scholarly journals Transmural Colonic Infarction after Routine Colonoscopy in a Young Patient without Risk Factors

2016 ◽  
Vol 10 (2) ◽  
pp. 479-488 ◽  
Author(s):  
Maurizio Zizzo ◽  
Carolina Castro Ruiz ◽  
Lara Ugoletti ◽  
Alessandro Giunta ◽  
Stefano Bonacini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conservative Therapy ◽  
Pathological Process ◽  
Screening Colonoscopy ◽  
Clinical State ◽  
Free Fluid ◽  
Transmural Infarction ◽  
Screening And Surveillance ◽  
Specific Mortality ◽  
Tomography Scan

Colonoscopy is one of the most widely used procedures in medical practice for the diagnosis and treatment of many benign and malignant diseases of the colorectal tract. Colonscopy has become the reference procedure for screening and surveillance of colorectal cancer. The overall rate of adverse events is estimated to be about 2.8 per 1,000 procedures, while complications requiring hospitalization are about 1.9 per 1,000 colonoscopies. Mortality from all causes and colonoscopy-specific mortality are estimated to be 0.07 and 0.007%, respectively. An exceptional fearsome postcolonoscopy complication is colon ischemia (CI); only few cases have been reported worldwide. We present the case of a 43-year-old woman who presented to the emergency department complaining of abdominal pain; fever and rectal bleeding appeared 12 h after a voluntary ‘screening’ colonoscopy. She had no risk factors for CI. Her laboratory tests showed alterations in inflammatory markers and a computed tomography scan showed a circumferential thickening in the left colon and free fluid in the abdomen. After 12 h of observation and conservative therapy, the clinical state of the patient worsened with the rising of signs of peritonitis. Laparoscopy showed that colon infarction extended from the distal third of the transverse colon to the proximal rectum. Laparotomy, resection of the pathological colon and terminal colostomy were performed. The specimen examined confirmed an extended ischemic colitis and transmural infarction on the antimesocolic side, in the absence of a vasculitis. The patient underwent recanalization after 8 months. CI after colonoscopy is a rare and alarming complication that must be known and taken into account in the differential diagnosis of symptomatic cases after colonoscopy, particularly in patients with known risk factors. The diagnosis is mainly based on clinical data, imaging and especially endoscopy. Treatment is almost always conservative but, in some cases in which the pathological process appears irreversible, surgery becomes mandatory.

scholarly journals Risk Factors of Inadequate Bowel Preparation for Screening Colonoscopy

2021 ◽  
Vol 10 (12) ◽  
pp. 2740
Author(s):  
Efrat L. Amitay ◽  
Tobias Niedermaier ◽  
Anton Gies ◽  
Michael Hoffmeister ◽  
Hermann Brenner
Keyword(s):  
Risk Factors ◽  
Bowel Preparation ◽  
Sociodemographic Factors ◽  
Cross Sectional Study ◽  
Screening Colonoscopy ◽  
Cross Sectional ◽  
Factors Associated ◽  
Screening Practice ◽  
Abdominal Symptoms ◽  
Inadequate Bowel Preparation

The success of a colonoscopy in detecting and removing pre-cancerous and cancerous lesions depends heavily on the quality of bowel preparation. Despite efforts, 20–44% of colonoscopy participants have an inadequate bowel preparation. We aimed to assess and compare risk factors for inadequate bowel preparation and for the presence of advanced colorectal neoplasms in routine screening practice. In this cross-sectional study, among 8125 participants of screening colonoscopy in Germany with a comprehensive assessment of sociodemographic factors, lifestyle and medical history, we examined factors associated with inadequate bowel preparation and with findings of advanced neoplasms using adjusted log-binomial regression models. Among the identified risk factors assessed, three factors were identified that were significantly associated with inadequate bowel preparation: age ≥ 70 years (adjusted prevalence ratios, aPR, 1.50 95%CI 1.31–1.71), smoking (aPR 1.29 95%CI 1.11–1.50) and abdominal symptoms (aPR 1.14 95%CI 1.02–1.27). The same risk factors were also associated with the prevalence of advanced neoplasms in our study (aPR 1.72, 1.62 and 1.44, respectively). The risk factors associated with inadequate bowel preparation in this study were also associated with a higher risk for advanced neoplasms. Inadequate bowel preparation for colonoscopy might lead to missed colorectal cancer (CRC) precursors and the late diagnosis of CRC. People at high risk of advanced neoplasms are in particular need of enhanced bowel preparation.

Umbilical Fascial Defects are Common and Predict Trocar Site Hernias After Laparoscopic Appendectomy

2021 ◽  
pp. 000313482199506
Author(s):  
Steven M. Hernandez ◽  
Elizabeth A. Kiselak ◽  
Tania Zielonka ◽  
Scarlett Tucker ◽  
Melissa Blatt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Laparoscopic Appendectomy ◽  
Medical Center ◽  
Area Under The Curve ◽  
Demographic Information ◽  
Fascial Defect ◽  
Trocar Site ◽  
Trocar Site Hernia ◽  
Preoperative Ct ◽  
Tomography Scan

Introduction Investigations have demonstrated that trocar site hernia (TSH) is an under-appreciated complication of laparoscopic surgery, occurring in as many as 31%. We determined the incidence of fascial defects prior to laparoscopic appendectomy and its impact relative to other risk factors upon the development of TSH. Methods TSH was defined as a fascial separation of ≥ 1 cm in the abdominal wall umbilical region on abdominal computerized tomography scan (CT) following laparoscopic appendectomy. Patients admitted to our medical center who had both a preoperative CT and postoperative CT for any reason (greater than 30 days after surgery) were reviewed for the presence of TSH from May 2010 to December 2018. CT scans were measured for fascial defects, while investigators were blinded to film timing (preoperative or postoperative) and patient identity. Demographic information was collected. Results 241 patients undergoing laparoscopic appendectomy had both preoperative and late postoperative CT. TSH was identified in 49 (20.3%) patients. Mean preoperative fascial gap was 3.3 ± 4.3 mm in those not developing a postoperative hernia versus 14.8 ± 7.3 mm in those with a postoperative hernia ( P < .0001). Preoperative fascial defect on CT was predictive of TSH ( P < .001, OR = 1.44), with an Area Under the Curve (AUC) of .921 (95%CI: .88–.92). Other major risk factors for TSH were: age greater than 59 years ( P < .031, OR = 2.48); and obesity, BMI > 30 ( P < .012, OR = 2.14). Conclusions The incidence of trocar site hernia was one in five following laparoscopic appendectomy. The presence of a pre-existing fascial defect, advanced age, and obesity were strong predictors for the development of trocar site hernia.

scholarly journals Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review

2021 ◽  
pp. 145749692110005
Author(s):  
S. Acosta ◽  
F. B. Gonçalves
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Conservative Therapy ◽  
Case Series ◽  
Celiac Artery ◽  
Artery Dissection ◽  
Covered Stents ◽  
Bowel Infarction

Background and Aims: There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited. Material and Methods: The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis. Results and Conclusions: Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.

scholarly journals Postoperative Pneumocephalus on Computed Tomography Might Predict Post-Corpus Callosotomy Chemical Meningitis

2021 ◽  
Vol 11 (5) ◽  
pp. 638
Author(s):  
Ayataka Fujimoto ◽  
Keisuke Hatano ◽  
Toshiki Nozaki ◽  
Keishiro Sato ◽  
Hideo Enoki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Risk Factor ◽  
Intractable Epilepsy ◽  
Epileptic Seizures ◽  
Computed Tomography Scan ◽  
Corpus Callosotomy ◽  
Significant Difference ◽  
Chemical Meningitis ◽  
Tomography Scan

Background: A corpus callosotomy (CC) is a procedure in which the corpus callosum, the largest collection of commissural fibers in the brain, is disconnected to treat epileptic seizures. The occurrence of chemical meningitis has been reported in association with this procedure. We hypothesized that intraventricular pneumocephalus after CC surgery represents a risk factor for postoperative chemical meningitis. The purpose of this study was to analyze the potential risk factors for postoperative chemical meningitis in patients with medically intractable epilepsy who underwent a CC. Methods: Among the patients who underwent an anterior/total CC for medically intractable epilepsy between January 2009 and March 2021, participants were comprised of those who underwent a computed tomography scan on postoperative day 0. We statistically compared the groups with (c-Group) or without chemical meningitis (nc-Group) to determine the risk factors. Results: Of the 80 patients who underwent a CC, 65 patients (25 females and 40 males) met the inclusion criteria. Their age at the time of their CC procedure was 0–57 years. The c-Group (17%) was comprised of seven females and four males (age at the time of their CC procedure, 1–43 years), and the nc-Group (83%) was comprised of 18 females and 36 males (age at the time of their CC procedure, 0–57 years). Mann–Whitney U-tests (p = 0.002) and univariate logistic regression analysis (p = 0.001) showed a significant difference in pneumocephalus between the groups. Conclusion: Postoperative pneumocephalus identified on a computed tomography scan is a risk factor for post-CC chemical meningitis.

Burden between Undersupply and Overtreatment in the Care of Primary Spontaneous Pneumothorax

2017 ◽  
Vol 66 (07) ◽  
pp. 575-582 ◽  
Author(s):  
Tobias Suttner ◽  
Reiner Neu ◽  
Tobias Potzger ◽  
Tamas Szöke ◽  
Christian Grosser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Recurrence Rate ◽  
Spontaneous Pneumothorax ◽  
Conservative Therapy ◽  
Thoracoscopic Surgery ◽  
Free Time ◽  
Primary Spontaneous Pneumothorax ◽  
Treatment Groups ◽  
True Recurrence ◽  
First Recurrence

Background The optimal treatment of primary spontaneous pneumothorax (PSP) is still controversial. The purpose of this study was to analyze the incidence of recurrence, the recurrence-free time, and to identify risk factors for recurrence after PSP. Methods We performed a retrospective analysis of 135 patients with PSP who were treated either conservatively with a chest tube (n = 87) or surgically with video-assisted thoracoscopic surgery (VATS; n = 48) from January 2008 through December 2012. Results In this study, 101 (74.8%) male and 34 (25.2%) female patients were included with a mean age of 35.7 years. The indications for surgery included blebs/bullae in the radiological images (n = 20), persistent air leaks (n = 15), or the occupations/wishes of the patients (n = 13). A first ipsilateral recurrent pneumothorax (true recurrence) was observed in 31.1% of all patients (VATS: 6.25%, conservative: 44.8%). Including contralateral recurrence, the overall first recurrence rate was 41.3% (VATS: 14.6%, conservative: 57.5%). The recurrence-free time did not differ significantly between the treatment groups (p = 0.51), and most recurrences were observed within the first 6 months after PSP. Independent risk factors identified for the first recurrence were conservative therapy (p = 0.0001), the size of the PSP (conservative; p = 0.016), and a body mass index <17 (VATS; 0.022). The risk for second and third recurrences of PSP was 17.5 and 70%, respectively, for both treatment groups, but it was 100% after conservative therapy. Conclusion Surgery for PSP should be selected based on the risk factors and the patient's wishes to prevent first recurrences but also to avoid overtreatment. The treatment of first and subsequent PSP recurrences should be with surgery since conservative treatment is associated with a 100% recurrence rate.

Heterotopic pregnancy; case report

2019 ◽  
Vol 7 (05) ◽  
Author(s):  
Vipul R. Khandagale
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Adnexal Mass ◽  
Heterotopic Pregnancy ◽  
Free Fluid ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
High Index Of Suspicion ◽  
Low Risk Women

Heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It can be a life threatening condition and easily missed with the diagnosis. We present the case of a 37 year old patient who was treated for a heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation.The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.It is difficult to estimate exactly the incidence of ectopic pregnancies, but on an average it is approximately 1:300 normal pregnancies worldwide.

scholarly journals Association of DNA Methylation-Based Biological Age With Health Risk Factors and Overall and Cause-Specific Mortality

2017 ◽  
Vol 187 (3) ◽  
pp. 529-538 ◽  
Author(s):  
Pierre-Antoine Dugué ◽  
Julie K Bassett ◽  
JiHoon E Joo ◽  
Laura Baglietto ◽  
Chol-Hee Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Dna Methylation ◽  
Health Risk ◽  
Biological Age ◽  
Health Risk Factors ◽  
Specific Mortality

scholarly journals Comparative Analysis of Atherosclerosis Risk Factors in the Staff of the Tbilisi (Georgia) Cleaning Service

2020 ◽  
Vol 2 (1) ◽  
pp. 1-10
Author(s):  
Murman Kantaria ◽  
Murman Kantaria ◽  
Pavle Machavariani ◽  
Giorgi Ormotsadze ◽  
Giorgi Ormotsadze ◽  
...  
Keyword(s):  
Risk Factors ◽  
Comparative Analysis ◽  
High Risk ◽  
Risk Group ◽  
Diagnostic Value ◽  
Redox Status ◽  
Pathological Process ◽  
High Risk Group ◽  
Average Value ◽  
Group I

Objective Search of pathogenetic mechanisms and risk factors of atherosclerosis in the employees of the cleaning service in Tbilisi. Materials and Methods As a result of a preliminary survey and examination of 200 employes of Tbilisi cleaning service aged 25-45 years (2014-2016), 22 patients with angina, hypercholesterolemia, intimae-media thickness > 0.65 mm, were selected into I group, and 23 individuals without these disorders into II group. In the blood plasma of the selected patients the intensity of oxidative metabolism parameters, TAA and MDA were determined. The variance and correlation analysis (АNOVA) was used for conducting the comparative analysis of the levels of studied parameters. Results In the combined group (I+II) there are several reliable correlations between the Age -TCol, Age-MDA, BMI-Tg, BMI-MDA, LDLChol-HDLChol, LDLChol–TChol, HDLChol-TChol, LDLChol-MDA, LDLChol-TAA. no correlation between these parameters in individual groups (I and II) was found. That indicates that we have an imaginary correlation related to the large intergroup difference between the average values of the group indicators, that is the values of various indicators change during the development of the pathological process, but there is no causal relationship between these alterations. The reliable TAA-MDA correlation in the combined group (I+II) is related to the high anticorrelation between these parameters and the significantly higher average value of TAA in the low-risk group (II) in comparison to the high-risk group (I). Conclusion The results analysis indicates both the diagnostic value of redox status indicators and their leading role in the atherogenesis processes. In populations with a high risk of atherosclerosis, monitoring of serum TAA is recommended.

Shoulder Stiffness – How to Treat?

2019 ◽  
Vol 157 (06) ◽  
pp. 668-675
Author(s):  
Davide Cucchi ◽  
Sebastian Gottfried Walter ◽  
Dieter Christian Wirtz ◽  
Max Julian Friedrich
Keyword(s):  
Risk Factors ◽  
Range Of Motion ◽  
Low Dose ◽  
Conservative Therapy ◽  
Clinical Situation ◽  
Level Of Evidence ◽  
Shoulder Stiffness ◽  
Rehabilitation Protocol ◽  
Conservative And Operative Treatment ◽  
High Level

AbstractShoulder stiffness is a condition of restricted glenohumeral range of motion, which can arise spontaneously or as consequence of a known cause, including surgical procedures on the shoulder. Several approaches to shoulder stiffness have been proposed and high-level evidence is available to analyze and discuss their results. The aim of this review was to summarize the current concepts on conservative and operative treatment of shoulder stiffness and discuss the results of the available studies with a high level of evidence, which should be considered to guide clinical practice. Treatment of shoulder stiffness should be tailored to the patientʼs clinical situation and the stage of its shoulder pathology and should aim at pain reduction, restoration of range of motion, functional regain and shortening of symptoms duration. When possible, known risk factors for primary shoulder stiffness and causes of secondary shoulder stiffness should be addressed to avoid relapse. Conservative therapy is the mainstay of treatment for shoulder stiffness and should include a multimodal and activity-oriented program. Intra-articular injection of a low dose of corticosteroid is safe and effective, provides immediate benefits, and is recommended in combination to an appropriate rehabilitation protocol. In conservative refractory cases, arthrolysis and capsular release can be performed with an arthroscopic approach.

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