Percutaneous cholecystostomy:Single centre experience in 111 patients with an acute cholecystitis

'Purpose: 'To evaluate the safety and long-term outcome of percutaneous cholecystostomy (PC) under radiologic guidance for acute calculous cholecystitis (ACC) and acute acalculous cholecystitis (AAC) in all patients undergoing that procedure at our institution. 'Materials and methods: 'We performed a retrospective analysis of 111 patients who underwent PC from 2004 to 2012. Patients were divided into two groups: AAC and ACC. For all patients, comorbidity and American Society of Anesthesiologists (ASA) classification were determined. The indications, complications, recurrence rate and long-term outcome for both groups were analysed. The mean follow-up was 55 months. 'Results: 'Twenty-four patients with AAC and 87 patients with ACC underwent PC. The most common sonographic findings of ACC and AAC were gallbladder wall thickening (90,9%) and hydrops (72,9%). Twelve of 24 patients with AAC (50%) were hospitalized at the Intensive Care Unit (ICU). Overall, the procedure failed in 2 (1,8%) patients. There were 4 (3,6%) abscesses and 2 (1,8%) fistulas post PC. Drain dislodgment was found without sequelae in 8 (7,2%) patients. Elective cholecystectomy was performed in 35/111 (31,5%). Fifty-one of 87 (58,6%) patients with gallstones underwent cholecystectomy; 36/87 (41,3%) did not undergo surgery due to a too short follow-up or death of nonbiliary disease. In the AAC group, there was no recurrent cholecystitis in 17/24 (70,8%) patients; 3/24 (12,5%) underwent surgery and 4/24 (16,6%) patients died in the ICU. 'Conclusion: 'PC is a minimally invasive treatment with low complication rate for patients with acute cholecystitis whom considered being at high-risk for urgent cholecystectomy. Good selection (ASA III and IV) and indication is needed in patients with ACC before PC because the majority will be operated later on. AAC can be managed nonoperatively and further treatment might not be needed

Targeting microbial biofilms: current and prospective therapeutic strategies

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Biofilm formation is now recognized as a key virulence factor for a wide range of chronic microbial infections. While it has been well known for decades that bacteria and fungi in biofilms become highly tolerant of antibiotics, the development of effective therapeutics has lagged behind our growing understanding of biofilm biology. The multifactorial nature of biofilm development and drug tolerance imposes significant challenges to conventional antimicrobials, and indicates the need for multi-targeted or combinatorial therapies. In light of the discrepancy between the explosion of papers presenting multitude of methods to control biofilms and the sparsity of biofilm specific treatments available to the clinician, in this review, we focus on current therapeutic strategies and those in development for the treatment of biofilm infections, which target vital structure-function traits and drug tolerance mechanisms, including the extracellular matrix and dormant cells. We emphasize strategies that are supported by in vivo or ex vivo studies, highlight emerging anti-biofilm technologies, and provide a rationale for multi-targeted therapies aimed at disrupting the complex biofilm microenvironment