Surgical Aspects of Celiac Disease

2015 ◽  
Vol 81 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Jon S. Thompson ◽  
David S. Thompson ◽  
Avishai Meyer
Keyword(s):  
Liver Transplantation ◽  
Celiac Disease ◽  
Surgical Procedures ◽  
Intestinal Inflammation ◽  
Adult Patients ◽  
Recurrent Pancreatitis ◽  
Motility Disorders ◽  
Increased Risk ◽  
Abdominal Operations ◽  
Surgical Aspects

Celiac disease, characterized by intestinal inflammation and malabsorption, occurs in 1 per cent of the population and is often undiagnosed. These patients are at increased risk for surgical procedures resulting from symptoms, associated intestinal disorders, and malignancy. Our aim was to determine the incidence and outcome of abdominal operations in patients with celiac disease. Records of 512 adult patients with celiac disease evaluated over a 22-year period were reviewed. Operations were classified as related or unrelated to celiac disease. One hundred eighty-eight (36%) of 512 patients underwent abdominal operations. One hundred twenty-seven (68%) of the 188 patients had unrelated procedures. Sixty-one (32%) had operations considered related to celiac disease. Twenty-six (43%) of 61 with related procedures were diagnosed preoperatively. Procedures were performed for pain, obstruction, motility disorders, and malignancy. Six patients had recurrent pancreatitis. Seven patients underwent liver transplantation. Thirty-five (57%) related procedures led to the diagnosis of celiac disease including “unmasking” (n = 25) and diagnostic findings (n = 10). One-third of patients with celiac disease undergo abdominal operations of which one-third are related to celiac disease. Operations are related to complications of celiac disease and often lead to the initial diagnosis.

scholarly journals Pattern of surgical site infection in contaminated and infected wounds and corelation with introperative bacterial growth

2021 ◽  
pp. 17-21
Keyword(s):  
Wound Infection ◽  
Surgical Procedures ◽  
Bacterial Contamination ◽  
Surgical Site Infections ◽  
Wound Infections ◽  
E Coli ◽  
Increased Risk ◽  
Infected Wounds ◽  
Abdominal Operations ◽  
Set Up

Surgical Site Infections (SSIs), previously called post operative wound infections, result from bacterial contamination during or after a surgical procedure.Surgical site infections are the third most common hospital associated infection, accounting for 14-16% of all infections in hospitalized patients. Aims and objectives are to establish the pattern of wound infection in terms of aerobic organisms after contaminated and infected surgical procedures. 50 patients having emergency or elective traumatic or non-traumatic abdominal operations who fulfil the criteria of infected and contaminated wounds are included in the study. Patients to be studied were selected in random basis. The incidence of wound infection is 31.57% in contaminated surgical procedures and 29.03% in infec-ted surgical procedure. Operation in emergency set up results in an increased risk of wound infection. Patients with positive intra operative bacteriology runs a higher risk of developing wound infection. The commonest organism isolated from intra operative swab cultures were E. coli followed by Klebsiella in both infected and contaminated procedures. Presence of polymicrobial flora in intraoperative swab culture is associated with hig-her rate of wound infection.

Cytidine Deaminase Residual Activity in Serum Is a Predictive Marker of Early Severe Toxicities in Adults After Gemcitabine-Based Chemotherapies

2010 ◽  
Vol 28 (1) ◽  
pp. 160-165 ◽  
Author(s):  
Joseph Ciccolini ◽  
Laetitia Dahan ◽  
Nicolas André ◽  
Alexandre Evrard ◽  
Muriel Duluc ◽  
...  
Keyword(s):  
Drug Exposure ◽  
Cytidine Deaminase ◽  
Residual Activity ◽  
Predictive Marker ◽  
Adult Patients ◽  
Functional Testing ◽  
Simple Test ◽  
Increased Risk ◽  
Significant Difference ◽  
Patients At Risk

Purpose Anticipating toxicities with gemcitabine is an ongoing story, and deregulation in cytidine deaminase (CDA) could be associated with increased risk of developing early severe toxicities on drug exposure. Patients and Methods A simple test to evaluate CDA phenotypic status was first validated in an animal model investigating relationships between CDA activity and gemcitabine-related toxicities. Next, relevance of this test as a marker for toxicities was retrospectively tested in a first subset of 64 adult patients treated with gemcitabine alone, then it was tested in a larger group of 130 patients who received gemcitabine either alone or combined with other drugs and in 20 children. Additionally, search for the 435 T>C, 208 G>A and 79 A>C mutations on the CDA gene was performed. Results In mice, CDA deficiency impacted on gemcitabine pharmacokinetics and had subsequent lethal toxicities. In human, 12% of adult patients experienced early severe toxicities after gemcitabine administration. A significant difference in CDA activities was observed between patients with and without toxicities (1.2 ± 0.8 U/mg v 4 ± 2.6 U/mg; P < .01). Conversely, no genotype-to-phenotype relationships were found. Of note, the patients who displayed particularly reduced CDA activity all experienced strong toxicities. Gemcitabine was well tolerated in children, and no CDA deficiency was evidenced. Conclusion Our data suggest that CDA functional testing could be a simple and easy marker to discriminate adult patients at risk of developing severe toxicities with gemcitabine. Particularly, this study demonstrates that CDA deficiency, found in 7% of adult patients, is associated with a maximum risk of developing early severe toxicities with gemcitabine.

scholarly journals Acute small intestinal inflammation results in persistent lymphatic alterations

2018 ◽  
Vol 314 (3) ◽  
pp. G408-G417 ◽  
Author(s):  
Sonia Rehal ◽  
Matthew Stephens ◽  
Simon Roizes ◽  
Shan Liao ◽  
Pierre-Yves von der Weid
Keyword(s):  
Dendritic Cell ◽  
Lymphatic System ◽  
Intestinal Inflammation ◽  
Critical Role ◽  
Lymphatic Vessels ◽  
Lymphoid Tissues ◽  
Functional Changes ◽  
Increased Risk ◽  
Small Intestinal ◽  
Acute Ileitis

Inflammatory bowel disease (IBD) has a complex pathophysiology with limited treatments. Structural and functional changes in the intestinal lymphatic system have been associated with the disease, with increased risk of IBD occurrence linked to a history of acute intestinal injury. To examine the potential role of the lymphatic system in inflammation recurrence, we evaluated morphological and functional changes in mouse mucosal and mesenteric lymphatic vessels, and within the mesenteric lymph nodes during acute ileitis caused by a 7-day treatment with dextran sodium sulfate (DSS). We monitored whether the changes persisted during a 14-day recovery period and determined their potential consequences on dendritic cell (DC) trafficking between the mucosa and lymphoid tissues. DSS administration was associated with marked lymphatic abnormalities and dysfunctions exemplified by lymphangiectasia and lymphangiogenesis in the ileal mucosa and mesentery, increased mesenteric lymphatic vessel leakage, and lymphadenopathy. Lymphangiogenesis and lymphadenopathy were still evident after recovery from intestinal inflammation and correlated with higher numbers of DCs in mucosal and lymphatic tissues. Specifically, a deficit in CD103+ DCs observed during acute DSS in the lamina propria was reversed and further enhanced during recovery. We concluded that an acute intestinal insult caused alterations of the mesenteric lymphatic system, including lymphangiogenesis, which persisted after resolution of inflammation. These morphological and functional changes could compromise DC function and movement, increasing susceptibility to further gastrointestinal disease. Elucidation of the changes in mesenteric and intestinal lymphatic function should offer key insights for new therapeutic strategies in gastrointestinal disorders such as IBD. NEW & NOTEWORTHY Lymphatic integrity plays a critical role in small intestinal homeostasis. Acute intestinal insult in a mouse model of acute ileitis causes morphological and functional changes in mesenteric and intestinal lymphatic vessels. While some of the changes significantly regressed during inflammation resolution, others persisted, including lymphangiogenesis and altered dendritic cell function and movement, potentially increasing susceptibility to the recurrence of gastrointestinal inflammation.

scholarly journals Otoplasty: a graduated approach

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Ahmed Soliman Ismail
Keyword(s):  
Postoperative Pain ◽  
Surgical Procedures ◽  
Adult Patients ◽  
Surgical Results ◽  
Auricular Cartilage ◽  
Surgical Time ◽  
Common Presentation ◽  
Ear Deformity ◽  
Surgical Tool ◽  
Bat Ear

Abstract Background Bat ear deformity is a common presentation among the ENT patients (22.5%). Many surgical procedures have been described to manage such a problem. A thorough study of the anatomical anomalies contributing to such deformity is required by any plastic surgeon in handling this anomaly. Results Modified anterior scoring (Chong-Chet) was done on 45 bat ear deformities in 31 patients. Good surgical results were obtained in 97.7% of patients, and the surgical time ranged from 60 t0 90 min. Postoperative pain and infection were minimal and effectively managed. Conclusions The modified Chong-Chet anterior scoring is a reliable and effective surgical tool for managing bat ear deformity done through one postauricular incision. This technique could be used in young as well as adult patients because it renders the auricular cartilage easier to manipulate.

Characteristics and outcomes of acute COVID-19 infection in paediatric and young adult patients with underlying cardiac disease

2021 ◽  
pp. 1-7
Author(s):  
Joshua M. Fisher ◽  
Sarah Badran ◽  
John T. Li ◽  
Jodie K. Votava-Smith ◽  
Patrick M. Sullivan
Keyword(s):  
Risk Factors ◽  
Young Adult ◽  
Pulmonary Disease ◽  
Cardiac Disease ◽  
Single Ventricle ◽  
Cardiac Risk ◽  
Adult Patients ◽  
Chronic Pulmonary Disease ◽  
Cardiac Risk Factors ◽  
Increased Risk

Abstract Objective To describe outcomes of acute coronavirus disease 2019 in paediatric and young adult patients with underlying cardiac disease and evaluate the association between cardiac risk factors and hospitalisation. Study design We conducted a retrospective single-institution review of patients with known cardiac disease and positive severe acute respiratory syndrome coronavirus 2 RT-PCR from 1 March, 2020 to 30 November, 2020. Extracardiac comorbidities and cardiac risk factors were compared between those admitted for coronavirus disease 2019 illness and the rest of the cohort using univariate analysis. Results Forty-two patients with a mean age of 7.7 ± 6.7 years were identified. Six were 18 years of age or more with the oldest being 22 years of age. Seventy-six percent were Hispanic. The most common cardiac diagnoses were repaired cyanotic (n = 7, 16.6%) and palliated single ventricle (n = 7, 16.6%) congenital heart disease. Fourteen patients (33.3%) had underlying syndromes or chromosomal anomalies, nine (21%) had chronic pulmonary disease and eight (19%) were immunosuppressed. Nineteen patients (47.6%) reported no symptoms. Sixteen (38.1%) reported only mild symptoms. Six patients (14.3%) were admitted to the hospital for acute coronavirus disease 2019 illness. Noncardiac comorbidities were associated with an increased risk of hospitalisation (p = 0.02), particularly chronic pulmonary disease (p = 0.01) and baseline supplemental oxygen requirement (p = 0.007). None of the single ventricle patients who tested positive required admission. Conclusions Hospitalisations for coronavirus disease 2019 were rare among children and young adults with underlying cardiac disease. Extracardiac comorbidities like pulmonary disease were associated with increased risk of hospitalisation while cardiac risk factors were not.

The Emerging Role of Metformin in the Prevention and Treatment of Colorectal Cancer: A Game Changer for Management of Colorectal Cancer

2021 ◽  
Vol 18 ◽  
Author(s):  
Moein Ala
Keyword(s):  
Colorectal Cancer ◽  
Intestinal Inflammation ◽  
Epithelial Mesenchymal Transition ◽  
Chemotherapeutic Agents ◽  
Advanced Adenoma ◽  
High Risk Population ◽  
Mesenchymal Transition ◽  
Cytotoxicity Activity ◽  
Increased Risk ◽  
Patients With Diabetes

: Metformin is an old, inexpensive and relatively safe anti-diabetic medication which can decrease the increased risk of several types of cancer in patients with diabetes. Recent meta-analyses revealed that metformin markedly decreased the incidence of colorectal adenoma, advanced adenoma and colorectal cancer (CRC) among patients with diabetes. Potential mechanisms by which metformin may decrease colorectal cancer risk include its effects on ameliorating intestinal inflammation and dysbiosis, suppressing major proliferative pathways, preventing DNA replication, accelerating tumor cells apoptosis, inhibiting intra-tumor angiogenesis and epithelial-mesenchymal transition (EMT), increasing tumor-infiltrating lymphocytes and CD68+ tumor-associated macrophages, and enhancing T cell cytotoxicity activity. It was uncovered that metformin can improve overall survival and CRC-specific survival among patients with diabetes and CRC. Interestingly, metformin decreased the incidence of colonic adenoma in patients with acromegaly and reduced the incidence of inflammatory bowel disease (IBD) among patients with diabetes, which can indirectly lower the risk of CRC. Results of phase II clinical trials revealed that metformin can enhance the anti-cancer effects of chemotherapeutic agents, such as 5-Fluorouracil (5-FU) and irinotecan on refractory CRC. Furthermore, metformin decreased the risk of new polyps and adenomas in patients without diabetes. Regarding the results of previous preclinical and clinical studies, it is rational to assess the effect of metformin in normoglycemic patients with CRC and expand its clinical application for treating CRC or preventing it in a high-risk population.

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