Database : MEDLINE
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[PMID]: 29523612
[Au] Autor:Miliaras S; Ziogas IA; Mylonas KS; Papadopoulos VN
[Ad] Address:1st Department of Surgery, Papageorgiou University General Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece.
[Ti] Title:Primary malignant melanoma of the ascending colon.
[So] Source:BMJ Case Rep;2018, 2018 Mar 09.
[Is] ISSN:1757-790X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Malignant gastrointestinal melanoma is usually a metastatic lesion. We report the case of a 67-year-old female patient who presented with intermittent abdominal pain, fever, rigor and diarrhoea. CT scan of the abdomen revealed a large mass at the right iliac fossa with features concerning for intra-abdominal abscess. Exploratory laparotomy confirmed the preoperative diagnosis of abscess, and a right hemicolectomy was performed. Histopathological examination of the surgical specimen was indicative of malignant melanoma, and immunohistochemical examination showed positivity to S100 protein, Melan-A, HMB-45 and vimentin. A series of postoperative clinical, laboratory and imaging examinations revealed no suspicious lesions in the skin, eye, leptomeninges or other sites. Therefore, the diagnosis of primary colonic melanoma was confirmed. Only 36 additional cases of primary colonic melanoma have been reported to date. These rare neoplasms are challenging to diagnose and usually require a multidisciplinary treatment approach, including surgery, chemotherapy and possibly immunotherapy or radiotherapy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Process

  2 / 9862 MEDLINE  
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[PMID]: 29415186
[Au] Autor:Reuken PA; Kruis W; Maaser C; Teich N; Büning J; Preiß JC; Schmelz R; Bruns T; Fichtner-Feigl S; Stallmach A; German IBD Study group (GISG)
[Ad] Address:Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany.
[Ti] Title:Microbial spectrum of intra-abdominal abscesses in perforating Crohn's disease: Results from a prospective German Registry.
[So] Source:J Crohns Colitis;, 2018 Feb 05.
[Is] ISSN:1876-4479
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Background: Intra-abdominal abscesses (IAA) are common life threatening complications in patients with Crohn's disease (CD). In addition to interventional drainage and surgical therapy, empirical antibiotic therapy represents a corner stone of treatment but contemporary data on microbial spectra and antimicrobial resistance are scarce. Methods: We recruited 105 patients with CD and IAA from 9 German centers for a prospective registry in order to characterize the microbiological spectrum, resistance profiles, antibiotic therapy and outcome. Results: In 92 of 105 patients microbial investigations of abscess material revealed pathogenic microorganisms. 174 pathogens were isolated with a median of 2 pathogens per culture (range: 1-6). Most frequently isolated pathogens were E. coli (45 patients), Streptococcus spp. (28 patients), Enterococci (27 patients), Candida (13 patients) and anaerobes (12 patients). Resistance to third-generation cephalosporins, penicillins with beta-lactamase inhibitors and quinolones were observed in 51, 36, and 35 patients, respectively. Seven patients had multiple-drug resistant bacteria. 30 patients received inadequate empirical treatment, which was more frequent in patients receiving steroids or immunosuppression (37%) than in patients without immunosuppression (10%: p=0.001) and was associated with a longer hospital stay (21 days vs. 13 days, p=0.003). Conclusion: Based on antimicrobial resistance profiles, we herein report a high rate of inadequate empirical first line therapy for IAA in CD, especially in patients receiving immunosuppression, which is associated with prolonged hospitalization.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/ecco-jcc/jjy017

  3 / 9862 MEDLINE  
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[PMID]: 29373647
[Au] Autor:Ugarte-Torres A; Gillrie MR; Griener TP; Church DL
[Ad] Address:Department of Medicine, Division of Infectious Diseases. Alberta Health Services, University of Calgary, Calgary Alberta, Canada.
[Ti] Title:Eggerthella lenta bloodstream infections are associated with increased mortality following empiric Piperacillin-Tazobactam (TZP) monotherapy: A population-based cohort study.
[So] Source:Clin Infect Dis;, 2018 Jan 24.
[Is] ISSN:1537-6591
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Background: Eggerthella lenta is a non-sporulating anaerobic gram-positive bacilli associated with polymicrobial intra-abdominal infections. Recently, E. lenta has been recognized as an important cause of anaerobic blood-stream infections (BSI) associated with high mortality. E. lenta has been reported to have high minimal inhibitory concentrations (MICs) to piperacillin-tazobactam (TZP), a broad-spectrum antibiotic with anaerobic coverage commonly used in multiple centers for empiric treatment of abdominal sepsis. Methods: We describe a retrospective population-based analysis of invasive E. lenta infections from 2009-2015. A logistic regression analysis for 30-day mortality risk factors was conducted. Results: We identified 107 cases of E. lenta infection, 95 (89%) were bloodstream infections, and 11 (10%) skin and soft tissue infections (SSTI) deep abscesses and 1 intra-abdominal abscess. Polymicrobial infections were found in 40%; 72% of isolates were from a gastrointestinal source, most commonly from appendicitis (33%) of which two-thirds were perforated. TZP MIC50 and MIC90 for E. lenta isolates were 32 and 64 µg/mL, respectively. The overall 30-day mortality for BSI was 23% and was independently associated with empiric TZP monotherapy (OR 4.4, 95% CI 1.2-16; p=0.02) and ICU stay (OR 6.2, 95% CI 1.4-27.3 p=0.01). 30-day mortality rates were significantly influenced by the use of different TZP MIC breakpoints. Conclusions: Our results demonstrate the increased recognition of E. lenta as an anaerobic opportunistic pathogen and highlight the need for improved empiric antimicrobial guidelines and TZP MIC breakpoints with better correlation to clinical outcomes to guide appropriate management of invasive E. lenta infections.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/cid/ciy057

  4 / 9862 MEDLINE  
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[PMID]: 29220430
[Au] Autor:Lightner AL; McKenna NP; Tse CS; Hyman N; Smith R; Ovsepyan G; Fleshner P; Crowell K; Koltun W; Ferrante M; D'Hoore A; Lauwers N; Verstockt B; Spinelli A; DiCandido F; Raffals LE; Mathis KL; Loftus EV
[Ad] Address:Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.
[Ti] Title:Postoperative Outcomes in Ustekinumab-Treated Patients Undergoing Abdominal Operations for Crohn's Disease.
[So] Source:J Crohns Colitis;, 2017 Dec 06.
[Is] ISSN:1876-4479
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Introduction: Ustekinumab, a monoclonal antibody targeting interleukins-12 and -23 is used to treat adults with Crohn's disease (CD). We determined the 30-day postoperative infectious complication rate among CD patients who received ustekinumab within 12 weeks prior to an abdominal operation as compared to patients who received anti-tumor necrosis factor (TNF) agents. Methods: A retrospective chart review of adults with CD who underwent an abdominal operation between 1/1/2015 and 5/1/2017 was performed across six sites. Surgical site infection (SSI) was defined as superficial skin and soft tissue infection, intra-abdominal abscess, anastomotic leak, and mucocutaneous separation of the stoma. Results: Forty-four patients received ustekinumab and 169 patients received anti-TNF therapy within the 12 weeks prior to surgery. The two groups were similar except anti-TNF patients were more likely to have received combination therapy with an immunomodulator (p=0.006). There were no significant differences in postoperative SSI (13% in ustekinumab versus 20% in anti TNF-treated patients, p=0.61) or hospital readmission rates (18% versus 10%, p=0.14), but ustekinumab-treated patients had a higher rate of return to the operating room (16% versus 5%; p=0.01). There were no significant predictors identified on multivariable analysis. Conclusions: Of the 44 patients with CD who received ustekinumab within 12 weeks of a major abdominal operation, 13% experienced a 30-day postoperative SSI, not statistically different from the 20% found in the anti-TNF cohort. Ustekinumab treatment within 12 weeks of surgery does not appear to increase the risk of postoperative SSI above that of CD patients treated with anti-TNF medications.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/ecco-jcc/jjx163

  5 / 9862 MEDLINE  
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[PMID]: 29499671
[Au] Autor:Fahrner R; Rauchfuss F; Scheuerlein H; Settmacher U
[Ad] Address:University Hospital Jena, Division of General, Visceral and Vascular Surgery, Am Klinikum 1, 07740, Jena, Germany.
[Ti] Title:Posttraumatic venous gas in the liver - a case report and review of the current literature.
[So] Source:BMC Surg;18(1):14, 2018 Mar 02.
[Is] ISSN:1471-2482
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: There are numerous causes of hepatic gas formation that range from serious pathologies to incidental findings, including mesenteric infarction, liver abscess, inflammatory bowel disease or minimally invasive hepatic interventions. CASE PRESENTATION: We report a case of a 50-year-old man who was admitted to the emergency room after a car accident. The clinical examination and further diagnostics revealed a craniocerebral injury with a fracture of the skull, concomitant soft tissue lesions and subarachnoidal bleeding. Furthermore, a blunt thoracic trauma with hemopneumothorax due to rib fractures was treated with a chest tube. No obvious abdominal pathology was seen. While in the operating theatre for the surgical revision of the cranial soft tissue lesions, a femoral venous catheter was inserted without any complications. A routine ultrasound of the abdomen six hours after the trauma revealed unclear hepatic gas formation. A contrast-enhanced computer tomography (CT) scan of the abdomen was performed, and the gas formation was found to be localized within the left hepatic vein. Afterwards, there was no specific treatment of the hepatic venous gas formation, as no alterations of liver function or liver enzymes were seen. The further course of the patient was uneventful regarding the gas formation in the liver, and another ultrasound two days later revealed no further gas in the liver. CONCLUSIONS: The placement of a femoral venous catheter is a risk factor for gas formation in liver veins. No further treatment is needed in cases with stable liver function. To rule out serious pathologies, diagnostic findings (e.g., ultrasound, CT), clinical history and underlying diseases need to be analyzed carefully after the detection of intrahepatic gas formation. With contrast-enhanced CT, the localization of the gas and its potential causes might be detectable.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Process
[do] DOI:10.1186/s12893-018-0345-z

  6 / 9862 MEDLINE  
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[PMID]: 29508010
[Au] Autor:Giambelluca D; Panzuto F; Giambelluca E; Midiri M
[Ad] Address:Section of Radiological Sciences, Di.Bi.Med, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy. dariojambo@hotmail.it.
[Ti] Title:The "double target sign" in liver abscess.
[So] Source:Abdom Radiol (NY);, 2018 Mar 05.
[Is] ISSN:2366-0058
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.1007/s00261-018-1533-0

  7 / 9862 MEDLINE  
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[PMID]: 29489659
[Au] Autor:Yao Z; Tian W; Xu X; Huang Q; Zhao Y
[Ad] Address:Department of General Surgery, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China.
[Ti] Title:An innovative method for placing a double-lumen irrigation-suction tube in the management of abdominal infection: A case report.
[So] Source:Medicine (Baltimore);97(9):e0048, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Currently, the use of double-lumen irrigation-suction tube for drainage has become increasingly more common. However, the insertion process is complex, and the position of the double cannula placed in this manner is not accurate. We developed a method for placing the drainage tube and use it in the treatment of an abdominal infection. PATIENT CONCERNS: A 51-year-old man with an abdominal infection due to colonic anastomotic fistula was admitted. Routine laboratory tests revealed an elevated white blood cell count (17 × 10/L) and C-reactive protein level (78 mg/L). Computed tomography (CT) revealed that the peritoneal cavity was filled with fluid. DIAGNOSES: The patient was diagnosed with colonic anastomosis fistula by gastrointestinal radiography. Abdominal infection was diagnosed based on CT scan, inflammatory markers, and patient signs and symptoms. INTERVENTIONS: Two punctures were performed. After skin expansion, the source of infection was drained with a suction catheter (diameter = 1.0 cm) under continuous negative pressure of 150 to 200 millibars, along with continuous saline irrigation at 300 mL/h. OUTCOMES: Pus in the abdomen drained completely. The abdominal infection was controlled. There were no adverse events. LESSONS: Abdominal infection in fistulas is a fatal disease. The main therapeutic target is full drainage at an early stage. Precise positioning of the tube, continuous negative pressure irrigation and drainage are key points in the treatment.
[Mh] MeSH terms primary: Abdominal Abscess/therapy
Suction/methods
[Mh] MeSH terms secundary: Abdominal Abscess/etiology
Colonic Diseases/complications
Humans
Intestinal Fistula/complications
Male
Middle Aged
Suction/instrumentation
Therapeutic Irrigation/instrumentation
Treatment Outcome
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010048

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[PMID]: 29480882
[Au] Autor:Yang JH; Shin JY; Roh SG; Chang SC; Lee NH
[Ad] Address:Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University.
[Ti] Title:Delayed diagnosis of xanthogranulomatous pyelonephritis in a quadriplegic patient with uncontrolled cutaneous fistula: A case report.
[So] Source:Medicine (Baltimore);97(2):e9659, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation that is characterized by urinary tract obstruction and invasion of the renal parenchyma. Although rare, XGP can lead to fatal complications, including perinephric inflammation, psoas abscess, and cutaneous fistula. PATIENT CONCERNS: A quadriplegic patient initially presented to the hospital with a chronic open wound and cutaneous fistula. DIAGNOSES: Abdominal computed tomography revealed a renal obstructing stone and enlarged right kidney with a perinephric fluid collection that communicated with the cutaneous fistula. INTERVENTIONS: The patient underwent a right nephrectomy at the department of urology. OUTCOMES: Two months after surgery, the patient was clinically well with no discharging fistula. LESSONS: The XGP accompanied by complications requires an immediate evaluation and early diagnosis. In this case, the diagnosis was delayed because the state of quadriplegia rendered no symptoms of XGP.
[Mh] MeSH terms primary: Cutaneous Fistula/complications
Pyelonephritis, Xanthogranulomatous/complications
Pyelonephritis, Xanthogranulomatous/diagnosis
Quadriplegia/complications
[Mh] MeSH terms secundary: Cutaneous Fistula/diagnosis
Delayed Diagnosis
Humans
Kidney/diagnostic imaging
Kidney/surgery
Male
Middle Aged
Nephrectomy
Pyelonephritis, Xanthogranulomatous/surgery
Quadriplegia/diagnosis
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009659

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[PMID]: 29453515
[Au] Autor:Naldini G; Sturiale A; Fabiani B; Giani I; Menconi C
[Ad] Address:Proctological and Perineal Surgery Unit, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy.
[Ti] Title:Micro-fragmented adipose tissue injection for the treatment of complex anal fistula: a pilot study accessing safety and feasibility.
[So] Source:Tech Coloproctol;22(2):107-113, 2018 Feb.
[Is] ISSN:1128-045X
[Cp] Country of publication:Italy
[La] Language:eng
[Ab] Abstract:BACKGROUND: The aim of the present study was to evaluate the safety and efficacy of autologous, micro-fragmented and minimally manipulated adipose tissue injection associated closure of the internal opening in promoting healing of complex anal fistula. METHODS: A pilot study was conducted on patients referred to our center with anal fistula, from April 2015-December 2016. Inclusion criteria were age over 16 years old and a diagnosis of complex anal fistula according to the American Gastroenterological Association classification The patients were divided into 2 groups; the "first time group" (Group I) in which micro-fragmented adipose tissue injection with closure of the internal opening was the first sphincter-saving procedure, and the "recurrent group" (Group II) consisting of patients who had failed prior sphincter-saving procedures. The procedure was carried out 4-6 weeks after seton placement. Follow-up visits were scheduled at 7 days, and 1, 3, 6 and 12 months after surgery. Fistula healing was defined as the closure of the internal and external openings without any discharge. RESULTS: Out of 47 patients with complex transsphincteric anal fistula, 19 met the inclusion criteria and were selected to undergo the procedure. Twelve of these patients (Group I) had micro-fragmented adipose tissue injection as first-line treatment, and 7 (Group II) had failed previous sphincter-saving procedures. The mean operative time was 55 ± 6 min (range 50-70 min). The mean postoperative pain score measured with the visual analog pain scale was 2 ± 1.4 (range 0-4). No intraoperative difficulties related to the use of the kit were recorded. There were no cases of postoperative fever or abdominal sepsis related to the procedure and no post-treatment perianal bleeding or impaired anal continence. Only 3 cases of minor abdominal wall hematoma that did not require any treatment and 1 case of perianal abscess were observed. Patients were evaluated for a mean follow-up time of 9 ± 3.1 months (range 3-12 months). The overall healing rate was 73.7, 83.3% for Group I and 57.1% for Group II. CONCLUSIONS: The injection of autologous, micro-fragmented and minimally manipulated adipose tissue associated with closure of the internal opening is a safe, feasible and reproducible procedure and may enhance complex anal fistula healing.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:In-Data-Review
[do] DOI:10.1007/s10151-018-1755-8

  10 / 9862 MEDLINE  
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[PMID]: 29500644
[Au] Autor:Alexander ES; Mick R; Nadolski GJ; Mondschein JI; Stavropoulos SW; Soulen MC
[Ad] Address:Department of Diagnostic Imaging, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Founders - MRI Education Center, Philadelphia, PA, 19104, USA. Erica.s.alexander@gmail.com.
[Ti] Title:Combined chemoembolization and thermal ablation for the treatment of metastases to the liver.
[So] Source:Abdom Radiol (NY);, 2018 Mar 03.
[Is] ISSN:2366-0058
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The purpose of the study was to evaluate safety, time to recurrence, and overall survival (OS) in patients with liver metastases (LM), treated with transarterial chemoembolization (TACE) followed by ablation. MATERIALS AND METHODS: This retrospective study included all patients with LM treated with combined TACE and ablation from August 1998 to September 2015. Forty-two patients (12 women, 30 men; age 62.9 ± 11.9 years) were treated for 44 LMs. Tumor characteristics, imaging response to treatment, recurrence, and OS data were reviewed. Statistical analysis included Kaplan-Meier estimation, Cox regression and Fisher's exact, Wilcoxon rank sum, or log rank tests. RESULTS: Median follow-up was 10.3 months. Eighteen patients had 1 hepatic lesion, 16 had 2-5, and 8 had > 5. Median index lesion size was 4.7 cm (range 1.5-8 .0 cm). Tumor response (mRECIST) was available for 41/44 treated lesions, with CR in 32 (78.0%), PR in 8 (19.5%), and PD in 1 (2.4%). Long-term imaging follow-up was available for 38 patients. Freedom from local recurrence was 61% at 1 year and 50% at 2 years. OS was 55% at 1 year and 30% at 2 years (median OS, 14.5 months). Tumor size and histology were not predictors of time to progression or OS. Complications occurred in 19 patients (45%). Major complications occurred in 19% of patients and included hospitalization for fever (n = 2), hepatic abscess (n = 3) and fall requiring transfusion, portal vein thrombus causing lobar infarct, biliary fistula, and retroperitoneal hematoma (n = 1 each). CONCLUSIONS: Combined TACE and ablation is effective for local tumor control of liver metastases up to 8 cm when part of a multidisciplinary treatment strategy. Major complications occurred in 19% of patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180303
[Lr] Last revision date:180303
[St] Status:Publisher
[do] DOI:10.1007/s00261-018-1536-x


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