Cholangiocarcinoma is the second most common malignant tumor after primary hepatic cancer.Despite advances in diagnostic techniques during the past decade, cholangiocarcinoma is usually encountered at an advanced stage. In this review, we describe the classification, diagnosis, and management of cholan-giocarcinoma with obstructive jaundice.

New developments appear in digestive tract anastmosis with better understanding to its healing process and the adoption of new techniques, such as single-layer anastomosis, combined suturing and me-chanical anastomosis. These issues are reviewed in this article.

BACKGROUND AND OBJECTIVES: Tinnitus is characterized as a perception of numerous auditory sounds in absence of external stimulus. Tinnitus can have a considerable consequence on a person’s quality of life, and is considered to be very complicated to quantify. The aim of this study was to investigate the reliability and validity of Urdu translation of the Tinnitus Handicap Inventory (THI) in Pakistan. It was designed to assess the presence of various auditory sounds without the external stimulus. Scale consisted of 25 items having three subscales functional, emotional, and catastrophic. SUBJECTS AND METHODS: The study comprised into two stages, preliminary and main studies. The results of preliminary study revealed that the overall scale had high internal consistency [alpha coefficient of Urdu version of THI (THI-U)= 0.99, alpha coefficient of English version of THI=0.98]. The overall scale had test-retest correlation over a fifteen days period of interval (0.99). Main study was performed on 110 tinnitus patients. The results of main study showed that the internal consistency and reliability of Urdu version was (α=0.93). The THI-U and its subscales demonstrated good internal consistency reliability ( α =0.81 to 0.86). RESULTS: High to moderate correlations were noted between tinnitus symptom ratings. A confirmatory factor analysis was used to validate the three subscales of THI-U, and high inter-correlations were found between the subscales also results revealed that a three-factor model for the THI-U was most tenable. The results displayed that the confirmatory factor analysis confirmed to validate the three subscales of THI-U. CONCLUSION: THI-U might present important information about precise facets of tinnitus distress along with diagnostic interviews in clinical practice.
Humans ; Pakistan ; Quality of Life ; Reproducibility of Results ; Tinnitus

OBJECTIVETo compare microcirculation and tissue healing process in gastrointestinal anastomosis with apposition or inverted suture.

METHODSThe study was performed in adult rabbits. Animals were randomly assigned to two groups. In group A, small intestine was transected at 20 cm and 40 cm from duodenojejunal ligament and apposition sutures were performed at 20 cm and inverted sutures at 40 cm. In group B, transaction and anastomosis were at the same location with group A while the suturing method was reversed. Anastomotic microcirculation and number of capillary were observed in vivo with naked eyes to evaluate inflammatory response, collagen proliferation and healing of epithelium and smooth muscle in both groups at postoperative day 3, 7, 14 and 28.

RESULTSIn group A, tissue layers at the anastomosis were approximated tight and neat with mild inflammation and primary wound healing. In group B, displacement and poor alignment of layers were seen with severe inflammation and secondary wound healing. Low frequency of microcirculation was detected in group A at day 3, and blood flow velocity significantly increased at day 7. Blood flow velocity was close to normal at day 14 and completely restored to the normal level at day 28. Microcirculation was lower in group A than that in group B at each time point. There were more capillaries, lower number of inflammatory cells, less collagen proliferation, and better healing of anastomotic epithelium and smooth muscle in group A than group B.

CONCLUSIONApposition suturing is better than inverted suturing in restoring local anastomotic microcirculation and healing of intestinal tissues.

Anastomosis, Surgical ; methods ; Animals ; Digestive System Surgical Procedures ; methods ; Female ; Male ; Microcirculation ; physiology ; Rabbits ; Surgical Stomas ; blood supply ; Suture Techniques ; Wound Healing ; physiology