Highlights
SARS-CoV-2 infection is associated with thrombotic complications.
Mesenteric thrombosis is rare in general population but not in COVID-19.
Thrombosis can occur in both hospitalized and non-hospitalized patients.
Early diagnosis is crucial to achieve a good.
INTRODUCTION:Epiphrenic diverticula (ED) are infrequent and conventional surgical treatment entails aggressive open or transthoracic surgery. Minimally invasive treatment has changed the surgical approach but some surgical controversies are not resolved.OBJECTIVE:The objective of this study is to describe our experience in minimally invasive treatment of the ED and to perform a systematic review of the current literature in this subject.MATERIALS AND METHODS:We reviewed all data from the Hospital de Sant Pau, focusing on patients that underwent minimally invasive treatment for an ED since 1998 to date. Furthermore, we performed a systematic literature review focused on the minimally invasive approach for ED.RESULTS:A total of 6 patients have been treated (5 transhiatal and 1 with abdominal and thoracic approach). We found a predominance of males with a median age of 63. The diagnosis was made with an endoscopy, barium swallow and manometry. Half of the manometry results were pathologic. The surgical technique involved a diverticulectomy, myotomy and a Dor partial founduplication. Two patients that presented suture line leakage (SLL) were treated conservatively. No mortality was reported. The systematic review was carried out under the Preferred Reporting Items for Systematic Reviews and Meta-analyses scheme, with a total of 20 studies where 189 patients were found. No comparative or prospective randomised trials were found. Overall morbidity was 24%, with a SLL rate of 12%, hospital stay of 5 days and mortality of 1.5%. After a median follow-up of 42 months, 81.5% of the patients were asymptomatic.CONCLUSION:The minimally invasive approach for ED is a safe and feasible procedure.
mortalidad. Resultados: Se incluyeron 154 casos, 59 mujeres y 95 hombres. El principal órgano causante de sepsis abdominal fue el apéndice (41.6%). La mortalidad global fue del 14.3%. La presencia de fallas orgánicas fue del 35.1%. El valor medio de HDL se situó en 37.64 mg/dl (desviación estándar: ± 16.16). Los hallazgos, sometidos a verificación estadística mediante la prueba t de Student, mostraron significancia entre los casos con SOFA > 4 (p = 0.01) y Mannheim > 26 (p = 0.001), CONUT > 6 (p = 0.001), presencia de fallas orgánicas (p = 0.001) y mortalidad (p = 0.003). Conclusión: Los valores de HDL se relacionan con la gravedad, con el desarrollo de fallas orgánicas y con la mortalidad en la sepsis.
Background: Biomarker combinations can improve timely diagnosis and survival. Objective: To determine the usefulness of serum procalcitonin concentration (PCT), C-reactive protein (PCR) and the PCR/PCT index as predictors of mortality.Method: Retrospective study of patients diagnosed with abdominal sepsis during the period from April 2017 to February 2018. Results: We included 182 cases. In the survivors, the mean PCR was 170 and procalcitonin (PCT) 10.5. In the deceased, the mean of C-reactive protein (CRP) was 328 and that of PCT was 17.6. When applying the student's t-test for independent samples, it was found that these differences were significant for PCR (p = 0.001); however, for PCT it was not significant (p = 0.460). Afterwards, the PCR/PCT index was studied, as a predictor of mortality, in the deceased cases a PCR/PCT score of 7534 (standard deviation [SD]: 19,303) and for survivors of 538 (SD:805) (p = 0.001) was obtained. Conclusion: CRP is associated with mortality, serum PCT does not correlate with mortality. The PCR/PCT index seems to be a better indicator to predict mortality in patients with abdominal sepsis due to secondary peritonitis.
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