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Endoscopic Gallbladder Drainage for Acute Cholecystitis
Jessica Widmer,Paloma Alvarez,Reem Z. Sharaiha,Sonia Gossain,Prashant Kedia,Savreet Sarkaria,Amrita Sethi,Brian G. Turner,Jennifer Millman,Michael Lieberman,Govind Nandakumar,Hiren Umrania,Monica Gaid 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.5
Background/Aims: Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods: Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results: During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions: Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.
Endoscopic Ultrasound-Guided Treatment beyond Drainage:Hemostasis, Anastomosis, and Others
Jessica L. Widmer,Michel Kahaleh 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.5
Since the introduction of endoscopic ultrasound (EUS) in the 1990s, it has evolved from a primarily diagnostic modality into an instrument that can be used in various therapeutic interventions. EUS-guided fine-needle injection was initially described for celiac plexus neurolysis. By using the fundamentals of this method, drainage techniques emerged for the biliary and pancreatic ducts, fluid collections, and abscesses. More recently, EUS has been used for ablative techniques and injection therapies for patients with for gastrointestinal malignancies. As the search for minimally invasive techniques continued, EUS-guided hemostasis methods have also been described. The technical advances in EUS-guided therapies may appear to be limitless; however, in many instances, these procedures have been described only in small case series. More data are required to determine the efficacy and safety of these techniques, and new accessories will be needed to facilitate their implementation into practice.
Chanpiwat, P.,Sthiannopkao, S.,Widmer, K.,Himeno, S.,Miyataka, H.,Vu, N.U.,Tran, V.V.,Pham, T.T.N. Pergamon Press 2016 CHEMOSPHERE - Vol.163 No.-
Fish is the main source of animal protein and micronutrients for inhabitants in the lower Mekong River basin. Consumption of fish in the basin ranges from 41 to 51 kg capita<SUP>-1</SUP> year<SUP>-1</SUP>. Thus, concerns of human health impacts caused by daily intake of metals contained in fish, and the incidence of bacterial contamination from Listeria and Escherichia coli have been raised. This study was conducted to 1) determine concentrations of metals, fecal indicator organisms, and Listeria spp. in cultivated common diet fish, and 2) assess human health risks as results of fish consumption on a daily basis. The results showed significant impacts of metal accumulation in fish especially from the intensive aquaculture. Chemical use to promote the rapid allometric growth of fish was expected to be the explanation for this finding. Concentrations of metals contained in different fish species were not statistically different with the exceptions of Na, Mn, and Zn. This might be due to the mobility of elements in aquaculture farms. Listeria and E. coli log CFU/g were 1.36 +/- 0.11 (standard error) and 1.57 +/- 0.1 s.e., respectively with higher counts observed in samples collected in market sites. Lastly, for human health risk assessment via fish consumption, it was found that hazard quotients of consuming As, Cu, and Zn contained in all fish species could contribute adverse health effects to the local residents (hazard quotients higher than 1). Therefore, risk management measures must be promoted and implemented in all study areas to reduce potential risks to local Vietnamese residents.
Unno, Tatsuya,Han, Dukki,Jang, Jeonghwan,Widmer, Kenneth,Ko, GwangPyo,Sadowsky, Michael J.,Hur, Hor-Gil Japanese Society of Microbial Ecology · The Japane 2011 Microbes and environments Vol.26 No.3
<P>South Korea uses more antibiotics for animal production than any other member of the OECD. The excessive use could potentially lead to a greater incidence of antibiotic resistant microorganisms, some of which may be pathogenic. In this study, we examined potential diarrheagenic and extraintestinal pathogenic <I>E. coli</I> (ExPEC) isolates using virulence gene profiling (<I>eaeA</I>, <I>est</I>, <I>elt</I>, <I>ipaH</I>, <I>stx1</I> and <I>stx2</I> as diarrheagenic and <I>afa/dra</I>, <I>iutA</I>, <I>kpsMT II</I>, <I>papA/C</I>, and <I>sfa/foc</I> as extraintestinal pathogenic virulence genes). A cluster analysis of DNA fingerprint data indicated that certain genotypes of chicken <I>E. coli</I> isolates are likely ExPEC. Moreover, our results showed 38 of the 60 potential diarrheagenic and ExPEC isolates obtained from animals and humans were also resistant to antibiotics, mostly to tetracycline groups, penicillin groups, and folate pathway inhibitors. Our results suggest that the use of antibiotics in agriculture should be controlled due to potential impacts on human health.</P>
Microbiological Quality of Fresh Produce from Open Air Markets and Supermarkets in the Philippines
Vital, Pierangeli G.,Dimasuay, Kris Genelyn B.,Widmer, Kenneth W.,Rivera, Windell L. Hindawi Publishing Corporation 2014 The Scientific World Journal Vol.2014 No.-
<P>This study is the first in the Philippines to conduct a comprehensive assessment of the prevalence of bacterial pathogens and somatic phages in retailed fresh produce used in salad preparation, namely, bell pepper, cabbage, carrot, lettuce, and tomato, using culture and molecular methods. Out of 300 samples from open air and supermarkets, 16.7% tested positive for thermotolerant <I>Escherichia coli</I>, 24.7% for <I>Salmonella</I> spp., and 47% for somatic phages. Results show that counts range from 0.30 to 4.03 log<SUB>10</SUB> CFU/g for <I>E. coli</I>, 0.66 to ≥2.34 log<SUB>10</SUB> MPN/g for <I>Salmonella</I> spp., and 1.30 to ≥3.00 log<SUB>10</SUB> PFU/g for somatic phages. Statistical analyses show that there was no significant difference in the microbial counts between open air and supermarkets (<I>α</I> = 0.05). TaqMan and AccuPower Plus DualStar real-time polymerase chain reaction (RT-PCR) was used to confirm the presence of these organisms. The relatively high prevalence of microorganisms observed in produce surveyed signifies reduction in shelf-life and a potential hazard to food safety. This information may benefit farmers, consumers, merchants, and policy makers for foodborne disease detection and prevention.</P>
Vital, Pierangeli G.,Van Ha, Nguyen Thi,Tuyet, Le Thi Hong,Widmer, Kenneth W. IWA Publishing 2017 Journal of water and health Vol.15 No.1
<P>Surface water samples in Vietnam were collected from the Saigon River, rural and suburban canals, and urban runoff canals in Ho Chi Minh City, Vietnam, and were processed to enumerate <I>Escherichia coli</I>. Quantification was done through membrane filtration and quantitative real-time polymerase chain reaction (PCR). Mean log colony-forming unit (CFU)/100 ml <I>E. coli</I> counts in the dry season for river/suburban canals and urban canals were log 2.8 and 3.7, respectively, using a membrane filtration method, while using Taqman quantitative real-time PCR they were log 2.4 and 2.8 for river/suburban canals and urban canals, respectively. For the wet season, data determined by the membrane filtration method in river/suburban canals and urban canals samples had mean counts of log 3.7 and 4.1, respectively. While mean log CFU/100 ml counts in the wet season using quantitative PCR were log 3 and 2, respectively. Additionally, the urban canal samples were significantly lower than those determined by conventional culture methods for the wet season. These results show that while quantitative real-time PCR can be used to determine levels of fecal indicator bacteria in surface waters, there are some limitations to its application and it may be impacted by sources of runoff based on surveyed samples.</P>