Digestive Department Research Articles

Analysis of infections associated with central vascular catheters used for parenteral nutrition administration

BackgroundCatheter-related infections(CRI) are highly prevalent and often associated with fatal complications. One year ago, intensive care unit (ICU) of our Hospital implemented a ‘Zero Bacteremia Project.’PurposeTo determine the rate of...

Diagnostic incidence of the presence of positive HBsAg: epidemiologic, clinical, and virological characteristics

To analyze the epidemiological, clinical, and virological characteristics of patients newly diagnosed with active hepatitis B virus (HBV) infection based on the presence of positive hepatitis B surface antigen (HBsAg) in the digestive diseases department of a district hospital. We performed a 3-year prospective study in patients newly diagnosed with HBV infection. We analyzed epidemiological, clinical, and virological characteristics, complete HBV markers, quantification of HBV DNA, and infection by hepatitis delta virus. We performed genotyping and resistance testing in patients with a high viral load. Results were obtained for patientswho required liver biopsy. We diagnosed 213 patients (18.8/10,000 inhabitants/year). Men accounted for 61%, and 59% were aged 20 to 40 years. Immigrants accounted for 53% of the population: 46% were from Rumania and 37% from Sub-Saharan African countries. At diagnosis, 2.3% had acute hepatitis (all with jaundice) and 3.3% had cirrhosis with portal hypertension. With the exception of cases of acute hepatitis, positive HBeAg was observed in 9%. Serum transaminase levels were normal in 62.2% of patients, HBV DNA was > 2,000 IU/mL in 33.8%, and delta virus was present in 3.3%. Genotyping and resistance testing were performed in 70 patients: the most common genotype was D, followed by A. Resistance was detected at baseline in only 2 cases: to adefovir in one case and to entecavir in another. Among the 36 biopsies performed, 32.4% showed inflammatory activity > or = 2, and 23.5% had fibrosis > or = 2 according to the METAVIR scoring system. According to clinical practice, specific treatment for HBV infection was necessary (any reason) in 17.4% of those diagnosed (3 patients per 100,000 inhabitants/year). Despite prevention and vaccination, HBV infection is a health problem that most commonly affects the immigrant population and men. Serum transaminase levels are normal in 62.2% of patients. The most frequent genotype is D, followed by A, and baseline resistance is scarce.

Hydatid cyst of the pancreas: A report on seven cases

Background and study aims Primary hydatid cyst of the pancreas is rare, representing 0.2–2% of all human cases. It is usually single and located in the head of the pancreas. The aim of this study was to describe clinical, radiological and therapeutic aspects of hydatid cysts of the pancreas. Patients and methods This study was carried out in the Department of Digestive and General Surgery in Sahloul University Hospital, Sousse in Tunisia during the period 1993–2009. Seven patients were treated for hydatid cyst of the pancreas, three men and four women with an average age of 30 years. Results The clinical signs were variable according to size and location of the cyst within the pancreas and the degree of biliopancreatic involvement. The main symptoms were pain in left upper quadrant, jaundice, fever and epigastric and right upper quadrant pain. The preoperative diagnosis was established in six patients by ultrasonography and computed tomography (CT). However, the diagnosis was established during laparotomy in one case. The echinococcal immunological test (ELISA) was positive in only two cases. Surgical treatment included resection of the prominent lump (cystectomy) in five cases, and distal pancreatectomy with splenic preservation in one case and with splenectomy in one case. The postoperative period was uneventful in six cases. Acute postoperative pancreatitis occurred in one case. The patients were free of symptoms and were followed up for 12 months without any recurrence as revealed by abdominal ultrasonography and CT scan. Conclusions Hydatid cysts in the pancreas are rare. Even if rare, these should be considered in the differential diagnosis of cystic lesions of the pancreas. The surgical treatment is to be considered whenever possible.

Diagnosis delay and follow-up strategies in colorectal cancer. Prognosis implications: a study protocol

BackgroundControversy exists with regard to the impact that the different components of diagnosis delay may have on the degree of invasion and prognosis in patients with colorectal cancer. The follow-up strategies after treatment also vary considerably. The aims of this study are: a) to determine if the symptoms-to-diagnosis interval and the treatment delay modify the survival of patients with colorectal cancer, and b) to determine if different follow-up strategies are associated with a higher survival rate.Methods/DesignMulti-centre study with prospective follow-up in five regions in Spain (Galicia, Balearic Islands, Catalonia, Aragón and Valencia) during the period 2010-2012. Incident cases are included with anatomopathological confirmation of colorectal cancer (International Classification of Diseases 9th revision codes 153-154) that formed a part of a previous study (n = 953).At the time of diagnosis, each patient was given a structured interview. Their clinical records will be reviewed during the follow-up period in order to obtain information on the explorations and tests carried out after treatment, and the progress of these patients.Symptoms-to-diagnosis interval is defined as the time calculated from the diagnosis of cancer and the first symptoms attributed to cancer. Treatment delay is defined as the time elapsed between diagnosis and treatment. In non-metastatic patients treated with curative intention, information will be obtained during the follow-up period on consultations performed in the digestive, surgery and oncology departments, as well as the endoscopies, tumour markers and imaging procedures carried out.Local recurrence, development of metastases in the follow-up, appearance of a new tumour and mortality will be included as outcome variables.Actuarial survival analysis with Kaplan-Meier curves, Cox regression and competitive risk survival analysis will be performed.DiscussionThis study will make it possible to verify if the different components of delay have an impact on survival rate in colon cancer and rectal cancer. In consequence, this multi-centre study will be able to detect the variability present in the follow-up of patients with colorectal cancer, and if this variability modifies the prognosis. Ideally, this study could determine which follow-up strategies are associated with a better prognosis in colorectal cancer.

Improving the Preoperative Diagnostic Yield of Gallbladder Cancers

Department of General and Digestive; Surgery; Flinders Medical Centre; Adelaide, South Australia; [email protected]

The Global Impact of Endoscopic Ultrasound (EUS) Regarding the Survival of a Pancreatic Adenocarcinoma in a Tertiary Hospital

Pancreatic ductal adenocarcinoma is a type of neoplasm with a high mortality rate. There are a number of different procedures that may be followed in the study of the pancreas; one such procedure is endoscopic ultrasonography (EUS). This study aimed to retrospectively evaluate the impact on patient survival of a biliopancreatic EUS performed 2 months prior to the first treatment session of the pancreatic ductal adenocarcinoma. We carried out a retrospective evaluation of the medical case histories of our patients who had been diagnosed with pancreatic ductal adenocarcinoma over a period of 10 years (1 Jan 1999-31 Dec 2008), combining the computer archives of our Pathological Anatomy (biopsy and cytology) Dept. and those of the Digestive Department's Endoscopic Ultrasonography Unit in order to exclude any pancreatic neoplasms derived from other origins. Information regarding the patients' age, sex, tumor location, and various diagnostic tests (EUS, EUS-fine-needle aspiration (FNA), helical computed tomography (CT), multidetector-row CT (MDCT)) were recorded, along with the different treatments that had been followed in each case. When the survival rates of patients diagnosed with and without EUS were compared, evaluating the average survival rate and the survival rate after 1, 3, and 5 years, respectively, the differences in the results proved to be statistically significant (p = 0.014) in favor of the diagnosis with EUS. However, no significant differences were found when using other diagnostic imaging methods, such as EUS-FNA (p = 0.271), helical CT (p = 0.843), or MDCT (p = 0.738). To evaluate other influencing survival factors, a study was undertaken to record data depending on the sex of the patients. Results showed a higher survival rate in the female patients with a median of 6.57 months compared to that of the male patients with a median of 4.7 months (p = 0.014). Variables, which had resulted significant prior to treatment, were included in a multivariate Cox regression model, after which only the sex and EUS remained significant. A biliopancreatic EUS carried out during the 2 months prior to the start of the treatment of the pancreatic ductal adenocarcinoma has a statistically significant impact on the patient survival rate. We believe that this is due to the possibility of a very-early-stage diagnosis of the adenocarcinoma permitted by the use of this technique.

Which treatment for squamous cell carcinoma of the pharyngoesophageal junction?

Journal of Surgical OncologyVolume 94, Issue 3 p. 175-177 Editorial Which treatment for squamous cell carcinoma of the pharyngoesophageal junction? C. Mariette MD, PhD, Corresponding Author C. Mariette MD, PhD c-mariette@chru-lille.fr Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, FranceDepartment of Digestive and Oncological Surgery, University Hospital C. Huriez, CHRU-Place de Verdun, 59037 Lille cedex, France. Fax: (33) 3 20 44 43 85.Search for more papers by this authorJ.P. Triboulet MD, J.P. Triboulet MD Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, FranceSearch for more papers by this author C. Mariette MD, PhD, Corresponding Author C. Mariette MD, PhD c-mariette@chru-lille.fr Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, FranceDepartment of Digestive and Oncological Surgery, University Hospital C. Huriez, CHRU-Place de Verdun, 59037 Lille cedex, France. Fax: (33) 3 20 44 43 85.Search for more papers by this authorJ.P. Triboulet MD, J.P. Triboulet MD Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, FranceSearch for more papers by this author First published: 09 August 2006 https://doi.org/10.1002/jso.20473Citations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume94, Issue31 September 2006Pages 175-177 RelatedInformation

Comparaison de deux schémas d'administration (continu ou discontinu) d'un antibiotique temps-dépendant : la Tazocilline

A predictive parameter of β-lactamines therapeutic efficacy is the time (T > MIC) while antibiotic seric concentrations are above the MIC of suspected bacteriological agents. This led us to carry out a randomised open study to compare the usually used intermittent administration of Tazocilline (three injections of 4 g/0.5 g a day) and continuous perfusion of 12 g/1.5 g a day by calculating these T > MIC. Patients from digestive reanimation department were randomised within two arms: continuous or intermittent administration. Sixteen taking of blood were executed over a forty hour period. After liquid/liquid extraction, piperacillin and tazobactam seric concentrations were determined by HPLC with a reversed phase column (C18) and a UV spectrophotometry detection. Then, from the time-concentration curves we have evaluate the T > MIC for an enterobacteria (MIC = 8 μg/mL) and for Pseudomonas (MIC = 16 μg/mL). Concerning intermittent administration T > MIC were 74% (c > MIC enterobacteria) and 62% (c > MIC Pseudomonas). These percentages in the continuous arm were 100% (c > MIC enterobacteria) and 99% (c > MIC Pseudomonas). Tazobactam concentrations were low and even undetectable between each injection in the intermittent administration arm. This were not find within the continuous administration arm. In conclusion, for the intermittent administration, we observed some long periods occurring before each injection while antibiotic concentrations were under the MIC of most bacteria. During these same periods tazobactam concentrations were under the efficacy threshold. These periods were not observed within the continuous administration arm.

In vivo determination of the intracolonic release of immunoglobulins in chronic ulcerative colitis : [formula omitted], M. Papo, F. Guarner, M. Antolin, R. Jardi, J.R. Armengol, J-R. Malagelada, Digestive System Research Unit and Department of Biochemistry, Hospital General Vall d'Hebron, Barcelona, Spain

In vivo determination of the intracolonic release of immunoglobulins in chronic ulcerative colitis : [formula omitted], M. Papo, F. Guarner, M. Antolin, R. Jardi, J.R. Armengol, J-R. Malagelada, Digestive System Research Unit and Department of Biochemistry, Hospital General Vall d'Hebron, Barcelona, Spain

Neuroendocrine tumors metastatic to the liver. Vascular occlusion therapy.

Annals of the New York Academy of SciencesVolume 733, Issue 1 p. 479-487 Neuroendocrine Tumors Metastatic to the Liver Vascular Occlusion Therapy JAFFER A. AJANI, Corresponding Author JAFFER A. AJANI Departments of Interventional Radiology, and Gastrointestinal Oncology and Digestive Diseases M. D. Anderson Cancer Center University of Texas 1515 Holcombe Blvd, Box 78 Houston, Texas 77030-4095To whom correspondence should be addressed at the Department of Gastrointestinal Oncology and Digestive Diseases.Search for more papers by this authorC. HUMBERTO CARRASCO, C. HUMBERTO CARRASCO Departments of Interventional Radiology, and Gastrointestinal Oncology and Digestive Diseases M. D. Anderson Cancer Center University of Texas 1515 Holcombe Blvd, Box 78 Houston, Texas 77030-4095Search for more papers by this authorSIDNEY WALLACE, SIDNEY WALLACE Departments of Interventional Radiology, and Gastrointestinal Oncology and Digestive Diseases M. D. Anderson Cancer Center University of Texas 1515 Holcombe Blvd, Box 78 Houston, Texas 77030-4095Search for more papers by this author JAFFER A. AJANI, Corresponding Author JAFFER A. AJANI Departments of Interventional Radiology, and Gastrointestinal Oncology and Digestive Diseases M. D. Anderson Cancer Center University of Texas 1515 Holcombe Blvd, Box 78 Houston, Texas 77030-4095To whom correspondence should be addressed at the Department of Gastrointestinal Oncology and Digestive Diseases.Search for more papers by this authorC. HUMBERTO CARRASCO, C. HUMBERTO CARRASCO Departments of Interventional Radiology, and Gastrointestinal Oncology and Digestive Diseases M. D. Anderson Cancer Center University of Texas 1515 Holcombe Blvd, Box 78 Houston, Texas 77030-4095Search for more papers by this authorSIDNEY WALLACE, SIDNEY WALLACE Departments of Interventional Radiology, and Gastrointestinal Oncology and Digestive Diseases M. D. Anderson Cancer Center University of Texas 1515 Holcombe Blvd, Box 78 Houston, Texas 77030-4095Search for more papers by this author First published: September 1994 https://doi.org/10.1111/j.1749-6632.1994.tb17298.xCitations: 14AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume733, Issue1Molecular and Cell Biological Aspects of Gastroenteropancreatic Neuroendocrine Tumor DiseaseSeptember 1994Pages 479-487 RelatedInformation