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https://www.readbyqxmd.com/read/28918445/pre-emptive-intestinal-transplant-the-surgeon-s-point-of-view
#1
REVIEW
Augusto Lauro, Ignazio R Marino, Kishore R Iyer
Pre-emptive transplantation is a well-established practice for certain types of end-organ failure such as in the use of kidney transplantation. For irreversible intestinal failure, total parenteral nutrition (TPN) remains the gold standard, due to the suboptimal long-term results of intestinal transplantation. As such, the only role for pre-emptive transplantation, if at all, will be for patients identified to be at high risk of complications and mortality while on definitive long-term TPN. In these patients, the timing of early listing and transplantation could become life-saving, taking into account that mortality on the waiting list is still the highest for intestinal candidates...
September 16, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28876642/outcome-of-liver-resection-for-carcinoid-neuroendocrine-metastases
#2
M D Polkinghorne, J E J Krige, E Jonas, U K Kotze, M M Bernon
BACKGROUND: Gastrointestinal carcinoid tumours, despite their low malignant potential, frequently metastasize to the liver. While liver resection improves survival and provides symptomatic relief, multifocal bilobar disease complicates surgical management. METHOD: All patients with carcinoid liver secondaries managed by resection from 1990-2015 were identified from a prospective departmental database. Demographic data, operative management, morbidity using the Accordion classification and mortality were analysed...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28876599/a-case-report-of-delayed-presentation-of-a-patient-with-a-ruptured-diaphragm-complicated-by-obstructed-diaphragmatic-hernia-with-gut-gangrene
#3
A Vyas, G Goel
Diaphragmatic rupture is a common occurrence following a major chest trauma and is most commonly associated with road-traffic accidents. Here we report a case of delayed presentation of a 40-year-old man with a ruptured diaphragm with obstruction and bowel infarction, three and a half year following a blunt trauma to chest. This case illustrates how the diagnosis and aggressive management of ruptured diaphragm can be central to life saving and demonstrates the importance of early intervention in cases with features suggestive of compromise of bowel vascularity...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28874089/outcome-of-surgeon-modified-fenestrated-branched-stent-grafts-for-symptomatic-complex-aortic-pathologies-or-contained-rupture
#4
Nikolaos Tsilimparis, Franziska Heidemann, Fiona Rohlffs, Holger Diener, Sabine Wipper, E Sebastian Debus, Tilo Kölbel
PURPOSE: To analyze the outcome of surgeon-modified fenestrated and branched stent-grafts (sm-FBSG) in high-risk patients with symptomatic complex aortic pathology or contained rupture. METHODS: A single-center retrospective analysis was conducted of 21 consecutive patients (mean age 70 years, range 58-87; 16 men) treated with a sm-FBSG from April 2014 to September 2016. The indications included 11 thoracoabdominal and 10 pararenal aortic pathologies, which presented as symptomatic in 8 and as contained rupture in 13 patients...
September 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28828936/optimal-management-strategy-for-spontaneous-isolated-dissection-of-a-visceral-artery
#5
Hiroyuki Otsuka, Toshiki Sato, Hiromichi Aoki, Yoshihide Nakagawa, Sadaki Inokuchi
Objectives To describe our clinical experiences and recommend a management strategy for spontaneous isolated dissection of a visceral artery. Methods A retrospective study of patients from December 2005 to December 2015 was performed. Thirty-two patients had spontaneous isolated dissection of a visceral artery. Clinical features, computed tomography findings, the treatment method, and follow-up results were evaluated. Results There were 28 men and 4 women (mean age, 54 years). Dissection locations were the celiac artery in 10, superior mesenteric artery in 17, and celiac artery and superior mesenteric artery in 5 patients...
January 1, 2017: Vascular
https://www.readbyqxmd.com/read/28818214/treatment-outcomes-and-risk-factors-for-bowel-infarction-in-patients-with-acute-superior-mesenteric-venous-thrombosis
#6
Hyung-Kee Kim, Deokbi Hwang, Sujin Park, Jong-Min Lee, Seung Huh
OBJECTIVE: The prognosis of acute superior mesenteric venous thrombosis (SMVT) remains obscure. We aimed to investigate the treatment outcomes and possible risk factors for bowel infarction in these patients. METHODS: We retrospectively included 66 patients with acute SMVT between January 2002 and June 2016. Each patient underwent contrast-enhanced computed tomography as part of the initial diagnosis. The standard protocol for management included a nonsurgical approach with early anticoagulation and selective exploration...
September 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28814593/unique-case-of-herniated-small-bowel-infarction-within-a-colonic-stomal-prolapse
#7
Robert Lloyd Miller, Derek Yeung, Simon McCluney, Oliver J Warren
The number of permanent colostomies carried out in the United Kingdom is approximately 6400 per year1. Stomal prolapse is a known complication of colostomy formation. We presented the first case of small bowel herniation into a healthy stomal prolapse with subsequent ischaemia of the herniated bowel in a 102-year-old patient. This rare sequela of a relatively common stomal complication highlights an important consideration when faced with a large prolapse presenting acutely. It also raises an important discussion point for the management of our ever-ageing patient population...
August 16, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28791045/conservative-management-of-spontaneous-isolated-dissection-of-the-superior-mesenteric-artery
#8
Jae Hyun Kwon, Yoon Hee Han, Jun Kyu Lee
PURPOSE: We report the clinical outcomes of patients with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) who were treated conservatively. MATERIALS AND METHODS: A retrospective review was performed in 14 patients from 2006 to 2016 with SIDSMA. Their clinical features and computed tomographic angiography (CTA) characteristics, treatment methods, and clinical outcomes were analyzed. The mean age was 53.6 (range, 41-73) years, and the mean follow-up duration was 20...
2017: Gastroenterology Research and Practice
https://www.readbyqxmd.com/read/28761667/correlation-between-capillary-oxygen-saturation-and-small-intestinal-wall-thickness-in-the-equine-colic-patient
#9
Elisabeth Mirle, Anna Wogatzki, Robert Kunzmann, Axel M Schoenfelder, Lutz F Litzke
The surgical evaluation of haemorrhagic infarcted intestine and the decision for or against bowel resection require a lot of experience and are subjective. The aim of this prospective, clinical study was to examine the correlation between oxygen saturation and small intestinal wall (IW) thickness, using two objective methods. In 22 colicky horses, the blood flow, oxygen saturation and relative amount of haemoglobin were measured intraoperatively via laser Doppler and white light spectroscopy (O2C, oxygen to see, LEA Medizintechnik) at six measuring points (MPs) in small and large intestines...
2017: Veterinary Record Open
https://www.readbyqxmd.com/read/28752257/what-is-the-best-revascularization-strategy-for-acute-occlusive-arterial-mesenteric-ischemia-systematic-review-and-meta-analysis
#10
Giancarlo Salsano, Antonio Salsano, Elena Sportelli, Francesco Petrocelli, M'ahmed Dahmane, Giovanni Spinella, Bianca Pane, Simone Mambrini, Domenico Palombo, Francesco Santini
PURPOSE: Acute mesenteric ischemia (AMI) is a life-threatening disease that leads to bowel infarction and death. The optimal management of AMI remains controversial. The present meta-analysis aimed to estimate the prognostic impact of surgical (SG) versus endovascular or hybrid intervention (EV) as the first-line treatment for acute arterial occlusive mesenteric ischemia and to assess whether endovascular strategy was actually effective in reducing bowel resection. METHODS: MEDLINE, Scopus and the Cochrane Library databases were searched...
July 27, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28733177/transjugular-local-thrombolysis-with-without-tips-in-patients-with-acute-non-cirrhotic-non-malignant-portal-vein-thrombosis
#11
Christoph Klinger, Bettina Riecken, Arthur Schmidt, Andrea De Gottardi, Benjamin Meier, Jaime Bosch, Karel Caca
BACKGROUND & AIMS: Therapeutic anticoagulation is the standard treatment in patients with acute non-cirrhotic portal vein thrombosis (PVT). In critically ill patients, anticoagulation only may not suffice to achive rapid and stable recanalization. This study evaluates efficacy and safety of transjugular interventional therapy in acute non-cirrhotic PVT. METHODS: This retrospective study includes 17 consecutive patients with acute noncirrhotic, non-malignant PVT...
June 27, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28724276/fatal-small-intestinal-ischemia-due-to-methamphetamine-intoxication-report-of-a-case-with-autopsy-results
#12
Hamid Attaran
Methamphetamine is one of the most common abused drugs, so its various effects on different body organs should be familiar to all physicians. Regarding its gastrointestinal sequels, there are few reports of ischemic colitis induced by its vasoconstrictive effects. This is the first report of isolated small intestinal infarction resulting in death following methamphetamine toxicity. A 40-year-old woman with a past history of medical treatment for obesity referred to hospital with severe chest and back pain, perspiration, nausea, agitation, high blood pressure, bradycardia and subsequent lethargy and vasomotor instability...
May 2017: Acta Medica Iranica
https://www.readbyqxmd.com/read/28654132/henoch-sch%C3%A3-nlein-purpura-a-literature-review
#13
Liv Eline Hetland, Kjærsti Sørensen Susrud, Kim Hein Lindahl, Anette Bygum
Henoch-Schönlein purpura is the most common childhood vasculitis, but may also affect adults. This article reviews the literature since 2011 on advances in diagnosis, clinical disease manifestations, pathophysiology and treatment of Henoch-Schönlein purpura. The clinical manifestations are thought to arise from IgA depositions in blood vessel walls in the affected organs, mostly skin, gastrointestinal tract, joints and kidneys. Corticosteroids may be effective in rapid resolution of renal manifestations and treating joint and abdominal pain, but they are not proven effective for treating organ manifestations and complications, such as glomerulonephritis, bowel infarction or intussusception...
June 27, 2017: Acta Dermato-venereologica
https://www.readbyqxmd.com/read/28646333/feeding-jejunostomy-associated-small-bowel-necrosis-after-elective-esophago-gastric-resection
#14
Omer S Al-Taan, Robert N Williams, James A Stephenson, Melanie Baker, S Murthy Nyasavajjala, David J Bowrey
BACKGROUND: Feeding jejunostomy has increasingly become a standard adjunctive procedure during major esophago-gastric resections. They provide nutritional support during the post-operative period as required. However, significant early complications have been reported, most notably small bowel necrosis. Literature reports have been restricted to case reports or series. This study aims to determine the frequency of this complication in a cohort of patients undergoing esophago-gastric resection, and identify any difference in the risk of this complication between patients undergoing esophagectomy and gastrectomy...
June 23, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28560512/biological-implant-for-complex-abdominal-wall-reconstruction-a-single-institution-experience-and-review-of-literature
#15
Elsa Limura, Pasquale Giordano
AIM: To present our single institution and surgeon's complex abdominal wall reconstructions (CAWR) experience with Permacol™ mesh through a non-randomized study. PATIENTS AND METHOD: Data of 51 consecutive patients were prospectively collected between 2003 and 2015. Patients had a median of 3 comorbidities (range 0-10) and 68% were Center for Disease Control class II-IV. The mean previous repair was 1.3 (range, 0-12), and 25 (44%) had a mesh in situ. The median defect size was 625 cm(2)...
May 30, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28548204/endovascular-treatment-for-ruptured-abdominal-aortic-aneurysm
#16
REVIEW
Stephen Badger, Rachel Forster, Paul H Blair, Peter Ellis, Frank Kee, Denis W Harkin
BACKGROUND: An abdominal aortic aneurysm (AAA) (pathological enlargement of the aorta) is a condition that can occur as a person ages. It is most commonly seen in men older than 65 years of age. Progressive aneurysm enlargement can lead to rupture and massive internal bleeding, which is fatal unless timely repair can be achieved. Despite improvements in perioperative care, mortality remains high (approximately 50%) after conventional open surgical repair. Endovascular aneurysm repair (EVAR), a minimally invasive technique, has been shown to reduce early morbidity and mortality as compared to conventional open surgery for planned AAA repair...
May 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28501119/nonocclusive-mesenteric-infarction-after-cardiac-surgery-potential-biomarkers
#17
Jiwon Hong, Eileen Gilder, Cherie Blenkiron, Yannan Jiang, Nicholas J Evennett, Maxim S Petrov, Anthony R J Phillips, John A Windsor, Michael Gillham
BACKGROUND: Nonocclusive mesenteric ischemia can cause intestinal infarction but the diagnosis is challenging. This prospective study evaluated three plasma biomarkers of intestinal infarction after cardiac surgery. MATERIALS AND METHODS: Patients were recruited after cardiac surgery if they required laparotomy (with or without intestinal resection) for suspected nonocclusive mesenteric ischemia. Plasma levels of D-lactate, intestinal fatty acid-binding protein (i-FABP), and smooth muscle actin (SMA) before laparotomy were measured...
May 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28473917/mesenteric-venous-thrombosis-precipitated-by-foodborne-gastrointestinal-illness
#18
Amy L Wojciechowski, Rajinder Ps Bajwa, Bala Thatigotla
Foodborne illnesses are common and are usually considered as part of the differential diagnosis when a patient presents with gastrointestinal symptoms including nausea, vomiting, abdominal pain, diarrhea and fever. The majority of foodborne illness is transient and self-limited, while life threatening complications are rare. Here, we describe a case of a patient presenting with inflammatory diarrhea after consumption of undercooked seafood. She developed mesenteric and portal venous thrombosis and small bowel infarction requiring surgical intervention and resection of gangrenous small bowel...
March 2017: Oxford Medical Case Reports
https://www.readbyqxmd.com/read/28473083/acr-appropriateness-criteria-%C3%A2-radiologic-management-of-mesenteric-ischemia
#19
Nicholas Fidelman, Ali F AbuRahma, Brooks D Cash, Baljendra S Kapoor, M-Grace Knuttinen, Jeet Minocha, Paul J Rochon, Colette M Shaw, Charles E Ray, Jonathan M Lorenz
Mesenteric vascular insufficiency is a serious medical condition that may lead to bowel infarction, morbidity, and mortality that may approach 50%. Recommended therapy for acute mesenteric ischemia includes aspiration embolectomy, transcatheter thrombolysis, and angioplasty with or without stenting for the treatment of underlying arterial stenosis. Nonocclusive mesenteric ischemia may respond to transarterial infusion of vasodilators such as nitroglycerin, papaverine, glucagon, and prostaglandin E1. Recommended therapy for chronic mesenteric ischemia includes angioplasty with or without stent placement and, if an endovascular approach is not possible, surgical bypass or endarterectomy...
May 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28425094/fatal-acute-hemorrhagic-bowel-infarction-caused-by-mesenteric-venous-thrombosis
#20
Supawon Srettabunjong
Acute mesenteric venous thrombosis (MVT) is a rare, but life-threatening medical phenomenon. MVT is normally characterized by insidious onset, with nonspecific signs and symptoms. A high index of clinical suspicion is required for diagnosis, and emergency surgery is necessary to optimize the chances of patient survival, especially in the people aged more than 70 years. Surprisingly, based on my review of the literature, no fatal acute MVT case has been reported in the forensic literature. All reported such cases have been documented in medical literature, and most of them have been associated with underlying risk factors for venous thrombosis, such as hypercoagulable state, certain cancers, and stasis of the blood flow...
April 20, 2017: Journal of Forensic Sciences
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