Stephan Vetter

Effectivity of current sterility methods for transgastric NOTES procedures: results of a randomized porcine study.

BACKGROUND AND AIM Natural-orifice transluminal endoscopic surgery (NOTES) is an emerging transluminal technique in which interventions are carried out by entering the abdominal cavity via a natural orifice such as the stomach. Infection is a potential risk of the procedure, and the potential pathogens are different from those encountered with skin incisions. Currently, available data regarding prophylactic anti-infective treatment are limited. We compared the effectiveness of topical antimicrobial lavage of mouth and stomach and proton pump inhibitor therapy with gastric cleansing with sterile saline solution in preventing NOTES-related contamination and infection. METHODS A randomized survival swine study was performed. Eight pigs underwent preparation with intravenously administered proton pump inhibitors, mouth and gastric lavage (chlorhexidine), and gastric irrigation (diluted neomycin), plus single-shot intravenous antibiotics. Control group (n = 8) underwent gastric cleansing with sterile saline solution. Peritoneal biopsy, multiple smears, and dilutions for cultures were taken and incubated. The swine were sacrificed after 14 days. Bacterial load was expressed in colony-forming units (CFU). RESULTS One pig died due to gallbladder perforation after 3 days, 2/15 swine presented minor clinical signs of infection in the 14-day follow-up (all 3 pigs were in the control group). Mean C-reactive protein levels were 5.7 +/- 2.4 g/dL (therapy group) and 12.2 +/- 3.8 g/dL (control) ( P = 0.17). Bacterial growth was seen in 1/8 swine (therapy group) and 6/8 swine (control group) ( P = 0.002). Bacterial load was 282 CFU/mL (therapy) vs. 3.2 x 10 (5) CFU/mL (control) ( P = 0.023) in the follow-up. CONCLUSION The use of intravenous antibiotics in addition to topical antimicrobial lavage of mouth and stomach and treatment with proton pump inhibitors decreased the peritoneal bacterial load to almost zero and this was associated with a significantly lower peritoneal infection rate compared with saline-only lavage.

Long-term follow-up after dilation in symptomatic esophageal intramural pseudodiverticulosis: an observational study in 22 cases.

Endoscopic bougienage seems to be the most effective therapy for dysphagia in esophageal intramural pseudodiverticulosis (EIPD), but nothing is known about the long-term success of this treatment option. This report presents long-term results for 21 of 22 patients with EIPD who were treated with bougienage. A total of 103 sessions of bougienage up to a diameter of 18 mm were performed, without major complications and with 100 % clinical success. During follow-up, symptom recurrence with further bougienage occurred in 12 /21 patients (57 %), who had variable symptom-free intervals (range 1.5 - 96 months). Symptom recurrence was associated with concomitant reflux esophagitis. Although this series demonstrates that bougienage is an effective method for relieving dysphagia in EIPD, the long-term effectiveness is limited.

Bacteremia after diagnostic conventional laparoscopy and minilaparoscopy: a prospective study in 100 patients.

Background/Goals Diagnostic laparoscopy under sedoanalgesia is a valuable tool in the work-up of liver diseases and is helpful as a staging procedure. The rate of bacteremia caused by this procedure is unknown, in particular when performed as minilaparoscopy. Study A 100 consecutive patients having undergone diagnostic laparoscopy carried out either conventionally (group I, n=50) or as minilaparoscopy (group II, n=50) were prospectively enrolled in this study. Blood cultures were drawn before and within 5 minutes after the procedure. Risk factors for bacteremia were evaluated. Results Bacterial growth occurred in 4 blood cultures drawn immediately after laparoscopy. No patient developed fever or other signs of infection in the follow-up. Risk factors predisposing to bacteremia could not be identified. Conclusions Conventional diagnostic laparoscopy under sedoanalgesia and minilaparoscopy are associated with a low rate of bacteremia as in diagnostic upper endoscopy.

Seltene akute Hepatitis bei einer Hämochromatosepatientin: eine Zoonose?

A 58-year-old female patient was transferred by her general practitioner with fatigue, nausea and icterus which had begun 2 weeks prior to admission. Laboratory results revealed acute hepatitis (ALAT [alanine aminotransferase] 3,871 U/l, ASAT [aspartate aminotransferase] 2,004 U/l, bilirubin 6.7 mg/dl, gamma-GT [gamma-glutamyl transferase] 503 U/l). The patients medical history included genetic hemochromatosis (without cirrhosis). Hepatitis A to C, infection with herpesviruses or Leptospira interrogans were excluded by serologic and molecular biological tests. There was no diagnostic evidence for underlying autoimmune or additional metabolic liver disease. Due to a trip to Africa 5 months earlier, the patient was tested for hepatitis E, leading to positive anti-hepatitis E-IgM and negative anti-hepatitis E-IgG. PCR (polymerase chain reaction) detection of hepatitis E virus (HEV) was positive as well. In conclusion, acute HEV infection was diagnosed. After close reconsideration, the nonfitting incubation period precluded a travel-associated infection. Additionally, there was no evidence for current HEV infections within the patients social environment, so that a zoonotic origin has to be discussed.ZusammenfassungEine 58-jährige Patientin wurde vom Hausarzt mit dem Bild einer unklaren akuten Hepatopathie vorgestellt. Bei der Patientin lag eine seit Jahren bekannte genetische Hämochromatose ohne zirrhotischen Umbau vor. Laborchemisch bot sich initial ein hepatitisches Bild (ALAT [Alaninaminotransferase] 3 871 U/l, ASAT [Aspartataminotransferase] 2 004 U/l, Bilirubin 6,7 mg/dl, γ-GT [γ-Glutamyltransferase] 503 U/l). Bei unauffälliger laborchemischer Differentialdiagnostik für virale, autoimmune und zusätzliche metabolische Lebererkrankungen wurde aufgrund einer auffälligen Reiseanamnese (Afrikaaufenthalt vor ca. 5 Monaten) ergänzend eine Hepatitis-E-Diagnostik durchgeführt. Überraschenderweise konnten ein positives Anti-HEV-(Hepatitis-E-Virus-) IgM bei negativem Anti-HEV-IgG sowie eine positive HEV-RNA nachgewiesen werden. Somit wurde die Diagnose einer akuten Hepatitis E gestellt. Bei letztlich nicht passender Inkubationszeit in Bezug auf den Afrikaaufenthalt sowie unauffälligem privaten Umfeld der Patientin muss hier, wie in der Literatur beschrieben, eine zoonotische Genese der Hepatitis E vermutet werden.AbstractA 58-year-old female patient was transferred by her general practitioner with fatigue, nausea and icterus which had begun 2 weeks prior to admission. Laboratory results revealed acute hepatitis (ALAT [alanine aminotransferase] 3,871 U/l, ASAT [aspartate aminotransferase] 2,004 U/l, bilirubin 6.7 mg/dl, γ-GT [γ-glutamyl transferase] 503 U/l). The patient’s medical history included genetic hemochromatosis (without cirrhosis). Hepatitis A to C, infection with herpesviruses or Leptospira interrogans were excluded by serologic and molec ular biological tests. There was no diagnostic evidence for underlying autoim - mune or additional metabolic liver disease. Due to a trip to Africa 5 months earlier, the patient was tested for hepatitis E, leading to positive anti-hepatitis E-IgM and negative anti-hepatitis E-IgG. PCR (polymerase chain reaction) detection of hepatitis E virus (HEV) was positive as well. In conclusion, acute HEV infection was diagnosed. After close reconsideration, the nonfitting incubation period precluded a travel-associated infection. Additionally, there was no evidence for current HEV infections within the patient’s social environment, so that a zoonotic origin has to be discussed.

[Rare acute hepatitis in a female patient with hemochromatosis: a zoonosis?].

A 58-year-old female patient was transferred by her general practitioner with fatigue, nausea and icterus which had begun 2 weeks prior to admission. Laboratory results revealed acute hepatitis (ALAT [alanine aminotransferase] 3,871 U/l, ASAT [aspartate aminotransferase] 2,004 U/l, bilirubin 6.7 mg/dl, gamma-GT [gamma-glutamyl transferase] 503 U/l). The patients medical history included genetic hemochromatosis (without cirrhosis). Hepatitis A to C, infection with herpesviruses or Leptospira interrogans were excluded by serologic and molecular biological tests. There was no diagnostic evidence for underlying autoimmune or additional metabolic liver disease. Due to a trip to Africa 5 months earlier, the patient was tested for hepatitis E, leading to positive anti-hepatitis E-IgM and negative anti-hepatitis E-IgG. PCR (polymerase chain reaction) detection of hepatitis E virus (HEV) was positive as well. In conclusion, acute HEV infection was diagnosed. After close reconsideration, the nonfitting incubation period precluded a travel-associated infection. Additionally, there was no evidence for current HEV infections within the patients social environment, so that a zoonotic origin has to be discussed.ZusammenfassungEine 58-jährige Patientin wurde vom Hausarzt mit dem Bild einer unklaren akuten Hepatopathie vorgestellt. Bei der Patientin lag eine seit Jahren bekannte genetische Hämochromatose ohne zirrhotischen Umbau vor. Laborchemisch bot sich initial ein hepatitisches Bild (ALAT [Alaninaminotransferase] 3 871 U/l, ASAT [Aspartataminotransferase] 2 004 U/l, Bilirubin 6,7 mg/dl, γ-GT [γ-Glutamyltransferase] 503 U/l). Bei unauffälliger laborchemischer Differentialdiagnostik für virale, autoimmune und zusätzliche metabolische Lebererkrankungen wurde aufgrund einer auffälligen Reiseanamnese (Afrikaaufenthalt vor ca. 5 Monaten) ergänzend eine Hepatitis-E-Diagnostik durchgeführt. Überraschenderweise konnten ein positives Anti-HEV-(Hepatitis-E-Virus-) IgM bei negativem Anti-HEV-IgG sowie eine positive HEV-RNA nachgewiesen werden. Somit wurde die Diagnose einer akuten Hepatitis E gestellt. Bei letztlich nicht passender Inkubationszeit in Bezug auf den Afrikaaufenthalt sowie unauffälligem privaten Umfeld der Patientin muss hier, wie in der Literatur beschrieben, eine zoonotische Genese der Hepatitis E vermutet werden.AbstractA 58-year-old female patient was transferred by her general practitioner with fatigue, nausea and icterus which had begun 2 weeks prior to admission. Laboratory results revealed acute hepatitis (ALAT [alanine aminotransferase] 3,871 U/l, ASAT [aspartate aminotransferase] 2,004 U/l, bilirubin 6.7 mg/dl, γ-GT [γ-glutamyl transferase] 503 U/l). The patient’s medical history included genetic hemochromatosis (without cirrhosis). Hepatitis A to C, infection with herpesviruses or Leptospira interrogans were excluded by serologic and molec ular biological tests. There was no diagnostic evidence for underlying autoim - mune or additional metabolic liver disease. Due to a trip to Africa 5 months earlier, the patient was tested for hepatitis E, leading to positive anti-hepatitis E-IgM and negative anti-hepatitis E-IgG. PCR (polymerase chain reaction) detection of hepatitis E virus (HEV) was positive as well. In conclusion, acute HEV infection was diagnosed. After close reconsideration, the nonfitting incubation period precluded a travel-associated infection. Additionally, there was no evidence for current HEV infections within the patient’s social environment, so that a zoonotic origin has to be discussed.

Seltene akute Hepatitis bei einer Hämochromatosepatientin: eine Zoonose?@@@Rare Acute Hepatitis in a Female Patient with Hemochromatosis: a Zoonosis?

A 58-year-old female patient was transferred by her general practitioner with fatigue, nausea and icterus which had begun 2 weeks prior to admission. Laboratory results revealed acute hepatitis (ALAT [alanine aminotransferase] 3,871 U/l, ASAT [aspartate aminotransferase] 2,004 U/l, bilirubin 6.7 mg/dl, gamma-GT [gamma-glutamyl transferase] 503 U/l). The patients medical history included genetic hemochromatosis (without cirrhosis). Hepatitis A to C, infection with herpesviruses or Leptospira interrogans were excluded by serologic and molecular biological tests. There was no diagnostic evidence for underlying autoimmune or additional metabolic liver disease. Due to a trip to Africa 5 months earlier, the patient was tested for hepatitis E, leading to positive anti-hepatitis E-IgM and negative anti-hepatitis E-IgG. PCR (polymerase chain reaction) detection of hepatitis E virus (HEV) was positive as well. In conclusion, acute HEV infection was diagnosed. After close reconsideration, the nonfitting incubation period precluded a travel-associated infection. Additionally, there was no evidence for current HEV infections within the patients social environment, so that a zoonotic origin has to be discussed.ZusammenfassungEine 58-jährige Patientin wurde vom Hausarzt mit dem Bild einer unklaren akuten Hepatopathie vorgestellt. Bei der Patientin lag eine seit Jahren bekannte genetische Hämochromatose ohne zirrhotischen Umbau vor. Laborchemisch bot sich initial ein hepatitisches Bild (ALAT [Alaninaminotransferase] 3 871 U/l, ASAT [Aspartataminotransferase] 2 004 U/l, Bilirubin 6,7 mg/dl, γ-GT [γ-Glutamyltransferase] 503 U/l). Bei unauffälliger laborchemischer Differentialdiagnostik für virale, autoimmune und zusätzliche metabolische Lebererkrankungen wurde aufgrund einer auffälligen Reiseanamnese (Afrikaaufenthalt vor ca. 5 Monaten) ergänzend eine Hepatitis-E-Diagnostik durchgeführt. Überraschenderweise konnten ein positives Anti-HEV-(Hepatitis-E-Virus-) IgM bei negativem Anti-HEV-IgG sowie eine positive HEV-RNA nachgewiesen werden. Somit wurde die Diagnose einer akuten Hepatitis E gestellt. Bei letztlich nicht passender Inkubationszeit in Bezug auf den Afrikaaufenthalt sowie unauffälligem privaten Umfeld der Patientin muss hier, wie in der Literatur beschrieben, eine zoonotische Genese der Hepatitis E vermutet werden.AbstractA 58-year-old female patient was transferred by her general practitioner with fatigue, nausea and icterus which had begun 2 weeks prior to admission. Laboratory results revealed acute hepatitis (ALAT [alanine aminotransferase] 3,871 U/l, ASAT [aspartate aminotransferase] 2,004 U/l, bilirubin 6.7 mg/dl, γ-GT [γ-glutamyl transferase] 503 U/l). The patient’s medical history included genetic hemochromatosis (without cirrhosis). Hepatitis A to C, infection with herpesviruses or Leptospira interrogans were excluded by serologic and molec ular biological tests. There was no diagnostic evidence for underlying autoim - mune or additional metabolic liver disease. Due to a trip to Africa 5 months earlier, the patient was tested for hepatitis E, leading to positive anti-hepatitis E-IgM and negative anti-hepatitis E-IgG. PCR (polymerase chain reaction) detection of hepatitis E virus (HEV) was positive as well. In conclusion, acute HEV infection was diagnosed. After close reconsideration, the nonfitting incubation period precluded a travel-associated infection. Additionally, there was no evidence for current HEV infections within the patient’s social environment, so that a zoonotic origin has to be discussed.