RESUMO
Primary biliary diseases have been associated in several studies with various malignancies. Understanding the risk and optimizing surveillance strategy of these malignancies in this specific subset of patients are an important facet of clinical care. For instance, primary sclerosing cholangitis is associated with an increased risk for cholangiocarcinoma (which is very challenging to diagnose) and when IBD is present for colorectal cancer. On the other hand, primary biliary cirrhosis patients with cirrhosis or not responding to 12 months of ursodeoxycholic acid therapy are at increased risk of hepatocellular carcinoma. In this review we will discuss in detail the risks and optimal surveillance strategies for patients with primary biliary diseases.
RESUMO
BACKGROUND: This study examines the efficacy and safety of immediate discharge from the postanesthesia care unit after laparoscopic appendectomy for patients with acute nonperforated appendicitis. METHODS: A retrospective study of 114 laparoscopic appendectomy cases was performed. Seventy-four patients met inclusion criteria of having uncomplicated acute appendicitis. Patient demographics, operative times, length of postoperative stay, and complication rates were analyzed. RESULTS: Only 3 of the 74 patients failed to be discharged immediately. Mean postoperative discharge time was 130.5 minutes with 86% of patients leaving within 3 hours. Delay in voiding was the most common cause of stays longer than 4 hours. Six of the 74 patients (8%) returned to the emergency room without need for readmission. There were no complications associated with the early discharge. CONCLUSIONS: Immediate discharge from the postanesthesia care unit for patients with acute nonperforated appendicitis appears safe and effective in the community hospital setting.