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 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Major extensive surgery still represents a cornstone of therapy of gynaecological cancer, and the adoption of implemented clinical guidelines for perioperative management can significantly decrease patient morbidity and mortality and reduce hospital stay. The overall risk of deep venous thrombosis in patients undergoing gynaecological surgery ranges from 7% to 45%, and fatal pulmonary embolism occurs in approximately 1% of these women. A meta-analyses of randomised trials showed a significant decrease in deep venous thrombosis in women receiving unfractioned heparin [UFH] compared with controls, and revealed no significant difference in deep venous thrombosis and pulmonary embolism between patients who received UFH and those who received low-molecular weight heparin [LMWH]. Potential advantages favouring LMWH over UFH include once-daily versus repeated daily injections and a lower risk of heparin-induced thrombocytopenia. All patients undergoing major surgical operations should receive LMWH that should be started preoperatively and then given for 7-10 days at least and prolonged for up to 4 weeks in high-risk cases. Antithrombotic mechanical methods can be added to pharmacological agents, but should not been used alone. Cephalosporins and amoxicillin-clavulanic acid have been widely used in gynaecological surgery prophylaxis. Both amoxicillin-clavulanic acid and cefazolin have good in vitro activity against the microbes more frequently involved in postoperative infections, such as Gram-negative bacilli, but amoxicillin-clavulanic acid is more effective against anaerobes. A single dose of antibiotics has been shown to be as effective as multiple doses in many trials that have compared a single-dose regimen with a multiple-dose regimen. Amoxicillin-clavulanic acid prophylaxis at the induction of anaesthesia can be suggested for gynaecological cancer patients undergoing major gynaecological surgery with or without colorectal resection. An additional antibiotic dose is recommended for prolonged operations or when intraoperative blood loss is important. Cephalosporins can be administered to women with a history of penicillin allergy not manifested by an immediate hypersensitivity reaction, whereas tigecyclin should be reserved to patients with a prior anaphylactic reaction to beta-lactams. Recent meta-analyses of randomised trials on patients undergoing elective colorectal surgery found more anastomotic leakages in patients who had preoperative mechanical bowel preparation with oral administration of different solutions than in those who had not, whereas there were no significant differences between the two arms as for wound infections, other septic complications, and non-septic complications. Therefore, preoperative mechanical bowel cleansing is not warranted for gynaecological cancer patients scheduled for surgery that may involve colon-rectum. After major abdominal gynaecological surgery, early oral feeding (within the first 24h regardless of the resolution of postoperative ileus) appears to be associated with increased nausea, shorter time to the presence of bowel sound, shorter time to first solid diet, and a trend toward shorter hospital stay when compared with delayed feeding. Since early oral feeding is safe but associated with increased nausea, the decision whether to adopt this postoperative regimen should be individualised. Decision making processes about thromboprophylaxis, antibiotic prophylaxis, bowel preparation for surgery that may involve colon-rectum, and timing of postoperative oral feeding will become more and more relevant for improved safety and quality of life of women with gynaecological cancer.
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PMID:The perioperative management of patients with gynaecological cancer undergoing major surgery: A debated clinical challenge. 1935 47

We report on a case of cavernous hemangioma of the small bowel mesentery. Fewer than five cases of large mesenteric cavernous hemangioma have been reported in the English literature. Cavernous hemangioma of the small bowel mesentery is extremely rare. A 32-year-old black male presented with 1 week of abdominal pain, nausea, vomiting, and anorexia. He had recently undergone computed tomographic guided biopsy of a pelvic mass at another facility. Repeat CT guided biopsy was nondiagnostic, mesenteric angiography was inconclusive, and magnetic resonance imaging was performed as well. Complete workup was performed to localize primary source of abdominal mass and eventual open biopsy was planned resulting in en bloc resection of the mass, which had invaded the terminal ileum and appendix. Final pathologic diagnosis was cavernous mesenteric hemangioma. The patient experienced a prolonged postoperative ileus and was eventually discharged in stable condition, tolerating a regular diet with adequate bowel and urinary function. Diagnosis of cavernous mesenteric hemangioma is difficult and multiple imaging modalities can prove inconclusive. Adequate biopsy can be difficult to obtain even in patients with small body habitus. Standard of care is resection of entire mass en bloc.
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PMID:Mesenteric cavernous hemangioma involving small bowel and appendix: a rare presentation of a vascular tumor. 1977 53

In April 2008, the US FDA granted approval to methylnaltrexone (Relistor), the first peripheral micro-opioid-receptor antagonist for the treatment of opioid-induced constipation in advanced-illness patients receiving palliative care and for whom other laxative therapies failed to achieve adequate results. Methylnaltrexone, a quaternary derivative of naltrexone, introduces a novel mechanism of action that selectively antagonizes the peripheral micro-receptors in the GI tract without effects on the CNS. In clinical trials, subcutaneous methylnaltrexone reversed opioid-induced constipation after the first dose in approximately 50-60% of the patients. In most of the cases, effective laxation occurred within 1 h. The therapeutic benefit was sustained in multiple-dose studies. Owing to the nature of the population studied, safety data are available for approximately 4 months of use. Although it is not the focus of this article, methylnaltrexone's mechanism of action suggests it could be beneficial for other peripheral, opioid-induced adverse effects, such as opioid-related nausea, vomiting, urinary retention, pruritus or postoperative ileus.
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PMID:Methylnaltrexone: a novel approach for the management of opioid-induced constipation in patients with advanced illness. 1981 69

Thyroid disease is common, and its effects on the gastrointestinal system are protean, affecting most hollow organs. Hashimoto disease, the most common cause of hypothyroidism, may be associated with an esophageal motility disorder presenting as dysphagia or heartburn. Dyspepsia, nausea, or vomiting may be due to delayed gastric emptying. Abdominal discomfort, flatulence, and bloating occur in those with bacterial overgrowth and improve with antibiotics. Reduced acid production may be due to autoimmune gastritis or low gastrin levels. Constipation may result from diminished motility, leading to an ileus, megacolon, or rarely pseudoobstruction. Ascites in myxedema is characterized by a high protein concentration. Graves' disease accounts for 60% to 80% of thyrotoxicosis. Hyperthyroidism is accompanied by normal gastric emptying with low acid production, partly due to an autoimmune gastritis with hypergastrinemia. Transit time from mouth to cecum is accelerated, resulting in diarrhea. Steatorrhea is due to hyperphagia and stimulation of the adrenergic system. Diarrhea in medullary carcinoma of the thyroid (MCT) may be due to elevated calcitonin, prostaglandins, or 5-hydroxyindoleacetic acid. Ileal or colonic function may be abnormal. The esophagus may be compressed by benign processes, but more often by malignancies. MRI and CT scans are the best diagnostic modalities. The gastrointestinal manifestations of thyroid disease are generally due to reduced motility in hypothyroidism, increased motility in hyperthyroidism, autoimmune gastritis, or esophageal compression by a thyroid process. Symptoms usually resolve with treatment of the thyroid disease.
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PMID:The thyroid and the gut. 2035 69

Peritoneal carcinomatosis remains an unsolved medical problem in modern oncologic treatment. Excruciating symptoms such as malignant ascites, ileus, nausea, vomiting, dyspnoea and pain deteriorate the quality of life for affected patients. There is still no effective standard treatment for peritoneal carcinomatosis. The trifunctional antibody catumaxomab (antiepithelial cell adhesion molecule x anti-CD3) is able to direct T lymphocytes and Fcg-receptor-positive accessory cells to epithelial cell adhesion molecule-positive tumor cells. Intraperitoneal catumaxomab therapy was shown to be the first effective therapy against accumulation of malignant ascites in patients with peritoneal carcinomatosis of epithelial cancer, reducing the need of paracentesis and prolonging puncture-free survival. This paper reviews the mode of action of catumaxomab and analyzes different fields of local immunotherapy in patients with peritoneal carcinomatosis. A summary of completed and ongoing studies is included. Catumaxomab is discussed to be an outstanding option for local control and therapy of peritoneal carcinomatosis, which could be an optimal modular therapy in addition to systemic chemotherapy and surgical tumor resection.
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PMID:The trifunctional antibody catumaxomab in treatment of malignant ascites and peritoneal carcinomatosis. 2091 24

Varenicline is a drug specifically developed for smoking cessation. Gastrointestinal symptoms are among the most common side effects (nausea, vomiting, and constipation). Here, we described the case of a 75 year-old man who suffered from functional adynamic ileus while taking varenicline. Adynamic ileus is a rare condition on treatment with varenicline. Clinicals should be aware of this side effect due to it could lead to varenicline withdrawal and reconsideration of patient smoking cessation strategy.
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PMID:Adynamic ileus induced by varenicline. 2124 Dec 40

Gallstone ileus is an uncommon cause of small bowel obstruction which occurs in patients with chronic cholecystitis and gallstones who develop a cholecystoenteric fistula. Although gallstone ileus is relatively rare, it has a substantial mortality rate due in part to patient comorbidities and delays in treatment. We describe the case of a 94-year-old woman who presented with nausea, vomiting, mild abdominal tenderness, leukocytosis, and a 2.5-cm obstruction in her small bowel. Even though this patient underwent a total cholecystectomy 30 years prior, a 2.5-cm gallstone was surgically removed from her ileum. This case illustrates the importance of including gallstone ileus in the differential diagnosis for patients who present with small bowel obstruction even decades postcholecystectomy.
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PMID:Gallstone ileus 30 years status postcholecystectomy. 2128 85

Women with ovarian cancer often undergo multimodal treatment, which may cause physical complications and decrease quality of life. As a result, this article describes postoperative complications in women with suspected primary ovarian cancer, explains factors related to developing postoperative complications, and discusses the clinical implications of postoperative complication management. The researchers used self-report questionnaires completed by women who were within one month after surgery for suspected ovarian cancer (N = 142) to identify postoperative complications. Demographic characteristics also were examined to determine factors that may predict postoperative complications. The most common complications reported were wound infection, fever, and sepsis, followed by ileus, nausea, and vomiting. Women diagnosed with new or late-stage cancer were equally likely to develop a postoperative complication. Healthcare providers should carefully assess women diagnosed with ovarian cancer before surgery to determine their individual risk of developing postoperative complications. All women should be monitored for complications; however, women who are at higher risk because of multiple modalities, late-stage cancer, or the presence of comorbidities warrant particular attention after surgery and discharge.
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PMID:Interventions to prevent postoperative complications in women with ovarian cancer. 2144 87

In patients with carcinomatous peritonitis caused by the invasion and peritoneal dissemination of gastrointestinal cancer, disease progression can trigger complications such as ileus, ascites, and hydronephrosis.Anorexia, impaired oral intake, nausea, vomiting, abdominal pain, abdominal bloating, anuria, and other symptoms can develop, negatively affecting patients' general condition and quality of life.The treatment of carcinomatous peritonitis is an important determinant of outcomes, but the guidelines for its diagnosis, the evaluation of its response to chemotherapy, and the question of which standard therapy to apply remain unestablished.In recent years, however, clinical trials have attempted to evaluate the benefits of systemic chemotherapy and the intraperitoneal administration of drugs such as cisplatin and paclitaxel in patients with advanced or recurrent gastric cancer who have peritoneal dissemination.In the field of palliative therapy, octreotide has been approved in Japan for the amelioration of symptoms associated with gastrointestinal obstruction.Such treatment is expected to contribute substantially to improving patients' quality of life.
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PMID:[Treatment of ileus and carcinomatous peritonitis]. 2150 72

Gastrointestinal dysmotility is commonly noted in the intensive care unit and postoperative settings. Characterized by delayed passage of stool and flatus, nausea, vomiting, and abdominal distention, the condition is associated with nutritional deficiencies, risk of aspiration, and considerable allocation of health care resources. Knowledge of gastrointestinal function in health and illness continues to expand. While the factors that precipitate ileus differ between postoperative and critically ill patients, the two clinical scenarios seem to have similar mechanisms and share many of the same pathophysiologic patterns. By reviewing and comparing the literature on the respective mechanisms and contributing factors generated in these separate clinical settings, a common more comprehensive management strategy may be derived with the potential for newer innovative therapeutic options.
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PMID:Can the intestinal dysmotility of critical illness be differentiated from postoperative ileus? 2162 18


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