This study evaluated long-term outcomes of complete endoscopic stone removal versus incomplete stone removal with stent placement in 211 elderly patients aged 85 years or older with bile duct stones. Patients who underwent complete stone removal had a significantly higher overall survival rate but similar disease-specific survival rate compared to those who underwent incomplete stone removal. The proportion of patients with dementia was higher in the incomplete removal group. Complete stone removal can be safely performed in elderly patients, and advanced age should not preclude attempting full stone clearance.
A simplified technique of esophageal self-expandable metallic stent placement...Peachy Essay
The advantages of the simplified technique are as follows: technical ease, cost-effectiveness, no exposure to radiation,
requirement of minimal manpower, and less time-consuming; these advantages make it the technique day-care procedure.
This study was conducted to evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones larger than 2 cm and to compare its results with percutaneous nephrolithotomy (PCNL).
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
A simplified technique of esophageal self-expandable metallic stent placement...Peachy Essay
The advantages of the simplified technique are as follows: technical ease, cost-effectiveness, no exposure to radiation,
requirement of minimal manpower, and less time-consuming; these advantages make it the technique day-care procedure.
This study was conducted to evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones larger than 2 cm and to compare its results with percutaneous nephrolithotomy (PCNL).
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Dr Pawan Sharma1*, Dr D K Verma2, Dr Raj Kumar3
1General Surgeon Incharge, Civil Hospital Rohru, Shimla (HP), India
2Professor of Surgery, IGMC Shimla (HP), India
3General Surgeon Incharge, Distt Hospital Bilaspur (HP), India
*Address for Correspondence: Dr. Pawan Sharma, General Surgeon Incharge, Department of Surgery, Civil Hospital,
Rohru, Shimla, HP, India
Received: 17 September 2016/Revised: 11 October 2016/Accepted: 25 October 2016
ABSTRACT- This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy (RPUL) as a viable
option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy (TPUL) & endoscopic urology and
to assess its place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. This
study was conducted on 20 selected patients of single large impacted calculus of size more than 8mm in upper & middle
ureter. It was observed that excessive bleeding was present in only one (5%) of the patients, while need for conversion to
open ureterolithotomy was seen in 8 (40%) cases. No major peri-operative complications were encountered. From our
experience, it can be concluded that this procedure has definitely shown decreased post-operative discomfort, decreased
requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered
as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective
minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter.
Key-words- Retroperitoneal ureterolithotomy (RPUL), Transperitoneal ureterolithotomy (TPUL), Extracorporeal
shockwave lithotripsy (ESWL)
Self-Expandable Metal Stents for the Management of Gastric Outlet Obstruction...JapaneseJournalofGas
Gastric outlet obstruction is commonly considered as advanced malignancies of the stomach, duodenum, pancreas, hepatobiliary, and ampullary regions. Surgical bypass and chemotherapy are the common treatment modalities for gastric obstruction. This study was done to determine the outcomes of self-expandable metal stents in patients with gastric outlet obstruction.
Gastric cancer was until the 1980s the most frequent diagnosed cancer all around the world, and it still remains even nowadays one of the most frequent and aggressive malignant tumors, having the power to cause annually an amazingly high number of deaths and affected people. Even if it went through some difficult phases for more 11 years, the stomach surgery managed to become today quite well defined even if it is not yet fully outlined.
Three Different Presentations of Metastatic Gastric MelanomaJapaneseJournalofGas
Melanoma is the most common metastatic tumor of the gastrointestinal (GI) tract and its diagnosis is rare during life since its symptoms are non-specific. The endoscopic gastric metastases appearance is heterogenous with no typical pattern. We report a patient who presented three different morphologies of metastatic gastric melanoma although the patient remained asymptomatic. This finding shows the importance of early upper digestive endoscopy in patients diagnosed with melanoma even in the absence of gastrointestinal symptoms.
Approximately one third of the world’s population has serological evidence of past or present infection with the hepatitis B virus (HBV). An estimated 350-400 million people are surface HBV antigen (HBsAg) carriers. India has 40 million HBV carriers i.e. 10–15% share of total pool of HBV carriers of the world. In India.
The primary indication for an esophagectomy is esophageal cancer or Barrett’s esophagus with high-grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy may be an operation involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to permit healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach).
Study of the sensitivity of Hydrocolonic Sonography (HS) in the detection of colonic lesions and how hydrocolonic sonography with echographic contrast agent (HSEC) can improve this technique.
HCC is the most common primary liver malignancy and cause of cancer-related death worldwide including Bangladesh. It occurs more often in males than females. The incidence of HCC continues to escalate due to HBV, HCV infection, non-alcoholic fatty liver disease (NAFLD). HBV and HCV are also important etiological factors for developing chronic liver disease (CLD) and HCC.
Epidemiology of Hepatocellular Carcinoma (HCC) In Tertiary Level Hospitals in...JapaneseJournalofGas
HCC is the most common primary liver malignancy and cause of cancer-related death worldwide including Bangladesh. It occurs more often in males than females. The incidence of HCC continues to escalate due to HBV, HCV infection, non-alcoholic fatty liver disease (NAFLD). HBV and HCV are also important etiological factors for developing chronic liver disease (CLD) and HCC.
Synthesis, Characterization, Biological Evaluation of Some Heterocyclic Oxaze...JapaneseJournalofGas
The new serious of pentyloxy and aryloxy benzaldehyde (3ae) were synthesized from the substitution reaction of 4-hydroxy benzaldehyde with different aryl bromide and alkyl bromide, on the basis of Williamson ether synthesis in the presence of Potassium carbonate using absolute ethanol as a solvent. The second step was the synthesis of 2-amino-5-(p-tolyl)1,3,4-thiadiazole.
The Corona Virus Disease 2019(COVID-19) could be a viral respiratory disorder that caused
by a new coronavirus called SARS-CoV-2 [1]. Severe acute respiratory syndrome coronavirus
(SARS- CoV) and Middle East respiratory syndrome coronavirus (MERS- CoV) are two
pathogenic viruses in humans. Both SARS?CoV and MERS?CoV are zoonotic in origin and
both viruses originated in bats, during this review; we summarize the origin of COVID-19.
In spite of the deep insight that has been gathered hitherto in Molecular Genetics, a few obscurities are as challenging as they were. Among these, introns, with reference to its functionality, have been debated quite often. And many theories that have emerged following such grappling discussions have given believable explanations but have failed to give a convincing answer eventually.
More Related Content
Similar to Long-Term Outcomes of Endoscopic Treatment for Bile Duct Stones in Patients Aged ≥ 85 Years
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Dr Pawan Sharma1*, Dr D K Verma2, Dr Raj Kumar3
1General Surgeon Incharge, Civil Hospital Rohru, Shimla (HP), India
2Professor of Surgery, IGMC Shimla (HP), India
3General Surgeon Incharge, Distt Hospital Bilaspur (HP), India
*Address for Correspondence: Dr. Pawan Sharma, General Surgeon Incharge, Department of Surgery, Civil Hospital,
Rohru, Shimla, HP, India
Received: 17 September 2016/Revised: 11 October 2016/Accepted: 25 October 2016
ABSTRACT- This study was carried out to evaluate laparoscopic retroperitoneal ureterolithotomy (RPUL) as a viable
option to open surgical ureterolithotomy, laparoscopic transperitoneal ureterolithotomy (TPUL) & endoscopic urology and
to assess its place in the spectrum of alternatives for the surgical treatment of ureteric calculi in a tertiary care centre. This
study was conducted on 20 selected patients of single large impacted calculus of size more than 8mm in upper & middle
ureter. It was observed that excessive bleeding was present in only one (5%) of the patients, while need for conversion to
open ureterolithotomy was seen in 8 (40%) cases. No major peri-operative complications were encountered. From our
experience, it can be concluded that this procedure has definitely shown decreased post-operative discomfort, decreased
requirement of post-operative analgesia, better cosmesis, early return to work and less morbidity. RPUL can be considered
as another well-established armamentarium in the armour of laparoscopic surgeons and is recommended as an effective
minimally invasive primary treatment in large, impacted difficult stones in the upper & mid ureter.
Key-words- Retroperitoneal ureterolithotomy (RPUL), Transperitoneal ureterolithotomy (TPUL), Extracorporeal
shockwave lithotripsy (ESWL)
Similar to Long-Term Outcomes of Endoscopic Treatment for Bile Duct Stones in Patients Aged ≥ 85 Years (10)
Self-Expandable Metal Stents for the Management of Gastric Outlet Obstruction...JapaneseJournalofGas
Gastric outlet obstruction is commonly considered as advanced malignancies of the stomach, duodenum, pancreas, hepatobiliary, and ampullary regions. Surgical bypass and chemotherapy are the common treatment modalities for gastric obstruction. This study was done to determine the outcomes of self-expandable metal stents in patients with gastric outlet obstruction.
Gastric cancer was until the 1980s the most frequent diagnosed cancer all around the world, and it still remains even nowadays one of the most frequent and aggressive malignant tumors, having the power to cause annually an amazingly high number of deaths and affected people. Even if it went through some difficult phases for more 11 years, the stomach surgery managed to become today quite well defined even if it is not yet fully outlined.
Three Different Presentations of Metastatic Gastric MelanomaJapaneseJournalofGas
Melanoma is the most common metastatic tumor of the gastrointestinal (GI) tract and its diagnosis is rare during life since its symptoms are non-specific. The endoscopic gastric metastases appearance is heterogenous with no typical pattern. We report a patient who presented three different morphologies of metastatic gastric melanoma although the patient remained asymptomatic. This finding shows the importance of early upper digestive endoscopy in patients diagnosed with melanoma even in the absence of gastrointestinal symptoms.
Approximately one third of the world’s population has serological evidence of past or present infection with the hepatitis B virus (HBV). An estimated 350-400 million people are surface HBV antigen (HBsAg) carriers. India has 40 million HBV carriers i.e. 10–15% share of total pool of HBV carriers of the world. In India.
The primary indication for an esophagectomy is esophageal cancer or Barrett’s esophagus with high-grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy may be an operation involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to permit healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach).
Study of the sensitivity of Hydrocolonic Sonography (HS) in the detection of colonic lesions and how hydrocolonic sonography with echographic contrast agent (HSEC) can improve this technique.
HCC is the most common primary liver malignancy and cause of cancer-related death worldwide including Bangladesh. It occurs more often in males than females. The incidence of HCC continues to escalate due to HBV, HCV infection, non-alcoholic fatty liver disease (NAFLD). HBV and HCV are also important etiological factors for developing chronic liver disease (CLD) and HCC.
Epidemiology of Hepatocellular Carcinoma (HCC) In Tertiary Level Hospitals in...JapaneseJournalofGas
HCC is the most common primary liver malignancy and cause of cancer-related death worldwide including Bangladesh. It occurs more often in males than females. The incidence of HCC continues to escalate due to HBV, HCV infection, non-alcoholic fatty liver disease (NAFLD). HBV and HCV are also important etiological factors for developing chronic liver disease (CLD) and HCC.
Synthesis, Characterization, Biological Evaluation of Some Heterocyclic Oxaze...JapaneseJournalofGas
The new serious of pentyloxy and aryloxy benzaldehyde (3ae) were synthesized from the substitution reaction of 4-hydroxy benzaldehyde with different aryl bromide and alkyl bromide, on the basis of Williamson ether synthesis in the presence of Potassium carbonate using absolute ethanol as a solvent. The second step was the synthesis of 2-amino-5-(p-tolyl)1,3,4-thiadiazole.
The Corona Virus Disease 2019(COVID-19) could be a viral respiratory disorder that caused
by a new coronavirus called SARS-CoV-2 [1]. Severe acute respiratory syndrome coronavirus
(SARS- CoV) and Middle East respiratory syndrome coronavirus (MERS- CoV) are two
pathogenic viruses in humans. Both SARS?CoV and MERS?CoV are zoonotic in origin and
both viruses originated in bats, during this review; we summarize the origin of COVID-19.
In spite of the deep insight that has been gathered hitherto in Molecular Genetics, a few obscurities are as challenging as they were. Among these, introns, with reference to its functionality, have been debated quite often. And many theories that have emerged following such grappling discussions have given believable explanations but have failed to give a convincing answer eventually.
Alpha-Fetoprotein and the Early Diagnosis of Hepatocellular CarcinomaJapaneseJournalofGas
Hepatocellular carcinoma is the most common primary malignant tumor of the liver. Cirrhosisis associated with its carcinogenesis, so periodic surveillance is necessary. Ultrasonography is currently the most appropriate test for screening hepatocellular carcinoma, and alpha-fetoprotein is the most used biomarker despite its low sensitivity
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Aortoenteric Fistula (AEF) is a rare cause of massive gastrointestinal bleeding. Primary AEF are rare and generally the consequence of an aortic aneurysm. The duodenum and esophagus are the main locations of AEF. Diagnosis is difficult and patients are often hemodynamically unstable at the time of management
We describe here the clinical history of a 74-year old man presenting with a gradually worsening pharyngeal dysphagia with globus, occasional intra-deglutitory coughing, hoarseness and a 5 kg weight loss in the previous two months. Apart from type II Diabetes Mellitus, the patient’s clinical history was unremarkable
Gallbladder Cancer (GBC)-Contemporary Aspects of Diag- nosis and TreatmentJapaneseJournalofGas
Gallbladder cancer is an uncommon malignant disease leading to the fact that even big centers only analyze small series of patients over a long time. GBC is the most common biliary tumor and the fifth most common gastrointestinal cancer
Combined Single Surgical Cession Anatomical Trans-Sphinc- ter Anal Fistulecto...JapaneseJournalofGas
Surgical techniques applied to treat ano-rectal fistulas has proved variable results, depending on how complex the fistula is. Many publications report promising results regarding simple and complex trans-sphincter fistulas
G-POEM in Patients with Gastro paresis – Gambling for Healing or Bigger Armam...JapaneseJournalofGas
Despite the euphoria about the introduction of a novel and apparently successful treatment in gastroparesis, the amount of high quality data supporting the clinical utility of G-POEM are limited. Above all, the selection of patients with gastroparesis for G-POEM is problematic
Diversion colitis is characterized by mucosal inflammation in segments of the colon that are surgically diverted from the fecal stream. This inflammatory disorder is reported to occur in up to 100% of individuals after colostomy or ileostomy, often occurring within a year following surgery
Atypical Presentation of Salmonella Typhi Blood Stream Infection in an Immuno...JapaneseJournalofGas
The genus Salmonella is an important enteric pathogen which carries high morbidity and mortality in many parts of the world [1, 2]. The serotypes of Salmonella enteric namely serovars Typhi, Paratyphi A, Paratyphi B and Paratyphi C are the causative agents of the enteric fever. Other serovars collectively called as Non Typhoidal Salmonella (NTS) mainly cause gastroenteritis
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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3. Materials and Methods
3.1. Study Population
This retrospective study initially enrolled 244 patients aged ≥ 85 years
who were diagnosed with bile duct stones by computed tomography
(CT) or magnetic resonance imaging. Patients underwent therapeutic
ERCP at our institution between January 2012 and March 2019. We
were unable to evaluate procedure times, adverse events, or long-
term prognosis in 33 patients due to surgically altered anatomy (other
than Billroth I) (12 patients) and various types of cancer (other than
biliary tract) (21 patients). After excluding these cases, 211 patients
(representing 354 ERCP procedures) were included in the analysis.
The study design was approved by the Institutional Review Board of
[blinded information] (approval number: 1-14). Research was conducted
in accordance with the Declaration of Helsinki. Written informed
consent was obtained from all patients before ERCP.
Based on the extent of stone removal, patients were divided into
two groups: complete stone removal (group C) and incomplete stone
removal with plastic stent insertion (group I). Patients initially treated
with biliary stent insertion and administered antibiotics for concur-
rent cholangitis who later underwent planned complete stone remov-
al were assigned to group C. Group C also included 13 patients with
difficult bile duct stones who were not scheduled for complete stone
removal; however, these stones decreased in number or shrank in size
sufficiently for complete stone removal to be performed during the
follow-up period (Figure 1). The characteristics and long-term prog-
nosis of the patients, as well as outcomes and adverse events of the
endoscopic procedures, were compared between the groups.
3.2. Sedation Procedures
During ERCP, patient vitals were monitored continuously (every
5 min), and an electrocardiography was performed. Patients received
oxygen at a rate of 2 L/min through a nasal cannula. Patients were
intravenously administered midazolam (1–3 mg) or flunitrazepam
(0.2–0.6 mg) for sedation and meperidine (5–10 mg) for analgesia be-
fore initiating the procedure. Additional doses of midazolam (1 mg),
flunitrazepam (0.2 mg), and meperidine (5 mg) were administered
intermittently, as needed, during the procedure.
There was no dedicated protocol for elderly patients; however, the
dosage and frequency of each bolus were adjusted according to age
and comorbidities. At our hospital, sedation was performed by an
endoscopist.
3.3. Endoscopic Procedures
After patients were confirmed to be adequately sedated, ERCP was
performed with a side-viewing endoscope (JF-260V and TJF-260V;
Olympus Medical Systems, Co., Ltd., Tokyo, Japan). The common
bile duct was selectively imaged, and the number and sizes of stones
were confirmed. To access the stones, endoscopic sphincterotomy
(EST), endoscopic papillary balloon dilation (EPBD), or endoscopic
papillary large balloon dilation (EPLBD) was selected and performed
at the operator’s discretion. For bile duct stone removal, a retriev-
al balloon catheter or stone extraction basket was used. Mechani-
cal lithotripsy was performed as needed. If complete stone removal
could not be achieved, a plastic stent was inserted. A 7-Fr pigtail
stent (Zimmon®; Cook Ireland Ltd., Limerick, Ireland) or a 7–8.5-Fr
straight stent (Flexima™; Boston Scientific Japan, Tokyo, Japan) was
placed in the bile duct.
The procedure time was defined as the time from endoscope inser-
tion to its removal. Stone removal was considered successful if there
was no evidence of radiolucent stones on contrast-enhanced imaging
after removal. All ERCPs were supervised by four endoscopists who
had performed over 1,000 ERCPs.
3.4. Definition of Adverse Events
Adverse events during endoscopy were defined as ERCP and/or
sedation-related adverse events, such as hypoxemia (oxygen satura-
tion < 90%), hypotension (systolic blood pressure < 90 mmHg), and
bradycardia (heart rate < 50 beats/min). Pancreatitis was defined as
abdominal pain with a threefold elevation in serum amylase levels.
Bleeding was defined as a decrease in hemoglobin level of ≥ 2 g/
dL (compared with the baseline) and clinical evidence of bleeding.
Perforation was defined as retroperitoneal or bowel-wall perforation
detected by any imaging modality.
3.5. Follow-Up
After ERCP, a protease inhibitor and an antimicrobial agent were
administered to prevent pancreatitis and infection [12, 13]. All pa-
tients routinely underwent follow-up investigations with laboratory
testing. For patients with abdominal pain, serum amylase levels were
measured, and abdominal CT was performed, if symptoms persisted.
After discharge, patients were either scheduled to visit our outpatient
clinic or referred to their family doctor. Family doctors were asked
to refer patients to our hospital if biliary tract infection (cholangitis,
cholecystitis, or liver abscess) was suspected. In such cases, labora-
tory tests, abdominal CT, and ERCP, if necessary, were performed.
The acceptance of stent exchange depends on the patients’ environ-
ment (i.e., whether or not sufficient community support is available).
Hence, although planned regular stent exchange is considered a good
strategy, it was not used in this study.
The Overall Survival (OS) and Disease-Specific Survival (DSS) rates
were calculated to evaluate the necessity of complete stone removal
in elderly patients with respect to prognosis. Survival time was calcu-
lated from the date of the initial ERCP to the date of the final surviv-
al confirmation. Disease-specific death was defined as death due to
cholangitis, retrograde biliary infection, stent occlusion or shedding,
stone recurrence, cholecystitis, or liver abscess.
Long-term follow-up data were collected by communicating with
family doctors, reviewing outpatient notes, or calling patients’ homes.
The follow-up period was defined as the date of initial admission to
the date of the last visit to the family doctor or outpatient clinic, or
the date of confirmed survival by telephone.
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3.6. Statistical Analyses
Continuous variables were presented as mean values, whereas cate-
gorical variables were reported as numbers and percentages. Contin-
uous variables were compared using Student’s t-tests or Mann–Whit-
ney U tests, and categorical variables were compared using Fisher’s
exact tests, as appropriate. Kaplan–Meier estimates of survival curves
and a fitted Cox proportional hazards model were used to assess
OS. Gray’s test was used to analyze DSS. Specifically, the cumulative
deaths caused by biliary events versus non-biliary events were inves-
tigated with respect to the two groups. Statistical significance was
set at p < 0.05. All statistical analyses were performed using PASW
18.0 (SPSS Inc., Chicago, IL, USA) and EZR (Easy R), a graphical
user interface for R (The R Foundation for Statistical Programming,
Vienna, Austria) [14].
4. Results
4.1. Patient Characteristics
A total of 211 patients were included in the study, which comprised
70 men (33%) and 141 women (67%). The median age at the time of
the first ERCP was 88 (range, 85–104) years. In addition, 148 patients
(70%) had complete stone removal (group C) and 63 patients (30%)
had incomplete stone removal with plastic stent insertion (group I).
Sex, age, body mass index, performance status, most comorbidities,
the use of antithrombotic drugs, and the presence of cholangitis
were not significantly different between the two groups. However,
the proportion of patients with dementia was significantly higher in
group I than in group C (48% vs. 24%; p = 0.01) (Table 1).
Table 1: Patient characteristics
Complete stone removal (n=148) Incomplete stone removal (n=63) p value
Sex, male : female, % (n) 34 (50) : 66 (98) 32 (20) : 68 (43) 0.873*
Age, years, median (range) 89 (85–104) 90 (85–96) 0.057**
BMI, median (range) 20 (14-31) 20 (12–27) 0.536**
Performance status(1)
, median (range) 2 (0-4) 2 (1–4) 0.334**
Comorbidities, % (n)
Coronary heart disease 8 (12/148) 16 (10/63) 0.137*
Respiratory disease 6 (9/148) 6 (4/63) 1.000*
Cerebrovascular disease 22 (33/148) 19 (12/63) 0.714*
Renal failure(2)
6 (9/148) 0 (0/63) 0.600*
Dementia 24 (36/148) 48 (30/63) 0.010*
Use of antithrombotic drugs, % (n) 30 (45/148) 41 (26/63) 0.152*
Cholangitis, % (n) 63 (93/148) 67 (42/63) 0.635*
(1) Eastern Cooperative Oncology Group. (2) Renal failure that needs hemodialysis.
*Fisher’s exact test. **Mann–Whitney U test. BMI, body mass index
4.2. Results of the Endoscopic Procedure
The median number of procedures performed was 1 (range, 1–5)
and 1 (range, 1–9) in groups C and I, respectively. The median pro-
cedure time was 34 min (range, 5–103) and 26 min (range, 6–125)
in groups C and I, respectively, with a significantly longer procedure
time in group C (p < 0.01).
The median number of stones was 2 (range, 0–23) and 1 (range,
0–12) in groups C and I, respectively. The median diameter of the
largest stone was 7 mm (range, 0–32) and 10 mm (range, 0–50) in
groups C and I, respectively, with a significantly smaller diameter in
group C (p = 0.028).
In group C, EST was performed in 65% (160/245) of the pro-
cedures, EPBD in 3% (7/245), and EPLBD in 11% (28/245). In
contrast, in group I, EST was performed in 20% (22/109) of the
procedures, EPBD in 1% (1/109), and EPLBD in 5% (5/109). The
number of ESTs and EPLBDs performed was significantly higher in
group C than in group I (p < 0.01 and 0.047, respectively) (Table 2).
Table 2: Results of endoscopic procedures
Complete stoneremoval (n=148) Incomplete stone removal (n=63) p value
Total number of procedures, n 245 times 109 times
Number of procedures, median (range) 1 (1–5) 1 (1–9) 0.156**
Procedure time, median, min (range) 34 (5–103) 26 (6–125) <0.01**
Number of stones, n (range) 2 (0(3)-
–23) 1 (0–12) 0.112**
Diameter of the largest stone, median, mm (range) 7 (0(3)
–32) 10 (0–50) 0.028**
Endoscopic procedure, % (n)
EST 65 (160/245) 20 (22/109) <0.01*
EPBD 3 (7/245) 1 (1/109) 0.443*
EPLBD 11 (28/245) 5 (5/109) 0.047*
(3) Debris counted as 0 and 0 mm.
*Fisher’s exact test. **Mann–Whitney U test
EST, endoscopic sphincterotomy; EPBD, endoscopic papillary balloon dilation; EPLBD, endoscopic papillary large balloon dilation; ERCP, endoscopic
retrograde cholangiopancreatography.
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4.3. Adverse Events
The frequency of adverse events (hypoxemia, hypotension, and bra-
dycardia during ERCP, and pancreatitis, bleeding, and perforation
after ERCP) that occurred in groups C and I are presented in (Table
3). The incidence of bradycardia was significantly higher in group C
than in group I (p < 0.01). The proportion of patients who devel-
oped pancreatitis was not significantly different between groups C
and I (0% and 2%, respectively; p = 0.238). No bleeding occurred
in either group. Only one patient in group C had perforation during
EPLBD. All patients who developed adverse events post-ERCP re-
covered with conservative treatment (Table 3).
Table 3: Adverse events
Complete stone removal (n=148) Incomplete stone removal (n=63) p value
During ERCP
Hypoxemia, % (n) 3 (8/245) 6 (6/109) 0.377*
Hypotension, % (n) 15 (37/245) 20 (22/109) 0.279*
Bradycardia, % (n) 9 (23/245) 0 (0/109) <0.01*
Post ERCP
Pancreatitis, % (n) 0 (1/245) 2 (2/109) 0.225*
Bleeding, % (n) 0 (0/245) 0 (0/109) NA
Perforation, % (n) 0 (1/245) 0 (0/109) NA
*Fisher’s exact test
ERCP, endoscopic retrograde cholangiopancreatography
4.4. Long-Term Prognosis
The causes of death during a median follow-up period of 549 days
(range, 6–2512) (group C) and 549 days (range, 2–2118) (group I) are
presented in (Table 4). The mortality rate was significantly higher in
group I than in group C (43% vs. 21%; p = 0.001). In groups C and I,
3 and 3 patients died of biliary tract infection, and 28 and 24 patients
died of other diseases, respectively.
Kaplan–Meier survival curves showed that the OS rate of group C
was significantly higher than that of group I (log-rank p = 0.002).
This was confirmed by the Cox proportional hazards model (hazard
ratio, 0.44; 95% confidence interval: 0.26–0.74; p = 0.002) (Figure 2).
The described numbers of deaths were used as competing risk events
in the DSS analysis. Gray’s test showed that the probability of an
incident (death) was significantly higher in group I than in group C in
case of “other diseases death” (statistic = 8.056; p = 0.005). In con-
trast, Gray’s test showed that the probability of an incident (death)
was not significantly different between the two groups in case of
“biliary tract infection death” (statistic = 1.023; p = 0.312) (Figure 3).
Table 4: Cause of deaths during the follow-up period
complete stone removal (n=148) Incomplete stone removal (n=63) p value
Follow-up period, median, days (range) 549 (6-2512) 549 (2-2118) 0.584**
Deaths during follow-up period, % (n) 20 (31/148) 43 (27/63) 0.001*
Cause of deaths
Senility, n 10 9 0.112*
Infection except cholangitis, n 5 9 0.006*
Heart/cerebrovascular disease, n 6 3 1.000*
Renal/hepatic failure, n 5 0 0.325*
Cholangitis, n 3 3 0.366*
Cancer, n 1 0 1.000*
Unknown, n 1 3 0.081*
*Fisher’s exact test. **Mann–Whitney U test
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Figure 1: Flowchart of patient enrollment. ERCP, endoscopic retrograde cholangiopancreatography.
Figure 2: Kaplan–Meier curves showing that the overall survival rate of group C was significantly higher than that of group I.
CI, confidence interval; HR, hazard ratio
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Figure 3: Gray’s test showing that the probability of an incident (death) was not significantly different between the two groups in case of “biliary tract
infection death”.
5. Discussion
This study showed that the DSS rate was not significantly different
between patients who underwent complete stone removal (group C)
and patients who underwent incomplete stone removal with plastic
stent insertion (group I). Many causes of death in these patients were
unrelated to biliary tract infection. Therefore, biliary stenting may be
an acceptable option for patients in whom it is difficult to achieve
complete stone removal. No adverse events were fatal and, hence,
complete stone removal may be a safe procedure in patients aged ≥
85 years. These results suggest that advanced age per se may not be a
reason to forgo complete stone removal.
ERCP is the intervention of choice for the treatment of bile duct
stones. Ukkonen et al. [15] reported a 96.6% success rate of com-
plete stone removal in 279 elderly patients who underwent ERCP,
with only 3.4% of patients experiencing complications. Therefore,
we performed endoscopic treatment to achieve complete stone re-
moval in elderly patients with bile duct stones.
Elderly patients occasionally have serious comorbidities and multiple
and/or large stones that are difficult to remove. Hence, the longer
procedure time and many treatments required to remove the stones
may be too physically demanding for these patients. In elderly pa-
tients, the complication rate associated with ERCP is higher, and the
rate of complete duct clearance is lower than of those in young-
er patients. Obana et al. [16] reported a significantly lower rate of
complete stone clearance in elderly patients than in younger patients
(92.4% vs. 99.0%; p < 0.01).
With regard to safety, EST and EPLBD were significantly more com-
monly performed, and the procedure time was significantly longer
in group C than in group I. These procedures were more physically
demanding in these patients, and bradycardia was significantly more
common in group C than in group I. Regarding adverse events, the
proportion of pancreatitis was 0% in group C and 2% in group I.
No bleeding occurred in either group. One patient in group C had
perforation during EPLBD. None of the adverse events were fatal.
Therefore, we consider endoscopic stone removal to be safe in pa-
tients aged ≥ 85 years.
Biliary stenting is an effective and safe strategy for treating bile duct
stones. It has a shorter procedure time, is less invasive than com-
plete stone removal, and can be performed at any facility [17]. It
also achieves remarkable improvements in the symptoms of acute
cholangitis by preventing incarceration of bile duct stones. Howev-
er, the incidence of acute cholangitis is higher after biliary stenting
than after complete stone removal, with reported recurrence rates of
20.0–63.2% [10, 18-20] and 11.3–13.2% [21, 22], respectively. This
supports the strategy of aiming to remove bile duct stones complete-
ly, if possible, to prevent cholangitis recurrence.
To the best of our knowledge, few reports have evaluated the long-
term prognosis of elderly patients with common bile duct stones
after endoscopic treatment. In addition, these were relatively small
reviews from a single facility.
An advantage of our study compared with previous reports is that
we evaluated efficacy. In this study, the OS rate was significantly high-
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er in group C than in group I. In contrast, the DSS rate was compa-
rable between the groups. However, Gray’s test is very sensitive; thus,
owing to the small number of deaths from biliary tract infection (n =
6), we could not definitively draw the conclusion that complete stone
removal leads to a good prognosis in elderly patients.
The median number of procedures was 1, and no difference was
found between the two groups. In terms of long-term prognosis, bil-
iary stenting had effects similar to complete stone removal. In group
I, the cause of death in many patients was unrelated to bile duct
stones before cholangitis recurrence. One reason is the retrospective
evaluation; hence, in patients with a relatively severe condition (and
high risk of death), clinicians tend to choose biliary stenting. In this
study, no significant differences in sex, age, body mass index, per-
formance status, and most comorbidities were found between the
groups; only the proportion of patients with dementia was signifi-
cantly higher in group I. Although dementia does not cause death,
patients with dementia were unable to report their symptoms ade-
quately, resulting in symptoms only being detected once the disease
became critical. In addition, other factors that we did not consider
might have also affected the patients’ condition. Thus, good prog-
nostic predictors of health status may be useful in deciding appropri-
ate treatments for bile duct stones in elderly patients.
This study has some limitations. First, this was a retrospective inves-
tigation. Information on the cases excluded from endoscopic sur-
gery was not available. Although elderly patients with severe comor-
bidities are probably at a greater risk of developing complications,
patients who should have been excluded from endoscopic surgery
could not be determined. Second, the treatment strategy for bile duct
stones was not randomized. Although individual factors such as age,
underlying disease, and patient preference may have affected treat-
ment decisions, performing a randomized trial was not possible for
ethical reasons.
6. Conclusion
This study could not definitively draw the conclusion that achieving
complete stone removal necessarily leads to a good prognosis. How-
ever, therapeutic ERCP can be performed safely in elderly patients.
Therefore, advanced age should not be a reason to forgo complete
stone removal.
References
1. Andriulli A, Loperfido S, Napolitano G. Incidence rates of post-ERCP
complications: a systematic survey of prospective studies. American
Journal of Gastroenterology. 2007; 102: 1781-8.
2. Freeman ML, Nelson DB, Sherman S. Complications of endoscopic
biliary sphincterotomy. New England Journal of Medicine. 1996; 335:
909-18.
3. Anderson MA, Fisher L. ASGE Standards of Practice Committee.
Complications of ERCP. Gastrointestinal Endoscopy. 2012; 75: 467-73.
4. Croker JR. Biliary tract disease in the elderly. Clinical Gastroenterology.
1985; 14: 773-809.
5. World Health Organization. The World Health Report 2003: Shaping
the Future. Geneva: World Health Organization. 2003.
6. Saito H, Koga T, Sakaguchi M. Safety and efficacy of endoscopic re-
moval of common bile duct stones in elderly patients ≥90 years of age.
Internal Medicine. 2019; 58: 2125-32.
7. Hu L, Sun X, Hao J. Long-term follow-up of therapeutic ERCP in 78
patients aged 90 years or older. Scientific Reports. 2014; 4: 4918.
8. Chopra KB, Peters RA, O’Toole PA. Randomised study of endoscopic
biliary endoprosthesis versus duct clearance for bileduct stones in high-
risk patients. Lancet. 1996; 348: 791-3.
9. Bergman JJ, Rauws EA, Tijssen JG, Tytgat GN, Huibregtse K. Bili-
ary endoprostheses in elderly patients with endoscopically irretrievable
common bile duct stones: report on 117 patients. Gastrointestinal En-
doscopy. 1995; 42: 195-201.
10. Pisello F, Geraci G, Li Volsi FL, Modica G, Sciume C. Permanent sten-
ting in “unextractable” common bile duct stones in high risk patients.
A prospective randomized study comparing two different stents. Lan-
genbeck›s Archives of Surgery. 2008; 393: 857-63.
11. Tanaka H, Ito K, Seno K. Clinical examination of EBD treatment for
elderly patients with choledocholith. The Japanese Society of Geriatric
Gastroenterology. 2005; 7: 86-90 (in Japanese).
12. Tsujino T, Komatsu Y, Isayama H. Ulinastatin for pancreatitis after en-
doscopic retrograde cholangiopancreatography: a randomized, control-
led trial. Clinical Gastroenterology and Hepatology. 2005; 3: 376-83.
13. Freeman ML, Guda NM. Prevention of post-ERCP pancreatitis: a
comprehensive review. Gastrointestinal Endoscopy. 2004; 59: 845-64.
14. Kanda Y. Investigation of the freely available easy-to-use software
“EZR” for medical statistics. Bone Marrow Transplant. 2013; 48: 452-
8.
15. Ukkonen M, Siiki A, Antila A, Tyrväinen T, Sand J, Laukkarinen J et al..
Safety and efficacy of acute endoscopic retrograde cholangiopancrea-
tography in the elderly. Dig Dis Sci. 2016; 61: 3302-8.
16. Obana T, Fujita N, Noda Y. Efficacy and safety of therapeutic ERCP
for the elderly with choledocholithiasis: comparison with younger pati-
ents. Internal Medicine. 2010; 49: 1935-41.
17. Hong WD, Zhu QH, Huang QK. Endoscopic sphincterotomy plus en-
doprostheses in the treatment of large or multiple common bile duct
stones. Digestive Endoscopy. 2011; 23: 240-3.
18. Hui CK, Lai KC, Ng M. Retained common bile duct stones: a com-
parison between biliary stenting and complete clearance of stones by
electrohydraulic lithotripsy. Alimentary Pharmacology & Therapeutics.
2003; 17: 289-96.
19. Ang TL, Fock KM, Teo EK, Chua TS, Tan J. An audit of the out-
come of long-term biliary stenting in the treatment of common bile
duct stones in a general hospital. Journal of Gastroenterology. 2006;
41: 765-71.
20. Li KW, Zhang XW, Ding J, Chen T, Wang J, Shi WJ et al. A prospective
study of the efficacy of endoscopic biliary stenting on common bile
duct stones. Journal of Digestive Diseases. 2009; 10: 328-31.
8. 8
2021, V6(22): 1-8
https://jjgastrohepto.org/
21. Tanaka M, Takahata S, Konomi H. Long-term consequence of endos-
copic sphincterotomy for bile duct stones. Gastrointestinal Endoscopy.
1998; 48: 465-9.
22. Sugiyama M, Atomi Y. Risk factors predictive of late complications af-
ter endoscopic sphincterotomy for bile duct stones: long-term (more
than 10 years) follow-up study. American Journal of Gastroenterology.
2002; 97: 2763-7.