ABSTRACT
AIMS: To evaluate tomato epiphyte lactic acid bacteria (LAB) hydrophobicity and auto-aggregation as an indicator of bacteria adhesion to tomato. Likewise, use LAB adhesion and co-aggregation as mechanisms to antagonize pathogen attachment. METHODS AND RESULTS: Fifty-four LAB were screened to evaluate their hydrophobic, auto- and co-aggregative properties against Salmonella Typhimurium, Saintpaul, Montevideo and Escherichia coli O157:H7. Subsequently, tomato adhesion of Enterococcus faecium Col1-1C, Weisella cibaria 11-E-2 and W. confusa Col 1-13 with high, medium and low hydrophobicity and high co-aggregation was investigated as well as their pathogen antagonism. Results indicate that bacteria hydrophobicity and auto-aggregation correspond to LAB adhesion to tomato. Enterococcus faecium Col1-1C interfered in most of the pathogen adhesion and micrographs revealed that such effect could be related to the inhibition of structures-type biofilm on E. coli O157:H7 and the aggregate formation on Salmonella. CONCLUSIONS: Lactic acid bacteria hydrophobicity and auto-aggregation can estimate bacteria adhesion to tomato and adhesive and co-aggregative properties could serve as a tool to antagonize foodborne pathogens under specific conditions. SIGNIFICANCE AND IMPACT OF THE STUDY: This study evidence the interference of Ent. faecium Col1-1C in E. coli O157:H7 biofilm formation and Salmonella colonization.
Subject(s)
Antibiosis/physiology , Bacterial Adhesion/physiology , Food Microbiology , Lactobacillales/physiology , Solanum lycopersicum/microbiology , Biofilms , Colony Count, Microbial , Enterococcus faecium/pathogenicity , Escherichia coli O157/drug effects , Hydrophobic and Hydrophilic Interactions , Salmonella typhimurium/physiologyABSTRACT
The by-products of Hibiscus sabdariffa L. (HsL), obtained after soaking or decoction of the calyces of Colima and Sudan cultivars, were used for pectin extraction. After soaking, the wastes of both cultivars gave higher yields of pectin than those obtained by decoction. The pectin of the wastes by soaking presented high methoxyl groups, galacturonic acid content, viscosity and gelling capacity. Pectin of this treatment also exhibited bands in the regions of 1750 cm-1 and 1630 cm-1 that represents the C=O stretching vibrations of methyl ester and the amounts and degree of esterification of the HsL pectin. Interestingly, the pectin retained the typical red color of fresh HsL calyces. The amounts of anthocyanins and ascorbic acid of pectin did not show effects against pathogenic microorganisms. Nonetheless, pectin of the Sudan HsL wastes obtained by soaking, exhibited higher properties than those of the citric pectin, thus, demonstrating its potential for industrial applications.
ABSTRACT
Household refrigerators are a potential pathogen contamination source for foods. An evaluation of the microbiological safety of 200 refrigerators in Guadalajara, Jalisco, Mexico, was made by visual inspection, ATP-bioluminescence levels, indicator microorganisms including Escherichia coli and Staphylococcus aureus, and the presence of Listeria monocytogenes and Salmonella. Additionally, interviews of the owners of the refrigerators were carried out to determine relationships between food storage practices, demographic aspects, and microbiological status. Dishcloths used to clean refrigerators were also analyzed. Operational conditions (cleanliness, fullness, organization, frequency of cleaning, and temperature) were evaluated by trained observers. Results showed deficient cleanliness in 55% of refrigerators, 22% were completely full, 43% very disorganized, 28% were usually cleaned only once in 3 to 6 months, and 53% had internal temperatures >7.1°C. ATP-bioluminescence levels were >300 relative light units on 67 and 74% of shelves and drawers, respectively, indicating that surfaces were dirty according to the luminometer manufacturer. Psychrotrophic aerobic bacteria counts on shelves, drawers, and dishcloths were 6.3, 5.2, and 6.3 log CFU/cm(2); for coliform bacteria, 5.2, 3.9, and 4.7 CFU/cm(2); for E. coli, 3.7, 3.5, and 4.8 CFU/cm(2); and for Staphylococcus aureus, 2.1, 2.5, and 2.3 CFU/cm(2), respectively. L. monocytogenes and Salmonella were isolated from 59.5, 20.5, and 17% and 32.5, 8.0 and 12.5% of shelves, drawers, and dishcloths, respectively. Four Salmonella serotypes and nine serogroups (partially serotyped isolates) were identified. The most prevalent were Salmonella Anatum (39.5%), Salmonella group E1 (19.7%), and Salmonella group E1 monophasic (12.5%). Operational conditions and microbiological status were clearly deficient in sampled refrigerators, highlighting the consequent risk of foodborne disease among users. Educational programs are needed to improve the domestic food safety in Mexico.
Subject(s)
Consumer Product Safety , Equipment Contamination , Food Handling/standards , Food Microbiology , Refrigeration/standards , Colony Count, Microbial , Escherichia coli/isolation & purification , Food Contamination/analysis , Food Contamination/prevention & control , Food Handling/methods , Listeria monocytogenes/isolation & purification , Mexico , Salmonella/isolation & purification , Staphylococcus aureus/isolation & purification , TemperatureABSTRACT
AIMS: To identify and characterize adhesion-associated proteins in the potential probiotic Lactobacillus fermentum BCS87. METHODS AND RESULTS: Protein suspensions obtained from the treatment of Lact. fermentum BCS87 with 1 mol 1(-1) LiCl were analysed by Western blotting using HRP-labelled porcine mucus and mucin. Two adhesion-associated proteins with relative molecular weight of 29 and 32 kDa were identified. The N-terminal and internal peptides of the 32 kDa protein (32-Mmubp) were sequenced, and the corresponding gene (32-mmub) was found by inverse polymerase chain reaction. The complete nucleotide sequence of 32-mmub revealed an open reading frame of 903 bp encoding a primary protein of 300 amino acids and a mature protein of 272 residues. A basic local alignment search showed 47-99% identity to solute-binding components of ATP binding cassette transporter proteins in Lactobacillus, Streptococcus and Clostridium. An OpuAC-conserved domain was identified and phylogenetic relationship analysis confirmed that 32-Mmubp belongs to the OpuAC family. CONCLUSIONS: Adhesion of Lact. fermentum BCS87 appeared to be mediated by two surface-associated proteins. 32-Mmubp is a component of ABC transporter system that also functions as an adhesin. SIGNIFICANCE AND IMPACT OF THE STUDY: Characterization of 32-Mmubp and 32-mmub will contribute to understanding the host-bacteria interactions of Lact. fermentum with the intestinal tract of pigs.
Subject(s)
Adhesins, Bacterial/genetics , Adhesins, Bacterial/metabolism , Limosilactobacillus fermentum/metabolism , Probiotics , ATP-Binding Cassette Transporters/metabolism , Amino Acid Sequence , Base Sequence , Blotting, Western , Limosilactobacillus fermentum/genetics , Molecular Sequence Data , Mucins/metabolism , Mucus/metabolism , Open Reading FramesABSTRACT
OBJECTIVE: Members of "Asociación de Ecografía Digestiva" decided to carry out a multicenter retrospective study on fine-needle aspiration biopsy for pancreatic space-occupying lesions under ultrasonographic guidance and via the percutaneous route in order to assess this technique s performance versus endoscopic ultrasound-guided biopsy. SUBJECTS: 10 hospitals for a total of 222 patients with suspiciously malignant, 8-120-mm pancreatic lesions were included in the study. RESULTS: The analysis of results shows a sensitivity of 89%, a specificity of 98%, a positive predictive value of 99%, and a negative predictive value of 74%, for an overall diagnostic accuracy of 91%. No major complications occurred. CONCLUSION: Percutaneous fine-needle aspiration for pancreatic lesions is highly cost-effective and has few and mild complications.
Subject(s)
Endoscopy, Gastrointestinal , Pancreas/diagnostic imaging , Pancreas/pathology , Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/pathology , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle/methods , Female , Humans , Male , Middle Aged , Retrospective Studies , UltrasonographyABSTRACT
Objetivo: en el seno de la Asociación de Ecografía Digestivase decidió realizar un estudio retrospectivo multicéntrico sobre lapunción-aspiración con aguja fina (PAAF) de lesiones ocupantesde espacio pancreáticas, mediante control ecográfico y por víapercutánea, con el objetivo de valorar el rendimiento de dicha técnicay poder compararla con la punción mediante ultrasonografíaendoscópica.Participantes: en el estudio han participado 10 hospitalescon 222 pacientes con lesiones pancreáticas entre 8 y 120 mm,sospechosas de malignidad.Resultados: el análisis de los resultados muestra una sensibilidaddel 89%, especificidad 98%, valor predictivo positivo 99% ynegativo 74%, con precisión diagnóstica global 91%. No encontramosninguna complicación significativa.Conclusión: la PAAF de lesiones pancreáticas por vía percutáneaes de alta rentabilidad diagnóstica y con pocas y leves complicaciones
Objective: members of Asociación de Ecografía Digestivadecided to carry out a multicenter retrospective study on fine-needleaspiration biopsy for pancreatic space-occupying lesions underultrasonographic guidance and via the percutaneous route in orderto assess this techniques performance versus endoscopic ultrasound-guided biopsy.Subjects: 10 hospitals for a total of 222 patients with suspiciouslymalignant, 8-120-mm pancreatic lesions were included inthe study.Results: the analysis of results shows a sensitivity of 89%, aspecificity of 98%, a positive predictive value of 99%, and a negativepredictive value of 74%, for an overall diagnostic accuracy of91%. No major complications occurred.Conclusion: percutaneous fine-needle aspiration for pancreaticlesions is highly cost-effective and has few and mild complications
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Punctures/methods , Biopsy, Fine-Needle/methods , Pancreatic Neoplasms/pathology , Endoscopy, Digestive System , Retrospective Studies , Sensitivity and Specificity , Predictive Value of Tests , Endosonography/methodsABSTRACT
No disponible
Subject(s)
Female , Middle Aged , Humans , Adenocarcinoma, Mucinous/diagnosis , Carcinoma, Pancreatic Ductal/diagnosis , Pancreatic Neoplasms/diagnosis , Adenocarcinoma, Mucinous/surgery , Carcinoma, Pancreatic Ductal/surgery , Cholangiopancreatography, Endoscopic Retrograde , Pancreas/pathology , Pancreas , Pancreas/surgery , Pancreatectomy/methods , Treatment OutcomeSubject(s)
Adenocarcinoma, Mucinous/diagnosis , Carcinoma, Pancreatic Ductal/diagnosis , Pancreatic Neoplasms/diagnosis , Adenocarcinoma, Mucinous/surgery , Carcinoma, Pancreatic Ductal/surgery , Cholangiopancreatography, Endoscopic Retrograde , Female , Humans , Middle Aged , Pancreas/diagnostic imaging , Pancreas/pathology , Pancreas/surgery , Pancreatectomy/methods , Pancreatic Neoplasms/surgery , Treatment OutcomeABSTRACT
OBJECTIVE: To prospectively assess the usefulness of ultrasonography in predicting the presence of cirrhosis in patients with asymptomatic chronic liver disease in unknown stage. EXPERIMENTAL DESIGN: Eighteen doppler and ultrasonographic features were prospectively assessed immediately before performing laparoscopy and/or liver biopsy. Usefulness of predictive variables selected by multiple regression analysis and included in a scoring scale was determined by ROC curves. PATIENTS: One hundred and thirteen consecutive patients with neither clinical nor biochemical signs of advanced liver disease submitted for study. RESULTS: Liver enlargement, liver surface nodularity, liver parenchyma distortion, flattening of flow wave in hepatic veins, portal and splenic veins dilatation, decreased variability in splenic vein caliber with breathing. Collateral vessels, and splenomegaly were associated to cirrhosis. Multivariate analysis showed the joint assessment of hepatic echostructure, portal vein caliber and spleen area to be the best approach to ultrasonographic staging, with sensitivity of 80%, specificity of 92% and accuracy of 89% in the diagnosis of cirrhosis. CONCLUSIONS: Ultrasonography enabled the presence or absence of cirrhosis to be correctly determined even in patients with asymptomatic disease. Combined assessment of hepatic echostructure, portal vein diameter and spleen size provides the highest accuracy.
Subject(s)
Liver Cirrhosis/diagnostic imaging , Adolescent , Adult , Aged , Chronic Disease , Diagnosis, Differential , Female , Humans , Hypertension, Portal/diagnostic imaging , Hypertension, Portal/pathology , Laparoscopy , Liver/diagnostic imaging , Liver/pathology , Liver Cirrhosis/pathology , Male , Middle Aged , Prospective Studies , ROC Curve , Regression Analysis , UltrasonographyABSTRACT
BACKGROUND: To relate the renal hemodynamic changes, as assessed by Doppler ultrasonography,with the development of ascites, renal function, and endogenous vasoactive systems in patients with liver cirrhosis. PATIENTS AND METHODS: 60 cirrhotic patients were studied prospectively, 31 of these compensated and 29 with ascites. The renal resistive index, renal function and plasmatic levels of renin, aldosterone, noradrenaline and ADH activity were determined. RESULTS: The renal resistive index was significantly higher in the cirrhotic patients with ascites (0.68) than in the compensated cirrhotics (0.63) and was significantly correlated with the serum levels of creatinine,urinary excretion of sodium, plasmatic renin activity and plasmatic concentration of aldosterone. CONCLUSIONS: The renal resistive index, study by means of Doppler ultrasonography, shows progressively increased levels with the evolution of the disease, with the deterioration of the renal function and with the activation of the endogenous vasoactive systems.
Subject(s)
Kidney Diseases/diagnostic imaging , Kidney Diseases/etiology , Liver Cirrhosis/complications , Adult , Aged , Ascites , Biomarkers/blood , Female , Humans , Kidney Diseases/diagnosis , Kidney Function Tests , Male , Middle Aged , Prospective Studies , Ultrasonography, Doppler, DuplexABSTRACT
OBJETIVO: valorar los cambios hemodinámicos renales mediante determinación con ecografía Doppler del índice de resistencia (IR) renal en pacientes con hepatopatía crónica en diferentes estadios evolutivos. En pacientes con cirrosis, analizar el IR renal en función de la presencia o no de ascitis y la respuesta al tratamiento diurético. PACIENTES Y MÉTODOS: se estudió de forma prospectiva 24 sujetos con hepatitis crónica, 39 pacientes cirróticos compensados y 34 con ascitis. Los cirróticos con ascitis se dividieron en grupo 1: con respuesta a medidas dietéticas y bajas dosis de diuréticos, y grupo 2: ascitis refractaria o que precisan dosis superiores de diuréticos. RESULTADOS: El IR renal fue significativamente superior en los pacientes cirróticos con ascitis (0,68 ñ 0,06) que en los cirróticos compensados (0,63 ñ 0,03; p < 0,01), y en éstos que en los sujetos con hepatitis crónica (0,61 ñ 0,04; p < 0,05). Los cirróticos con ascitis del grupo 1 presentaron un IR renal inferior a los del grupo 2 (0,65 ñ 0,05 vs 0,72 ñ 0,06; p < 0,01). CONCLUSIONES: el IR renal se incrementa conforme avanza la hepatopatía crónica. Los pacientes cirróticos con elevación del IR renal son no respondedores o requieren mayor dosis de diuréticos. Se requieren estudios para valorar la utilidad del IR renal en la predicción de la respuesta al tratamiento diurético en pacientes con ascitis (AU)
Subject(s)
Middle Aged , Adult , Male , Female , Humans , Ultrasonography, Doppler , Vascular Resistance , Renal Artery , Prospective Studies , Hepatitis, Chronic , Liver Cirrhosis , HemodynamicsABSTRACT
OBJECTIVE: Although cirrhosis is known to predispose toward hepatocellular carcinoma (HCC), there is no agreement on the factors that can influence the risk for HCC in patients with cirrhosis. This study was designed to identify differences in cirrhosis-related risk factors for developing HCC in relation to epidemiological characteristics, stage of the disease and etiology. METHODS: 512 patients from southwestern Spain with Child-Pugh stage A or B cirrhosis were examined periodically by ultrasonography, and alpha-fetoprotein (AFP) concentration was measured. RESULTS: The average length of follow-up was 37 months. A total of 52 cases of HCC were detected, which represented a risk of 17% after 5 years of follow-up. The Cox model showed that the risk of HCC increased by 8% per year of increasing age. Male sex (relative risk: 3.4), hepatitis C virus infection (relative risk: 4.6), hepatitis B virus infection (relative risk: 2.9) and AFP levels higher than 15 ng/ml (relative risk: 2.5) were also shown to be risk factors. Among alcoholic patients, only age (risk increased by 15% per year), and hepatitis C virus infection (relative risk: 5.4) were risk factors for HCC. However, in patients infected by hepatitis C virus, the main risk factors were age (relative risk increased by 8% per year), male sex (relative risk: 3.9), co-infection with hepatitis B virus (relative risk: 4.9), and increased AFP (relative risk: 2.8). Of the patients with HCC, 71% were infected with hepatitis C virus. Alcoholism, Child-Pugh stage and duration of cirrhosis did not increase the risk of the appearance of HCC. CONCLUSIONS: The risk of HCC increased to 17% after 5 years of follow-up in patients with Child-Pugh stage A or B cirrhosis. Hepatitis C virus infection was the main risk factor in patients with cirrhosis. Other risk factors were age, male sex, hepatitis B virus infection and altered AFP level.
Subject(s)
Carcinoma, Hepatocellular/etiology , Liver Cirrhosis/complications , Liver Neoplasms/etiology , Adolescent , Adult , Aged , Carcinoma, Hepatocellular/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Liver Neoplasms/epidemiology , Male , Middle Aged , Multivariate Analysis , Risk FactorsABSTRACT
OBJETIVO: determinar la existencia de diferencias en el riesgo de presentar un carinoma hepatocelular (CHC) en pacientes con cirrosis en función de sus características epidemiológicas, evolución de la hepatopatía y su etiología. PACIENTES Y MÉTODOS: 512 pacientes cirróticos en grado A/13 de Child-Pugh menores de 70 años fueron valorados periódicamente mediante ecografía y determinaciones de alfa-fetoproteína (AFP). RESULTADOS: tras un seguimiento medio de 37 meses se detectaron 52 CHC (riesgo acumulado del 17 por ciento a los 5 años). El modelo de Cox demostró que por cada año de edad el riesgo de CHC se incrementó un 8 por ciento. El sexo varón (RR: 3,4), la infección por virus C (RR: 4,6), la infección por el virus B (RR: 2,9) y la alteración de la AFP (RR: 2,5) también se mostraron como factores de riesgo. Entre los pacientes etílicos, sólo la edad (incremento del 15 por ciento por cada año transcurrido) y la infección por el virus C (RR: 5,4) fueron factores de riesgo. En los pacientes infectados por el virus C supusieron un mayor riesgo: la edad (S por ciento por cada año), el sexo varón (RR: 3,9), la coinfección por el virus B (RR: 4,9) y la elevación de la AFP (RR: 2,8). El 71 por ciento de los pacientes con CHC tenían infección por el virus C. El etilismo y la duración de la cirrosis no incrementaron el riesgo de aparición del tumor, CONCLUSIONES: el riesgo de aparición del CHC asciende al 17 por ciento tras 5 años de seguimiento en pacientes con cirrosis en grado A/B de Child-Pugh. El virus C es el principal factor de riesgo en nuestro medio. Otros factores demostrados son la edad, el sexo varón, la infección por el virus B y la alteración de la AFP. El etilismo y la duración de la hepatopatía no influye en el riesgo de aparición del tumor (AU)
Subject(s)
Middle Aged , Adult , Adolescent , Aged , Male , Female , Humans , Risk Factors , Multivariate Analysis , Incidence , Carcinoma, Hepatocellular , Liver Cirrhosis , Follow-Up Studies , Liver NeoplasmsABSTRACT
UNLABELLED: Percutaneous drainage is currently the treatment of choice in liver abscess. The most commonly used technique is catheter placement but this procedure is not free of complications. OBJECTIVE: To analyze the safety and efficacy of needle aspiration in the treatment of liver abscesses. PATIENTS AND METHODS: Non-random, prospective study of nine patients with pyogenic liver abscess who underwent simple needle aspiration with sonographic guidance. RESULTS: In all patients, aspiration identified the etiologic agent. In eight patients (88.9%) the procedure was effective and in the remaining patients, the abscess was finally drained by sonographically guided catheter placement. In five patients, aspiration was successful at the first attempt and only one abscess required more than two attempts. No complications were observed. CONCLUSIONS: In our experience, needle aspiration with sonographic guidance is safe and effective in the treatment of pyogenic liver abscesses. Use of catheters is reserved for cases of rapid reaccumulation of exudate without general improvement in the patient.
Subject(s)
Liver Abscess/therapy , Suction/methods , Adult , Aged , Female , Humans , Liver Abscess/diagnostic imaging , Male , Middle Aged , Prospective Studies , Ultrasonography, InterventionalABSTRACT
AIM: To assess renal hemodynamics by Doppler analysis of resistive index (RI) in small intrarenal arteries in patients with chronic liver diseases at different stages, and to analyze renal RI in patients with cirrhosis as a function of the absence or presence of ascites and the response to diuretic therapy. METHODS: Prospective cross-sectional study of 24 patients with chronic hepatitis, 39 with compensated cirrhosis, and 34 with ascites. The last group was divided into two subgroups: 1) responders to sodium restriction and a low dose of diuretics, and 2) patients with refractory ascites or those requiring high-dose therapy. RESULTS: Renal RI was increased in patients with cirrhosis and ascites (0.68 +/- 0.06) in comparison with patients with compensated cirrhosis (0.63 +/- 0.03, p < 0.01). Renal RI in the latter group was higher than in patients without cirrhosis (0.61 +/- 0.04, p < 0.05). Renal RI in patients with ascites was lower in subgroup 1 than in subgroup 2 (0.65 +/- 0.05 vs 0.72 +/- 0.06, p < 0.01). CONCLUSIONS: Renal RI increases as liver disease progresses. Patients with cirrhosis and ascites and increased RI require high-dose treatment or do not respond. Further studies are needed to demonstrate the predictive value of renal RI in assessing the effectiveness of diuretic therapy.
Subject(s)
Hepatitis, Chronic/diagnostic imaging , Hepatitis, Chronic/physiopathology , Liver Cirrhosis/diagnostic imaging , Liver Cirrhosis/physiopathology , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Ultrasonography, Doppler , Adult , Female , Hemodynamics , Humans , Male , Middle Aged , Prospective Studies , Vascular ResistanceABSTRACT
OBJECTIVE: The aim of this study was to identify factors related with mortality in patients with cirrhosis in the absence of habitual biochemical markers of liver dysfunction. METHODS: Seventy-five cirrhotic patients in Child-Pugh stage A, without hepatocellular carcinoma, were followed until death or the end of the study period. We analyzed the association between cumulative survival and 15 variables determined at the moment of inclusion: age, sex, time from diagnosis of cirrhosis, alcohol abuse, history of variceal bleeding, hepatitis B and C virus infection, Child-Pugh score, plasma albumin and bilirubin levels, prothrombin activity, and four sonographic parameters (size of liver, portal vein diameter, size of spleen, and presence of collateral circulation). RESULTS: Mean follow-up was 38.7+/-10 months. Eighteen patients died. Four-year cumulative survival was 77.4+/-5%. Only five variables had a significant influence on survival according to log-rank test: sex, previous variceal bleeding, hepatitis B virus infection, portal vein diameter, and size of the spleen. Multivariate Cox's model showed male sex (relative risk 4.6; 95% confidence interval 1.2-16.8) and diameter of the portal vein > 13 mm, splenomegaly > 145 mm, or both together (relative risk 6.0; 95% confidence interval 1.3-27.2) as independent predictors of the risk of death. CONCLUSIONS: Child-Pugh stage A cirrhotic patients have substantial variability in mid-term survival. Ultrasonography is a useful aid in establishing their prognosis. Men with dilation of the portal vein, splenomegaly, or both, form a group with a significantly higher risk of death.
Subject(s)
Hypertension, Portal/diagnostic imaging , Liver Cirrhosis, Alcoholic/diagnostic imaging , Liver Cirrhosis, Biliary/diagnostic imaging , Adult , Aged , Female , Follow-Up Studies , Hepatitis B, Chronic/diagnostic imaging , Hepatitis B, Chronic/mortality , Hepatitis C, Chronic/diagnostic imaging , Hepatitis C, Chronic/mortality , Humans , Hypertension, Portal/mortality , Liver/diagnostic imaging , Liver Cirrhosis, Alcoholic/mortality , Liver Cirrhosis, Biliary/mortality , Liver Function Tests , Male , Middle Aged , Portal Vein/diagnostic imaging , Survival Rate , UltrasonographyABSTRACT
OBJECTIVE: to analyze certain epidemiological and ultrasonographic features, and the response to percutaneous treatment, of abdominal tuberculous abscesses in patients with human acquired immunodeficiency syndrome. METHODS: we reviewed the clinical records and ultrasonographic findings in 7 patients with abdominal tuberculous abscesses who were treated in our service by ultrasonography-guided percutaneous drainage. RESULTS: in 5 patients there was a previous diagnosis of AIDS. The abscesses (two in one patient) were located mainly in the retroperitoneum and appeared mottled at ultrasonography. Seven of the abscesses were drained via catheter, whereas in the remaining case aspiration puncture was used. Mycobacterium tuberculosis was found in the drained material in 6 patients, and 1 case presented superinfection by Enterococcus faecalis. Percutaneous drainage was effective in 6 patients, and in the remaining case it was only palliative. CONCLUSIONS: the incidence of abdominal tuberculous abscesses is increasing in patients with AIDS, and in some patients it is the first symptom. Abscesses are located primarily in the retroperitoneum. They can be dealt with satisfactorily by percutaneous drainage guided by ultrasonography.
Subject(s)
AIDS-Related Opportunistic Infections/therapy , Abdominal Abscess/therapy , HIV-1 , Tuberculosis/therapy , Adult , Combined Modality Therapy , Enterococcus faecalis , Gram-Positive Bacterial Infections/therapy , Humans , Male , Retroperitoneal Space , Risk Factors , Substance Abuse, Intravenous/complications , Suction/methods , Treatment Outcome , Ultrasonography, InterventionalABSTRACT
The differences in sonographic measurements of the splanchnic vessels, their modifications during respiration, the spleen size and the presence of collaterals of the portal system among 110 cirrhotic patients with portal hypertension and 30 control subjects are analyzed to verify the usefulness of conventional sonography in the diagnosis of portal hypertension. We achieved a sensitivity above 70% and a specificity of at least 90% with the following signs: 1) dilation of portal, splenic and superior mesenteric veins, 2) limited variations of the latter two during respiration, and 3) splenomegaly. A higher sensitivity was achieved considering variations in splenic caliber during respiration under 33% (91%) or superior mesenteric vein during forced expiration above or equal than 7 mm (88%). These measurements could be found in 71.8% and 57.2% respectively. On the other hand, values of portal vein and spleen size were easily obtained. The usefulness of all measurements persists if we take into account only patients with Child-Pugh score < 7. Collateral circulation was demonstrated in 18%. Portal vein above 14 mm, variations in splenic caliber under 13% or superior mesenteric vein during forced expiration above or equal than 9 mm were obtained in any of control subjects but respectively in 33%, 46% and 69% of patients in portal hypertension group. We conclude that ultrasonography is a reliable and noninvasive tool in the diagnosis of portal hypertension in cirrhotic patients.
Subject(s)
Abdomen/diagnostic imaging , Hypertension, Portal/diagnostic imaging , Liver Cirrhosis/diagnostic imaging , Chi-Square Distribution , Female , Humans , Hypertension, Portal/etiology , Liver Cirrhosis/complications , Male , Middle Aged , ROC Curve , Sensitivity and Specificity , UltrasonographyABSTRACT
We report the case of a 52-years-old smoking male, diagnosed of liver cirrhosis, who developed a squamous cell carcinoma of the esophagus 36 months after undergoing endoscopic injection sclerotherapy for bleeding esophageal varices. Nine courses with 3% polidocanol were performed along 10 months. It was injected intra and paravariceal at a total dose of 117 ml. The relationship between endoscopic injection sclerotherapy and developing squamous cell carcinoma of the esophagus is discussed.