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INTRODUCTION: Non-steroidal anti-inflammatory drugs and corticosteroids are both used in the treatment acute gouty arthritis and may adversely interact with colchicine. Gastrointestinal toxicity of colchicine is dose-dependent and can be aggravated by drug-drug and drug-patient interactions. CASE PRESENTATION: Colonic perforation associated with second-line administration of colchicine for acute gouty arthrtitis was identified in an elderly man with several comorbidities who was also treated with non-steroidal anti-inflammatory drugs and corticostroids. Underlying diverticular disease was discovered at the time of surgical therapy. CONCLUSIONS: Initial treatment of acute gouty arthritis with non-steroidal anti-inflammatory drugs or corticosteroids may increase colchicine toxicity by subsequent pharmacokinetic and pharmacodynamic interaction in the gut wall. The literature is reviewed suggesting that diverticular disease should be included in the list of adverse event risk factors when colchicine is being considered.
RESUMO
OBJECTIVE: The authors used new ultrasonically activated scissors and blades in open and laparoscopic liver resections to investigate their capabilities. SUMMARY BACKGROUND DATA: Despite standardized techniques for liver resection, the surgical death rate ranges from 4% to 20%. Dissection of liver parenchyma may cause considerable blood loss. Further complications include liver failure, hematoma, infections, and bile leakage. The surgical technique is an important factor in preventing intraoperative and postoperative complications. Various techniques have been developed for safe and careful dissection of the liver parenchyma. In addition to blunt dissection using the "finger fracture" technique, various ultrasonic dissectors, water jet dissectors, laser systems, and specially prepared suction devices have been used, but none of these techniques can achieve complete hemostasis during dissection. METHODS: The instrument was used in open and laparoscopic liver resections. It works by means of a longitudinally vibrating blade or scissors in tissue dissection, coagulation, and preparation. Denaturation of protein and coagulation of vessels up to 2 to 3 mm is possible as a result of the vibration. In this prospective study of a consecutively sampled case series of 41 patients, the author sought to gain experience in handling this instrument and in its capabilities, and they also measured the extent of intraoperative and postoperative blood loss. RESULTS: The UltraCision was used for 64 open liver resections in 39 patients and for 2 laparoscopic liver resections in 2 patients. Blood loss in laparoscopic resections was less than 50 mL; in open resections it averaged 820 mL. Eleven patients (28%) needed blood transfusions. There were no biliary leakages or abscesses. One patient died after postoperative bleeding leading to fatal liver failure after 4 weeks. Handling of the instrument and cutting and coagulation quality were satisfactory. CONCLUSIONS: The advantages over other resection techniques are limited heat and smoke generation and the lack of current flow through the patient. The handling and coagulation and cutting quality of the UltraCision appeared satisfactory and safe. The new instrument can be recommended for laparoscopic and open resections of the liver.
