scholarly journals Comprehensive Ultrasound Diagnosis of Sigmoid Diverticulitis

2021 ◽  
Vol 31 (4) ◽  
pp. 45-54
Author(s):  
A. I. Кoushnerou ◽  
I. A. Hadji-Ismail ◽  
A. V. Vorobei ◽  
S. I. Rudenka
Keyword(s):  
The Netherlands ◽  
South Korea ◽  
Diverticular Disease ◽  
Ultrasound Examination ◽  
Acute Diverticulitis ◽  
Sigmoid Diverticulitis ◽  
Colonic Wall ◽  
X Ray ◽  
Colon And Rectum ◽  
Abdominal Quadrant

Aim. A definition and systematisation of sigmoid diverticulitis semiotics in a comprehensive ultrasonic check-up for early illness diagnosis.Materials and methods. Ultrasound examination data on 64 patients with sigmoid diverticulum have been analysed. The primary visit reason was recurrent varying-intensity pain in left abdominal quadrant, unstable stool and flatulence. The patients were 28 (43.75%) men and 36 (56.25%) women aged 38–85 years, mean age 55.6 years; 31 (48.44%) were diagnosed with diverticulitis. We used the HD15 (Philips, the Netherlands), HS 60 (Samsung, South Korea) and Hi Vision Preirus (Hitachi, Japan) ultrasound instruments equipped with convex and intracavitary microconvex 2–12 MHz linear transducers. Patients were examined on an empty stomach and unprepared intestine. Colon and rectum were explored at different approaches, transabdominally, transperineally, transrectally and transvaginallyResults. The findings laid out a more elaborated ultrasound semiotics of diverticulitis. Ultrasound check-up enables a reliable estimation of blood supply and peristalsis, colonic wall thickness and layers, presence of asymptomatic diverticula, signs of acute diverticulitis (pain on sensor touch, mesocolic tissue infiltration, presence of faecal calculi and gas in diverticulum, peridiverticulitis) and other complications of diverticular disease (fistulae, abscess or peritonitis), as well as a consistent differential instrumental diagnosis of other organ illnesses.Conclusion. Ultrasound is an indispensable supplement in clinical diagnosis of diverticula, diverticulitis and their complications in the cases when other methods like X-ray, CT or colonoscopy are contraindicated.

scholarly journals How Far Away Are World Economies from Circularity: Assessing the Capacity of Circular Economy Policy Packages in the Operation of Raw Materials and Industrial Wastes

2021 ◽  
Vol 13 (8) ◽  
pp. 4394
Author(s):  
Margarita Ignatyeva ◽  
Vera Yurak ◽  
Alexey Dushin ◽  
Vladimir Strovsky ◽  
Sergey Zavyalov ◽  
...  
Keyword(s):  
The Netherlands ◽  
Waste Management ◽  
South Korea ◽  
Circular Economy ◽  
Raw Materials ◽  
Industrial Wastes ◽  
New Guidelines ◽  
The 1960S ◽  
Degree Level ◽  
The Eu

Nowadays, circular economy (CE) is on the agenda, however, this concept of closed supply chains originated in the 1960s. The current growing quantity of studies in this area accounts for different discourses except the holistic one, which mixes both approaches—contextual and operating (contextual approach utilizes the thorough examination of the CE theory, stricture of the policy, etc.; the operating one uses any kind of statistical data)—to assess the capacity of circular economy regulatory policy packages (CERPP) in operating raw materials and industrial wastes. This article demonstrates new guidelines for assessing the degree level of capacity (DLC) of CERPPs in the operation of raw materials and industrial wastes by utilizing the apparatus of the fuzzy set theory. It scrupulously surveys current CERPPs in three regions: the EU overall, Finland and Russia; and assesses for eight regions—the EU overall, Finland, Russia, China, Greece, France, the Netherlands and South Korea—the DLC of CERPPs in operating raw materials and industrial wastes. The results show that EU is the best in CE policy and its CERPP is 3R. The following are South Korea and China with the same type of CERPP. Finland, France and the Netherlands have worse results than EU with the type of CERPP called “integrated waste management” because of the absence of a waste hierarchy (reduce, recover, recycle). Russia closes the list with the type of CERPP “basic waste management”.

scholarly journals Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1288
Author(s):  
Marilia Carabotti ◽  
Francesca Falangone ◽  
Rosario Cuomo ◽  
Bruno Annibale
Keyword(s):  
Systematic Review ◽  
Diverticular Disease ◽  
Dietary Habits ◽  
Acute Diverticulitis ◽  
High Quality ◽  
Eligibility Criteria ◽  
Diverticular Bleeding ◽  
Recurrent Diverticulitis ◽  
Increased Risk

Recent evidence showed that dietary habits play a role as risk factors for the development of diverticular complications. This systematic review aims to assess the effect of dietary habits in the prevention of diverticula complications (i.e., acute diverticulitis and diverticula bleeding) in patients with diverticula disease. PubMed and Scopus databases were searched up to 19 January 2021, 330 records were identified, and 8 articles met the eligibility criteria and were subjected to data extraction. The quality of the studies was evaluated by the Newcastle-Ottawa quality assessment form. No study meets the criteria for being a high-quality study. A high intake of fiber was associated to a decreased risk of diverticulitis or hospitalization due to diverticular disease, with a protective effect for fruits and cereal fiber, but not for vegetable fiber; whereas, a high red meat consumption and a generally Western dietary pattern were associated with an increased risk of diverticulitis. Alcohol use seemed to be associated to diverticular bleeding, but not to recurrent diverticulitis or diverticular complications. Further high-quality studies are needed to better define these associations. It is mandatory to ascertain the role of dietary habits for the development of recurrent acute diverticulitis and diverticular bleeding.

scholarly journals Gut Microbiota and Acute Diverticulitis: Role of Probiotics in Management of This Delicate Pathophysiological Balance

2021 ◽  
Vol 11 (4) ◽  
pp. 298
Author(s):  
Andrea Piccioni ◽  
Laura Franza ◽  
Mattia Brigida ◽  
Christian Zanza ◽  
Enrico Torelli ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Bacterial Species ◽  
Mucosal Inflammation ◽  
Abdominal Symptoms ◽  
Pubmed Database ◽  
Anti Inflammatory ◽  
Key Terms

How can the knowledge of probiotics and their mechanisms of action be translated into clinical practice when treating patients with diverticular disease and acute diverticulitis? Changes in microbiota composition have been observed in patients who were developing acute diverticulitis, with a reduction of taxa with anti-inflammatory activity, such as Clostridium cluster IV, Lactobacilli and Bacteroides. Recent observations supported that a dysbiosis characterised by decreased presence of anti-inflammatory bacterial species might be linked to mucosal inflammation, and a vicious cycle results from a mucosal inflammation driving dysbiosis at the same time. An alteration in gut microbiota can lead to an altered activation of nerve fibres, and subsequent neuronal and muscular dysfunction, thus favoring abdominal symptoms’ development. The possible role of dysbiosis and mucosal inflammation in leading to dysmotility is linked, in turn, to bacterial translocation from the lumen of the diverticulum to perivisceral area. There, a possible activation of Toll-like receptors has been described, with a subsequent inflammatory reaction at the level of the perivisceral tissues. Being aware that bacterial colonisation of diverticula is involved in the pathogenesis of acute diverticulitis, the rationale for the potential role of probiotics in the treatment of this disease becomes clearer. For this review, articles were identified using the electronic PubMed database through a comprehensive search conducted by combining key terms such as “gut microbiota”, “probiotics and gut disease”, “probiotics and acute diverticulitis”, “probiotics and diverticular disease”, “probiotics mechanism of action”. However, the amount of data present on this matter is not sufficient to draw robust conclusions on the efficacy of probiotics for symptoms’ management in diverticular disease.

scholarly journals Left-Sided Sigmoid Diverticulitis Presenting as Right-Sided Thigh Abscess

2013 ◽  
Vol 97 (4) ◽  
pp. 285-287 ◽  
Author(s):  
Patrick Bates Murphy ◽  
Paul Belliveau
Keyword(s):  
Diverticular Disease ◽  
Gastrointestinal Symptoms ◽  
Sigmoid Diverticulitis ◽  
North American Population ◽  
American Population ◽  
The North ◽  
Colocutaneous Fistula ◽  
Atypical Presentations ◽  
Thigh Abscess ◽  
Uncommon Complication

Abstract Acquired diverticular disease of the colon is very common in the North American population. Atypical presentations are usually due to complications and rarely the predominant complaint may be related to an associated fistula. Thigh abscesses due to colocutaneous fistula represent an uncommon complication of sigmoid diverticulitis. In rare cases, a thigh abscess may be the only symptom, but gas in the thigh should raise the index of suspicion for bowel pathology. We report the second known case of a left-sided sigmoid diverticulitis leading to an isolated right thigh abscess with no gastrointestinal symptoms.

scholarly journals State-of-the-art surgery for sigmoid diverticulitis

2021 ◽  
Author(s):  
Roberto Cirocchi ◽  
Paolo Sapienza ◽  
Gabriele Anania ◽  
Gian Andrea Binda ◽  
Stefano Avenia ◽  
...  
Keyword(s):  
Diverticular Disease ◽  
Fluid Resuscitation ◽  
State Of The Art ◽  
Colonic Resection ◽  
Hartmann’S Procedure ◽  
Sigmoid Diverticulitis ◽  
Definitive Treatment ◽  
Complication Rates ◽  
Bridge To Surgery ◽  
Hartmann's Procedure

Summary Background In the last two decades, there has been a Copernican revolution in the decision-making for the treatment of Diverticular Disease. Purpose This article provides a report on the state-of-the-art of surgery for sigmoid diverticulitis. Conclusion Acute diverticulitis is the most common reason for colonic resection after cancer; in the last decade, the indication for surgical resection has become more and more infrequent also in emergency. Currently, emergency surgery is seldom indicated, mostly for severe abdominal infective complications. Nowadays, uncomplicated diverticulitis is the most frequent presentation of diverticular disease and it is usually approached with a conservative medical treatment. Non-Operative Management may be considered also for complicated diverticulitis with abdominal abscess. At present, there is consensus among experts that the hemodynamic response to the initial fluid resuscitation should guide the emergency surgical approach to patients with severe sepsis or septic shock. In hemodynamically stable patients, a laparoscopic approach is the first choice, and surgeons with advanced laparoscopic skills report advantages in terms of lower postoperative complication rates. At the moment, the so-called Hartmann’s procedure is only indicated in severe generalized peritonitis with metabolic derangement or in severely ill patients. Some authors suggested laparoscopic peritoneal lavage as a bridge to surgery or also as a definitive treatment without colonic resection in selected patients. In case of hemodynamic instability not responding to fluid resuscitation, an initial damage control surgery seems to be more attractive than a Hartmann’s procedure, and it is associated with a high rate of primary anastomosis.

Do Imports Increase Unemployment? Empirical Estimates That Are Not Model Dependent

2021 ◽  
Vol 16 (3) ◽  
pp. 447-469
Author(s):  
Jonathan E. Leightner ◽  
Keyword(s):  
Czech Republic ◽  
New Zealand ◽  
Theoretical Model ◽  
The Netherlands ◽  
South Korea ◽  
Trade Liberalization ◽  
Empirical Results ◽  
Empirical Estimates ◽  
The Us ◽  
The Uk

Some Ricardian models would predict a fall in unemployment with trade liberalization. In contrast, the Heckscher-Ohlin model (Stolper Samuelson Theorem) would predict trade liberalization would cause a fall in wages for labor scarce countries, resulting in greater unemployment if there are wage rigidities. The choice of which theoretical model is used affects the empirical results obtained. This paper produces estimates of the change in unemployment due to a change in imports that are not model dependent. The estimates produced are total derivatives that capture all the ways that imports and unemployment are correlated. I find that unemployment increases with increased imports for Austria, Greece, Japan, Portugal, South Korea, Slovenia, and Sweden, but that unemployment decreases with increased imports for Australia, Belgium, Canada, Czech Republic, Denmark, Estonia, Finland, France, Germany, Hungary, Ireland, Israel, Italy, Latvia, the Netherlands, New Zealand, Norway, Poland, Slovakia, Spain, the UK, and the US.

Racial Disparity in the Surgical Management of Diverticular Disease

2021 ◽  
pp. 000313482110586
Author(s):  
Warqaa M. Akram ◽  
Nasreen Vohra ◽  
William Irish ◽  
Emmanuel E. Zervos ◽  
Jan Wong
Keyword(s):  
Diverticular Disease ◽  
Racial Disparity ◽  
Acute Diverticulitis ◽  
Binary Logistic Regression ◽  
National Database ◽  
Inclusion Criteria ◽  
Surgical Quality ◽  
Improvement Project ◽  
Surgery Outcomes ◽  
Main Effects

Introduction Although minimally invasive surgery (MIS) has clearly been associated with improved colorectal surgery outcomes, not all populations benefit from this approach. Using a national database, we analyzed both, the trend in the utilization of MIS for diverticulitis and differences in utilization by race. Methods Colon-targeted participant user files (PUFs) from 2012 to 18 were linked to respective PUFs in National Surgical Quality Improvement Project. Patients undergoing colectomy for acute diverticulitis or chronic diverticular disease were included. Surgical approach was stratified by race and year. To adjust for confounding and estimate the association of covariates with approach, data were fit using multivariable binary logistic regression main effects model. Using a joint effects model, we evaluated whether the odds of a particular approach over time was differentially affected by race. Results Of the 46 713 patients meeting inclusion criteria, 83% were white, with 7% black and 10% other. Over the study period, there was a decrease in the rate of open colectomy of about 5% P < .001, and increase in the rate of utilization of laparoscopic and robotic approaches (RC) P < .0001. After adjusting for confounders, black race was associated with open surgery P < .0001. Conclusion There is disparity in the utilization of MIS for diverticulitis. Further research into the reasons for this disparity is critical to ensure known benefits of MIC are realized across all races.

Colonic diverticular disease

2020 ◽  
pp. 2960-2966
Author(s):  
Nicolas C. Buchs ◽  
Roel Hompes ◽  
Shazad Q. Ashraf ◽  
Neil J.McC. Mortensen
Keyword(s):  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Underlying Disease ◽  
Fistula Formation ◽  
Bowel Habit ◽  
Elective Resection ◽  
Sigmoid Carcinoma ◽  
Fibre Diet ◽  
Colonic Diverticula ◽  
Colonic Diverticular Disease

Colonic diverticula are herniations of mucosa through the bowel musculature. They are seen most often in the sigmoid and descending colon, with a prevalence of up to 65% in people over the age of 80 in European populations. They are uncommon in African and Asian countries, where the prevalence is only 0.2%. A lifelong diet deficient in dietary fibre is associated with their development, but it is not known why some diverticula become symptomatic. Diverticula are usually discovered incidentally, but symptoms which are attributable to diverticular disease include colicky abdominal pain and bloating, often accompanied by a change in bowel habit with the passage of broken, pellety stools after considerable straining. All patients with such presentation should be investigated to exclude rectal or sigmoid carcinoma. Treatment is with reassurance that there is no serious underlying disease, a high-fibre diet, and—for patients with pain—antispasmodics such as mebeverine. Elective resection may be indicated in the few patients who have repeated severe attacks. Complications of diverticular disease include diverticulitis, pericolic abscess formation, peritonitis, intestinal obstruction, haemorrhage, and fistula formation. Acute diverticulitis typically presents with pain and tenderness over the left lower abdomen, and the patient may have pyrexia, malaise, anorexia, and nausea. Treatment is with rest, broad-spectrum antibiotics, and analgesia. Resection of the sigmoid colon may be necessary if symptoms fail to resolve or recur, or for patients with complications (peritonitis, fistula, obstruction). Overall, percutaneous drainage, antibiotic treatment, and expectant policies have reduced the need for both acute and elective surgical treatment.

scholarly journals Role of Inflammation in the Pathogenesis of Diverticular Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Antonio Tursi ◽  
Walter Elisei
Keyword(s):  
Diverticular Disease ◽  
Acute Diverticulitis ◽  
Human Colon ◽  
Recurrent Abdominal Pain ◽  
Preliminary Evidence ◽  
Low Grade ◽  
Symptom Persistence ◽  
Uncomplicated Diverticular Disease ◽  
Low Grade Inflammation

Diverticulosis of the colon is the most common condition in Western societies and it is the most common anatomic alteration of the human colon. Recurrent abdominal pain is experienced by about 20% of patients with diverticulosis, but the pathophysiologic mechanisms of its occurrence are not completely understood. In the last years, several fine papers have showed clearly the role of low-grade inflammation both in the occurrence of symptoms in people having diverticulosis, both in symptom persistence following acute diverticulitis, even if the evidence available is not so strong. We do not know yet what the trigger of this low-grade inflammation occurrence is. However, some preliminary evidence found colonic dysbiosis linked to low-grade inflammation and therefore to symptom occurrence in those patients. The aim of this paper is to summarize current evidences about the role of inflammation in symptom occurrence in symptomatic uncomplicated diverticular disease and in symptom persistence after an episode of acute diverticulitis.

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