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Wetzel S, Müller A, Kohnert E, Mehrbarzin N, Huber R, Häcker G, Kreutz C, Lederer AK, Badr MT. Longitudinal dynamics of gut bacteriome and mycobiome interactions pre- and post- visceral surgery in Crohn's disease. Front Cell Infect Microbiol 2024; 13:1275405. [PMID: 38287975 PMCID: PMC10822897 DOI: 10.3389/fcimb.2023.1275405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/12/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Alterations of the gut microbiome are involved in the pathogenesis of Crohn's disease (CD). The role of fungi in this context is unclear. This study aimed to determine postoperative changes in the bacterial and fungal gut communities of CD patients undergoing intestinal resection, and to evaluate interactions between the bacteriome and mycobiome and their impact on the patients' outcome. Methods We report a subgroup analysis of a prospective cohort study, focusing on 10 CD patients whose fecal samples were collected for bacterial 16S rRNA and fungal ITS2 genes next-generation sequencing the day before surgery and on the 5th or 6th postoperative day. Results No significant differences in bacterial and fungal diversity were observed between preoperative and postoperative stool samples. By in-depth analysis, significant postoperative abundance changes of bacteria and fungi and 17 interkingdom correlations were detected. Network analysis identified 13 microbial clusters in the perioperative gut communities, revealing symbiotic and competitive interactions. Relevant factors were gender, age, BMI, lifestyle habits (smoking, alcohol consumption) and surgical technique. Postoperative abundance changes and identified clusters were associated with clinical outcomes (length of hospital stay, complications) and levels of inflammatory markers. Conclusions Our findings highlight the importance of dissecting the interactions of gut bacterial and fungal communities in CD patients and their potential influence on postoperative and disease outcomes.
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Affiliation(s)
- Simon Wetzel
- Institute of Medical Microbiology and Hygiene, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Müller
- Center for Complementary Medicine, Department of Medicine II, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Kohnert
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Negin Mehrbarzin
- Institute of Medical Microbiology and Hygiene, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roman Huber
- Center for Complementary Medicine, Department of Medicine II, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Häcker
- Institute of Medical Microbiology and Hygiene, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Centre for Biological Signaling Studies (BIOSS), University of Freiburg, Freiburg, Germany
| | - Clemens Kreutz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Ann-Kathrin Lederer
- Center for Complementary Medicine, Department of Medicine II, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamed Tarek Badr
- Institute of Medical Microbiology and Hygiene, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Aufdecken gemeinsamer Prinzipien immunvermittelter Erkrankungen: von der Grundlagenwissenschaft zu neuen Therapien (IMM-PACT)-Program, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Heiliger C, Heiliger T, Deodati A, Winkler A, Grimm M, Kalim F, Esteban J, Mihatsch L, Ehrlich V Treuenstätt VH, Mohamed KA, Andrade D, Frank A, Solyanik O, Mandal S, Werner J, Eck U, Navab N, Karcz K. AR visualizations in laparoscopy: surgeon preferences and depth assessment of vascular anatomy. MINIM INVASIV THER 2023; 32:190-198. [PMID: 37293947 DOI: 10.1080/13645706.2023.2219739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/11/2023] [Indexed: 06/10/2023]
Abstract
Introduction: This study compares five augmented reality (AR) vasculature visualization techniques in a mixed-reality laparoscopy simulator with 50 medical professionals and analyzes their impact on the surgeon. Material and methods: The different visualization techniques' abilities to convey depth were measured using the participant's accuracy in an objective depth sorting task. Demographic data and subjective measures, such as the preference of each AR visualization technique and potential application areas, were collected with questionnaires. Results: Despite measuring differences in objective measurements across the visualization techniques, they were not statistically significant. In the subjective measures, however, 55% of the participants rated visualization technique II, 'Opaque with single-color Fresnel highlights', as their favorite. Participants felt that AR could be useful for various surgeries, especially complex surgeries (100%). Almost all participants agreed that AR could potentially improve surgical parameters, such as patient safety (88%), complication rate (84%), and identifying risk structures (96%). Conclusions: More studies are needed on the effect of different visualizations on task performance, as well as more sophisticated and effective visualization techniques for the operating room. With the findings of this study, we encourage the development of new study setups to advance surgical AR.
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Affiliation(s)
- Christian Heiliger
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Thomas Heiliger
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Alessandra Deodati
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Alexander Winkler
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Computer Aided Medical Procedures & Augmented Reality (CAMP), Technical University of Munich (TUM), Munich, Germany
| | - Matthias Grimm
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Computer Aided Medical Procedures & Augmented Reality (CAMP), Technical University of Munich (TUM), Munich, Germany
- Maxer Endoscopy GmbH, Wurmlingen, Germany
| | | | - Javier Esteban
- Computer Aided Medical Procedures & Augmented Reality (CAMP), Technical University of Munich (TUM), Munich, Germany
| | - Lorenz Mihatsch
- Department of Anesthesiology and Intensive Care Medicine, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Viktor H Ehrlich V Treuenstätt
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Khaled Ahmed Mohamed
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Dorian Andrade
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Alexander Frank
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Olga Solyanik
- Department of Radiology, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | | | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Ulrich Eck
- Computer Aided Medical Procedures & Augmented Reality (CAMP), Technical University of Munich (TUM), Munich, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures & Augmented Reality (CAMP), Technical University of Munich (TUM), Munich, Germany
- Laboratory for Computational Sensing and Robotics, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Konrad Karcz
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany
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Henze IS, Navarro Altuna V, Steiger JI, Torgerson PR, Kutter APN. Evaluation of the Analgesic Efficacy of Undiluted Intraperitoneal and Incisional Ropivacaine for Postoperative Analgesia in Dogs after Major Abdominal Surgery. Animals (Basel) 2023; 13:ani13091489. [PMID: 37174527 PMCID: PMC10177421 DOI: 10.3390/ani13091489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Recommendations for intraperitoneal (IP) and incisional (INC) administration of local anaesthetics after visceral surgery exist, but evidence is scarce. This prospective, randomized, blinded, controlled, clinical trial compared postoperative pain in dogs undergoing major abdominal surgery. Sixteen client-owned dogs were anaesthetized with a standardized balanced protocol including opioids and received either 2 mg/kg ropivacaine IP (0.27 mL/kg) and a 1 mg/kg INC splash (0.13 mL/kg) or equal volumes of saline. Influence of the treatment on heart rate (HR) and postoperative pain was assessed using the Short Form of the Glasgow Composite Pain Scale (GCPS-SF), a dynamic interactive visual analogue scale (DIVAS) and mechanical nociceptive threshold testing (MNT). Data was tested with mixed ordinal regression and log linear mixed models for 0.5, 1, 2, 3, 4, 6, 8, 10 and 12 h after extubation. Rescue analgesia was given to 3/8 dogs after ropivacaine and 0/8 dogs after saline. GCPS-SF and MNT were not different between groups. DIVAS was slightly higher after ropivacaine (odds increased by 5.44 (confidence interval (CI) 1.17-9.96, p = 0.012)), and HR after ropivacaine was 0.76 * that after saline (CI 0.61-0.96, p = 0.02) with no effect of time (p = 0.1). Undiluted ropivacaine IP and INC was not beneficial for postoperative analgesia.
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Affiliation(s)
- Inken S Henze
- Section of Anaesthesiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Victoria Navarro Altuna
- Section of Anaesthesiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Joëlle I Steiger
- Section of Anaesthesiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Paul R Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | - Annette P N Kutter
- Section of Anaesthesiology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
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Hipp J, Kuvendjiska J, Hillebrecht HC, Timme-Bronsert S, Fichtner-Feigl S, Hoeppner J, Diener MK. Pathological complete response in multimodal treatment of esophageal cancer: a retrospective cohort study. Dis Esophagus 2022. [PMID: 36572398 DOI: 10.1093/dote/doac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
To evaluate pathological complete response (pCR, ypT0ypN0) after neoadjuvant treatment compared with non-complete response (non-CR) in patients with esophageal cancer (EC), and 393 patients were retrospectively analyzed. Survival probability was analyzed in patients with: (i) pCR vs non-CR; (ii) complete response of the primary tumor but persisting lymphatic metastases (non-CR-T0N+) and (iii) pCR and tumor-free lymphnodes exhibiting signs of postneoadjuvant regression vs. no signs of regression. (i) Median overall survival (mOS) was favorable in patients with pCR (pCR: mOS not reached vs. non-CR: 41 months, P < 0.001). Multivariate analysis revealed that grade of regression was not an independent predictor for prolonged survival. Instead, the achieved postneoadjuvant TNM-stage (T-stage: Hazard ratio [HR] ypT3-T4 vs. ypT0-T2: 1.837; N-stage: HR ypN1-N3 vs. ypN0: 2.046; Postneoadjuvant M-stage: HR ypM1 vs. ycM0: 2.709), the residual tumor (R)-classification (HR R1 vs. R0: 4.195) and the histologic subtype of EC (HR ESCC vs. EAC: 1.688) were prognostic factors. Patients with non-CR-T0N+ have a devastating prognosis, similar to those with local non-CR and lymphatic metastases (non-CR-T + N+) (non-CR-T0N+: 22.0 months, non-CR-T + N-: mOS not reached, non-CR-T + N+: 23.0 months; P-values: non-CR-T0N+ vs. non-CR-T + N-: 0.016; non-CR-T0N+ vs. non-CR-T + N+: 0.956; non-CR-T + N- vs. non-CR-T + N+: <0.001). Regressive changes in lymphnodes after neoadjuvant treatment did not influence survival-probability in patients with pCR (mOS not reached in each group; EAC-patients: P = 0.0919; ESCC-patients: P = 0.828). Particularly, the achieved postneoadjuvant ypTNM-stage influences the survival probability of patients with EC. Patients with non-CR-T0N+ have a dismal prognosis, and only true pathological complete response with ypT0ypN0 offers superior survival probabilities.
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Affiliation(s)
- Julian Hipp
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Jasmina Kuvendjiska
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Hans Christian Hillebrecht
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Sylvia Timme-Bronsert
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Breisacher Str. 115A, 79106 Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Jens Hoeppner
- Department of Surgery, University Medical Center Schleswig-Holstein, UKSH Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Markus K Diener
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Schneider MA, Vithiananthan S, Gero D. Editorial: Bariatric surgery-its influence on the development, diagnosis, and treatment of tumors. Front Surg 2022; 9:1110401. [PMID: 36620380 PMCID: PMC9816995 DOI: 10.3389/fsurg.2022.1110401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Marcel André Schneider
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sivamainthan Vithiananthan
- Department of Surgery, Cambridge Health Alliance & Harvard, T.H. Chan School of Public Health Cambridge, Cambridge, MA, United States
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Strobel RM, Leistner R, Leonhardt M, Neumann K, Eschlböck SM, Lee LDG, Seifarth C, Schineis CHW, Kamphues C, Weixler B, Beyer K, Lauscher JC. Is There an Association between Intra-Operative Detection of Pathogens in Subcutaneous Tissue and Surgical Site Infections? Results from a Prospective Study. Surg Infect (Larchmt) 2022; 23:372-379. [PMID: 35263172 DOI: 10.1089/sur.2021.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical site infections (SSIs) are a common complication in visceral surgery. Pathogens causing SSIs vary depending on the type of surgery. Patients and Methods: Within the scope of the Reduction of Postoperative Wound Infections by Antiseptica (RECIPE) trial we analyzed the pathogens cultured in intra-operative, subcutaneous swabs and in swabs from SSI in a single-center, prospective, randomized controlled study. Definition of SSI complied with the criteria of the U.S. Centers for Disease Control and Prevention (CDC). Results: The overall rate of SSI was 28.2% in 393 patients. Colorectal surgery was performed in 68.2% of elective laparotomies. Pathogens were more often detected in intra-operative subcutaneous swabs in patients who developed SSIs than in patients who did not develop SSIs (64.4% vs. 38.0%; p < 0.001). Enterococci were found in 29.1% of intra-operative swabs in patients with SSIs, followed by Escherichia coli in 15.5%. A higher rate of Enterococcus faecium was found in patients with anemia versus those without anemia (9.2% vs. 2.3%; p = 0.006) and in patients who smoked versus those who did not (11.8% vs. 3.6%; p = 0.008). A positive subcutaneous swab (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.47-4.29; p = 0.001), pre-operative anemia (OR, 1.84; 95% CI, 1.08-3.13; p = 0.016), and renal insufficiency (OR, 2.15; 95% CI, 1.01-4.59; p = 0.048) were risk factors for SSIs. Conclusions: There is an association between the intra-operative detection of pathogens in subcutaneous tissue and the development of SSIs in visceral surgery. The most prevalent pathogens causing SSIs were enterococci and Escherichia coli. More efforts are justified to reduce subcutaneous colonization with pathogens, for example by using intra-operative wound irrigation with polyhexanide solution. This trial is registered at www.ClinicalTrials.gov (ID: NCT04055233).
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Affiliation(s)
- Rahel M Strobel
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Rasmus Leistner
- Department of Gastroenterology, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Marja Leonhardt
- Innlandet Hospital Trust, Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Brumunddal, Norway
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Sophie M Eschlböck
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Lucas D G Lee
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Claudia Seifarth
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Christian H W Schineis
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Carsten Kamphues
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Beyer
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Johannes C Lauscher
- Department of General and Visceral Surgery, Rheumatology, and Infectiology, Charité-Campus Benjamin Franklin, Berlin, Germany
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Gruber MM, Weber A, Jung J, Werner J, Draenert R. Impact and Sustainability of Antibiotic Stewardship on Antibiotic Prescribing in Visceral Surgery. Antibiotics (Basel) 2021; 10:antibiotics10121518. [PMID: 34943730 PMCID: PMC8698864 DOI: 10.3390/antibiotics10121518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antibiotic stewardship (AS) ward rounds are a core element in clinical care for surgical patients. Therefore, we aimed to analyze the impact of surgical AS ward rounds on antibiotic prescribing, and the sustainability of the effect after the AS interventions are no longer provided. METHODS On four wards of the department of visceral surgery, we conducted two independent retrospective prescribing analyses (P1, P2) over three months each. During the study periods, the level of AS intervention differed for two of the four wards (ward rounds/no ward rounds). RESULTS AS ward rounds were associated with a decrease in overall antibiotic consumption (91.1 days of therapy (DOT)/100 patient days (PD) (P1), 70.4 DOT/100PD (P2)), and improved de-escalation rates of antibiotic therapy (W1/2: 25.7% (P1), 40.0% (P2), p = 0.030; W3: 15.4 (P1), 24.2 (P2), p = 0.081). On the ward where AS measures were no longer provided, overall antibiotic usage remained stable (71.3 DOT/100PD (P1), 74.4 DOT/100PD (P2)), showing the sustainability of AS measures. However, the application of last-resort compounds increased from 6.4 DOT/100PD to 12.1 DOT/100PD (oxazolidinones) and from 10.8 DOT/100PD to 13.2 DOT/100PD (carbapenems). CONCLUSIONS Antibiotic consumption can be reduced without negatively affecting patient outcomes. However, achieving lasting positive changes in antibiotic prescribing habits remains a challenge.
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Affiliation(s)
- Magdalena Monika Gruber
- Antibiotic Stewardship Team, University Hospital, LMU Munich, 81377 München, Germany; (M.M.G.); (A.W.); (J.J.)
- Hospital Pharmacy, University Hospital, LMU Munich, 81377 München, Germany
| | - Alexandra Weber
- Antibiotic Stewardship Team, University Hospital, LMU Munich, 81377 München, Germany; (M.M.G.); (A.W.); (J.J.)
- Hospital Pharmacy, University Hospital, LMU Munich, 81377 München, Germany
| | - Jette Jung
- Antibiotic Stewardship Team, University Hospital, LMU Munich, 81377 München, Germany; (M.M.G.); (A.W.); (J.J.)
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, 81377 München, Germany
| | - Jens Werner
- Department of General, Visceral und Transplantation Surgery, University Hospital, LMU Munich, 81377 München, Germany;
| | - Rika Draenert
- Antibiotic Stewardship Team, University Hospital, LMU Munich, 81377 München, Germany; (M.M.G.); (A.W.); (J.J.)
- Correspondence:
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Myers D, Jacobson X, Dale M, Sahasranaman V, Nandipati K. Impact of Paraesophageal Hernia Repair on Respiratory Function: A Systematic Review. Front Surg 2021; 8:666686. [PMID: 34262930 PMCID: PMC8273160 DOI: 10.3389/fsurg.2021.666686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/29/2021] [Indexed: 01/23/2023] Open
Abstract
Background and Objectives: Surgical repair of hiatal and paraesophageal hernia is widely accepted for the treatment of gastroesophageal reflux symptoms. The respiratory benefit of this surgery is less clear. The objective of this review is to quantify the benefit to pulmonary function and subjective dyspnea of paraesophageal hernia repair with the aim of refining the indications and contraindications for elective paraesophageal hernia repair. Methods: Articles were gathered from systematic searches of the Medline Complete Database via the Creighton University Health Sciences Library literature search services. Publications with both pre and postoperative pulmonary function data or both pre and postoperative subjective dyspnea data with regards to surgical paraesophageal hernia repair were included. Results: Six studies were included in this review. The majority of studies in this review show improvement in pulmonary function postoperatively with regards to FEV1, FVC, and VC when stratified by % intrathoracic stomach (ITS), particularly in groups >50% ITS. No significant change was seen in postoperative DLCO or FEV1/FVC. Conclusion: Paraesophageal hernia repair has shown to improve pulmonary function both objectively and subjectively. This review was limited by the paucity of literature on the subject as well as the lack of a standardized method for measurement of %ITS.
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Affiliation(s)
- Dominick Myers
- School of Medicine, Creighton University, Omaha, NE, United States
| | - Xander Jacobson
- School of Medicine, Creighton University, Omaha, NE, United States
| | - Matthew Dale
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, United States
| | - Venket Sahasranaman
- Department of Pulmonology, School of Medicine, Creighton University, Omaha, NE, United States
| | - Kalyana Nandipati
- Department of Surgery, School of Medicine, Creighton University, Omaha, NE, United States
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Grudzińska E, Mrowiec S, Pilch-Kowalczyk J, Ciupińska M, Kusnierz K. Small Intestinal Intussusception Due to Complicated Giant Jejunal Diverticulosis. ACTA ACUST UNITED AC 2021; 57:medicina57020116. [PMID: 33525341 PMCID: PMC7910828 DOI: 10.3390/medicina57020116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 01/04/2023]
Abstract
Background: Jejunal diverticulosis and jejunal lipomatosis are uncommon conditions. Usually asymptomatic, they may cause severe complications in some cases. Intussusception is unusual in adults, but when diagnosed swiftly it can be treated surgically, usually with good outcome. Case presentation: We present a 60-year-old female patient with a history of chronic malnutrition and anemia, complaining of acute abdominal pain, vomiting and diarrhea. Contrast-enhanced abdominal computed tomography (CT) showed intussusception, multiple giant jejunal diverticula and multiple lipomas. The patient underwent urgent surgery, but radical treatment was not possible due to the extent of the diseases. One month later, another surgery was needed due to ileostomy obstruction caused by lipomas. The patient’s condition deteriorated due to malnutrition and concomitant metabolic disorders, which eventually led to her demise. Conclusions: Radical treatment is not always possible in an extensive jejunal disease. Prolonged malnutrition impairs postoperative healing, and therefore surgical or nutritional treatment should be considered in jejunal diverticulosis before the onset of severe complications requiring urgent surgical intervention.
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Affiliation(s)
- Ewa Grudzińska
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (E.G.); (K.K.)
| | - Sławomir Mrowiec
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (E.G.); (K.K.)
- Correspondence: ; Tel.: +48-6-0145-7648
| | | | - Monika Ciupińska
- Department of Pathomorphology and Molecular Diagnostics, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Katarzyna Kusnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland; (E.G.); (K.K.)
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Alassani AC, Hodonou AM, Dovonou AC, Gbessi GD, Ahoui S, Dossou FM, Mêhinto DK. Fréquence et déterminants de la dénutrition post-opératoire en chirurgie viscérale au Centre National Hospitalier et Universitaire Koutoucou Hubert Maga, Cotonou. Pan Afr Med J 2018; 29:19. [PMID: 29662604 PMCID: PMC5899781 DOI: 10.11604/pamj.2018.29.19.10805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/29/2017] [Indexed: 11/13/2022] Open
Abstract
L'objectif de cette étude était de déterminer la fréquence et les facteurs associés à la dénutrition chez les patients opérés en chirurgie viscérale en 2014. Il s'est agi d'une étude transversale, descriptive et analytique couvrant la période du 11septembre 2014 au 11 décembre 2014. La population d'étude était constituée des patients opérés en chirurgie viscérale au Centre National Hospitalier Universitaire Hubert Koutoucou MAGA de Cotonou. La dénutrition a été définie pour un indice de masse corporelle inférieur à 18,5 kg/m2. Au total 90 patients avaient été inclus dans l'étude, 57,78 % (52 patients) étaient de sexe masculin. La moyenne d'âge des patients était 55±6,32 ans. La dénutrition était observée chez 42 patients (46,67%). Les facteurs associés à la dénutrition chez les patients en postopératoire étaient : l'âge supérieur ou égal à 50 ans, les apports énergétique, protéique et hydrique faibles, la diarrhée, la présence de cancer, la chirurgie sur le tractus digestif, la chirurgie urgente, une perte de poids significative et l'hyperleucocytose. La dénutrition est fréquente chez les patients en postopératoire. Elle nécessite un dépistage et une prise en charge précoces.
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Affiliation(s)
- Adébayo Cossi Alassani
- Service de Médecine Interne, Centre Hospitalier Universitaire Départemental du Borgou (CHUD-B) Parakou (République du Bénin).,Faculté des Sciences de la Santé de l'UAC, Ecole de Nutrition, Cotonou, (République du Bénin)
| | - Adrien Montcho Hodonou
- Département de Chirurgie et Spécialités, Faculté de Médecine, Service de Chirurgie Générale du CHUD-B, Université de Parakou, Parakou (République du Bénin)
| | - Albert Comlan Dovonou
- Département de Médecine et Spécialités, Faculté de Médecine de l'Université de Parakou, Centre Hospitalier Universitaire Département du Borgou, Parakou (République du Bénin)
| | - Gaspard Dansou Gbessi
- Cliniques Universitaires de Chirurgie Viscérale, Centre National Hospitalier et Universitaire (CNHU) HKM de Cotonou (République du Bénin)
| | - Séraphin Ahoui
- Département de Médecine et Spécialités, Faculté de Médecine, Université de Parakou, Unité de Néphrologie et Dialyse, Centre Hospitalier Universitaire Départemental du Borgou, Parakou (République du Bénin)
| | - Francis Moïse Dossou
- Cliniques Universitaires de Chirurgie Viscérale, Centre National Hospitalier et Universitaire (CNHU) HKM de Cotonou (République du Bénin)
| | - Delphin Kouassi Mêhinto
- Cliniques Universitaires de Chirurgie Viscérale, Centre National Hospitalier et Universitaire (CNHU) HKM de Cotonou (République du Bénin)
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Téoule P, Birgin E, Zaltenbach B, Kähler G, Wilhelm TJ, Kienle P, Rückert F. A Retrospective, Unicentric Evaluation of Complicated Diverticulosis Jejuni: Symptoms, Treatment, and Postoperative Course. Front Surg 2015; 2:57. [PMID: 26618161 PMCID: PMC4643121 DOI: 10.3389/fsurg.2015.00057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/26/2015] [Indexed: 11/13/2022] Open
Abstract
Background In contrast to the diverticulosis of the colon, jejunal diverticulosis is a rare condition. The incidence is 0.06–5% in large autopsy series. Complicated diverticulosis jejuni (CDJ) often presents with unspecific symptoms. Therefore, diagnosis is often a challenging process and due to the clinical rarity generally valid recommendation of perioperative management does not exist. Patients and methods We considered only patients who were operated in our center between April 2007 and August 2014. Patients were identified by data bank search via International Statistical Classification of Diseases and Related Health Problems diagnosis code K57.10. Data were manually screened, and patients with Meckel’s and duodenal diverticula were excluded from this study. Eleven consecutive patients with CDJ were finally included in this study. We analyzed symptoms, diagnostic procedures, surgical treatment, and postoperative morbidity and mortality. Results The median age of our patients was 76 years (range: 34–87). CDJ presented most frequently as intestinal bleeding or as diverticulitis. Clinical symptoms were unspecific abdominal pain, hematemesis or melena, ileus, nausea, and emesis as well as patients with acute abdomen. Esophagogastroduodenoscopies confirmed CDJ in two of the three patients. An abdominal computed tomography scan only helped to diagnose CDJ in two of the 10 patients. Eight (72.7%) patients received an open segmental resection with primary anastomosis. In three (27.3%) cases, a reoperation was necessary. Overall morbidity rate was 45.5%, and perioperative mortality was 9.1%. Conclusion Due to the acute character of the disease, patients with CDJ are seriously ill. To diagnose patients with CDJ remains challenging as diagnostic investigations are usually not helpful in confirming the diagnosis. Still, diagnosis of CDJ is most frequently confirmed intraoperatively.
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Affiliation(s)
- Patrick Téoule
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Emrullah Birgin
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Benjamin Zaltenbach
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Georg Kähler
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Torsten J Wilhelm
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Peter Kienle
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
| | - Felix Rückert
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University , Mannheim , Germany
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Zachariah SK, Kolathur NM, Balakrishnan M, Parakkadath AJ. Minimal incision scar-less open umbilical hernia repair in adults - technical aspects and short-term results. Front Surg 2015; 1:32. [PMID: 25593956 PMCID: PMC4287018 DOI: 10.3389/fsurg.2014.00032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 08/06/2014] [Indexed: 01/15/2023] Open
Abstract
Background: There is no gold standard technique for umbilical hernia (UH) repair. Conventional open UH repair often produces an undesirable scar. Laparoscopic UH repair requires multiple incisions beyond the umbilicus, specialized equipments, and expensive tissue separating mesh. We describe our technique of open UH repair utilizing a small incision. The technique was derived from our experience with single incision laparoscopy. We report the technical details and short-term results. Methods: This is a retrospective analysis of the first 20 patients, who underwent minimal incision scar-less open UH repair, from June 2011 to February 2014. A single intra-umbilical curved incision was used to gain access to the hernia sac. Primary suture repair was performed for defects up to 2 cm. Larger defects were repaired using an onlay mesh. In patients with a BMI of 30 kg/m2 or greater, onlay mesh hernioplasty was performed irrespective of the defect size. Results: A total of 20 patients, 12 males and 8 females underwent the procedure. Mean age was 50 (range 29–82) years. Mean BMI was 26.27 (range 20.0–33.1) kg/m2. Average size of the incision was 1.96 range (1.5–2.5) cm. Mesh hernioplasty was done in nine patients. Eleven patients underwent primary suture repair alone. There were no postoperative complications associated with this technique. Average postoperative length of hospital stay was 3.9 (range 2–10) days. Mean follow-up was 29.94 months (2 weeks to 2.78 years). On follow-up there was no externally visible scar in any of the patients. There were no recurrences on final follow-up. Conclusion: This technique provides a similar cosmetic effect as obtained from single port laparoscopy. It is easy to perform, safe, offers good cosmesis, does not require incisions beyond the umbilicus, and cost effective, with encouraging results on short-term follow-up. Further research is needed to assess the true potential of the technique and the long-term results.
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Affiliation(s)
- Sanoop K Zachariah
- Department of General, Laparoscopic and Gastrointestinal Surgery, Malankara Orthodox Syrian Church Medical College , Cochin , India
| | - Najeeb Mohamed Kolathur
- Department of General, Laparoscopic and Gastrointestinal Surgery, Malankara Orthodox Syrian Church Medical College , Cochin , India
| | - Mahesh Balakrishnan
- Department of General, Laparoscopic and Gastrointestinal Surgery, Malankara Orthodox Syrian Church Medical College , Cochin , India
| | - Arun Joseph Parakkadath
- Department of General, Laparoscopic and Gastrointestinal Surgery, Malankara Orthodox Syrian Church Medical College , Cochin , India
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