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Ursi MP, Bertolino L, Andini R, D'Amico F, Iossa D, Karruli A, D'Avenia E, Manduca S, Bernardo M, Zampino R, Durante-Mangoni E. Enterococcal infective endocarditis is a marker of current occult or future incident colorectal neoplasia. Eur J Intern Med 2021; 83:68-73. [PMID: 33046347 DOI: 10.1016/j.ejim.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies suggest an association between Enterococcal infective endocarditis (EIE) and colorectal disease, including colorectal neoplasia (CRN) and colorectal cancer (CRC). In this study, we analyze differences in prevalence, risk factors and outcome of CRN and CRC between EIE and Streptococcus gallolyticus infective endocarditis (SGIE). METHODS Single center, observational study of 166 patients with definite EIE or SGIE. Clinical data were collected prospectively in a standardized IE protocol. Colonoscopy data were collected retrospectively on 90 patients. RESULTS 85 patients had EIE, 81 SGIE. EIE patients had a higher rate of prior cancer (20% vs 6%) and health-care associated infection (12% vs 1%), but similar mortality than SGIE. Colonoscopy performed in 90 patients showed intestinal diseases in 30 of 42 (71%) EIE patients vs. 40 of 48 (83%) SGIE patients (p = 0.174), with a predominance of CRN. Among 78 patients who underwent colonoscopy after IE diagnosis, no difference between EIE and SGIE was observed in the rate of non-neoplastic lesions (48% vs 47%), benign (32% vs 40%) or malignant (13% vs 15%) neoplastic lesions. Adverse events during colonoscopy were uncommon, although a careful handling of anticoagulation was required. CONCLUSIONS EIE seems to be associated with colorectal disease, including colorectal neoplasia and colorectal cancer, to the same extent as SGIE. EIE should be considered a marker of colorectal neoplasia, even in patients with a clear health-care related acquisition. Colonoscopy is generally safe in EIE patients, and should be considered to early diagnose and treat colorectal disease.
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Affiliation(s)
- Maria Paola Ursi
- Internal Medicine, University of Campania 'L. Vanvitelli', Via De Crecchio 7, 80138 Napoli, Italy
| | - Lorenzo Bertolino
- Internal Medicine, University of Campania 'L. Vanvitelli', Via De Crecchio 7, 80138 Napoli, Italy
| | - Roberto Andini
- Units of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Fabiana D'Amico
- Internal Medicine, University of Campania 'L. Vanvitelli', Via De Crecchio 7, 80138 Napoli, Italy
| | - Domenico Iossa
- Internal Medicine, University of Campania 'L. Vanvitelli', Via De Crecchio 7, 80138 Napoli, Italy
| | - Arta Karruli
- Internal Medicine, University of Campania 'L. Vanvitelli', Via De Crecchio 7, 80138 Napoli, Italy
| | - Eugenio D'Avenia
- Digestive Endoscopy, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Sabrina Manduca
- Surgical Echocardiography, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Mariano Bernardo
- Microbiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Rosa Zampino
- Internal Medicine, University of Campania 'L. Vanvitelli', Via De Crecchio 7, 80138 Napoli, Italy; Units of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine, University of Campania 'L. Vanvitelli', Via De Crecchio 7, 80138 Napoli, Italy; Units of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy.
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Bozzi R, Di Martino V, Inzirillo A, D'Avenia E, Inzirillo M, Cattaneo F, Cattaneo D. Pneumatic dilation and botulinum toxin: when and why? Ann Ital Chir 2013; 84:501-504. [PMID: 24141252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pneumatic dilation and botulinum toxin:when and why? The endoscopic treatment options of achalasia include botulinum toxin (BT) injection and pneumatic dilation (PD) of the lower esophageal sphincter (LES). BT can reduce the LES pressure by blocking the release of acetylcoline from presynaptic cholinergic nerve terminals in the myenteric plexus. Although the procedure is safe and good initial response is reported, there is a wide variability in the duration of the response and the effect tends to decrease over time. BT is usually recommended for elderly patients or patients with comorbid illnesses, who are poor candidates for more invasive procedures. PD aims at tearing the muscle fibers of the LES and is considered the most effective nonsurgical treatment for achalasia. Technical details of the procedure vary in different institutions and in many clinical settings the choice between PD or minimally invasive surgical myotomy depends upon local expertise in the procedures. Further endoscopic treatment options such as submucosal esophageal myotomy or self-expanding metallic stents are being studied.
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De Simone R, Sorge F, D'Avenia E, Salzano FA, Motta G, D'Angelo L. Headache in nasal hyperreactivity. Acta Neurol (Napoli) 1987; 9:116-23. [PMID: 3508347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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