Timing of Cholecystectomy for Acute Biliary Pancreatitis

Background : Biliary stones are the leading cause of acute pancreatitis. Although cholecystectomy and selective endoscopic retrograde cholangiography (ERC) comprise the current treatment in patients with acute biliary pancreatitis (ABP), the time of intervention is still controversial. Objective : In this study the outcomes of cholecystectomy was evaluated. Methods : on first admission for ABP and in patients with recurrent biliary pancreatitis. A series of 45 patients with ABP between January 2003 and November 2008 were evaluated retrospectively. Patients were classified into two groups. Group I included 30 patients who underwent cholecystectomy on first admission before discharge from the hospital. Group II comprised of 15 patients who had recurrent biliary pancreatitis and then underwent cholecystectomy. The severity of the pancreatitis was determined by Ranson's criteria. Age, gender, length of hospital stay, severity of pancreatitis, amylase level, and complications of cholecystectomy were evaluated in both groups. Patients in group I underwent cholecystectomy during the first hospital admission and patients in group II during an admission for a recurrence. Results: there were 24 patients with a Ranson's score 3 in group I and 12 in group II. The mean hospital stays were 15.29 days (range 4-48 days) and 36.66 days (range 15-123 days) in groups I and II, respectively (p = 0.006). Morbidity was 11% without mortality in group I and 43% with one mortality in group II (p = 0.023). Conclusions: Definitive treatment of ABP can be accomplished effectively and safely by cholecystectomy following clinical improvement, with selective ERC performed during the first admission (delayed cholecystectomy). Waiting to perform cholecystectomy (interval cholecystectomy) may result in recurrent biliary pancreatitis, which may increase morbidity and the length of the hospital stay. Key words : Timing of cholecystectomy, acute biliary pancreatitisDOI: 10.3329/bsmmuj.v1i1.3690 BSMMU J 2008; 1(1): 11-1

Techniques for Liver Resection

In 1952, Jean Louis Lortat-Jacob undertook the first successful extended right hepatectomy.It was pioneering surgery. Improvement in liver resection has been achieved in the past decade. Among other factors, a gradual change of technology, platforms and refinement of surgical techniques have played significant roles. In this review, the various surgical approaches, operative techniques, operative instruments and adjunctive measures as applied in liver resection are described, along with discussion of the pros and cons of each of these attributes. A brief description of laparoscopic liver resection is also included to address this important and emerging area in liver surgery. Keywords: Liver resection; surgical techniques; Laparoscopic liver resection. DOI: 10.3329/bsmmuj.v3i2.7064BSMMU J 2010; 3(2): 112-11

Isolated liver tuberculosis

Isolated liver tuberculosis is still considered a rare condition and its atypical clinical presentation challenges the clinical acumen of the treating physician. There is difficulty in reaching the correct preoperative diagnosis of nodular hepatic tuberculosis that presents as a space-occupying lesion. It is usually unsuspected and confused with primary or metastatic carcinoma of the liver. In this report, we describe a rare case of isolated liver tuberculosis

An Unusual Cause of Rectal Bleeding -Report of Three Cases and Literature Review

Haemangioma of the rectum and colon is very rare malformation with only around 100 cases have been reported so far. Most commonly young adult is affected. Common site is recto sigmoid junction. Here we present three cases of rectal haemangioma affecting two males and one female patient. All were having cavernous type of haemangioma at rectum and recto sigmoid junction with one involving additional caecum and ascending colon. All the cases were misdiagnosed previously. Colonoscopy is the cornerstone for evaluation of these patients showing bluish discoloration with engorged mucosa. Rectum and sigmoid colon are commonly affected. Abdominoperineal resection was the favored procedure in the past. At present, definitive treatment of diffuse cavernous haemangioma (DCH) of rectum and sigmoid colon is excision of the involved bowel with sphincter saving procedure with either stapling or hand sewn anastomosis of colon and anal canal. Key words: Rectal haemangioma; sphincter saving surgery.DOI: 10.3329/bsmmuj.v2i1.3709 BSMMU J 2009; 2(1): 36-3

An Unusual Cause of Rectal Bleeding -Report of Three Cases and Literature Review

Haemangioma of the rectum and colon is very rare malformation with only around 100 cases have been reported so far. Most commonly young adult is affected. Common site is recto sigmoid junction. Here we present three cases of rectal haemangioma affecting two males and one female patient. All were having cavernous type of haemangioma at rectum and recto sigmoid junction with one involving additional caecum and ascending colon. All the cases were misdiagnosed previously. Colonoscopy is the cornerstone for evaluation of these patients showing bluish discoloration with engorged mucosa. Rectum and sigmoid colon are commonly affected. Abdominoperineal resection was the favored procedure in the past. At present, definitive treatment of diffuse cavernous haemangioma (DCH) of rectum and sigmoid colon is excision of the involved bowel with sphincter saving procedure with either stapling or hand sewn anastomosis of colon and anal canal. Key words: Rectal haemangioma; sphincter saving surgery.DOI: 10.3329/bsmmuj.v2i1.3709 BSMMU J 2009; 2(1): 36-3

A Case Report: Isolated Liver Tuberculosis

Isolated liver tuberculosis is still considered a rare condition and atypical clinical presentation challenges the clinical acumen of the treating physician. There is difficulty in reaching the correct preoperative diagnosis of a nodular hepatic tuberculosis that presents as a space-occupying lesion. It is usually unsuspected and confused with primary or metastatic carcinoma of the liver. In this report, we describe a rare case of isolated liver tuberculosis without pulmonary spread. Keywords: S0L in Liver; Liver tuberculosis DOI: 10.3329/bsmmuj.v2i2.4765 BSMMU J 2009; 2(2): 88-8

Geopolitical risk and corporate capital structure

Using a news-based index of geopolitical risk (GPR) and over 62 years of data, we find that GPR has a long-lasting negative impact on leverage. Our result is robust to different model specifications, different proxies for leverage, a battery of robustness tests, and survives after addressing endogeneity concerns. Further, we provide evidence that the effect is channeled through declining shifts in both the demand and supply of credit. Cross-sectional tests indicate that the effect is stronger for firms with higher existing leverage, those with more irreversible investment, and those whose stock returns are more sensitive to GPR. Overall, our analysis indicates that GPR is more important than other macro-level determinants of capital structure such as inflation, GDP growth, interest rate variables and other widely used measures of uncertainty

Measurements of the pp → ZZ production cross section and the Z → 4ℓ branching fraction, and constraints on anomalous triple gauge couplings at √s = 13 TeV

Four-lepton production in proton-proton collisions, pp -> (Z/gamma*)(Z/gamma*) -> 4l, where l = e or mu, is studied at a center-of-mass energy of 13 TeV with the CMS detector at the LHC. The data sample corresponds to an integrated luminosity of 35.9 fb(-1). The ZZ production cross section, sigma(pp -> ZZ) = 17.2 +/- 0.5 (stat) +/- 0.7 (syst) +/- 0.4 (theo) +/- 0.4 (lumi) pb, measured using events with two opposite-sign, same-flavor lepton pairs produced in the mass region 60 4l) = 4.83(-0.22)(+0.23) (stat)(-0.29)(+0.32) (syst) +/- 0.08 (theo) +/- 0.12(lumi) x 10(-6) for events with a four-lepton invariant mass in the range 80 4GeV for all opposite-sign, same-flavor lepton pairs. The results agree with standard model predictions. The invariant mass distribution of the four-lepton system is used to set limits on anomalous ZZZ and ZZ. couplings at 95% confidence level: -0.0012 < f(4)(Z) < 0.0010, -0.0010 < f(5)(Z) < 0.0013, -0.0012 < f(4)(gamma) < 0.0013, -0.0012 < f(5)(gamma) < 0.0013