Acute Mesenteric Infarction: The Chameleon of Acute Abdomen Evaluating the Quality of the Diagnostic Parameters in Acute Mesenteric Ischemia

2021 ◽  
pp. 1-9
Author(s):  
Rainer Grotelueschen ◽  
Verena Miller ◽  
Lena M. Heidelmann ◽  
Nathaniel Melling ◽  
Tarik Ghadban ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Mesenteric Ischemia ◽  
Medical Center ◽  
Acute Mesenteric Ischemia ◽  
Mesenteric Infarction ◽  
Diagnostic Quality ◽  
Diagnostic Parameters ◽  
Significant Difference ◽  
Low Sensitivity

<b><i>Introduction/Objective:</i></b> Acute mesenteric ischemia (AMI) is difficult to diagnose. Since the established parameters have low sensitivity and specificity, the aim of this study is to analyze the diagnostic quality of the established parameters of AMI. <b><i>Methods:</i></b> All patients that underwent emergency surgery due to suspected diagnosis of mesenteric ischemia at the University Medical Center Hamburg-Eppendorf between 2008 and 2014 were evaluated. Overall, 275 patients were enrolled and pre-, intra- and postoperative data were evaluated. <b><i>Results:</i></b> In 200 patients, a mesenteric ischemia was confirmed intraoperatively, and 75 patients had no ischemia. Comparing these groups, the rate of patients with pH &#x3c; 7.2 (25 vs. 12%; <i>p</i> = 0.021) and elevated mean CRP level (175 ± 117 mg/L vs. 139 ± 104 mg/L; <i>p</i> = 0.019) was significantly higher in ischemic patients. There was no significant difference in the level of preoperative lactate. Concerning abdominal CT scan, a sensitivity and specificity of 61 and 68%, respectively, was found. <b><i>Conclusion:</i></b> New diagnostic parameters are needed. So far, explorative laparotomy is the only reliable diagnostic method to detect mesenteric infarction.

scholarly journals Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tilahun Fufa Debela ◽  
Zerihun Asefa Hordofa ◽  
Aster Berhe Aregawi ◽  
Demisew Amenu Sori
Keyword(s):  
Quality Of Life ◽  
Surgical Repair ◽  
Obstetric Fistula ◽  
Medical Center ◽  
Mean Value ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
Jimma University

Abstract Background The consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences on them. Obstetric fistula affects the entire health and entire life of women. Women suffering from obstetric fistula are often abandoned by her partner, relatives, and the community. This study aimed to determine the quality of life of obstetrics fistula patients before and after surgical repair. Methods Institutional-based prospective, before and after study design was conducted in the Jimma University Medical Center from November 1, 2019–October 30, 2020. A face-to-face interview was conducted with fistula patients who visited Jimma University Medical center, fistula clinic during the study period. All fistula patients were included in the study. Accordingly, 78 women who underwent surgical repair were interviewed. The means and the standard deviation were computed using conventional statistics formulas. The unpaired t-test was used to compare two independent means, and one-way analysis of variance (ANOVA) was used to compare the quality of life before repair and after a successful repair. Linear regression analysis was done for identifying determinants of quality of life. A P value of 0.05 will be considered statistical significance. Result The overall quality of life of women was 58.17 ± 7.2 before the surgical repair and 71.20 ± 10.79 after surgical repair. The result indicates there is a significant difference in the mean value of pre and post-operative (P < 0.001). The overall satisfaction of women with their health status before the surgical repair was 22.5 ± 1.30and it has increased to 53.0 ± .90after surgical repair. The physical health dimension score was 16.51 ± 5.27 before the surgical repair while it has increased to 21.77 ± 5.38 after the surgical repair. The score of the social domain before the surgical repair was 5.19 ± 1.34 and it has increased to 7.13 ± 3.67 after the surgical repair. The score of the environmental health domain was 17.41 ± 2.89 before the surgery while it also increased to 21.65 ± 4.04 after the surgical repair. The results have shown there was a significant difference in the mean values of pre and post-operatives in both social and environmental scores (P < 0.001). The score of the psychological health domain before the surgery was 19.06 ± 1.46 and it was increased to 19.84 ± 3.21 after the surgical repair. The result showed there is a significant difference in mean value pre and post-operative (P = 0.048), though it is a slight improvement compared to other domains. Conclusion The overall quality of life of the patient with fistula was improved after successful surgical repair. Although all domains of quality of life had shown significant improvement after successful surgical repair, the psychological domain showed slight improvement.

Sleeve gastrectomy is the most common cause of Gastro-esophageal Reflux Disease in comparison with other bariatric operations

2021 ◽  
Author(s):  
majdi abu sneineh ◽  
malek abu sneineh ◽  
Monther Abu Sneineh ◽  
mustafa abu sneineh ◽  
muneer abu snineh ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Medical Center ◽  
Bariatric Procedure ◽  
P Value ◽  
Significant Difference ◽  
Symptomatic Gerd ◽  
Swallow Study ◽  
Contrast Swallow ◽  
Gerd Symptoms

Abstract Introduction GERD is one of the complications of bariatric operations that might affect the quality of life. We aim to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. Besides, we are attempting to identify the risk factors of GERD after bariatric surgery. Methods Medical records of 729 patients undergone bariatric operations between January 2010 and June 2019 at Shamir (Assaf Harofeh) Medical Center were reviewed. Results There was a significant difference between the type of bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent SG was 39.9% (p =0.0131). This was significantly higher compared to 16.4% following roux en y gastric bypass, 23.4% following LAGB, and 11% following OAGB. 113 patients out of 718 had a positive swallow test and of these patient 71 developed GERD symptoms post-operatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (P-value <0.001) and to our knowledge this was never reported in the literature. Conclusion SG is a good bariatric procedure option but should be contraindicated in asymptomatic reflux contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD post-operatively. Asymptomatic reflux at contrast swallow study pre-operatively should be considered a risk factor for GERD after the operation.

scholarly journals Use of the Nuclear Matrix Protein 22 BladderChek Test for the Detection of Primary and Recurrent Urothelial Carcinoma

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Chang-sheng Xia ◽  
Chun-hong Fan ◽  
Ming Su ◽  
Qing-song Wang ◽  
Hui-zhang Bao
Keyword(s):  
Urothelial Carcinoma ◽  
Sensitivity And Specificity ◽  
Nuclear Matrix ◽  
Matrix Protein ◽  
Benign Disease ◽  
Urine Cytology ◽  
Nuclear Matrix Protein ◽  
Combined Use ◽  
Significant Difference ◽  
Low Sensitivity

Objective. To evaluate the performance of the nuclear matrix protein 22 (NMP22) BladderChek test in urothelial carcinoma (UC). Methods. We retrospectively analyzed 1318 patients who performed the NMP22 BladderChek tests. Of them, 103 were primary UC patients, 90 were surgical treatment UC patients, and 1125 were benign disease patients. The performance of the NMP22 BladderChek test for the diagnosis of primary and recurrent UC was evaluated. Moreover, the performance of urine cytology and the NMP22 BladderChek test for the diagnosis of primary UC was compared in 90 available subjects including 48 primary UC patients and 42 benign disease patients. Results. The sensitivity and specificity of the NMP22 BladderChek test were 37.9% and 95.8%, respectively, for the diagnosis of primary UC (n=1228). The corresponding parameters of the NMP22 BladderChek test were 31.0% and 88.5%, respectively, for the diagnosis of recurrent UC (n=90). The sensitivity and specificity of urine cytology were 54.2% and 97.6%, respectively, for the diagnosis of primary UC (n=90); the corresponding parameters of the NMP22 BladderChek test were 41.7% and 83.3%, respectively; the corresponding parameters of the two tests combination were 64.6% and 83.3%, respectively. There was a significant difference in the performance between the NMP22 BladderChek test and urine cytology or the combination of two tests (P=0.017 and 0.001, respectively). Conclusions. The NMP22 BladderChek test has a low sensitivity for detecting primary and recurrent UC. Urine cytology is superior to the NMP22 BladderChek test, and combined use of the two tests improves the sensitivity in the detection of primary UC.

P025 THE PRIOR AUTHORIZATION PREDICAMENT: AN EVALUATION OF TIME TO INITIATION OF BIOLOGIC TREATMENT IN IBD PATIENTS

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S56-S57
Author(s):  
Vinay Rao ◽  
Scott Baumgartner ◽  
Danielle Kirelik ◽  
Katherine Negreira ◽  
Jessica Gibilisco ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medical Center ◽  
Wait Time ◽  
Indeterminate Colitis ◽  
Prior Authorization ◽  
Biologic Treatment ◽  
Patient Demographics ◽  
Time To Initiation ◽  
Significant Difference

Abstract Background Biologics are a mainstay in the treatment of moderate-severe IBD. Unlike other IBD medications, biologics typically require prior authorization from insurance providers. There is a paucity of information characterizing the length of the authorization process. Delays in the initiation of biologic therapy have the potential to impact clinical outcomes and quality of life. This study identified the time of biologic prescription and subsequent time for authorization and time of administration at a university medical center. Methods A chart review evaluating IBD patients seen in the GI clinic of a university medical center over a 5-year period was performed. Patient age, gender, race, IBD diagnosis, and biologic use were recorded in a confidential database generated using Microsoft Excel. Biologic agents evaluated included infliximab, adalimumab, vedolizumab and ustekinumab. The agreed upon date (AUD) of starting a biologic, length of time to approval (TTA), and length of time to first infusion (TFI) were recorded. TTA was set as the number of days between agreeing to start a biologic and prior authorization approval. TFI was set as the number of days between agreeing to start a biologic and their first infusion or injection. Patients were excluded if biologic was initiated at another institution or documentation of AUD or TFI was not apparent. Statistical analysis was performed using a t-test with significance set at p&lt;0.05. The study was approved by the institutional IRB. Results 458 total IBD patients were analyzed. 66 are currently being treated with a biologic (32 infliximab, 14 adalimumab, 13 vedolizumab, 7 ustekinumab). 37 patients had ulcerative colitis, 27 Crohn’s disease, and 2 indeterminate colitis. There were 38 men and 28 women (mean age 43.2 years; range 23–76). 32 patients were white, 26 African American, 1 Asian, 5 other/unknown, and 2 declined. Average TTA was 30.5 days (range 1–145) and average TFI was 45.3 days (range 2–166). There was no significant difference in TFI between a specific biologic compared to all others: infliximab (p=0.615), adalimumab (p=0.183), vedolizumab (p=0.804), ustekinumab (p=0.812). There were no significant differences in TFI with regard to gender (p=0.562), race (p=0.575), or IBD diagnosis (p=0.209). Discussion In IBD patients with an indication for biologic treatment, reducing the time to initiation of biologics can result in improved patient outcomes and quality of life. Average wait time for first infusion at our institution was 43.5 days with no difference based on the type of biologic or patient demographics. While a national benchmark does not exist for initiating patients on biologics, there is a need for continued evaluation of the authorization and treatment processes. As new biologic therapies for IBD become available, streamlining the approval process will be of increasing importance.

scholarly journals Serum Lactate and Acute Mesenteric Ischemia: An Observational, Controlled Multicenter Study

2021 ◽  
Author(s):  
Olivier Collange ◽  
Marc LOPEZ ◽  
Anne LEJAY ◽  
Patrick PESSAUX ◽  
Alexandre OUATTARA ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Serum Lactate ◽  
Control Group ◽  
Adult Intensive Care Unit ◽  
Diagnosis And Prognosis ◽  
Significant Difference ◽  
Lactate Levels ◽  
Matching Criteria

Abstract Purpose Early diagnosis of acute mesenteric ischemia (AMI) is key to survival but remains extremely difficult, as the symptoms are vague and non-specific. Although international guidelines recommend that serum lactate is not used for AMI diagnosis, this parameter is still specifically taken into account for the diagnosis and prognosis of AMI. Our hypothesis was that serum lactate levels cannot be used to diagnose AMI or predict its outcome. Methods This was an ancillary, retrospective, observational, controlled multicenter study, approved by an Ethics Committee. Patients with AMI at adult intensive care unit (ICU) admission were included (AMI group) and matched to ICU patients without AMI (control group). Matching criteria were center, period, gender, age, and severity. Serum lactate levels were measured on day 0 (D0) and day 1 (D1) and the lactate difference (D0-D1) was calculated. Results Two hundred and seventy-four patients were included. Serum lactate levels were elevated in both groups at D0 and D1 but there was no significant difference between groups at D0 (2.7 [1.3; 5.5] vs 3.4 [1.9; 6.1] mmol/L; p = 0.284), D1 (1.8 [1.2; 3.1] vs 2.4 [1.5; 4.6] mmol/L, p = 0.547; respectively for control and AMI groups) or D0-D1. Thus, the performance of serum lactate for AMI diagnosis was poor. Concerning AMI outcome, serum lactate levels predicted ICU death in both groups at D0 and D1. Conclusions no specific association was observed between serum lactate levels and AMI. Serum lactate should not be used for the diagnosis of AMI but may help assess disease severity.

DOZ047.42: The value of rigid tracheobronchoscopy for the diagnosis of tracheomalacia in esophageal atresia patients

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
I P Aanen ◽  
B Pullens ◽  
J van Rosmalen ◽  
R M H Wijnen
Keyword(s):  
Sensitivity And Specificity ◽  
Esophageal Atresia ◽  
Surgical Intervention ◽  
Medical Center ◽  
Primary Repair ◽  
Demographic Data ◽  
P Value ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Low Sensitivity

Abstract Aim of the Study The aim of this study is to evaluate routine airway endoscopy prior to the closure of the trachea-esophageal fistula (TOF) and esophageal atresia (EA) repair in a tertiary medical center concerning pre- and postoperative tracheomalacia. Methods We evaluated all patients with EA born between 2013 and 2016 who underwent routine rigid tracheobronchoscopy (TBS) before primary repair of the EA at our center. Inclusion criteria included peroperative rigid TBS performed by an otolaryngologist. Exclusion criteria included impossibility to determine pre- and or postoperative TM (because of logistic or medical reasons). Demographic data, comorbidities, surgical intervention, TBS findings, and subsequent surgical management were analyzed. Main Results Twenty-four patients with EA were included in this study. Eight of the 24 patients developed postoperative TM. Of these 8 patients with TM, 5 were diagnosed at the preoperative TBS (62.5%). Of the 16 patients without postoperative TM, there were 6 patients (37.5%) with peroperative diagnosed TM. So the sensitivity and specificity of routine airway endoscopy prior to EA-repair are, respectively, 62.5% (CI 30.4%–86.5%) and 62.5% (CI 38.5%–81.6%). Concerning postoperative TM, there is a significant higher appearance in females versus males (P-value 0.021). There was no significant causality between mean gestational age, birth weight, type of EA, type of surgery (open or thoracoscopic), presence of gastroesophageal reflux disease, and the appearance of postoperative TM. Conclusions Preoperative TBS can be useful for the evaluation of tracheoesophageal fistula but has a low sensitivity and specificity to detect postoperative TM.

scholarly journals The value of potassium, pH and D-dimer levels in early diagnosis of acute mesenteric ischemia: an experimental study on rats

2021 ◽  
Vol 17 (1) ◽  
pp. 236-240
Author(s):  
Semih Hot ◽  
Seracettin Egin ◽  
Mehmet Ilhan ◽  
Suleyman Bademler ◽  
Okan Dikker ◽  
...  
Keyword(s):  
Experimental Study ◽  
Early Diagnosis ◽  
Mesenteric Ischemia ◽  
Peritoneal Lavage ◽  
Acute Mesenteric Ischemia ◽  
Lavage Fluid ◽  
Experimental Medicine ◽  
Peritoneal Lavage Fluid ◽  
Significant Difference ◽  
D Dimer

IntroductionThe aim of this randomized controlled experimental study was to evaluate the efficacy of potassium, pH and D-dimer levels in blood, as well as potassium and pH levels in peritoneal lavage fluid, in the early diagnosis of acute mesenteric ischemia.Material and methodsThis study was conducted at the Istanbul University Center of Experimental Medicine after having received approval from the Istanbul University animal testing ethics committee. Male albino Wistar rats (n = 24; 250 to 350 g) were divided into two control groups and two ischemic groups. Levels of potassium, pH, and D-dimer in blood and levels of potassium and pH in peritoneal lavage fluid were analyzed for 1 h and 2 h after the induced acute mesenteric ischemia procedure. The degree of ischemic injury was determined using the histopathological damage score in tissue samples taken from the terminal ileum.ResultsIschemic groups had statistically significant differences in potassium and pH in blood and peritoneal lavage fluid compared to non-ischemic groups (p < 0.05). There was no significant difference between control and ischemic groups in terms of D-dimer and histologic grading results after 1 h (p = 0.132, p = 0.475 respectively), while there was a significant difference between control and ischemic groups after 2 h (p < 0.05).ConclusionsThe levels of potassium, pH, and D-dimer could be useful in daily practice for the early diagnosis of acute mesenteric ischemia.

Incidence of contrast-induced acute kidney injury in patients with acute mesenteric ischemia and identification of potential predictive factors

Vascular ◽  
2021 ◽  
pp. 170853812110507
Author(s):  
Emmanuel Augène ◽  
Fabien Lareyre ◽  
Julien Chikande ◽  
Lucas Guidi ◽  
Grégoire Mutambayi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Contrast Medium ◽  
Predictive Factors ◽  
Mesenteric Ischemia ◽  
Kidney Injury ◽  
Acute Mesenteric Ischemia ◽  
Creatinine Concentration ◽  
Increased Risk ◽  
Significant Difference

Objective Contrast-enhanced computed tomography angiography (CTA) is commonly used to investigate acute abdominal conditions, but the risk of contrast-induced acute kidney injury (CI-AKI) has been poorly investigated in patients with acute mesenteric ischemia. The aim of the present study was to evaluate the incidence of CI-AKI in these patients and identify potential predictive factors. Methods Patients admitted for acute mesenteric ischemia who had a diagnostic CTA with contrast medium and a follow-up of creatinine concentration were retrospectively included. Results Among 53 patients included, 9 (16.9%) developed CI-AKI. The prevalence of chronic kidney disease did not differ significantly between those who developed CI-AKI and those who did not (33.3 vs 18.2%, p=.372). Plasma total bilirubin and conjugated bilirubin levels were significantly higher in patients who developed CI-AKI (17.5 vs 8.0 μmol/L, p=.013 and 8.0 vs 3.0 μmol/L, p=.031, respectively). The proportion of patients who had revascularization was similar between patients who developed CI-AKI and those who did not (11.1 vs 20.5%, p>.999). No significant difference was observed for 30-day mortality and all-cause mortality for a median follow-up of 168 days (22.2 vs 13.6%, p=.611; and 33.3 vs 61.4%, p=.153, respectively). Conclusion This study reports the incidence of CI-AKI in patients with acute mesenteric ischemia after diagnostic CTA with contrast medium. Plasma bilirubin levels were a predictive factor of CI-AKI in these patients. The administration of contrast media during revascularization was not associated with an increased risk of CI-AKI.

scholarly journals Gut Microbiota Restricts NETosis in Acute Mesenteric Ischemia-Reperfusion Injury

2020 ◽  
Vol 40 (9) ◽  
pp. 2279-2292 ◽  
Author(s):  
Stefanie Ascher ◽  
Eivor Wilms ◽  
Giulia Pontarollo ◽  
Henning Formes ◽  
Franziska Bayer ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Mesenteric Ischemia ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Acute Mesenteric Ischemia ◽  
Neutrophil Extracellular Traps ◽  
Mesenteric Infarction ◽  
Extracellular Traps ◽  
Injury Model ◽  
The Impact

Objective: Recruitment of neutrophils and formation of neutrophil extracellular traps (NETs) contribute to lethality in acute mesenteric infarction. To study the impact of the gut microbiota in acute mesenteric infarction, we used gnotobiotic mouse models to investigate whether gut commensals prime the reactivity of neutrophils towards formation of neutrophil extracellular traps (NETosis). Approach and Results: We applied a mesenteric ischemia-reperfusion (I/R) injury model to germ-free (GF) and colonized C57BL/6J mice. By intravital imaging, we quantified leukocyte adherence and NET formation in I/R-injured mesenteric venules. Colonization with gut microbiota or monocolonization with Escherichia coli augmented the adhesion of leukocytes, which was dependent on the TLR4 (Toll-like receptor-4)/TRIF (TIR-domain–containing adapter-inducing interferon-β) pathway. Although neutrophil accumulation was decreased in I/R-injured venules of GF mice, NETosis following I/R injury was significantly enhanced compared with conventionally raised mice or mice colonized with the minimal microbial consortium altered Schaedler flora. Also ex vivo, neutrophils from GF and antibiotic-treated mice showed increased LPS (lipopolysaccharide)-induced NETosis. Enhanced TLR4 signaling in GF neutrophils was due to elevated TLR4 expression and augmented IRF3 (interferon regulatory factor-3) phosphorylation. Likewise, neutrophils from antibiotic-treated conventionally raised mice had increased NET formation before and after ischemia. Increased NETosis in I/R injury was abolished in conventionally raised mice deficient in the TLR adaptor TRIF. In support of the desensitizing influence of enteric LPS, treatment of GF mice with LPS via drinking water diminished LPS-induced NETosis in vitro and in the mesenteric I/R injury model. Conclusions: Collectively, our results identified that the gut microbiota suppresses NETing neutrophil hyperreactivity in mesenteric I/R injury, while ensuring immunovigilance by enhancing neutrophil recruitment.

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