Auswahl der wissenschaftlichen Literatur zum Thema „Intra-intestinal“

Diverticular disease is the most common morphological abnormality of the colon. It is increasing in prevalence proportionally to progressive aging and modern alimentary diet. The majority of the diverticular disease affects the sigmoid colon and the segmental inflammatory process can have different outcomes, from self-limited, low-grade inflammation to severe cases evolving to complications such as abscess, fistulas to different organs, free perforation and peritonitis, sepsis, intestinal obstruction, and hemorrhage. In this chapter, we will focus on a few of these complications—focal low-grade inflammation, intra-abdominal abscess, and fistulas.

Cerebral Palsy (CP) is a limiting deficiency, characterized by a permanent neuromotor disorder which affects movements, resulting in non-progressive lesions of the immature brain during the neuro psychomotor stages. Epidemiological studies of premature births correlated with the presence of high levels of inflammation in the umbilical cord, amniotic fluid, and fetal blood, being that one of the most relevant underlying physiopathological mechanisms includes inflammation and intra-amniotic infection, with inflammatory response and damage to the developing brain. Recently attributed to the excessive production of cytokines, CP inflammation is mostly modulated through diet restriction, intestinal dysfunction, and drug intake. The high prevalence of convulsive crises in individuals with CP (77%) on its own does not bring about post inflammatory and post convulsive cytokine synthesis, treated with antiepileptic medication. In these individuals, there is high incidence of intestinal constipation (47%), besides oral dysbiosis, gingival bleeding and even greater increase in chronic inflammation. The dysbiosis causes an increase in mucous permeability (leaky-gut) of the gut-brain axis, and increase in seric endotoxin, demonstrating a persistent inflammatory state, and supporting the emergence of new side effects, which can become the object of future research.

Abstract Adhesions remain one of the more challenging issues in surgical practice. This is in part due to the fact that the density of their formation, time interval to subsequent development of symptoms, and severity of clinical presentation are variable. Although the majority of adhesions are clinically silent, the consequences of adhesion formation can represent a life-long problem including chronic abdominal pain, recurrent intestinal obstruction, and infertility. Moreover, adhesive disease can become a chronic medical condition with significant morbidity and without effective therapy. The aim of this chapter is to review the aetiology and pathophysiology behind adhesion formation, with particular emphasis on post-operative adhesions. The spectrum of clinical presentations will also be discussed, along with strategies for their management. Finally, an overview of recent advances in prevention strategies for development of post-operative adhesions will be discussed.

Cystic fibrosis (CF) is one of the most common indications for lung transplant (LTx) and nearly one-third of the LTx worldwide are performed in people with CF (PwCF). Due to vast developments in diagnostic modalities, antibiotic therapies, and management of associated comorbidities in dedicated and experienced centres, over the past few decades, more PwCF are reaching adulthood than ever before. This has increased the burden on transplant programs particularly in a universal donor shortage scenario. To improve the donor pool a diligent and proactive donor care management, acceptance of marginal organs and utilisation of ex-vivo lung perfusion systems for organ preservation, assessment, and improvement is being advocated widely. LTx is not a readily available therapy and the average waiting time is 18 months in the UK. Therefore, it is essential that PwCF are referred for LTx assessment when their disease is stable, before respiratory deterioration leads to overall deconditioning of the patients. Once listed for LTx, it is crucial to control waiting list mortality by prioritising rapidly deteriorating patients through schemes like the lung allocation score, national urgent and super-urgent waiting lists, and institutional highlighting of deteriorating patients that do not meet other urgent criteria. LTx in PwCF is challenging due to colonisation of the respiratory tract with multi-drug resistant organisms, associated comorbidities such as diabetes, liver disease, gastro-oesophageal reflux, and distal intestinal obstruction syndrome (DIOS) and CF-specific technical difficulties (adhesions due to prior pneumothoraces or pleurodesis, or bronchial collaterals that increase surgical time). Hilar lymphadenopathy and bronchial collaterals may increase surgical time, organ ischemia time, intra and post-operative bleeding, and blood transfusions. Advances in immunosuppression, prophylactic anti-viral and anti-fungal therapies, early ambulation and rigorous physiotherapy, and meticulous postoperative follow up with spirometry, x-rays, and bronchoscopies to detect rejection at the early stage followed by its efficient treatment have helped to improve post-LTx survival in the CF patients. Constant development in the surgical field with adoption of off-pump transplantation, sternal sparing bilateral thoracotomy approach, and utilisation of mechanical circulatory assist as a bridge to transplant and as a support for primary graft failure strives for better outcomes. However, chronic lung allograft dysfunction, chronic refractory infections, malignancies, and CF associated comorbidities remain major determinants of post-LTx long term survival. Despite this, CF patients are often good candidates for re-do LTx with improving survival outcomes. In this chapter, we are compiling the different aspects of LTx in PwCF emphasising the advances in bridge to transplantation, the surgical approach, management of primary graft failure, and immunosuppression as well as complications post-transplant.

Mesenteric pseudocyst (MP) is a rare heterogeneous group of intra-abdominal benign cystic lesions with different etiopathogenesis and clinically silent behaviours. These lesions are introduced as one of the entities based on the histological features of thick fibrous cyst walls, barren of the epithelial lining. Often, they present as expanding abdominal masses or are diagnosed incidentally in conventional radiological studies, exploratory laparotomies, or with symptoms of complications such as infection, torsion, or rupture. Surgical removal of the cyst, with or without resection of the affect