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C. perfringens Blood Stream Infection due to Nontransmural Ischemia of the Esophagus, Stomach, and Left Colon: Case Report. 食管、胃和左结肠非横纹肌缺血导致的C. perfringens血流感染:病例报告。
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-06-01 Epub Date: 2023-06-12 DOI: 10.1159/000530031
Johannes Reiner, Katharina Reichenbach, Imad Kamaleddine, Daniel Mokosch, Felix Streckenbach, Beate Brinkmann, Annette Pertschy, Maria Witte, Clemens Schafmayer, Marc-André Weber, Georg Lamprecht

We report the case of a 74-year-old female with abdominal pain, tarry stools, and tachycardia. Previous history included diabetes mellitus with micro- and macroangiopathy. Imaging revealed portal gas, left sided colitis, and emphysematous gastritis, besides severe atherosclerosis with subtotal celiac trunk occlusion and moderate stenosis of the inferior mesenteric artery. Upper endoscopy revealed findings consistent with focal necrotizing gastritis at the greater curvature and acute esophageal necrosis. Blood cultures immediately grew Clostridium perfringens. The patient was treated with broad spectrum antibiotics and was discharged after 21 days in the hospital. This case demonstrates the rare coincident occurrence of nontransmural ischemia of the left colon, the esophagus, and the stomach as a result of low-flow circulatory compromise, which then precipitated C. perfringens associated emphysematous gastritis and blood stream infection.

我们报告了一例 74 岁女性的病例,她患有腹痛、柏油样便和心动过速。既往病史包括糖尿病并发微血管和大血管病变。影像学检查发现门脉积气、左侧结肠炎和气肿性胃炎,此外还有严重的动脉粥样硬化,腹腔干次全闭塞和肠系膜下动脉中度狭窄。上内镜检查发现,大弯处有局灶性坏死性胃炎,食管急性坏死。血液培养立即培养出产气荚膜梭菌。患者接受了广谱抗生素治疗,住院 21 天后出院。该病例表明,由于低流量循环受损,左结肠、食管和胃同时发生非横纹肌缺血,进而诱发与产气荚膜梭菌相关的气肿性胃炎和血流感染,这种情况十分罕见。
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引用次数: 0
Front & Back Matter 正面和背面
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1159/000531605
U. Denzer, T. Hackert
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引用次数: 0
Society Bulletins 社会公告
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-06-01 DOI: 10.1159/000531095
Darmkrebsmonat März, Matthias P. Ebert, Vorstandsmitglied der Dgvs
In der Normalbevölkerung steigt das Darmkrebsrisiko ab dem 50. Lebensjahr. Daher erhalten gesetzlich Versicherte in diesem Alter regelmäßig Einladungen zur Darmkrebsvorsorge. Für Menschen, bei denen bereits Darmkrebsfälle in der Familie bekannt sind, wären regelmäßige Vorsorgeuntersuchungen bereits ab dem 30. Lebensjahr sinnvoll und kosteneffektiv. Das zeigen die Ergebnisse der im vergangenen Jahr veröffentlichten FARKOR-Studie. Im Rahmen der Studie wurden Menschen mit familiärer Darmkrebs-Vorbelastung zu einem Darmkrebs-Screening eingeladen. Das Ergebnis: Jede achte Untersuchung brachte Darmkrebs-Vorstufen zutage. Die Deutsche Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) begrüßt daher die Empfehlung des Gemeinsamen Bundesausschusses (G-BA), das familiäre Darmkrebsscreening in die Krebsfrüherkennungsrichtlinie aufzunehmen und fordert eine Umsetzung noch in diesem Jahr. Das Kürzel FARKOR steht für das Projekt „Vorsorge bei familiärem Risiko für das kolorektale Karzinom“ – eine Studie, die auf Initiative der Felix Burda Stiftung als bayrisches Modellprojekt durch den Innovationsausschuss des G-BA seit 2017 gefördert wurde und deren Auswertung nun vorliegt. „Die Studie belegt klar den Nutzen einer früheren Darmkrebsvorsorge bei Menschen mit familiärer Vorbelastung“, sagt Professor Dr. med. Frank Kolligs, Chefarzt der Inneren Medizin und Gastroenterologie am Helios Klinikum Berlin-Buch, der die Task Force Darmkrebs der DGVS leitet. Als familiär DGVS fordert zum Darmkrebsmonat März
在普通人口中,从50岁起罹患肠癌的可能性就会增加。o .因此,该年龄成为法定受益人的人经常受到肠道癌的邀请。30岁开始进行定期体检。生命科学,请。这表明去年发表的法拉克研究的结果。在这项研究中,有家庭结肠癌先天症状的人被邀请来进行肠癌筛选。结果,每8次检查就发现了肠癌的尖端。因此,德国肠胃病、肠胃病和代谢病协会(DGVS)欢迎联合联邦委员会(gba)关于为癌症筛查制定相关标准的建议,并呼吁在今年予以执行。可,FARKOR最近代表“偶发车祸家庭风险预防”项目——该研究自2017年以来一直由g集团创新委员会赞助并获得成果——由费利克斯·布尔达基金会(Felix Burda狮子座基金会)发起。这项研究很明显证明了以前的肠道癌对有家庭病史的人有好处。”嘿,我想我会参加这场盛大的聚会
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引用次数: 0
Society Bulletins 社会公告
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-03-28 DOI: 10.1159/000530032
biliären Karzinomen
Das Leitlinienprogramm Onkologie hat seine S3-Leitlinie zum Hepatozellulären Karzinom (HCC) und zu biliären Karzinomen aktualisiert. Die überarbeitete Fassung enthält unter anderem neue Empfehlungen zur Zweitlinientherapie bei biliären Karzinomen und zu seltenen Erkrankungen als Risikofaktoren für HCC. Die S3Leitlinie entstand unter Federführung der Deutschen Gesellschaft für Gastroenterologie, Verdauungsund Stoffwechselkrankheiten (DGVS) und unter Mitwirkung von 36 Fachgesellschaften und Organisationen. Ziel ist es, evidenzbasierte Behandlungsmöglichkeiten aufzuzeigen und die Therapie von Patient*innen mit hepatobiliären Tumoren zu verbessern.
肿瘤学指南计划更新了其关于肝细胞癌(HCC)和胆管癌的S3指南。修订版包括关于胆管癌二线治疗和作为HCC危险因素的罕见病的新建议。S3Guideline是在德国胃肠病、消化和代谢疾病学会(DGVS)的领导下制定的,有36个专业学会和组织参与。目的是确定循证治疗方案,并改进肝胆肿瘤患者的治疗。
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引用次数: 0
Endoscopic Vacuum Therapy for Treating an Esophago-Pulmonary Fistula after Esophagectomy: A Case Report and Review of the Literature. 治疗食管切除术后食管-肺瘘的内窥镜真空疗法:病例报告和文献综述。
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-03-01 Epub Date: 2023-02-23 DOI: 10.1159/000529725
Imad Kamaleddine, Magdalena Popova, Ahmad Alwali, Clemens Schafmayer

An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus.

后天性食管-呼吸道瘘是食管和呼吸系统之间的异常连接。它通常是由恶性肿瘤和感染引起的,或者是手术或放射治疗后的并发症。根据解剖层次可分为食管-气管瘘、食管-支气管瘘,以及最罕见的食管-肺瘘(EPF)。我们介绍了一例食管癌 Ivor-Lewis 手术后吻合口漏(AL)加重的 EPF 病例。我们使用 Eso-Sponge® 系统(B. Braun Melsungen AG,德国梅尔松根)进行了内窥镜真空治疗(EVT)。在接下来的治疗过程中,患者在口服流质食物后再次出现剧烈咳嗽,因此被怀疑患有 EPF。在内窥镜检查中,将亚甲蓝染料注入食管旁腔,并通过同时进行的支气管镜检查证实亚甲蓝染料存在于呼吸道中,从而证实了这一怀疑。此外,口腔造影剂计算机断层扫描显示右肺下叶存在造影剂。对这一并发症采取了EVT和抗生素的保守治疗。营养通过现有的空肠造口输入。两个瘘管和食道旁腔完全愈合,口服营养得以维持,患者康复出院。这种罕见的危及生命的并发症可以采取保守治疗。其治疗方法具有挑战性和争议性,缺乏普遍共识。
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引用次数: 0
Diagnostic and Therapeutic Management of Early Colorectal Cancer. 早期结直肠癌的诊断和治疗管理。
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-03-01 Epub Date: 2022-11-30 DOI: 10.1159/000526633
Mathilda Knoblauch, Florian Kühn, Viktor von Ehrlich-Treuenstätt, Jens Werner, Bernhard Willibald Renz

Background: Early colorectal cancer (eCRC) is defined as cancer that does not cross the submucosal layer of the colon or rectum, including carcinoma in situ (pTis), pT1a, and pT1b. Early carcinomas differ in their prognosis depending on the risk profile. The differentiation between low and high risk is essential. The low-risk group includes R0-resected, well (G1) or moderately (G2) differentiated tumors without lymphatic vessel invasion (L0), without blood vessel invasion (V0) and a tumor size ≤3 cm. In this constellation, the estimated risk of lymph node metastasis is around 1% or below. The high-risk group includes tumors with incomplete resection (Rx), poor (G3) or undifferentiated (G4) carcinomas, and/or lymphatic and blood vessel invasion (L1) and size ≥3 cm. In a "high-risk" situation, there is a risk for lymph node metastasis of up to 23%.

Summary: The incidence of eCRC is rising with a rate of 10% in all endoscopically removed lesions during colonoscopy. For a correct histological evaluation, all suspected lesions should be completely resected. In case of a pT1 lesion in the rectum, pelvic magnetic resonance imaging should be performed to evaluate for suspicious lymph nodes. The therapeutic approach for eCRC is based on histological assessment and ranges from endoscopic resection to radical oncological surgery. The advantages, disadvantages, and associated risks of the individual treatment strategy need to be carefully discussed on a tumor board and with the patient.

Key messages: Treatment options for early colorectal cancer depend on the histological assessment. Poorly differentiated carcinomas, a Kudo ≥ SM2 classified lesion, and a Haggitt level 4 always represent a "high-risk" situation. It should also be mentioned that in rectal cancer, local surgical tumor excision (full-wall excision) is also sufficient for pT1 carcinomas with a "low-risk" constellation (G1/G2; L0, size <3 cm) and an R0 resection.

背景:早期结直肠癌(eCRC)是指未跨越结肠或直肠粘膜下层的癌症,包括原位癌(pTis)、pT1a 和 pT1b。早期癌的预后因风险状况而异。区分低风险和高风险至关重要。低风险组包括 R0 切除、分化良好(G1)或中度(G2)、无淋巴管侵犯(L0)、无血管侵犯(V0)且肿瘤大小≤3 厘米的肿瘤。在这种情况下,估计发生淋巴结转移的风险约为 1%或以下。高风险组包括未完全切除(Rx)、差(G3)或未分化(G4)癌和/或淋巴及血管侵犯(L1)且肿瘤大小≥3 厘米的肿瘤。在 "高危 "情况下,淋巴结转移的风险高达 23%。小结:eCRC 的发病率正在上升,在结肠镜检查的所有内镜下切除病灶中的发病率为 10%。为了进行正确的组织学评估,所有疑似病灶都应完全切除。如果是直肠内的 pT1 病变,则应进行盆腔磁共振成像,以评估可疑淋巴结。eCRC 的治疗方法以组织学评估为基础,从内窥镜切除到根治性肿瘤手术不等。需要在肿瘤委员会上与患者仔细讨论各种治疗策略的优缺点和相关风险:早期结直肠癌的治疗方案取决于组织学评估。分化较差的癌、工藤≥SM2 级病变和 Haggitt 4 级病变始终代表着 "高风险 "情况。还应提及的是,在直肠癌中,对于 "低风险 "的 pT1 癌(G1/G2;L0,大小
{"title":"Diagnostic and Therapeutic Management of Early Colorectal Cancer.","authors":"Mathilda Knoblauch, Florian Kühn, Viktor von Ehrlich-Treuenstätt, Jens Werner, Bernhard Willibald Renz","doi":"10.1159/000526633","DOIUrl":"10.1159/000526633","url":null,"abstract":"<p><strong>Background: </strong>Early colorectal cancer (eCRC) is defined as cancer that does not cross the submucosal layer of the colon or rectum, including carcinoma in situ (pTis), pT1a, and pT1b. Early carcinomas differ in their prognosis depending on the risk profile. The differentiation between low and high risk is essential. The low-risk group includes R0-resected, well (G1) or moderately (G2) differentiated tumors without lymphatic vessel invasion (L0), without blood vessel invasion (V0) and a tumor size ≤3 cm. In this constellation, the estimated risk of lymph node metastasis is around 1% or below. The high-risk group includes tumors with incomplete resection (Rx), poor (G3) or undifferentiated (G4) carcinomas, and/or lymphatic and blood vessel invasion (L1) and size ≥3 cm. In a \"high-risk\" situation, there is a risk for lymph node metastasis of up to 23%.</p><p><strong>Summary: </strong>The incidence of eCRC is rising with a rate of 10% in all endoscopically removed lesions during colonoscopy. For a correct histological evaluation, all suspected lesions should be completely resected. In case of a pT1 lesion in the rectum, pelvic magnetic resonance imaging should be performed to evaluate for suspicious lymph nodes. The therapeutic approach for eCRC is based on histological assessment and ranges from endoscopic resection to radical oncological surgery. The advantages, disadvantages, and associated risks of the individual treatment strategy need to be carefully discussed on a tumor board and with the patient.</p><p><strong>Key messages: </strong>Treatment options for early colorectal cancer depend on the histological assessment. Poorly differentiated carcinomas, a Kudo ≥ SM2 classified lesion, and a Haggitt level 4 always represent a \"high-risk\" situation. It should also be mentioned that in rectal cancer, local surgical tumor excision (full-wall excision) is also sufficient for pT1 carcinomas with a \"low-risk\" constellation (G1/G2; L0, size <3 cm) and an R0 resection.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10230821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9571889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Current Surgical Concepts in Lynch Syndrome and Familial Adenomatous Polyposis. 林奇综合征和家族性腺瘤性息肉病的当前手术概念。
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-03-01 Epub Date: 2023-03-28 DOI: 10.1159/000530030
Karoline Horisberger, Carolina Mann, Hauke Lang

Background: Approximately 5% of colorectal cancers (CRCs) are associated with hereditary cancer syndromes. The natural history of these syndromes differs from sporadic cancers, and due to their increased risk of metachronous carcinomas, surgical approaches also differ. This review focuses on the current recommendations for surgical treatment and what evidence has led to these recommendations in the most clinically relevant hereditary CRC syndromes: Lynch syndrome (LS) and (attenuated) familial adenomatous polyposis (FAP).

Summary: LS has no common phenotype and is caused by individual germline variants in one of the mismatch repair genes (MLH1, MSH2, MSH6, or PMS2). Because each gene is associated with a different risk of metachronous cancer, guidelines now differentiate between genes in their recommendations for oncology interventions. Classical and attenuated FAP are caused by germline mutations in the APC gene and have a characteristic phenotype. Although correlations exist between phenotype and genotype, the indication for surgery is predominantly based on clinical manifestation rather than specific gene mutations.

Key message: Currently, the recommendation on the two diseases tends to go in opposite directions: while some forms of FAP may require less extensive surgery, in some LS patients, more sophisticated knowledge of metachronous carcinoma risk leads to more extensive surgery.

背景:约有 5% 的结直肠癌 (CRC) 与遗传性癌症综合征有关。这些综合征的自然病史与散发性癌症不同,而且由于其发生间变性癌的风险增加,手术方法也有所不同。本综述重点介绍目前对遗传性 CRC 综合征手术治疗的建议,以及导致这些建议的证据:摘要:林奇综合征没有共同的表型,是由错配修复基因(MLH1、MSH2、MSH6 或 PMS2)之一的单个种系变异引起的。由于每种基因都与不同的罹患晚期癌症的风险有关,因此现在的指南在推荐肿瘤学干预措施时会区分不同的基因。典型和减弱的 FAP 是由 APC 基因的种系突变引起的,具有特征性的表型。虽然表型与基因型之间存在相关性,但手术指征主要基于临床表现而非特定基因突变:目前,对这两种疾病的建议倾向于相反的方向:虽然某些形式的 FAP 可能需要较小范围的手术,但对某些 LS 患者来说,对远期癌风险的更深入了解会导致更大范围的手术。
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引用次数: 0
PharmaNews
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-02-08 DOI: 10.1159/000529371
Sabine M. Rüdesheim
Chronisch-entzündliche Darmerkrankungen (CED) werden oft im jungen Erwachsenenalter diagnostiziert. Wie therapiert man Menschen mit Kinderwunsch, wenn sie z.B. an einer Colitis ulcerosa (CU) leiden? Für Mesalazin (5Aminosalicylsäure, 5-ASA) zeigt eine großangelegte, kontrollierte Untersuchung nun: Die Therapie ist bei angehenden Vätern und Müttern auch für das Kind sicher [1]. Die dänische Kohortenstudie wertete landesweit die Gesundheitsdaten aller zwischen Januar 1997 und Dezember 2018 neugeborenen Kinder von Eltern mit einer CED-Erkrankung aus. In Dänemark werden Diagnosen und die Historie der Medikamenten-Verschreibungen aller Einwohner zentral erfasst. So ließen sich auch Neugeborene identifizieren, bei deren Vätern (N = 6343) bzw. Müttern (N = 6432) eine CU diagnostiziert war [1]. Verglichen wurden die Daten Neugeborener, deren Eltern mit CED-Erkrankung kein 5-ASA-Präparat verschrieben bekommen hatten, mit jenen, deren Vater in den 3 Monaten vor der Konzeption – d.h. von der Spermatogenese bis zur Empfängnis – ein 5-ASA-Präparat verschrieben bekam (N = 1714 erhielten Mesalazin) oder deren Mutter während der Schwangerschaft ein 5-ASA-Medikament angewendet hatte (N = 2712 erhielten Mesalazin) [1].
慢性炎症性肠病(CED)通常在年轻成年时被诊断出来。如何治疗想要孩子的人,例如,如果他们患有溃疡性结肠炎(CU)?对于美沙拉秦(5-氨基水杨酸,5-ASA),一项大规模对照研究表明,该疗法对准爸爸和准妈妈的孩子是安全的[1]。丹麦队列研究评估了1997年1月至2018年12月期间父母患有CED疾病的所有新生儿的健康数据。在丹麦,所有居民的诊断和药物处方史都集中记录。因此,新生儿也可以在其父亲(N6343)或其父亲(N3343)中被识别。母亲(N6432)被诊断为CU[1]。将患有CED疾病的父母未服用5-ASA的新生儿的数据与患有CED的父母的数据进行比较其父亲在受孕前三个月,即从精子发生到受孕(N1714接受了美沙拉秦),或其母亲在怀孕期间使用了5-ASA(N2712接受了美沙拉秦)[1]。
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引用次数: 0
Colitis ulcerosa - Upadacitinib als neue orale Therapieoption 溃疡性结肠炎Upadacitinib作为一种新的口服治疗方案
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-02-08 DOI: 10.1159/000529372
information@karger.com www.karger.com ent*innen über eine signifikante Symptomverbesserung [5] und schon in Woche 2 zeigten 62% der Patient*innen unter Upadacitinib versus 27% unter Placebo in einer gepoolten Analyse ein klinisches Ansprechena [2]. Upadacitinib war Placebo außerdem in Bezug auf Mukosaheilungb in Woche 8 signifikant überlegen: in U-ACHIEVE-SS II erreichten 36% der Patient*innen unter Upadacitinib versus 7% unter Placebo eine Mukosaheilungb; in UACCOMPLISH waren es 44% bzw. 8% [1].
information@karger.comwww.karger.com报道了症状的显著改善[5],在第2周,在汇总分析中,62%的服用乌帕替尼的患者显示出临床反应,而27%的服用安慰剂的患者表现出临床反应[2]。在第8周,乌帕达西替尼在粘膜愈合方面也显著优于安慰剂:在U-ACHIEVE-S II中,接受乌帕达西替尼治疗的患者中,36%的患者实现了粘膜愈合,而接受安慰剂治疗的患者为7%;UACCOMPLISH分别为44%。8%[1]。
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引用次数: 0
Durvalumab + Gem-Cis: Neuer Goldstandard bei BTC
4区 医学 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000534344
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引用次数: 0
期刊
Visceral Medicine
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