The Experts below are selected from a list of 6561 Experts worldwide ranked by ideXlab platform
Sean J Mulvihill - One of the best experts on this subject based on the ideXlab platform.
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Gastrointestinal Perforation and the acute abdomen
Medical Clinics of North America, 2008Co-Authors: John Langell, Sean J MulvihillAbstract:The acute abdomen accounts for up to 40% of all emergency-surgical hospital admissions and is considered in the differential in the more than 7 million visits to the emergency department annually for abdominal pain in the United States. A large percentage of these cases are secondary to Perforation or impending Gastrointestinal Perforation. Gastrointestinal Perforation causes considerable mortality and usually requires emergency surgery.Rapid diagnosis and treatment of these conditions is essential to reduce the high morbidity and mortality of late-stage presentation. Successful treatment requires a thorough understanding of the anatomy, microbiology, and pathophysiology of this disease process and in-depth knowledge of the therapy, including resuscitation,antibiotics, source control, and physiologic support.
Ronald R Salem - One of the best experts on this subject based on the ideXlab platform.
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Gastrointestinal Perforation due to bevacizumab in colorectal cancer
Annals of Surgical Oncology, 2007Co-Authors: Muhammad Wasif Saif, Aymen Elfiky, Ronald R SalemAbstract:Bevacizumab is the first U.S. Food and Drug Association-approved vascular endothelial growth factor-targeted agent that greatly increases progression-free and overall survival in combination with standard chemotherapy regimens in patients with metastatic colorectal cancer. Although bevacizumab is generally well tolerated, some serious adverse events have occurred in some patients in clinical trials, including arterial thromboembolism and Gastrointestinal (GI) Perforation. GI Perforation was first observed in the pivotal phase 3 trial, in which six events occurred in bevacizumab group (1.5%), compared with no events in the control group. Since then, similar rates of GI Perforation have been observed in other large trials. Typical presentation was abdominal pain associated with constipation and vomiting. Such events occurred throughout treatment and were not correlated with duration of exposure. No difference in rate of GI Perforations was found in patients who did and did not have a baseline history of peptic ulcer disease, diverticulosis, and history of chronic use of nonsteroidal anti-inflammatory drugs. However, the incidence of GI Perforation seemed to be higher in patients with primary tumor intact, recent history of sigmoidoscopy or colonoscopy, or previous adjuvant radiotherapy, but it is necessary to confirm these preliminary findings by multivariate analyses. The mechanism responsible for causing GI Perforation is not known and may be multifactorial. Bevacizumab should be permanently discontinued in patients who develop GI Perforation. This article reviews the incidence, presentation, pathogenesis, risk factors, and management of GI Perforation in patients with colorectal cancer who are treated with bevacizumab.
Takashi Sasaki - One of the best experts on this subject based on the ideXlab platform.
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recurrent Gastrointestinal Perforation in a patient with ehlers danlos syndrome due to tenascin x deficiency
Journal of Dermatology, 2015Co-Authors: Tomo Sakiyama, Ken-ichi Matsumoto, Akiharu Kubo, Takashi Sasaki, Taketo Yamada, Nobushige Yabe, Yuko FuteiAbstract:Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous disorder. Using a customized targeted exome-sequencing system we identified nonsense mutations in TNXB in a patient who had recurrent Gastrointestinal Perforation due to tissue fragility. This case highlights the utility of targeted exome sequencing for the diagnosis of congenital diseases showing genetic heterogeneity, and the importance of attention to Gastrointestinal Perforation in patients with tenascin-X deficient type EDS.
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clinical outcomes of secondary gastroduodenal self expandable metallic stent placement by stent in stent technique for malignant gastric outlet obstruction
Digestive Endoscopy, 2015Co-Authors: Takashi Sasaki, Hiroyuki Isayama, Yousuke Nakai, Hirofumi Kogure, Naminatsu Takahara, Tsuyoshi Hamada, Suguru Mizuno, Dai Mohri, Hiroshi Yagioka, Toshihiko ArizumiAbstract:Background and Aim To evaluate the efficacy and safety of secondary gastroduodenal stent placement after first stent dysfunction for malignant gastric outlet obstruction. Methods We conducted a retrospective analysis to investigate the efficacy and safety of secondary stent-in-stent gastroduodenal stent placement. Results Among 260 patients who had been treated with first gastroduodenal stent placement for malignant gastric outlet obstruction, 29 patients (11.2%) were treated with secondary gastroduodenal stent placement because of first stent dysfunction. Pancreatic cancer was the major primary cancer (55.2%). A WallFlex duodenal stent was the most frequently inserted stent both as a first stent (75.9%) and as a secondary stent (62.1%). There were 22 patients (75.9%) that received gastroduodenal stents at the bending site (supraduodenal angle or infraduodenal angle). Technical and clinical success rates were 100% and 86.2%, respectively. Median eating period was 3.0 months, and median survival time was 3.5 months. As for related complications, Gastrointestinal Perforation, insufficient stent expansion, tumor ingrowth, tumor overgrowth, and cholangitis were experienced in 13.8% (four cases), 6.9% (two cases), 6.9% (two cases), 3.4% (one case), and 3.4% (one case), respectively. Conclusion Secondary gastroduodenal stent placement might be effective for managing first stent dysfunction in malignant gastric outlet obstruction. However, Gastrointestinal Perforation was the major complication.
Freddy Penninckx - One of the best experts on this subject based on the ideXlab platform.
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surgical therapy and histological abnormalities in functional isolated small bowel obstruction and idiopathic Gastrointestinal Perforation in the very low birth weight infant
World Journal of Surgery, 2003Co-Authors: Marc Miserez, Suzanna Barten, Karel Geboes, Gunnar Naulaers, Hugo Devlieger, Freddy PenninckxAbstract:We examined surgical treatment, outcome, and histological findings in very low birth weight (VLBW) infants with functional isolated small bowel obstruction (FISBO) and idiopathic Gastrointestinal Perforation (IGIP). The files of 18 neonates (average gestational age 27.5 weeks; average birth weight 880 g), surgically treated for IGIP ( n = 12) or FISBO ( n = 6), were retrospectively reviewed. In both groups segmental or diffuse dilatation of the small bowel was seen. All but two Perforations were localized in the small bowel. In half of the patients a discontinuous absence of the internal layer of the muscularis propria or muscularis mucosae was found. Signs of necrotizing enterocolitis (NEC) were absent. Most of the patients were treated with an enterostomy (IGIP: n = 11; FISBO: n = 4). Overall survival in both groups was 83%. Follow-up after enterostomy closure (mean 23 months) shows normal Gastrointestinal function without failure to thrive in 67% of the survivors. Muscular wall abnormalities and small bowel distension are found in both FISBO and IGIP. Although the underlying etiology remains unclear, segmental muscular wall absence may be a major predisposing factor in both conditions. Creation of a temporary enterostomy is a valid surgical option in VLBW infants with minimal risk for recurrent obstruction and/or Perforation. Survival and long-term Gastrointestinal function is excellent. IGIP should be distinguished from NEC.
Toshihiko Arizumi - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of secondary gastroduodenal self expandable metallic stent placement by stent in stent technique for malignant gastric outlet obstruction
Digestive Endoscopy, 2015Co-Authors: Takashi Sasaki, Hiroyuki Isayama, Yousuke Nakai, Hirofumi Kogure, Naminatsu Takahara, Tsuyoshi Hamada, Suguru Mizuno, Dai Mohri, Hiroshi Yagioka, Toshihiko ArizumiAbstract:Background and Aim To evaluate the efficacy and safety of secondary gastroduodenal stent placement after first stent dysfunction for malignant gastric outlet obstruction. Methods We conducted a retrospective analysis to investigate the efficacy and safety of secondary stent-in-stent gastroduodenal stent placement. Results Among 260 patients who had been treated with first gastroduodenal stent placement for malignant gastric outlet obstruction, 29 patients (11.2%) were treated with secondary gastroduodenal stent placement because of first stent dysfunction. Pancreatic cancer was the major primary cancer (55.2%). A WallFlex duodenal stent was the most frequently inserted stent both as a first stent (75.9%) and as a secondary stent (62.1%). There were 22 patients (75.9%) that received gastroduodenal stents at the bending site (supraduodenal angle or infraduodenal angle). Technical and clinical success rates were 100% and 86.2%, respectively. Median eating period was 3.0 months, and median survival time was 3.5 months. As for related complications, Gastrointestinal Perforation, insufficient stent expansion, tumor ingrowth, tumor overgrowth, and cholangitis were experienced in 13.8% (four cases), 6.9% (two cases), 6.9% (two cases), 3.4% (one case), and 3.4% (one case), respectively. Conclusion Secondary gastroduodenal stent placement might be effective for managing first stent dysfunction in malignant gastric outlet obstruction. However, Gastrointestinal Perforation was the major complication.
