Urological Injuries during Colorectal Surgery

AbstractThe proximity of the colon and rectum to the organs of the urologic system virtually ensures that iatrogenic urologic injuries become a distinct possibility during complex colorectal surgical procedures. An intimate knowledge of urogenital anatomy as well as strategies for identification and repair of potential injuries is of paramount importance. Attention is mandated when operating within the narrow confines of the pelvis, as this is where these structures are most at risk. The ureters are at highest risk of injury, followed by the bladder and urethra. The nature of these injuries encompasses both functional and mechanical morbidities. Patient factors, including prior pelvic surgery, radiation, inflammatory bowel disease, infectious processes, and urogenital abnormalities all increase the risk of injury. As colorectal surgeons encounter an increasing number of patients with the above risk factors, it is important to be familiar with the various urologic injury patterns, their diagnosis, and appropriate management.

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The Yearly Prevalence of Findings in Endoscopy of the Lower Part of the Gastrointestinal Tract

ISRN Gastroenterology ◽

10.5402/2012/527634 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

R. J. L. F. Loffeld ◽

B. Liberov ◽

P. E. P. Dekkers

Keyword(s):

Colorectal Cancer ◽

Inflammatory Bowel Disease ◽

Gastrointestinal Tract ◽

Bowel Disease ◽

Diagnostic Yield ◽

Steady Increase ◽

High Diagnostic Yield ◽

Number Of Patients ◽

Colon And Rectum ◽

Inflammatory Bowel

Introduction. Endoscopy of the colon and rectum is increasingly used. Aim of the Study. All consecutive endoscopies of the colon and rectum were studied in order to assess the yearly prevalence of significant endoscopic diagnoses. Methods. All consecutive endoscopies of the colon and rectum were included. Endoscopies were done with endoscopes of Olympus. Significant endoscopic diagnoses were defined as colorectal cancer, polyps, diverticuli, large sessile polyps, and inflammatory bowel disease. Results. In 20 years a total of 24431 endoscopies were done. The yearly number of sigmoidoscopies was mean 96, range of 42–370. The number of colonoscopies was mean 1126, range of 643–1912. The number of colonoscopies significantly increased. The number of colonoscopies on request of an internist or gastroenterologist showed a slow but steady increase. Successful caecal intubation rose from 70% to 92% in 2011. Since 1996 there is a steep increase in the percentage of procedures with abnormalities. The number of cancer and polyps increased in twenty years. No great changes were seen in inflammatory bowel disease. Conclusion. Colonoscopy is a procedure with a high diagnostic yield. The number of patients with tumours rose in twenty years.

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Features of the complex treatment of ulcerative colitis in clinical practice

Terapevt (General Physician) ◽

10.33920/med-12-2005-01 ◽

2020 ◽

pp. 6-11

Author(s):

Svetlana Svetlana ◽

Mikhail Klimentov ◽

Olga Neganova ◽

Alina Nazmieva ◽

Anastasiya Kochurova

Keyword(s):

Ulcerative Colitis ◽

Clinical Practice ◽

Statistical Study ◽

Age Groups ◽

Length Of Hospital Stay ◽

Unknown Etiology ◽

Number Of Patients ◽

First Republic ◽

Bowel Diseases ◽

Inflammatory Bowel

Nowadays there are certain difficulties in the early diagnosis of ulcerative colitis, proceeding with minimal intestinal symptoms. The etiology of the disease remains unclear to this day; there is no exact information about the prevalence of the disease due to the large number of latent forms and the low number of patients seeking medical help. This article presents the results of a retrospective analysis of the incidence of ulcerative colitis in the coloproctology department of the First Republic Clinical Hospital of Izhevsk. The study was conducted to assess the frequency of occurrence and determine the internal picture of ulcerative colitis. To achieve this goal, we selected 34 patients with ulcerative colitis. A statistical study was conducted on the following criteria: gender composition, age groups, forms of the disease, localization, complications, and main complaints. The length of hospital stay often was not more than 20 days. The literature on this pathology was also studied and presented in the form of a theoretical basis, which consisted of the determination and etiology of inflammatory bowel diseases. Due to the unknown etiology, insufficiently studied pathogenesis, difficult differential diagnosis with other intestinal diseases and insufficiently perfect treatment methods, there are a large number of unresolved problems in the field of ulcerative colitis. That is why, in this article we tried to reveal the problem of the features of the course and complex therapy of that disease in clinical practice.

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COVID-19 Changed the Injury Patterns of Hospitalized Patients

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000285 ◽

2021 ◽

Vol 36 (3) ◽

pp. 251-259

Author(s):

Michael Rozenfeld ◽

Kobi Peleg ◽

Adi Givon ◽

Miklosh Bala ◽

Gad Shaked ◽

...

Keyword(s):

Trauma Registry ◽

Road Traffic ◽

Disease Outbreaks ◽

Injury Patterns ◽

Severe Injuries ◽

Study Objective ◽

Major Health ◽

National Trauma ◽

Number Of Patients ◽

Injured Patients

AbstractIntroduction:Injury patterns are closely related to changes in behavior. Pandemics and measures undertaken against them may cause changes in behavior; therefore, changes in injury patterns during the coronavirus disease 2019 (COVID-19) outbreak can be expected when compared to the parallel period in previous years.Study Objective:The aim of this study was to compare injury-related hospitalization patterns during the overall national lockdown period with parallel periods of previous years.Methods:A retrospective study was completed of all patients hospitalized from March 15 through April 30, for years 2016-2020. Data were obtained from 21 hospitals included in the national trauma registry during the study years. Clinical, demographic, and circumstantial parameters were compared amongst the years of the study.Results:The overall volume of injured patients significantly decreased during the lockdown period of the COVID-19 outbreak, with the greatest decrease registered for road traffic collisions (RTCs). Patients’ sex and ethnic compositions did not change, but a smaller proportion of children were hospitalized during the outbreak. Many more injuries were sustained at home during the outbreak, with proportions of injuries in all other localities significantly decreased. Injuries sustained during the COVID-19 outbreak were more severe, specifically due to an increase in severe injuries in RTCs and falls. The proportion of intensive care unit (ICU) hospitalizations did not change, however more surgeries were performed; patients stayed less days in hospital.Conclusions:The lockdown period of the COVID-19 outbreak led to a significant decrease in number of patients hospitalized due to trauma as compared to parallel periods of previous years. Nevertheless, trauma remains a major health care concern even during periods of high-impact disease outbreaks, in particular due to increased proportion of severe injuries and surgeries.

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Serum biomarkers confirming stable remission in inflammatory bowel disease

Scientific Reports ◽

10.1038/s41598-021-86251-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Christoph Kessel ◽

Miha Lavric ◽

Toni Weinhage ◽

Markus Brueckner ◽

Sytze de Roock ◽

...

Keyword(s):

Disease Control ◽

Serum Biomarkers ◽

Treat To Target ◽

Optimal Management ◽

Tight Control ◽

Follow Up Study ◽

Number Of Patients ◽

Bowel Diseases ◽

Inflammatory Bowel

AbstractCrohn's disease (CD) and ulcerative colitis (UC) have a chronic-remittent course. Optimal management of inflammatory bowel diseases (IBD) relies on early intervention, treat-to-target strategies and a tight disease control. However, it is challenging to assess the risk of relapses in individual patients. We investigated blood-based biomarkers for the confirmation of disease remission in patients with IBD. We retrospectively analyzed samples of 40 IBD patients (30 UC, 10 CD) enrolled in a tight-control follow-up study. Half of the patients had a flare during follow up. Serum was analyzed for S100A12 as well as S100A8/A9 and for 50 further biomarkers in a bead-based multiplex assay. The concentrations of 9 cytokines/chemokines and S100A8/A9 significantly differed in IBD patients with unstable remission (before flares) when compared to IBD patients with stable remission. Although the number of patients was small, ROC curve analyses revealed a number of biomarkers (IL-1β, IL-1RA, IL-8, IL13, IL-15, IL-21, IL-25, IFN-β, CXCL9, CXCL10, CXCL11, Galectin-1, G-CSF and S100A8/A9) that were elevated in patients with later occurring relapses. While earlier studies on peripheral biomarkers in IBD are limited to only few analytes, our study using a broad screening approach identified serum biomarkers with the potential to indicate unstable disease control in IBD, which may help to steer individual therapies to maintain remission.

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Cannabis and Canabidinoids on the Inflammatory Bowel Diseases: Going Beyond Misuse

International Journal of Molecular Sciences ◽

10.3390/ijms21082940 ◽

2020 ◽

Vol 21 (8) ◽

pp. 2940

Author(s):

Antonelly Cassio Alves de Carvalho ◽

Gabriela Achete de Souza ◽

Samylla Vaz de Marqui ◽

Élen Landgraf Guiguer ◽

Adriano Cressoni Araújo ◽

...

Keyword(s):

Quality Of Life ◽

Inflammatory Bowel Diseases ◽

Literature Search ◽

Cannabis Sativa ◽

Antioxidant Properties ◽

Number Of Patients ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Anti Inflammatory

Inflammatory bowel diseases (IBD) are characterized by a chronic and recurrent gastrointestinal condition, including mainly ulcerative colitis (UC) and Crohn’s disease (CD). Cannabis sativa (CS) is widely used for medicinal, recreational, and religious purposes. The most studied compound of CS is tetrahydrocannabinol (THC) and cannabidiol (CBD). Besides many relevant therapeutic roles such as anti-inflammatory and antioxidant properties, there is still much controversy about the consumption of this plant since the misuse can lead to serious health problems. Because of these reasons, the aim of this review is to investigate the effects of CS on the treatment of UC and CD. The literature search was performed in PubMed/Medline, PMC, EMBASE, and Cochrane databases. The use of CS leads to the improvement of UC and CD scores and quality of life. The medical use of CS is on the rise. Although the literature shows relevant antioxidant and anti-inflammatory effects that could improve UC and CD scores, it is still not possible to establish a treatment criterion since the studies have no standardization regarding the variety and part of the plant that is used, route of administration and doses. Therefore, we suggest caution in the use of CS in the therapeutic approach of IBD until clinical trials with standardization and a relevant number of patients are performed.

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Noncanonical NF-κB Signaling Upregulation in Inflammatory Bowel Disease Patients is Associated With Loss of Response to Anti-TNF Agents

Frontiers in Pharmacology ◽

10.3389/fphar.2021.655887 ◽

2021 ◽

Vol 12 ◽

Author(s):

Vu Q. Nguyen ◽

Kristin Eden ◽

Holly A. Morrison ◽

Megan B. Sammons ◽

Kristin K. Knight ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Signaling Pathway ◽

Bowel Disease ◽

Target Genes ◽

Preliminary Evidence ◽

Lymphocyte Migration ◽

Clinical Criteria ◽

Number Of Patients ◽

Effective Therapeutic Strategy ◽

Inflammatory Bowel

Objectives: Targeting tumor necrosis factor (TNF) with biologic agents, such as infliximab and adalimumab, is a widely used and effective therapeutic strategy in inflammatory bowel disease (IBD). Unfortunately, a significant number of patients fail to respond or lose response over time to these agents. Previous studies have defined multiple complex roles for canonical NF-κB signaling in the pathogenesis of IBD. However, preliminary evidence suggests that the lesser defined noncanonical NF-κB signaling pathway also contributes to disease pathogenesis and response to anti-TNF agents. The objective of this study was to evaluate this hypothesis in Crohn’s disease (CD) and ulcerative colitis (UC) patients.Design: A total of 27 subjects with IBD (19 with CD and 8 with UC) and 15 control subjects were tested. Clinical criteria, patient history, and endoscopic disease activity were factors used to categorize patients and define therapeutic response. Biopsy specimens were collected during colonoscopy and expression was determined for 88 target genes known to be associated with noncanonical NF-κB signaling and IBD.Results: Noncanonical NF-κB signaling was significantly upregulated in IBD patients and was associated with increased gastrointestinal inflammation, epithelial cell death, lymphocyte migration, and Nod-like receptor signaling. Furthermore, noncanonical NF-κB signaling was further upregulated in patients unresponsive to anti-TNF agents and was suppressed in responsive patients. MAP3K14, NFKB2, CCL19, CXCL12, and CXCL13 were significantly dysregulated, as were genes that encode pathway regulators, such as CYLD, NLRP12, and BIRC2/3.Conclusion: Our study identifies a previously uncharacterized role for the understudied noncanonical NF-κB signaling pathway in the pathogenesis of IBD and anti-TNF therapy responsiveness. The genes and pathways identified may ultimately prove useful in IBD management and could potentially be used as biomarkers of drug response.

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Effectiveness and safety of inpatient versus extended venous thromboembolism (VTE) prophylaxis with heparin following major pelvic surgery for malignancy: protocol for a systematic review

Systematic Reviews ◽

10.1186/s13643-019-1179-1 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Bridget Heijkoop ◽

Natalie Parker ◽

George Kiroff ◽

Daniel Spernat

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Systematic Reviews ◽

Pelvic Surgery ◽

Current Evidence ◽

Cochrane Library ◽

Vte Prophylaxis ◽

Optimum Duration ◽

Number Of Patients ◽

Increased Risk

Abstract Background Venous thromboembolism (VTE) is a common postoperative complication associated with significant morbidity and mortality. The use of prophylactic heparin postoperatively reduces this risk, and the use of extended duration prophylaxis is becoming increasingly common. Malignancy and pelvic surgery both independently further increase the risk of postoperative VTE and patients undergoing major pelvic surgery for malignancy are at particularly high risk of VTE. However, the optimum duration of prophylaxis specifically in this population currently remains unclear. Methods We will conduct a systematic review of literature in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.,2011) to evaluate current evidence of the effectiveness and safety of inpatient versus extended VTE prophylaxis with heparin (all forms) following major pelvic surgery for malignancy. We will search PubMed, EMBASE, and the Cochrane Library. Regarding safety, Food and Drug Administration (FDA), and Therapeutic Goods Administration (TGA) websites will be searched, including all levels of evidence. Results will be the postoperative timeframe in which a VTE event can be considered to have been provoked by the surgery, and the number of patients needed to treat with both inpatient and extended prophylaxis to prevent a VTE event in this timeframe, comparing these to determine if there is a significant benefit from extended prophylaxis. Discussion This systematic review will aim to identify the postoperative period in which patients undergoing major pelvic surgery for malignancy are at further increased risk of VTE as a result of their surgery and the optimum duration of heparin VTE prophylaxis with heparin to reduce this risk. Determining this will allow evidence-based recommendations to be made for the optimum duration of heparin VTE prophylaxis post major pelvic surgery for malignancy, leading to improved standards of care that are consistent between different providers and institutions. Systematic review registration In accordance with guidelines, our systematic review was submitted to PROSPERO for consideration of registration on 16/12/17 and was registered on 12/1/18 with the registration number CRD42018068961, and it was last updated on December 1, 2018.

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Serum Interleukin-6 and -8 as Predictors of Response to Vedolizumab in Inflammatory Bowel Diseases

Journal of Clinical Medicine ◽

10.3390/jcm9051323 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1323 ◽

Cited By ~ 2

Author(s):

Lorenzo Bertani ◽

Gian Paolo Caviglia ◽

Luca Antonioli ◽

Rinaldo Pellicano ◽

Sharmila Fagoonee ◽

...

Keyword(s):

Clinical Response ◽

Inflammatory Bowel Diseases ◽

Area Under The Curve ◽

Clinical Role ◽

Faecal Calprotectin ◽

Prediction Ability ◽

Prospective Multicentre Study ◽

Number Of Patients ◽

Bowel Diseases ◽

Inflammatory Bowel

Vedolizumab, a monoclonal antibody directed against integrin α4β7, is an effective treatment for inflammatory bowel diseases. However, a significant number of patients do not achieve steroid-free clinical remission in the first year of treatment. An early identification of these patients is one of the most important challenges for clinicians and offers the possibility of therapeutic optimization in order to personalize biological therapy. The aim of our study was to test the prediction ability of interleukin (IL)-6 and -8 of clinical response after 12 months of therapy with vedolizumab (T2). We performed a prospective, multicentre study in patients affected by inflammatory bowel disease by analysing cytokines level before starting vedolizumab (T0) and after 10 weeks of therapy (T1). In the overall cohort (n = 54), IL-8 decrease > 2.6 pg/mL in the first 10 weeks of therapy was able to predict clinical response (area under the curve (AUC) = 0.70, sensitivity = 66%, specificity = 75%, p = 0.010), negative C-reactive protein (CRP) (AUC = 0.71, sensitivity = 64%, specificity = 80%, p = 0.009) and calprotectin < 250 mg/kg (AUC = 0.69, sensitivity = 64%, specificity = 78%, p = 0.030) after 44 weeks of therapy. In patients with ulcerative colitis (n = 40), baseline IL-8 values > 8.6 pg/mL and a decrease of IL-6 values > 0.4 pg/mL from T0 to T1 were significant and independent predictors of clinical response after 12 months of vedolizumab therapy (odds ratio (OR) = 6.96, 95% CI 1.27–38.22, p = 0.026 and OR = 7.29, 95% CI 1.42–37.50, p = 0.017, respectively). In patients with Crohn’s disease (n = 14), baseline IL-8 values > 8.6 pg/mL and baseline IL-6 values > 1.6 pg/mL allowed the identification of patients achieving negative CRP at T2 (AUC = 0.75, sensitivity = 74%, specificity = 76%, p < 0.001) and patients with faecal calprotectin values < 250 mg/kg at T2 (AUC = 0.71, sensitivity = 78%, specificity = 63%, p = 0.004). In conclusion, our study highlights a potential clinical role of serum cytokine levels for the prediction of clinical and biochemical steroid-free response in patients treated with vedolizumab.

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Diagnostic Radiation Exposure in Patients with Inflammatory Bowel Disease

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/2030735 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Catherine Langevin ◽

Lysanne Normandeau ◽

Mickael Bouin

Keyword(s):

Inflammatory Bowel Disease ◽

Radiation Exposure ◽

Bowel Disease ◽

Indeterminate Colitis ◽

Number Of Patients ◽

Inflammatory Bowel ◽

The Mean ◽

Effects Of Radiation ◽

And Control

Background. Because of the chronic and relapsing nature of inflammatory bowel disease (IBD), which often requires characterization with CT scan, IBD patients might be exposed to a large amount of radiation. As a cumulative effective dose (CED) ≥ 100 mSv is considered significant for stochastic risks of cancer, it is important to monitor and control the radiation exposure of the IBD patients. In the present work, we aimed to quantify the mean CED in IBD patients to assess any harmful effects of radiation. Methods. This study includes 200 IBD patients, identified retrospectively, from the outpatient clinics of the Centre Hospitalier de l’Université de Montréal between January 1, 2010, and February 15, 2017, from the gastroenterologists’ patients lists. The number and type of each radiology test performed were listed for each patient during the study period and the CED was calculated using our institution’s dose index when available and standardized tables. Results. Among the 200 IBD patients, 157 patients had Crohn’s disease (CD), 41 had ulcerative colitis (UC), and 2 had indeterminate colitis. The mean CED for IBD patients was 23.1 ± 45.2 mSv during a mean follow-up duration of 4.3 years. CED was higher among patients with CD than with UC (27.5 ± 49.5 versus 6.8 ± 14.8 mSv; p<0.01). Six patients were exposed to a high CED (>100 mSv) and all had CD. Conclusion. While potentially harmful levels of radiation exposure are of concern in only a small number of patients, strategies to limit such exposure are encouraged when clinically appropriate.

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Cyclic Adenosine 3′, 5′ Monophosphate: A Possible Indicator of Premalignant Changes in the Large Bowel

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456327901600129 ◽

1979 ◽

Vol 16 (1-6) ◽

pp. 127-130 ◽

Cited By ~ 2

Author(s):

A. L. Latner ◽

G. A. Turner ◽

D. Tregoning

Keyword(s):

Cyclic Amp ◽

Large Bowel ◽

Colonic Mucosa ◽

Rectal Adenocarcinoma ◽

Rectal Mucosa ◽

Normal Colonic Mucosa ◽

Colon And Rectum ◽

Inflammatory Bowel ◽

Descending Colon ◽

Malignant Changes

Cyclic adenosine 3′, 5′ monophosphate (cyclic-AMP) has been estimated in mucosal biopsy samples removed from the descending colon and rectum at endoscopy to investigate the possibility of using this substance for monitoring pre-malignant changes in the large bowel. Four groups of patients have been studied: those with normal large bowel and rectal mucosa; those with non-malignant inflammatory bowel disease; those with an adenomatous polyp in the descending colon or sigmoid colon; and those with a rectal adenocarcinoma. No difference was found in the cyclic-AMP content of ‘normal’ rectal mucosa, ‘normal’ colonic mucosa, ‘diseased’ colonic mucosa, carcinomas, and uninvolved mucosa adjacent to the polyps. Less cyclic-AMP was found in the polyps than in adjacent uninvolved mucosa. Conversely, more cyclic-AMP was found in the carcinomas than in adjacent uninvolved mucosa. It is concluded that although cyclic-AMP may be a very useful parameter for delineating the extent of the disease in individual patients, it is not a suitable biochemical marker for the screening of neoplastic changes in the large bowel in the population as a whole.

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