or lobectomy, is seldom needed. Hepatic artery ligation controls deep arterial not involving the portal venous supply. The retrohepatic caval atrial shunt will facilitate hemostasis from central liver injuries involving the hepatic veins or retrohepatic cava. Debridement of emacerated liver tissue should be extended to good liver parenchyma where deep liver sutures help with approximate the edges. Drainage is not used for minor injuries. Closed suctions are best for larger wounds. Common duct drainage should be avoided. Conclusion Most liver injuries are treated by NOT. Operative therapy involves hemostasis, debridement when necessary, and selective drainage. How to cite this article Lucas CE. The Evolution of Liver Injury Diagnosis and Treatment in the Past 50 Years. Panam J Trauma Crit Care Emerg Surg 2014;3(3):124-131.

Duodenal Perforation Caused Septic Shock: a Rare Case Combined With Coronavirus Disease 2019

2020 ◽  
Author(s):  
Huanhuan Guo ◽  
Jing Hu ◽  
Yunxiang Li ◽  
Wei Xiang ◽  
Quan Gan
Keyword(s):  
Septic Shock ◽  
Medical Intensive Care Unit ◽  
Duodenal Perforation ◽  
Emergency Laparotomy ◽  
Case Presentation ◽  
Risk Pregnancy ◽  
Multidisciplinary Cooperation ◽  
Epidemic Period ◽  
Medical Intensive Care ◽  
Novel Coronavirus

Abstract Background: Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy, which is especially easy to be overlooked during the outbreak of 2019 novel coronavirus (2019-nCoV) after delivery.Case presentation: Here, we report a case of duodenal perforation-induced septic shock with coronavirus disease 2019 (COVID-19), and the patient underwent emergency laparotomy after reporting to the hospital management department under strict protection. Her recovery in postoperative period in Medical Intensive Care Unit (MICU) was uneventful and she was transferred to a designated hospital for treatment of COVID-19 5 days later.Conclusions: The establishment of emergency green channel for maternal health care, and timely and comprehensive multidisciplinary cooperation during the epidemic period, strengthen the standardized management of high-risk pregnancy, and better guarantee the safety of mothers and infants.

Managing rivers for conservation and ecotourism in the Kruger National Park

1995 ◽  
Vol 32 (5-6) ◽  
pp. 227-233 ◽  
Author(s):  
F. J. Venter ◽  
A. R. Deacon
Keyword(s):  
National Park ◽  
Good Condition ◽  
Kruger National Park ◽  
Rapid Expansion ◽  
Natural Environments ◽  
The West ◽  
The Past ◽  
Management Actions ◽  
Flow Through ◽  
Three Rivers

Six major rivers flow through the Kruger National Park (KNP). All these rivers originate outside and to the west of the KNP and are highly utilized. They are crucially important for the conservation of the unique natural environments of the KNP. The human population growth in the Lowveld during the past two decades brought with it the rapid expansion of irrigation farming, exotic afforestation and land grazed by domestic stock, as well as the establishment of large towns, mines, dams and industries. Along with these developments came overgrazing, erosion, over-utilization and pollution of rivers, as well as clearing of indigenous forests from large areas outside the borders of the KNP. Over-utilization of the rivers which ultimately flow through the KNP poses one of the most serious challenges to the KNP's management. This paper gives the background to the development in the catchments and highlights the problems which these have caused for the KNP. Management actions which have been taken as well as their results are discussed and solutions to certain problems proposed. Three rivers, namely the Letaba, Olifants and Sabie are respectively described as examples of an over-utilized river, a polluted river and a river which is still in a fairly good condition.

scholarly journals Faecopneumothorax due to missing diaphragmatic hernia: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Resul Nusretoğlu ◽  
Yunus Dönder
Keyword(s):  
Computed Tomography ◽  
Diaphragmatic Hernia ◽  
Colon Resection ◽  
Emergency Laparotomy ◽  
Hernia Sac ◽  
Case Presentation ◽  
Abdominal Tenderness ◽  
History Of ◽  
Diaphragmatic Hernias ◽  
Tomography Scan

Abstract Background Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma. Case presentation A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day. Conclusions Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.

scholarly journals Immune-Mediated Drug-Induced Liver Injury: Immunogenetics and Experimental Models

2021 ◽  
Vol 22 (9) ◽  
pp. 4557
Author(s):  
Alessio Gerussi ◽  
Ambra Natalini ◽  
Fabrizio Antonangeli ◽  
Clara Mancuso ◽  
Elisa Agostinetto ◽  
...  
Keyword(s):  
Liver Injury ◽  
Experimental Models ◽  
Clinical Event ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Immune Mediated ◽  
Liver Injuries ◽  
Immunological Mechanisms ◽  
Molecular Aspects ◽  
Therapeutic Tools

Drug-induced liver injury (DILI) is a challenging clinical event in medicine, particularly because of its ability to present with a variety of phenotypes including that of autoimmune hepatitis or other immune mediated liver injuries. Limited diagnostic and therapeutic tools are available, mostly because its pathogenesis has remained poorly understood for decades. The recent scientific and technological advancements in genomics and immunology are paving the way for a better understanding of the molecular aspects of DILI. This review provides an updated overview of the genetic predisposition and immunological mechanisms behind the pathogenesis of DILI and presents the state-of-the-art experimental models to study DILI at the pre-clinical level.

scholarly journals Liver Injury and the Macrophage Issue: Molecular and Mechanistic Facts and Their Clinical Relevance

2021 ◽  
Vol 22 (14) ◽  
pp. 7249
Author(s):  
Siyer Roohani ◽  
Frank Tacke
Keyword(s):  
Bone Marrow ◽  
Liver Injury ◽  
Current Knowledge ◽  
Hepatocellular Cancer ◽  
Complete Recovery ◽  
Hepatic Macrophages ◽  
Liver Injuries ◽  
Microbial Products ◽  
Injured Liver

The liver is an essential immunological organ due to its gatekeeper position to bypassing antigens from the intestinal blood flow and microbial products from the intestinal commensals. The tissue-resident liver macrophages, termed Kupffer cells, represent key phagocytes that closely interact with local parenchymal, interstitial and other immunological cells in the liver to maintain homeostasis and tolerance against harmless antigens. Upon liver injury, the pool of hepatic macrophages expands dramatically by infiltrating bone marrow-/monocyte-derived macrophages. The interplay of the injured microenvironment and altered macrophage pool skews the subsequent course of liver injuries. It may range from complete recovery to chronic inflammation, fibrosis, cirrhosis and eventually hepatocellular cancer. This review summarizes current knowledge on the classification and role of hepatic macrophages in the healthy and injured liver.

A case of statin-induced liver injury with positive rechallenge with a second statin. Is there a class effect?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Giovanna Onfiani ◽  
Fabio Nascimbeni ◽  
Francesca Carubbi
Keyword(s):  
Liver Injury ◽  
Clinical Symptoms ◽  
High Risk Population ◽  
Drug Induced ◽  
Case Presentation ◽  
Drug Induced Liver Injury ◽  
Aged Woman ◽  
Cardiovascular Morbidity And Mortality ◽  
Middle Aged Woman

Abstract Objectives Statins have proved to reduce cardiovascular morbidity and mortality in high-risk population and are generally well tolerated, although adverse events can occur. Up to 3% of patients develop aminotransferases elevation, which usually normalizes with continued treatment and hardly is associated with clinical symptoms. Serious statin-related liver injury is exceedingly rare. Furthermore, literature regarding rechallenge with a second statin is extremely poor. Some authors caution that re-exposure to these drugs is associated with a more serious liver injury but safe switching to a second statin after drug-induced liver injury (DILI) is also reported. Case presentation We describe a case of a middle-aged woman who developed hepatocellular liver injury after simvastatin dose escalation; a rechallenge with low dose rosuvastatin caused rapid recurrence of DILI. Conclusions In our opinion, clinicians should be very cautious upon rechallenge and closely follow-up patients who experienced statin-induced liver injury when trying re-exposure to another statin.

What are dental professionals posting on Facebook? A cross-sectional content analysis

2021 ◽  
pp. 146531252110333
Author(s):  
Keelin Fox ◽  
Parmjit Singh
Keyword(s):  
Content Analysis ◽  
Communication Strategies ◽  
Median Number ◽  
Cross Sectional ◽  
Case Presentation ◽  
Plain Text ◽  
The Past ◽  
Group Members ◽  
Group Characteristics ◽  
Product Promotion

Objective: To profile the posts on open orthodontic Facebook groups and identify which communication strategies and media modalities generate the most engagement from users. Design: A cross-sectional content analysis. Setting: Facebook Internet-based search. Methods: Post data were collected over a one-month period from the 10 largest public orthodontic Facebook groups. Evaluation of group characteristics included membership levels, number of administrators, time each group had been in existence and growth rate of each group. The number of posts, the numbers and types of engagement (likes, emojis, comments, shares) and engagement rate were calculated. The communication strategies (e.g. case presentation, course promotion, etc.) and media modalities (e.g. plain text, photograph, etc.) were recorded. Results: The study identified 190,268 Facebook members from the 10 largest orthodontic Facebook groups (median 17,811; interquartile range [IQR] 11,977). The median time the groups had existed was six years (median 2175 days; IQR 2311 days) and the median number of new group members in the past month was 1257 (IQR 2773). The median number of new group members in the past month was 1257 (IQR 2773). There were 227 postings during the study period with 2546 engagements. The overall median number of engagements was 196 (IQR 445) and the engagement rate of posts was 1.3% overall. Posts relating to course promotion (n = 63, 28%) followed by product promotion (n = 42, 19%) were the most common. Case presentation style posts accounted for 15% (n = 35). The level of engagement was greater for posts that had a clinical component compared to posts that did not ( P < 0.001). For media modality, posts that included a photograph had greater engagement ( P < 0.001). Conclusion: There are frequent posts on course and product promotion in orthodontic Facebook groups; however, these are associated with low levels of engagement. Posts that are clinically orientated and include photographs have higher levels of engagement.

scholarly journals Removal of a suture needle: a case report

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Suyun Seon ◽  
Baek-Soo Lee ◽  
Byung-Joon Choi ◽  
Joo-Young Ohe ◽  
Jung-Woo Lee ◽  
...  
Keyword(s):  
Foreign Bodies ◽  
Mouth Opening ◽  
Ct Scanning ◽  
Purulent Discharge ◽  
Dental Clinic ◽  
Case Presentation ◽  
Left Behind ◽  
Successful Removal ◽  
Oral Surgical Procedure ◽  
Location Measurement

Abstract Background Foreign bodies may be embedded or left behind in the oral cavity during oral surgical procedure. The loss of instruments such as impression material, surgical gauze, and broken injection needles are commonly reported in the dental field. These complications are generally symptomatic and show signs of inflammation, pain, and purulent discharge. Accidental breakage of suture needles is a rare but potentially dangerous event. Case presentation In this report, we present one case of lost suture needle during the procedure of flap operation at local dental clinic and its successful removal under local/general anesthesia administration via CBCT with a help of two reference needles to localize the 6-0 nylon needle and consulting with the clinician. Conclusion CT scanning taken while mouth-closing may not be accurate with regard to real location measurement performed while mouth-opening. If so, other up-to-date radiographic devices and methods to retrieve a needle are recommended.

scholarly journals TGR5-dependent hepatoprotection through the regulation of biliary epithelium barrier function

Gut ◽  
2019 ◽  
Vol 69 (1) ◽  
pp. 146-157 ◽  
Author(s):  
Grégory Merlen ◽  
Nicolas Kahale ◽  
Jose Ursic-Bedoya ◽  
Valeska Bidault-Jourdainne ◽  
Hayat Simerabet ◽  
...  
Keyword(s):  
Liver Injury ◽  
Barrier Function ◽  
Bile Leakage ◽  
Liver Parenchyma ◽  
Knock Out ◽  
Epithelial Barrier Function ◽  
Biliary Epithelium ◽  
Duct Ligation

ObjectiveWe explored the hypothesis that TGR5, the bile acid (BA) G-protein-coupled receptor highly expressed in biliary epithelial cells, protects the liver against BA overload through the regulation of biliary epithelium permeability.DesignExperiments were performed under basal and TGR5 agonist treatment. In vitro transepithelial electric resistance (TER) and FITC-dextran diffusion were measured in different cell lines. In vivo FITC-dextran was injected in the gallbladder (GB) lumen and traced in plasma. Tight junction proteins and TGR5-induced signalling were investigated in vitro and in vivo (wild-type [WT] and TGR5-KO livers and GB). WT and TGR5-KO mice were submitted to bile duct ligation or alpha-naphtylisothiocyanate intoxication under vehicle or TGR5 agonist treatment, and liver injury was studied.ResultsIn vitro TGR5 stimulation increased TER and reduced paracellular permeability for dextran. In vivo dextran diffusion after GB injection was increased in TGR5-knock-out (KO) as compared with WT mice and decreased on TGR5 stimulation. In TGR5-KO bile ducts and GB, junctional adhesion molecule A (JAM-A) was hypophosphorylated and selectively downregulated among TJP analysed. TGR5 stimulation induced JAM-A phosphorylation and stabilisation both in vitro and in vivo, associated with protein kinase C-ζ activation. TGR5 agonist-induced TER increase as well as JAM-A protein stabilisation was dependent on JAM-A Ser285 phosphorylation. TGR5 agonist-treated mice were protected from cholestasis-induced liver injury, and this protection was significantly impaired in JAM-A-KO mice.ConclusionThe BA receptor TGR5 regulates biliary epithelial barrier function in vitro and in vivo through an impact on JAM-A expression and phosphorylation, thereby protecting liver parenchyma against bile leakage.

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