BACKGROUND Despite being a benign disease, hepatolithiasis has a poor prognosis because of its intractable nature and frequent recurrence. Nonsurgical treatment is associated with high incidences of residual and recur...BACKGROUND Despite being a benign disease, hepatolithiasis has a poor prognosis because of its intractable nature and frequent recurrence. Nonsurgical treatment is associated with high incidences of residual and recurrent stones. Consequently, surgery via hepatic lobectomy or segmental hepatectomy has become the main treatment modality. Clinical management and resolution of complicated hepatolithiasis with bilateral or diffuse intrahepatic stones remain very difficult and challenging. Repeated cholangitis and calculous obstruction may result in secondary biliary cirrhosis, a limiting factor in the treatment of hepatolithiasis.CASE SUMMARY A 53-year-old woman with a 5-year history of intermittent abdominal pain and fever was admitted to the hepatopancreatobiliary surgery department following worsening symptoms over a 3-d period. Blood tests revealed elevated transaminases, alkaline phosphatase, γ-glutamyl transpeptidase, and total bilirubin, as well as anemia. Magnetic resonance cholangiopancreatography showed dilatation of the intrahepatic, left and right hepatic, common hepatic, and common bile ducts, and multiple short T2 signals in the intrahepatic and common bile ducts. Abdominal computed tomography showed splenomegaly and splenic varices. The diagnosis was bilateral hepatolithiasis and choledocholithiasis with cholangitis. Surgical treatment included hepatectomy of segments Ⅱ and Ⅲ, cholangioplasty, left hepaticolithotomy, second biliary duct exploration, choledocholithotomy, T-tube drainage, and accretion lysis. Surgical and pathological findings confirmed secondary biliary cirrhosis. Liver-protective therapy and anti-infectives were administered. The patient developed liver and respiratory failure, severe abdominal infection, and septicemia. Eventually, her family elected to discontinue treatment.CONCLUSION Liver transplantation, rather than hepatectomy, might be a treatment option for complicated bilateral hepatolithiasis with secondary liver cirrhosis.展开更多
Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest.During CPR,both healthcare and non-healthcare workers who provide re...Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest.During CPR,both healthcare and non-healthcare workers who provide resuscitation are at risk of infection.The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients.Main recommendations:1)A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs.2)Psychological counseling and treatment are highly recommended,since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest.3)Healthcare workers should wear personal protective equipment(PPE).4)Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19.5)Hands-only chest compression and mechanical chest compression are recommended.6)Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early.7)CPR should be provided for 20-30 min.8)Various factors should be taken into consideration such as the interests of patients and family members,ethics,transmission risks,and laws and regulations governing infectious disease control.Changes in management:The following changes or modifications to CPR strategy in COVID-19 patients are proposed:1)Healthcare workers should wear PPE.2)Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols.3)Both the benefits to patients and the risk of infection should be considered.4)Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.展开更多
文摘BACKGROUND Despite being a benign disease, hepatolithiasis has a poor prognosis because of its intractable nature and frequent recurrence. Nonsurgical treatment is associated with high incidences of residual and recurrent stones. Consequently, surgery via hepatic lobectomy or segmental hepatectomy has become the main treatment modality. Clinical management and resolution of complicated hepatolithiasis with bilateral or diffuse intrahepatic stones remain very difficult and challenging. Repeated cholangitis and calculous obstruction may result in secondary biliary cirrhosis, a limiting factor in the treatment of hepatolithiasis.CASE SUMMARY A 53-year-old woman with a 5-year history of intermittent abdominal pain and fever was admitted to the hepatopancreatobiliary surgery department following worsening symptoms over a 3-d period. Blood tests revealed elevated transaminases, alkaline phosphatase, γ-glutamyl transpeptidase, and total bilirubin, as well as anemia. Magnetic resonance cholangiopancreatography showed dilatation of the intrahepatic, left and right hepatic, common hepatic, and common bile ducts, and multiple short T2 signals in the intrahepatic and common bile ducts. Abdominal computed tomography showed splenomegaly and splenic varices. The diagnosis was bilateral hepatolithiasis and choledocholithiasis with cholangitis. Surgical treatment included hepatectomy of segments Ⅱ and Ⅲ, cholangioplasty, left hepaticolithotomy, second biliary duct exploration, choledocholithotomy, T-tube drainage, and accretion lysis. Surgical and pathological findings confirmed secondary biliary cirrhosis. Liver-protective therapy and anti-infectives were administered. The patient developed liver and respiratory failure, severe abdominal infection, and septicemia. Eventually, her family elected to discontinue treatment.CONCLUSION Liver transplantation, rather than hepatectomy, might be a treatment option for complicated bilateral hepatolithiasis with secondary liver cirrhosis.
文摘Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest.During CPR,both healthcare and non-healthcare workers who provide resuscitation are at risk of infection.The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients.Main recommendations:1)A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs.2)Psychological counseling and treatment are highly recommended,since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest.3)Healthcare workers should wear personal protective equipment(PPE).4)Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19.5)Hands-only chest compression and mechanical chest compression are recommended.6)Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early.7)CPR should be provided for 20-30 min.8)Various factors should be taken into consideration such as the interests of patients and family members,ethics,transmission risks,and laws and regulations governing infectious disease control.Changes in management:The following changes or modifications to CPR strategy in COVID-19 patients are proposed:1)Healthcare workers should wear PPE.2)Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols.3)Both the benefits to patients and the risk of infection should be considered.4)Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.
