Viszeralmedizin最新文献

{"title":"Therapy of Liver Abscesses.","authors":"Christoph Lübbert,&nbsp;Johannes Wiegand,&nbsp;Thomas Karlas","doi":"10.1159/000366579","DOIUrl":"https://doi.org/10.1159/000366579","url":null,"abstract":"<p><strong>Background: </strong>Liver abscess (LA) is an uncommon but potentially life-threatening disease with significant morbidity and mortality.</p><p><strong>Methods: </strong>This review comprehensively describes epidemiology, pathogenesis, diagnosis, and treatment of LA, with a strong focus on antimicrobial treatment choices and the impact of multidrug-resistant pathogens.</p><p><strong>Results: </strong>In industrialized areas, pyogenic liver abscess (PLA) accounts for over 80% of the cases, whereas Entamoeba histolyticais responsible for up to 10% of the cases, with a higher incidence in tropical areas. Highly virulent strains of Klebsiella pneumoniaehave emerged as a predominant cause of PLA in Asian countries and tend to spread to the USA, Australia, and European countries, therefore requiring special alertness. Most common symptoms of LA are fever, chills, and right upper quadrant abdominal pain, although a broad spectrum of non-specific symptoms may also occur.</p><p><strong>Conclusion: </strong>Imaging studies (ultrasound, computed tomography scan) and microbiological findings play a crucial role in the diagnosis of LA. The treatment of choice for PLA is a multimodal approach combining broad-spectrum antibiotics and aspiration or drainage of larger abscess cavities. Amebic LA can be cured by metronidazole therapy without drainage.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 5","pages":"334-41"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366579","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34000807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calculated Antibiosis of Acute Cholangitis and Cholecystitis","authors":"T. Bornscheuer, S. Schmiedel","doi":"10.1159/000368335","DOIUrl":"https://doi.org/10.1159/000368335","url":null,"abstract":"Background: The aim of this article is to present the most recent suggestions for the therapy of acute cholangitis and cholecystitis based on a review of the current literature. Methods: We performed a systematic literature search in the Medline, PubMed, and Google Scholar databases using the keywords mentioned above. This article is strongly influenced by the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07, TG13) in 2007 and 2013. These were the first practical guidelines targeting diagnosis and treatment of acute cholangitis and cholecystitis. These guidelines are based on the best published evidence and a consensus conference of international experts in the field. Results and Conclusion: Acute cholangitis and acute cholecystitis are common conditions that may result in progressively severe infection and death when not treated appropriately. Beside supportive therapy and antiobstructive measures, therapy with antimicrobial agents is an important component in the management of affected patients. Here, we discuss the use of antimicrobial agents that are suitable for the first-line management of these infections. Empirical therapy depends upon the knowledge of local microbial epidemiology and patient-specific factors affecting the selection of appropriate agents.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 1","pages":"297 - 302"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64746203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rational Therapy of Clostridium difficile Infections.","authors":"Peter M Keller,&nbsp;Marko H Weber","doi":"10.1159/000366302","DOIUrl":"https://doi.org/10.1159/000366302","url":null,"abstract":"<p><strong>Background: </strong>Clostridium difficile infections (CDI) are increasingly important in patients with antibiotic treatments, ranging from mild, self-limiting to severe, life-threatening disease. Currently, diagnostic algorithms and treatment guidelines are being adapted to novel tests and therapeutic options for recurrent CDI.</p><p><strong>Methods: </strong>A systematic literature search using the terms 'Clostridium difficile' and 'treatment' was carried out. Current guidelines are being discussed from a clinical point of view.</p><p><strong>Results: </strong>State-of-the-art diagnostics for C. difficile diagnosis rely on the patient's history, clinical symptoms, and laboratory examination of stool. Recommendations are in favour of glutamate dehydrogenase (GDH) screening tests and confirmatory detection of C. difficile toxin genes (polymerase chain reaction (PCR)). Therapeutic strategies depend on disease severity (mild vs. severe) and endorse metronidazole and vancomycin as well as fidaxomycin for recurrent disease. In very severe cases, surgical therapy is recommended. For relapsing diseases, faecal transfer is considered as a therapeutic option if available.</p><p><strong>Conclusion: </strong>Current guidelines have been adapted to new pathways in diagnosing CDI and have included statements on novel therapeutic options such as fidaxomycin and faecal transplant for recurrent disease. Depending on the severity of the disease, standard therapy with either metronidazole or vancomycin is recommended.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 5","pages":"304-9"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34105751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute and Chronic Infections of the Gastrointestinal Tract.","authors":"Andreas Stallmach,&nbsp;Utz Settmacher","doi":"10.1159/000368988","DOIUrl":"https://doi.org/10.1159/000368988","url":null,"abstract":"All things change, nothing is extinguished. (Ovid, around 8 A.D.) \u0000 \u0000The times they are a-changin’. (Bob Dylan, 1963) \u0000 \u0000Whereas the victory of mankind over infectious diseases was prematurely celebrated in the 1960s [1], nature has struck back with its ability to adapt and to respond, thus requiring new strategies to prevent and treat infections today. Especially in the interdisciplinary field of gastrointestinal medicine and surgery, intra-abdominal and luminal infections challenge clinicians in their everyday decisions and practice. In their report on the threat of antibiotic resistance in 2013, the Centers for Disease Control and Prevention (CDC) have classified pathogens as ‘urgent’ and ‘serious threats’ based on their clinical and economic impact, current and estimated incidence, transmissibility, availability of effective antibiotics, and available barriers for prevention, which are well known to gastroenterologists and visceral surgeons: Clostridium difficile, carbapenem-resistant enterobacteriaceae, extended beta-lactamase-producing enterobacteriaceae, and drug-resistant Salmonella, Shigella, Campylobacter, Pseudomonas, and Candida species [2]. In addition to the challenge of antimicrobial resistance, advances in medicine have also lead to an increasing number of immunosuppressed patients presenting with atypical or opportunistic infections by emerging and re-emerging pathogens. In order to successfully treat abdominal infections, physicians do not only need to carefully diagnose the source of infection and assess the severity of the disease but also to assess individual host as well as environmental factors to decide on empiric first-line therapy in a multidimensional approach [3]. \u0000 \u0000This issue of VISZERALMEDIZIN covers different aspects of contemporary diagnosis, prevention, and treatment of bacterial infections in the ever-evolving field of gastroenterology and abdominal surgery. In addition to a close interdisciplinary collaboration to control the infectious focus, the selection of the appropriate empiric antibiotic therapy remains of particular importance for the treatment of hepatobiliary infections and abdominal sepsis. Herein, Hagel and Scheuerlein [4] provide an armamentarium of strategies to optimize empiric antibiotic therapies for intra-abdominal infections and peritonitis with the aim to decrease mortality and to reduce unnecessary antibiotic use. In addition, a specific risk- and severity-based approach to the treatment of biliary infections is given by Bornscheuer and Schmiedel [5] in their review in which they provide expert recommendations for suitable antibiotic regimes based on the updated Tokyo guidelines from 2013. Pyogenic liver abscess is a dreaded complication of uncontrolled cholangitis and portal pyemia which requires prompt broad-spectrum antibiotic therapy, diagnostic aspiration, and therapeutic drainage. In addition to presenting rationale-based antimicrobial therapy regimens for clinical practice, Lubbert e","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 5","pages":"293-4"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368988","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34088772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Verrucous Oesophageal Carcinoma: Single Case Report and Case Series Including 15 Patients – Issues for Consideration of Therapeutic Strategies","authors":"A. Behrens, M. Stolte, O. Pech, A. May, Christian Ell","doi":"10.1159/000368270","DOIUrl":"https://doi.org/10.1159/000368270","url":null,"abstract":"Background: Verrucous carcinomas (VC) of the oesophagus are a rarity. Due to their histological resemblance to squamous cell carcinoma, the diagnostic and treatment standards applicable to the latter have so far also been applied to VC as a disease entity. Quite limited data are available including two case series of 5 or 11 patients. The present study reports on a single case treated by local endoscopic therapy and a series of 15 patients, 9 of whom received local endoscopic therapy. Methods: The data for patients diagnosed with VC of the oesophagus who had been treated from January 1999 to May 2011 were analysed retrospectively. Results: 15 patients with the diagnosis of oesophageal VC were included. The male-female ratio was 3:1. 9 of 11 pT1-VC patients presented with the cardinal symptom dysphagia or odynophagia. For the majority of the patients, the growth pattern is one of extensive superficial expansion showing a median length of 9 cm (range: 2-22 cm). Surprisingly, none of the VC patients showed lymph node or distant metastasis. 9 of 15 VC patients received local endoscopic therapy; 4 were treated with curative intent and 5 were treated palliatively. 3 patients underwent oesophageal resection, and definitive chemoradiotherapy was administered in a further 3 patients. One severe complication, consisting of a postoperative anastomotic insufficiency with a fatal outcome, occurred in this group of patients. Conclusion: This is the largest published study describing patients diagnosed with VC of the oesophagus so far. The option of local endoscopic therapy and its results in 9 patients are reported for the first time. The superficial growth pattern of the tumour and the frequent absence of lymph node or distant metastasis suggest that endoscopic resection can be carried out as a diagnostic and/or therapeutic approach. Due to the rarity of this entity, the case numbers are unfortunately so limited that evidence-based recommendations are unlikely to become available even in the future.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 1","pages":"346 - 352"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368270","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64745450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute and Chronic Infections of the Gastrointestinal Tract.","authors":"Peter Kujath,&nbsp;Christian Eckmann,&nbsp;Tobias Keck,&nbsp;Arne Rodloff,&nbsp;Erik Schlöricke,&nbsp;Martin Hoffmann","doi":"10.1159/000368623","DOIUrl":"https://doi.org/10.1159/000368623","url":null,"abstract":"within community care. These studies have identified the cultural anthropological dimension of uncertainty avoidance (UA) as being particularly relevant in explaining why doctors in some European countries have a greater propensity to prescribe antibiotics for predominantly viral conditions, such as colds, flu, and sore throat, in the face of clear scientific evidence. UA is described in the Geert Hofstede model of cultural dimension as a construct estimating the extent to which a society tolerates uncertainty and ambiguity. Such cultures often try to counteract the unease created by situations of uncertainty through the adoption of dogmatic and excessive measure, even when there is no evidence of cost-effectiveness or risk attenuation. There is no evidence to support postoperative prophylaxis.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 5","pages":"342-5"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34088773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infections and Chronic Inflammatory Bowel Disease.","authors":"Torsten Kucharzik,&nbsp;Christian Maaser","doi":"10.1159/000366463","DOIUrl":"https://doi.org/10.1159/000366463","url":null,"abstract":"<p><p>In the more recent years since the introduction of anti-TNF therapy, the treatment strategy in chronic inflammatory bowel disease has developed more towards an early intensive, often double immunosuppression. While this leads to an improved therapeutic success, this intensified therapy also increases the risk for side effects and especially for infectious complications. The early detection of this complication in the immunocompromised patient is often more difficult due to the potential broad spectrum of infectious agents, the often atypical presentation in conjunction with the immunosuppression as well as often similar symptoms regarding intestinal infectious complications common for a flare of the underlying disease. In the first part, this overview will discuss the broad spectrum of potential infectious complications, using pulmonary infections as an example and presenting an algorithm for detection and therapy. In the second part, common intestinal infectious complications will be discussed from diagnosis to therapy. </p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 5","pages":"326-32"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366463","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33932843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytoreductive Surgery and HIPEC in the Baltic States: An International Scientific Workshop with Live Surgery","authors":"E. Poskus, K. Strupas, V. Gushchin, P. Sugarbaker","doi":"10.1159/000368685","DOIUrl":"https://doi.org/10.1159/000368685","url":null,"abstract":"Background: Around the globe a new interest in the multidisciplinary management of peritoneal metastases using neoadjuvant chemotherapy, cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and adjuvant systemic chemotherapy has occurred. The combined use of these treatment modalities has required the creation of centers of excellence to manage patients with peritoneal metastases with a high level of success as well as a low incidence of adverse events. Methods: A 2-day workshop hosted by the Center of Abdominal Surgery, Vilnius University Hospital, with 230 participants was organized to explore the current practice in the Baltic states. Live surgery with video transmission initiated the efforts. Then, presentations by five experts from high-volume peritoneal surface malignancy centers were made and discussed. A summary of the efforts to date in Lithuania and Estonia was presented and collected for publication. Results: The live surgery served as a focal point for all subsequent presentations. The five invited speakers reviewed the rationale, current literature, indications and contraindications, implementation, and current European guidelines for management. The results of CRS and HIPEC from five centers in Lithuania and Estonia currently active revealed 127 patients treated to date, half of whom carried a diagnosis of ovarian cancer. There was an incidence of major complications of 11.8% and a mortality of 1.6%. Data regarding long-term survival benefits will require further follow-up. Conclusions: Progress in peritoneal surface oncology in the Baltic states was confirmed. With a low morbidity and mortality, these clinical programs promise to provide continued benefit for patients with peritoneal metastases - a condition judged to be terminal in the past.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 1","pages":"353 - 359"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368685","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64748322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Antibiotic Prophylaxis and Antimicrobial Therapy of Intra-Abdominal Infections","authors":"S. Hagel, H. Scheuerlein","doi":"10.1159/000368582","DOIUrl":"https://doi.org/10.1159/000368582","url":null,"abstract":"Background: The increase of antimicrobial resistances to first- and second-line antibiotics, especially of Gram-negative bacteria, and the lack of novel antimicrobial substances are a challenge in the treatment of intra-abdominal infections. Methods: Review article. Results: The efficacy and safety of perioperative antibiotic prophylaxis in visceral surgery has been demonstrated by several meta-analyses. Perioperative antibiotic prophylaxis is defined as a single administration of antibiotics shortly before a surgical intervention. A so-called prolonged prophylaxis including the postoperative period (e.g. 1-3 days postoperatively) should be avoided as it does not reduce the number of wound infections and is associated with an increased risk of antimicrobial resistance and side effects. Antimicrobial management of severe intra-abdominal infections involves a delicate balance of optimizing empirical therapy which has been shown to improve outcomes while simultaneously reducing unnecessary use of antimicrobials. Conclusion: Antimicrobial resistance poses a serious threat to human health and requires a rational use of antibiotics to curb further spreading. This applies for perioperative prophylaxis as well as for the treatment of intra-abdominal infections.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 1","pages":"310 - 316"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368582","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64746962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiosis of Necrotizing Pancreatitis.","authors":"Alexander Arlt,&nbsp;Wiebke Erhart,&nbsp;Clemens Schafmayer,&nbsp;Hanns-Christoph Held,&nbsp;Jochen Hampe","doi":"10.1159/000367948","DOIUrl":"https://doi.org/10.1159/000367948","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing pancreatitis is a life-threatening presentation of acute pancreatitis. The mortality of 20-80% initially depends on the persistence of organ failure and systemic inflammatory response syndrome (SIRS) and, in the later course of the disease, on secondary infection of the necrosis. The questions whether prophylactic antibiotics aiming to prevent this infection should be administered and which antibiotic is the best to use, as well as the problem of fungal infection under antibiotic treatment are still intriguing and insufficiently solved.</p><p><strong>Methods: </strong>A search of the literature using PubMed was carried out, supplemented by a review of the programmes of the Digestive Disease Week (DDW) and the United European Gastroenterology Week (UEGW).</p><p><strong>Results: </strong>Despite the widely practised prophylactic antibiotic administration in severe pancreatitis, no evidence for the benefit of this strategy exists. One of the drawbacks might be a tendency for disastrous fungal infection under prophylactic antibiotics. Bacterial translocation from the gut in the second week after the onset of symptoms is the major source for infection of pancreatic necrosis and provides a clear indication for antibiotic treatment. However, routine fine-needle aspiration for a calculated antibiotic therapy cannot be recommended, and all other tests offer only indirect signs. Important factors such as enteral versus parenteral feeding and the method of necrosectomy are mostly neglected in the trials but seem to be essential for the outcome of the patient.</p><p><strong>Conclusions: </strong>Even though most meta-analyses including the newer double-blind, placebo-controlled trials on prophylactic antibiotics showed no beneficial effects in the prevention of infection of necrosis and/or outcome of the patients, this strategy is still widely used in clinical routine. Since nearly all trials published so far show systematic problems (i.e. inaccurate definition of the severity of the disease, poor statistical testing, and neglect of differences in the route of nutrition), there is a need for randomized controlled prospective trials with exact definitions of the disease.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"30 5","pages":"318-24"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000367948","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33934017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}