Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has...Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigationof even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.展开更多
Pancreatic ductal adenocarcinoma is a highly aggressive malignancy with a poor prognosis.Effective treatment with acceptable outcomes is yet to be found,with chemo-and radioresistance comprising major impediments towa...Pancreatic ductal adenocarcinoma is a highly aggressive malignancy with a poor prognosis.Effective treatment with acceptable outcomes is yet to be found,with chemo-and radioresistance comprising major impediments towards this goal.Although upfront surgery is the established therapeutic approach for resectable and borderline resectable disease,neoadjuvant treatment has recently monopolized the interest in clinical trials.This also applies to locally advanced pancreatic adenocarcinomas that could potentially be rendered operable.Chemotherapy and chemoradiotherapy are the most utilized therapeutic modalities in the neoadjuvant setting,while immunotherapy and targeting agents have been gaining significant attention.This critical review focuses on the clinical experience gained from retrospective and phase II/III randomized trials,reporting on the outcomes of neoadjuvant chemotherapy and chemoradiotherapy for pancreatic adenocarcinoma.Moreover,the ongoing trials,including those that involve immunotherapy and targeting agents,are summarized.展开更多
文摘Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigationof even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.
文摘Pancreatic ductal adenocarcinoma is a highly aggressive malignancy with a poor prognosis.Effective treatment with acceptable outcomes is yet to be found,with chemo-and radioresistance comprising major impediments towards this goal.Although upfront surgery is the established therapeutic approach for resectable and borderline resectable disease,neoadjuvant treatment has recently monopolized the interest in clinical trials.This also applies to locally advanced pancreatic adenocarcinomas that could potentially be rendered operable.Chemotherapy and chemoradiotherapy are the most utilized therapeutic modalities in the neoadjuvant setting,while immunotherapy and targeting agents have been gaining significant attention.This critical review focuses on the clinical experience gained from retrospective and phase II/III randomized trials,reporting on the outcomes of neoadjuvant chemotherapy and chemoradiotherapy for pancreatic adenocarcinoma.Moreover,the ongoing trials,including those that involve immunotherapy and targeting agents,are summarized.
