Divertikulitis Lauscher, Johannes Christian
Coloproctology,
12/2023, Letnik:
45, Številka:
6
Journal Article
Recenzirano
Zusammenfassung
Die Divertikulitis gehört zu den häufigsten Erkrankungen der Viszeralmedizin. Ihre Prävalenz steigt mit dem Lebensalter. Kennzeichnend ist ein chronisch-rezidivierender Verlauf. Akute ...linksseitige Unterbauchschmerzen, Fieber und Leukozytose bei einem Patienten >50 Jahre machen eine akute Divertikulitis wahrscheinlich. Eine weiterführende Diagnostik mit Sonographie und/oder Computertomographie erlaubt die korrekte Diagnosestellung. Die unkomplizierte Divertikulitis kann in der Regel ambulant therapiert werden, Patienten mit komplizierter Divertikulitis sollen stationär antibiotisch behandelt werden. Im Falle eines Makroabszesses ist zusätzlich zumeist die perkutane Drainage erforderlich. Patienten mit freier Perforation und Peritonitis bedürfen der notfallmäßigen Operation. Ist der Patient stabil und nicht immunsupprimiert, ist eine Sigmaresektion mit primärer Anastomose möglich. Patienten mit chronisch-rezidivierender Divertikulitis profitieren in Bezug auf ihre Lebensqualität langfristig von der elektiven Sigmaresektion.
Objectives: The COVID-19 pandemic and its associated restrictions have resulted in delayed diagnoses across various tumor entities, including rectal cancer. Our hypothesis was based on the ...expectation of a reduced number of primary operations due to higher tumor stages compared to the control group. Methods: In a single-center retrospective study conducted from 1 March 2018 to 1 March 2022, we analyzed 120 patients with an initial diagnosis of rectal cancer. Among them, 65 patients were part of the control group (pre-COVID-19), while 55 patients were included in the study group (during the COVID-19 pandemic). We compared tumor stages, treatment methods, and complications, presenting data as absolute numbers or mean values. Results: Fewer primary tumor resections during the COVID-19 pandemic (p = 0.010), as well as a significantly lower overall number of tumor resections (p = 0.025) were seen compared to the control group. Twenty percent of patients in the COVID-19 group received their diagnosis during lockdown periods. These patients presented significantly higher tumor stages (T4b: 27.3% vs. 6.2%, p = 0.025) compared to the control group prior to the pandemic. In addition, more patients with angiolymphatic invasion (ALI) were identified in the COVID-19 group following neoadjuvant treatment compared to the control group (p = 0.027). No differences were noted between the groups regarding complications, stoma placement, or conversion rates. Conclusions: The COVID-19 pandemic, particularly during lockdown, appears to have contributed to delayed diagnoses, resulting in higher tumor stages and a decreased number of surgeries. The quality of rectal cancer treatment can be maintained under pandemic conditions.
Zusammenfassung
Die akute komplizierte Divertikulitis umfasst die Typen 2a, 2b und 2c nach der Classification of Diverticular Disease (CDD). Bei komplizierter Divertikulitis ist die stationäre ...Aufnahme und Antibiotikatherapie indiziert. Im Fall der komplizierten Divertikulitis mit parakolischen Luftbläschen und/oder Mikroabszess wird im Intervall keine elektive Sigmaresektion empfohlen. Bei komplizierter Divertikulitis mit Makroabszess (Typ 2b) liegen die Vorteile einer elektiven Sigmaresektion gegenüber der konservativen Therapie in einer geringeren Rezidivrate und einer verbesserten Lebensqualität im Langzeitverlauf. Bei frei perforierter Divertikulitis mit Peritonitis ist der operative Standard die Sigmaresektion mit Anastomose unter Vorschaltung eines Ileostomas. Bei eitriger Peritonitis und einem Patienten ohne relevante Nebenerkrankungen kann auf die Vorschaltung eines Ileostomas verzichtet werden. Bei stuhliger Peritonitis und Immunsuppression sollte der Hartmann-Operation der Vorzug gegeben werden.
The TNF-superfamily member TRAIL is known to mediate selective apoptosis in tumor cells suggesting this protein as a potential antitumor drug target. However, initial successful pr-clinical results ...could not be translated into the clinic. Reasons for the ineffectiveness of TRAIL-targeting in tumor therapies could include acquired TRAIL resistance. A tumor cell acquires TRAIL resistance, for example, by upregulation of antiapoptotic proteins. In addition, TRAIL can also influence the immune system and thus, tumor growth. We were able to show in our previous work that TRAIL
mice show improved survival in a mouse model of pancreatic carcinoma. Therefore, in this study we aimed to immunologically characterize the TRAIL
mice. We observed no significant differences in the distribution of CD3
, CD4
, CD8
T-cells, Tregs, and central memory CD4
and CD8
cells. However, we provide evidence for relevant differences in the distribution of effector memory T-cells and CD8
CD122
cells but also in dendritic cells. Our findings suggest that T-lymphocytes of TRAIL
mice proliferate at a lower rate, and that the administration of recombinant TRAIL significantly increases their proliferation, while regulatory T-cells (Tregs) from TRAIL
mice are less suppressive. Regarding the dendritic cells, we found more type-2 conventional dendritic cells (DC2s) in the TRAIL
mice. For the first time (to the best of our knowledge), we provide a comprehensive characterization of the immunological landscape of TRAIL-deficient mice. This will establish an experimental basis for future investigations of TRAIL-mediated immunology.
: The popularity of robotic-assisted surgery for rectal cancer is increasing, but its superiority over the laparoscopic approach regarding safety, efficacy, and costs has not been well established.
: ...A retrospective single-center study was conducted comparing consecutively performed robotic-assisted and laparoscopic surgeries for rectal cancer between 1 January 2016 and 31 September 2021. In total, 125 adult patients with sporadic rectal adenocarcinoma (distal extent ≤ 15 cm from the anal verge) underwent surgery where 66 were operated on robotically and 59 laparoscopically.
: Severe postoperative complications occurred less frequently with robotic-assisted compared with laparoscopic surgery, as indicated by Clavien-Dindo classification grades 3b-5 (13.6% vs. 30.5%,
= 0.029). Multiple logistic regression analyses after backward selection revealed that robotic-assisted surgery was associated with a lower rate of total (Clavien-Dindo grades 1-5) (OR = 0.355; 95% CI 0.156-0.808;
= 0.014) and severe postoperative complications (Clavien-Dindo grades 3b-5) (OR = 0.243; 95% CI 0.088-0.643;
= 0.005). Total inpatient costs (median EUR 17.663 IQR EUR 10.151 vs. median EUR 14.089 IQR EUR 12.629;
= 0.018) and surgery costs (median EUR 10.156 IQR EUR 3.551 vs. median EUR 7.468 IQR EUR 4.074;
< 0.0001) were higher for robotic-assisted surgery, resulting in reduced total inpatient profits (median EUR -3.196 IQR EUR 9.101 vs. median EUR 232 IQR EUR 6.304;
= 0.004).
: In our study, robotic-assisted surgery for rectal cancer resulted in less severe and fewer total postoperative complications. Still, it was associated with higher surgery and inpatient costs. With increasing experience, the operative time may be reduced, and the postoperative recovery may be further accelerated, leading to reduced surgery and total inpatient costs.
Background: Robotic-assisted colorectal surgery is gaining popularity, but limited data are available on the safety, efficacy, and cost of robotic-assisted restorative proctectomy with the ...construction of an ileal pouch and ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). Methods: A retrospective study was conducted comparing consecutively performed robotic-assisted and laparoscopic proctectomy with IPAA between 1 January 2016 and 31 September 2021. In total, 67 adult patients with medically refractory UC without proven dysplasia or carcinoma underwent surgery: 29 operated robotically and 38 laparoscopically. Results: There were no differences between both groups regarding postoperative complications within 30 days according to Clavien-Dindo classification’ grades 1−5 (51.7% vs. 42.1%, p = 0.468) and severe grades 3b−5 (17.2% vs. 10.5%, p = 0.485). Robotic-assisted surgery was associated with an increased urinary tract infection rate (n = 7, 24.1% vs. n = 1, 2.6%; p = 0.010) and longer operative time (346 ± 65 min vs. 281 ± 66 min; p < 0.0001). Surgery costs were higher when operated robotically (median EUR 10.377 IQR EUR 4.727 vs. median EUR 6.689 IQR EUR 3.170; p < 0.0001), resulting in reduced total inpatient profits (median EUR 110 IQR EUR 4.971 vs. median EUR 2.853 IQR EUR 5.386; p = 0.001). Conclusion: Robotic-assisted proctectomy with IPAA can be performed with comparable short-term clinical outcomes to laparoscopy but is associated with a longer duration of surgery and higher surgery costs. As experience increases, some advantages may become evident regarding operative time, postoperative recovery, and length of stay. The robotic procedure might then become cost-efficient.
(1)
Surgical site infections (SSIs) are a relevant problem with a 25% incidence rate after elective laparotomy due to inflammatory bowel disease (IBD). The aim of this study was to evaluate whether ...stricter hygienic measures during the COVID-19 pandemic influenced the rate of SSI. (2)
This is a monocentric, retrospective cohort study comparing the rate of SSI in patients with bowel resection due to IBD during COVID-19 (1 March 2020-15 December 2021) to a cohort pre-COVID-19 (1 February 2015-25 May 2018). (3)
The rate of SSI in IBD patients with bowel resection was 25.8% during the COVID-19 pandemic compared to 31.8% pre-COVID-19 (OR 0.94; 95% CI 0.40-2.20;
= 0.881). There were seventeen (17.5%) superficial and four (4.1%) deep incisional and organ/space SSIs, respectively, during the COVID-19 pandemic (
= 0.216). There were more postoperative intra-abdominal abscesses during COVID-19 (7.2% vs. 0.9%;
= 0.021). The strictness of hygienic measures (mild, medium, strict) had no influence on the rate of SSI (
= 0.553). (4)
Hygienic regulations in hospitals during COVID-19 did not significantly reduce the rate of SSI in patients with bowel resection due to IBD. A ban on surgery, whereby only emergency surgery was allowed, was likely to delay surgery and exacerbate the disease, which probably contributed to more SSIs and postoperative complications.
Pflege Kolleg 7_Wunde Im Fokus Strobel, Rahel; Kreis, PD Dr. med. Johannes Christian Lauscher, Martin; Lauscher, Johannes Christian ...
Procare: Das Forbildungsmagazin Fur Pflegeberufe,
05/2021, Letnik:
26, Številka:
4
Journal Article
Recenzirano
Die World Health Organization (WHO) hat in ihrer Leitlinie zur Prävention postoperativer Wundinfektionen aus dem Jahr 2016 die Inzidenz für verschiedene Fachdisziplinen in Europa beschrieben: Die ...Rate liegt bei kolorektalen Eingriffen bei 9,5%, in der Herzchirurgie bei ca. 3,5% für Bypassoperationen, in der Orthopädie bei 1% für Hüftendoprothesen, 0,75% für Knieendoprothesen und 0,8% für Laminektomien. In vielen Studien war ein Übergewicht (Body- Mass-Index BMI >25) bzw. Es konnte ein Zusammenhang zwischen der Schwere der HIV („human immunodeficiency virus“)-induzierten Immunsuppression und der Rate von Wundinfektionen nachgewiesen werden. Das Erregerspektrum variiert je nach Operationsgebiet und Art der Operation.
