We model cross-market Bitcoin prices as long-memory processes and study dynamic interdependence in a fractionally cointegrated VAR framework. We find (i) long-memory in both individual market and five-market systems depicting non-homogeneous informational inefficiency and (ii) a cointegration relationship with slow adjustment of shocks where uncertainty leaves a negative impact.
Mirizzi syndrome is a complication of long standing cholelithiasis. In this, obstruction of the extrahepatic bile duct by stone/s in the Hartman's pouch or cystic duct (Mirrizi type I) may erode in to the bile duct forming cholecystobiliary fistula (Mirrizi type II). Altered biliary tract anatomy and the associated pathology make cholecystectomy, open or laparoscopic, a formidable undertaking. Awareness of this entity and its preoperative diagnosis is of paramount importance to avoid injury to the bile duct at surgery. Improper surgical procedures may lead to long-term stricture formation. The present article reviews the available literature on various aspect of this syndrome including its pathogenesis, diagnosis and recommended management guidelines.
We recommend routine synchronous cholecystectomy with bariatric procedure. In spite of synchronous cholecystectomy, incidence of cholelithiasis in our post-bariatric patient is 10.53 % of which up to one third were symptomatic and required surgery, and incidence of choledocholithiasis is comparable to that of general population.
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