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1.
Chirurgia (Bucur) ; 115(1): 112-119, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155406

RESUMO

Postoperative ileus (POI) is a complex phenomenon with important morbidity and mortality, well known in many surgical fields. POI occurs commonly after abdominal and pelvic surgery, especially in cancer patients. We report the case of a 63-year-old patient without known risk factors for POI, who underwent total hysterectomy with bilateral adnexectomy for ovarian tumor with suspicion of malignancy, invalidated by the extemporaneous pathology examination. The postoperative evolution is marked by reduced bowel movements, lack of intestinal transit for flatus and stool for 6 days. In cooperation with the general surgeon conservative treatment for POI was administered, without effect. The abdomen remained distended, with no nausea or vomiting. On the 6th postoperative day a wound dehiscence with incomplete evisceration occurred, after a CT scan of the abdomen and pelvic region was requested to make a differential diagnosis between an intestinal mass and other pathology involving the bowell. In conjunction with the General Surgery team the surgical reintervention was decided and performed. After the procedure, the patient successfully regained transit, with flatus and stool emission, but another 2 complications occurred, which were successfully treated: sepsis and deep vein thrombosis. Understanding the pathophysiology could help to prevent, diagnose, and implement protocols in order to avoid POI and its complications, to reduce hospital stay and cost burden.


Assuntos
Hérnia Ventral/cirurgia , Histerectomia/efeitos adversos , Íleus/etiologia , Hérnia Incisional/cirurgia , Neoplasias Ovarianas/cirurgia , Feminino , Hérnia Ventral/diagnóstico por imagem , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/diagnóstico por imagem , Hérnia Incisional/etiologia , Enteropatias/diagnóstico por imagem , Enteropatias/etiologia , Enteropatias/cirurgia , Pessoa de Meia-Idade , Reoperação , Deiscência da Ferida Operatória/diagnóstico por imagem , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia
2.
Medicine (Baltimore) ; 98(44): e17783, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689848

RESUMO

RATIONALE: Postoperative intussusception in adults is a rare but serious complication after gastrointestinal anastomosis surgery. Postoperative intussusception in adults caused by tube feeding was rarely been reported before. The aim of the current study was to summarize the clinical data on a group of patients with tube feeding associated postoperative intussusceptions. The possible etiology and preventive measures will also be discussed. PATIENT CONCERNS: During the period from May 2013 to January 2018, patients who received gastrointestinal anastomosis in our center were retrospectively reviewed. Preoperative variables including standard demographic and pathological characteristics as well as the treatment and prognosis were also analyzed. DIAGNOSES: Tube feeding associated postoperative intussusceptions. INTERVENTIONS: 7 patients were identified with tube feeding associated postoperative intussusceptions with a prevalence of 0.38%. Intussusceptions occurred from 10 to 69 days (median 25.7 days) postoperatively in an acute form. OUTCOMES: None of the patients had spontaneous reduction and all patients underwent surgery. Antegrade efferent limb intussusceptions were found in all the cases. Intussusception occurred at efferent loop at 23.6 cm (range 15-60) from the gastrointestinal or Braun anastomosis. None of the patients was found recurrence throughout the follow-up period. LESSONS: In contrast with other postoperative intussusceptions, the tube feeding associated postoperative intussusceptions have special clinical manifestations. It is more likely to occur in early period of time after the surgery and in an acute form. Surgical correction is recommended for most of patients. Several measures have been proposed to prevent such complications after gastrointestinal surgery, however more research and information are still needed.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Nutrição Enteral/efeitos adversos , Enteropatias/epidemiologia , Intussuscepção/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Enteropatias/etiologia , Intussuscepção/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Prevalência , Estudos Retrospectivos
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(11): 1021-1026, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31770832

RESUMO

Radiation-induced bowel injury is a common complication of radiation therapy for pelvic malignancy. Given the huge number of patients diagnosed with pelvic malignancy, the number of patients diagnosed with radiation-induced bowel injury increased year by year, which put a great burden on the clinical diagnosis and treatment of radiation-induced bowel injury. In particular, chronic radiation-induced bowel injury, which is manifested in the process of prolonged, repeated and progressive aggravation, seriously affects the physical and mental health of patients and makes clinical diagnosis and treatment difficult. However, due to insufficient attention and understanding from doctors and patients, standardized diagnosis and treatment of radiation-induced bowel injury still have a long way to go. Radiation-induced bowel injury is self-limited but irreversible. During diagnosis, we should pay attention to overall evaluation of the stage of disease based on clinical symptoms, endoscopic examination, imaging examination, pathology and nutritional risk. The treatment methods include health education, drug therapy, enema therapy, formalin local treatment, endoscopic treatment and surgical treatment, etc. The treatment decision-making should be based on clinical symptoms, endoscopic or imaging findings to alleviate the clinical symptoms of patients as the primary goal and to improve the long-term quality of life of patients as the ultimate goal.


Assuntos
Enteropatias/terapia , Neoplasias Pélvicas/radioterapia , Lesões por Radiação/terapia , Radioterapia/efeitos adversos , Doença Crônica , Humanos , Enteropatias/diagnóstico , Enteropatias/etiologia , Intestinos/efeitos da radiação , Qualidade de Vida , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(11): 1034-1040, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31770834

RESUMO

Objective: To investigate the safety and efficacy of surgical treatment for chronic radiation intestinal injury. Methods: A descriptive cohort study was performed. Clinical data of 73 patients with definite radiation history and diagnosed clinically as chronic radiation intestinal injury, undergoing operation at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to February 28, 2019, were reviewed and analyzed retrospectively. Patients did not undergo operation or only received adhesiolysis were excluded. All the patients had preoperative examination and overall evaluation of the disease. According to severity of intestinal obstruction and patients' diet, corresponding nutritional support and conservative treatment were given. Surgical methods: The one-stage bowel resection and anastomosis was the first choice for surgical treatment of chronic radiation intestinal injury. Patients with poor nutritional condition were given enterostomy and postoperative enteral nutrition and second-stage stoma closure and intestinal anastomosis if nutritional condition improved. For those who were unable to perform stoma closure, a permanent stoma should be performed. Patients with severe abdominal adhesion which was difficult to separate, enterostomy or bypass surgery after adhesiolysis would be the surgical choice. For patients with tumor metastasis or recurrence, enterostomy or bypass surgery should be selected. Observation parameters: the overall and major (Clavien-Dindo grades III to V) postoperative complication within 30 days after surgery or during hospitalization; mortality within postoperative 30 days; postoperative hospital stay; time to postoperative recovery of enteral nutrition; time to removal of drainage tube. Results: Of the 73 patients who had been enrolled in this study, 10 were male and 63 were female with median age of 54 (range, 34-80) years. Preoperative evaluation showed that 61 patients had intestinal stenosis, 63 had intestinal obstruction, 11 had intestinal perforation, 20 had intestinal fistula, 3 had intestinal bleeding, and 6 had abdominal abscess, of whom 64(87.7%) patients had multiple complications. Tumor recurrence or metastasis was found in 15 patients. A total of 65(89.0%) patients received preoperative nutritional support, of whom 35 received total parenteral nutrition and 30 received partial parenteral nutrition. The median preoperative nutritional support duration was 8.5 (range, 6.0-16.2) days. The rate of one-stage intestine resection was 69.9% (51/73), and one-stage enterostomy was 23.3% (17/73). In the 51 patients undergoing bowel resection, the average length of resected bowel was (50.3±49.1) cm. Among the 45 patients with intestinal anastomosis, 4 underwent manual anastomosis and 41 underwent stapled anastomosis; 36 underwent side-to-side anastomosis, 5 underwent end-to-side anastomosis, and 4 underwent end-to-end anastomosis. Eighty postoperative complications occurred in 39 patients and the overall postoperative complication rate was 53.4% (39/73), including 39 moderate to severe complications (Clavien-Dindo grade III-V) in 20 patients (27.4%, 20/73) and postoperative anastomotic leakage in 2 patients (2.7%, 2/73). The mortality within postoperative 30 days was 2.7% (2/73); both patients died of abdominal infection, septic shock, and multiple organ failure caused by anastomotic leakage. The median postoperative hospital stay was 13 (11, 23) days, the postoperative enteral nutrition time was (7.2±6.9) days and the postoperative drainage tube removal time was (6.3±4.2) days. Conclusions: Surgical treatment, especially one-stage anastomosis, is safe and feasible for chronic radiation intestine injury. Defining the extent of bowel resection, rational selection of the anatomic position of the anastomosis and perioperative nutritional support treatment are the key to reduce postoperative complications.


Assuntos
Enteropatias/cirurgia , Lesões por Radiação/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Doença Crônica , Enterostomia , Feminino , Humanos , Enteropatias/etiologia , Intestinos/efeitos da radiação , Intestinos/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Lesões por Radiação/complicações , Estudos Retrospectivos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(36): e16981, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490379

RESUMO

RATIONALE: Henoch-Schönlein purpura (HSP) is a common disease in children. However, HSP with intussusception and intestinal obstruction has a low morbidity in children and is occasionally seen in adults. Herein, a rare adult case of HSP complicated with intussusception and hemafecia that was successfully treated with surgery is described. PATIENT CONCERNS: A 19-year-old Chinese man suffered from HSP combined with intussusception and intestinal obstruction and presented with vomiting, diarrhea, abdominal pain, and rash. DIAGNOSIS: Henoch-Schönlein purpura with intussusception and intestinal obstruction. INTERVENTIONS: The patient underwent an emergency laparotomy and manual reset. OUTCOME: The patient was discharged 7 days after surgery in stable condition. We followed the patient to the sixth month after surgery. This patient has no long-term complications after surgery. LESSONS: HSP with intussusception and intestinal obstruction is rarely seen in adults. Patients with HSP often present with abdominal pain as the first symptom, which is easily confused with other diseases. Once the HSP is diagnosed, surgery should be performed as soon as possible, provided there is no absolute contraindication.


Assuntos
Hemorragia Gastrointestinal/etiologia , Enteropatias/etiologia , Intussuscepção/etiologia , Púrpura de Schoenlein-Henoch/complicações , Humanos , Enteropatias/cirurgia , Intussuscepção/cirurgia , Masculino , Adulto Jovem
6.
Int J Clin Oncol ; 24(11): 1385-1396, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31297704

RESUMO

BACKGROUND: The Japan Society for Oriental Medicine makes a compilation of structured abstracts of randomized controlled trials (RCTs) of Kampo medicines available on its Evidence Reports of Kampo Treatment (EKAT) website. METHODS: Using EKAT, we conducted a systematic review and meta-analysis on the efficacy of using daikenchuto ( https://mpdb.nibiohn.go.jp/stork ) for bowel dysfunction after surgery for gastrointestinal cancer. The primary outcomes were the time to first postoperative flatus and the time to first postoperative bowel movement (BM). RESULTS: We found nine relevant RCTs. The mean differences between the daikenchuto group and control group (daikenchuto was not administered) were - 0.43 (95% CI: - 0.77 to - 0.09) days for the time to first postoperative flatus, - 0.29 (95% CI: - 0.59 to 0.01) days for the time to first postoperative BM, and - 0.95 (95% CI: - 1.70 to - 0.21) days for the length of postoperative hospital stay, and the risk ratio of the incidence of intestinal obstruction was 0.60 (95% CI: 0.35-1.03). The time to first postoperative flatus and the length of postoperative hospital stay were significantly shorter in the daikenchuto group than those in the control group (P = 0.01). However, only double-blind studies were evaluated; the results turned to be non-significant. CONCLUSION: As a result of meta-analysis by all retrieved according to the registered protocol, daikenchuto was efficacious in improving postoperative bowel dysfunction in patients with gastrointestinal cancers. However, limiting to articles with description of COI and blindness, significance disappeared.


Assuntos
Neoplasias Gastrointestinais/cirurgia , Enteropatias/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Motilidade Gastrointestinal/efeitos dos fármacos , Humanos , Enteropatias/etiologia , Tempo de Internação , Medicina Kampo , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
J Surg Res ; 243: 363-370, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31277013

RESUMO

BACKGROUND: Intestinal ischemia/reperfusion (I/R) is a grave condition related to high morbidity and mortality. Autophagy, which can induce a new cell death named type II programmed cell death, has been reported in some intestinal diseases, but little is known in I/R-induced intestinal injury. In this study, we aimed to explore the role of autophagy in intestinal injury induced by I/R and its potential mechanisms. MATERIALS AND METHODS: The rats pretreated with rapamycin or 3-methyladenine had intestinal I/R injury. After reperfusion, intestinal injury was measured by Chiu's score, intestinal mucosal wet-to-dry ratio, and lactic acid level. Intestinal mucosal oxidative stress level was measured by malondialdehyde and superoxide dismutase. Autophagosome, LC3, and p62 were detected to evaluate autophagy level. Mammalian target of rapamycin (mTOR) was detected to explore potential mechanism. RESULTS: Chiu's score, intestinal mucosal wet-to-dry ratio, lactic acid level, malondialdehyde level, autophagosomes, and LC3-II/LC3-I were significantly increased, and superoxide dismutase level and expression of p62 were significantly decreased in intestinal mucosa after intestinal ischemia/reperfusion. Pretreatment with rapamycin significantly aggravated intestinal injury evidenced by increased Chiu's score, intestinal mucosal wet-to-dry ratio and lactic acid level, increased autophagy level evidenced by increased autophagosomes and LC3-II/LC3-I and decreased expression of p62, and downregulated expression of p-mTOR/mTOR. On the contrary, pretreatment with 3-methyladenine significantly attenuated intestinal injury and autophagy level and upregulated expression of p-mTOR/mTOR. CONCLUSIONS: In summary, autophagy was significantly enhanced in intestinal mucosa after intestinal ischemia/reperfusion, and inhibition of autophagy attenuated intestinal injury induced by I/R through activating mTOR signaling.


Assuntos
Adenina/análogos & derivados , Autofagia/efeitos dos fármacos , Enteropatias/prevenção & controle , Traumatismo por Reperfusão/prevenção & controle , Adenina/farmacologia , Adenina/uso terapêutico , Animais , Avaliação Pré-Clínica de Medicamentos , Enteropatias/enzimologia , Enteropatias/etiologia , Enteropatias/patologia , Mucosa Intestinal/enzimologia , Mucosa Intestinal/ultraestrutura , Masculino , Malondialdeído/metabolismo , Distribuição Aleatória , Ratos Sprague-Dawley , Traumatismo por Reperfusão/enzimologia , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia , Sirolimo , Superóxido Dismutase/metabolismo , Serina-Treonina Quinases TOR/antagonistas & inibidores , Serina-Treonina Quinases TOR/metabolismo
8.
World J Gastroenterol ; 25(25): 3116-3122, 2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31333305

RESUMO

The intestinal epithelium possesses a remarkable ability for both proliferation and regeneration. The last two decades have generated major advances in our understanding of the stem cell populations responsible for its maintenance during homeostasis and more recently the events that occur during injury induced regeneration. These fundamental discoveries have capitalised on the use of transgenic mouse models and in vivo lineage tracing to make their conclusions. It is evident that maintenance is driven by rapidly proliferating crypt base stem cells, but complexities associated with the technicality of mouse modelling have led to several overlapping populations being held responsible for the same behaviour. Similarly, it has been shown that essentially any population in the intestinal crypt can revert to a stem cell state given the correct stimulus during epithelial regeneration. Whilst these observations are profound it is uncertain how relevant they are to human intestinal homeostasis and pathology. Here, these recent studies are presented, in context with technical considerations of the models used, to argue that their conclusions may indeed not be applicable in understanding "homeostatic regeneration" and experimental suggestions presented for validating their results in human tissue.


Assuntos
Enteropatias/patologia , Mucosa Intestinal/patologia , Regeneração , Células-Tronco/fisiologia , Animais , Diferenciação Celular , Linhagem da Célula , Proliferação de Células , Modelos Animais de Doenças , Humanos , Enteropatias/etiologia , Mucosa Intestinal/citologia , Mucosa Intestinal/lesões , Camundongos , Modelos Animais
9.
J Surg Res ; 244: 69-76, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31279996

RESUMO

BACKGROUND: Acute hemorrhage-induced excessive excitation of sympathetic-adrenal-medullary system (SAS) leads to gut hypoperfusion and barrier dysfunction, which is a critical event during hemorrhagic shock-induced multiple organ injury. Stellate ganglion blockade (SGB) has been widely used for suppression of sympathetic-adrenal-medullary system in the clinical practice. However, whether SGB improves intestinal barrier function after hemorrhagic shock remains unclear. Here, we hypothesized that the implementation of SGB restores intestinal barrier function and reduces gut injury. MATERIALS AND METHODS: Male rats received the SGB pretreatment and underwent hemorrhagic shock followed by resuscitation. The 96-h survival rate, intestinal permeability and morphology, D-lactic acid concentration and diamine oxidase activity in plasma, and expressions of F-actin, Claudin-1, and E-cadherin in intestinal tissues were observed. RESULTS: Pretreatment with SGB significantly enhances the 96-h survival rate in rats subjected to hemorrhagic shock (from 8.3% to 66.7%). Hemorrhagic shock reduced the coverage scale of intestinal mucus and intestinal villus width and height, enhanced the intestinal permeability to fluorescein isothiocyanate-dextran 4 and D-lactic acid concentration in plasma, and decreased the expressions of F-actin, Claudin-1, and E-Cadherin in intestinal tissue. These hemorrhagic shock-induced adverse effects were abolished by SGB treatment. CONCLUSIONS: SGB treatment has a beneficial effect during hemorrhagic shock, which is associated with the improvement of intestine barrier function. SGB may be considered as a new therapeutic strategy for treatment of hemorrhagic shock.


Assuntos
Enteropatias/prevenção & controle , Mucosa Intestinal/patologia , Bloqueio Nervoso/métodos , Choque Hemorrágico/terapia , Gânglio Estrelado/efeitos dos fármacos , Anestésicos Locais/administração & dosagem , Animais , Modelos Animais de Doenças , Enteropatias/etiologia , Enteropatias/patologia , Mucosa Intestinal/inervação , Masculino , Permeabilidade/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Ressuscitação , Ropivacaina/administração & dosagem , Choque Hemorrágico/complicações , Choque Hemorrágico/mortalidade , Organismos Livres de Patógenos Específicos , Taxa de Sobrevida , Resultado do Tratamento
10.
Gynecol Oncol ; 154(3): 577-582, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31235241

RESUMO

OBJECTIVE: To evaluate the prevalence of low anterior resection syndrome (LARS) in patients with debulking surgery for primary advanced epithelial ovarian cancer and to identify potential risk factors for development of LARS. METHODS: We reviewed data on 552 consecutive patients with primary epithelial ovarian cancer (EOC), who underwent upfront or interval cytoreductive surgery including low anterior resection at two different academic institutions (Kliniken-Essen-Mitte, Germany, and Medical University of Vienna, Austria). Intestinal dysfunction was assessed by the validated LARS-questionnaire via telephone call. We performed descriptive statistics and a binary logistic regression model to evaluate risk factors for LARS. RESULTS: In total, 341 patients were eligible and 206 (60.4%) were successfully contacted and provided complete information. Major LARS was observed in 78 (37.9%) patients, minor LARS in 44 (21.4%) patients, and no LARS in 84 (40.8%) patients. The prevalence rate of major LARS was not influenced by time interval between surgery and LARS assessment, type of cytoreductive surgery, and recurrent disease at the time of assessment. In multivariate analyses, number of anastomosis was independently associated with an increased risk for presence of major LARS (OR 3.76 [1.95-7.24]). In the present cohort, 25.2% patients had more than one bowel anastomosis. CONCLUSIONS: LARS in general and major LARS in particular seem to be a frequent long-term complication after debulking surgery including low anterior resection in primary advanced EOC patients. Particularly EOC patients with more than one bowel anastomosis during surgery seem to be at an increased risk for major LARS.


Assuntos
Carcinoma Epitelial do Ovário/cirurgia , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Enteropatias/etiologia , Neoplasias Ovarianas/cirurgia , Carcinoma Epitelial do Ovário/patologia , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Complicações Pós-Operatórias/etiologia , Prevalência , Estudos Retrospectivos , Síndrome
11.
Nutr. hosp ; 36(3): 743-747, mayo-jun. 2019. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-184577

RESUMO

Case report: we present the case of a 44-year-old male who presented with uncontrollable diarrhea, severe protein-calorie malnutrition and multiple vitamin deficiencies, along with peripheral neuropathy ten years after classic biliopancreatic diversion (BPD). He underwent nutritional support and had the surgery converted to a Roux-en-Y gastric bypass, with an uneventful outcome. The histopathology of the resected bowel revealed lipofuscinosis of the muscular layer compatible with brown bowel syndrome. Discussion: brown bowel syndrome is a rare complication of malnutrition that can be observed after BPD. It is associated with vitamin E deficiency. After recovery with nutritional support, a reoperation that elongates the common channel, and thus minimizes the degree of malabsorption, should be indicated in these cases


Caso clínico: presentamos el caso de un paciente varón de 44 años que presentó diarrea incontrolable, desnutrición proteica-calórica severa y deficiencias de múltiples vitaminas, junto con neuropatía periférica diez años después de derivación biliopancreatica clásica (DBP). Se sometió a soporte nutricional y la cirugía se convirtió en un bypass gástrico en Y de Roux, con un resultado sin complicaciones. La histopatología del intestino resecado reveló una lipofuscinosis de la capa muscular compatible con el síndrome del intestino marrón. Discusión: el síndrome de intestino marrón es una complicación rara de la desnutrición que se puede observar después de la DBP. Se asocia a deficiencia de vitamina E. Después de la recuperación con soporte nutricional, se debe indicar una reoperación que alargue el canal común y, por lo tanto, minimice el grado de malabsorción en estos casos


Assuntos
Humanos , Masculino , Adulto , Cirurgia Bariátrica/efeitos adversos , Desnutrição Proteico-Calórica/complicações , Desnutrição/complicações , Síndromes de Malabsorção/complicações , Apoio Nutricional , Deficiência de Vitamina E/complicações , Enteropatias/etiologia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Transtornos da Pigmentação/complicações , Enteropatias/patologia , Enteropatias/complicações
12.
Gynecol Oncol ; 154(1): 183-188, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31104905

RESUMO

OBJECTIVE: Women with endometrial or cervical cancer at risk for recurrence receive postoperative radiation therapy (RT). A patient reported outcomes (PRO) instrument to assess bowel and urinary toxicities is the Expanded Prostate Cancer Index Composite (EPIC), which has been validated in men with prostate cancer. As this instrument specifically measures bowel toxicity and the degree to which this is a problem, it was used in NRG Oncology/RTOG 1203 to compare intensity modulated RT (IMRT) to standard RT. This paper reports on the expanded validation of EPIC for use in women receiving pelvic RT. METHODS: In addition to the EPIC bowel domain, urinary toxicity (EPIC urinary domain), patient reported bowel toxicities (PRO-CTCAE) and quality of life (Functional Assessment of Cancer Therapy (FACT)) were completed before, during and after treatment. Sensitivity, reliability and concurrent validity were assessed. RESULTS: Mean bowel and urinary scores among 278 women enrolled were significantly worse during treatment and differed between groups. Acceptable to good reliability for bowel and urinary domain scores were obtained at all time points with the exception of one at baseline. Correlations between function and bother scores within the bowel and urinary domains were consistently stronger than those across domains. Correlations between bowel domain scores and PRO-CTCAE during treatment were stronger than those with the FACT. CONCLUSION: Correlations within and among the instruments indicate EPIC bowel and urinary domains are measuring conceptually discrete components of health. These EPIC domains are valid, reliable and sensitive instruments to measure PRO among women undergoing pelvic radiation.


Assuntos
Neoplasias do Endométrio/radioterapia , Enteropatias/etiologia , Doenças Urológicas/etiologia , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Enteropatias/diagnóstico , Intestinos/efeitos da radiação , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Cuidados Pós-Operatórios , Qualidade de Vida , Lesões por Radiação/diagnóstico , Radioterapia de Intensidade Modulada , Reprodutibilidade dos Testes , Uretra/efeitos da radiação , Doenças Urológicas/diagnóstico , Neoplasias do Colo do Útero/cirurgia
13.
J Dermatol ; 46(6): 540-543, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31106904

RESUMO

Toxic epidermal necrolysis (TEN) is a rare condition, causing life-threatening adverse cutaneous reactions. TEN occurrence after bone marrow transplantation (BMT) is a well-known phenomenon; however, to date, only a few cases have been reported in the published work. Here, we describe the case of a 53-year-old woman who experienced TEN after undergoing allogenic BMT for malignant lymphoma. Skin erosion spread across a maximum of 70% of the body surface area and severe mucosal lesions developed. Steroid pulse therapy, plasma apheresis and immunoglobulin therapy were administrated, which resulted in the complete resolution of TEN. However, she developed hemophagocytic lymphohistiocytosis and died 38 days after BMT, owing to rupture of the lower digestive tract complicated by multi-organ failure. In our case, engraftment failure occurred, and the peripheral white blood cell count was less than 100/µL during the TEN course, suggesting that the presence of only a few immune cells could cause TEN. Our findings showed that high mortality rates and widespread skin erosion could be regarded as the most important characteristics of TEN occurring after BMT.


Assuntos
Transplante de Medula Óssea/efeitos adversos , Rejeição de Enxerto/imunologia , Síndrome de Stevens-Johnson/imunologia , Evolução Fatal , Feminino , Rejeição de Enxerto/complicações , Rejeição de Enxerto/prevenção & controle , Humanos , Enteropatias/etiologia , Linfo-Histiocitose Hemofagocítica/etiologia , Linfoma/terapia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Ruptura Espontânea/etiologia , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/terapia
14.
Parasit Vectors ; 12(1): 216, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064387

RESUMO

BACKGROUND: Humans are susceptible to over 1400 pathogens. Co-infection by multiple pathogens is common, and can result in a range of neutral, facilitative, or antagonistic interactions within the host. Soil-transmitted helminths (STH) are powerful immunomodulators, but evidence of the effect of STH infection on the direction and magnitude of concurrent enteric microparasite infections is mixed. METHODS: We collected fecal samples from 891 randomly selected children and adults in rural Laos. Samples were analyzed for 5 STH species, 6 viruses, 9 bacteria, and 5 protozoa using a quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay. We utilized logistic regression, controlling for demographics and household water, sanitation, and hygiene access, to examine the effect of STH infection on concurrent viral, bacterial, and protozoal infection. RESULTS: We found that STH infection was associated with lower odds of concurrent viral infection [odds ratio (OR): 0.48, 95% confidence interval (CI): 0.28-0.83], but higher odds of concurrent bacterial infections (OR: 1.81, 95% CI: 1.06-3.07) and concurrent protozoal infections (OR: 1.50, 95% CI: 0.95-2.37). Trends were consistent across STH species. CONCLUSIONS: The impact of STH on odds of concurrent microparasite co-infection may differ by microparasite taxa, whereby STH infection was negatively associated with viral infections but positively associated with bacterial and protozoal infections. Results suggest that efforts to reduce STH through preventive chemotherapy could have a spillover effect on microparasite infections, though the extent of this impact requires additional study. The associations between STH and concurrent microparasite infection may reflect a reverse effect due to the cross-sectional study design. Additional research is needed to elucidate the exact mechanism of the immunomodulatory effects of STH on concurrent enteric microparasite infection.


Assuntos
Coinfecção/epidemiologia , Helmintíase/complicações , Helmintíase/transmissão , Enteropatias/etiologia , Solo/parasitologia , Adulto , Infecções Bacterianas/complicações , Criança , Pré-Escolar , Estudos Transversais , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Feminino , Helmintíase/epidemiologia , Humanos , Enteropatias/microbiologia , Enteropatias/parasitologia , Enteropatias/virologia , Enteropatias Parasitárias/complicações , Laos/epidemiologia , Masculino , Prevalência , Viroses/complicações
15.
Radiat Oncol ; 14(1): 57, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30943992

RESUMO

BACKGROUND: Advanced pelvic radiotherapy techniques aim to reduce late bowel toxicity which can severely impact the lives of pelvic cancer survivors. Although advanced techniques have been largely adopted worldwide, to achieve their aim, knowledge of which dose-volume parameters of which components of bowel predict late bowel toxicity is crucial to make best use of these techniques. The rectum is an extensively studied organ at risk (OAR), and dose-volume predictors of late toxicity for the rectum are established. However, for other components of bowel, there is a significant paucity of knowledge. The Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) reviews recommend dose-volume constraints for acute bowel toxicity for peritoneal cavity and bowel loops, although no constraints are recommended for late toxicity, despite its relevance to our increasing number of survivors. This systematic review aims to examine the published literature to seek dose-volume predictors and constraints of late bowel toxicity for OARs (apart from the rectum) for use in clinical practice. METHODS: A systematic literature search was performed using Medline, Embase, Cochrane Library, Web of Science, Cinahl and Pubmed. Studies were screened and included according to specific pre-defined criteria. Included studies were assessed for quality against QUANTEC-defined assessment criteria. RESULTS: 101 studies were screened to find 30 relevant studies. Eight studies related to whole bowel, 11 to small bowel, and 21 to large bowel (including 16 of the anal canal). The anal canal is an important OAR for the development of late toxicity, and we recommend an anal canal Dmean <40Gy as a constraint to reduce late incontinence. For other components of bowel (sigmoid, large bowel, intestinal cavity, bowel loops), although individual studies found statistically significant parameters and constraints these findings were not corroborated in other studies. CONCLUSIONS: The anal canal is an important OAR for the development of late bowel toxicity symptoms. Further validation of the constraints found for other components of bowel is needed. Studies that were more conclusive included those with patient-reported data, where individual symptom scores were assessed rather than an overall score, and those that followed statistical and endpoint criteria as defined by QUANTEC.


Assuntos
Enteropatias/etiologia , Intestino Delgado/efeitos da radiação , Órgãos em Risco/efeitos da radiação , Neoplasias Pélvicas/radioterapia , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Humanos , Prognóstico , Dosagem Radioterapêutica
17.
J Obstet Gynaecol ; 39(5): 587-593, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30822180

RESUMO

A small bowel prolapse through the vaginal introitus after a transvaginal instrumental gravid uterus perforation is a surgical emergency. To define the mechanisms of an irreversible, small bowel ischaemia due to small bowel prolapse through a vaginal introitus, ClinicalTrials.gov, PubMed, PubMed Central, and Google Scholar were searched. Out of the 81 articles screened, 28 cases of a small bowel evisceration through vaginal introitus were included. A small bowel obstruction severity grading was defined with risk factors; potential mechanisms of different severity grades after a transvaginal instrumental gravid uterine perforation with a vaginal evisceration. The duration of symptoms or a delay in the diagnosis did not change the incidence of the two most severe grades-mesenteric stripping and a small bowel degloving. Both obstruction types develop immediately during an instrumental abortion. The severity of obstruction does not influence the maternal outcome.


Assuntos
Enteropatias/etiologia , Intestino Delgado , Instrumentos Cirúrgicos/efeitos adversos , Perfuração Uterina/complicações , Vagina , Feminino , Humanos , Enteropatias/patologia , Enteropatias/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Mesentério/patologia , Gravidez , Prolapso , Fatores de Risco , Perfuração Uterina/cirurgia
18.
Medicine (Baltimore) ; 98(9): e14624, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817580

RESUMO

RATIONALE: Behçet's disease (BD) is a chronic immune-mediated inflammatory disorder involving multiple organ systems. In BD, intestinal ulcers can present as a refractory lesion capable of perforation, which makes the choice of treatment difficult. PATIENT CONCERNS: A 34-year-old male who was diagnosed with intestinal BD and suffered with an ileocecal perforation. He underwent surgery for an ileostomy and was given corticosteroids as treatment. However, the ulcerative lesion remained resistant to the therapy that was provided which delayed the closure operation. DIAGNOSIS: Intestinal BD with severe post-operative complication. INTERVENTIONS: A course of adalimumab (ADa) therapy was started. Subsequently surgery was performed. And ADa and thalidomide were used as a maintenance therapy. OUTCOMES: In this case, a course of ADa therapy was given which healed the intestinal ulcers and allowed us to successfully perform the closure operation. LESSONS: This case indicates that ADa may be an effective treatment option in future cases, minimizing complications and allowing the closure operation to be performed successfully.


Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Síndrome de Behçet/terapia , Ileostomia/efeitos adversos , Perfuração Intestinal/terapia , Complicações Pós-Operatórias/terapia , Adulto , Ceco/lesões , Humanos , Ileostomia/métodos , Íleo/lesões , Enteropatias/etiologia , Enteropatias/terapia , Perfuração Intestinal/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Reoperação , Resultado do Tratamento , Úlcera/etiologia , Úlcera/terapia
19.
Med Sci Monit ; 25: 2104-2111, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30897070

RESUMO

BACKGROUND Intestinal complications are a major cause of morbidity after colorectal cancer surgery. This study aimed to develop an effective nomogram for predicting risk of intestinal complications following colorectal cancer surgery. MATERIAL AND METHODS We retrospectively analyzed 1876 patients who underwent colorectal cancer surgery at Yangpu and Zhuji hospitals from January 2013 to October 2018. Intestinal complications were defined as intestinal obstruction, leakage or bleeding, or peritonitis within 30 days after surgery. A logistic regression model was used to identify the risk factors associated with postoperative intestinal complications, and a nomogram for intestinal complications was established. The predictive accuracy of the nomogram was assessed using area under the receiver operating characteristic curve (AUC) and calibration plot. RESULTS A total of 164 patients (8.7%) developed intestinal complications after colorectal cancer surgery; 35 (21.3%) of whom died in the postoperative period. Multivariate logistic analysis showed that male gender, history of abdominal surgery, preoperative intestinal obstruction/perforation, metastatic cancer, and lower level of hemoglobin and prognostic nutrition index were independent risk factors (P<0.05 for all). A nomogram was then constructed, and it displayed good accuracy in predicting postoperative intestinal complications with an AUC of 0.76. The calibration plot also showed an excellent agreement between the predicted and observed probabilities. CONCLUSIONS We constructed a nomogram based on clinical variables, which could provide individual prediction of postoperative intestinal complications with good accuracy.


Assuntos
Neoplasias Colorretais/cirurgia , Complicações Intraoperatórias/prevenção & controle , Nomogramas , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Previsões/métodos , Humanos , Enteropatias/etiologia , Enteropatias/prevenção & controle , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco
20.
BMC Endocr Disord ; 19(1): 29, 2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30849982

RESUMO

BACKGROUND: To determine the relation between daily glycemic fluturation and the intestinal mucosal barrier dysfunction in type 2 diabetes mellitus (T2DM). METHODS: Totally 66 patients with T2DM were enrolled, 33 healthy volunteers were also recruited according to the enrolled patients' gender and age in a ratio of 2: 1. Patients were bisected by the median of endotoxins level into low(< 12.31 µ/l, n = 33) and high(≥12.31 µ/l, n = 33) blood endotoxin groups. Clinical data and blood glucose fluctuations were compared between groups. Multivariate regression analysis was used to determine the independent factors affecting the intestinal mucosal barrier. RESULTS: Serum endotoxin [12.1 (4.2~22.0) vs 3.2 (1.3~6.0), P < 0.001] and fasting blood glucose levels [9.8 ± 3.6 vs 5.4 ± 0.7, P < 0.001] were significantly higher in patients with T2DM than the control group. The standard deviation of blood glucose (SDBG) within 1 day [2.9 (2.0~3.3) vs. 2.1 (1.6~2.5), P = 0.012] and the largest amplitude of glycemic excursions (LAGE) [7.5 (5.4~8.9) vs. 5.9 (4.3~7.4), P = 0.034] were higher in the high endotoxin group than in the low endotoxin group. A multiple linear stepwise regression revealed a positive correlation between SDBG with endotoxin (standard partial regression coefficient = 0.255, P = 0.039). CONCLUSIONS: T2DM patients who incapable of maintaining stable blood glucose level are at a higher risk to associated with intestinal mucosal barrier injury.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Hiperglicemia/complicações , Hipoglicemia/complicações , Enteropatias/etiologia , Biomarcadores/análise , Permeabilidade da Membrana Celular , China/epidemiologia , Feminino , Seguimentos , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Incidência , Enteropatias/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
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