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Current indications and role of surgery in the management of sigmoid diverticulitis

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World Journal of Gastroenterology 2010年第7期16卷 804-817页

作者： Luca Stocchi department of colorectal Surgery Digestive Disease InstituteCleveland ClinicClevelandOH 44195United States

Sigmoid diverticulitis is a common disease which carries both a significant morbidity and a societal economic *** review article analyzes the current data regarding management of sigmoid diverticulitis in its variable clinical ***-spectrum antibiotics are the standard of care for uncomplicated *** published data indicate that sigmoid diverticulitis does not mandate surgical management after the second episode of uncomplicated disease as previously ***,a more individualized approach,taking into account frequency,severity of the attacks and their impact on quality of life,should guide the indication for *** the other hand,complicated diverticular disease still requires surgical treatment in patients with acceptable comorbidity risk and remains a life-threatening condition in the case of free peritoneal *** surgery is increasingly accepted as the surgical approach of choice for most presentations of the disease and has also been proposed in the treatment of generalized *** is not sufficient evidence supporting any changes in the approach to management in younger ***,the available evidence suggests that surgery should be indicated after one attack of uncomplicated disease in immunocompromised *** clinical presentations of sigmoid diverticulitis and their possible association with inflammatory bowel disease are also discussed.

关键词： Sigmoid diverticulitis Diverticulitis management Diverticulitis surgery Acute diverticulitis Complicated diverticulitis Perforated diverticulitis Laparoscopic colectomy

Primary sclerosing cholangitis and the risk of colon neoplasia in patients with Crohn’s colitis

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Gastroenterology Report 2016年第3期4卷 226-231,I0002页

作者： Udayakumar Navaneethan Tarun Rai Preethi GK Venkatesh Ravi P Kiran department of Gastroenterology Digestive disease InstituteThe Cleveland ClinicClevelandOHUSA department of colorectal Surgery Digestive disease InstituteThe Cleveland ClinicClevelandOHUSA

Background and aim:Crohn’s colitis(CC)is associated with primary sclerosing cholangitis(PSC).However the risk of colon cancer or dysplasia in CC and PSC is *** aim was to study the risk of colon neoplasia in CC in patients with and without ***:This is a nested,case-control cohort study of all patients diagnosed with concurrent CC and PSC,seen at the Cleveland Clinic between 1985 and ***-three patients with both CC and PSC were compared with a random sample of 159 CC controls without PSC during the same ***:Seven(16.3%)of 43 CC patients with PSC developed colon cancer or dysplasia,compared with 22(13.8%)of 159 controls(P=0.98).Of seven colon neoplasia cases in the PSC group,100%occurred proximal to the splenic flexure,compared with 50%(11/22)cases of colon neoplasia in controls occurring in the proximal colon(P=0.001).Based on Cox regression analysis,male gender independently increased the risk of neoplasia[hazard ratio(HR)=2.68;95%confidence interval(CI)1.30-5.54;P=0.008],as did age at CC diagnosis(HR=1.29;95%CI 1.14-1.47;P<0.001),while the use of azathioprine/6-mercaptopurine was protective(HR=0.30;95%CI 0.13-0.70;P=0.005).The presence of PSC did not increase the risk for colon neoplasia(HR=0.45;95%CI 0.18-1.13;P=0.09).Conclusions:CC patients with PSC appear not to be at increased risk of developing colon *** patients in our cohort with colon neoplasia and concurrent PSC,the neoplasia occurred in the proximal colon in all cases.

关键词： Crohn’s colitis primary sclerosing cholangitis colon neoplasia

Role of Tenascin-X in regulating TGF-β/Smad signaling pathway in pathogenesis of slow transit constipation

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World Journal of Gastroenterology 2020年第7期26卷 717-724页

作者： Yi-Chao Zhang Bao-Xiang Chen Xiao-Yu Xie Yan Zhou Qun Qian Cong-Qing Jiang department of colorectal and Anal Surgery of Zhongnan Hospital of Wuhan University Clinical Center of Intestinal and Colorectal Diseases of Hubei Province Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University) Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University) Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province

BACKGROUND Chronic constipation is a gastrointestinal functional disease that seriously harms physical and mental health and impacts the quality of life of *** incidence rate is 2%-27%.Slow transit constipation(STC)is a common type of chronic functional constipation,accounting for 10.3%-45.5%of such *** have performed many studies on the pathogenesis of *** studies have indicated that the occurrence of STC may be related to multiple factors,such as dysfunction of the enteric nervous system,interstitial cells of Cajal(ICC)damage,and changes in neurotransmitters regulating intestinal *** To investigate the role of Tenascin-X(TNX)in regulating the TGF-β/Smad signaling pathway in the pathogenesis of *** This study included an experimental group and a control *** experimental group included 28 patients with severe colonic STC,and the control group included 18 patients with normal colon ***(IHC)was used to detect c-Kit,a specific marker of the *** blot,immunofluorescence,and IHC were used to detect the localization and expression of TNX and TGF-β/*** IHC showed that the number of ICC with positive c-Kit expression was significantly reduced in the colon of STC patients(22.17±3.28 vs 28.69±3.53,P0.8)and TGF-β(P<0.05,|R|=0.7).CONCLUSION The extracellular matrix protein TNX may activate the TGF-β/Smad signaling pathway by upregulat

关键词： Slow transit constipation Tenascin-X Extracellular matrix glycoproteins TGF-β

Controversies in the pathological assessment of colorectal cancer

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World Journal of Gastroenterology 2014年第29期20卷 9850-9861页

作者： Aoife Maguire Kieran Sheahan department of Histopathology and Centre for colorectal disease St.Vincent’s University Hospital School of Medicine and Medical Science University College Dublin

Pathologic assessment of colorectal cancer specimens plays an essential role in patient management,informing prognosis and contributing to therapeutic decision *** tumor-node-metastasis(TNM)staging system is a key component of the colorectal cancer pathology report and provides important prognostic *** there is significant variation in outcome of patients within the same tumor *** other histological features such as tumor budding,vascular invasion,perineural invasion,tumor grade and rectal tumor regression grade that may be of prognostic value are not part of TNM *** of extramural tumor deposits and peritoneal involvement contributes to TNM staging but there are some difficulties with the definition of both of these *** in colorectal cancer pathology reporting include the subjective nature of some of the elements assessed,poor reporting rates and reproducibility and the need for standardized examination protocols and *** pathology is becoming increasingly important in prognostication and prediction of response to targeted therapies but accurate morphology still has a key role to play in colorectal cancer pathology reporting.

关键词： colorectal cancer Staging Prognosis Histopathology Tumor-node-metastasis

Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn’s disease

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Gastroenterology Report 2018年第2期6卷 114-121,I0002页

作者： Nan Lan Luca Stocchi Yi Li Bo Shen Center for Inflammatory Bowel disease and Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA department of colorectal Surgery Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA

Background:We have previously demonstrated that blood transfusion(BT)was associated with post-operative complications in patients undergoing surgery for Crohn’s disease(CD),based on our institutional data *** aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program(ACS NSQIP)***:All CD patients undergoing surgery between 2005 and 2013 were identified from *** were defined according to the ACS NSQIP *** primary outcome was infectious complications,including superficial,deep and organ/space surgical site infection,wound dehiscence,urinary tract infection,pneumonia,systemic sepsis and septic *** analyses were performed to assess the risk factors for post-operative ***:All 10100 eligible patients were included and 611(6.0%)received perioperative *** patients were older,lighter in weight and more likely to be functionally *** patients were more likely to have post-operative infectious complications than those without BT,including superficial surgical site infection(SSI)(10.8%vs 7.4%,p¼0.002),deep SSI(3.3%vs 1.6%,p¼0.003),organ/space SSI(14.2%vs 5.4%,pdisease,diabetes,hypertension and the use of ***-operative BT,however,was not found to be a risk factor to post-operative ***:Intra-and/or post-operative,not p

关键词： blood transfusion Crohn’s disease infectious complications surgical outcomes

Evolution of continent ileostomy

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World Journal of Gastroenterology 2012年第27期18卷 3479-3482页

作者： Gurel Nessar James S Wu department of Gastrointestinal Surgery Yuksek Ihtisas HospitalAnkara 06100Turkey department of colorectal Surgery Digestive Disease InstituteClevelandOH 44195United States

Continent ileostomy can be defined as a surgical procedure that facilitates planned intermittent evacuation of a bowel reservoir through an *** was devised by Nils Kock in ***,continent ileostomy (or Kock pouch) became a viable alternative in the management of patients who had traditionally required an end *** pouch appeared to provide substantial physical and psychosocial benefits over a conventional *** procedure became popular until ileal pouch anal anastomosis (IPAA) was introduced in *** its benefits,continent ileostomy had many short term complications including intubation problems,ileus,anastomotic leaks,peritonitis and valve *** mortalities have also been reported in the *** of these problems have been eliminated with increasing experience;however,valverelated problems remain as an "Achilles' heel" of the *** modifications have been introduced to prevent this *** patients have had their pouch removed because of complications mainly related to valve *** revision rates can be high,most of the patients who retain their reservoirs are satisfied with regard to their health status and quality of ***,this procedure is still appropriate for selected patients for whom pouch surgery is not possible or for patients who have failed *** the patient and their physician must be highly motivated to accept the risk of failure and the subsequent need for revisional operations.

关键词： Continent ileostomy Kock pouch Ileal res-ervoir Surgical technique

Massive presacral bleeding during rectal surgery: From anatomy to clinical practice

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World Journal of Gastroenterology 2013年第25期19卷 4039-4044页

作者： Zheng Lou Wei Zhang Rong-Gui Meng Chuan-Gang Fu department of colorectal Surgery Changhai Hospital

AIM: To investigate control of two different types of massive presacral bleeding according to the anatomy of the presacral venous system. METHODS: A retrospective review was performed in 1628 patients with middle or low rectal carcinoma who were treated surgically in the department of colorectal Surgery, Changhai Hospital, Shanghai, China from January 2008 to December 2012. In four of these patients, the presacral venous plexus (n = 2) or basivertebral veins (n = 2) were injured with massive presacral bleeding during mobilization of the rectum. The first two patients with low rectal carcinoma were operated upon by a junior associate professor and the source of bleeding was the presacral venous plexus. The other two patients with recurrent rectal carcinoma were both women and the source of bleeding was the basivertebral ***: Two different techniques were used to con-trol the bleeding. In the first two patients with massive bleeding from the presacral venous plexus, we used suture ligation around the venous plexus in the area with intact presacral fascia that communicated with the site of bleeding (surrounding suture ligation). In the second two patients with massive bleeding from the basivertebral veins, the pelvis was packed with gauze, which resulted in recurrent bleeding as soon as it was removed. Following this, we used electrocautery applied through one epiploic appendix pressed with a long Kelly clamp over the bleeding sacral neural foramen where was felt like a pit Electrocautery adjusted to the highest setting was then applied to the clamp to "weld" closed the bleeding point. Postoperatively, the blood loss was minimal and the drain tube was removed on days 4-7. CONCLUSION: Surrounding suture ligation and epiploic appendices welding are effective techniques for controlling massive presacral bleeding from presacral venous plexus and sacral neural foramen, respectively.

关键词： Massive presacral bleeding Rectal surgery Suture ligation Welding

Value of routine stool testing for pathogenic bacteria in the evaluation of symptomatic patients with ileal pouches

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Gastroenterology Report 2018年第2期6卷 93-100,I0001页

作者： Amandeep Singh Jean Ashburn Gursimran Kochhar Rocio Lopez Tracy L.Hull Bo Shen department of Gastroenterology&Hepatology Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA department of colorectal Surgery Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA department of Quantitative Health Sciences Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandOHUSA

Background:In symptomatic patients with an ileal pouch,stool studies are often sent to diagnose enteric *** of this study is to find the value of routine stool studies in the evaluation of symptomatic patients and the clinical implications of such pathogens in patients with ileal ***:Consecutive ileal pouch-anal anastomosis(IPAA)patients who had stool tests out of a 2283-case registry from 2002 to 2015 were included in the *** with positive stool cultures were compared with controls(symptomatic without positive stool culture)in a 1:4 *** to antibiotic therapy,recurrence rate and rate of hospitalization at 1 and 3 months were ***:A total of 643(28%)had stool cultures done and only 1.7%(11/643)were found to be positive for stool *** spp.(45%)was the most common pathogen followed by Aeromonas spp.(36%).Non-smokers and patients without any antibiotic use in the last 3 months were found to have higher prevalence of positive stool cultures than controls(pdisease course of *** clinical utility of routine stool culture in those patients warrants further study.

关键词： pouchitis ileal pouch enteric pathogens stool culture

Unexplainable development of a hydatid cyst

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World Journal of Gastroenterology 2009年第26期15卷 3309-3311页

作者： Antonio Di Cataldo Rosalia Latino Aldo Cocuzza Giovanni Li Destri department of Digestive and colorectal Surgery University of Catania

Echinococcosis is a cyclozoonosis characterized by cystic lesions usually situated inside or outside the liver. We discuss the case of a 77-year-old woman with a recurrent hydatidosis with a cyst arising from the liver, growing through the lateral right abdomen wall, and reaching the subcutaneous tissue of the lumbar region. In the literature, rare subcutaneous or muscular Iocalizations of hydatid cysts are described, however, there is no mention of a cyst growing over the abdominal wall muscles, shaped like an hourglass, partially in the liver and partially in the subcutaneous tissue, as in our case. We have not found any pathogenetic explanation for this growth pattern which is not typical of the biological behaviour of a hydatid cyst.

关键词： Echinococcosis Growth Hepatic Hydatid cyst Pathogenesis