62 research outputs found
The Digestive System in the Era of COVID-19
No full textIn the last few years, the scientific world has been forced to find ways to manage the SARS-CoV-2 pandemic and its many effects. Even though COVID-19 was first considered a respiratory disease, it is now identified as a systematic disease. It is common for SARS-CoV-2 to also infect the digestive system. This type of infection in patients with COVID-19 has a wide symptom range. The aim of this reprint is to evaluate and discuss the optimal management of emergency surgeries in patients with SARS-CoV-2 infection and co-infections. Furthermore, this reprint refers to rare conditions of the digestive system and emphasizes the importance of considering these entities in the differential diagnosis. Awareness of diagnostic imaging hallmarks is crucial to optimize the management of these patients. In this reprint, we discuss the risk of new-onset liver injuries due to COVID-19 in preexisting hepatic conditions, their prognosis, severity and outcome, as well as the immunosuppressant treatments administered for COVID-19 and the possibility of reactivation of the hepatic virus. Moreover, we refer to the drugs used during therapy of hospitalized COVID-19 patients, which have adverse side-effects of drug-induced liver injury—DILI. Finally, this reprint punctuates the importance of vaccination against SARS-CoV-2 in chronic digestive diseases
The effect of pneumoperitoneum and positive end-expiratory pressure on splanchnic hemodynamics
No full textSince it is well documented that PEEP and elevated intra-abdominal pressure markedly affect cardiopulmonary and splanchnic hemodynamic performance leading to visceral ischemia, the present study was designed to evaluate the influence of the combination of PEEP and intra-abdominal pressure on abdominal viscera. Therefore, eight mechanically ventilated pigs were subjected to two steps [5 and 10 cmH2O] of PEEP ventilation adding 12 mmHg pneumoperitoneum and the following parameters were assessed every 30 min: hepatic artery, portal vein, and superior mesenteric artery blood flow by means of transit time flowmetry, hepatic and intestinal mucosa microcirculation by means of laser-Doppler flowmetry, hepatic tissue pO2 by means of a Clark- type electrode [Tissutrak], intestinal mucosa pHi by means of tonometry and systemic hemodynamics. Statistical analysis of the hepatic and intestinal measurements revealed a statistical significant decrease of all parameters during the 5 and 10 cmH2O PEEP ventilation period. The addition of 12 mmHg pneumoperitoneum led to an extreme deterioration of all parameters in relation to the 10 cmH2O PEEP level. These findings demonstrate that PEEP and intra-abdominal hypertension act cumulatively on the abdominal viscera, producing conditions of extreme low hypoperfusion and ischemia. Such hypoperfusion states are well experimentally known that affect dramatically the intestinal mucosal barrier leading to bacterial translocation and that, in clinical practice, the intestinally derived bacteria may serve to trigger a septic state and multiple organ dysfunction that increase mortality in ICU’s. Thus, although data of the present study need to be reproduced clinically, PEEP ventilated patients treated in surgical intensive care units, being candidates for the development of intra-abdominal hypertension must be monitored for abdominal pressure elevation as well as for splanchnic ischemia.Επειδή η θετική τελοεκπνευστική πίεση και η αυξημένη ενδοκοιλιακή πίεση προκαλούν πλην των συστηματικών αιμοδυναμικών διαταραχών και σπλαγχνική ισχαιμία, μελετήθηκε αν ο συνδυασμός τους επηρεάζει αθροιστικά την αιμοδυναμική των ενδοκοιλιακών σπλάγχων. Σε 8 χοιρίδια υπό μηχανικό αερισμό εφαρμόσθηκε αρχικά PEEP 5 cmH2O για 30 min, κατόπιν PEEP 10 cmH2O για τα επόμενα 30 min και στη συνέχεια αυξήθηκε και η ενδοκοιλιακή πίεση με πρόκληση πνευμοπεριτοναίου 12 mmHg, με αέριο He, για 60 min. Αξιολογήθηκαν ανά 30 min: 1. η ροή στην ηπατική αρτηρία, την πυλαία φλέβα και τη μεσεντέριο αρτηρία με αισθητήρες ροόμετρου transit time, 2. η μικροκυκλοφορία στο ήπαρ και το βλεννογόνο του λεπτού εντέρου με αισθητήρες ροόμετρου laser-Doppler, 3. το ιστικό οξυγόνο [pO2] του ηπατικού παρεγχύματος με ηλεκτρόδιο τύπου Clark [Tissutrak], 4. το εντερικό βλεννογόνιο pHi με τονόμετρο και 5. οι αιμοδυναμικές παράμετροι της συστηματικής κυκλοφορίας. Η στατιστική ανάλυση των αποτελεσμάτων έδειξε στατιστικά σημαντική μείωση [p=0.0001] της αιματικής ροής στην ηπατική αρτηρία, την πυλαία φλέβα και την άνω μεσεντέριο αρτηρία, όπως και της μικροκυκλοφορίας του ήπατος και του εντέρου, τόσο σε PEEP 5 cmH2O όσο και σε 10 cmH2O. Όμοια μειώθηκε και η p02 του ηπατικού παρεγχύματος, ενώ το εντερικό βλεννογόνιο pH έφθασε σε τιμές που είναι ενδεικτικές βλεννογόνιας ισχαιμίας [7.29 σε PEEP 10 cmH20], Η προσθήκη πνευμοπεριτοναίου 12 mmHg οδήγησε σε περαιτέρω σημαντική μείωση όλων των παραμέτρων. Τα αποτελέσματα της μελέτης μας αποδεικνύουν ότι ο αερισμός με PEEP και η αυξημένη ενδοκοιλιακή πίεση, δρουν συνεργικά στην αιμοδυναμική των ενδοκοιλιακών σπλάγχνων, οδηγώντας σε σοβαρή διαταραχή της σπλαγχνικής αιματικής ροής. Η μείωση της ροής του αίματος στα μεσεντέρια αγγεία και της αιμάτωσης του εντερικού βλεννογόνου έχει αποδειχθεί, πειραματικά, ότι μπορεί να οδηγήσει στην κατάργηση του εντερικού βλεννογόνιου φραγμού, στη βακτηριακή μετακίνηση και την έναρξη του συνδρόμου έκπτωσης της λειτουργίας πολλών συστημάτων, που αυξάνει τη θνητότητα στους βαρέως πάσχοντες ασθενείς των Μονάδων Εντατικής Θεραπείας. Παρόλο που τα δεδομένα της μελέτης μας πρέπει να αναπαραχθούν και κλινικά, θα ήταν φρόνιμο ασθενείς νοσηλευόμενοι στις Μονάδες Εντατικής Θεραπείας που αερίζονται μηχανικά με PEEP και είναι πιθανόν να αναπτύξουν ενδοκοιλιακή υπέρταση, να παρακολουθούνται στενά για αύξηση της ενδοκοιλιακής τους πίεσης και τη συνακόλουθη εμφάνιση σπλαγχνικής ισχαιμίας
Three-dimensional printing as an educational tool in colorectal surgery.
No full text3D printing is a rapidly advancing technology which represents a significant technological achievement that could be useful in a variety of biomedical applications. In the field of surgery, 3D printing is envisioned as a significant step in the areas of surgical planning, education and training. The 3D printed models are considered as high quality and efficient educational tools. In this paper A randomized controlled trial was performed to compare the educational role of 3D printed models with that of the conventional MRI films in the training of surgical residents. Statistical analysis revealed that Resident surgeons who studied only the anal fistula printed models, (Group B) achieved a higher overall score in the fistula assessment test (87,2 (82,6-91,6)) compared to resident surgeons (Group A) who studied only MRI images (74,85 (66,8-73,5)). 3D printing technology can lead to improvement in preoperative planning accuracy, followed by efficient optimization of the treatment strategy. It is believed that 3D printing technology could be used in the case of various other surgical applications, thus representing a novel tool for surgical education
Presence of an Isolated Hydatid Cyst in the Left Kidney: Report of a Case of This Rare Condition Managed Surgically
Get PDFIntroduction. Hydatid cyst disease caused by Echinococcus granulosus is rarely presented in the kidneys, whereas isolated renal occurrence is estimated to be about as low as 2–4% of all cases. We present a case of a female patient suffering from this condition that was treated successfully in our department. Case Presentation. A 44-year-old woman was incidentally diagnosed with a 14 cm left renal cystic mass through ultrasound imaging performed during upper abdominal pain investigation. Laboratory examinations were normal and CT imaging set the diagnosis of an isolated left renal hydatid cyst. The cyst was excised and the postoperative period was uneventful. Discussion. Isolated renal hydatid cyst is a very rare condition and could possibly be misdiagnosed with other renal masses. The clinical history, laboratory tests, and thorough radiologic imaging are crucial for the accurate preoperative diagnosis
Stoma prolapse handmade repair under local anesthesia with variation of Altemeier method in severe patients: a case report and review of the literature
No full textDiagnostic Colonoscopy Leading to Perforated Appendicitis: A Case Report and Systematic Literature Review
Get PDFIntroduction. Intestinal perforation is a known complication after colonoscopy. However, appendiceal involvement with inflammation and perforation is extremely rare and only 37 cases of postcolonoscopy appendicitis have been reported so far. We describe a case of perforated appendicitis 24 hours after colonoscopy that was treated successfully in our Department. Case Report. A 60-year-old female patient underwent a colonoscopy during the investigation of nontypical abdominal pain without pathologic findings. 24 hours after the examination she presented gradually increased right lower quadrant abdominal pain and a CT scan was performed, showing an inflammation of the appendiceal area with free peritoneal air. Through laparotomy, perforated appendicitis was diagnosed and an appendectomy was performed. The patient was discharged on the tenth postoperative day in good health condition. Discussion. The characteristics of all cases reported in the literature are described, including our case. Perforated appendicitis soon after a colonoscopy is a rare, but serious complication; therefore, it is crucial to be included in the differential diagnosis of postcolonoscopy acute abdominal pain
Updated Perspectives on the Diagnosis and Management of Familial Adenomatous Polyposis
No full textFilippos Kyriakidis,1,* Dionysios Kogias,2,* Theodora Maria Venou,1,* Eleni Karlafti,3,4 Daniel Paramythiotis5 1Second Chemotherapy Department, Theagenio Cancer Hospital of Thessaloniki, Thessaloniki, Greece; 2First Department of Internal Medicine, University General Hospital of Alexandroupolis, Alexandroupolis, Greece; 3Emergency Department, AHEPA General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 4First Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, Thessaloniki, Greece; 5First Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece*These authors contributed equally to this workCorrespondence: Filippos Kyriakidis, Tel +30 6984996573, Email [email protected]: Familial adenomatous polyposis (FAP) is an autosomal dominant cancer predisposition syndrome marked by extensive colorectal polyposis and a high risk of colorectal cancer (CRC). Having access to screening and enrollment programs can improve survival for patients with FAP by enabling them to undergo surgery before the development of colorectal cancer. Provided that there are a variety of surgical options available to treat colorectal polyps in patients with adenomatous polyposis, the appropriate surgical option for each patient should be considered. The gold-standard treatment to reduce this risk is prophylactic colectomy, typically by the age of 40. However, colectomy is linked to morbidity and constitutes an ineffective way at preventing extra-colonic disease manifestations, such as desmoid disease, thyroid malignancy, duodenal polyposis, and cancer. Moreover, extensive studies have been conducted into the use of chemopreventive agents to prevent disease progression and delay the necessity for a colectomy as well as the onset of extracolonic disease. The ideal chemoprevention agent should demonstrate a biologically plausible mechanism of action and provide safety, easy tolerance over an extended period of time and a lasting and clinically meaningful effect. Although many pharmaceutical and non-pharmaceutical products have been tested through the years, there has not yet been a chemoprevention agent that meets these criteria. Thus, it is necessary to develop new FAP agents that target novel pathways, such as the mTOR pathway. The aim of this article is to review the prior literature on FAP in order to concentrate the current and future perspectives of diagnosis and treatment. In conclusion, we will provide an update on the diagnostic and therapeutic options, surgical or pharmaceutical, while focusing on the potential treatment strategies that could further reduce the risk of CRC.Keywords: FAP, colorectal cancer, surveillance, genetic testing, surgery, chemopreventio
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