Current opinion in gastroenterology
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Pruritus is a frequent symptom in patients with cholestatic liver diseases. Itching may be excruciating, may seriously impair quality of life and even induce suicidal ideation in the most severe cases. ⋯ On the basis of our results, we hypothesize that during cholestasis expression of autotaxin is induced, which gives rise to increased local formation of LPA near unmyelinated nerve endings of itch fibres. LPA activates these neurons through one of the LPA receptors, which in turn potentiates action potentials along itch fibres leading to the perception of pruritus.
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Curr. Opin. Gastroenterol. · Mar 2011
ReviewPsychological factors and weight loss in bariatric surgery.
Morbid obesity is associated with a high prevalence of psychopathological conditions that might have an impact on postsurgery outcomes. This review summarizes recent data about psychological disorders in obese patients before and after bariatric surgery as well as the assessment and impact of these factors on postsurgery outcomes. ⋯ Psychological assessment before bariatric surgery and systematic follow-up are necessary to guarantee optimal weight loss and weight loss maintenance. The field of psychological factors in bariatric surgery is still in need of controlled randomized prospective trials to better understand relation between psychological presurgery conditions and surgical outcomes. Self-monitoring and cognitive behavioral programs could prevent weight regain.
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Curr. Opin. Gastroenterol. · Mar 2011
ReviewVentilator-associated pneumonia management in critical illness.
Ventilator-associated pneumonia (VAP) is a frequent adverse event in the intensive care unit.We review recent publications about the management and prevention of VAP. ⋯ In view of the recently available data, it can be concluded that the implementation of care bundles on the general management of ventilated patients in daily practice has reduced the VAP rates. The main pharmacological measures to prevent VAP are proper hands hygiene, high nurse-to-patient ratio, avoid unnecessary transfer of ventilated patients, use of noninvasive mechanical ventilation, shortening weaning period, avoid the use of nasal intubation, prevent bio-film deposition in endotracheal tube, aspiration of subglottic secretions, maintenance of adequate pressure of endotracheal cuffs, avoid manipulation of ventilator circuits, semi-recumbent position and adequate enteral feeding.In addition, updated guidelines incorporate more comprehensive diagnostic protocols to the evidence-based management of VAP.
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Curr. Opin. Gastroenterol. · Nov 2010
ReviewEndoscopic management in the bariatric surgical patient.
Morbid obesity is a global health epidemic. As the prevalence of bariatric surgery rises, it becomes increasingly important for gastroenterologists to understand their role in the perioperative care of bariatric surgical patients, to recognize potential complications of surgery that can be addressed endoscopically, and to learn about endoluminal approaches that may provide alternatives to bariatric surgery in the future. ⋯ The gastroenterologist can improve outcomes in bariatric surgical patients by understanding the issues of care that present themselves perioperatively and that lend themselves to minimally invasive endoscopic treatments.
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Curr. Opin. Gastroenterol. · Jul 2010
ReviewEsophageal perforation: surgical, endoscopic and medical management strategies.
The purpose of this article is to review current therapeutic strategies and outcomes in the management of esophageal perforation. The relative rarity and unpredictability of esophageal perforation has precluded a randomized or multiinstitutional study of this condition. Practice standards are based primarily on retrospective reviews and expert opinions. ⋯ Perforation of the esophagus, regardless of the cause, remains a major life-threatening event. Early recognition and aggressive care by a clinical team with experience in a variety of treatment modalities is increasingly important in achieving optimal outcomes in this difficult problem. Recently, encouraging results have been published utilizing esophageal stents and diligent nonoperative care in patients with esophageal perforation. The guiding principles in the treatment of this challenging condition remain early diagnosis, appropriate resuscitation, sepsis control, nutritional support, and re-establishment of esophageal continuity. Herein, we review the recent reports on the surgical, medical, and endoscopic treatment of esophageal perforation.