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Jornal Vascular Brasileiro 2024Chronic mesenteric ischemia (CMI) is a debilitating disease with a heavy burden on quality of life. Stenting of the superior mesenteric artery (SMA) is the first option...
BACKGROUND
Chronic mesenteric ischemia (CMI) is a debilitating disease with a heavy burden on quality of life. Stenting of the superior mesenteric artery (SMA) is the first option for treatment, but there is a lack of consensus defining precise indications for open revascularization (OR).
OBJECTIVES
To describe a series of 4 patients with CMI treated with OR and to present an algorithm for the management of this condition.
METHODS
Three patients presented with typical intestinal angina and weight loss. One patient was subjected to prophylactic revascularization during open abdominal aortic aneurysm repair. Surgical techniques included: 1) Bypass from the infrarenal aorta to the SMA; 2) Bypass from an aorto-bifemoral polyester graft to the SMA; 3) Bypass from the right iliac artery to the SMA; 4) Bypass from the right graft limb of an aorto-biiliac polyester graft to the median colic artery at Riolan's arcade. PTFE was used in all surgeries. All grafts were placed in a retrograde configuration, tunneled under the left renal vein, making a smooth C-loop. A treatment algorithm was constructed based on the institution's experience and a review of recent literature.
RESULTS
All patients demonstrated resolution of symptoms and recovery of body weight. All grafts are patent after mean follow-up of two years.
CONCLUSIONS
Open revascularization using the C-loop configuration is a valuable technique for CMI and may be considered in selected cases. The algorithm constructed may help decision planning in other quaternary centers.
PubMed: 38433982
DOI: 10.1590/1677-5449.202301482 -
Urology Annals 2024The objective of the study was to evaluate hematuria as a diagnostic test for renal and ureteral stones compared with a noncontrast-enhanced computed tomography (CT)...
OBJECTIVES
The objective of the study was to evaluate hematuria as a diagnostic test for renal and ureteral stones compared with a noncontrast-enhanced computed tomography (CT) scan (gold standard test) in emergency room patients with acute flank pain.
PATIENTS AND METHODS
In total, 604 patients treated in our emergency department from 2006 to 2011, with a history of flank pain and suspected urolithiasis were included in a retrospective review. All patients were evaluated with a noncontrast-enhanced CT scan and urine analysis. Using the noncontrast CT scan as the gold standard for the evaluation of the presence, number, size, and site (renal or ureteral [upper, middle, and lower]) of the stones, we calculated the sensitivity, specificity, and positive and negative predictive values of hematuria for diagnosing both renal and ureteral stones.
RESULTS
Urolithiasis was diagnosed in 388 patients (64%) and 216 patients (36%) had no stones on a noncontrast-enhanced CT scan. The sensitivity, specificity, positive predictive value, and negative predictive value for microhematuria were 77%, 33%, 67%, and 45%, respectively. Microhematuria was more common in patients with ureteral stones only (139 patients) and had a sensitivity of 85% compared to patients with renal stones only (32 patients), with a sensitivity of 55% ( < 0.001). There were no significant differences in the specificity or positive or negative predictive values.
CONCLUSION
Although microhematuria is more sensitive to ureteral stones, the absence of microhematuria does not exclude the possibility of urolithiasis and a noncontrast-enhanced CT scan should be the gold standard diagnostic tool.
PubMed: 38415233
DOI: 10.4103/ua.ua_66_23 -
The American Journal of Case Reports Feb 2024BACKGROUND Nephro-colic fistulas are uncommon, generally caused by local inflammation, trauma, or neoplasia affecting the kidney or the colon. Their association with a...
BACKGROUND Nephro-colic fistulas are uncommon, generally caused by local inflammation, trauma, or neoplasia affecting the kidney or the colon. Their association with a coralliform stone is described in a few case reports, but their management is difficult and differs quite a lot, depending on the clinical situation. We report an atypical clinical case of a reno-colic fistula associated with a staghorn calculus. This case adds to the literature an iconography rarely found. CASE REPORT A 68-year-old woman presented to the Emergency Department with respiratory symptoms and chronic abdominal pain. The biological results showed a high inflammatory syndrome. The radiological assessment revealed a retroperitoneal and left retro-renal abscess, attributed to a left nephro-colic fistula associated with the partial passage of a lithiasis within the colonic lumen. Colonoscopy confirmed the diagnosis. Multiple recurrences of diverticulitis in this region could be the origin of the complication. First, the patient was treated with antibiotic therapy and radiological drainage. Second, she benefited from a left nephrectomy, left segmental colectomy, and splenectomy. The clinical and radiological evolution were favorable after surgery. The follow-up was disrupted by hospitalizations in the Cardiology Department for cardiac decompensation. CONCLUSIONS Kidney stones along with local inflammatory phenomena can be the cause of a nephro-colic fistula. Due to the lack of guidelines in such cases, their diagnosis and management are difficult to ascertain. Surgery is the right course of treatment.
Topics: Female; Humans; Aged; Staghorn Calculi; Colic; Abscess; Kidney Calculi; Abdominal Abscess; Intestinal Fistula
PubMed: 38408028
DOI: 10.12659/AJCR.943206 -
Pediatric Health, Medicine and... 2024To identify factors predicting the failure of ultrasound-guided hydrostatic reduction of intussusception in children.
PURPOSE
To identify factors predicting the failure of ultrasound-guided hydrostatic reduction of intussusception in children.
PATIENTS AND METHODS
The medical records of 174 children who underwent ultrasound-guided hydrostatic reduction of intussusception over four years were reviewed at Tikur Anbessa Specialized Hospital. Patient's demography, clinical data, and sonography findings (type of intussusception, length of intussusception, presence of lead point, trapped fluid, lymph node, and free peritoneal fluid) were entered into SPSS 25 (IBM) and analyzed using logistic regression.
RESULTS
The overall success rate of ultrasound-guided hydrostatic reduction was 81.6%. The sex, presence of abdominal cramps, vomiting, diarrhea, trapped lymph nodes on ultrasound, or history of upper respiratory tract infection had no association with hydrostatic reducibility. Currant jelly stool (OR 0.128; 95% CI, 0.27-0.616; P=0.01), Ileo-ileo colic intussusception (OR 0.055; 95% CI, 0.005-0.597; P=0.017), pathologic lead point (OR 0.66; 95% CI, 0.01-0.447; P=0.005) and abdominal distention (OR 0.209; 95% CI, 0.044-0.998; P=0.048) showed significant association with failed hydrostatic reduction.
CONCLUSION
The presence of currant jelly stool, ileo-ileo colic type intussusception, pathologic lead point, and abdominal distention are the most important predictors for failed ultrasound ultrasound-guided reduction intussusception in children.
PubMed: 38405413
DOI: 10.2147/PHMT.S451832 -
Microorganisms Jan 2024Probiotics, known to be live microorganisms, have been shown to improve or restore the gut microbiota, which in turn has been linked to improved health. It is believed... (Review)
Review
Probiotics, known to be live microorganisms, have been shown to improve or restore the gut microbiota, which in turn has been linked to improved health. It is believed that probiotics are the modern equivalent of a panacea, with claims that they may treat or prevent different diseases both in children and adults (e.g., from colic in babies to cardiovascular disease, respiratory infection, and cancer in adults). Ever since the early 2000s, probiotic-based fermented foods have had a resurgence in popularity, mostly due to claims made regarding their health benefits. Fermented foods have been associated with the prevention of irritable bowel syndrome, lactose intolerance, gastroenteritis, and obesity, but also other conditions such as chronic diarrhea, allergies, dermatitis, and bacterial and viral infections, all of which are closely related to an unhealthy lifestyle. Recent and ongoing developments in microbiome/microbiota science have given us new research directions for probiotics. The new types, mechanisms, and applications studied so far, and those currently under study, have a great potential to change scientific understanding of probiotics' nutritional applications and human health care. The expansion of fields related to the study of the microbiome and the involvement of probiotics in its improvement foreshadow an era of significant changes. An expanding range of candidate probiotic species is emerging that can address newly elucidated data-driven microbial niches and host targets. In the probiotic field, new variants of microbiome-modulating interventions are being developed, including prebiotics, symbiotics, postbiotics, microbial consortia, live biotherapeutic products, and genetically modified organisms, with renewed interest in polyphenols, fibers, and fermented foods to ensure human health. This manuscript aims to analyze recent, emerging, and anticipated trends in probiotics (sources, doses, mechanism of action, diseases for which probiotics are administered, side effects, and risks) and create a vision for the development of related areas of influence in the field.
PubMed: 38399637
DOI: 10.3390/microorganisms12020234 -
Journal of Clinical Medicine Feb 2024Functional gastrointestinal disorders are very common condition. The aim of this study is to evaluate the implications of the mode of pregnancy termination and early...
Gastrointestinal Disorders and Atopic Dermatitis in Infants in the First Year of Life According to ROME IV Criteria-A Possible Association with the Mode of Delivery and Early Life Nutrition.
Functional gastrointestinal disorders are very common condition. The aim of this study is to evaluate the implications of the mode of pregnancy termination and early infant feeding on the incidence of gastrointestinal disorders and atopic dermatitis at birth and 3, 6, and 12 months of age. This study included 82 pregnant women and their newborns born at term. All newborns were examined at birth and 3, 6, and 12 months of age according to the ROME IV criteria. In children born after cesarean section, the incidence of regurgitation was significantly higher. In children fed mostly or exclusively with formula, dry skin with allergic features was observed more often compared to breastfed children, but this relation was statistically significant only at the age of 12 months. The use of antibiotic therapy increased the risk of allergic skin lesions by almost seven times at 3 months of life. Gastrointestinal disorders in the form of regurgitation, colic, and constipation occur within the period of up to 12 months of the child's life and may be related to the mode of the termination of pregnancy via cesarean section and the use of artificial feeding or antibiotic therapy. The occurrence of atopic dermatitis in infants at 12 months of life is correlated with the mode of the termination of pregnancy after cesarean section. One of the risk factors for the occurrence of atopic dermatitis and gastrointestinal disorders in the period up to 12 months of the child's life may be a cesarean section and the use of formula feeding or antibiotic therapy.
PubMed: 38398241
DOI: 10.3390/jcm13040927 -
Animals : An Open Access Journal From... Feb 2024The aim of this study is to describe clinical data associated with acorn intoxication and to find variables associated with survival. Data from horses presented at...
The aim of this study is to describe clinical data associated with acorn intoxication and to find variables associated with survival. Data from horses presented at CISCO-ONIRIS from 2011 to 2018 with a diagnosis of acorn intoxication were included. Diagnosis was based on the following: season, the presence of acorns in the environment, clinical and hemato-biochemical parameters suggestive of a digestive/renal disease, the co-morbidity of companion animals, and post-mortem findings. Statistical analysis was completed using Student's t-test for mean comparisons and a Chi-square test for group comparisons ( < 0.05). A total of 25 horses were included, and seasonality suggests that the intoxication may vary from year to year. Clinical signs associated with acorn intoxication were signs of circulatory shock (lethargy, tachycardia, abnormal mucous membrane, tachypnea), digestive signs (diarrhea, ileus, colic), and abnormal temperature. Clinical pathological findings included increased hematocrit, WBC, creatinine, BUN, GGT, AST, CK and decreased albumin. Overall, 44% (11/25) of horses survived. The majority (13/14) of non-survivors died, or were euthanized, during the first 48 h. Findings significantly associated with non-survival were age, heart rate, hemorrhagic diarrhea, ileus, hematocrit, creatinine, blood lactate, and thickness of the colon wall at ultrasonography. This study provides equine practitioners with valuable prognostic information in cases of acorn intoxication.
PubMed: 38396567
DOI: 10.3390/ani14040599 -
Veterinary Sciences Feb 2024Horses undergoing abdominal exploratory surgery are at risk of hypotension and hypoperfusion. Normal mean arterial pressure is used as a surrogate for adequate tissue...
Horses undergoing abdominal exploratory surgery are at risk of hypotension and hypoperfusion. Normal mean arterial pressure is used as a surrogate for adequate tissue perfusion. However, measures of systemic circulation may not be reflective of microcirculation. This study measured the mean arterial pressure, cardiac index, lactate, and four microcirculatory indices in six healthy, anesthetized adult horses undergoing elective laparotomies. The microcirculatory parameters were measured at three different sites along the gastrointestinal tract (oral mucosa, colonic serosa, and rectal mucosa) with dark-field microscopy. All macro- and microcirculatory parameters were obtained when the horses were normotensive, hypotensive, and when normotension returned following treatment with dobutamine. Hypotension was induced with increases in inhaled isoflurane. The horses successfully induced into hypotension did not demonstrate consistent, expected changes in systemic perfusion or microvascular perfusion parameters at any of the three measured gastrointestinal sites. Normotension was successfully restored with the use of dobutamine, while the systemic perfusion and microvascular perfusion parameters remained relatively unchanged. These findings suggest that the use of mean arterial pressure to make clinical decisions regarding perfusion may or may not be accurate.
PubMed: 38393113
DOI: 10.3390/vetsci11020095 -
Journal of Surgical Case Reports Feb 2024As the inguinal lymph nodes do not serve as the primary route for the lymphatic drainage of the colon, inguinal metastasis from colorectal carcinomas is considered an...
As the inguinal lymph nodes do not serve as the primary route for the lymphatic drainage of the colon, inguinal metastasis from colorectal carcinomas is considered an unusual finding, especially in the 2nd year follow-up. A 76-year-old male patient, operated on for non-metastatic right colic adenocarcinoma, consulted 2 years after for a right inguinal swelling. A biopsy was performed. Unexpectedly, it showed an adenocarcinoma metastasis in favor of a colonic origin. There was no relapse of the disease. The pathological examination of the resected inguinal lymph node confirmed malignant cells from a colonic origin. As the positron emission tomography scan showed no other tumoral localizations, a multidisciplinary discussion ensued, culminating in the choice of chemotherapy for optimal pathological response. This case highlights the fact that colic drainage may encounter inguinal lymph nodes and thus inguinal groin metastasis could exceptionally have been seen in colonic carcinomas.
PubMed: 38389518
DOI: 10.1093/jscr/rjae024 -
Journal of Surgical Case Reports Feb 2024A 35-year-old woman presented to the emergency department with severe right iliac fossa pain with features of subacute intestinal obstruction and recurrent episodes of...
A 35-year-old woman presented to the emergency department with severe right iliac fossa pain with features of subacute intestinal obstruction and recurrent episodes of similar pain in the past. CT scan showed a mass with fluid collection with no trace of the appendix in the right iliac fossa. The patient was taken up for a diagnostic laparoscopy and proceeded. Operative findings were that of a mass in the lumen of the terminal ileum just 6 inches from the ileocaecal junction. Normal pelvis with normal uterus and ovaries. The patient underwent a laparoscopic resection of the terminal ileum and limited resection of the ascending colon with an ileo-colic anastomosis. The patient recovered well and was discharged. The biopsy was reported as invasive endometriosis involving the muscularis layer of the terminal ileum with stricture of the terminal ileum with transmural inflammation. The case is being presented for the rarity of invasive endometriosis causing bowel obstruction with a normal pelvis.
PubMed: 38389510
DOI: 10.1093/jscr/rjae082