Renoduodenal Fistula Following Penetrating Abdominal Injury

2021 ◽  
pp. 000313482110545
Author(s):  
Julien Hohenleitner ◽  
Yasong Yu ◽  
Amy Gore ◽  
Frank Traupman ◽  
Maya Jackson ◽  
...  
Keyword(s):  
Inflammatory Process ◽  
Gunshot Wound ◽  
Treatment Options ◽  
Traumatic Injury ◽  
Ureteral Injury ◽  
Fistula Formation ◽  
Initial Operation ◽  
Urine Leak ◽  
Penetrating Abdominal Injury ◽  
Tract Infections

Renoduodenal fistula is an uncommon occurrence and usually results as a complication of injury or inflammatory process. Here, we describe a case of renoduodenal fistula formation after traumatic injury via gunshot wound to the abdomen. The patient suffered right renal and ureteral injury, complicated by urine leak, managed by surgery, interventional radiology, and urology. His post-hospital course was complicated by recurrent urinary tract infections and was found to have a renoduodenal fistula 3 months after the initial operation. Patient underwent uncomplicated right nephrectomy and repair of fistula. Etiology, presentation, diagnosis, and treatment options of renoduodenal fistula are discussed.

scholarly journals 1578. Treatments for complicated urinary tract infections (cUTI) caused by multidrug resistant (MDR) Gram-negative (GN) pathogens- a systematic review and network meta-analysis (NMA)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S787-S787
Author(s):  
Tim Reason ◽  
Karan Gill ◽  
Christopher Longshaw ◽  
Rachael McCool ◽  
Katy Wilson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Economics ◽  
Meta Analysis ◽  
Treatment Options ◽  
Final Analysis ◽  
Similar Efficacy ◽  
Global Public Health ◽  
Efficacy And Safety ◽  
Support Unit ◽  
Tract Infections

Abstract Background Antimicrobial resistance is a major and growing threat to global public health. Cefiderocol (CFDC) is a new siderophore-cephalosporin with a wide activity spectrum covering all aerobic GN pathogens including all WHO critical priority pathogens, that was recently approved by FDA for the treatment of GN cUTI in susceptible organisms. We aim to understand the relative efficacy and safety of current treatment options for cUTI caused by MDR GN pathogens. Methods We conducted a systematic review to identify all relevant trials that investigated the efficacy and safety of antimicrobial regimens, for the treatment of GN pathogens in cUTI. Outcomes of interest included clinical cure and microbiological eradication (ME) at time of cure (TOC) and sustained follow up (SFU), and safety. Evidence networks were constructed using data for outcomes of interest and analyses were conducted in a frequentist framework using NMA methods outlined by the NICE decision support unit using the netmeta package in R. Results A total of 5 studies, 6 interventions and 2,349 randomised patients were included in the final analysis. Interventions included CFDC, imipenem-cilastatin (IPM-CIL), ceftazidime-avibactam (CAZ/AVI), doripenem (DOR), levofloxacin and ceftolozane-tazobactam (CEF/TAZ). Trials included predominantly Enterobacterales, and Pseudomonas aeruginosa and very few Acinetobacter baumannii. The patient population presented some clinical differences across trials, which were not adjusted for the NMA. Overall, there were numerical differences (especially in endpoints at SFU favouring CFDC), but all treatments showed similar efficacy and safety, with exception of higher ME rate at TOC for CFDC vs IPM, Table 1, also observed at SFU, consistent with the data from the individual clinical trial. Table 1- Results for microbiological eradication Table 1- Results for microbiological eradication Conclusion This NMA, showed superiority of CFDC vs IPM-CIL in ME at TOC and SFU and similar efficacy and safety vs all other comparators, with numeric differences favouring CFDC for outcomes at SFU. These traditional methodologies for NMA, are only valid within a similar pathogens pool and population across the trials, and may not reflect the full value of breadth of coverage that new therapeutic options bring for the treatment of MDR GN pathogens. Disclosures Tim Reason, PhD, Shionogi (Consultant) Karan Gill, MSc, Shionogi BV (Employee) Christopher Longshaw, PhD, Shionogi B.V. (Employee) Rachael McCool, PhD, York Health Economics Consortium (Employee, YHEC was commissioned by Shionogi to conduct the systematic review) Katy Wilson, PhD, York Health Economics Consortium (Employee, Shionogi commissioned YHEC to conduct the systematic review) Sara Lopes, PharmD, Shionogi BV (Employee)

scholarly journals Mesh complications: best practice in diagnosis and treatment

2020 ◽  
Vol 12 ◽  
pp. 175628722094299
Author(s):  
Paulina Bueno Garcia Reyes ◽  
Hashim Hashim
Keyword(s):  
Urinary Tract ◽  
Minimally Invasive ◽  
Best Practice ◽  
Treatment Options ◽  
Urinary Stress Incontinence ◽  
Mesh Complications ◽  
Treatment Pathways ◽  
Mesh Placement ◽  
Minimally Invasive Surgical Procedure ◽  
Tract Infections

Mesh was a promising, minimally invasive, and ‘gold standard’ treatment for urinary stress incontinence. Time has shown that complications from these devices can happen early, or even several years, after mesh placement and can be catastrophic. Pain, erosion, voiding dysfunction, infection, recurrent UTIs [urinary tract infections (UTIs)], fistulae, organ perforation, bleeding, vaginal scarring, neuromuscular alterations, LUTS (lower urinary tract symptoms), bowel complications and even immune disorders have been linked to mesh. Various tools, such as imaging, endoscopic and functional studies, are available for diagnosis of mesh complications. Since the spectrum of complications is wide, involvement of other specialties is usually beneficial in the diagnosis and management of these complications. There is still much to learn on the accuracy and utility of diagnostic studies in each type of complication. Evidence on the best diagnostic and treatment pathways for these complications is scarce but continuously growing as information is being reported, and we continue to gain expertise in dealing with patients affected by mesh. Treatment options include conservative and medical management initially and then open or minimally invasive surgical procedure approaches. This article will describe diagnostic and treatment pathways for mesh complications.

scholarly journals Nasopharyngeal Microbiota Profiles in Rural Venezuelan Children Are Associated With Respiratory and Gastrointestinal Infections

2020 ◽  
Author(s):  
Lilly M Verhagen ◽  
Ismar A Rivera-Olivero ◽  
Melanie Clerc ◽  
Mei Ling J N Chu ◽  
Jody van Engelsdorp Gastelaars ◽  
...  
Keyword(s):  
Treatment Options ◽  
Therapeutic Approaches ◽  
Gastrointestinal Infections ◽  
Differential Abundance ◽  
Associated Bacteria ◽  
16S Sequencing ◽  
Forest Models ◽  
Random Forest Models ◽  
Tract Infections ◽  
Klebsiella Spp

Abstract Background Recent research suggests that the microbiota affects susceptibility to both respiratory tract infections (RTIs) and gastrointestinal infections (GIIs). In order to optimize global treatment options, it is important to characterize microbiota profiles across different niches and geographic/socioeconomic areas where RTI and GII prevalences are high. Methods We performed 16S sequencing of nasopharyngeal swabs from 209 Venezuelan Amerindian children aged 6 weeks–59 months who were participating in a 13-valent pneumococcal conjugate vaccine (PCV13) study. Using random forest models, differential abundance testing, and regression analysis, we determined whether specific bacteria were associated with RTIs or GIIs and variation in PCV13 response. Results Microbiota compositions differed between children with or without RTIs (P = .018) or GIIs (P = .001). Several species were associated with the absence of infections. Some of these health-associated bacteria are also observed in developed regions, such as Corynebacterium (log2(fold change [FC]) = 3.30 for RTIs and log2(FC) = 1.71 for GIIs), while others are not commonly observed in developed regions, such as Acinetobacter (log2(FC) = 2.82 and log2(FC) = 5.06, respectively). Klebsiella spp. presence was associated with both RTIs (log2(FC) = 5.48) and GIIs (log2(FC) = 7.20). Conclusions The nasopharyngeal microbiota of rural Venezuelan children included several bacteria that thrive in tropical humid climates. Interestingly, nasopharyngeal microbiota composition not only differed in children with an RTI but also in those with a GII, which suggests a reciprocal interplay between the 2 environments. Knowledge of region-specific microbiota patterns enables tailoring of preventive and therapeutic approaches.

scholarly journals Impact of Rhinovirus Infections in Children

Viruses ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 521 ◽  
Author(s):  
Silvia Vandini ◽  
Carlotta Biagi ◽  
Maximilian Fischer ◽  
Marcello Lanari
Keyword(s):  
Rna Virus ◽  
Pediatric Population ◽  
Treatment Options ◽  
Respiratory Morbidity ◽  
Upper Respiratory Tract ◽  
Direct Cell ◽  
The Subject ◽  
Upper Respiratory ◽  
Syncytial Virus ◽  
Tract Infections

Rhinovirus (RV) is an RNA virus that causes more than 50% of upper respiratory tract infections in humans worldwide. Together with Respiratory Syncytial Virus, RV is one of the leading causes of viral bronchiolitis in infants and the most common virus associated with wheezing in children aged between one and two years. Because of its tremendous genetic diversity (>150 serotypes), the recurrence of RV infections each year is quite typical. Furthermore, because of its broad clinical spectrum, the clinical variability as well as the pathogenesis of RV infection are nowadays the subjects of an in-depth examination and have been the subject of several studies in the literature. In fact, the virus is responsible for direct cell cytotoxicity in only a small way, and it is now clearer than ever that it may act indirectly by triggering the release of active mediators by structural and inflammatory airway cells, causing the onset and/or the acute exacerbation of asthmatic events in predisposed children. In the present review, we aim to summarize the RV infection’s epidemiology, pathogenetic hypotheses, and available treatment options as well as its correlation with respiratory morbidity and mortality in the pediatric population.

scholarly journals Does cranberry extract reduce antibiotic use for symptoms of acute uncomplicated urinary tract infections (CUTI)? Protocol for a feasibility study

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Oghenekome Gbinigie ◽  
Julie Allen ◽  
Anne-Marie Boylan ◽  
Alastair Hay ◽  
Carl Heneghan ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Feasibility Study ◽  
Urinary Tract Infections ◽  
Treatment Options ◽  
Sample Size Calculation ◽  
Antibiotic Use ◽  
Primary Objective ◽  
Feasibility Trial ◽  
Tract Infections

Abstract Background Consultations in primary care for symptoms of urinary tract infections (UTIs) are common and patients are frequently treated with antibiotics. Given increasing antimicrobial resistance, there has been interest in non-antibiotic treatment options for common infections. One such option is the use of cranberry extract to treat symptoms attributable to UTIs. Methods A target of 45 women consulting in primary care, with symptoms suggestive of an uncomplicated UTI for whom the practitioner would normally prescribe antibiotics, will be randomised to receive one of three treatment approaches: (1) immediate prescription for antibiotics; (2) immediate prescription for antibiotics plus a 7-day course of cranberry capsules and (3) cranberry capsules plus a delayed prescription for antibiotics to be used in case their symptoms do not get better, or get worse. Follow-up will be by daily rating of symptoms and recording of treatments used for 2 weeks in an online symptom diary. Interviews will be conducted with around 10–15 study participants, as well as with around 10–15 women who have experienced a UTI but have not been approached to take part in the study. Both groups will be asked about their experience of having a UTI, their thoughts on non-antibiotic treatments for UTIs and their thoughts on, or experience of, the feasibility trial. The primary objective is to assess the feasibility of undertaking a full trial in primary care of the effectiveness of cranberry extract to reduce antibiotic use for symptoms of acute uncomplicated UTI. The secondary objective is to conduct a preliminary assessment of the extent to which cranberry might reduce antibiotic use and symptom burden. Discussion This feasibility study with embedded interviews will inform the planning and sample size calculation of an adequately powered trial to definitively determine whether cranberry helps to alleviate the symptoms of acute uncomplicated UTIs in women and whether it can safely reduce antibiotic use. Trial registration ISRCTN registry, ID: 10399299. Registered on 24 January 2019.

scholarly journals Urinary tract infections in women: etiology and treatment options

2011 ◽  
pp. 333 ◽  
Author(s):  
Daniele Minardi ◽  
d'Anzeo ◽  
Cantoro ◽  
Conti ◽  
Muzzonigro
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Treatment Options ◽  
Tract Infections

scholarly journals Xanthogranulomatous Pyelonephritis of a Lower Pole Moiety in a Duplicated Collecting System Kidney

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Jean Paul Wuilleumier ◽  
Ariel Schulman ◽  
Antonio Montgomery ◽  
Ervin Teper
Keyword(s):  
Urinary Tract ◽  
Clinical Features ◽  
Urinary Tract Infections ◽  
Kidney Stones ◽  
Inflammatory Process ◽  
Xanthogranulomatous Pyelonephritis ◽  
Lower Pole ◽  
Duplicated Collecting System ◽  
Tract Infections ◽  
Collecting System

Xanthogranulomatous pyelonephritis (XGP) is a destructive inflammatory process which is frequently caused by recurrent urinary tract infections or chronic obstruction by kidney stones. We present a 56-year-old female with an extensive retroperitoneal urinoma and xanthogranulomatous pyelonephritis of the lower pole moiety in a kidney with a duplicated collecting system due to obstructive nephrolithiasis. After drainage of the urinoma, the patient underwent a definitive lower pole heminephrectomy with preservation of the functional upper pole. We review important clinical features of xanthogranulomatous pyelonephritis and considerations for surgery on a duplicated kidney.

scholarly journals Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas

2000 ◽  
Vol 9 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Mark W. Hawk ◽  
Kee D. Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Treatment Options ◽  
Traumatic Injury ◽  
Bed Rest ◽  
Diagnostic Tools ◽  
Lumbar Region ◽  
Low Back ◽  
True Incidence ◽  
Blood Patch ◽  
Close Observation

Spinal pseudomeningoceles and cerebrospinal fluid (CSF) fistulas are uncommon extradural collections of CSF that may result from inadvertent tears in the dural–arachnoid layer, traumatic injury, or may be congenital in origin. Most pseudomeningoceles are iatrogenic and occur in the posterior lumbar region following surgery. The true incidence of iatrogenic pseudomeningoceles following laminectomy or discectomy is unknown; however, the authors of several published reports suggest that the incidence of lumbar pseudomeningoceles following laminectomy or discectomy is between 0.07% and 2%. Pseudomeningoceles are often asymptomatic, but patients may present with recurrence of low-back pain, radiculopathy, subcutaneous swelling, or with symptoms of intracranial hypotension. Very rarely, they present with delayed myelopathy. Although magnetic resonance imaging is the neurodiagnostic study of choice, computerized tomography myelography and radionuclide myelographic study may be helpful diagnostic tools in some cases. Analysis of suspect fluid for β2 transferrin may be a useful adjunctive study. Treatment options include close observation for spontaneous resolution, conservative measures such as bed rest and applicaton of an epidural blood patch, lumbar subarachnoid drainage, and definitive surgical repair.

scholarly journals Incidental Finding of Complete Bilateral Persistent Sciatic Arteries

2021 ◽  
Vol 8 (1) ◽  
pp. 2
Author(s):  
Sofia M. Ramos ◽  
Reinhardt G. Dreyer ◽  
Thandi E. Buthelezi
Keyword(s):  
Computed Tomography ◽  
Lower Limb ◽  
Rare Case ◽  
Gunshot Wound ◽  
Incidental Finding ◽  
Treatment Options ◽  
Vascular Anomaly ◽  
Young Female ◽  
Imaging Findings ◽  
Accurate Reporting

Persistence of bilateral sciatic arteries (PSA) is a rare congenital vascular anomaly. We report an exceptionally rare case of complete bilateral persistent sciatic arteries, diagnosed incidentally on computed tomography angiography (CTA) in a young female patient who sustained a gunshot wound to the lower limb. The embryology, variants, clinical and imaging findings, potential complications, and treatment options are discussed. PSAs, found incidentally, are unlikely to have clinical significance, however, the unusual anatomy and higher incidence of future complications requires accurate reporting of such variants.

scholarly journals Prostate Artery Embolization—Review of Indications, Patient Selection, Techniques and Results

2021 ◽  
Vol 10 (21) ◽  
pp. 5139
Author(s):  
Sailendra G. Naidu ◽  
Harish Narayanan ◽  
Gia Saini ◽  
Nicole Segaran ◽  
Sadeer J. Alzubaidi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Treatment Options ◽  
Benign Prostatic Hypertrophy ◽  
Clinical Results ◽  
Artery Embolization ◽  
Prostate Artery Embolization ◽  
Urinary Tract Symptoms ◽  
Surgical Options ◽  
Tract Infections ◽  
Lower Urinary

Lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) are a very common problem in men ranging from mild urinary symptoms to recurrent urinary tract infections or renal failure. Numerous treatment options are available ranging from conservative medical therapies to more invasive surgical options. Prostate artery embolization (PAE) has emerged as a novel treatment option for this common problem with clinical efficacy comparable to the current surgical gold standard, transurethral resection of the prostate (TURP). PAE offers fewer complications and side effects without a need for general anesthesia or hospitalization. This review discusses the indications for prostate artery embolization in addition to LUTS, patient evaluation in patients with LUTS, PAE technique and clinical results, with an emphasis on efficacy and safety.

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