Minerva medica
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This review is to summarize the current knowledge about preoperative biliary drainage (PBD) in patients with biliary obstruction caused by pancreatic cancer. Most patients with pancreatic carcinoma (85%) will present with obstructive jaundice. The presence of toxic substances as bilirubin and bile salts, impaired liver function and altered nutritional status due to obstructive jaundice have been characterized as factors for development of complications after surgery. ⋯ Arguments for PBD have shifted from a potential therapeutic benefit towards a logistic problem such as patients suffering from cholangitis and severe jaundice at admission or patients who need extra diagnostic tests, or delay in surgery due to a referral pattern or waiting list for surgery as well as candidates for neoadjuvant chemo(radio)therapy. If drainage is indicated in these patients it should be performed with a metal stent to reduce complications after the drainage procedure such as stent occlusion and cholangitis. Considering a change towards more neoadjuvant therapy regimes improvement of the quality of the biliary drainage concept is still important.
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To investigate the hippocampal regional deformation modes by means of a novel method of automatic segmentation for discriminating between Alzheimer's disease (AD) and normal aging; and to further provide the effective evidence for the early diagnosis of AD. ⋯ This novel method of automated segmentation of the hippocampus based on AAM has been found to be reliable and accurate in our study, which may be an alternative to manual segmentation. The featured atrophy of hippocampal head can be regarded as an important biomarker for the early diagnosis of AD.