Article of interest: Endoscopy in the early postoperative setting after primary gastrointestinal anastomosis

Amr MA, et al. Endoscopy in the early postoperative setting after primary gastrointestinal anastomosis. J Gastrointest Surg. 2014 Nov;18(11):1911-6. Full-text for Emory users.

Methods: Review of patients from 2002 to 2013 who underwent flexible endoscopy within 6 weeks of creation of gastrointestinal anastomosis. Exclusion criteria included intraoperative endoscopy, anastomotic perforation prior to endoscopy, and endoscopy remote from the anastomotic site. Data are presented as median (interquartile range; IQR) or percentages as appropriate.

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Pneumobilia versus portal venous gas

“Pneumobilia should be differentiated from portal venous gas. Portal venous gas is peripherally distributed to within 2 cm of the liver margin, whereas pneumobilia is centrally distributed.” (Gupta, P, et al. “PLAIN FILMS: BASICS.” Acute Care Surgery: Imaging Essentials for Rapid Diagnosis Eds. Kathryn L. Butler, et al. McGraw Hill, 2015.)

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Pathologies of acute tubular necrosis

Perazella MA. Clinical Approach to Diagnosing Acute and Chronic Tubulointerstitial Disease. Adv Chronic Kidney Dis. 2017 Mar;24(2):57-63. Full-text for Emory users.

Abbreviations: ATIN, acute tubulointerstitial nephritis; CTIN, chronic
tubulointerstitial nephritis; NSAIDs, nonsteroidal anti-inflammatory
drugs; PPIs, proton pump inhibitors; SLE, systemic lupus erythematosis;
TIN, tubulointerstitial nephritis; TINU, tubulointerstitial nephritis
uveitis; DRESS, drug related eosinophilia systemic syndrome. (Perazella, p. 59)
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Parathyroidectomy in the management of tertiary hyperparathyroidism

Ferreira GF, et al. Parathyroidectomy after kidney transplantation: short-and long-term impact on renal function. Clinics (Sao Paulo). 2011;66(3):431-5. Free full-text.

Materials and methods: This was a retrospective case-controlled study. Nineteen patients with persistent hyperparathyroidism underwent parathyroidectomy due to hypercalcemia. The control group included 19 patients undergoing various general and urological operations.

Results: In the parathyroidectomy group, a significant increase in serum creatinine from 1.58 to 2.29 mg/dl (P < 0.05) was noted within the first 5 days after parathyroidectomy. In the control group, a statistically insignificant increase in serum creatinine from 1.49 to 1.65 mg/dl occurred over the same time period. The long-term mean serum creatinine level was not statistically different from baseline either in the parathyroidectomy group (final follow-up creatinine = 1.91 mg/dL) or in the non-parathyroidectomy group (final follow-up creatinine = 1.72 mg/dL).

Conclusion: Although renal function deteriorates in the acute period following parathyroidectomy, long-term stabilization occurs, with renal function similar to both preoperative function and to a control group of kidney-transplanted patients who underwent other general surgical operations by the final follow up.

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Colorectal surgery in cirrhotic patients

Paolino J, Steinhagen RM. Colorectal surgery in cirrhotic patients. ScientificWorldJournal. 2014 Jan 15;2014:239293. Free full-text.

Patients with cirrhosis have a greater risk of morbidity and mortality following colorectal surgery. Therefore, preoperative medical optimization and risk assessment using criteria such as the MELD score are vital in preventing complications. Some risk factors include age, urgency of surgery, and ASA score. Postoperative morbidity and mortality are related to portal hypertension, ascites, infection, and anastomotic and stomal complications. This review highlights the assessment of risk and perioperative management of cirrhotic patients undergoing colorectal surgery.

ISPD peritonitis guideline recommendations: 2022 update on prevention & treatment

Li PK, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int. 2022 Mar;42(2):110-153. Free full-text.

Abstract: The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year.

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Loeys-Dietz Syndrome

Velchev JD, Van Laer L, Luyckx I, Dietz H, Loeys B. Loeys-Dietz Syndrome. Adv Exp Med Biol. 2021;1348:251-264. Full-text for Emory users.

From: Table 11.1. Clinical features at initial diagnosis of LDS. (Velchev JD, et al., p. 253.)

  • Vascular findings
    • Arterial tortuosity 92%
      • Most common in head and neck vessels
        • Carotids (55%)
        • Vertebral (56%)
        • Intracranial (37%)
        • Ascending aorta (5%), aortic arch (10%)
        • Descending thoracic (4%) or abdominal
        • (7%) Ao, also other vessels (e.g. iliacs)
  • Aneurysms
    • Aorta
      • Root 87%
      • Ascending 27%
      • Arch 10%
      • Desc thoracic 15%
      • Abdominal 12%
    • Vessel beyond Ao 30%
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