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Abdominal Radiology (New York) Feb 2024To assess the diagnostic performance and reliability of 18 CT signs to diagnose cecal volvulus, a surgical emergency, versus a group of non-volvulus mimickers.
PURPOSE
To assess the diagnostic performance and reliability of 18 CT signs to diagnose cecal volvulus, a surgical emergency, versus a group of non-volvulus mimickers.
MATERIALS AND METHODS
Four radiologists retrospectively and independently assessed 18 CT signs in 191 patients with cecal volvulus (n = 63) or a non-volvulus control group ((n = 128), including cecal bascule (n = 19), mobile cecum (n = 95), and colonic pseudo-obstruction (n = 14)) at a single institution from 2013 to 2021. Fleiss' kappa coefficient was used to assess inter-reader agreement. For diagnostic performance metrics, we assessed sensitivity, specificity, and positive and negative predictive values. For predictive performance, all 18 signs were included in bivariate and stepwise lasso multivariate logistic regression models to diagnose cecal volvulus. Performance was assessed by ROC curves.
RESULTS
191 patients (mean age: 63 years +/- 15.5 [SD]; 135 women) were included in the study. Nine of the 18 CT signs of cecal volvulus demonstrated good or better (> 0.6) inter-reader agreement. Individual CT signs with sensitivity, specificity, positive and negative predictive values all above 70% for diagnosing cecal volvulus were transition point, bird beak, and X-marks-the-spot. A lasso regression model determined four CT features: transition point, bird beak, coffee bean, and whirl had excellent prediction (AUC = .979) for cecal volvulus if all present.
CONCLUSION
CT signs for cecal volvulus that have high sensitivity and specificity include: transition point, bird beak, and X-marks-the-spot and were reliable in distinguishing non-volvulus mimickers. If the following four features were present: transition point, bird beak, coffee bean, and whirl, there was excellent prediction (AUC = .979) for cecal volvulus.
Topics: Humans; Female; Middle Aged; Intestinal Volvulus; Retrospective Studies; Reproducibility of Results; Tomography, X-Ray Computed; Predictive Value of Tests; Cecal Diseases
PubMed: 37989898
DOI: 10.1007/s00261-023-04092-9 -
Medizinische Klinik, Intensivmedizin... May 2024The presence of gastrointestinal dysfunction is an outcome-relevant complication in critically ill ICU patients. (Review)
Review
BACKGROUND
The presence of gastrointestinal dysfunction is an outcome-relevant complication in critically ill ICU patients.
AIMS, MATERIALS AND METHODS
The following review aims to show the importance of gastrointestinal dysfunction. Multimodal therapy for gastroparesis and paralytic ileus is discussed.
CONCLUSION
Erythromycin and metoclopramide are options for gastroparesis, while neostigmine is commonly used for paralytic ileus.
Topics: Humans; Gastroparesis; Metoclopramide; Combined Modality Therapy; Intestinal Pseudo-Obstruction; Neostigmine; Erythromycin; Enteral Nutrition; Critical Care; Gastrointestinal Agents
PubMed: 37985511
DOI: 10.1007/s00063-023-01082-z -
Gastrointestinal Endoscopy Clinics of... Jan 2024Large bowel obstruction is a serious event that occurs in approximately 25% of all intestinal obstructions. It is attributed to either benign, malignant, functional... (Review)
Review
Large bowel obstruction is a serious event that occurs in approximately 25% of all intestinal obstructions. It is attributed to either benign, malignant, functional (pseudo-obstruction), or mechanical conditions. Benign etiologies of colonic obstructions include colon volvulus, anastomotic strictures, radiation injury, ischemia, inflammatory processes such as Crohn's disease, diverticulitis, bezoars, and intussusception.
Topics: Humans; Colonic Diseases; Stents; Intestinal Obstruction; Endoscopy; Crohn Disease
PubMed: 37973225
DOI: 10.1016/j.giec.2023.09.011 -
Neurological Sciences : Official... Mar 2024
Topics: Humans; Glial Fibrillary Acidic Protein; Brain; Autoimmune Diseases of the Nervous System; Astrocytes; Autoantibodies
PubMed: 37955783
DOI: 10.1007/s10072-023-07136-6 -
Revista Espanola de Enfermedades... Feb 2024Chronic intestinal dysmotility is a rare and debilitating digestive disorder characterized by symptoms of mechanical obstruction without an organic lesion. It has...
Chronic intestinal dysmotility is a rare and debilitating digestive disorder characterized by symptoms of mechanical obstruction without an organic lesion. It has diverse causes and involves various pathological mechanisms. Small bowel manometry is the preferred diagnostic method, particularly for patients with severe and progressive symptoms. The condition can be categorized as intestinal pseudo-obstruction and enteric dysmotility, both entities share abnormal small bowel motility, but with important differences in prognosis and management.
Topics: Humans; Gastrointestinal Motility; Intestinal Pseudo-Obstruction; Ileus; Intestine, Small; Prognosis; Chronic Disease
PubMed: 37929992
DOI: 10.17235/reed.2023.10038/2023 -
Medicina Clinica Feb 2024
Topics: Humans; Immunoglobulin G4-Related Disease; Intestinal Pseudo-Obstruction; Chronic Disease
PubMed: 37919119
DOI: 10.1016/j.medcli.2023.08.014 -
Annals of Vascular Surgery Feb 2024Thoracofemoral bypass has been applied mostly secondary to previous procedures in the treatment of aortoiliac occlusive disease. However, its application as an initial...
BACKGROUND
Thoracofemoral bypass has been applied mostly secondary to previous procedures in the treatment of aortoiliac occlusive disease. However, its application as an initial treatment is less common, and long-term outcomes remain uncertain. The aim of this analysis was to review the 16-year experience and long-term outcomes of 31 consecutive patients who underwent thoracofemoral bypass as the primary procedure.
METHODS
All patients who underwent thoracofemoral bypass for severe aortoiliac occlusive disease between 2005 and 2021 were retrospectively analyzed. The occlusion and calcified plaques of the abdominal aorta at the renal level were common characteristics of all patients. The patients were divided into 2 groups: severe claudication group (Rutherford III group) and chronic limb-threatening ischemia group (Rutherford IV-V). Chi-square test or Fisher's exact test was used to compare categorical variables between the groups, and t-test or Mann-Whitney U-tests were used to compare continuous variables according to their distributions. The Kaplan-Meier curve was used to depict the time-to-event data.
RESULTS
Thirty-one patients [age: 62 (56-67.5); male: 87%] underwent thoracofemoral bypass. Among the 31 patients, 21 (67.7%) belonged to the severe claudication group (Rutherford III), while 10 (32.3%) were in the chronic limb-threatening ischemia (Rutherford IV-V). Twenty-two patients (83.8%) remained asymptomatic after thoracofemoral bypass. The mean follow-up duration was 79 ± 32 months. The 30-day mortality rate was 3.2% (n = 1). Major complications were observed in 9.6% of patients (n = 3; respiratory: 6.4%, retroperitoneal hematoma: 3.2%). No significant difference was found between the claudication and chronic limb-threatening ischemia groups regarding major complications (3.2% vs. 6.4%, P = NS). Minor complications occurred in 41.9% of patients, including pleural effusion 9.6% (n = 3), acute kidney injury 9.6% (n = 3), gastrointestinal bleeding 3.2% (n = 1), paralytic ileus 6.4% (n = 2), and superficial skin infection 12.9% (n = 4). The rate of postoperative superficial skin infection was higher in the chronic limb-threatening ischemia group compared to the claudication group (4 [40%] vs. 0 [0%], P: 0.007). The univariable Cox regression analysis revealed that hypertension and diabetes mellitus were not related to primary patency of the thoracofemoral bypass graft. The 5-year Kaplan-Meier estimated primary patency for the entire study was 96% ± 7% (95% confidence interval [CI]: 88.6-100), and the secondary patency was 96.3% ± 6% (95% CI: 89.4-100). The 5-year Kaplan-Meier estimated survival rate after thoracofemoral bypass was 93.4% ± 3 (95% CI: 91-100).
CONCLUSIONS
We demonstrated in this study that thoracofemoral bypass can yield good outcomes when preferred as the initial treatment in selected patients with juxtarenal total aortic occlusion. Despite being a complex surgical technique, thoracofemoral bypass has shown to have safe, acceptable mortality and morbidity rates, as well as excellent long-term follow-up results in selected patients.
Topics: Humans; Male; Middle Aged; Aorta, Abdominal; Chronic Limb-Threatening Ischemia; Retrospective Studies; Treatment Outcome; Vascular Patency; Risk Factors; Femoral Artery; Postoperative Complications; Intermittent Claudication
PubMed: 37918658
DOI: 10.1016/j.avsg.2023.09.069 -
Heliyon Oct 2023It is challenging to manage schizophrenic catatonia and comorbid chronic intestinal pseudo-obstruction (CIPO). The pathology of catatonia is unclear. There are few...
It is challenging to manage schizophrenic catatonia and comorbid chronic intestinal pseudo-obstruction (CIPO). The pathology of catatonia is unclear. There are few reports or research on this issue. In this case, we present a middle-aged woman diagnosed with schizophrenia with catatonic features and comorbid CIPO. In the treatment process, modified electroconvulsive therapy (mECT) improved her stupor and CIPO partially. Lorazepam alleviated her stupor and CIPO completely. It is the first report describing complete remission with lorazepam in patient suffering from comorbid schizophrenic catatonia and CIPO, which may benefit the exploration of pathophysiology and treatment of comorbidity of schizophrenia with catatonia and CIPO.
PubMed: 37916112
DOI: 10.1016/j.heliyon.2023.e21067 -
Clinical and Experimental Rheumatology Oct 2023Gastrointestinal dysmotility may arise in a variety of auto-immune and auto-inflammatory diseases and hitherto has not been described in Behçet's syndrome (BS). (Clinical Trial)
Clinical Trial
OBJECTIVES
Gastrointestinal dysmotility may arise in a variety of auto-immune and auto-inflammatory diseases and hitherto has not been described in Behçet's syndrome (BS).
METHODS
We present data on a cohort of seven patients under our care who presented with symptoms of and investigations compatible with an immune associated disorder of gastrointestinal motility, or enteric neuropathy.
RESULTS
We describe the clinical features and investigation results. We undertook a trial of a novel treatment in the disease, apheresis, and noted a response not only to the enteric neuropathy but also to the systemic features of the disease, despite previous maximal immunosuppressive therapy in most cases.
CONCLUSIONS
Gastrointestinal dysmotility may arise in BS and is effectively treated by apheresis. The mechanism by which this response is made immunologically requires to be elucidated in future studies.
Topics: Humans; Behcet Syndrome; Intestinal Pseudo-Obstruction; Phenotype
PubMed: 37902272
DOI: 10.55563/clinexprheumatol/hjs8yp -
Cureus Sep 2023Strongyloides hyperinfection syndrome is a rare manifestation caused by the parasite and has mortality rates close to 90% if left untreated. Corticosteroids are...
Strongyloides hyperinfection syndrome is a rare manifestation caused by the parasite and has mortality rates close to 90% if left untreated. Corticosteroids are commonly implicated as a trigger for hyperinfection syndrome in patients with Strongyloides autoinfection, and it has been suggested that even a single dose of corticosteroids can trigger hyperinfection syndrome. Here, we report a case of hyperinfection syndrome eight days after administering a single 8 mg dose of dexamethasone for fetal lung development before a late preterm, emergency cesarean section (C-section) delivery secondary to placental abruption. Prior to the C-section, the patient had been exhibiting signs of autoinfection syndrome, cough, and abdominal pain, for several months. Following corticosteroid administration, she had sequelae of Strongyloides hyperinfection syndrome, including gram-negative bacteremia, undulating fevers, protein wasting enteropathy, and hypersensitivity pneumonitis. Sputum cultures were positive for Strongyloides, and after treatment with ivermectin and albendazole, the patient fully recovered. Strongyloides hyperinfection syndrome is a documented consequence of short courses of corticosteroids. Still, this case is unique because the patient only received a single dose of corticosteroids before developing hyperinfection syndrome. Clinicians must recognize patients at risk for Strongyloides hyperinfection syndrome and understand the risks of administering corticosteroids to patients harboring the parasite.
PubMed: 37900370
DOI: 10.7759/cureus.46067