For patients with VAP who have had appropriate treatment and shown a favorable clinical response, mortality and duration of stay can be further improved by de-escalation therapy.
Both early-onset and late-onset VAP were mainly caused by potentially multiresistant bacteria, most commonly P. aeruginosa and MRSA. Antimicrobial agents against these pathogens should be prescribed empirically, at least in our institution.
Bile duct lesions, including leaks and strictures, are immanent complications of open or laparoscopic cholecystectomy (LC). Endoscopic procedures have gained increasing potential as the treatment of choice in the management of postoperative bile duct injuries. Bile duct injury (BDI) is a severe and potentially life-threatening complication of LC. Several series have described a 0.5% to 0.6% incidence of BDI during LC. Early recognition and an adequate multidisciplinary approach are the cornerstones for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.
Gastrointestinal infection due to Enterobius vermicularis occurs worldwide and is considered to be the most common helminth infection. The simple presence of E. vermicularis in the appendix usually produces symptoms of acute appendicitis. The association of this parasitic infestation with acute appendicitis varies from 0.2%-41.8% worldwide. We present a case of a 15 year old female with enterobiasis of appendix presented with clinical features of acute appendicitis. The appendix was surgically removed and the specimen was pathologically diagnosed to contain of E. vermicularis in non-inflamed and histologically normal appendix. Even if this condition is not uncommon in the Greek population, to the best of our knowledge this is the first report presented in the English literature.
Introduction. The pathogenesis of GERD is strongly
related with mixed acid and bile reflux. Benign and malignant
esophageal and gastric lesions have been associated with synergetic
activity between those parameters. Bile reflux causes reactive
gastropathy evaluated with Bile Reflux Index (BRI). The aim was to
investigate if the sequence: bile reflux-intestinal
metaplasia-GERD-esophagitis, is associated with
apoptotic/oncogenetic disturbances.
Materials/Methods. Fifteen asymptomatic subjects and
53 GERD patients underwent gastroscopy with biopsies. The
specimens examined histologically and immunohistochemically for
p53, Ki-67, Bax, and Bcl-2. Results.
Elevated BRI score detected in 47% (25/53) of patients with GERD
and in 13% (2/15) of controls (P = 0.02). Severe esophageal lesions were significantly more common
in BRI (+) patients (14/25) compared to BRI (−) ones (P = 0.0049). Immunohistochemical analysis did not show associations
between BRI score and biomarker expression.
Conclusions. Bile reflux gastropathy is
associated with GERD severity, but not with oncogene expression or
apoptotic discrepancies of the upper GI mucosa.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.