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1.
G. E. Theodoropoulos T. Karantanos P. Stamopoulos G. Zografos 《Techniques in coloproctology》2013,17(1):27-38
Background
The aim of the present study was to prospectively determine health-related quality of life (HRQoL) changes and affecting factors after elective laparoscopic colectomy for cancer.Methods
The SF-36, EORTC QLQ-C30 and QLQ-CR29, and Gastrointestinal Quality of life Index (GIQLI) were used to assess 85 patients preoperatively and at 1, 3, 6, and 12 months.Results
An initial drop form baseline values was observed in 3 of 8 SF-36 domains, 3 of 5 QLQ-C30 functional scales and 1 of 5 GIQLI subscales. Emotional functioning (EF) was better postoperatively even from the first month (p = 0.03). Most functional domains were improved compared to baseline. The statistically significant changes (p < 0.05) were in the SF-36: general health (GH) (3 months), physical function (PF) (12 months) and role limitations due to emotional problems (12 months); in the QLQ-C30: EF (12 months); in the GIQLI: the global score and PF at 12 months and EF (3, 6, 12 months). From the first month after surgery, most QLQ-C30 “symptom” items were better than baseline. QLQ-CR29 “anxiety” and the “defecation problems” scales were significantly better than baseline at 1, 12 and at 6, 12 months (p < 0.05). Advanced stage (III) and chemotherapy were linked to worse EF, social function (SF), GH and global quality of life (QOL) at 3 and 6 months (p < 0.01). Males appeared to have a worse HRQoL than females at 3 and 6 months, and in 5 of 8 SF-36 domains and 3 of 5 GIQLI subscales at 12 months (p < 0.05). According to the QLQ-CR29, rectal surgery was associated more often with “impotence,” “stoma problems” and “incontinence” up to 6 months, and ostomies with “embarrassment” and “stoma problems” (p < 0.05).Conclusions
HRQoL generally improved over the first year after laparoscopic colectomy reaching even better levels than before surgery. There was an early postoperative improvement in patients’ emotional status. The main factors affecting HRQoL seem to be tumor stage, chemotherapy and male sex. 相似文献2.
Q. Qian C. Jiang Y. Chen Z. Ding Y. Wu K. Zheng Q. Qin Z. Liu 《Techniques in coloproctology》2014,18(7):629-634
Background
The aim of this study was to evaluate outcomes of total colonic exclusion with antiperistaltic ileorectal anastomosis (TCE-AIA) for elderly patients with slow transit constipation (STC).Methods
Elderly patients (defined as age >65) who underwent TCE-AIA for severe idiopathic STC between 2009 and 2012 at our institution were identified. Postoperative outcomes and routine follow-up were assessed using the Wexner constipation score (WCS), gastrointestinal quality of life index (GIQLI) and four-point postoperative satisfaction scales.Results
A total of 13 elderly patients were met the inclusion criteria. Five patients (38.5 %) were male, and eight patients (61.5 %) were female. The mean age of this population was 74 years (range 63–82 years). The mean operative time was 55 min (range 28–32), and blood loss was minimal. The mean postoperative hospital stay was 6.7 days (range 5–12 days). The mean time until the first postoperative bowel movement was 4 days (range 2–8 days). There was no procedure-related mortality and no major in-hospital complications. The median duration of follow-up was 12.4 months (range 6–29 months). None of the 13 patients had fecal incontinence or recurrence of constipation at the follow-up end point. However, eight patients underwent colonoscopy during follow-up, and four patients presented with diversion colitis. The patients’ preoperative WCS was 22.8 ± 3.3, and it had significantly improved to 5.4 ± 2.1 on 6 months after operation (p < 0.05). The preoperative GIQLI of 93.6 ± 20.5 had significantly increased to 120.8 ± 13.0 on 6 months after surgery (p < 0.05). Patient satisfaction at 6 months was very high in 11 patients and high in two patients.Conclusions
TCE-AIA is a relatively simple procedure. It might be an effective surgical intervention for the selected elderly patients with STC. 相似文献3.
Uday C. Ghoshal Philip Abraham Shobna J. Bhatia Sri Prakash Misra Gourdas Choudhuri K. D. Biswas Karmabir Chakravartty Sunil Dadhich B. D. Goswami V. Jayanthi Sunil Kumar Abraham Koshy K. R. Vinay Kumar Govind Makharia Sandeep Nijhawan Nitesh Pratap Gautam Ray Sanjeev Sachdeva Shivaram Prasad Singh Varghese Thomas Harsh Udawat 《Indian journal of gastroenterology》2013,32(6):369-375
Background
Attempts to diagnose and subtype irritable bowel syndrome (IBS) by symptom-based criteria have limitations, as these are developed in the West and might not be applicable in other populations.Objectives
This study aimed to compare different criteria for diagnosing and subtyping of IBS in India.Method
Manning's and the Rome I, II, and III criteria as well as the Asian criteria were applied to 1,618 patients (from 17 centers in India) with chronic lower gastrointestinal (GI) symptoms with no alarm features and negative investigations.Results
Of 1,618 patients (aged 37.5 [SD 12.6] years; 71.2 % male), 1,476 (91.2 %), 1,098 (67.9 %), 649 (40.1 %), 849 (52.5 %), and 1,206 (74.5 %) fulfilled Manning's, Rome I, II, and III, and the Asian criteria, respectively. The most common reason for not fulfilling the criteria was absence of the following symptoms: “more frequent stools with onset of pain,” “loose stool with onset of pain,” “relief of pain with passage of stool,” “other abdominal discomfort/bloating,” and, in a minority, not meeting the duration criterion of 3 months/12 weeks. By stool frequency, constipation-predominant IBS (<3 stools/week) was diagnosed in 319 (19.7 %), diarrhea-predominant IBS (>3 stools/day) in 43 (2.7 %), and unclassified in 1,256 (77.6 %). By Bristol stool form, constipation, diarrhea, and unclassified were diagnosed in 655 (40.5 %), 709 (43.8 %), and 254 (15.7 %) patients, respectively. By their own perception, 462 (28.6 %), 541 (33.4 %), and 452 (27.9 %) patients reported constipation-predominant, diarrhea-predominant, and alternating types, respectively.Conclusion
By Manning's and the Asian criteria, a diagnosis of IBS was made frequently among Indian patients with chronic functional lower GI symptoms with no alarm features; the Rome II criteria gave the lowest yield. By the stool frequency criteria, a majority of patients had unclassified pattern, unlike by the stool form and patients' perception of their symptoms. 相似文献4.
Julia Konanz Florian Herrle Christel Weiss Stefan Post Peter Kienle 《International journal of colorectal disease》2013,28(5):679-688
Purpose
Limits for sphincter preservation in rectal cancer have been expanded under the assumption that patients with a permanent colostomy have worse quality of life (QoL). Incontinence and painful defecation are common problems; therefore, this study compares functional outcome and QoL after sphincter-sparing intersphincteric resection (ISR), low anterior resection (LAR), and abdominoperineal resection (APR) for rectal cancer.Methods
From a prospective database, three matched groups of patients after surgery for rectal cancer between 1999 and 2009 were extracted. Median follow-up was 59 months. Of 131 patients receiving a questionnaire, 95 % could be analyzed further. Generic and disease-specific validated QoL (European Organization for Research and Treatment in Cancer QLQ-C30, CR38) and Wexner incontinence score were used.Results
Global QoL was comparable between the groups. Physical functioning was significantly better after sphincter preservation surgery than APR (p?<?0.05). Symptom scores for diarrhea (DIA) and constipation (CON) were higher after sphincter-preserving surgery (ISR: DIA 45.4, CON 20.2; LAR: DIA 34.1, CON 25.2) compared to APR (DIA 16.6, CON 12.0) (p?<?0.05 and <0.01, respectively). Disease-specific QoL assessment showed significantly worse QoL regarding to male sexual function after APR (80.8) than after ISR (53.6) (p?<?0.005). Regarding defecation, the ISR group showed significantly higher symptom scores than patients after LAR (p?<?0.05). Wexner scores were significantly higher after ISR (12.9) than after LAR (9.5) (p?<?0.005). 相似文献5.
Jennifer C. Livaudais PhD Rebeca Franco MPH Kezhen Fei MS Nina A. Bickell MD MPH 《Journal of general internal medicine》2013,28(5):630-636
OBJECTIVE
Physicians are mandated to offer treatment choices to patients, yet not all patients may want the responsibility that entails. We evaluated predisposing factors for, and long-term consequences of, too much and not enough perceived decision-making responsibility among breast cancer patients.DESIGN
Longitudinal assessment, with measurements collected just after surgical treatment (baseline) and 6-month follow-up.PARTICIPANTS
Women with early-stage breast cancer treated surgically at eight NYC hospitals, recruited for a randomized controlled trial of patient assistance to improve receipt of adjuvant treatment.MEASUREMENTS
Using logistic regression, we explored multivariable-adjusted associations between perceived treatment decision-making responsibility and a) baseline knowledge of treatment benefit and b) 6-month decision regret.RESULTS
Of 368 women aged 28–89 years, 72 % reported a “reasonable amount”, 21 % “too much”, and 7 % “not enough” responsibility for treatment decision-making at baseline. Health literacy problems were most common among those with “not enough” (68 %) and “too much” responsibility (62 %). Only 29 % of women had knowledge of treatment benefits; 40 % experienced 6-month decision regret. In multivariable analysis, women reporting “too much” vs. “reasonable amount” of responsibility had less treatment knowledge ([OR] = 0.44, [95 % CI] = 0.20–0.99; model c?=?0.7343;p?<?0.01) and more decision regret ([OR] = 2.,91 [95 % CI] = 1.40–6.06; model c?=?0.7937;p?<?0.001). Findings were similar for women reporting “not enough” responsibility, though not statistically significant.CONCLUSION
Too much perceived responsibility for breast cancer treatment decisions was associated with poor baseline treatment knowledge and 6-month decision regret. Health literacy problems were common, suggesting that health care professionals find alternative ways to communicate with low health literacy patients, enabling them to assume the desired amount of decision-making responsibility, thereby reducing decision regret. 相似文献6.
Thiruppathy K Roy A Preziosi G Pannicker J Emmanuel A 《Digestive diseases and sciences》2012,57(7):1908-1914
Background
Bowel dysfunction amongst multiple sclerosis (MS) and spinal cord injury (SCI) patients often manifests as fecal incontinence (FI) or constipation, but the pathophysiology is poorly understood. Anorectal physiology provides an objective assessment of lower bowel functions and is increasingly being used in clinical practice.Aim
The purpose of this study was to correlate symptoms of bowel dysfunction in patients with spinal cord disease with findings in anorectal physiology. We hypothesized that specific abnormalities will correlate with symptoms: prolonged recto-anal inhibitory reflex in patients with incontinence and decreased rectal mucosal blood flow in patients with constipation.Methods
Forty-nine patients with MS (35 with predominant FI and 14 constipation), 46 supraconal SCI (mixed symptom load), and 21 healthy volunteers matched for age and sex were studied. Subjects completed validated constipation and FI symptom questionnaires. Patients underwent standard anorectal physiology, including assessment of rectal mucosal blood flow and recto-anal inhibitory reflex (RAIR).Results
Severity of constipation correlates significantly with distension sensitivity (urge volume [r = 0.68, p = 0.002] and maximal volume [r = 0.39, p = 0.03]). Severity of constipation also correlated with diminished rectal mucosal blood flow in both patient groups (r = ?0.51, p = 0.006). In both groups, constipation correlated with diminished relaxation of the sphincters in the RAIR whilst fecal incontinence correlated with a prolonged duration of RAIR (r = 0.33, p = 0.009) and recovery phase (r = 0.37, p = 0.05).Conclusion
Bowel symptoms in patients with MS and SCI correlate with specific alterations of anorectal physiology. This provides objective assessment of bowel symptoms and may allow tailored treatment to individual patients. 相似文献7.
G. Bazzocchi T. Giovannini C. Giussani P. Brigidi S. Turroni 《Techniques in coloproctology》2014,18(10):945-953
Background
Data on the benefits of synbiotics in functional constipation are conflicting. The aim of this study was to assess whether the administration of the synbiotic supplement Psyllogel Megafermenti® normalized stool consistency and decreased intestinal transit time (ITT) in patients with severe functional constipation, based on its ability to impact on the gut microbiota.Methods
We conducted a pilot randomized, double-blind, controlled trial. After a 2-week run-in period, patients from a tertiary care setting with severe functional constipation fulfilling the Rome III Diagnostic Criteria in the past year were randomly assigned to receive by mouth 2 bags/day of Psyllogel Megafermenti® (Group A) or 2.8 g of maltodextrin twice daily (Group B) for 8 weeks. Primary endpoints were increase of bowel evacuations with normal stool consistency and volume, and ITT reduction. Secondary endpoints included symptom improvement according to the Rome III Diagnostic Criteria, reduction of the Agachan–Wexner score and changes in gut microbiota composition.Results
Twenty-nine patients completed the study: 17 were allocated to Group A and 12 to Group B. A statistically significant increase in stools with normal consistency was observed only in Group A (p = 0.001), even when considering patients with normal stools ≤50 % of time at baseline. In Group A, a significant reduction in ITT was also found (p = 0.022). According to polymerase chain reaction–denaturing gradient gel electrophoresis profiling of stool samples, 50 % of the patients treated with synbiotics harbored all the probiotic species of the study product.Conclusions
An 8-week treatment with Psyllogel Megafermenti® improved the main clinical parameters of functional constipation in patients extremely homogeneous for disorder severity and underlying pathophysiology (Eudract.ema.europa.eu, No. 2008-000913-30). 相似文献8.
Meghraj Ingle Abhijit Deshmukh Devendra Desai Philip Abraham Anand Joshi Tarun Gupta Camilla Rodrigues 《Indian journal of gastroenterology》2013,32(3):179-183
Introduction
Clostridium difficile-associated diarrhea (CDAD) is an increasing problem. Recent reports suggest presence of community acquired CDAD (CA CDAD). Studies in India have shown varied results.Aims
The following are the aims of this study: (a) the prevalence of CDAD and CA CDAD in patients with acute diarrhea; (b) the incremental yield of second stool sample for the diagnosis of C. difficile infection (CDI); and (c) the risk factors for CDI.Patients and Methods
Patients with acute diarrhea (<4 weeks) between April 2009 and December 2010 had two stool sample tested for C. difficile toxin (CDT) by enzyme-linked immunofluorescent assay. Demographic, clinical data, risk factors, clinical course, complications, treatment, and response were noted.Results
Of 150 patients (mean age, 47.3 years; 76 males), 12 (8 %) had their first stool sample positive for CDT. Two patients (1.3 %) had community acquired CDI. The study group was compared with 138 patients (“control group”, stool samples negative for CDT). Compared to the controls, the study group were more likely to have had intensive care unit (ICU) stay (p?=?0.018) and tube feeding (p?=?0.035). Eleven patients were treated with metronidazole. One patient did not respond to metronidazole and was treated with vancomycin. No patient developed complications of CDAD.Conclusions
The prevalence of CDAD in our population was 8 % and of CA CDAD was 1.3 %. There was no advantage of testing two samples. ICU stay and tube feeding were major risk factors for the CDAD. Metronidazole was an effective first-line therapy. 相似文献9.
Kamil Karolczak Robert Pietruszynski Jozef Drzewoski Jacek Kasznicki Cezary Watala 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2013,27(6):549-558
Purpose
To verify the hypothesis that erythrocytes play a role in suboptimal blood platelet response to acetylsalicylic acid (ASA, aspirin) in subjects with coronary artery disease (CAD).Methods
In a cross-over randomized controlled intervention study we evaluated blood platelet response to 30-day treatment with 75 mg/d or 150 mg/d of ASA (enteric coated) in CAD patients (n?=?125). In vitro platelet response to collagen or arachidonic acid was monitored with impedance aggregometry and plasma thromboxane B2 was assayed immunoenzymatically. Blood morphology and several plasma biochemical parameters were determined using routine diagnostic procedures.Results
CAD patients demonstrated lower blood platelet responsiveness to 75 mg/d of ASA compared to healthy subjects. The improved platelet responsiveness to 150 mg/d of ASA was particularly evident in “poor” responding patients. Positive correlations between platelet “poor” response to lower (75 mg/d) ASA dose and red blood cell count (Rs?=?0.215; p?<?0.04), haemoglobin (Rs?=?0.232; p?<?0.02) and haematocrit (Rs?=?0.239; p?<?0.02) were found in CAD patients. Association between “poor” platelet response with lower ASA dose was confirmed by conditional maximum likelihood logistic regression, which showed the independency between erythrocyte-derived parameters, as the risk factors for suboptimal platelet response to ASA, and other risk factors, like CRP or LDL-cholesterol. In “poor” ASA responders taking the higher ASA dose (150 mg/d) the correlation between platelets’ response to ASA and erythrocyte-derived parameters was not significant.Conclusions
Red blood cell parameters are associated with suboptimal blood platelet response to ASA in patients with CAD. Such a platelet refractoriness to ASA may be effectively overcome by increasing the ASA dose. 相似文献10.
Ozge Gumusay Ugur Coskun Tülay Akman Ahmet Siyar Ekinci Muharrem Kocar Özlem Balvan Erceleb Ozan Yazıcı Mehmet Ali Kaplan Veli Berk Bulent Cetin Burcu Yapar Taskoylu Ayhan Yildiz Gamze Goksel Ahmet Alacacioglu Umut Demirci Efnan Algin Mukremin Uysal Ilhan Oztop Berna Oksuzoglu Faysal Dane Mahmut Gumus Suleyman Buyukberber 《Journal of cancer research and clinical oncology》2014,140(1):151-157
Background
The development of brain metastases (BMs) was associated with poor prognosis in melanoma patients. Patients with BMs have a median survival of <6 months. Melanoma is the third most common tumor to metastasize to the brain with a reported incidence of 10–40 %. Our aim was to identify factors predicting development of BMs and survival.Patients and methods
We performed a retrospective analysis of 470 melanoma patients between 2000 and 2012. The logistic regression analyses were used to identify the clinicopathological features of primary melanoma that are predictive of BMs development and survival after a diagnosis of brain metastases.Results
There were 52 patients (11.1 %) who developed melanoma BMs during the study period. The analysis of post-BMs with Kaplan–Meier curves has resulted in a median survival rate of 4.1 months (range 2.9–5.1 months). On logistic regression analysis site of the primary tumor on the head and neck (p = 0.002), primary tumor thickness (Breslow >4 mm) (p = 0.008), ulceration (p = 0.007), and pathologically N2 and N3 diseases (p = 0.001) were found to be significantly associated with the development of BMs. In univariate analysis, tumor thickness and performance status had a significant influence on post-BMs survival. In multivariate analysis, these clinicopathologic factors were not remained as significant predictive factors.Conclusions
Our results revealed the importance of primary tumor characteristics associated with the development of BMs. Ulceration, primary tumor thickness, anatomic site, and pathologic ≥N2 disease were found to be significant predictors of BMs development. 相似文献11.
Background
Laparoscopic ventral rectopexy for rectal prolapse combines the advantages of a minimally invasive approach with the low recurrence rate observed after abdominal procedures. To date, only a few long-term functional studies and no quality of life assessment are available. The aim of this study was to assess long-term functional outcomes and quality of life after laparoscopic ventral rectopexy.Methods
Between January 2007 and December 2008, patients who underwent laparoscopic ventral rectopexy for full-thickness external rectal prolapse and/or rectocele were prospectively included. Fecal incontinence and constipation were scored (Wexner score and Rome II criteria). Quality of life was assessed using the gastrointestinal quality of life form (GIQLI).Results
Thirty-three patients were included and 30 (91 %) completed all the questionnaires. There was no morbidity or mortality. The mean length of hospital stay was 5 ± 1 days (range 3–7 days). After a mean follow-up of 42 ± 7 months (range 32–52 months), recurrence of rectocele was observed in two patients (6 %). At the end of follow-up, constipation was improved in 13/18 patients (72 %) and two patients (7 %) presented de novo constipation. The patients’ Wexner score improved between preoperative status and end of follow-up (12 ± 7 vs. 4 ± 3, p = 0.002). Compared to the preoperative score, quality of life significantly improved over time: 77 ± 21 preoperatively versus 107 ± 17 at 1 year versus 109 ± 18 at the end of follow-up (p < 0.001).Conclusions
This prospective study showed that laparoscopic ventral rectopexy was associated with excellent postoperative outcomes and a low long-term recurrence rate. Long-term functional results were excellent in terms of continence, with significant improvement of quality of life and without worsening constipation. 相似文献12.
Dong Hwan Kim Sun Hyung Kang Woo Suk Jeong Hee Seok Moon Eaum Seok Lee Seok Hyun Kim Jae Kyu Sung Byung Seok Lee Hyun Yong Jeong 《Digestive diseases and sciences》2013,58(2):504-508
Objective
To determine if the level of serum C-reactive protein (CRP) can be used to differentiate between inflammatory diarrhea and non-inflammatory diarrhea in patients with acute infectious diarrhea or acute gastrointestinal infection.Methods
This was a retrospective study based on medical records from a single military hospital located in Daejeon, Republic of Korea. The records of 1,085 patients who presented with abdominal pain, fever (≥37.8 °C), and diarrhea between May 2008 and May 2011 were reviewed, and 538 patients were selected. The eligible patients had undergone abdominal contrast tomography (CT) or colonoscopy within 3 days and blood sampling on the day of admission. The selected patients were divided into two groups on the basis of their abdominal CT or colonoscopy findings: group A, the inflammatory diarrhea group (n = 234), and group B, the non-inflammatory diarrhea group (n = 304). We then compared the clinical and laboratory characteristics of these two groups.Results
Erythrocyte sedimentation rate and CRP levels were significantly higher in group A (inflammatory diarrhea) patients than group B (non-inflammatory diarrhea) patients (16.47 ± 5.46 vs. 15.29 ± 5.72 (P < 0.05), respectively, and 4.92 ± 2.49 vs. 1.79 ± 0.95 (P < 0.05), respectively). Multivariate analysis revealed that CRP level on admission was the most important predictor of inflammatory diarrhea (OR 7.39, P < 0.05). Receiver operating characteristic analysis results also showed that CRP had the highest area-under-the-curve value (0.91; 95 % confidence interval 0.88–0.93; P < 0.05) for distinguishing inflammatory diarrhea from non-inflammatory diarrhea. At a cut-off level of 3.08 mg/dL, CRP had a sensitivity of 82 % and a specificity of 85 %.Conclusions
CRP as a diagnostic marker of inflammatory diarrhea was superior to the other inflammatory markers and clinical characteristics we evaluated in this study. A patient’s CRP level on admission may aid clinical decision-making, for example initiating empiric antibiotics therapy and/or performing additional clinical tests. 相似文献13.
Masaaki Kobayashi Satoru Hashimoto Ken Nishikura Ken-ichi Mizuno Manabu Takeuchi Yuichi Sato Yoichi Ajioka Yutaka Aoyagi 《Journal of gastroenterology》2013,48(12):1332-1342
Background
Even after successful Helicobacter pylori eradication, primary or metachronous gastric cancers are sometimes discovered. The endoscopic features of these cancers may be modified by controlling inflammation. Characteristic findings for such lesions in terms of narrow-band imaging with magnifying endoscopy (NBI-ME) and histopathology need to be clarified to allow accurate diagnosis.Methods
Distinctive NBI-ME characteristics were examined retrospectively in intramucosal or minimally submucosal and differentiated-type adenocarcinomas from a successful eradication group (42 patients, 50 lesions) and a non-eradicated control group (44 patients, 50 lesions) matched in age and sex. A “gastritis-like” appearance under NBI-ME was characterized by uniform papillae and/or tubular pits with a whitish border, regular or faint microvessels and unclear demarcation, resembling the adjacent noncancerous mucosa. Histological differentiation at the luminal surface of the cancer was evaluated according to Ki-67 immunoreactivity restricted at the middle or lower portion of the tubules. NBI-ME alteration was prospectively confirmed in 29 patients (30 lesions) after eradication therapy.Results
The frequency of a “gastritis-like” appearance was 44 % (22/50) for the eradication group, which was significantly higher than the 4 % (2/50) for the control group (p < 0.001). In the eradication group, the “gastritis-like” appearance was significantly correlated with histological surface differentiation (p < 0.001). In the prospective study, NBI-ME showed changes to heterogeneous papillary microstructures in 43 % (10/23) of the lesions after successful eradication at short-term follow-up.Conclusions
Identification of surface maturation under NBI-ME offers a promising approach for accurate diagnosis of early gastric cancers after successful eradication. 相似文献14.
Shashank Garg Yusra R. Mirza Mohit Girotra Vivek Kumar Samuel Yoselevitz Ankur Segon Sudhir K. Dutta 《Digestive diseases and sciences》2013,58(12):3407-3412
Background
Previous epidemiological studies on Clostridium-difficile-Associated Diarrhea (CDAD) have focused on hospitalized patients with nosocomial transmission. However, increasing numbers of patients with CDAD are being admitted to acute-care hospitals from long-term care facilities (LTCFs) and the local community. The purpose of our study was to study the changing epidemiological trends of CDAD patients admitted to an acute-care hospital and examine factors contributing to this shift in epidemiology.Materials and Methods
This IRB-approved retrospective study included 400 randomly selected patients with a diagnosis of CDAD, admitted to an acute-care hospital between January, 2005 and December, 2010. CDAD was defined as ≥3 episodes of loose stools in <24 h with a positive Clostridium difficile stool toxin assay. The patients were divided into three groups: hospital-acquired CDAD, long-term care facility (LTCF)-acquired CDAD, and community-acquired CDAD. The groups were compared in terms of demographics, ICU admissions, hospital length of stay, co-morbidities, presenting complaint, and medication use. Patients who were hospitalized in the preceding 12 weeks or who had history of antibiotic use in the prior 8 weeks were excluded.Results
Final analysis included 258 toxin-positive CDAD patients. Only 53 (20.6 %) patients had hospital-acquired CDAD. Patients from LTCFs (n = 119, 46.1 %) and the community (86 patients, 33.3 %) comprised 79.4 % of patients. The mean age for LTCF population was significantly higher than the hospital-acquired and community-acquired CDAD groups (p < 0.0001). The presenting complaint was categorized as diarrhea or non-diarrheal symptom. Other non-diarrheal symptoms included fever, abdominal pain and altered mental status. Only 15.2 % of LTCF patients had diarrhea as their presenting complaint (n = 18) as compared to 29.1 % of patients from the community (n = 25; p < 0.05). Most LTCF patients (n = 101, 84.8 %) had non-diarrheal symptoms as their presenting complaint as compared to only 61 patients from the community (70.9 %) (p < 0.05). Use of proton pump inhibitor (PPI) was more frequent in LTCF patients (73 %) and patients with hospital-acquired CDAD (69.8 %) as compared to patients with community-acquired CDAD (43 %) (p < 0.05). No valid indication was found for PPI use in 24.13 % of LTCF patients and 32.1 % of patients with community-acquired CDAD as compared to only 12.9 % of patients with hospital-acquired CDAD.Conclusion
These observations suggest that CDAD originated predominantly in patients from LTCFs (46.1 %) and community (33.3 %) rather than from hospitalized patients (20.6 %). Diarrhea was the presenting complaint in LTCF patients in only 15.2 % of cases. Hence, CDAD should be suspected if LTCF patients present with symptoms such as abdominal pain, fever, or altered mental status along with loose stools. Majority of the LTCF patients were found to be on PPIs, a risk factor for CDAD, with as many as 24 % of these patients with no valid indication for their use. 相似文献15.
Daisuke Hoshi Ayako Nakajima Kumi Shidara Yohei Seto Eiichi Tanaka Atsuo Taniguchi Shigeki Momohara Hisashi Yamanaka 《Modern rheumatology / the Japan Rheumatism Association》2013,23(6):1205-1210
Objective
To analyze the efficacy of tocilizumab (TCZ) and the factors that influence achievement of Boolean-based remission in patients with rheumatoid arthritis (RA) treated with TCZ in daily clinical practice.Methods
The efficacy of TCZ at 24 weeks after initiation of TCZ in 80 patients with RA was analyzed by comparing achievement of “DAS28 remission” with that of “Boolean-based remission”. The predictive factors that influence achievement of Boolean-based remission were determined using multiple logistic regression analysis using a step-wise method.Results
DAS28 remission and Boolean-based remission were achieved in 50.0 and 12.5 % of patients, respectively. Significant differences in achieving Boolean-based remission were observed when patients were stratified by disease duration in tertiles (p < 0.05) and by physical function in tertiles (p < 0.05); no such differences were observed for achieving DAS28 remission. The least achievable component among the Boolean-based remission criteria was patient’s global assessment. The predictive factor for not achieving Boolean-based remission at 24 weeks was having a worse baseline physical function (odds ratio, 3.66; 95 % confidence interval, 1.17–14.48).Conclusions
This study suggests that baseline disability predicts a lack of achievement of Boolean-based remission. Thus, better responses to TCZ may be obtained when TCZ is initiated in RA patients before disability develops. 相似文献16.
Henry P. Parkman Katherine Yates William L. Hasler Linda Nguyen Pankaj J. Pasricha William J. Snape Gianrico Farrugia Kenneth L. Koch Jorge Calles Thomas L. Abell Irene Sarosiek Richard W. McCallum Linda Lee Aynur Unalp-Arida James Tonascia Frank Hamilton 《Digestive diseases and sciences》2013,58(4):1062-1073
Background
Many patients with gastroparesis have had their gallbladders removed.Aim
To determine if clinical presentations of patients with gastroparesis differ in those with prior cholecystectomy compared to patients who have not had their gallbladder removed.Methods
Gastroparetic patients were prospectively enrolled in the NIDDK Gastroparesis Registry. Detailed history and physical examinations were performed; patients filled out questionnaires including patient assessment of GI symptoms.Results
Of 391 subjects with diabetic or idiopathic gastroparesis (IG), 142 (36 %) had a prior cholecystectomy at the time of enrollment. Patients with prior cholecystectomy were more often female, older, married, and overweight or obese. Cholecystectomy had been performed in 27/59 (46 %) of T2DM compared to 19/78 (24 %) T1DM and 96/254 IG (38 %) (p = 0.03). Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization, and had a worse quality of life. Independent characteristics associated with prior cholecystectomy included insidious onset (OR = 2.06; p = 0.01), more comorbidities (OR = 1.26; p < 0.001), less severe gastric retention (OR(severe) = 0.68; overall p = 0.03) and more severe symptoms of retching (OR = 1.19; p = 0.02) and upper abdominal pain (OR = 1.21; p = 0.02), less severe constipation symptoms (OR = 0.84; p = 0.02), and not classified as having irritable bowel syndrome (OR = 0.51; p = 0.02). Etiology was not independently associated with a prior cholecystectomy.Conclusions
Symptom profiles in patients with and without cholecystectomy differ: postcholecystectomy gastroparesis patients had more severe upper abdominal pain and retching and less severe constipation. These data suggest that prior cholecystectomy is associated with selected manifestations of gastroparesis. 相似文献17.
P. Sileri L. Franceschilli A. De Lorenzo B. Mezzani P. Todisco F. Giorgi A. L. Gaspari F. Jacoangeli 《Techniques in coloproctology》2014,18(5):439-444
Background
Defecatory disorders in patients with eating disorders have been overlooked. We evaluated the prevalence and type of defecatory disorders in patients with anorexia nervosa.Methods
The aim of our questionnaire-based study was to determine the prevalence of constipation and faecal incontinence (FI) in patients with anorexia nervosa attending our dedicated eating disorders outpatient clinics and whether length of illness and low body mass index (BMI) exacerbate both constipation and FI. The Wexner constipation score (WCS), Altomare’s obstructed defecation score (OD score) and the faecal incontinence severity index (FISI) were used to evaluate constipation and incontinence. A WCS ≥5, OD score ≥10 and a FISI ≥10 were considered clinically relevant.Results
Eighty-five patients (83 females; mean age 28 years ± 13) with anorexia nervosa (study group) and mean BMI of 16 ± 2 kg/m2 (range 14–19 kg/m2) were studied. This group was compared to 57 healthy volunteers (control group) with mean BMI of 22 ± 3 kg/m2 (range 20–27 kg/m2). In the study group, 79/85 (93 %) patients suffered from defecatory disorders defined as at least one abnormal score, either WCS, OD score or FISI, compared to 7/57 (12 %) controls (p < 0.001). Constipation (defined as WCS ≥5) was present in 70/85 (83 %) patients with anorexia and in 7/57 (12 %) controls (p = 0.001), while obstructed defecation syndrome (defined as OD score ≥10) was present in 71/85 (84 %) patients with anorexia and 7/57 (12 %) controls (p < 0.001). In patients with anorexia, the mean WCS score was 10 ± 5 standard deviation (SD) (3 ± 2 SD in controls; p < 0.001), and the mean OD score was 12 ± 4 SD (3 ± 4 SD in controls; p < 0.001). Overall, 62/85 (73 %) patients with anorexia had FI defined as FISI score ≥10, and the mean FISI score in anorexia patients was 12 ± 9 SD. A combination of constipation and FI (either both WCS and FISI abnormal or both OD score and FISI abnormal) was present in 55/85 (64 %) and 8/85 (9 %) presented with FI alone. Moreover, all results are influenced by the severity of the disease measured by BMI and duration. The percentage of defecatory disorders rises from 75 to 100 % when BMI is <18 kg/m2 and from 60 to 75 % when the duration of illness is ≥5 years (p < 0.001 and p = 0.021, respectively).Conclusions
Defecatory disorders are associated with anorexia nervosa and increased with the duration and severity of the illness. 相似文献18.
Malobika Bhattacharya Seema Kapoor Anand Prakash Dubey 《Indian journal of gastroenterology》2013,32(2):98-102
Background
Nondiarrheal celiac disease (NDCD) is being increasingly reported but data from India is limited.Aim
We undertook this study to compare the clinical spectrum of NDCD with that of diarrheal/classical celiac disease (CCD).Method
This facility-based retrospective observational study included consecutive patients diagnosed with celiac disease (CD) (as per modified ESPGHAN criteria) from October 2009 to August 2011.Results
A total of 381 patients were diagnosed with CD during the study period. NDCD was present in 192 (51.8 %). NDCD had higher mean age at presentation (5.8?±?2.8 vs. 6.9?±?2.9 years respectively; p?=?0.003) and longer duration of symptoms prior to diagnosis (2.9?±?1.7 years vs. 3.6?±?2.2 years; p?=?0.02) as compared to CCD. In the NDCD group, the most frequent gastrointestinal (GI) symptoms were recurrent abdominal pain [122 (63.5 %)] and abdominal distension [102 (53.1 %)] followed by constipation [48 (25 %)], vomiting [76 (39.6 %)] and recurrent oral ulcers [89 (46.4 %)]. Vomiting and constipation were more frequently seen in NDCD as compared to CCD (p? <?0.001 in both). Commonly enumerated extraintestinal manifestations in NDCD included failure to thrive [109 (56.8 %)], isolated short stature [36 (18.8 %)], persistent anemia [83 (43.2 %)] and hepatomegaly/splenomegaly or both [56 (29.2 %)]. Associated comorbidities included autoimmune thyroiditis [11 (5.7 %)], type 1 diabetes mellitus [8 (4.2 %)], bronchial asthma [23 (11.9 %)], idiopathic pulmonary hemosiderosis [4 (2.1 %)], Down’s syndrome [3 (1.6 %)], alopecia areata [6 (3.1 %)], polyarthritis [2 (1.0 %)], dermatitis herpetiformis [6 (3.1 %)] and chronic liver disease [6 (3.1 %)]. The number of patients with a Marsh score IIIb and above of duodenal biopsy was significantly more in the CCD group (p?<?0.001).Conclusions
NDCD is not uncommon in India. Long-term follow up is needed to evaluate the impact of the disease and of treatment in these children. 相似文献19.
Martina?Brandlhuber Christian?Genzinger Bernhard?Brandlhuber Wieland?H.?Sommer Mario?H.?Müller Martin?E.?Kreis
Purpose
It is controversial whether patients fare better with conservative or surgical treatment in certain stages of acute diverticulitis (AD), in particular when phlegmonous inflammation or covered micro- or macro-perforation are present. The aim of this study was to determine long-term quality of life (QoL) for AD patients who received either surgery or conservative treatment in different stages.Methods
We included patients treated for AD at the University Hospital Grosshadern, Munich, Germany, between January 1, 2000, and December 31, 2010. Patients were classified by the Hansen and Stock (HS) classification, the modified Hinchey classification, and the German classification of diverticular disease (CDD). Pre-therapeutic staging was based on multidetector computed tomography. Long-term QoL was assessed by the Cleveland Global Quality of Life (CGQL) questionnaire, the Short Form 36 (SF-36), and the Gastrointestinal Quality of Life Index (GIQLI). Data are mean?±?SEM.Results
Patients with phlegmonous AD (HS type 2a, Hinchey Ia and CDD 1b, respectively) had a better long-term QoL on the GIQLI when they were operated (78.5?±?2.5 vs. 70.7?±?2.1; p?<?0.05). Patients with micro-abscess (CDD 2a) had a better long-term QoL on the GIQLI, CGQL, and the “Role Physical” scale of the SF-36 when they were not operated (GIQLI 86.9?±?2.1 vs. 76.8?±?1.0; p?=?0.10; CGQL 82.8?±?5.1 vs. 65.3?±?11.0; p?=?0.08; SF-36/Role Physical 100?±?0.0 vs. 41.7?±?13.9; p?<?0.001). Patients with macro-abscess (CDD 2b) had a better long-term QoL when they were operated (GIQLI 89.3?±?1.4 vs. 69.5?±?4.5; p?<?0.01; CGQL 80.3?±?7.6 vs. 60.5?±?5.8; p?<?0.05; SF-36/Role Physical 95.8?±?4.2 vs. 47.9?±?13.6; p?<?0.001).Conclusion
Considering long-term QoL, phlegmonous AD (HS type 2a, Hinchey Ia and CDD 1b, respectively) should be treated conservatively. In patients with covered perforation, abscess size should guide the decision on whether to perform surgery later on or not. In the light of long-term quality of life, patients fare better after elective sigmoid colectomy when abscess size exceeds 1 cm.20.