Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mor...Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.展开更多
Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor;over the years,its use in clinical practice has decreased in favor of more recent drugs.However,it is a rather handy drug,whic...Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor;over the years,its use in clinical practice has decreased in favor of more recent drugs.However,it is a rather handy drug,which can be useful in several clinical settings when managing critically ill patients.The objective of this review is the evaluation of the most recent evidence on the use of acetazolamide in emergency medicine and critical care medicine.Furthermore,the safety profile of this drug has been evaluated.This is a narrative review on the use of acetazolamide in the main contexts in which this drug can be useful in emergency situations for patients with potential critical issues.For the timeline 1999–2024,a search was conducted on the main scientific platforms;resources of greatest relevance for the use of acetazolamide in critical care and emergency medicine were selected.The most common emergency situations in which a critically ill patient could benefit from acetazolamide therapy are acute heart failure,acute mountain sickness,post hypercapnic metabolic alkalosis,idiopathic intracranial hypertension and acute angle-closure glaucoma.In a few cases,however,randomized controlled clinical trials have been conducted.There are also other less solid indications based mostly on experience or retrospective data.Acetazolamide seems to be an overall safe drug;serious side effects are rare and can be avoided by carefully selecting the patients to be treated.Acetazolamide represents a precious resource for emergency physicians and intensivists;critical patients with different conditions can in fact benefit from it;furthermore,acetazolamide is a safe drug if administered to correctly selected patients.展开更多
文摘Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.
文摘Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor;over the years,its use in clinical practice has decreased in favor of more recent drugs.However,it is a rather handy drug,which can be useful in several clinical settings when managing critically ill patients.The objective of this review is the evaluation of the most recent evidence on the use of acetazolamide in emergency medicine and critical care medicine.Furthermore,the safety profile of this drug has been evaluated.This is a narrative review on the use of acetazolamide in the main contexts in which this drug can be useful in emergency situations for patients with potential critical issues.For the timeline 1999–2024,a search was conducted on the main scientific platforms;resources of greatest relevance for the use of acetazolamide in critical care and emergency medicine were selected.The most common emergency situations in which a critically ill patient could benefit from acetazolamide therapy are acute heart failure,acute mountain sickness,post hypercapnic metabolic alkalosis,idiopathic intracranial hypertension and acute angle-closure glaucoma.In a few cases,however,randomized controlled clinical trials have been conducted.There are also other less solid indications based mostly on experience or retrospective data.Acetazolamide seems to be an overall safe drug;serious side effects are rare and can be avoided by carefully selecting the patients to be treated.Acetazolamide represents a precious resource for emergency physicians and intensivists;critical patients with different conditions can in fact benefit from it;furthermore,acetazolamide is a safe drug if administered to correctly selected patients.
