Background:Adhesive capsulitis of the shoulder (ACS) is a common self-limiting condition characterized by disabling pain and restricted movements. Its pathophysiology is poorly understood, clinically it is characterized by stages of pain and stiffness, and finally often patients never recover fully. However, there is no consensus about available methods of treatment for ACS. The aims of this paper are to discuss and develop issues regarding approaches to management in ACS in the stages of it.Methods:A review of the literature was performed and guidelines for the treatment of that clinical entity for doctors and health care professionals are provided.Results:Anti-inflammatory medications, steroid and/or hyaluronate injections and physiotherapy is the mainstay of conservative management either alone in the first stages or in combination with other treatment modalities in the later stages. Next line of treatment, involving minor to moderate intervention, includes suprascapular nerve block, distension arthrography and manipulation under anaesthesia. In order to avoid complications of “blind intervention”, arthroscopic capsular release is gradually more commonly applied, and in recalcitrant severe cases open release is a useful option.Conclusion:Various modalities of conservative management and gradually more surgical release are applied. However, often clinicians choose on personal experience and training rather than on published evidence.
Background:
Laparoscopic cholecystectomy (LC) has been associated with an increase in the incidence of biliary and vascular injuries. Pseudoaneurysms (PAs) following LC are rare life-threatening events with limited available experience regarding diagnosis and treatment.
Materials and Methods:
An extensive review of literature during a 26-year period (1994–2020) using MEDLINE
®
database and Google Scholar
®
academic search engine revealed 134 patients with at least one symptomatic PA following LC.
Results:
Nearly 81% of patients with PAs become symptomatic during the first 8 weeks following LC. The most common symptoms were gastrointestinal bleeding (74%) and abdominal pain (61%). In 28% of cases, there was a concomitant bile duct injury or leak from the cystic duct stump, whereas in about one-third of cases, PAs presented following an uneventful LC. The most common involved arteries were the right hepatic artery (70%), the cystic artery (19%) or both of them (3%). Trans-arterial embolisation was the favoured first-line treatment with a success rate of 83%. During a median follow-up of 9 months, the mortality rate was 7%.
Conclusion:
Clinicians should be aware of the PA occurrence following LC. Prompt diagnosis and treatment are essential.
Even that thinking, and innovative thinking, in particular, is supposed to be borderless and unbiased, it seems that most of the innovations globally derive from regions that have built a brand name on it. This limits the opportunities to bright ideas form bright people outside the innovation hubs, resulting in a general loss of intellectual capital for the global economy. This paper aims to democratize innovation by redefining geo-entrepreneurship through a reverse innovation framework that exposes the hidden intellectual capital around the world, evaluates innovation drives and opportunities and empowers the development, commercialization and utilization of innovation. Based on the Company Democracy Model the proposed framework impacts reversely national brain-drain contributes to innovation scouting, strategic partnerships, and redistributes success opportunities. This geo-entrepreneurial approach identifies innovation potential globally, reduces inequalities among all those who can and want to create opportunities regardless of where innovation takes place and by whom.
Introduction: Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure worldwide. The aim of the present study was to evaluate the long-term e cacy of SG as a stand-alone bariatric procedure.Methods: A single center retrospective analysis of 104 patients who underwent SG as a stand-alone bariatric procedure between January 2005 and December 2009. Weight loss, weight regain, remission or improvement of comorbidities, and the new onset of comorbidities were the main outcomes of the study.Results: At a mean follow-up of 13.4 years, % excess body weight loss (%EBWL), % excess BMI loss (%EBMIL) and % total body weight loss (%TBWL) were 59 ± 25, 69 ± 29 and 29 ± 12, respectively. Approximately two third of patients (67.3%) maintained an %EBWL of > 50 at the last follow-up. The percentage of patients who experienced signi cant weight regain ranged from 47% to 64%, depending on the de nition used for weight regain. The rate of improvement or remission of hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea and degenerative joint disease at a mean follow-up of 13.4 years was 40%, 94.7%, 70%, 100% and 42.9%, respectively. The new onset of gastroesophageal re ux disease (GERD) in the same period was 43%. Conclusion: Our data support that SG results in long-lasting weight loss in the majority of patients and acceptable rates of remission or improvement of comorbidities. Weight regain and GERD may be issues of particular concern during long-term follow-up after SG.
Primary aortoenteric fistula (PAEF) is a rare entity that demands high clinical suspicion and efficient management in a limited time. The evolution of interventional radiology established endovascular repair (EVAR) as an attractive option. The English literature was searched using the PubMed database with the terms "primary aortoenteric fistula", "primary aortoduodenal fistula" or "aortoduodenal fistula", and "endovascular repair" in different combinations. Studies and original articles that described the role and the outcomes of EVAR for primary aortoenteric fistula were included. Fourteen articles with a total of 15 patients with primary aortoenteric fistula who were managed with EVAR were included in our literature review. PAEF is a rare and lethal entity that everyone should be aware of. EVAR is a salvage option and a valuable weapon in our armamentarium. Is EVAR really a "bridge to surgery" or is it the birth pangs of a minimally invasive definite treatment of PAEF?
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