Archive for May 11, 2013

Complicated diverticular disease – the changing paradigm for treatment.

Rev Col Bras Cir. 2012 Jul-Aug;39(4):322-7.

Fingerhut A, Veyrie N.

Source

University of Athens, Athens, Greece. abefingerhut@aol.fr

Abstract

The term “complicated” diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to:

1) laparoscopic colonic resection followed or not (Hartmann’s procedure) by restoration of intestinal continuity,

2) simple laparoscopic lavage (for peritonitis +/- resection).

Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann’s procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.

PDF

http://www.scielo.br/pdf/rcbc/v39n4/13.pdf

May 11, 2013 at 4:37 pm

Testing for HCV Infection: An Update of Guidance for Clinicians and Laboratorians

MMWR Weekly  May 10, 2013  V.62  N.18 P.362-365

In the United States, an estimated 4.1 million persons have been infected with hepatitis C virus (HCV), of whom an estimated 3.2 (95% confidence interval [CI] = 2.7–3.9) million are living with the infection. New infections continue to be reported particularly among persons who inject drugs and persons exposed to HCV-contaminated blood in health-care settings with inadequate infection control.

Since 1998, CDC has recommended HCV testing for persons with risks for HCV infection. In 2003, CDC published guidelines for the laboratory testing and result reporting of antibody to HCV. In 2012, CDC amended testing recommendations to include one-time HCV testing for all persons born during 1945–1965 regardless of other risk factors….

FULL TEXT

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a5.htm?s_cid=mm6218a5_e

PDF

http://www.cdc.gov/mmwr/pdf/wk/mm6218.pdf

May 11, 2013 at 4:34 pm


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