Cerebral edema is the accumulation of water in intracellular and interstitial brain tissue due to some neurological pathology. There are three principle mechanisms for cerebral edema: Cytotoxic edema, Vasogenic edema, Hydrostatic edema. There are multiple options available for treating cerebral edema including: medical management and surgical management. But none of the current treatment modalities address the underlying pathogenetic mechanism. So, targeted therapies are need of the hour. It may include NKCC1 antagonists, aquaporin inhibitors, Sur1-Trpm4 channel inhibitors, NHE inhibitors and VEGF inhibitors; which are in different stages of development. But, there are very few human trials that are conducted to assess the role of these pharmacologic agents in cerebral edema due to traumatic brain injury
Introduction: Management of common bile duct stones (CBDS) presents a surgical challenge since it is the major cause of hepatobiliary morbidity and complications. The aim of the study was to evaluate the best line of treatment for CBD stone and complications related to every approach. Material and Methods:This retrospective study includes patients with CBDS who were treated with conservative treatment or endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). Primary outcome was successful clearance of common bile duct and secondary outcomes were complications, total cost and hospital stay. Results:Out of 25 patients, 13 were treated by ERCP (Endoscopic Retrograde Cholangio Pancreatography) and 12 by Conservative approach. There was complete clearance of CBDS in 10 (76%) cases out of 13, in the endoscopic retrograde cholangiopancreatography (ERCP) group and in the remaining 3 patients, the Common bile duct stone was removed by the trans-cystic exploration. In the conservative group, there was complete clearance of CBDS in 8 (66%) cases, and in the remaining 4 (33%)patients, the common bile duct stone was removed by the transcystic exploration.Conclusion: Management of CBDS represents a surgical challenge. CBDS increases the technical difficulty of ERCP and increases the risk of PEP. Conservative management of CBDS avoids the risks associated with ERCP and is also effective in clearing CBDS so one should consider a conservative line of treatment in CBDS in order to decrease the cost and avoid unnecessary ERCP.
Introduction: Management of common bile duct stones (CBDS) presents a surgical challenge since it is the major cause of hepatobiliary morbidity and complications. The aim of the study was to evaluate the clinical outcome for CBD stone and evaluate the treatment modality. Material and Methods: This retrospective study was done in 30 cases of Common bile duct stone for period of 1 year. All 30 patients included in the study were appropriately investigated by laboratory investigations, USG, CT scan and MRCP. Results: Out of 30 patients included in the study, 26 had undergone successful ERCP and had successful clearance of CBD which were followed by Laparoscopic cholecystectomy. 2 patients had failed ERCP clearance, out of which 1 patient had undergone re-ERCP with successful clearance of the stone. The other 1 patient had to undergo Open CBD exploration followed by cholecystectomy. 2 patients with CBD stone greater than 2 cm had to undergo direct CBD exploration without undergoing ERCP Conclusion: Appropriate identification of CBD stone size, location, number and CBD diameter associated with features of cholangitis, jaundice and pancreatitis is essential. It is a complicated procedure requiring a step-wise strategic approach. The gold standard for the removal of CBD stone is ERCP followed by laparoscopic cholecystectomy.Common bile duct exploration is considered in patients with failed clearance of CBD following ERCP OR CBD stone size > 2cm.
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