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Ileosigmoid Knotting: Analysis of Patients Clinical Profiles and Determinants of Outcomes.

ABSTRACT: Introduction:Ileosigmoid knotting (ISK) is an uncommon form of bowel obstruction due to wrapping of the ileum or sigmoid colon around the base of the other. It is associated with poor prognosis. Data on ISK are scarce in our country. The aim of this study was to assess clinical profiles, management, and outcome of patients operated for ISK. Methodology. A retrospective analysis of all patients operated for ISK at St. Paul's hospital millennium medical college (SPHMMC) from February 2014 to January 2020 was performed. Results:A total of 28 patients (M: F?=?3?:?1) were studied. The mean age was 41.7 years (SD?±?19.5) and ranged from 18 to 80 years. The mean duration of illness was 1.6 days (SD?±?1.1). Abdominal pain and vomiting were seen in all patients followed by abdominal distention (24, 85.7%) and failure to pass feces or flatus (23, 82.1%). Preoperative diagnosis was correct in 6 (21.4%) patients. Almost all patients (26, 92.8%) had gangrenous bowel. The commonest procedure performed was resection of the gangrenous segments with primary ileoileal anastomosis and sigmoid end colostomy (16, 57.1%). Complications were seen in 11 (39.3%) patients and the commonest being surgical site infection (SSI) (7, 25%). Death occurred in 6 (21.4%) patients, and it was significantly (p=0.020) associated with intraoperative shock (systolic blood pressure (SBP)?

SUBMITTER: Abebe K

PROVIDER: S-EPMC7396096 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Ileosigmoid Knotting: Analysis of Patients Clinical Profiles and Determinants of Outcomes.

Abebe Kirubel K Sherefa Kalid K Teshome Henok H Abebe Engida E

Surgery research and practice 20200723

<h4>Introduction</h4>Ileosigmoid knotting (ISK) is an uncommon form of bowel obstruction due to wrapping of the ileum or sigmoid colon around the base of the other. It is associated with poor prognosis. Data on ISK are scarce in our country. The aim of this study was to assess clinical profiles, management, and outcome of patients operated for ISK. <i>Methodology</i>. A retrospective analysis of all patients operated for ISK at St. Paul's hospital millennium medical college (SPHMMC) from Februar ...[more]

PMID: 32775608

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Project description:BackgroundPopulation-based studies on the clinical course and prognosis of autoimmune hepatitis (AIH) from Caribbean countries are limited.ObjectiveThe aim of this study was to provide information regarding the clinical and laboratory findings, histological profile, treatments, and outcomes of patients with AIH with long-term follow-up in a tertiary referral center.MethodsA retrospective study was performed at the National Institute of Gastroenterology in Havana, Cuba, by enrolling 82 patients with a well-documented, long-term clinical course of AIH. Clinical and laboratory findings, histological profiles, treatments, and outcomes were analyzed.ResultsAt diagnosis, 73 (89%) patients had AIH type 1, 84.1% were women, and their median age was 46.5 years (range, 17-79 years). The median follow-up period was 84 months (interquartile range, 12-276 months). Clinical onset was mild or subclinical in 72% of patients and asymptomatic in 12.2%. At diagnosis, the Hennes's median score was 6 (range, 3-8). Complications were seen in 44 (53.6%) patients, 42 (51.2%) with liver-related complications and 9 (10.9%) without liver-related complications. Cirrhosis was present at diagnosis in 32 (39%) patients. Cirrhosis was subsequently diagnosed in the other 28 patients who were not cirrhotic at diagnosis, over a median follow-up of 12 (IQR, 2-84) months. During follow-up, 6 patients died (7.3%). Cumulative survival at 5 and 10 years was 98.4% and 89%, respectively. A complete biochemical response was achieved in 79% of patients in a mean (SD) of 11.7 (11.6) months. Side effects due to treatment were reported in 76 (92.7%) patients, and no pretreatment factors were found to predict treatment response.ConclusionsThese Cuban patients with AIH had acceptable disease remission rate and a prompt treatment response. Although most patients had advanced-stage liver disease at diagnosis or developed during follow-up, the cumulative survival rate was high when patients were receiving and complying with treatment.

Project description:Background and Purpose- The aim of this study was to prospectively validate our prior findings of smaller hematoma volume and lesser neurological deficit in nonvitamin K oral anticoagulant (NOAC) compared with Vitamin K antagonist (VKA)-related intracerebral hemorrhage (ICH). Methods- Prospective 12-month observational study in 15 tertiary stroke centers in the United States, Europe, and Asia. Consecutive patients with premorbid modified Rankin Scale score of <2 with acute nontraumatic anticoagulant-related ICH divided into 2 groups according to the type of anticoagulant: NOAC versus VKA. We recorded baseline ICH volume, significant hematoma expansion (absolute [12.5 mL] or relative [>33%] increase), neurological severity measured by National Institutes of Health Stroke Scale score, 90-day mortality, and functional status (modified Rankin Scale score). Results- Our cohort comprised 196 patients, 62 NOAC related (mean age, 75.0±11.4 years; 54.8% men) and 134 VKA related (mean age, 72.3±10.5; 73.1% men). There were no differences in vascular comorbidities, antiplatelet, and statin use; NOAC-related ICH patients had lower median baseline hematoma volume (13.8 [2.5-37.6] versus 19.5 [6.6-52.0] mL; P=0.026) and were less likely to have severe neurological deficits (National Institutes of Health Stroke Scale score of >10 points) on admission (37% versus 55.3%, P=0.025). VKA-ICH were more likely to have significant hematoma expansion (37.4% versus 17%, P=0.008). NOAC pretreatment was independently associated with smaller baseline hematoma volume (standardized linear regression coefficient:-0.415 [95% CI, -0.780 to -0.051]) resulting in lower likelihood of severe neurological deficit (odds ratio, 0.44; 95% CI, 0.22-0.85) in multivariable-adjusted models. Conclusions- Patients with NOAC-related ICH have smaller baseline hematoma volumes and lower odds of severe neurological deficit compared with VKA-related ICH. These findings are important for practicing clinicians making anticoagulation choices.

Dataset Information

Ileosigmoid Knotting: Analysis of Patients Clinical Profiles and Determinants of Outcomes.

Publications

Ileosigmoid Knotting: Analysis of Patients Clinical Profiles and Determinants of Outcomes.

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