Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 132
Filtrar
1.
Expert Rev Gastroenterol Hepatol ; 16(1): 33-49, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34923892

RESUMO

INTRODUCTION: Abdominal tuberculosis (TB) is a common epitome of extrapulmonary TB (EPTB), wherein peritoneal and intestinal TB are the most prevalent forms. Diagnosis of abdominal TB is a daunting challenge owing to variable anatomical locations, paucibacillary nature of specimens and atypical clinical presentations that mimic other abdominal diseases, such as Crohn's disease and malignancies. In this review, we made a comprehensive study on the diagnosis of abdominal TB. AREA COVERED: Various modalities employed for abdominal TB diagnosis include clinical features, imaging, bacteriological tests (smear/culture), histopathological/cytological observations, interferon-gamma release assays and nucleic acid amplification tests (NAATs). Among NAATs, loop-mediated isothermal amplification assay, PCR, multiplex-PCR, nested PCR, real-time PCR and GeneXpert® MTB/RIF were discussed. Identification of circulating Mycobacterium tuberculosis cell-free DNA by real-time PCR within ascitic fluids is another useful approach. EXPERT OPINION: Several novel molecular/immunological methods, such as GeneXpert Ultra, aptamer-linked immobilized sorbent assay, immuno-PCR (I-PCR) and nanoparticle-based I-PCR have recently been developed for detecting pulmonary TB and several EPTB types, which may also be explored for abdominal TB diagnosis. Precise and prompt diagnosis of abdominal TB may initiate an early therapy so as to reduce the complications, i.e. abdominal pain, ascites, abdominal distension, intestinal obstruction/perforation, etc., and avoid surgical involvement.Plain Language SummaryAbdominal tuberculosis (TB) is a manifestation of extrapulmonary TB (EPTB), where peritoneal and intestinal TB are two major forms. Diagnosis of abdominal TB is difficult owing to low bacterial load present in clinical samples and non-specific clinical presentations as it mimics other diseases such as inflammatory bowel diseases, abdominal malignancies, etc. Bacteriological tests (smear/culture) almost fail owing to poor sensitivities and it is not always possible to get representative tissue samples for histopathological and cytological observations. In recent years, molecular tests i.e. nucleic acid amplification tests (NAATs), such as PCR/multiplex-PCR (M-PCR), nested PCR and GeneXpert are widely employed. Markedly, PCR/M-PCR and nested PCR exhibited reasonable good sensitivities/specificities, while GeneXpert revealed low sensitivity in most of the studies but high specificity, thus it could assist in differential diagnosis of intestinal TB and Crohn's disease. Further, novel molecular/immunological tests employed for pulmonary TB and other EPTB types were described and those tests can also be utilized to diagnose abdominal TB. Reliable and rapid diagnosis of abdominal TB would initiate an early start of anti-tubercular therapy and reduce the severe complications.


Assuntos
Doenças Peritoneais/diagnóstico , Doenças Peritoneais/microbiologia , Tuberculose Gastrointestinal/diagnóstico , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico , Sensibilidade e Especificidade , Tuberculose Gastrointestinal/microbiologia
2.
Ann R Coll Surg Engl ; 103(9): e285-e287, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34414779

RESUMO

Ectopic ovary is a rare gynaecological condition that results in problems with menstruation and pregnancy and may develop into a malignant tumour. However, as the condition is often asymptomatic, diagnosis is difficult and frequently delayed. We report a case of a 42-year-old female who presented with a 10-day history of abdominal pain. The patient underwent surgery that confirmed the diagnosis of an ectopic ovary with an internal abscess. The findings of our study indicate that ectopic ovaries can present with an abscess. Ectopic ovaries should be included in the differential diagnosis of masses with internal abscesses.


Assuntos
Abscesso/etiologia , Mesentério , Ovário/anormalidades , Doenças Peritoneais/etiologia , Adulto , Feminino , Humanos , Doenças Peritoneais/microbiologia
3.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(4): 567-572, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32691569

RESUMO

OBJECTIVE: To identify the risk factors of ESKAPE pathogens infection and related death in cancer patients, and to supply evidence for clinical precaution and diagnosis. METHODS: A retrospective study of clinical and experimental data of cancer patients with bloodstream infection were carried out in Sichuan Cancer Hospital from 2013 to 2018. The clinical feature, predisposing factors and risk factors of death in ESKAPE group and non-ESKAPE group were analyzed by univariate analysis and multivariate logistic regression. RESULTS: A total of 753 patients were enrolled in the study. Totally 795 pathogenic bacteria strains were isolated from blood culture and there were 278 ESKAPE strains, which took up 34.97% of isolated strains. Univariate analysis and multivariate logistic regression analysis showed that gender of male, multiple pathogens, history of exposure to enzyme inhibitors and agranulocytosis were independent risk factors of ESKAPE pathogens bloodstream infection. Peritoneal infection and combined fungal infection were independent risk factors of ESKAPE bloodstream infection related death. CONCLUSION: The bloodstream infection of ESKAPE pathogens is a problem worthy of clinical attention for cancer patients with neutrophil deficiency, previous antibiotic exposure, and fungal infection and peritoneal infection.


Assuntos
Bacteriemia , Neoplasias , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , China/epidemiologia , Humanos , Masculino , Micoses/complicações , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/microbiologia , Neutrófilos/patologia , Doenças Peritoneais/complicações , Doenças Peritoneais/microbiologia , Estudos Retrospectivos , Fatores de Risco
5.
Hum Reprod Update ; 26(2): 214-246, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32108227

RESUMO

BACKGROUND: Endometriosis is a gynaecological hormone-dependent disorder that is defined by histological lesions generated by the growth of endometrial-like tissue out of the uterus cavity, most commonly engrafted within the peritoneal cavity, although these lesions can also be located in distant organs. Endometriosis affects ~10% of women of reproductive age, frequently producing severe and, sometimes, incapacitating symptoms, including chronic pelvic pain, dysmenorrhea and dyspareunia, among others. Furthermore, endometriosis causes infertility in ~30% of affected women. Despite intense research on the mechanisms involved in the initial development and later progression of endometriosis, many questions remain unanswered and its aetiology remains unknown. Recent studies have demonstrated the critical role played by the relationship between the microbiome and mucosal immunology in preventing sexually transmitted diseases (HIV), infertility and several gynaecologic diseases. OBJECTIVE AND RATIONALE: In this review, we sought to respond to the main research question related to the aetiology of endometriosis. We provide a model pointing out several risk factors that could explain the development of endometriosis. The hypothesis arises from bringing together current findings from large distinct areas, linking high prenatal exposure to environmental endocrine-disrupting chemicals with a short anogenital distance, female genital tract contamination with the faecal microbiota and the active role of genital subclinical microbial infections in the development and clinical progression of endometriosis. SEARCH METHODS: We performed a search of the scientific literature published until 2019 in the PubMed database. The search strategy included the following keywords in various combinations: endometriosis, anogenital distance, chemical pollutants, endocrine-disrupting chemicals, prenatal exposure to endocrine-disrupting chemicals, the microbiome of the female reproductive tract, microbiota and genital tract, bacterial vaginosis, endometritis, oestrogens and microbiota and microbiota-immune system interactions. OUTCOMES: On searching the corresponding bibliography, we found frequent associations between environmental endocrine-disrupting chemicals and endometriosis risk. Likewise, recent evidence and hypotheses have suggested the active role of genital subclinical microbial infections in the development and clinical progression of endometriosis. Hence, we can envisage a direct relationship between higher prenatal exposure to oestrogens or estrogenic endocrine-disrupting compounds (phthalates, bisphenols, organochlorine pesticides and others) and a shorter anogenital distance, which could favour frequent postnatal episodes of faecal microbiota contamination of the vulva and vagina, producing cervicovaginal microbiota dysbiosis. This relationship would disrupt local antimicrobial defences, subverting the homeostasis state and inducing a subclinical inflammatory response that could evolve into a sustained immune dysregulation, closing the vicious cycle responsible for the development of endometriosis. WIDER IMPLICATIONS: Determining the aetiology of endometriosis is a challenging issue. Posing a new hypothesis on this subject provides the initial tool necessary to design future experimental, clinical and epidemiological research that could allow for a better understanding of the origin of this disease. Furthermore, advances in the understanding of its aetiology would allow the identification of new therapeutics and preventive actions.


Assuntos
Endometriose/etiologia , Doenças Peritoneais/etiologia , Canal Anal/microbiologia , Canal Anal/patologia , Infecções Assintomáticas/epidemiologia , Pesos e Medidas Corporais , Disruptores Endócrinos/toxicidade , Endometriose/epidemiologia , Endometriose/microbiologia , Endometriose/patologia , Endométrio/efeitos dos fármacos , Endométrio/patologia , Poluentes Ambientais/toxicidade , Feminino , Microbioma Gastrointestinal/efeitos dos fármacos , Microbioma Gastrointestinal/fisiologia , Genitália Feminina/efeitos dos fármacos , Genitália Feminina/microbiologia , Genitália Feminina/patologia , Humanos , Doenças Peritoneais/epidemiologia , Doenças Peritoneais/microbiologia , Doenças Peritoneais/patologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/microbiologia , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia
6.
Hum Reprod ; 34(6): 1106-1116, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31037294

RESUMO

STUDY QUESTION: Does altering gut microbiota with antibiotic treatment have any impact on endometriosis progression? SUMMARY ANSWER: Antibiotic therapy reduces endometriosis progression in mice, possibly by reducing specific gut bacteria. WHAT IS KNOWN ALREADY: Endometriosis, a chronic condition causing abdominal pain and infertility, afflicts up to 10% of women between the ages of 25 and 40, ~5 million women in the USA. Current treatment strategies, including hormone therapy and surgery, have significant side effects and do not prevent recurrences. We have little understanding of why some women develop endometriosis and others do not. STUDY DESIGN, SIZE, DURATION: Mice were treated with broad-spectrum antibiotics or metronidazole, subjected to surgically-induced endometriosis and assayed after 21 days. PARTICIPANTS/MATERIALS, SETTING, METHODS: The volumes and weights of endometriotic lesions and histological signatures were analysed. Proliferation and inflammation in lesions were assessed by counting cells that were positive for the proliferation marker Ki-67 and the macrophage marker Iba1, respectively. Differences in faecal bacterial composition were assessed in mice with and without endometriosis, and faecal microbiota transfer studies were performed. MAIN RESULTS AND THE ROLE OF CHANCE: In mice treated with broad-spectrum antibiotics (vancomycin, neomycin, metronidazole and ampicillin), endometriotic lesions were significantly smaller (~ 5-fold; P < 0.01) with fewer proliferating cells (P < 0.001) than those in mice treated with vehicle. Additionally, inflammatory responses, as measured by the macrophage marker Iba1 in lesions and IL-1ß, TNF-α, IL-6 and TGF-ß1 in peritoneal fluid, were significantly reduced in mice treated with broad-spectrum antibiotics (P < 0.05). In mice treated with metronidazole only, but not in those treated with neomycin, ectopic lesions were significantly (P < 0.001) smaller in volume than those from vehicle-treated mice. Finally, oral gavage of faeces from mice with endometriosis restored the endometriotic lesion growth and inflammation (P < 0.05 and P < 0.01, respectively) in metronidazole-treated mice. LARGE-SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: These findings are from a mouse model of surgically-induced endometriosis. Further studies are needed to determine the mechanism by which gut bacteria promote inflammation, identify bacterial genera or species that promote disease progression and assess the translatability of these findings to humans. WIDER IMPLICATIONS OF THE FINDINGS: Our findings suggest that gut bacteria promote endometriosis progression in mice. This finding if translated to humans, could aid in the development of improved diagnostic tools and personalised treatment strategies. STUDY FUNDING AND COMPETING INTEREST(S): This work was funded, in part, by: a National Institutes of Health (NIH)/ National Institute of Child Health and Human Development (NICHD) grant (R00HD080742) to RK; Washington University School of Medicine start-up funds to RK; an Endometriosis Foundation of America Research Award to R.K.; and an NIH/NICHD grant (R01HD091218) to IUM. The authors report no conflict of interest.


Assuntos
Antibacterianos/administração & dosagem , Endometriose/tratamento farmacológico , Microbioma Gastrointestinal/efeitos dos fármacos , Metronidazol/administração & dosagem , Doenças Peritoneais/tratamento farmacológico , Animais , Modelos Animais de Doenças , Progressão da Doença , Endometriose/microbiologia , Endometriose/patologia , Endométrio/patologia , Transplante de Microbiota Fecal/efeitos adversos , Fezes/microbiologia , Feminino , Microbioma Gastrointestinal/fisiologia , Humanos , Camundongos , Doenças Peritoneais/microbiologia , Doenças Peritoneais/patologia
8.
Saudi J Kidney Dis Transpl ; 30(2): 470-477, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31031383

RESUMO

The objective is to study the clinical profile of tuberculosis (TB) in chronic kidney disease (CKD). This is retrospective study of CKD patients who were diagnosed to have TB over a period of seven years at a tertiary care hospital. TB was diagnosed in 115 patients with an incidence of 4200/100,000. Mean age of the patients was 46.9 ± 16 years. Sixty-two patients (53.9%) were male. Causes of CKD were diabetic nephropathy and hypertension in 11.3% each, chronic glomerulonephritis in 31.3%, chronic tubulointerstitial nephritis in 39.1%, autosomal dominant polycystic kidney disease, and post-renal transplant CKD in 3.5% each. About 68.7% of patients with TB had advanced CKD stage of 4-5D, whereas 31.3% of patients had early CKD stage 1-3. Twenty percent of patients were on dialysis. Three-fourths of the patients had extrapulmonary TB. Pleuropulmonary (41.8%), kidney and urinary tract (20%), and abdomen and lymph node (13% each) were the most common sites for TB. The main clinical presentation of TB was: fever/pyrexia of unknown origin in 24.3%, constitutional symptoms of anorexia, fever, night sweats, and weight loss in 27.8%, abnormal chest radiograph in 31.2%, ascites/peritonitis in 13.9%, pleural effusion in 25.2%, lymphadenopathy in 20%, and sterile pyuria/hematuria/chronic pyelonephritis in 13%. Microbiological and/or histopathological diagnoses were made in 45.2% and in the other 54.8%, diagnosis of TB was made on clinical grounds. Adverse effects of anti-TB drugs were seen in 9.6% of patients. Ninety-three percent completed the treatment and survived. Eight patients (7%), all in CKD stage 5D, died. The incidence of TB was high among CKD stages 4 and 5 and in those receiving dialysis. Extrapulmonary disease such as pleuropulmonary, renal, peritoneal, and lymph node were the common forms of TB.


Assuntos
Falência Renal Crônica/epidemiologia , Doenças Linfáticas/epidemiologia , Doenças Peritoneais/epidemiologia , Doenças Pleurais/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anorexia/microbiologia , Antituberculosos/uso terapêutico , Comorbidade , Doenças Endêmicas , Feminino , Febre de Causa Desconhecida/microbiologia , Humanos , Incidência , Índia/epidemiologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/fisiopatologia , Doenças Linfáticas/complicações , Doenças Linfáticas/microbiologia , Masculino , Pessoa de Meia-Idade , Doenças Peritoneais/complicações , Doenças Peritoneais/microbiologia , Doenças Pleurais/complicações , Doenças Pleurais/microbiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Redução de Peso , Adulto Jovem
9.
BMJ Case Rep ; 12(1)2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30696650

RESUMO

We report the case of a 59-year-old Russian man who presented with a painless, slow-growing, epigastric mass. CT revealed a large heterogeneous mass within the omentum infiltrating into adjacent tissues. During diagnostic laparoscopy, the omental mass was noted to be firm, raising the suspicion of malignancy. Surgical en-bloc resection of the mass, including the posterior rectus sheath, transverse colon and small bowel, was performed with primary anastomoses at laparotomy. Histological examination was inconsistent with malignancy and revealed the mass to be actinomycosis, confirmed by microscopy and gram staining. Surgical resection was followed by an 8-week course of penicillin and doxycycline antibiotic therapy. This treatment resulted in full clinical and radiological recovery with no complications. Although the clinical and radiological findings, in this case, were highly suspicious of malignancy, abdominal actinomycosis should be considered a differential diagnosis in patients with infiltrative abdominal masses and mild constitutional symptoms.


Assuntos
Parede Abdominal/microbiologia , Actinomicose/diagnóstico , Colo Transverso/microbiologia , Intestino Delgado/microbiologia , Omento/microbiologia , Doenças Peritoneais/microbiologia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Actinomicose/diagnóstico por imagem , Actinomicose/terapia , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Colo Transverso/diagnóstico por imagem , Colo Transverso/cirurgia , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Humanos , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Omento/diagnóstico por imagem , Omento/cirurgia , Doenças Peritoneais/diagnóstico por imagem , Doenças Peritoneais/terapia , Tomografia Computadorizada por Raios X/métodos
10.
Hum Reprod ; 33(4): 607-616, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29462324

RESUMO

STUDY QUESTION: What happens to the gut microbiota during development of murine endometriosis? SUMMARY ANSWER: Mice with the persistence of endometrial lesions for 42 days develop a distinct composition of gut microbiota. WHAT IS KNOWN ALREADY: Disorders in the immune system play fundamental roles in changing the intestinal microbiota. No study has used high-throughput DNA sequencing to show how endometriosis changes the gut microbiota, although endometriosis is accompanied by abnormal cytokine expression and immune cell dysfunction. STUDY DESIGN, SIZE, DURATION: This study includes a prospective and randomized experiment on an animal endometriosis model induced via the intraperitoneal injection of endometrial tissues. PARTICIPANTS/MATERIALS, SETTING, METHODS: The mice were divided into endometriosis and mock groups and were sacrificed at four different time points for model confirmation and fecal sample collection. To detect gut microbiota, 16S ribosomal-RNA gene sequencing was performed. Alpha diversity was used to analyze the complexity and species diversity of the samples through six indices. Beta diversity analysis was utilized to evaluate the differences in species complexity. Principal coordinate analysis and unweighted pair-group method with arithmetic means clustering were performed to determine the clustering features. The microbial features differentiating the fecal microbiota were characterized by linear discriminant analysis effect size method. MAIN RESULTS AND THE ROLE OF CHANCE: The endometriosis and mock mice shared similar diversity and richness of gut microbiota. However, different compositions of gut microbiota were detected 42 days after the modeling. Among the discriminative concrete features, the Firmicutes/Bacteroidetes ratio was elevated in mice with endometriosis, indicating that endometriosis may induce dysbiosis. Bifidobacterium, which is known as a commonly used probiotic, was also increased in mice with endometriosis. LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: More control groups should be further studied to clarify the specificity of the dysbiosis induced by endometriosis. This study was performed only on mice. Thus, additional data acquired from patients with endometriosis are needed in future research. We only detected the changes of gut microbiota at 42 days after the modeling, while the long-term effect of endometriosis on gut microbiota remains poorly understood. Moreover, we only revealed a single effect of endometriosis on gut microbiota. WIDER IMPLICATIONS OF THE FINDINGS: This study provided the first comprehensive data on the association of endometriosis and gut microbiota from high-throughput sequencing technology. The gut microbiota changed with the development of endometriosis in a murine model. The communication between the host and the gut microbiota is bidirectional, and further studies should be performed to clarify their relationship. STUDY FUNDING/COMPETING INTEREST(S): This research was supported by Grant (81571417) from the National Science Foundation of China and Grant (2015GSF118092) from the Technology Development Plan of Shandong Province. The authors report no conflict of interest.


Assuntos
Endometriose/microbiologia , Microbioma Gastrointestinal/fisiologia , Doenças Peritoneais/microbiologia , Animais , Modelos Animais de Doenças , Feminino , Camundongos
11.
J R Coll Physicians Edinb ; 47(4): 353-355, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29537407

RESUMO

A 47-year-old female, with multiple comorbidities, presented with a cough of two months, loss of weight and appetite. She was treated for pneumonia. A chest X-ray showed bilateral reticulonodular opacities. She was noted to have a vague central abdominal mass and a systolic murmur over the mitral region. Ultrasonography and computed tomography of the abdomen showed an omental mass and loculated ascites. Oesophagoduedenoscopy showed antral gastritis and during colonoscopy the surgical team was unable to advance the scope beyond 40 cm due to external compression. An echocardiogram showed a right atrial mass and a pericardial effusion over the posterior wall. A possible diagnosis of atrial myxoma was made. Sputum acid-fast bacillus was negative. The patient was treated empirically for disseminated tuberculosis and scheduled for bronchoscopy by the pulmonology team. The patient showed remarkable improvement after day 7 of anti-tuberculosis medication. GeneXpert study came back as positive. CT abdomen and echocardiogram repeated after 2 weeks of treatment showed reduction in the mass.


Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Doenças Peritoneais/diagnóstico por imagem , Tuberculoma/diagnóstico por imagem , Tuberculose Cardiovascular/diagnóstico por imagem , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Átrios do Coração , Humanos , Pessoa de Meia-Idade , Omento/diagnóstico por imagem , Doenças Peritoneais/tratamento farmacológico , Doenças Peritoneais/microbiologia , Tomografia Computadorizada por Raios X , Tuberculoma/tratamento farmacológico , Tuberculose Cardiovascular/tratamento farmacológico
13.
Ugeskr Laeger ; 176(3A): V06130418, 2014 Jan 13.
Artigo em Dinamarquês | MEDLINE | ID: mdl-25347178

RESUMO

We report a case of omental actinomycosis in a female patient with an intrauterine device. A computed tomography had shown an inflammatory tumour in the abdomen. The patient was treated with laparoscopic resection of the tumour and prolonged antibiotic therapy. Abdominal actinomycosis should be considered as a differential diagnosis in patients with abdominal symptoms and unspecific clinical, radiological and laboratory findings. Definitive diagnosis of actinomycosis requires histological examination of affected tissue. Laparoscopic resection seems feasible as an alternative to open surgery.


Assuntos
Actinomicose/tratamento farmacológico , Actinomicose/cirurgia , Omento/microbiologia , Doenças Peritoneais/microbiologia , Actinomicose/diagnóstico por imagem , Actinomicose/patologia , Antibacterianos/uso terapêutico , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos , Pessoa de Meia-Idade , Omento/diagnóstico por imagem , Omento/patologia , Omento/cirurgia , Doenças Peritoneais/diagnóstico por imagem , Doenças Peritoneais/tratamento farmacológico , Doenças Peritoneais/patologia , Doenças Peritoneais/cirurgia , Tomografia Computadorizada por Raios X
14.
Conn Med ; 78(9): 537-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25675594

RESUMO

Blastomycosis is a disease caused by the fungus Blastomyces dermatitidis. Pulmonary blastomycosis is the most common form of blastomycosis. Disseminated blastomycosis is the fulminant form of the disease, with rare reports of peritoneal cavity involvement. We report a case of extensive form of the disease presenting initially as abdominal pain and mimicking peritoneal carcinomatosis.


Assuntos
Blastomicose/complicações , Blastomicose/diagnóstico , Carcinoma/diagnóstico , Neoplasias Peritoneais/diagnóstico , Dor Abdominal/etiologia , Líquido Ascítico/microbiologia , Blastomyces/isolamento & purificação , Blastomicose/tratamento farmacológico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Doenças Peritoneais/microbiologia , Vômito/etiologia
15.
J Nephrol ; 26(6): 1160-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24284522

RESUMO

BACKGROUND: Bacterial peritonitis in patients undergoing peritoneal dialysis (PD) is a major cause of therapy interruption due to peritoneal insufficiency. Here we studied the effect of a selective mineralocorticoid receptor (MR) blocker, eplerenone, on the prevention of peritoneal damage.
 METHODS: Male Sprague-Dawley rats were treated with a daily infusion of human use PD solution (100 mL/kg i.p., PD group, n = 5), or with PD solution and intermittent intraperitoneal injections of lipopolysaccharide (LPS group, n = 5) or with LPS and eplerenone (100 mg/kg/d, po, Ep group, n = 5) for 4 weeks. Peritoneal samples were subjected to assessment following the peritoneal equilibration test (PET). RESULTS: Histological observations revealed that LPS treatment resulted in significant peritoneal thickening associated with increased ED-1-positive cell infiltration and the number of transforming growth factor (TGF)-ß1-positive cells, and that eplerenone reduced these changes. LPS administration also evoked significant upregulation of monocyte chemotactic protein-1 and TGF-ß1, which were inhibited by eplerenone. PET revealed that ultrafiltration and transperitoneal osmotic diffusion were significantly impaired by LPS and restored by eplerenone. Increased value of the mass transfer area coefficients for creatinine values was also recovered by Ep (0.10 ± 0.01 in the PD, 0.14 ± 0.02 in the LPS and 0.08 ± 0.0 in the Ep groups). Immunostaining for von Willebrand factor showed a significant increase by LPS and its restoration by Ep.
 CONCLUSIONS: Ep effectively diminished LPS-induced peritoneal insufficiency. A selective blockade of MR might prevent peritoneal insufficiency associated with bacterial peritonitis.


Assuntos
Soluções para Diálise/efeitos adversos , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Doenças Peritoneais/prevenção & controle , Espironolactona/análogos & derivados , Animais , Quimiocina CCL2/metabolismo , Creatinina , Eplerenona , Lipopolissacarídeos , Masculino , Osmose/efeitos dos fármacos , Diálise Peritoneal , Doenças Peritoneais/microbiologia , Peritônio/efeitos dos fármacos , Peritônio/patologia , Peritonite/tratamento farmacológico , Peritonite/etiologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Espironolactona/uso terapêutico , Fator de Crescimento Transformador beta1/metabolismo , Ultrafiltração , Fator de von Willebrand/metabolismo
16.
Intensive Care Med ; 39(12): 2092-106, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24105327

RESUMO

INTRODUCTION: intra-abdominal candidiasis (IAC) may include Candida involvement of peritoneum or intra-abdominal abscess and is burdened by high morbidity and mortality rates in surgical patients. Unfortunately, international guidelines do not specifically address this particular clinical setting due to heterogeneity of definitions and scant direct evidence. In order to cover this unmet clinical need, the Italian Society of Intensive Care and the International Society of Chemotherapy endorsed a project aimed at producing practice recommendations for the management of immune-competent adult patients with IAC. METHODS: A multidisciplinary expert panel of 22 members (surgeons, infectious disease and intensive care physicians) was convened and assisted by a methodologist between April 2012 and May 2013. Evidence supporting each statement was graded according to the European Society of Clinical Microbiology and Infection Diseases (ESCMID) grading system. RESULTS: Only a few of the numerous recommendations can be summarized in the Abstract. Direct microscopy examination for yeast detection from purulent and necrotic intra-abdominal specimens during surgery or by percutaneous aspiration is recommended in all patients with nonappendicular abdominal infections including secondary and tertiary peritonitis. Samples obtained from drainage tubes are not valuable except for evaluation of colonization. Prophylactic usage of fluconazole should be adopted in patients with recent abdominal surgery and recurrent gastrointestinal perforation or anastomotic leakage. Empirical antifungal treatment with echinocandins or lipid formulations of amphotericin B should be strongly considered in critically ill patients or those with previous exposure to azoles and suspected intra-abdominal infection with at least one specific risk factor for Candida infection. In patients with nonspecific risk factors, a positive mannan/antimannan or (1→3)-ß-D-glucan (BDG) or polymerase chain reaction (PCR) test result should be present to start empirical therapy. Fluconazole can be adopted for the empirical and targeted therapy of non-critically ill patients without previous exposure to azoles unless they are known to be colonized with a Candida strain with reduced susceptibility to azoles. Treatment can be simplified by stepping down to an azole (fluconazole or voriconazole) after at least 5-7 days of treatment with echinocandins or lipid formulations of amphotericin B, if the species is susceptible and the patient has clinically improved. CONCLUSIONS: Specific recommendations were elaborated on IAC management based on the best direct and indirect evidence and on the expertise of a multinational panel.


Assuntos
Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Infecções Intra-Abdominais/tratamento farmacológico , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/microbiologia , Adulto , Técnicas Bacteriológicas , Candida/isolamento & purificação , Candidíase/microbiologia , DNA Fúngico/análise , Humanos , Infecções Intra-Abdominais/microbiologia , Técnicas de Tipagem Micológica , Doenças Peritoneais/tratamento farmacológico , Doenças Peritoneais/microbiologia , Reação em Cadeia da Polimerase , Fatores de Risco
17.
Immunol Lett ; 147(1-2): 75-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22771342

RESUMO

Sepsis is a systemic inflammatory response to infection associated with multiple organ dysfunction syndrome and a high mortality rate. In septic shock induced by severe peritonitis, early response of peritoneal macrophages against infected microbes is vital in preventing the spread of infection. We found that the mucosal homing receptor CCR9, is induced in peritoneal macrophages in response to inflammatory stimulation. We used a cecal ligation and puncture (CLP) model of sepsis to determine the role of CCR9 with respect to peritoneal macrophages, and controlling peritoneal infection and systemic inflammation. CCR9(-/-) mice showed aggravated septic shock with higher mortality rates compared with wild-type (WT) mice. Six hours after CLP, CCR9(-/-) mice demonstrated a greater inflammatory response. This was associated with higher production of inflammatory cytokines, such as IL-6, TNF and IP-10 in peritoneal lavage compared with WT mice. Although the numbers of peritoneal bacteria were elevated in CCR9(-/-) mice subjected to CLP compared with WT mice, this was normalized in CCR9(-/-) mice subjected to CLP through the adoptive transfer of WT peritoneal macrophages. We conclude that CCR9 is required for recruitment of peritoneal macrophages in the steady state to control systemic sepsis during early phases of peritoneal infection.


Assuntos
Infecções Bacterianas/imunologia , Macrófagos Peritoneais/imunologia , Doenças Peritoneais/imunologia , Peritonite/imunologia , Receptores CCR/fisiologia , Sepse/imunologia , Animais , Infecções Bacterianas/genética , Citocinas/biossíntese , Citocinas/imunologia , Mediadores da Inflamação/imunologia , Mediadores da Inflamação/metabolismo , Macrófagos Peritoneais/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Neutrófilos/imunologia , Cavidade Peritoneal/microbiologia , Cavidade Peritoneal/patologia , Doenças Peritoneais/genética , Doenças Peritoneais/microbiologia , Peritonite/genética , Peritonite/microbiologia , Receptores CCR/deficiência , Receptores CCR/genética , Sepse/genética , Sepse/microbiologia
18.
Endoscopy ; 44(7): 684-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22528675

RESUMO

BACKGROUND AND STUDY AIMS: Animal data and limited clinical evidence suggest a low incidence of infection following transvaginal natural orifice transluminal endoscopic surgery (NOTES). However, a systematic microbiological evaluation has not yet been carried out. The aim of this prospective cohort study was to evaluate the extent of microbiological contamination of the peritoneal cavity caused by the transvaginal access for NOTES and the impact of preoperative vaginal disinfection on vaginal colonization. PATIENTS AND METHODS: Consecutive female patients with symptomatic cholecystolithiasis were offered either transvaginal rigid-hybrid cholecystectomy (tvCCE) or conventional laparoscopic cholecystectomy. Patients who opted for tvCCE were prospectively evaluated between February and June 2010. Disinfection in patients undergoing tvCCE included hexetidine tablets and octenidine applied vaginally. All patients received a single dose of perioperative cefuroxime. Swabs were obtained from the posterior fornix and the peritoneal cavity at different intervals. RESULTS: Of 32 patients, 27 (84 %) opted to undergo tvCCE. One patient (4 %; 95 % confidence interval [CI] 0.7 % - 18.3 %) had a positive bacterial culture in the Douglas pouch prior to transvaginal access compared with two patients (7 %; 95 %CI 2.1 % - 23.4 %) following colpotomy closure (P = 1.000). Vaginal disinfection significantly decreased vaginal bacterial load (P = 0.001) and bacterial growth in routine cultures (P < 0.001); in 16 patients (59 %; 95 %CI 40.7 % - 75.5 %) vaginal swabs were sterile after disinfection. No postoperative surgical site infections occurred (95 %CI 0 % - 12.5 %). CONCLUSIONS: In selected patients and following vaginal antisepsis, transvaginal access for NOTES is associated with microbiological contamination of the peritoneal cavity in a minority of patients, indicating a low risk of peritoneal contamination caused by the transvaginal access.


Assuntos
Antibioticoprofilaxia/métodos , Carga Bacteriana/efeitos dos fármacos , Colecistectomia , Colpotomia/efeitos adversos , Endoscopia Gastrointestinal , Doenças Peritoneais , Complicações Pós-Operatórias , Vagina/microbiologia , Administração Intravaginal , Adulto , Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Cefuroxima/uso terapêutico , Colecistectomia/efeitos adversos , Colecistectomia/métodos , Colecistectomia Laparoscópica/métodos , Colecistolitíase/cirurgia , Colpotomia/métodos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/métodos , Contaminação de Equipamentos/prevenção & controle , Feminino , Hexitidina/uso terapêutico , Humanos , Iminas , Pessoa de Meia-Idade , Doenças Peritoneais/etiologia , Doenças Peritoneais/microbiologia , Doenças Peritoneais/prevenção & controle , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Piridinas/uso terapêutico , Resultado do Tratamento , Vagina/cirurgia
19.
Surg Laparosc Endosc Percutan Tech ; 21(5): e288-90, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22002299

RESUMO

Omental actinomycosis without any predisposing factors is rare, and there are few reports on it invading the contiguous bowels to form fistulae. We describe the case of a 55-year-old male patient with omental actinomycosis that presented as an inflammatory tumor that formed fistulae with the transverse colon and upper jejunum. On admission, he had complaints of a palpable, tender mass on the left mid-abdomen without gastrointestinal symptoms. After 7 days of conservative treatments (NPO and intravenous antibiotics), the size of the mass was decreased and tenderness was more improved. Laparoscopic resected omental mass revealed fistulae to the colon and jejunum. There was no evidence of Crohn disease. After 1-week use of antibiotics owing to the concern about actinomycosis, the mass was decreased and it was more amenable to dissect laparoscopically.


Assuntos
Actinomicose/cirurgia , Doenças do Colo/cirurgia , Fístula Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Laparoscopia/métodos , Doenças Peritoneais/cirurgia , Actinomicose/diagnóstico , Actinomicose/microbiologia , Antifúngicos/uso terapêutico , Biópsia , Colo Transverso , Doenças do Colo/diagnóstico , Doenças do Colo/microbiologia , Colonoscopia , Diagnóstico Diferencial , Seguimentos , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/microbiologia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/microbiologia , Masculino , Pessoa de Meia-Idade , Omento , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/microbiologia , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA