Visceral Medicine最新文献

{"title":"The Role of Magnesium in Acute Pancreatitis and Pancreatic Injury: A Systematic Review.","authors":"Ilaria Pergolini, Stephan Schorn, Helmut Friess, Ihsan Ekin Demir","doi":"10.1159/000540507","DOIUrl":"https://doi.org/10.1159/000540507","url":null,"abstract":"<p><strong>Introduction: </strong>As natural calcium (Ca) antagonist, magnesium (Mg) seems to counteract Ca-signaling pathways involved in the intracellular protease activation leading to acute pancreatitis. We systematically reviewed the current literature to investigate the role of Mg in the pathogenesis of acute pancreatitis and its possible use in detecting, predicting, and preventing acute pancreatitis.</p><p><strong>Methods: </strong>A systematic search was performed in PubMed/Scopus/Web of Science to identify in vivo and in vitro studies reporting data on Mg in acute pancreatitis.</p><p><strong>Results: </strong>Twelve studies were included. Due to their heterogeneity, we conducted a review without the intent of inference. Mg deficiency in pancreatic acinar cells seems to be frequently associated with serum hypocalcemia and acute pancreatitis. Mg seems to contrast intracellular Ca accumulation which induces premature enzyme activation and acute pancreatitis. Several in vivo and in vitro experiments showed beneficial effects of Mg supplementation in counteracting Ca-signaling pathways and subsequent pathological events. Moreover, a recent randomized trial demonstrated the efficacy of Mg supplementation in reducing the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in high-risk patients.</p><p><strong>Conclusion: </strong>Mg is a natural antagonist of Ca-signaling pathways and, when deficient, predisposes to acute pancreatitis. Mg supplementation may be useful to prevent acute pancreatitis in many contexts, such as post-ERCP or after pancreatic surgery. The heterogeneity of the included studies represents an important limitation that may hinder robust conclusions.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"40 5","pages":"264-275"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastroesophageal Reflux Disease: Still a Complex and Complicated Disease with Many Uncertainties and Challenges.","authors":"Joachim Labenz, Yves Borbély","doi":"10.1159/000540531","DOIUrl":"https://doi.org/10.1159/000540531","url":null,"abstract":"","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"40 5","pages":"233-235"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Early Removal of Urinary Catheter in Patients Undergoing Abdominal and Thoracic Surgeries with Continuous Thoracic Epidural Analgesia on Postoperative Urinary Retention.","authors":"Ahmed Alwali, Ernst Klar, Imad Kamaleddine, Aenne Glass, Matthias Leuchter, Clemens Schafmayer, Eberhard Grambow","doi":"10.1159/000540740","DOIUrl":"https://doi.org/10.1159/000540740","url":null,"abstract":"<p><strong>Background: </strong>Postoperative continuous thoracic epidural analgesia (TEA) is an integral aspect of pain management after major abdominal and thoracic surgery. Under TEA, postoperative urinary retention (POUR) is frequently noted, prompting a common practice of maintaining the transurethral catheter (UC) until the cessation of TEA to avoid the necessity for reinsertion of the UC. This study analyzes the effect of an early bladder catheter removal during TEA on POUR incidence.</p><p><strong>Methods: </strong>The retrospective study was conducted on 71 patients undergoing elective abdominal and thoracic operations with TEA for postoperative pain control. Patients were divided into two groups based on the UC removal time in relation to the epidural catheter removal. In the early removal group (ERG), the UC was removed within 3 days of surgery, while in the standard group (SG), it was removed after completion of TEA. All patients in the ERG were still receiving TEA at the time of the UC removal. The primary outcome assessed was the incidence of POUR, while secondary outcomes included urinary tract infections (UTI), hospital length of stay (LOS), and patient's comfort.</p><p><strong>Results: </strong>The overall prevalence of POUR was 7%, with five POUR cases - two (4.9%) of 41 patients in SG and three (10%) of 30 in ERG (<i>p</i> = 0.644). No significant difference was found in POUR occurrence between ERG and SG (<i>p</i> = 0.644). Additionally, no UTIs were observed in the study. The postoperative pain scores (visual analog scale [VAS]) 72 h and 96 h and the LOS (SG: 16.74 [±8.39] days; ERG: 14.53 [±6.99] days; <i>p</i> = 0.3) were similar between both study groups.</p><p><strong>Conclusion: </strong>Based on our results, it can be concluded that the removal of UC in the early postoperative period, even during TEA, can be performed safely without significantly increasing the risk of recatheterization.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"40 5","pages":"256-263"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Resection of Neoplasia in the Lower GI Tract: A Clinical Algorithm.","authors":"Timothy O'Sullivan, Michael J Bourke","doi":"10.1159/000539219","DOIUrl":"10.1159/000539219","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is a highly prevalent malignancy and a significant driver of cancer mortality and health-related expenditure worldwide. Polyp removal reduces the incidence and mortality of colorectal cancer. In 2024, endoscopists have an array of resection modalities at their disposal. Each technique requires a unique skillset and has individual advantages and limitations. Consequently, resection in the colorectum requires an evidence-based algorithm approach that considers these factors.</p><p><strong>Summary: </strong>A literature review of endoscopic resection for colonic neoplasia was conducted. Best supporting scientific evidence was summarized for the endoscopic resection of diminutive polyps, large ≥20 mm lesions and polyps containing invasive cancer. Factors including resection modality, complications and lesion selection were explored to inform an algorithm approach to colorectal resection.</p><p><strong>Key messages: </strong>Endoscopic resection in the colorectum is not a one-size-fits-all approach. Detailed understanding of polyp size, location, morphology and predicted histology are critical factors that inform appropriate endoscopic resection practice.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"40 4","pages":"217-227"},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11326768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopy First: The Best Choice to Optimize Outcomes for Early Gastrointestinal Malignancy.","authors":"Konstantinos Kouladouros, Michael J Bourke","doi":"10.1159/000539178","DOIUrl":"10.1159/000539178","url":null,"abstract":"","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"40 3","pages":"107-109"},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11166897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatocellular Carcinoma: The Role of Surgery in Liver Cirrhosis.","authors":"Dominik T Koch, Fabian Horné, Matthias P Fabritius, Jens Werner, Matthias Ilmer","doi":"10.1159/000535782","DOIUrl":"10.1159/000535782","url":null,"abstract":"<p><strong>Background: </strong>Liver surgery is an essential component of hepatocellular carcinoma (HCC) treatment. Advances in surgical techniques and perioperative care have improved outcomes and have helped to expand surgical indications. However, liver fibrosis and cirrhosis still remain major problems for liver surgery due to the relevant impact on liver regeneration of the future liver remnant (FLR) after surgery. Especially in patients with clinically significant portal hypertension due to liver cirrhosis, surgery is limited. Despite recent efforts in developing predictive models, estimating the postoperative hepatic function remains difficult.</p><p><strong>Summary: </strong>In this review, we focus on the role of surgery in the treatment of HCC in structurally altered livers. The importance of assessing FLR with techniques such as contrast-enhanced CT, e.g., with the help of artificial intelligence is highlighted. Moreover, strategies for increasing the FLR with approaches like portal vein embolization and liver vein deprivation prior to surgery are discussed. Patient selection, minimally invasive liver surgery including robotic techniques, and perioperative concepts like the Enhanced Recovery After Surgery (ERAS) guidelines are identified as crucial parts of avoiding posthepatectomy liver failure.</p><p><strong>Key message: </strong>The need for ongoing research to optimize patient selection criteria and perioperative care and to develop innovative biomarkers for outcome prediction is emphasized.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"40 1","pages":"20-29"},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Challenge of Anticoagulation in Liver Cirrhosis.","authors":"Julia Carolin Eichholz, Heiner Wedemeyer, Benjamin Maasoumy","doi":"10.1159/000535438","DOIUrl":"10.1159/000535438","url":null,"abstract":"<p><strong>Background: </strong>Advanced liver diseases are characterized by a number of changes in the hemostatic system. Due to the occurrence of bleeding events in patients with liver cirrhosis, there seems to be a hesitance to the administration of anticoagulant medications. This review summarizes challenges, recommendations, and current developments of anticoagulation in the cirrhotic patient.</p><p><strong>Summary: </strong>The risk of thrombotic events in patients with liver cirrhosis is at least as high as in patients with healthy liver function if not even higher. Standard laboratory markers do not truly reflect the complexity of changes that take place in the coagulative system and therefore cannot be used as a reference for risk of thrombosis or hemorrhage. Potential options for anticoagulant therapy are heparins, vitamin K antagonists, and direct-acting oral anticoagulants which come with differences in safety, application, possible side effects, and data availability for the patient cohort.</p><p><strong>Key message: </strong>The administration of anticoagulation can be beneficial in patients with liver disease if the indication is present and bleeding prophylaxis has been established. Direct-acting oral anticoagulants appear to be a promising new approach with many improvements compared to conventional substances. Nevertheless, there is a need for further data and prospective trials on the use in patients with liver cirrhosis.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 6","pages":"169-176"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline Interleukin-6 as a Preoperative Biomarker for Liver Fibrosis.","authors":"Dominik Thomas Koch, Dionysios Koliogiannis, Moritz Drefs, Malte Schirren, Viktor von Ehrlich-Treuenstätt, Hanno Nieß, Bernhard Renz, Matthias Ilmer, Joachim Andrassy, Markus O Guba, Jens Werner, Florian Kühn","doi":"10.1159/000535627","DOIUrl":"10.1159/000535627","url":null,"abstract":"<p><strong>Introduction: </strong>Liver (hepatic) fibrosis (LF) is characterized by impaired function and regenerative capacity of the liver and can lead to significantly increased morbidity and mortality in the context of surgical liver resection (LR). For this reason, it is crucial to identify the extent of LF preoperatively. Interleukin-6 (IL-6) is known to play a key role in the pathogenesis of LF, but its exact value as a preoperative marker is unknown. This study aimed to investigate the correlation between preoperatively determined IL-6 and the presence of LF.</p><p><strong>Methods: </strong>In this prospective study, IL-6 was determined in 134 consecutive patients undergoing LR. Patients with liver cirrhosis (LC) and patients with clinical or laboratory signs of inflammation were excluded. LF was graded by a blinded pathologist with regard to the degree of LF according to the Desmet classification (0-4). Baseline IL-6 and degree of LF were correlated.</p><p><strong>Results: </strong>A total of 134 patients were prospectively included prior to LR. For 104 patients, LF was graded and inflammatory parameters were available. Thirty-five of these patients showed LC (Desmet 4), and another 33 patients showed preoperatively elevated inflammatory markers. Two of the remaining patients were liver transplant patients. These patients were excluded from the final analysis. According to Desmet, the remaining 34 patients had LF grade 0 or 1 (none or minimal LF) in 26 cases and LF grade 2 or 3 (moderate-to-severe LF) in 8 cases. Correlation of LF with preoperatively determined IL-6 yielded significantly higher IL-6 levels in the group of patients with moderate-to-severe LF (Desmet 2 or 3) compared to the group with none or minimal LF (Desmet 0 or 1; <i>p</i> = 0.0495).</p><p><strong>Conclusion: </strong>In the context of LR, our results showed a correlation of preoperatively determined IL-6 with the extent of LF present. Higher serum baseline IL-6 concentrations were associated with a higher degree of LF, whereas no other blood parameter or score was that predictive for LF. Our results suggest that baseline IL-6 might serve as a valuable parameter to assess LF prior to LR. More patients need to be analyzed to further evaluate and confirm the predictive accuracy of IL-6 for LF.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"39 6","pages":"184-192"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiota Manipulation as an Emerging Concept in Cancer Therapy","authors":"M. Spalinger, Michael Scharl","doi":"10.1159/000534810","DOIUrl":"https://doi.org/10.1159/000534810","url":null,"abstract":"Background: The human body is colonized by billions of bacteria that provide nutrients to the host, train our immune system, and importantly affect our heath. It has long been suggested that microbes might play a role in tumor pathogenesis; however, compelling evidence was only provided in the past decades when novel detection methods that do not depend on culturing techniques had been developed. Summary: The microbiome impacts tumor development and anti-tumor therapies on various levels. Bacteria can promote or suppress tumor growth via direct interactions with cancer cells, production of metabolites that promote or inhibit tumor growth, and via stimulation or suppression of the local and systemic immune response. Cancer patients harbor a distinct microbiome when compared to healthy controls, which could potentially be employed to detect, identify, and treat cancer. Manipulation of the microbiome either via supplementation of single strains, bacterial consortia, fecal microbiota transfer or the use of pre- and probiotics has been suggested as therapeutic approach to directly target tumor growth or to enhance the efficacy of current state-of-the-art treatment options. Key Messages: (1) Bacteria have a tremendous impact on anti-cancer immune responses. (2) Cancer patients harbor a distinct microbiome when compared to healthy controls. (3) The microbiome seems to be cancer-type specific. (4) Exploitation of bacteria to promote anti-tumor therapy is a novel, very promising venue in cancer treatment.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"33 21","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139008976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Open-Pore Film Drainage Systems in Endoscopic Vacuum Therapy: Current Status and Review of the Literature","authors":"Konstantinos Kouladouros, Dörte Wichmann, Gunnar Loske","doi":"10.1159/000535029","DOIUrl":"https://doi.org/10.1159/000535029","url":null,"abstract":"Background: Endoscopic vacuum therapy (EVT) is an increasingly popular endoscopic technique used for the treatment of wall defects in the gastrointestinal tract. Open-pore film drainage (OFD) systems are a new addition to the armamentarium of EVT and have shown encouraging results in a wide spectrum of applications. The aim of this review is to summarize the current literature on the applications of OFD systems in the gastrointestinal tract. Summary: Open-pore film drainage (OFD) systems have been used for the treatment of several defects of the gastrointestinal tract. The small size and easy placement of these devices make them very useful, particularly for the treatment of defects that are small in size or difficult to reach. OFDs have been successfully used for both perforations and anastomotic leaks in various locations, with most reports focusing on the treatment of duodenal defects, although successful applications in the esophagus, stomach, and colon have also been reported. Lately, the role of OFDs in preemptive EVT has also been explored. Key Messages: OFD systems are easy to use, particularly for small defects and challenging localizations. The current literature, consisting mainly of small case series and case reports, shows encouraging results, but further prospective studies are needed to explore and verify the indications and technical aspects of this innovative method.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"43 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138979299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}