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Posthemithyroidectomy Hypothyroidism: Updated Meta-Analysis of Risk Factors and Rates of Remission. J Surg Res 2024; 293:102-120. [PMID: 37734294 DOI: 10.1016/j.jss.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/09/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION The aim of this study was to determine the incidence and risk factors for hypothyroidism, both clinical and subclinical, following hemithyroidectomy in preoperatively euthyroid patients, as well as hypothyroidism remission and its time of remission. MATERIALS AND METHODS A search was performed in Medline (via PubMed), Web of Science, and the Cochrane Library using the keywords "hemithyroidectomy + postoperative + hypothyroidism" and "hemithyroidectomy + hormone supplementation". RESULTS Fifty-four studies with a total of 9,999 patients were included. After a mean follow-up interval of 48.2 mo, the pooled hypothyroidism rate was 29%. The subclinical hypothyroidism rate was 79% of patients with hypothyroidism (18 studies). Moreover, a meta-analysis of 12 studies indicated a pooled hypothyroidism remission rate after hemithyroidectomy of 42% (95% CI: 24%-60%). Older patient age (MD = -2.54, 95% CI = -3.99, -1.10, P = 0.0006), female gender (OR = 0.69, 95% CI = 0.58, 0.82, P < 0.0001), higher preoperative thyroid-stimulating hormone levels (MD = -0,81, 95% CI = -0.96, -0.66, P < 0.00001), pathological preoperative anti-thyroid peroxidase antibodies (OR = 0.37, 95% CI = 0.24, 0.57, P < 0.00001) and anti-thyroglobulin antibodies (OR = 0.52, 95% CI = 0.36, 0.75, P = 00,005), and right-sided hemithyroidectomy (OR = 0.54, 95% CI = 0.43, 0.68, P < 0.00001) were associated with postoperative hypothyroidism development. In metaregression analysis, Asia presented a significantly higher hypothyroidism rate after hemithyroidectomy (34.6%, 95% CI = 29.3%-9.9%), compared to Europe (22.9%, 95% CI = 16.2%-29.5%, P = 0.037) and Canada (1.8%, 95% CI = -22.6%-26.2%, P = 0.013). CONCLUSIONS Hypothyroidism is a frequent and significant postoperative sequela of hemithyroidectomy, necessitating individualization of treatment strategy based on the underlying disease as well as the estimated risk of hypothyroidism and its risk factors.
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Abstract
Primary Gastrointestinal Angiosarcoma (PGAS) constitutes a rare malignant tumor arising from vascular or lymphatic endothelial cells. The aim of this study was to review the available literature on PGAS and to elucidate its biological behavior and optimal therapeutic approach. PubMed and Embase bibliographical databases were systematically searched (last search April 8th, 2020) for studies concerning PGAS. Ninety-eight studies met our inclusion criteria, involving 110 patients (male/female = 1.5) with an age of 62.40 ± 17.84 (mean, SD) years. They were most frequently located at small (44.5%) and large intestine (35.5%), while 12.7% were multifocal. Surgical resection of the tumor was conducted at 84.0% of the cases combined with adjuvant therapy at 12.3%. One-year cumulative survival was 55.18% (95% CI: 34.33%-71.84%) for large intestine, 30.2% (95% CI: 17.1%-44.5%) for small intestine, whereas multifocal PGAS had a 6-months cumulative survival of 23.08% (95% CI: 5.58%-47.46%). Therefore, PGAS is an extremely rare entity with atypical clinical presentation, challenging diagnosis and aggressive behavior. High clinical suspicion is crucial for its prompt management. Further studies and the development of novel therapeutic agents are required in order to improve survival.
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Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes. Nutrients 2020; 12:nu12113522. [PMID: 33207657 PMCID: PMC7696582 DOI: 10.3390/nu12113522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 01/14/2023] Open
Abstract
We have previously described increased fasting plasma glucose levels in patients with normocalcemic primary hyperparathyroidism (NPHPT) and co-existing prediabetes, compared to prediabetes per se. This study evaluated the effect of parathyroidectomy (PTx) (Group A), versus conservative follow-up (Group B), in a small cohort of patients with co-existing NPHPT and prediabetes. Sixteen patients were categorized in each group. Glycemic parameters (levels of fasting glucose (fGlu), glycosylated hemoglobin (HbA1c), and fasting insulin (fIns)), the homeostasis model assessment for estimating insulin secretion (HOMA-B) and resistance (HOMA-IR), and a 75-g oral glucose tolerance test were evaluated at baseline and after 32 weeks for both groups. Measurements at baseline were not significantly different between Groups A and B, respectively: fGlu (119.4 ± 2.8 vs. 118.2 ± 1.8 mg/dL, p = 0.451), HbA1c (5.84 ± 0.3 %vs. 5.86 ± 0.4%, p = 0.411), HOMA-IR (3.1 ± 1.2 vs. 2.9 ± 0.2, p = 0.213), HOMA-B (112.9 ± 31.8 vs. 116.9 ± 21.0%, p = 0.312), fIns (11.0 ± 2.3 vs. 12.8 ± 1.4 μIU/mL, p = 0.731), and 2-h post-load glucose concentrations (163.2 ± 3.2 vs. 167.2 ± 3.2 mg/dL, p = 0.371). fGlu levels demonstrated a positive correlation with PTH concentrations for both groups (Group A, rho = 0.374, p = 0.005, and Group B, rho = 0.359, p = 0.008). At the end of follow-up, Group A demonstrated significant improvements after PTx compared to the baseline: fGlu ((119.4 ± 2.8 vs. 111.2 ± 1.9 mg/dL, p = 0.021) (−8.2 ± 0.6 mg/dL)), and 2-h post-load glucose concentrations ((163.2 ± 3.2 vs. 144.4 ± 3.2 mg/dL, p = 0.041), (−18.8 ± 0.3 mg/dL)). For Group B, results demonstrated non-significant differences: fGlu ((118.2 ± 1.8 vs. 117.6 ± 2.3 mg/dL, p = 0.031), (−0.6 ± 0.2 mg/dL)), and 2-h post-load glucose concentrations ((167.2 ± 2.7 vs. 176.2 ± 3.2 mg/dL, p = 0.781), (+9.0 ± 0.8 mg/dL)). We conclude that PTx for individuals with NPHPT and prediabetes may improve their glucose homeostasis when compared with conservative follow-up, after 8 months of follow-up.
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Paraduodenal hernias: a systematic review of the literature. Hernia 2019; 23:1187-1197. [PMID: 31006063 DOI: 10.1007/s10029-019-01947-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2-0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. METHODS After a detailed search in PubMed and Medline, using the keywords "paraduodenal hernia", 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. RESULTS A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1 years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. CONCLUSIONS PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.
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Validation of the new Sepsis-3 definitions: proposal for improvement in early risk identification. Clin Microbiol Infect 2016; 23:104-109. [PMID: 27856268 DOI: 10.1016/j.cmi.2016.11.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/19/2016] [Accepted: 11/04/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Sepsis-3 definitions generated controversies regarding their general applicability. The Sepsis-3 Task Force outlined the need for validation with emphasis on the quick Sequential Organ Failure Assessment (qSOFA) score. This was done in a prospective cohort from a different healthcare setting. METHODS Patients with infections and at least two signs of systemic inflammatory response syndrome (SIRS) were analysed. Sepsis was defined as total SOFA ≥2 outside the intensive care unit (ICU) or as an increase of ICU admission SOFA ≥2. The primary endpoints were the sensitivity of qSOFA outside the ICU and sepsis definition both outside and within the ICU to predict mortality. RESULTS In all, 3346 infections outside the ICU and 1058 infections in the ICU were analysed. Outside the ICU, respective mortality with ≥2 SIRS and qSOFA ≥2 was 25.3% and 41.2% (p <0.0001); the sensitivities of qSOFA and of sepsis definition to predict death were 60.8% and 87.2%, respectively. This was 95.9% for sepsis definition in the ICU. The sensitivity of qSOFA and of ≥3 SIRS criteria for organ dysfunction outside the ICU was 48.7% and 72.5%, respectively (p <0.0001). Misclassification outside the ICU with the 1991 and Sepsis-3 definitions into stages of lower severity was 21.4% and 3.7%, respectively (p <0.0001) and 14.9% and 3.7%, respectively, in the ICU (p <0.0001). Adding arterial pH ≤7.30 to qSOFA increased sensitivity for prediction of death to 67.5% (p 0.004). CONCLUSIONS Our analysis positively validated the use of SOFA score to predict unfavourable outcome and to limit misclassification into lower severity. However, qSOFA score had inadequate sensitivity for early risk assessment.
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Polymorphisms of cystathionine beta-synthase gene are associated with susceptibility to sepsis. Eur J Hum Genet 2015; 24:1041-8. [PMID: 26508567 DOI: 10.1038/ejhg.2015.231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/14/2015] [Accepted: 09/29/2015] [Indexed: 11/09/2022] Open
Abstract
Sepsis is the systemic inflammatory host response to infection. Cystathionine beta-synthase (CBS)-dependent homocysteine (Hcy) pathway was demonstrated to affect disease severity and mortality in patients with severe sepsis/septic shock. Independent studies identified a single-nucleotide polymorphism (SNP, rs6586282, hg19 chr21:g.44478497C>T) in intron 14 of the CBS-coding gene (CBS) associated with Hcy plasma levels. We aimed to describe the association of this SNP and variants of a splice donor-affecting variable-number tandem repeat (VNTR, NG_008938.1:g.22763_22793[16_22]) 243 bp downstream of rs6586282 with severe human sepsis. We analyzed the VNTR structure and genotyped variants of rs6586282 and a neighboring SNP (rs34758144, hg19 chr21:g.44478582G>A) in two case-control studies including patients with severe sepsis/septic shock from Germany (n=168) and Greece (n=237). In both studies, we consistently observed an association of CBS VNTR alleles with sepsis susceptibility. Risk linearly increased with number of tandem repeats (per allele odds ratio in the adjusted analysis 1.34; 95% confidence interval (CI)=1.17-1.55; P<0.001). Association had also been shown for rs34758144 whose risk allele is in linkage disequilibrium with one long VNTR allele (19 repeat). In contrast, we observed no evidence for an effect on 28-day survival in patients with severe sepsis/septic shock (per allele hazard ratio in the adjusted analysis for VNTR 1.10; 95% CI=0.95-1.28; P=0.20). In a minigene approach, we demonstrated alternative splicing in distinct VNTR alleles, which, however, was independent of the number of tandem units. In conclusion, there is no ordinary conjunction between human CBS and severe sepsis/septic shock, but CBS genotypes are involved in disease susceptibility.
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-572 G/C single nucleotide polymorphism of interleukin-6 and sepsis predisposition in chronic renal disease. Eur J Clin Microbiol Infect Dis 2015; 34:2439-46. [PMID: 26463449 PMCID: PMC7102147 DOI: 10.1007/s10096-015-2500-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/28/2015] [Indexed: 11/30/2022]
Abstract
Single nucleotide polymorphisms (SNPs) of interleukin (IL)-6 are associated with the development of chronic renal disease (CRD). Their impact for sepsis in the field of CRD was investigated. One control cohort of 115 patients with CRD without infection and another case cohort of 198 patients with CRD and sepsis were enrolled. Genotyping at the −174 (rs1800795) and −572 positions of IL-6 (rs1800796) was done by restriction fragment length polymorphism. Circulating IL-6 was measured by an enzyme immunoassay. The GG genotype of rs1800796 was more frequent among cases (78.3 %) than controls (62.6 %). No difference in the genotype frequencies of rs1800795 between cases and controls were found. Odds ratio for sepsis was 2.07 (95%CI 1.24–3.44, p = 0.005) with the GG genotype of rs1800796, which was confirmed by logistic regression analysis taking into consideration the presence of chronic comorbidities. All-cause mortality until day 28 was similar between patients with the GG genotype and the GC/CC genotypes of rs1800796, but death caused from cardiovascular events not-related with infection was more frequent with the GG genotype (14.6 % vs 2.4 %, p = 0.031). Circulating IL-6 was greater among patients of the GC/CC genotypes of rs1800796 and multiple organ dysfunction (p = 0.013). The GG genotype of rs1800796 predisposes to sepsis in CRD and to 28-day mortality by sepsis-unrelated cardiovascular phenomena.
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A rare case of a parathyroid adenoma inside a parathyroid cyst. ACTA ACUST UNITED AC 2014; 58:776-8. [PMID: 25372589 DOI: 10.1590/0004-2730000003211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 03/29/2014] [Indexed: 11/22/2022]
Abstract
Parathyroid cysts (PCs) are rare lesions, located in the neck and anterior mediastinal region. The vast majority are non-functioning, presented as nodular cervical lesions. Large, non-functioning PCs can manifest with compressive symptoms of the surrounding tissues. Rarely, PCs produce excessive amounts of parathyroid hormone (PTH), resulting in primary hyperparathyroidism. We report a case of functional PC, describing its diagnostic and therapeutic approach.
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Effect of moxifloxacin on survival, lipid peroxidation and inflammation in immunosuppressed rats with soft tissue infection caused byStenotrophomonas maltophilia. Microbiol Immunol 2014; 58:96-102. [PMID: 24372798 DOI: 10.1111/1348-0421.12124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 12/01/2013] [Accepted: 12/17/2013] [Indexed: 11/28/2022]
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Effect of clarithromycin in patients with Gram-negative sepsis: subgroup analysis of a randomized trial. Crit Care 2014. [PMCID: PMC4068371 DOI: 10.1186/cc13432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Effect of clarithromycin in patients with suspected Gram-negative sepsis: results of a randomized controlled trial. J Antimicrob Chemother 2013; 69:1111-8. [DOI: 10.1093/jac/dkt475] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Thyroid neurofibroma in a female patient with neurofibromatosis type I: report of a case. BMJ Case Rep 2013; 2013:bcr-2012-008216. [PMID: 23744851 DOI: 10.1136/bcr-2012-008216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurofibromas are benign tumours arising from the Schwann cells of peripheral nerves. They usually occur on the limbs and rarely present at other sites such as the thyroid gland. Lesions associated with the thyroid are usually benign but should be closely followed up. When the presence of a plexiform neurofibroma in the thyroid gland is confirmed by radiological investigations, total thyroidectomy is the treatment of choice because of the substantial risk of malignant transformation. This case report details a rare case of thyroid plexiform neurofibroma in a young female patient with known Von Recklinghausen disease.
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Need for restoration of cortisol serum levels for successful antimicrobial therapy in experimental sepsis. Crit Care 2013. [PMCID: PMC3642924 DOI: 10.1186/cc12008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R149. [PMID: 22873681 PMCID: PMC3580738 DOI: 10.1186/cc11463] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/08/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Early risk assessment is the mainstay of management of patients with sepsis. APACHE II is the gold standard prognostic stratification system. A prediction rule that aimed to improve prognostication by APACHE II with the application of serum suPAR (soluble urokinase plasminogen activator receptor) is developed. METHODS A prospective study cohort enrolled 1914 patients with sepsis including 62.2% with sepsis and 37.8% with severe sepsis/septic shock. Serum suPAR was measured in samples drawn after diagnosis by an enzyme-immunoabsorbent assay; in 367 patients sequential measurements were performed. After ROC analysis and multivariate logistic regression analysis a prediction rule for risk was developed. The rule was validated in a double-blind fashion by an independent confirmation cohort of 196 sepsis patients, predominantly severe sepsis/septic shock patients, from Sweden. RESULTS Serum suPAR remained stable within survivors and non-survivors for 10 days. Regression analysis showed that APACHE II ≥ 17 and suPAR ≥ 12 ng/ml were independently associated with unfavorable outcome. Four strata of risk were identified: i) APACHE II <17 and suPAR <12 ng/ml with mortality 5.5%; ii) APACHE II < 17 and suPAR ≥ 12 ng/ml with mortality 17.4%; iii) APACHE II ≥ 17 and suPAR <12 ng/ml with mortality 37.4%; and iv) APACHE II ≥ 17 and suPAR ≥ 12 ng/ml with mortality 51.7%. This prediction rule was confirmed by the Swedish cohort. CONCLUSIONS A novel prediction rule with four levels of risk in sepsis based on APACHE II score and serum suPAR is proposed. Prognostication by this rule is confirmed by an independent cohort.
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Abstract
Metastatic melanoma of unknown primary is a rare entity with low life expectancy. Inoperable metastatic malignant melanoma in lungs has a survival rate of <6%. Regression of the primary lesion is a well-documented theory in the literature, since melanoma is one of the tumours that can undergo regression. We present a case of a young man with metastatic malignant melanoma in lungs, whose survival duration is longer than expected even without metastasectomy.
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TREM-1 expression on neutrophils and monocytes of septic patients: relation to the underlying infection and the implicated pathogen. BMC Infect Dis 2011; 11:309. [PMID: 22050935 PMCID: PMC3241479 DOI: 10.1186/1471-2334-11-309] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 11/04/2011] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Current knowledge on the exact ligand causing expression of TREM-1 on neutrophils and monocytes is limited. The present study aimed at the role of underlying infection and of the causative pathogen in the expression of TREM-1 in sepsis. METHODS Peripheral venous blood was sampled from 125 patients with sepsis and 88 with severe sepsis/septic shock. The causative pathogen was isolated in 91 patients. Patients were suffering from acute pyelonephritis, community-acquired pneumonia (CAP), intra-abdominal infections (IAIs), primary bacteremia and ventilator-associated pneumonia or hospital-acquired pneumonia (VAP/HAP). Blood monocytes and neutrophils were isolated. Flow cytometry was used to estimate the TREM-1 expression from septic patients. RESULTS Within patients bearing intrabdominal infections, expression of TREM-1 was significantly lower on neutrophils and on monocytes at severe sepsis/shock than at sepsis. That was also the case for severe sepsis/shock developed in the field of VAP/HAP. Among patients who suffered infections by Gram-negative community-acquired pathogens or among patients who suffered polymicrobial infections, expression of TREM-1 on monocytes was significantly lower at the stage of severe sepsis/shock than at the stage of sepsis. CONCLUSIONS Decrease of the expression of TREM-1 on the membrane of monocytes and neutrophils upon transition from sepsis to severe sepsis/septic shock depends on the underlying type of infection and the causative pathogen.
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Pica: an uncommon cause of acute abdominal pain in children. Indian J Pediatr 2011; 78:886-7. [PMID: 21328077 DOI: 10.1007/s12098-011-0376-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 01/25/2011] [Indexed: 10/18/2022]
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Clarithromycin modulates immune responses in experimental peritonitis. Int J Antimicrob Agents 2011; 37:347-51. [DOI: 10.1016/j.ijantimicag.2010.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 11/18/2010] [Accepted: 11/18/2010] [Indexed: 01/24/2023]
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Early alterations of the innate and adaptive immune statuses in sepsis according to the type of underlying infection. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R96. [PMID: 20504311 PMCID: PMC2911733 DOI: 10.1186/cc9031] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/19/2010] [Accepted: 05/26/2010] [Indexed: 02/06/2023]
Abstract
Introduction Although major changes of the immune system have been described in sepsis, it has never been studied whether these may differ in relation to the type of underlying infection or not. This was studied for the first time. Methods The statuses of the innate and adaptive immune systems were prospectively compared in 505 patients. Whole blood was sampled within less than 24 hours of advent of sepsis; white blood cells were stained with monoclonal antibodies and analyzed though a flow cytometer. Results Expression of HLA-DR was significantly decreased among patients with severe sepsis/shock due to acute pyelonephritis and intraabdominal infections compared with sepsis. The rate of apoptosis of natural killer (NK) cells differed significantly among patients with severe sepsis/shock due to ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) compared with sepsis. The rate of apoptosis of NKT cells differed significantly among patients with severe sepsis/shock due to acute pyelonephritis, primary bacteremia and VAP/HAP compared with sepsis. Regarding adaptive immunity, absolute counts of CD4-lymphocytes were significantly decreased among patients with severe sepsis/shock due to community-acquired pneumonia (CAP) and intraabdominal infections compared with sepsis. Absolute counts of B-lymphocytes were significantly decreased among patients with severe sepsis/shock due to CAP compared with sepsis. Conclusions Major differences of the early statuses of the innate and adaptive immune systems exist between sepsis and severe sepsis/shock in relation to the underlying type of infection. These results may have a major impact on therapeutics.
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The role of prosthetic repair in the treatment of an incarcerated recurrent inguinal hernia with acute appendicitis (inflamed Amyand's hernia). Hernia 2009; 13:335-6; author reply 337. [PMID: 19418014 DOI: 10.1007/s10029-009-0505-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 04/23/2009] [Indexed: 01/26/2023]
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CO(2) pneumoperitoneum prolongs survival in an animal model of peritonitis compared to laparotomy. J Surg Res 2009; 152:69-75. [PMID: 18499131 DOI: 10.1016/j.jss.2008.02.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 01/31/2008] [Accepted: 02/12/2008] [Indexed: 02/05/2023]
Abstract
BACKGROUND The advantages of laparoscopic surgery have been well documented. However, the impact of pneumoperitoneum on sepsis sequelae is still equivocal. This study aimed to evaluate the effect of CO(2) pneumoperitoneum, applied under different pressures and exposure times, on sepsis cascade and mortality. MATERIAL AND METHODS In 42 New Zealand rabbits, peritonitis was induced by the cecum ligation and puncture model. After 12 h, the animals were randomized in seven groups: a control group, four groups with pneumoperitoneum (10-15 mmHg for 60-180 min), and two groups with laparotomy (for 60 and 180 min). Blood samples were collected before cecum ligation and puncture, 12 h later and 1, 3, and 6 h after pneumoperitoneum desufflation or abdominal trauma closure to evaluate bacteremia, endotoxemia, white blood cells count, C-reactive protein, and procalcitonin levels. Furthermore, the mortality time was recorded in all animals. RESULTS Bacteremia and endotoxemia were induced in all groups. Endotoxemia levels were significantly more elevated in the group where pneumoperitoneum was performed under 15 mmHg for 180 min compared with all other groups at 1 and 3 h after pneumoperitoneum desufflation (P < 0.05), except when compared with the group where pneumoperitoneum was performed under 10 mmHg for 180 min. White blood cell and C-reactive protein levels showed similar trends for all groups. However, serum procalcitonin reached statistically higher levels (P < 0.05) in groups with laparotomy compared with groups with pneumoperitoneum and with the control group at 6 h. Survival was lower in the laparotomy groups compared with the pneumoperitoneum groups and with the control group (P < 0.05). CONCLUSIONS In the presence of peritonitis, CO(2) pneumoperitoneum applied in clinically standard pressures, even for extended time intervals, reduces the severity of sepsis and prolongs survival.
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Abstract
INTRODUCTION The aim of this study was to quantify the role of time between symptom onset and surgery on the changing risk of perforation, and to evaluate the possible factors leading to delay to the operation. PATIENTS AND METHODS The files of 169 patients who underwent appendectomy in our clinic over a two-year period (May 2004-June 2006) were reviewed. The relative risk of perforation was calculated according to the "time-table" method. Time was divided into intervals, initially of 12 hours and, later on, of 24 hours. RESULTS 18 patients were found to have perforated appendicitis. The time from symptom-onset to first examination ("symptom onset to presentation" time, "SOP" time) was longer for patients with perforation than for those without (p = 0.047). On the other hand, the time from initial examination in the emergency department to the operating room ("ER to OR" time) was shorter for patients with perforation than for those without (p = 0.027). Overall time from symptom onset to operating room, showed no statistical difference between patients with rupture and those without. The risk of perforation was negligible within the first twelve hours of untreated symptoms, but then increased to 8% within the first twenty-four hours. It then decreased to approximately 1.3% to 2% during 36 to 48 hours, and subsequently rose again to approximately 6% (7.6% to 5.8%) for each ensuing 24-hour period. In multivariate analysis, neither the "SOP" nor the "ER to OR" time remained significant contributors to the probability of an individual to suffer from appendiceal perforation. CONCLUSION When time matters and the risk of adverse outcomes can be reduced, we should change our current approach to care. Surgeons should be mindful of delaying surgery beyond 24 hours of symptom onset in patients with assumed appendicitis.
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Predictive value of procalcitonin for the diagnosis of bowel strangulation. World J Surg 2008; 32:1566-7; author reply 1568. [PMID: 18305993 DOI: 10.1007/s00268-008-9498-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Carcinoma developing in ectopic pancreatic tissue in the stomach: a case report. CASES JOURNAL 2008; 1:249. [PMID: 18928565 PMCID: PMC2577107 DOI: 10.1186/1757-1626-1-249] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 10/18/2008] [Indexed: 02/11/2023]
Abstract
The development of pancreatic tissue outside the confines of the main gland, without anatomic or vascular connections between them, is a congenital abnormality referred to as heterotopic pancreas. A heterotopic pancreas in the gastrointestinal tract is usually discovered incidentally and the risk of its malignant transformation is extremely low. In this study, we describe the first case of endoepithelial carcinoma arising in a gastric heterotopic pancreas of a 56-year old woman in Greece. She presented with epigastric pain, periodic nausea and vomiting. Esophagogastroduodenoscopy revealed an ulcerated lesion in the gastric antrum, biopsies of which showed intense epithelial dysplasia with incipient malignant degeneration. The pathology report of the distal gastrectomy specimen demonstrated a 2 cm in diameter ulcerative mass in the gastric antrum. Microscopically, an endoepithelial (in situ) carcinoma of the gastric antrum was determined, which in places turned into an microinvasive endomucosal adenocarcinoma. It also incidentally demonstrated heterotopic pancreatic ducts, detected within the mucosa to the muscularis propria of the same region of the stomach, in which an endoepithelial (in situ) carcinoma was evolving. The follow-up course was uneventful 6 months postoperatively.
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Gastric Perforation and Death after the Insertion of an Intragastric Balloon. Obes Surg 2008; 19:393-6. [DOI: 10.1007/s11695-008-9706-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 09/10/2008] [Indexed: 01/26/2023]
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The effect of the type of intraperitoneally implanted prosthetic mesh on the systemic inflammatory response. Hernia 2008; 12:277-83. [PMID: 18188504 DOI: 10.1007/s10029-007-0327-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 12/07/2007] [Indexed: 12/16/2022]
Abstract
BACKGROUND The purpose of this study was to determine any differences in the systemic inflammatory response after the intraperitoneal implantation of three different types of polypropylene mesh. METHODS Thirty-two male New Zealand rabbits underwent a 6-cm midline incision and opening of the peritoneal cavity. The animals were randomly divided into four groups. In groups A, B, and C, there was an intraperitoneal placement of polypropylene mesh, titanium-coated polypropylene mesh, and composite polypropylene/e-PTFE mesh, respectively. Group D received a sham operation. Blood was sampled preoperatively and at 6, 24, 48, and 168 h postoperatively to measure white blood cell count (WBC), tumor necrosis factor-alpha (TNF-alpha), and malondialdehyde (MDA). RESULTS Statistically significant elevations of WBC, TNF-alpha and MDA were observed in all four groups at 6, 24, and 48 h postoperatively (P<0.05). There were no statistically significant differences in WBC, TNF-alpha, and MDA between groups A, B, and C at any time interval. However, a statistically significant elevation of WBC (P<0.05) and TNF-alpha (P<0.05) was observed between each of the groups with mesh implantation and group D at 24 h postoperatively. CONCLUSION Intraperitoneal mesh implantation induces mild systemic inflammatory response regardless of the type of implanted mesh.
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Modifications of coagulation and fibrinolysis mechanism in laparoscopic vs. open cholecystectomy. HEPATO-GASTROENTEROLOGY 2007; 54:1335-8. [PMID: 17708249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND/AIMS The incidence of thromboembolic complications following laparoscopic cholecystectomy as well as the indication for prophylactic thrombophylaxis is still controversially discussed. The aim of this study is to evaluate the alterations of the coagulation and fibrinolytic mechanism after laparoscopic vs. open cholecystectomy. METHODOLOGY Forty-five patients, who were submitted to laparoscopic (LC-group, n=30) or open cholecystectomy (OC-group, n=15) were included in the study. The following parameters were measured preoperatively and 24h and 48h postoperatively: platelet count (PLT), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (FG), d-dimers (DD) and antithrombin III (AT-III). RESULTS The preoperative values were within the normal range and did not differ between the two groups. No significant alterations were noted concerning PT and PTT. FG and PLT were significantly increased in both groups at 24h and 48h compared to the baseline values, with no statistical significant difference between them at all time points. D-dimers were significantly elevated at 24h and 48h postoperatively in both groups. The LC-group showed significantly higher AT-III levels at 24h, and significantly lower DD levels at 24h and 48h compared to the OC-group (p < 0.05). CONCLUSIONS Laparoscopic cholecystectomy seems to induce a lower activation of the hemostatic mechanism compared to open cholecystectomy.
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The value of endothelin 1 in the early diagnosis of severe intestinal strangulation. Gut 2007; 56:890-1. [PMID: 17519497 PMCID: PMC1954842 DOI: 10.1136/gut.2006.118448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Experimental Comparison of Monofile Light and Heavy Polypropylene Meshes: Less Weight Does not Mean Less Biological Response. World J Surg 2007; 31:865; author reply 866. [PMID: 17372664 DOI: 10.1007/s00268-006-0785-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Idiopathic hypertrophic pyloric stenosis combined with left paraduodenal hernia in an adult. Med Princ Pract 2007; 16:151-4. [PMID: 17303953 DOI: 10.1159/000098370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Accepted: 05/22/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We report a case of primary hypertrophic pyloric stenosis combined with a paraduodenal hernia in a 35-year-old woman. CLINICAL PRESENTATION AND INTERVENTION The patient presented with signs of obstructive ileus. CT of the abdomen revealed a marked dilatation of the stomach and the proximal jejunum as well as a circumferential thickening of the antral-pyloric region with characteristics indicating hypertrophic pyloric stenosis. Exploratory laparotomy revealed the presence of a paraduodenal hernia containing jejunal loops and marked thickening of the pyloric region. The jejunum was reduced to its normal place and the ostium of the paraduodenal hernia closed with a running suture. The hypertrophic pyloric stenosis was treated with pyloromyotomy. Since the patient had no predisposing factors for the development of secondary pyloric stenosis, we considered the pyloric stenosis as congenital in origin. CONCLUSION To our knowledge this is the first reported case of congenital pyloric stenosis combined with the presence of a paraduodenal hernia in an adult.
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Primary hydatid cyst of the thigh. Chirurgia (Bucur) 2006; 101:419-21. [PMID: 17059155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Echinococcosis of the musculoskeletal system is found in 0,5-4% of the patients suffering from hydatid disease. We describe a case of primary hydatid cyst of the posterior thigh in a 73 year-old woman, who presented with a painless mass. The diagnosis was set intraoperatively after biopsy of the cyst wall. A wide excision of the cyst with part of the attached muscles was performed. The postoperative course of the patient was uneventful. A postoperative CT-scan of the thorax and abdomen revealed no signs of other echinococcal cysts. Thus, the case was considered as a primary hydatid cyst of the thigh. The patient received adjuvant oral treatment with albendazole for six months. The patient remains in good general condition and without any signs of recurrence, one year after the operation. Hydatid disease should be considered in the differential diagnosis of any cystic mass detected in the thigh, especially if occurs in regions where the disease in endemic.
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A rare form of isolated mesenteric Castleman's disease presenting as an abdominal mass (isolated mesenteric Castleman's disease). JOURNAL OF GASTROINTESTINAL AND LIVER DISEASES : JGLD 2006; 15:171-4. [PMID: 16802013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Castleman's disease is a rare disorder characterized by proliferation of the lymphoid tissue. The most frequent location of the disease is the mediastinum. The location of the disease in the mesentery is rare and it is usually associated with the generalized form of the disease. We report a case of a 22-year old woman with isolated mesenteric Castleman's disease of the lymphoid variant, which presented as a palpable abdominal mass. The final diagnosis was reached after exploratory laparotomy and resection of the tumor. The described case is the first reported case of Castleman's disease of the lymphoid subtype, located in the mesentery.
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Topical 0.5% nifedipine vs. lateral internal sphincterotomy for the treatment of chronic anal fissure: long-term follow-up. Int J Colorectal Dis 2006; 21:179-83. [PMID: 16091912 DOI: 10.1007/s00384-005-0766-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to compare the efficacy of the local application of 0.5% nifedipine ointment vs. lateral internal sphincterotomy in the healing of chronic anal fissure. PATIENTS AND METHODS Sixty-four patients with symptomatic chronic anal fissures were randomly assigned to 0.5% nifedipine ointment (n=32) every 8 h for 8 weeks or lateral internal sphincterotomy (n=32). Both groups received stool softeners and fiber supplements and were assessed at 2, 4, 6, and 8 weeks. Long-term outcomes were determined after a median follow-up of 19 months (nifedipine group) and 20.5 months (lateral internal sphincterotomy group). RESULTS Complete healing at 8 weeks was achieved in 30 out of 31 patients (96.7%) in the nifedipine group and 32 out of 32 patients (100%) in the lateral internal sphincterotomy group (p=0.49). The overall healing rates at the end of follow-up were 28 out of 30 (93%) vs. 32 out of 32 (100%) in the nifedipine and sphincterotomy groups respectively (p=0.48). Two of the 30 patients in the nifedipine group relapsed whereas none in the sphincterotomy group did. Sixteen patients (50%) developed side effects in the nifedipine group, compared with six patients (18.7%) in the sphincterotomy group. CONCLUSIONS Topical application of 0.5% nifedipine ointment represents a new, promising, easily handled, effective alternative to lateral internal sphincterotomy.
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Secondary Aortoduodenal Fistula with a Fatal Outcome: Report of Six Cases. Surg Today 2005; 35:677-81. [PMID: 16034550 DOI: 10.1007/s00595-004-2970-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2004] [Accepted: 10/01/2004] [Indexed: 10/25/2022]
Abstract
Secondary aortoenteric fistulas (AEFs) are a well-known but uncommon cause of gastrointestinal hemorrhage. They usually occur secondary to reconstructive surgery of an abdominal aneurysm. We report six cases of secondary aortoduodenal fistulas, involving patients who, despite presenting with classic "herald bleeding," died as a result of delayed operative intervention. We also discuss the pathogenesis, clinical presentation, and diagnosis of AEFs, emphasizing the value of clinical suspicion and negative endoscopy in establishing the diagnosis and the need for early operative intervention.
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Abstract
INTRODUCTION Cecal diverticulitis is a rare condition in the western population. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We present our experience of the surgical management of eight cases of cecal diverticulitis over a 25-year period. PATIENTS AND METHODS The mean age of the patients was 54.2 years. Five patients underwent diverticulectomy, 2 patients underwent ileocecal resection, and 1 patient underwent suture of the perforated diverticulum. RESULTS The postoperative course of all patients was uneventful. At long-term follow-up (mean 14.6 years, range 1-25 years) none of the patients who underwent diverticulectomy, mentioned any symptom or complication. CONCLUSION We conclude that diverticulectomy, if technically feasible, could be considered as adequate therapy for cecal diverticulitis. Aggressive resection should be considered in cases of extensive inflammatory changes.
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Abstract
BACKGROUND Obstructive jaundice is often accompanied by bacterial translocation and subsequent sepsis. The effect of lactulose in preventing that process was evaluated in an experimental model. Obstructive jaundice was induced in 23 rabbits after common bile duct ligation. METHODS Animals were divided into two groups. Group A of 11 animals-controls and group B of 12 rabbits, which received 2 ml/kg of lactulose p.o. by a nasogastric tube. Blood was sampled daily, before and after operation. Samples were applied for culture and for estimation of endotoxins (LPS), tumor necrosis factor (TNFa), and malondialdehyde (MDA). RESULTS Mean (+/-SD) survival of animals of group A was 3.08+/-0.19 days compared to 5.36+/-0.41 days of animals of group B. Serum concentrations of LPS and TNFa of each day of treatment remain constant in animals of group A; they were steadily decreased in animals of group B reaching statistical significance on the fourth day. Similar changes were not found for MDA. CONCLUSION The administration of lactulose may prevent systemic endotoxaemia and the subsequent inflammatory response in an experimental model of obstructive jaundice, so as to extend survival. These results merit further clinical evaluation.
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Disruption of the Small-Intestine Mucosal Barrier After Intestinal Occlusion: A Study with Light and Electron Microscopy. J INVEST SURG 2003. [DOI: 10.1080/08941930390153069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Disruption of the small-intestine mucosal barrier after intestinal occlusion: a study with light and electron microscopy. J INVEST SURG 2003; 16:23-8. [PMID: 12554336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
It is known that the gut may serve as a reservoir for various microorganisms, which under specific circumstances may intrude into the systemic circulation, causing systemic infections. The aim of the present study was to estimate the "critical time" of disruption of the small-intestine mucosal barrier in conditions of experimentally induced intestinal occlusion, based on the histopathological alterations observed under light and electron microscopy. Forty rabbits underwent small-intestine obstruction through ligation with a nonabsorbable suture. Blood cultures from portal vein and inferior vena cava, as well as cultures from the peritoneal fluid, a hepatic fragment, and a mesenteric lymph node, were obtained before the ligation (0 h). The same cultures were repeated at 4 and 8 h (group A, 20 rabbits) and at 6 and 12 h after the ligation (group B, 20 rabbits). Small-intestine specimens proximal to the occlusion were taken for examination under the optic and electronic microscope in the same time intervals. Five of 20 rabbits of group A died within 4 h and 6 of 20 rabbits of group B died within 6 h after the operation. All anaerobic cultures were negative. All aerobic cultures that became positive developed Escherichia coli colonies. Intestinal epithelium of dead animals was transformed to cuboid with destruction of goblet cells and alteration in secretion of acid polysaccharides. The mucosal appearance of all rabbits that survived 12 hours after ligation was the same. The disruption of the mucosal barrier begins 4 h after complete intestinal occlusion. At 12 h after complete intestinal occlusion, the disruption is total with different degrees of severity.
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Modern stapled Longo procedure vs. conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial. Int J Colorectal Dis 2002; 17:50-3. [PMID: 12018455 DOI: 10.1007/s003840100342] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Postoperative pain is the most distressing sequela of conventional hemorrhoidectomy. A modern alternative of circumferential mucosectomy has been proposed to reduce the pain in this procedure. PATIENTS AND METHODS This controlled trial included 80 patients with second to fourth degree hemorrhoidal disease operated on over a 2-year period. The patients were randomly allocated to undergo either the stapled Longo procedure (group 1) or Milligan-Morgan hemorrhoidectomy (group 2) under epidural anesthesia. The operating time, postoperative pain scores at 3, 6, 12, and 24 h, analgesic consumption, hospital stay, and complication rate were recorded. At follow-up the outcome and patient satisfaction were evaluated. RESULTS The mean operating time in group 1 was shorter than in group 2, postoperative pain scores at all time points and the mean epidural morphine requirement was lower, and mean hospital stay was shorter. The complication rate did not differ (three cases of postoperative bleeding in group 1 and two cases in group. At follow-up no recurrence or complains were recorded except three cases of mild incontinence (one in group 1 and two in group 2). The patients in group 1 (95%) were more satisfied than in group 2 (89%). CONCLUSION The Longo procedure is thus a simple, safe, and effective method that entails less postoperative pain, more satisfaction, and shorter hospital stay than the standard Milligan-Morgan hemorrhoidectomy.
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