Kappelkjer6715

The patient was treated with antibiotics alone and cured successfully. Early diagnosis and proper treatment are needed, and percutaneous drainage or urgent surgery would be beneficial for such cases depending on the patient's condition.We provide a unique case of haemorrhagic shock complicating a corticosteroid-resistant diffuse ulcerative enteritis in a patient treated with a combination of an anti CTLA-4 and an anti PD-1 for metastatic melanoma. Immunotherapy has changed the perspective for the management of patients with metastatic melanoma but are also responsible for digestive complications mainly represented by immunomediated colitis. Digestive bleeding is common in patients with extensive colonic lesions but has never been described in enteritis independent of colitis. The patient with acute intestinal obstruction related ileitis without evidence of stricture on imaging and then had a gastro-intestinal bleed. In the absence of haemorrhagic lesions on upper gastrointestinal endoscopy, colonoscopy and CT angiography, a surgical exploration with enteroscopy was performed. This revealed an extensive ulcerated jejunoileitis, with active bleeding, within a Meckel's diverticulum. Management included resection of the Meckel diverticulum with a transient double barrel ileostomy. Two infliximab infusions were given due to persistent bleeding. We observed a dramatic improvement after infliximab treatment with complete cessation of bleeding and no further need for transfusions. A complete mucosal healing has been achieved on enteroscopy at 3 months with disappearance of histological inflammatory lesions. This observation suggests that infliximab represents a therapeutic option in severe enteritis and may be as effective as in more moderate immune-mediated enterocolitis.Choosing to use a percutaneous endoscopic gastrostomy (PEG tube) for long term artificial nutrition in the setting of inadequate oral intake after stroke is complex because the decision must be made in a relatively short amount of time and prognosis is often uncertain. This case study utilized interviews with attending and resident neurologists, and surrogate medical decision makers in order to examine how neurologists and surrogate medical decision makers approached the decision to either receive a PEG tube or pursue comfort measures after severe stroke in two patients. Although these two patients presented with similar clinical characteristics and faced similar medical decisions, different decisions regarding PEG tube placement were made. Major challenges included physicians who did not agree on prognosis and surrogates who did not agree on whether to place a PEG tube. These cases demonstrate the importance of the role of the surrogate medical decision maker and the necessity of physicians and surrogate medical decision makers approaching the complex decision of PEG tube placement after stroke together. Additionally, these cases highlight the differing views on what defines a good quality of life and show the vital importance of high-quality goals of care conversations about prognosis and quality of life when deciding whether to place a PEG tube after severe stroke.

This narrative review traces the evolutionary journey of ERAS® with emphasis on challenges specific to pancreatic cancer. This article will also attempt to explore the barriers to routine ERAS® implementation and offers possible solutions to increasing its uptake and compliance rates.

Enhanced Recovery After Surgery (ERAS®) represents a paradigm shift in the perioperative management of surgical patients using a multi-modality approach each of which is based on best available evidence. ERAS® has come a long way since its inception and can now be regarded as one of the promising ways forward in the perioperative management of patients undergoing pancreatic surgery.

We identified 37 studies on the impact of ERAS® in pancreatic surgery, published over the last 2 decades. Implementation of ERAS® helped in shortening the length of stay without an increase in hospital re-admissions, morbidity, or mortality. Compliance to ERAS® is relatively low following pancreatic surgery, with a reported median compliance of 52 %. Elderly patients or those with higher BMI, higher ASA scores, hypoalbuminemia, cardiac comorbidities or longer operative duration are more prone for deviations.

ERAS pathways have been successful in achieving their intended outcomes, despite low compliance. NSC-330507 Complementing existing ERAS® pathways with prehabilitation measures, risk-stratified clinical pathways and the accessibility to step-down care facilities following discharge may facilitate its wider utilisation.

ERAS pathways have been successful in achieving their intended outcomes, despite low compliance. Complementing existing ERAS® pathways with prehabilitation measures, risk-stratified clinical pathways and the accessibility to step-down care facilities following discharge may facilitate its wider utilisation.In 2016, the World Health Organization (WHO) released the most recent update to the classification of central nervous system tumors. This update has led to the reshaping of tumor identification and subsequently changed current understanding of treatment options for patients. Moreover, the restructuring of the classification of central nervous system tumors to include molecular markers has led to the need to re-evaluate how to interpret pivotal trials. These trials originally enrolled patients purely based upon histologic diagnoses without the use of adjunctive, and frequently diagnostic molecular testing. With this new paradigm also comes the need to assess how one should incorporate molecular markers into current trials as well as shape future trials. First, we will discuss updates on the molecular classification of glioblastoma (GBM) (and its histologic mimics). This will be followed by a review of key pivotal trials which have defined our standard of care for glioblastoma within the context of molecular classification of their study populations. This will be followed by preliminary results of ongoing phase 3 cooperative group trials for high-grade gliomas that were initiated prior to routine molecular classification of tumors and how one could interpret these results in light of advances in molecular classification. Finally, we will end with suggestions for future clinical trial design with a focus on enrollment based upon molecular diagnostics.