Infant botulism mimicking Hirschprung's disease

We report a case of infant botulism presenting as primary colonic ileus—mimicking Hirschprung's megacolon. Infant botulism should be considered in any infant with constipation and neurologic abnormalities.     

Clinical usefulness of chemosensitivity testing using the MTT assay

The results of in vitro chemosensitivity testing using the MTT assay of tumor cells from 140 patients were analyzed with reference to the clinical antitumor effects of the chemotherapy. One hundred and twenty-four (88.6%) of 140 specimens were successfully tested by the method of Mosmann (J Immunol Methods 65:55-63, 1983) with some modifications. When the results of the assay were compared with the clinical effects of chemotherapy in 22 patients with remaining measurable tumor lesions, the overall prediction rate was 86.4% (19/22). Among 31 patients with stage III-V gastric and colorectal carcinomas without remaining measurable tumor lesions, the survival rate of nine patients treated with drugs shown to be effective in the assay was significantly (P less than 0.05) better than that of 22 patients treated with drugs shown to be ineffective.     

Early ERCP for Gallstone Pancreatitis: For Whom and When?

The indications for early endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are unclear, and the examination is often requested or performed without substantial supporting evidence. Several trials have been performed to determine the benefit of early ERCP in pancreatitis, yet the results of these studies are inconsistent. To more closely analyze these studies, we performed an evidence-based review of the outcomes of early ERCP in gallstone pancreatitis. To obtain the best available evidence, a PubMed search using the MeSH terms “gallstones” and “pancreatitis” was performed and further refined to identify appropriate studies. We included five randomized trials, a meta-analysis, and a Cochrane Database Systematic Review in our detailed examination of the pertinent literature. Collectively, these studies suggest that early ERCP does not alter mortality in gallstone pancreatitis. In addition, few patients with mild pancreatitis benefit from the procedure, whereas some studies indicate that patients with severe pancreatitis or documented biliary obstruction may experience fewer complications if ERCP is performed. The data in the studies are confounding because of heterogeneity of the patient population and the inability to confirm gallstones in up to one third of patients. In conclusion, ERCP is not indicated for patients with mild pancreatitis. In select patients with severe disease or biliary obstruction, ERCP may be indicated. A multicenter trial designed to study the effect of early ERCP in severe pancreatitis only may provide additional useful information in patients with documented gallstones. Presented at the Postgraduate Course of the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract (Digestive Disease Week 2007), Washington DC, USA, May 20, 2007.     

粘连性肠梗阻手术时机的选择

目的分析了解粘连性肠梗阻病程发展，正确掌握肠梗阻的手术时机。方法对1990年-2006年9月我科手术治疗的312剜粘连性肠梗阻患者的临床资料进行回顾性总结、分析。结果急诊手术探查218例，中转手术94例，术后出现并发症23例，其中15例为肠绞窄患者。死亡9倒，均为出现肠坏死患者，治愈298例（95.5％），好转5例。结论非手术治疗无效者应及时手术治疗，最好在发病后24h内手术，以减少术后并发症及病死率，改善绞窄性肠梗阻预后，提高治愈率，     

Vapreotide,a new somatostatin analogue in the palliative management of obstructive ileus in advanced cancer

Obstructive ileus is not common, but is a very distressing syndrome in a palliative care unit. The case of a 86-year-old woman with obstructive ileus due to advanced pancreatic cancer is presented. Successful management was made possible by a new somatostatin analogue (Vapreotide), administered i.m. at weekly intervals. Vapreotide was found to reduce nausea and vomiting considerably, by inhibiting the release and action of gastrointestinal hormones and the secretory and motor functions of stomach and intestines. The role of somatostatin analogues in the management of obstructive ileus in advanced cancer is discussed.     

Early life growth patterns persist for 12 years and impact pulmonary outcomes in cystic fibrosis

Background

In children with cystic fibrosis (CF), recovery from growth faltering within 2?years of diagnosis (Responders) is associated with better growth and less lung disease at age 6?years. This study examined whether these benefits are sustained through 12?years of age.

Minimizing antipsychotic medication obviated the need for enema against severe constipation leading to paralytic ileus: a case report

OBJECTIVE: To report the usefulness of antipsychotic dose-reduction for avoiding paralytic ileus in a patient with chronic schizophrenia and comorbid dementia. CASE SUMMARY: A 65-year-old in-patient developed severe paralytic ileus warranting a transfer to the general hospital. Constipation was very troublesome and he often needed enema to prevent intestinal obstruction. He had originally been treated with 24 mg of bromperidol, which was reduced to 4 mg, and other psychotropic treatments were simultaneously simplified. As a result, bowel habits improved and enema is now only rarely necessary. Constipation is a frequent adverse effect of antipsychotics and adjunctive psychotropics, which can be severe and may lead to life-threatening paralytic ileus. Dose-reduction obviated a necessity of enema against persistent constipation, while the patient's mental status remained under control. Assessment using the Naranjo probability scale revealed a definite causal relationship. DISCUSSION: With an increasing number of elderly patients with schizophrenia, more cases of severe gastrointestinal motility problems from antipsychotic medication are to be expected. In this patient population dose-reduction of antipsychotics and simplification of concomitant psychotropics should be seriously considered.     

Health-related quality of life and cost-effectiveness analysis of gum chewing in patients undergoing colorectal surgery: results of a randomized controlled trial

Background: Postoperative ileus (POI) and anastomotic leakage (AL) following colorectal surgery severely increase healthcare costs and decrease quality of life. This study evaluates the effects of reducing POI and AL via perioperative gum chewing compared to placebo (control) on in-hospital costs, health-related quality of life (HRQoL), and assesses cost-effectiveness.

Methods: In patients undergoing elective, open colorectal surgery, changes in HRQoL were assessed using EORTC-QLQ-C30 questionnaires and costs were estimated from a hospital perspective. Incremental cost-effectiveness ratios were estimated.

Results: In 112 patients, mean costs for ward stay were significantly lower in the gum chewing group when compared to control (€3522 (95% CI €3034–€4010) versus €4893 (95% CI €3843–€5942), respectively, p?=?.020). No differences were observed in mean overall in-hospital costs, or in mean change in any of the HRQoL scores or utilities. Gum chewing was dominant (less costly and more effective) compared to the control in more than 50% of the simulations for both POI and AL.

Conclusion: Reducing POI and AL via gum chewing reduced costs for ward stay, but did not affect overall in-hospital costs, HRQoL, or mapped utilities. More studies with adequate sample sizes using validated questionnaires at standardized time points are needed.     

急性胆源性胰腺炎手术治疗探讨——附96例报告

目的 探讨急性胆源性胰腺炎手术时机的选择。方法 回顾性分析1999-2004年收治的急性胆源性胰腺炎96例患者的临床资料。结果 59例急性非梗阻性胆源性胰腺炎中，48例经非手术治疗症状缓解后1-2周内延期手术；11例急诊手术，1例死亡。37例急性梗阻性胆源性胰腺炎先经非手术治疗，18例在24-48h后症状不缓解行急诊手术，19例在症状缓解后1—2周内行延期手术，均获治愈。结论 急性非梗阻性胆源性胰腺炎早期应选择非手术治疗，症状缓解后延期手术。急性梗阻性胆源性胰腺炎在非手术治疗24h-48h症状不缓解则急诊手术。