RESUMEN
BACKGROUND: Chronic cholecystitis, characterized by persistent inflammation of the gallbladder, predominantly stems from the prolonged presence of gallstones. Calculous cholecystitis has demonstrated a consistent escalation in its incidence over time.Gallbladder stones have been recognized as a predisposing factor for the development of biliary tract infections.Concomitantly, there have been substantial shifts in the distribution and resistance profiles of pathogenic microorganisms responsible for biliary tract infections. The timely acquisition of bile samples for pathogen analysis is of paramount importance, given its critical role in guiding judicious clinical pharmacotherapy and enhancing patient prognosis. CASE PRESENTATION: We present a case involving a 66-year-old female patient who had previously undergone subtotal gastrectomy due to diffuse large B-cell lymphoma. The patient was admitted to our institution with complaints of abdominal pain. Subsequent diagnostic evaluation revealed concurrent choledocholithiasis and cholecystolithiasis. The patient underwent surgical cholecystectomy as the therapeutic approach. Histopathological examination of the excised gallbladder disclosed characteristic features indicative of chronic cholecystitis. Subsequent laboratory analysis of the patient's bile specimen yielded Gram-positive cocci, subsequently identified through biochemical assays, mass spectrometry, and 16 S rRNA analysis as Vagococcus fluvialis. Further in vitro antimicrobial susceptibility testing using disk diffusion and microfluidic dilution showed that this strain exhibited inhibition zone diameters ranging from 12.0 to 32.0 mm in response to 26 antibiotics, including ampicillin, cefazolin, cefuroxime, cefotaxime, ceftriaxone, cefepime, ampicillin/sulbactam, piperacillin, ciprofloxacin, cefoperazone/sulbactam, imipenem, meropenem, piperacillin/tazobarb, penicillin, erythromycin, chloramphenicol, vancomycin, methotrexate/sulfamethoxazole, teicoplanin, linezolid, tigecycline, cefoxitin, ceftazidime, levofloxacin, minocycline and tobramycin. However, the inhibition zone diameters were 6.0 mm for amikacin, oxacillin, clindamycin, and tetracycline. The patient received ceftazidime anti-infective therapy both preoperatively and within 24 h postoperatively and was discharged successfully one week after surgery. CONCLUSION: In this study, we present the inaugural isolation and identification of Vagococcus fluvialis from bile specimens of patients afflicted with calculous cholecystitis. This novel finding lays a substantial experimental groundwork for guiding clinically rational antimicrobial therapy and advancing the exploration of relevant pathogenic mechanisms pertaining to Vagococcus fluvialis infections.
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Antiinfecciosos , Colecistitis , Cocos Grampositivos , Femenino , Humanos , Anciano , Ceftazidima , Sulbactam , Bilis , Farmacorresistencia Bacteriana , Pruebas de Sensibilidad Microbiana , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Antiinfecciosos/farmacología , Ampicilina , Piperacilina , Colecistitis/complicaciones , Colecistitis/tratamiento farmacológicoRESUMEN
BACKGROUND: Cholecystitis is a rare but dolorous complication after Y90-radioembolization of liver malignancies. PURPOSE: To decide the occlusion of the cystic artery (CA) to prevent cholecystitis after Y90 radioembolization using an algorithm. MATERIAL AND METHODS: In 130 patients, the gallbladder was at risk of embolization as the right liver lobe was targeted. Precautionary measures (e.g. coil occlusion of the cystic artery) were decided by enhancement of the gallbladder in pre-treatment Tc99m-MAA SPECT/CT and performed directly before Y90 radioembolization. In non-enhancing cases, the CA was left open. The outcome was determined by clinical symptoms of acute or chronic cholecystitis as well as imaging and laboratory parameters. Findings were additionally classified according to the Tokyo Guidelines of acute cholecystitis. RESULTS: Only 16 patients demonstrated enhancement of the gallbladder in Tc99m-MAA SPECT/CT. Including additional indications from angiographic findings, prophylactic measures were scheduled in 22 patients (standard of care). Thus, 121 patients were at risk of non-target embolization to the gallbladder during Y90 microsphere administration (investigative arm). Four cases (3.0%) of cholecystitis occurred by clinical presentation: two patients with onset of acute symptoms within 48â h after Y90 radioembolization ("embolic cholecystitis") and two patients with late onset of symptoms ("radiogenic cholecystitis"). The incidence of cholecystitis was not significantly more frequent without indication of precautionary measures (investigative cohort 2.9% vs. standard of care 4.7%; P = 0.53). CONCLUSION: The overall incidence of cholecystitis after Y90 radioembolization is low. Determination of cystic artery intervention using Tc99m-MAA SPECT/CT successfully balances the incidence of symptomatic cholecystitis with unnecessary vessel occlusion.
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Colecistitis , Embolización Terapéutica , Neoplasias Hepáticas , Humanos , Colecistitis/inducido químicamente , Colecistitis/tratamiento farmacológico , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/complicaciones , Radioisótopos de Itrio/uso terapéutico , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Resultado del Tratamiento , MicroesferasRESUMEN
BACKGROUND: Lower back pain is a frequent cause of emergency department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain. METHODS: A 79-year-old man presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment 4 weeks prior to admission. The magnetic resonance imaging (MRI) highlighted multisegmental hyperintensities in the intervertebral disk spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic, and dental examinations turned out negative for a focus of infection. A computed tomography (CT) guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the keywords "spondylodiscitis," "spine," "abdominal," and "cholecystitis," to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies. RESULTS: No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases, among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered. CONCLUSION: Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day 7. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions. Some had undergone unnecessary surgical procedures before the right diagnosis was made. Because of the high incidence of symptoms such as lumbar back pain and abdominal pain, considering optimal patient care as well as economic aspects, it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics.
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Colecistitis , Deterioro Clínico , Discitis , Dolor de la Región Lumbar , Masculino , Femenino , Humanos , Anciano , Discitis/diagnóstico por imagen , Discitis/etiología , Dolor de la Región Lumbar/tratamiento farmacológico , Vértebras Lumbares/diagnóstico por imagen , Colecistitis/complicaciones , Colecistitis/tratamiento farmacológico , Dolor Abdominal/complicaciones , Dolor Abdominal/tratamiento farmacológico , Antibacterianos/uso terapéutico , Imagen por Resonancia Magnética/efectos adversosRESUMEN
Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic disorder characterized by tissue eosinophilic infiltration and vasculitis. Although EGPA causes multiple organ damage, it causes cholecystitis less frequently. We herein report a case of acute cholecystitis associated with EGPA in which successful treatment with glucocorticoid therapy allowed surgery to be avoided. EGPA can present as acute cholecystitis. It is important not to overlook acute cholecystitis associated with EGPA in patients with abdominal pain with peripheral eosinophilia. Furthermore, in cases of mild cholecystitis associated with EGPA that are diagnosed preoperatively, cholecystectomy might be avoided with conservative glucocorticoid treatment.
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Colecistitis Aguda , Colecistitis , Síndrome de Churg-Strauss , Eosinofilia , Granulomatosis con Poliangitis , Humanos , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/tratamiento farmacológico , Granulomatosis con Poliangitis/diagnóstico , Síndrome de Churg-Strauss/diagnóstico , Glucocorticoides/uso terapéutico , Colecistitis Aguda/complicaciones , Colecistitis Aguda/tratamiento farmacológico , Colecistitis/complicaciones , Colecistitis/tratamiento farmacológico , Eosinofilia/complicaciones , Eosinofilia/tratamiento farmacológicoRESUMEN
BACKGROUND: Dermatomyositis is a rare idiopathic inflammatory disease with diverse presentations that can have varying degrees of cutaneous and systemic involvement. This phenotypic heterogeneity makes DM a therapeutic challenge. Some therapeutic drugs, such as hormones and immunosuppressants, have poor therapeutic effects. In recent years, tofacitinib has been reported to be effective in the treatment of dermatomyositis. CASE PRESENTATION: We report a case of anti-MDA5 antibody-positive dermatomyositis that was relieved after treatment with tofacitinib, during which gallbladder gangrene and suppurative cholecystitis occurred. After cholecystectomy, we continued to use tofacitinib and achieved a good therapeutic effect. CONCLUSIONS: Tofacitinib is effective in the treatment of anti-MDA5 antibody-positive dermatomyositis, but the risk of infection is increased. It can still be used after infection control. Close follow-up should be performed during the use of tofacitinib.
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Colecistitis , Dermatomiositis , Enfermedades Pulmonares Intersticiales , Autoanticuerpos , Colecistitis/complicaciones , Colecistitis/tratamiento farmacológico , Dermatomiositis/complicaciones , Dermatomiositis/tratamiento farmacológico , Humanos , Helicasa Inducida por Interferón IFIH1 , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Piperidinas , PirimidinasRESUMEN
Background: Manifestations of gallbladder disease range from intermittent abdominal pain (symptomatic cholelithiasis) to potentially life-threatening illness (gangrenous cholecystitis). Although surgical intervention to treat acute cholecystitis is well defined, the role of antibiotic administration before or after cholecystectomy to decrease morbidity or mortality is less clear. Methods: The Surgical Infection Society's Therapeutics and Guidelines Committee convened to develop guidelines for antibiotic use in patients undergoing cholecystectomy for gallbladder disease to prevent surgical site infection, other infection, hospital length of stay, or mortality. PubMed, Embase, and the Cochrane Database were searched for relevant studies. Evaluation of the published evidence was performed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Using a process of iterative consensus, all authors voted to accept or reject each recommendation. Results: We recommend against routine use of peri-operative antibiotic agents in low-risk patients undergoing elective laparoscopic cholecystectomy. We recommend use of peri-operative antibiotic agents for patients undergoing laparoscopic cholecystectomy for acute cholecystitis. We recommend against use of post-operative antibiotic agents after elective laparoscopic cholecystectomy for symptomatic cholelithiasis. We recommend against use of post-operative antibiotic agents in patients undergoing laparoscopic cholecystectomy for mild or moderate acute cholecystitis. We recommend a maximum of four days of antibiotic agents, and perhaps a shorter duration in patients undergoing cholecystectomy for severe (Tokyo Guidelines grade III) cholecystitis. Conclusions: This guideline summarizes the current Surgical Infection Society recommendations for antibiotic use in patients undergoing cholecystectomy for gallbladder disease.
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Colecistectomía Laparoscópica , Colecistitis Aguda , Colecistitis , Colelitiasis , Antibacterianos/uso terapéutico , Colecistectomía/efectos adversos , Colecistitis/tratamiento farmacológico , Colecistitis/etiología , Colecistitis/cirugía , Colecistitis Aguda/tratamiento farmacológico , Colelitiasis/tratamiento farmacológico , Colelitiasis/etiología , Colelitiasis/cirugía , HumanosRESUMEN
Across Southeast Asia and China, more than 17000 Asian bears are kept under suboptimal conditions and farmed for their bile to meet the consumer demand for traditional medicine products. Years of unsterile and repetitive bile extraction contribute to the development of chronic sterile or bacterial cholecystitis, a pathology commonly diagnosed in formerly bile-farmed bears. In both human and veterinary medicine, the diagnostic value of the macroscopic bile examination for assessing gallbladder disease is unclear. The objective of this study is to identify the role of gallbladder bile color, viscosity, and turbidity, while comparing them with established markers of cholecystitis. Moreover, it aims to define the optimal duration of oral antibiotic treatment for chronic bacterial cholecystitis in bears associated with bile farming. Thirty-nine adult, formerly bile-farmed Asiatic black bears (Ursus thibetanus) were examined under anesthesia and underwent percutaneous ultrasound guided cholecystocentesis. A total of 59 bile samples were collected with 20 animals sampled twice to evaluate the therapeutic success. All bile aspirates were assessed macroscopically and microscopically followed by submission for bacterial culture and antimicrobial sensitivity. In the majority of bears, samples with cytological evidence of bactibilia lacked inflammatory cells and did not always correlate with positive bacterial cultures. The most common bacterial isolates were Enterococcus spp, Streptococcus spp and Escherichia coli. Based on our findings, the optimal duration of antibiotic treatment for chronic bacterial cholecystitis is 30 days. Moreover, unlike Gamma-glutamyl Transferase (GGT) and gallbladder wall thickness, the organoleptic properties of bile were found to be reliable markers of chronic gallbladder inflammation with color and turbidity indicating cholestasis. The current study highlights the importance of cholecystocentesis for the management of gallbladder disease and provides initial results on the possible diagnostic value of macroscopic bile examination.
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Colecistitis , Enfermedades de la Vesícula Biliar , Ursidae , Animales , Antibacterianos/uso terapéutico , Bilis/microbiología , Colecistitis/diagnóstico , Colecistitis/tratamiento farmacológico , Colecistitis/veterinaria , Enfermedades de la Vesícula Biliar/veterinariaRESUMEN
Cholelithiasis with chronic cholecystitis is prevalent and threatens human health. Most cholecystitis caused by bacterial infection or biofilms is accompanied by gallstones in the clinic, making gallbladder removal the only effective solution. Here, we provide a strategy to eliminate gallstone biofilms and dissolve gallstones by oral administration of a supernatant derived from nanoscale iron sulfide (nFeS supernatant). First, by using gallstones obtained from the clinic, we simulated biofilm formation on gallstones and tested the antibacterial activity of a nFeS supernatant in vitro. We found that the supernatant kills bacteria with a 5-log reduction in viability and destroys the biofilm structure. Smashed gallstones coincubated with E. coli biofilms promote gallstone formation, while nFeS supernatant can inhibit this process. Second, by using a murine (C57BL/6) model of cholelithiasis and cholecystitis, we tested the antibacterial efficacy and therapeutic effects of nFeS supernatant on cholelithiasis in vivo. Animal experimental data show that oral administration of nFeS supernatant can reduce 60% of bacteria in the gallbladder and, remarkably, remove gallstones with 2 days of treatment compared with clinical drug combinations (chenodeoxycholid acid and ciprofloxacin). Third, by performing protein abundance analysis of L02 cells and mouse livers, we observed the changes in CYP7a1, HMGCR, and SCP2 expression, indicating that the nFeS supernatant can also regulate cholesterol metabolism to prevent gallstone formation. Finally, hematologic biochemistry analysis and high-throughput sequencing technology show that the nFeS supernatant possesses high biocompatibility. Therefore, our work demonstrates that the nFeS supernatant may be a potential regimen for the treatment of cholelithiasis and cholecystitis by oral administration.
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Antibacterianos/farmacología , Materiales Biocompatibles/farmacología , Colecistitis/tratamiento farmacológico , Compuestos Ferrosos/farmacología , Cálculos Biliares/tratamiento farmacológico , Nanopartículas/química , Administración Oral , Animales , Antibacterianos/administración & dosificación , Materiales Biocompatibles/administración & dosificación , Biopelículas/efectos de los fármacos , Línea Celular , Colecistitis/microbiología , Enfermedad Crónica , Modelos Animales de Enfermedad , Escherichia coli/efectos de los fármacos , Compuestos Ferrosos/administración & dosificación , Cálculos Biliares/microbiología , Humanos , Masculino , Ensayo de Materiales , Ratones , Ratones Endogámicos C57BL , Pruebas de Sensibilidad Microbiana , Nanopartículas/administración & dosificación , Tamaño de la PartículaRESUMEN
INTRODUCTION: Duplicity of the common bile duct (BCBD) is an unusual congenital disorder. CASE REPORT: A 80-year-old woman with duplication of the common bile duct with retrograde endoscopic cholangiopancreatography (ERCP) who did not resolve the symptoms. DISCUSSION: Our case is a variant of type IV to the classification of DCBC. The MR cholangiography and presurgical ERCP allows assessment of the bile ducts, their caliber, and assessment of abnormalities. The treatment before DCBC will depend on the clinic and the type of opening of the CBCA. CONCLUSIONS: It is important to perform a pre-surgical study and during surgery with CIO.
INTRODUCCIÓN: La duplicidad del conducto biliar común (DCBC) es una alteración congénita insólita. CASO CLÍNICO: Mujer de 80 años con duplicación de la vía biliar común con colangiopancreatografía retrógrada endoscópica (CPRE) que no dilucida la clínica. DISCUSIÓN: Este caso es una variante del tipo IV de la clasificación de DCBC. La colangiorresonancia y la CPRE prequirúrgica permiten valorar las vías biliares, su calibre y las anormalidades. El tratamiento depende de la clínica y el tipo de apertura del conducto biliar común accesorio. CONCLUSIONES: Es importante realizar estudio prequirúrgico y durante la operación con colangiografía intraoperatoria.
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Conducto Colédoco/anomalías , Conducto Colédoco/cirugía , Anciano de 80 o más Años , Embolectomía con Balón , Colangiografía , Colangiopancreatografia Retrógrada Endoscópica , Colecistitis/tratamiento farmacológico , Colecistitis/cirugía , Enfermedad Crónica , Terapia Combinada , Conducto Colédoco/diagnóstico por imagen , Femenino , Conducto Hepático Común/anomalías , Humanos , Imagen por Resonancia Magnética , Prótesis e Implantes , Esfinterotomía Endoscópica , Tomografía Computarizada por Rayos X , Ácido Ursodesoxicólico/uso terapéuticoAsunto(s)
Colecistitis/cirugía , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Reacciones Falso Negativas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Enfermedad Aguda , COVID-19 , Prueba de COVID-19 , Colecistectomía Laparoscópica , Colecistitis/complicaciones , Colecistitis/tratamiento farmacológico , Infecciones por Coronavirus/etiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Italia , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/etiología , Neumonía Viral/prevención & controlRESUMEN
BACKGROUND: Outpatient parenteral antibiotic therapy (OPAT) was not used in Belgium before 2013, except for patients with cystic fibrosis. Thus, we have performed a pilot study to evaluate clinical characteristics and outcomes of patient receiving OPAT in a Belgian setting. METHODS: The study was a prospective observational single-center study of patients receiving OPAT between 1 September 2013 and 31 December, 2017. RESULTS: We included 218 OPATs. The median age was 58 years and 71% were men. At the end of the treatment, 92% of the patients on OPAT were cured. Risk factors for treatment failure were obesity, diabetes and diabetic foot infections, longer duration of hospitalization before OPAT, and duration of OPAT >16 days. An average of 24 days of hospitalization per patient discharge was saved, which amounted to 5205 days saved during the project. During the OPAT and 30 days thereafter, 71 (32.6%) of patients were readmitted, but only 26 (12%) readmissions were directly related to OPAT. Risk factors for readmissions were diabetes and diabetic foot infections, endovascular infections, longer duration of hospitalization before OPAT, duration of OPAT >30 days, and history of hospitalizations in the year before OPAT. There were 2.3 intravenous catheter-related events per 1000 days of catheter use. Patients' level of satisfaction was high (99.5%). CONCLUSIONS: In this pilot study, OPAT is found to be efficacious in saving hospitalization's days, with a low rate of readmissions and complications and a high patients' level of satisfaction. We therefore conclude that OPAT is feasible and safe. BACKGROUND: Outpatient parenteral antibiotic therapy (OPAT) was not used in Belgium before 2013, except for patients with cystic fibrosis. Thus, we have performed a pilot study to evaluate clinical characteristics and outcomes of patient receiving OPAT in a Belgian setting. METHODS: The study was a prospective observational single-center study of patients receiving OPAT between 1 September 2013 and 31 December, 2017. RESULTS: We included 218 OPATs. The median age was 58 years and 71% were men. At the end of the treatment, 92% of the patients on OPAT were cured. Risk factors for treatment failure were obesity, diabetes and diabetic foot infections, longer duration of hospitalization before OPAT, and duration of OPAT >16 days. An average of 24 days of hospitalization per patient discharge was saved, which amounted to 5205 days saved during the project. During the OPAT and 30 days thereafter, 71 (32.6%) of patients were readmitted, but only 26 (12%) readmissions were directly related to OPAT. Risk factors for readmissions were diabetes and diabetic foot infections, endovascular infections, longer duration of hospitalization before OPAT, duration of OPAT >30 days, and history of hospitalizations in the year before OPAT. There were 2.3 intravenous catheter-related events per 1000 days of catheter use. Patients' level of satisfaction was high (99.5%). CONCLUSIONS: In our study, OPAT is found to be efficacious in saving hospitalization's days, with a low rate of readmissions and complications and a high patients' level of satisfaction. We therefore conclude that OPAT is feasible and safe.
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Atención Ambulatoria/organización & administración , Antibacterianos/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Servicios de Atención de Salud a Domicilio/organización & administración , Administración Intravenosa , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/métodos , Artritis Infecciosa/tratamiento farmacológico , Bélgica , Enfermedades Óseas Infecciosas/tratamiento farmacológico , Cateterismo Periférico , Niño , Preescolar , Colangitis/tratamiento farmacológico , Colecistitis/tratamiento farmacológico , Cistitis/tratamiento farmacológico , Diabetes Mellitus , Pie Diabético/tratamiento farmacológico , Farmacorresistencia Bacteriana Múltiple , Duración de la Terapia , Endocarditis/tratamiento farmacológico , Femenino , Hospitalización , Humanos , Tiempo de Internación/estadística & datos numéricos , Absceso Hepático/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Obesidad , Readmisión del Paciente/estadística & datos numéricos , Satisfacción del Paciente , Proyectos Piloto , Estudios Prospectivos , Prostatitis/tratamiento farmacológico , Pielonefritis/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Factores de Riesgo , Insuficiencia del Tratamiento , Resultado del Tratamiento , Infección de Heridas/tratamiento farmacológico , Adulto JovenAsunto(s)
Antiinfecciosos/uso terapéutico , Colangitis/tratamiento farmacológico , Colecistitis/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Enfermedad Aguda , Colangitis/diagnóstico , Colecistitis/diagnóstico , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tokio , Resultado del TratamientoRESUMEN
INTRODUCTION: Spinal cord injury includes damage to the motor, sensory and autonomic nervous system. CASE PRESENTATION: A man in his seventies was admitted to hospital after an acute traumatic incomplete cervical spinal cord injury. Over the following weeks, he experienced multiple febrile episodes with CRP elevated to 100 >300 mg/L, but few other symptoms. Two weeks after admission, he was febrile with neuropathic pain, and oxygen saturation spontaneously decreased from 98 % to 87 %. Chest X-ray showed pneumonia, which was treated with antibiotics. Four weeks after the injury he again experienced fever and increased spasticity. Clinical examination revealed dull abdominal pain on palpation in the left upper quadrant. The same day, a PEG placement procedure had been performed. CT abdomen, chest X-ray and microbiological investigation revealed no clear infectious origin. The patient was treated with antibiotic coverage for presumed abdominal infection, with successful recovery. Two months after his injury, the patient became febrile and delirious. Clinical examination revealed mild pain on palpation in the upper right quadrant. CT abdomen revealed cholecystitis. DISCUSSION: Diagnosis of acute serious illness in a patient with spinal cord injury may be challenging due to scarce and atypical clinical presentation. Prevalence of gallstones is increased after spinal cord injury.
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Colecistitis/etiología , Traumatismos de la Médula Espinal/complicaciones , Accidentes por Caídas , Anciano , Vértebras Cervicales , Colecistitis/diagnóstico por imagen , Colecistitis/tratamiento farmacológico , Colecistitis/cirugía , Delirio/etiología , Fiebre/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Dolor Referido , Traumatismos de la Médula Espinal/diagnóstico por imagen , Tomografía Computarizada por Rayos XAsunto(s)
Colecistitis/diagnóstico por imagen , Vesícula Biliar/diagnóstico por imagen , Situs Inversus/diagnóstico por imagen , Administración Intravenosa , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Ceftriaxona/administración & dosificación , Ceftriaxona/uso terapéutico , Colecistectomía/métodos , Colecistitis/tratamiento farmacológico , Colecistitis/patología , Colecistitis/cirugía , Vesícula Biliar/patología , Humanos , Masculino , Situs Inversus/epidemiología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Ultrasonografía/métodos , Adulto JovenRESUMEN
AIM: To analyze concentration of some antimicrobial peptides and cytotoxins in acute calculous cholecystitis regarding gallbladder inflammation grade. MATERIAL AND METHODS: There were 69 patients with catarrhal (29), phlegmonous (24) inflammation and gangrenous phlegmon (19). Some antimicrobial peptides (HNP-α, BPI, endotoxin, neutrophil elastase, lactoferritin, hepcidin) and cytokines (TNF-α, IL-6, 8, 10) in blood serum as well as hepcidin, TNF-α and IL-6 in hepatic biopsy samples were assessed. RESULTS: Significantly increased concentration of all antimicrobial peptides and cytokines was observed in all patients at admission compared with healthy persons. Changes depended on severity of gallbladder inflammation. There was a positive correlation of antimicrobial peptides and TNF-α, IL-6, IL-8. CONCLUSION: The use of antimicrobial peptides as the most informative biomarker for early diagnosis of destructive acute cholecystitis reduces postoperative morbidity.
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Colecistitis Aguda , Colecistitis , Antiinfecciosos/uso terapéutico , Colecistitis/tratamiento farmacológico , Citocinas , Humanos , Factor de Necrosis Tumoral alfaRESUMEN
Gallbladder (GB) empyema is an uncommon complication in acute myeloid leukaemia (AML). Non-specific signs and symptoms and rarity of disease in AML make it difficult to diagnose early. We report a case of 13-year-old boy who had AML and developed GB empyema in the neutropaenic period. The patient was managed with antibiotics, ultrasound-guided tapping and interval cholecystectomy and recovered well. GB empyema is a life-threatening complication which should be kept as a possibility while evaluating patients with neutropaenia with pain abdomen localised to right hypochondrium as early diagnosis and treatment can lead to better outcomes.
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Colecistitis/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Adolescente , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antineoplásicos/administración & dosificación , Antineoplásicos/uso terapéutico , Colecistectomía , Colecistitis/complicaciones , Colecistitis/diagnóstico por imagen , Colecistitis/tratamiento farmacológico , Diagnóstico Diferencial , Fiebre/etiología , Humanos , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/tratamiento farmacológico , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Epstein-Barr virus (EBV) infection results in a spectrum of clinical manifestations. The host immune response to EBV plays a key role in the extent and degree of clinical features, which in children under 4 years of age are usually mild, non-specific and self-limiting. A 2-year-old boy in whom no known immune disorder could be found presented with acute acalculous cholecystitis, renal dysfunction with massive proteinuria, ascites, pleural effusion, minimal peripheral oedema and a severe systemic inflammatory response. Improvement occurred after initiation of corticosteroids and antiviral treatment with gancyclovir. In severely symptomatic or complicated EBV infection, a primary immunodeficiency must be suspected. If a primary immunodeficiency has been ruled out, the correct management of severe EBV infection in the immunocompetent host remains controversial.
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Colecistitis/complicaciones , Colecistitis/etiología , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico , Herpesvirus Humano 4/aislamiento & purificación , Síndrome Nefrótico/complicaciones , Síndrome Nefrótico/etiología , Corticoesteroides/administración & dosificación , Antiinflamatorios/administración & dosificación , Antivirales/administración & dosificación , Preescolar , Colecistitis/tratamiento farmacológico , Colecistitis/patología , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Infecciones por Virus de Epstein-Barr/patología , Ganciclovir/administración & dosificación , Humanos , Masculino , Síndrome Nefrótico/tratamiento farmacológico , Síndrome Nefrótico/patología , Resultado del TratamientoRESUMEN
Results of examination and surgical tratment of 56 patients, suffering chronic calculous cholecystitis with concomitant schemic heart disease, were analyzed. In all the patients a laparoscopic cholecystectomy was performed. Monitoring of cardiovascular compli- cations was estimated with the help of a Helter recording of EGG intraoperatively and in the early postoperative period. Depending on a kind of preoperative preparation done, the patients were divided on two groups: those, to whom cardioprotection using a Vasopro preparation was conducted, and those without cardioprotection. Depending on the intraoperative pneumoperitoneum regime used in every group two subgroups were delineated: in intraabdominal pressure 5-7.9 mm Hg and 8-10 mm Hg. In the patients, to whom cardioprotection was conducted and operative intervention in a carboxyperitoneum regime performed while intraabdominal pressure 5-7.9 mm Hg, a frequency of cardiovascular complications was lesser than in a control group.
Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Colecistitis/cirugía , Isquemia Miocárdica/cirugía , Complicaciones Posoperatorias/prevención & control , Anciano , Arritmias Cardíacas/etiología , Arritmias Cardíacas/patología , Cardiotónicos/uso terapéutico , Colecistitis/complicaciones , Colecistitis/tratamiento farmacológico , Colecistitis/patología , Enfermedad Crónica , Electrocardiografía Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/tratamiento farmacológico , Isquemia Miocárdica/patología , Neumoperitoneo Artificial/métodos , Periodo Posoperatorio , Estudios ProspectivosRESUMEN
A content of a biliary ways microflora and its correlation with clinical form and severity of inflammatory-destructive processes in hepatopancreatobiliary zone were studied up. The investigation objective was the optimization of a treatment--diagnostic tactics for the complications and remote recurrences rate reduction in a complicated biliary calculous disease. There was established, that a standard bacteriological investigation do not give a possibility to estimate some causes of a biliary ducts affection, a chlamidial infection in particular. So on, for the individual antibacterial therapy choosing a more detailed and modern examination of patients is needed.