Double Cystic Duct as Rare Anatomic Variant

Summary The variations of the cystic duct are so common that only 30% of all humans present the classical anatomical arrangement between the common bile duct (CBD), the cystic duct, and adjacent arteries. Thus, it could be considered that anomalies of the biliary tree are a rule rather than an exception. Duplication of the cystic duct, however, is a very uncommon anatomical finding. In the Department of General and Digestive Surgery of the University Hospital Complex Albacete, a 73-year-old patient was admitted with symptoms of cholangitis. He underwent emergency surgery that found exacerbated chronic cholecystitis and dilation of the CBD. Cholecystectomy was performed with identification of a double cystic duct that drained separately in the CBD and exploration of the last revealed cholangitis without choledocholithiasis. The postoperative period progressed favourably, proceeding to discharge from the hospital with Kehr drainage closed. In conclusion, we consider that the routine use of intraoperative cholangiography when there is suspicion of anatomical variations of the biliary tree is mandatory to rule out lesions or alterations thereof.

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Generalized myoclonus in COVID-19

Neurology ◽

10.1212/wnl.0000000000009829 ◽

2020 ◽

Vol 95 (6) ◽

pp. e767-e772 ◽

Cited By ~ 23

Author(s):

Pablo Rábano-Suárez ◽

Laura Bermejo-Guerrero ◽

Antonio Méndez-Guerrero ◽

Javier Parra-Serrano ◽

Daniel Toledo-Alfocea ◽

...

Keyword(s):

Medical Records ◽

Startle Response ◽

Respiratory Arrest ◽

University Hospital ◽

Voluntary Movements ◽

Inflammatory Phase ◽

Immune Mediated ◽

The University ◽

Order Structures ◽

Rule Out

ObjectiveTo report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus.MethodsPatient data were obtained from medical records from the University Hospital “12 de Octubre,” Madrid, Spain.ResultsThree patients (2 men and 1 woman, aged 63–88 years) presented with mild hypersomnia and generalized myoclonus following the onset of the so-called inflammatory phase of coronavirus disease 2019 (COVID-19). All of them had presented previously with anosmia. Myoclonus was generalized with both positive and negative jerks, predominantly involving the facial, trapezius, sternocleidomastoid, and upper extremities muscles. These myoclonic jerks occurred spontaneously and were extremely sensitive to multisensory stimuli (auditive and tactile) or voluntary movements, with an exaggerated startle response. Other causes of myoclonus were ruled out, and none of the patients had undergone respiratory arrest or significant prolonged hypoxia. All of them improved, at least partially, with immunotherapy.ConclusionsOur 3 cases highlight the occurrence of myoclonus during the COVID-19 pandemic as a post- or para-infectious immune-mediated disorder. However, we cannot rule out that SARS-CoV-2 may spread transneuronally to first- and second-order structures connected with the olfactory bulb. Further investigation is required to clarify the full clinical spectrum of neurologic symptoms and optimal treatment.

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Rare Biliary Anatomy in Two Patients Presenting with Biliary Obstruction Diagnosed with ERCP

Canadian Journal of Gastroenterology ◽

10.1155/1991/104079 ◽

1991 ◽

Vol 5 (5) ◽

pp. 161-164

Author(s):

Gary R May ◽

David S Reid ◽

Noel B Hershfield

Keyword(s):

Cystic Duct ◽

Incidental Findings ◽

Biliary Obstruction ◽

Biliary Tree ◽

Stone Extraction ◽

Biliary Anatomy ◽

Endoscopic Retrograde ◽

Potential Problems ◽

Therapeutic Procedures ◽

Rare Anatomic Variant

Anatomic anomalies of the exrrahepatic biliary tree are common and often incidental findings at endoscopic retrograde cholangiopancreatography; however, they rarely complicate therapeutic procedures such as stone extraction. The cases of two patients with biliary obstruction due to stones are presented, who were found to have the cystic duct a rising almost directly from the ampulla. This rare anatomic variant posed problems both in terms of interpretation of the cholangiogram and removal of stones. Therapeutic endoscopists should be aware of this and other anomalies of the biliary tract and of the potential problems faced in both interpretation of the cholangiogram and in therapeutic procedures.

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Anatomical variations of the hepatobiliary system in Sudanese patients undergoing endoscopic retrograde cholangiopancreatography (ERCP)

International Journal of Medicine ◽

10.14419/ijm.v5i1.7394 ◽

2017 ◽

Vol 5 (1) ◽

pp. 105

Author(s):

Wael Doush ◽

Mohammed A/Galil ◽

Shakir Ibrahim

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Cystic Duct ◽

Congenital Anomalies ◽

Vascular Anatomy ◽

Invasive Procedure ◽

Anatomical Variations ◽

Ampulla Of Vater ◽

University Hospital ◽

Endoscopic Retrograde ◽

Hepatobiliary System

Background: The meticulous identification of the hepatobiliary tree system normal anatomy during surgical operations is crucial in iatrogenic injury prevention. Equally important, an understanding of the congenital variations of biliary and vascular anatomy, as the literature abounds with reports of specific anatomical variations, and their surgical implications.Aim: This study aimed to study the presence of anatomical variations within the hepatobiliary system in Sudanese population undergoing endoscopic retrograde cholangiopancreatography (ERCP).Patients and methods: The records of patients undergoing ERCP in Soba University Hospital during 2004 to 2008 were analyzed. There were 277 Sudanese patients who had complained of right hypochondrial abdominal pain & history of jaundice (obstructive jaundice) that underwent ERCP were included within this study. The exclusion criteria included the following: Sudanese patients in whom ERCP failed or patients who had advanced hepatobiliary disease like cancers, strictures either cancerous or iatrogenic, fistula and iatrogenic biliary leak.Results: The analysis of 277 Sudanese patients undergoing ERCP of the hepatobiliary system showed the following results regarding the variations: The choledochal cyst type one (fusiform type) was present in 3 (1.08%) patients; very low cystic duct insertion (parallel) was present in 1 (0.36%) patient and long cystic duct was present in 3 (1.08%) patients. The ampulla of Vater size variations occurred as A) Normal in 158 (57%) patient, B) Small in 56 (20.2%) patients, C) Large in 29 (10.5%) patients, D) Periampullary diverticula in 4 (1.4%) patients and E) unclassified in 30 (10.8%) patients. Other forms of congenital anomalies were not found.Conclusion: The using of endoscopic retrograde cholangiopancreatography (ERCP) is a reliable radiological method for depicting congenital anomalies of the hepatobiliary system, but it is an invasive procedure.

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External validation of a suggested extension of the ESC 0/1h-algorithm for early rule out of myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1703 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Lopez Ayala ◽

T Nestelberger ◽

I Strebel ◽

P.D Ratmann ◽

J Boeddinghaus ◽

...

Keyword(s):

Myocardial Infarction ◽

Troponin T ◽

Clinical Care ◽

External Validation ◽

High Sensitivity ◽

University Hospital ◽

Funding Source ◽

Absolute Change ◽

The University ◽

Rule Out

Abstract Background The European Society of Cardiology (ESC) high sensitivity cardiac troponin T 0/1h-algorithm has substantially improved the management of patients with suspected acute myocardial infarction (AMI) by triaging about 75% of patients to rapid rule-out and/or rapid rule-in. However, about 25% of patients remain in the “observe-zone”, and the optimal management of these patients is unknown. Recently, a pilot single center study with a low prevalence of AMI suggested that an absolute change of less than 7ng/L between the 0h and 3h hs-cTnT concentration would allow to help in the evaluation of patients in the observe-zone and allow triage towards rule-out with very high negative predictive value [NPV]. Purpose To externally validate this suggested modification of the ESC 0/1h-algorithm for early rule out of AMI. Methods In an ongoing multicentre international study, we prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of MI. Final diagnoses were centrally adjudicated by two independent cardiologists using all available medical records obtained during clinical care including 90 day follow-up information and cardiac imaging. High sensitivity-cTnT (Elecsys) concentrations were measured at presentation and after 1 and 3 hours. The primary outcome was safety, quantified by the sensitivity and NPV for early rule out of NSTEMI. Results Among 1633 enrolled patients with available 0, 1 and 3h hs-cTnT concentrations, NSTEMI was the adjudicated final diagnosis in 337 (20.6%) patients. The ESC 0/1h-algorithm ruled out 918 (56.2%) patients, with a sensitivity of 98.8% (95% confidence interval [CI], 97.0–99.5) and a NPV of 99.6% (95% CI, 98.9–99.8). A total of 428 patients (26.2%) remained in the observe zone. After applying the suggested 0–3 hour absolute change cut-off criteria of 7ng/L, 393 (92.0%) additional patients from the observe zone were triaged towards ruled out. However, the safety of this triage step was poor with 62 patients with NSTEMI missed, resulting in a sensitivity of 33.3% and a NPV of 84.2% for rule-out. Conclusions The suggested 0/3h absolute change cut-off of 7ng/L for patients remaining in the observe zone of the ESC 0/1h-algorithm does NOT allow safe rule-out of AMI and should therefore NOT be implemented into routine clinical care. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, the Swiss Heart Foundation, the Stiftung für kardiovaskuläre Forschung Basel, the University of Basel and the University Hospital Basel

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Abstract #216: Knowledge About Inpatient Diabetes Management: Impact of an Educational Intervention in Nurses at the University Hospital of Puerto Rico

Endocrine Practice ◽

10.1016/s1530-891x(20)42522-4 ◽

2015 ◽

Vol 21 ◽

pp. 30-31

Author(s):

Anette Garces-Dominguez ◽

Loida Gonzalez-Rodriguez ◽

Monica Vega ◽

Myriam Allende-Vigo

Keyword(s):

Puerto Rico ◽

Educational Intervention ◽

Diabetes Management ◽

University Hospital ◽

Inpatient Diabetes ◽

Inpatient Diabetes Management ◽

The University

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Symptomatic vascular complications after vascular closure device use following diagnostic and interventional catheterisation

VASA ◽

10.1024/0301-1526.33.2.78 ◽

2004 ◽

Vol 33 (2) ◽

pp. 78-81 ◽

Cited By ~ 21

Author(s):

Thalhammer ◽

Aschwanden ◽

Jeanneret ◽

Labs ◽

Jäger

Keyword(s):

Current Literature ◽

Vascular Complications ◽

University Hospital ◽

Closure Device ◽

Ultrasound Guided ◽

Vascular Closure Device ◽

Device Use ◽

Arterial Stenoses ◽

The University ◽

Stenotic Lesions

Background: Haemostatic puncture closure devices for rapid and effective hemostasis after arterial catheterisation are a comfortable alternative to manual compression. Implanting a collagen plug against the vessel wall may become responsible for other kind of vascular injuries i.e. thrombotic or stenotic lesions and peripheral embolisation. The aim of this paper is to report our clinically relevant vascular complications after Angio-Seal® and to discuss the results in the light of the current literature. Patients and methods: We report the symptomatic vascular complications in 17 of 7376 patients undergoing diagnostic or therapeutic catheterisation between May 2000 and March 2003 at the University Hospital Basel. Results: Most patients presented with ischaemic symptoms, arterial stenoses or occlusions and thrombotic lesions (n = 14), whereas pseudoaneurysms were extremely rare (n = 3). Most patients with ischaemic lesions underwent vascular surgery and all patients with a pseudoaneurysm were successfully treated by ultrasound-guided compression. Conclusions: Severe vascular complications after Angio-Seal® are rare, consistent with the current literature. There may be a shift from pseudoaneurysms to ischaemic lesions.

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User Evaluation of an Integrated Medical Workstation for Clinical Data Analysis

Methods of Information in Medicine ◽

10.1055/s-0038-1634954 ◽

1993 ◽

Vol 32 (05) ◽

pp. 365-372 ◽

Cited By ~ 2

Author(s):

T. Timmeis ◽

J. H. van Bemmel ◽

E. M. van Mulligen

Keyword(s):

Data Analysis ◽

Clinical Research ◽

Clinical Data ◽

University Hospital ◽

User Evaluation ◽

Scientific Staff ◽

Medical Institutions ◽

Clinical Data Analysis ◽

Research Problems ◽

The University

AbstractResults are presented of the user evaluation of an integrated medical workstation for support of clinical research. Twenty-seven users were recruited from medical and scientific staff of the University Hospital Dijkzigt, the Faculty of Medicine of the Erasmus University Rotterdam, and from other Dutch medical institutions; and all were given a written, self-contained tutorial. Subsequently, an experiment was done in which six clinical data analysis problems had to be solved and an evaluation form was filled out. The aim of this user evaluation was to obtain insight in the benefits of integration for support of clinical data analysis for clinicians and biomedical researchers. The problems were divided into two sets, with gradually more complex problems. In the first set users were guided in a stepwise fashion to solve the problems. In the second set each stepwise problem had an open counterpart. During the evaluation, the workstation continuously recorded the user’s actions. From these results significant differences became apparent between clinicians and non-clinicians for the correctness (means 54% and 81%, respectively, p = 0.04), completeness (means 64% and 88%, respectively, p = 0.01), and number of problems solved (means 67% and 90%, respectively, p = 0.02). These differences were absent for the stepwise problems. Physicians tend to skip more problems than biomedical researchers. No statistically significant differences were found between users with and without clinical data analysis experience, for correctness (means 74% and 72%, respectively, p = 0.95), and completeness (means 82% and 79%, respectively, p = 0.40). It appeared that various clinical research problems can be solved easily with support of the workstation; the results of this experiment can be used as guidance for the development of the successor of this prototype workstation and serve as a reference for the assessment of next versions.

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Sharing of Worldwide Spread Knowledge Using Hypermedia Facilities & Fast Communication Protocols (Mosaic and World Wide Web): The Example of ExPASy

Methods of Information in Medicine ◽

10.1055/s-0038-1634588 ◽

1995 ◽

Vol 34 (01/02) ◽

pp. 75-78 ◽

Cited By ~ 5

Author(s):

R. D. Appel ◽

O. Golaz ◽

Ch. Pasquali ◽

J.-C. Sanchez ◽

A. Bairoch ◽

...

Keyword(s):

World Wide Web ◽

World Wide ◽

Relevant Literature ◽

Communication Protocols ◽

Laboratory Data ◽

Central Element ◽

University Hospital ◽

New Information ◽

The University ◽

Link Information

Abstract:The sharing of knowledge worldwide using hypermedia facilities and fast communication protocols (i.e., Mosaic and World Wide Web) provides a growth capacity with tremendous versatility and efficacy. The example of ExPASy, a molecular biology server developed at the University Hospital of Geneva, is striking. ExPASy provides hypermedia facilities to browse through several up-to-date biological and medical databases around the world and to link information from protein maps to genome information and diseases. Its extensive access is open through World Wide Web. Its concept could be extended to patient data including texts, laboratory data, relevant literature findings, sounds, images and movies. A new hypermedia culture is spreading very rapidly where the international fast transmission of documents is the central element. It is part of the emerging new “information society”.

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