Persistent endoleak after endovascular aneurysm repair for acute Q-fever-infected aortocaval fistula.

We present a case of an endovascular aneurysm repair for a Q-fever-infected acute abdominal aortic aneurysm with aortocaval fistula. Type 2 endoleak persisted after successful endovascular repair.

Pulmonary phagocyte depression induced by an acid or alkaline solution in a rat model of peritonitis.

BACKGROUND: Peritonitis is a surgical problem with a high mortality rate attributable to various complications, including respiratory infection. This complication is more common under certain conditions reflective of the origin of peritonitis, suggesting that the composition of the peritoneal fluid exerts an influence on the intensity of the macrophage and peritoneal response. To establish a correlation among macrophage function, absorption of bacteria from the peritoneal cavity, and the pH of the peritoneal fluid, we carried out this study. METHODS: Thirty female Wistar rats were divided into three equal groups, all of which received infusions of 0.9% saline by parietal puncture. In group A (control), the saline pH was 7.0; in group B, it was 2.5; and in group C, it was 8.5. After 40 min, 0.25 mL of a suspension containing 10(11) colony-forming units of (99m)Tc-labeled Escherichia coli was infused by the same route. After another 40 min, samples of vena caval blood, spleen, liver, and lung were removed; the radioactivity was counted; bacterial absorption was determined; and the proportional radioactivity/g of tissue was calculated. The values were compared among the groups by the Student t-test, with the level of significance set at p < 0.05. RESULTS: There was significantly greater bacterial absorption in group B than in group C (p = 0.004) but no differences in the numbers of bacteria in the liver and spleen. Bacteria were significantly more numerous in the peripheral blood in group B than in groups A and C (p = 0.04 for both). Pulmonary phagocytosis was significantly reduced in group B compared with group A (p = 0.008) and group C (p = 0.005). CONCLUSION: Peritonitis associated with acidic conditions in the peritoneal cavity is correlated with a reduction in pulmonary phagocytosis and an increase in the numbers of nonphagocytized bacteria in the peripheral blood, possibly representing a direct or indirect cause of the higher incidence of pneumonia and sepsis in these individuals.

Candida sepsis following infected iliocaval thrombosis: a case report.

The authors report the case of a patient who developed a thrombosis of the right iliac vein involving also the inferior vena cava (IVC), in association with Candida sepsis. Despite adequate and prolonged antimycotic treatment, the patient recovered from the fungal sepsis only following the surgical removal of the infected thrombus.

Translocation of Salmonella typhimurium in rats; effect of enteral and parenteral nutrition.

OBJECTIVE: To study translocation of Salmonella typhimurium from ileal loops in rats fed enterally or parenterally. DESIGN: Laboratory experiment. SETTING: University departments of surgery and microbiology, Japan. SUBJECTS: Male Wistar rats and female BALB/C CrSlc mice. INTERVENTIONS: First experiment: portal venous blood and mesenteric lymph nodes from normally fed rats were cultured under aerobic and anaerobic conditions. Second experiment: various concentrations of S. typhimurium (GIFU 12142) were injected intraperitoneally in mice and their survival was monitored. Third experiment: 7 rats were given total parenteral nutrition for 14 days and 6 were given standard chow and water for the same period. Cultures of S. typhimurium were injected into closed ileal loops and portal and vena caval blood and mesenteric lymph nodes were cultured. MAIN OUTCOME MEASURES: Presence and number of bacteria in all samples, and survival of mice. RESULTS: In the first experiment 3/17 blood samples and 9/17 node samples grew enteric bacteria. In the second experiment all the mice died within 5 days. In the third experiment no sample grew bacteria in the enterally fed group, whereas at least some samples from 5/7 rats in the parenterally fed group grew organisms; the difference was significant (p = 0.02). CONCLUSION: Total parenteral nutrition encourages the translocation of S. typhimurium from ileal loops.

Susceptibility of endothelial cells derived from different blood vessels to common viruses.

We examined whether endothelial cells derived from different blood vessels vary in their susceptibility to viral infection. Five common viral pathogens of humans (herpes simplex 1, measles, mumps, echo 9, and coxsackie B4 viruses) were evaluated for growth in endothelial cells derived from bovine fetal pulmonary artery, thoracic aorta, and vena cava. All five viruses replicated in each type of endothelial cell. There were apparent differences in the quantities of measles and mumps viruses produced in pulmonary artery endothelium compared with thoracic aorta and vena cava when endothelial cells were obtained from different animals. However, when pulmonary artery endothelial cells were compared with vena cava cells from the same animal, growth of each virus was similar in the two cell types. Four of the viruses replicated in the various endothelial cells without producing appreciable changes in cell morphology. These results indicate that endothelial cells from different blood vessels are equally susceptible to the human viruses evaluated, and that viral replication can occur without major alterations in cell morphology. Endothelial cells could serve as permissive cells permitting viruses to leave the circulation and initiate infection in adjacent tissues, including subendothelial smooth muscle cells.

Endoscopic evaluation of infected pancreatic necrosis.

The most severe form of acute pancreatitis is characterized by necrosis of the pancreatic parenchyma and/or peripancreatic tissue. Secondary infection of this necrotic tissue carries a high mortality because there is little limitation to the spread of this infection in the retroperitoneum. Improvements in the management of infected pancreatic necrosis have been achieved by techniques that allow complete removal of the infected debris. Problems still remain in identifying the extent of necrosis and removing all of it. Intraoperative endoscopy can be used to evaluate tracking of the infected process to other areas of the retroperitoneum. Direct visualization of the path that the necrotizing process has taken to areas of the retroperitoneum that are difficult to reach allows the dissection to be limited if there is no necrosis or expansion to remove all necrotic material completely. The endoscope can also be used to remove necrotic material either by irrigation or by direct debridement. The methodology of this technique is described.