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2.
Ann R Coll Surg Engl ; 102(2): e26-e28, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31418283

RESUMO

Superior mesenteric artery syndrome, a rare cause of duodenal obstruction, occasionally requires surgery. Bowel emphysema might also require surgery and might be an ominous sign of a serious condition. We report the case of a 69-year-old Japanese man with left pneumothorax who was also diagnosed as having bowel emphysema and superior mesenteric artery syndrome simultaneously without serious infection after surgery for the pneumothorax. Following gastric decompression via a nasogastric tube, his general condition resolved quickly with no need for surgical intervention. Prompt and precise diagnosis by computed tomography and both adequate judgment and treatment can avoid surgery in such cases.


Assuntos
Enfisema/etiologia , Intubação Gastrointestinal , Enfisema Pulmonar/cirurgia , Síndrome da Artéria Mesentérica Superior/etiologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Idoso , Duodeno/diagnóstico por imagem , Enfisema/diagnóstico , Enfisema/terapia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Enfisema Pulmonar/complicações , Enfisema Pulmonar/diagnóstico por imagem , Síndrome da Artéria Mesentérica Superior/diagnóstico , Síndrome da Artéria Mesentérica Superior/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Int Urol Nephrol ; 51(10): 1709-1713, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31309391

RESUMO

PURPOSE: In view of the differences in early and late management experiences based on Huang and Tseng CT classification of emphysematous pyelonephritis (EP), our study included 34 patients aimed to re-correlate the current management plans with CT classification. METHODS: A retrospective review from January 2009 to December 2018, in patients with primary or final diagnosis of EP. Data included; patients' demographics, routine laboratory and imaging work-up. CT was performed for all, and images were classified based on Huang and Tseng classification. The CT classification was correlated to the laboratory parameters and the final treatment plans. Data were collected and analyzed using SPSS®. RESULTS: Complete data for 34 patients were analyzed. The majority (70%) had positive urine culture, and Carbapenems and Ureidopenicillin were the most commonly used antibiotics. Based on CT classification, 75% (26/34) of the patients were in class I and II, 6 cases with class IIIa, and only two with class IIIb, with no cases of class IV. All patients in class I and II responded well to the medical therapy, and eight required PCN/DJ. Four required nephrectomy in class III, with zero mortality. CONCLUSION: Patients in class I and II comprise the majority of EP patients, and respond well to medical treatment with excellent outcome. Insertion of PCN and DJ are not required routinely, but with urinary obstruction requiring drainage, and a few cases who required nephrectomy-all with class III. Our data show improvement in the overall survival in patients for EP.


Assuntos
Enfisema/classificação , Enfisema/terapia , Pielonefrite/classificação , Pielonefrite/terapia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Correlação de Dados , Enfisema/complicações , Enfisema/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Pielonefrite/complicações , Pielonefrite/diagnóstico por imagem , Estudos Retrospectivos
8.
Cell Tissue Res ; 376(2): 233-245, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30610451

RESUMO

Large expansion of human mesenchymal stem cells (MSCs) is of great interest for clinical applications. In this study, we examine the feasibility of human fibroblast-derived extracellular matrix (hFDM) as an alternative cell expansion setting. hFDM is obtained from decellularized extracellular matrix (ECM) derived from in vitro cultured human lung fibroblasts. Our study directly compares conventional platforms (tissue culture plastic (TCP), fibronectin (FN)-coated TCP) with hFDM using umbilical cord blood-derived MSCs (UCB-MSCs). Early cell morphology shows a rather rounded shape on TCP but highly elongated morphology on hFDM. Cell proliferation demonstrates that MSCs on hFDM were significantly better compared to the others in both 10 and 2% serum condition. Cell migration assay suggests that cell motility was improved and a cell migration marker CXCR4 was notably up-regulated on hFDM. MSCs differentiation into osteogenic lineage on hFDM was also very effective as examined via gene expression, von Kossa staining and alkaline phosphatase activity. In addition, as the MSCs were expanded on each substrate, transferred to 3D polymer mesh scaffolds and then cultivated for a while, the data found better cell proliferation and more CXCR4 expression with MSCs pre-conditioned on hFDM. Moreover, higher gene expression of stemness and engraftment-related markers was noticed with the hFDM group. Furthermore when UCB-MSCs expanded on TCP or hFDM were injected into emphysema (a lung disease) animal model, the results indicate that MSCs pre-conditioned on hFDM (with 2% serum) retain more advanced therapeutic efficacy on the improvement of emphysema than those on TCP. Current works demonstrate that compared to the conventional platforms, hFDM can be a promising source of cell expansion with a naturally derived biomimetic ECM microenvironment and may find some practical applications in regenerative medicine.


Assuntos
Enfisema/terapia , Matriz Extracelular , Sangue Fetal/citologia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/fisiologia , Regeneração , Animais , Materiais Biomiméticos , Movimento Celular , Proliferação de Células , Modelos Animais de Doenças , Fibroblastos/metabolismo , Fibroblastos/ultraestrutura , Humanos , Pulmão/citologia , Camundongos , Camundongos Endogâmicos C57BL , Receptores CXCR4/metabolismo , Medicina Regenerativa , Engenharia Tecidual , Tecidos Suporte
9.
J Infect Chemother ; 25(4): 302-306, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30448360

RESUMO

Emphysematous pyelonephritis (EPN) is a life-threatening renal infection characterized by the formation of gas within the renal parenchyma and collecting duct system, as well as perinephric tissues. We herein report a case of bilateral EPN accompanied by the urinary tract infection caused by spherical growth of Candida albicans in a patient with underlying diabetes mellitus and prostate cancer. The diagnosis was assisted by computed tomography, urography, and gram staining. Despite immediate percutaneous catheter drainage and a 4-week course of antifungal treatment, the C. albicans infection was refractory, as indicated by continuous isolation from the urine, and the patient eventually died. A local autopsy of urinary organs revealed C. albicans in the renal tissue. EPN caused by Candida species frequently occurs in men, and almost all cases have underlying poorly controlled diabetes. This condition is subject to delayed diagnosis, which may lead to extended disease and high mortality. Candida species should be considered as causative microorganism for refractory EPN in patients with poorly controlled diabetes who are receiving antibiotic treatment. Gram staining may contribute to an early diagnosis of EPN caused by Candida species, which may require long-term antifungal therapy.


Assuntos
Antifúngicos/uso terapêutico , Candida albicans/isolamento & purificação , Enfisema/microbiologia , Pielonefrite/microbiologia , Idoso de 80 Anos ou mais , Enfisema/diagnóstico por imagem , Enfisema/terapia , Evolução Fatal , Humanos , Masculino , Nefrectomia , Pielonefrite/diagnóstico por imagem , Pielonefrite/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Urografia
10.
Transpl Infect Dis ; 21(1): e13026, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30414224

RESUMO

Emphysematous pyelonephritis (EPN) is a rare condition which can rapidly progress to sepsis and multiple organ failure with high mortality. We experienced a rare case of EPN in a renal allograft related to antibody-mediated rejection (AMR). The patient received a deceased donor kidney transplant due to end-stage renal disease secondary to diabetes mellitus. Cross-match test was negative but she had remote history of anti-HLA-A2 antibody corresponding with the donor HLA. Surgery concluded without any major events. Anti-thymoglobulin was given perioperatively for induction. She was compliant with her immunosuppressive medications making urine of 2 L/d with serum creatinine of 1.9 mg/dL at discharge on post-operative day (POD) 6. She did well until POD 14 when she presented to the clinic with features of sepsis, pain over the transplanted kidney area and decline in urine volume with elevated serum creatinine. CT revealed extensive gas throughout the transplanted kidney. Renal scan revealed non-functional transplant kidney with no arterial flow. Based on these findings, a decision to perform transplant nephrectomy was made. At laparotomy, the kidney was completely necrotic. Pathology showed non-viable kidney parenchyma with the tubules lacking neutrophilic casts suggestive of ischemic necrosis. Donor-specific antibody (DSA) returned positive with high intensity anti-HLA-A2 antibody. This is the first case of early EPN in allograft considered to have occurred as a result of thrombotic ischemia secondary to AMR. This case suggests consideration of perioperative anti-B-cell and/or anti-plasma cell therapies for historical DSA and strict post-operative follow-up in immunologically high-risk recipients to detect early signs of rejection and avoid deleterious outcomes.


Assuntos
Enfisema/imunologia , Rejeição de Enxerto/imunologia , Isoanticorpos/imunologia , Transplante de Rim/efeitos adversos , Pielonefrite/imunologia , Aloenxertos/irrigação sanguínea , Aloenxertos/diagnóstico por imagem , Aloenxertos/imunologia , Aloenxertos/patologia , Biópsia , Enfisema/diagnóstico , Enfisema/patologia , Enfisema/terapia , Feminino , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/patologia , Rejeição de Enxerto/terapia , Sobrevivência de Enxerto/imunologia , Humanos , Isquemia/diagnóstico , Isquemia/imunologia , Isquemia/patologia , Isquemia/terapia , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Rim/imunologia , Rim/patologia , Falência Renal Crônica/cirurgia , Pessoa de Meia-Idade , Pielonefrite/diagnóstico , Pielonefrite/patologia , Pielonefrite/terapia , Renografia por Radioisótopo , Diálise Renal , Tromboembolia/diagnóstico , Tromboembolia/imunologia , Tromboembolia/patologia , Tromboembolia/terapia
11.
Medicine (Baltimore) ; 97(45): e11272, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30407278

RESUMO

INTRODUCTION: Emphysematous pyelonephritis (EPN) or cystitis (EC) is a severe infection of the urinary tract with high mortality. EPN is uncommon among the patients of end stage of renal failure (ESRD) CASE PRESENTATION:: A 38-year-old male with uremia and anuria who was on hemodialysis was found to have gas formation in the bilateral pelvis, ureters, and urinary bladder by CT scan. The diagnosis was emphysematous pyelonephritis and cystitis. And Foley catheter was placed and bladder irrigation was performed. Escherichia coli infection was identified in urine culture and antibiotic was prescribed accordingly. Gas disappeared completely and the patient recovered uneventfully. CONCLUSION: This is the first case report of asymptomatic EPN and EC in uremic patient, and conservative management was optimistic in this condition. More attention should be paid to EPN and EC happening to ESRD patients.


Assuntos
Anuria/complicações , Cistite/etiologia , Enfisema/etiologia , Infecções por Escherichia coli/complicações , Pielonefrite/etiologia , Uremia/complicações , Adulto , Anuria/terapia , Tratamento Conservador , Cistite/terapia , Enfisema/terapia , Infecções por Escherichia coli/tratamento farmacológico , Humanos , Masculino , Diálise Renal/efeitos adversos , Uremia/terapia
12.
Expert Rev Med Devices ; 15(11): 847-857, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30345840

RESUMO

INTRODUCTION: Bronchoscopic lung volume reduction with endobronchial valves is a recently acknowledged treatment option in patients with severe emphysema and absence of interlobar collateral ventilation. In endobronchial valve treatment, implantation of one-way valves leads to deflation of a hyperinflated lung lobe. Multiple studies showed significant improvements in lung function, exercise capacity, and quality of life in this patient subgroup which often did not have any remaining treatment options. AREAS COVERED: In this review, efficacy outcomes and adverse events of endobronchial valve treatment are summarized. The importance of selection of the right patients and target lobe is discussed. The role of bodyplethysmography, quantitative CT analysis, and quantification of interlobar collateral ventilation in this selection process are evaluated. Furthermore, this review has a special focus on ongoing trials and future perspectives of this treatment. EXPERT OPINION: Development of advanced diagnostic imaging methods will result in a better patient and target selection and improved outcomes. Furthermore, optimizing the device and the procedure might be an important focus in future developments to enhance outcomes and reduce adverse events.


Assuntos
Broncoscopia/métodos , Enfisema/patologia , Enfisema/terapia , Pulmão/patologia , Broncoscopia/efeitos adversos , Enfisema/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Tamanho do Órgão , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
BMJ Case Rep ; 20182018 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-30262542

RESUMO

Gastric emphysema is characterised by the presence of air within the wall of the stomach. The radiographic finding of gastric emphysema with hepatic portal venous gas is classically an ominous sign, associated with a high mortality rate. We report one case from our clinical experience and undertake a review of the previously reported cases of vomiting-induced gastric emphysema retrieved from the PubMed. A total of 14 cases were found to date. The mean age at the time of diagnosis was 45.6 years (range, 9 months to 81 years). Computed tomography abdomen was the frequently used diagnostic modality. Interestingly, conservative treatment led to a clinical cure and resolution of gastric emphysema as well as the associated hepatic portal venous gas in most of the patients. This review illustrates that vomiting-related gastric emphysema entails a more benign course and surgical intervention can be avoided with a prompt aetiology establishment in these patients.


Assuntos
Enfisema/etiologia , Gastropatias/etiologia , Vômito/complicações , Tratamento Conservador , Diagnóstico Diferencial , Enfisema/terapia , Gastrite/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Gastropatias/terapia
14.
BMJ Case Rep ; 20182018 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209146

RESUMO

Emphysematous pyelonephritis (EPN) is a rare, necrotising infection of the renal parenchyma, predominantly associated with Escherichia coli infection and unless promptly recognised and dealt with, it carries a poor prognosis. The current treatment is one of antimicrobial therapies together with nephrectomy in a majority of patients. We report an elderly man with multiple comorbidities with a diagnosis of EPN whose condition improved with antimicrobial and supportive therapy, and no surgical intervention was required.


Assuntos
Tratamento Conservador/métodos , Enfisema/terapia , Pielonefrite/terapia , Idoso , Antibacterianos/uso terapêutico , Enfisema/complicações , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/terapia , Humanos , Masculino , Pielonefrite/complicações , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Ned Tijdschr Geneeskd ; 1622018 09 03.
Artigo em Holandês | MEDLINE | ID: mdl-30212014

RESUMO

A 74-year-old man presented to the Emergency Department after a fall from a ladder. Plain radiographic screening of the lumbar spine revealed an unanticipated curvilinear, oval-shaped air configuration in the pelvis. Computed tomography of the lumbar spine showed air within the bladder wall and lumen. Urine cultures were positive for Escherichia coli. The patient was discharged after bladder drainage and empiric antibiotic treatment.


Assuntos
Enfisema/diagnóstico por imagem , Pelve/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Antibacterianos/uso terapêutico , Drenagem/métodos , Enfisema/terapia , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Bexiga Urinária/diagnóstico por imagem
16.
Wiad Lek ; 71(4): 917-921, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30099435

RESUMO

Emphysematous pyelonephritis is a rare form of acute necrotizing pyelonephritis. It is a gas-producing, necrotizing infection involving the renal parenchyma and surrounding tissues. It is associated with high mortality and morbidity. In the majority of cases, patients with long-standing diabetes and poor glycemic control are affected. We report the case of a 67 yr old female who survived severe sepsis due to emphysematous pyelonephritis. Potential therapeutic strategies in the aftermath from a diabetologist's point of view are discussed.


Assuntos
Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2/complicações , Enfisema/terapia , Pielonefrite/terapia , Idoso , Complicações do Diabetes/complicações , Enfisema/etiologia , Feminino , Humanos , Pielonefrite/etiologia , Sepse/terapia
17.
Nihon Shokakibyo Gakkai Zasshi ; 115(7): 655-661, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-29998988

RESUMO

A 69-year-old Japanese man underwent successful percutaneous endoscopic gastrostomy (PEG) without any intra-procedural adverse event. However, 3 days postoperatively, he presented with melena and bloody discharge from the gastrostomy tube. Computed tomography revealed gastric emphysema, hepatic portal venous gas, portal vein thrombosis, and swelling of the ascending colon. We administered antibiotics and discontinued enteral feeding; this resulted in resolution of gastric emphysema, hepatic portal venous gas, and portal vein thrombosis and an improvement in the swelling of the ascending colon. To the best of our knowledge, till date, only three patients have been reported to develop gastric emphysema and hepatic portal venous gas after PEG. All previously reported patients were treated with antibiotics and/or discontinuation of enteral feeding, exhibiting recovery within 6-14 days. Although the occurrence of gastric emphysema and hepatic portal venous gas after a PEG procedure is rare, conservative management can ensure recovery in such patients.


Assuntos
Tratamento Conservador , Enfisema/terapia , Gastrite/terapia , Idoso , Humanos , Japão , Fígado , Masculino , Veia Porta
20.
J Int Med Res ; 46(7): 2954-2960, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29916283

RESUMO

This present case report describes a 64-year-old female patient with type 2 diabetes mellitus who also had emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC). Computed tomography revealed well defined emphysematous pyelonephritis and cystitis. Broad-spectrum antibiotic and percutaneous drainage of the right kidney were used as part of a conservative management regimen. The patient achieved clinical recovery and was discharged 12 days after admission. Furthermore, 13 other cases of EPC and EC that were reported between 1962 and 2017 were reviewed and discussed. The overall mortality was 15.4% (two of 13 patients), compared with 25% for EPN alone or 7.4% for EC alone as reported in the literature. The primary pathogen identified in the 13 patients was Escherichia coli (53.8%). All 13 patients were treated with antibiotics.


Assuntos
Cistite/diagnóstico por imagem , Enfisema/diagnóstico por imagem , Infecções por Escherichia coli/microbiologia , Escherichia coli/isolamento & purificação , Pielonefrite/diagnóstico por imagem , Antibacterianos/uso terapêutico , China , Cistite/microbiologia , Cistite/terapia , Diabetes Mellitus Tipo 2/complicações , Drenagem , Enfisema/microbiologia , Enfisema/terapia , Infecções por Escherichia coli/diagnóstico por imagem , Infecções por Escherichia coli/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Pielonefrite/microbiologia , Pielonefrite/terapia
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