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1.
Rev Col Bras Cir ; 46(6): e20192314, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32022110

RESUMO

OBJECTIVE: to assess whether laparoscopy with peritoneal lavage is superior to computed tomography for staging gastric adenocarcinoma and whether it can modify the surgical approach. METHODS: we conducted a retrospective study of 46 patients with gastric adenocarcinoma treated by the digestive surgery team of the Passo Fundo Clinics Hospital (RS), from January 2015 to December 2018, and submitted to laparoscopy with preoperative peritoneal lavage. All patients underwent preoperative clinical staging with computed tomography. RESULTS: of the 46 patients analyzed, the majority had tumors located in the cardia (34.8%), poorly differentiated (69.6%), and subtype signet ring cells (65.2%). In 91.3%, the computed tomography scan did not identify peritoneal carcinomatosis or distant metastasis. Among these patients with negative computed tomography for distant disease, 21.8% had positive peritoneal lavage for neoplastic cells and had their therapeutic approaches modified. CONCLUSION: laparoscopy and peritoneal lavage altered the surgical decision in 21.8% of patients, providing a more reliable preoperative staging in gastric adenocarcinoma.


Assuntos
Adenocarcinoma/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/métodos , Lavagem Peritoneal/métodos , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Idoso , Feminino , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 98(50): e18047, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852066

RESUMO

BACKGROUND: There currently exists no substantial evidence reporting the efficacy of peritoneal irrigation in reducing the incidence of postoperative intra-abdominal abscess in pediatric patients. The purpose of our study was to perform a meta-analysis to compare rates of intra-abdominal abscess after appendectomy between irrigation and suction alone groups. METHODS: We identified studies by a systematic search in EMBASE, PubMed, Web of Science, and the Cochrane Library to recognize randomized controlled trials and case control studies from the 1950 to May 2019. We limited the English language studies. We checked the reference list of studies to recognize other potentially qualified trials. We analyzed the merged data with use of the Review Manager 5.3. RESULTS: We identified 6 eligible papers enrolling a total of 1633 participants. We found no significant difference in the incidence of postoperative intraabdominal abscess, wound infection, and the length of hospitalization between 2 group, but duration of surgery is longer in irrigation group (MD = 6.76, 95% CI = 4.64 to 8.87, P < .001; heterogeneity, I = 25%, P = .26). CONCLUSION: Our meta-analysis did not provide strong evidence allowing definite conclusions to be drawn, but suggested that peritoneal irrigation during appendectomy did not decrease the incidence of postoperative IAA. This meta-analysis also indicated the need for more high-quality trials to identify methods to decrease the incidence of postoperative IAA in pediatric perforated appendicitis patients.Trial registration number Standardization of endoscopic treatment of acute abdomen in children: 14RCGFSY00150.


Assuntos
Abscesso Abdominal/prevenção & controle , Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Lavagem Peritoneal/métodos , Complicações Pós-Operatórias/prevenção & controle , Abscesso Abdominal/etiologia , Apendicite/complicações , Criança , Humanos , Período Intraoperatório , Complicações Pós-Operatórias/etiologia
3.
Int J Surg ; 71: 182-189, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31610284

RESUMO

BACKGROUND: Diverticulitis is one of the most common gastrointestinal diseases in western population. Colonic resection is recommended by international guidelines as a routinely used technique for purulent diverticulitis. Laparoscopic lavage was introduced as a non-resection alternative. The studies available so far have shown contradictory results. This meta-analysis aims to compare laparoscopic lavage versus colonic resection in patients with Hinchey Ⅲ-Ⅳ diverticulitis. METHODS: We did a systematic review of articles published before March 20, 2019, with no language restriction by searching PubMed, Cochrane library, EMBASE databases, clinicaltrials.gov, and Google Scholar databases. We included all RCTs and cohort studies comparing outcomes between patients with Hinchey Ⅲ-Ⅳ diverticulitis undergoing laparoscopic lavage versus colonic resection. Important outcomes were mortality, complications, length of stay, readmission and reoperation rates. We combined data to assess the outcomes using DerSimonian and Laird random-effects model. RESULTS: A total of 569 patients with diverticulitis of which more than 80% were Hinchey Ⅲ were enrolled from 3 RCTs and 5 cohort studies. Laparoscopic lavage was associated with shorter operative time (WMD -78.9, 95%CI -100.58 to -57.11, P < 0.0001) and total postoperative hospital stay (WMD -7.62, 95%CI -11.60 to -3.63, P = 0.0002) but a higher rate of intra-abdominal abscess (OR 2.69, 95%CI 1.39 to 5.21, P = 0.0032) and secondary peritonitis (OR 5.30, 95%CI 1.91 to 14.73, P = 0.0014). CONCLUSION: Laparoscopic lavage for patients with Hinchey Ⅲ to Ⅳ diverticulitis does provide similar mortality, shorter operative time and hospital stay. However, the evidence so far suggests that it might be inadequate for sepsis control and may result in more unplanned reoperations. Further studies are needed to standardize the formal indication for laparoscopic lavage.


Assuntos
Colectomia/efeitos adversos , Doença Diverticular do Colo/cirurgia , Laparoscopia/efeitos adversos , Lavagem Peritoneal/efeitos adversos , Complicações Pós-Operatórias/etiologia , Abscesso Abdominal/etiologia , Adulto , Idoso , Colectomia/métodos , Feminino , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Lavagem Peritoneal/métodos , Peritonite/etiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Reoperação/estatística & dados numéricos , Resultado do Tratamento
4.
Surgery ; 166(4): 469-475, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31383465

RESUMO

BACKGROUND: Surgical site infection affects 25% of patients undergoing pancreatoduodenectomy. This double-blind, randomized controlled trial tested the efficacy of intraperitoneal antibiotic irrigation in decreasing infection and pancreatic fistula after pancreatoduodenectomy. METHODS: Patients undergoing pancreatoduodenectomy were randomized (1:1 ratio) to intraperitoneal antibiotic (polymyxin B, 500,000 units/L) irrigation or 0.9% NaCl irrigation. All patients received 1 dose of standard parenteral antibiotics within 1 hour of incision. The trial was powered to detect a 15% difference in any surgical site infection (primary endpoint) within 30 days after pancreatoduodenectomy. RESULTS: One hundred ninety patients undergoing pancreatoduodenectomy were randomized: 95 to antibiotic irrigation and 95 to saline irrigation. Groups were well matched regarding demographics, diagnosis, preoperative biliary stenting, bactibilia, texture of the pancreatic parenchyma, pancreatic and bile duct size, portal vein resection, and anastomotic technique. Overall, 30-day surgical site infection was observed in 24 (13%) patients: antibiotic irrigation in 10 (11%) versus saline in 14 (15%) (P = .62). Superficial (n = 9, 5%) and organ-space (n = 15, 8%) surgical site infection rates were 3% and 7% (antibiotic) and 6% and 8% (saline), respectively (P > .31). Clinically relevant postoperative pancreatic fistula occurred in 11 (12%) patients in the antibiotic arm and 10 (11%) in saline controls (P > .95). CONCLUSION: The addition of antibiotic solution to intraperitoneal irrigation does not decrease the incidence of postoperative infectious complications or pancreatic fistula after pancreatoduodenectomy.


Assuntos
Antibacterianos/uso terapêutico , Fístula Pancreática/prevenção & controle , Pancreaticoduodenectomia/métodos , Lavagem Peritoneal/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreaticoduodenectomia/mortalidade , Prognóstico , Valores de Referência , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento
5.
World J Emerg Surg ; 14: 25, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31164914

RESUMO

Background: Laparoscopic appendectomy has progressively gained acceptance as the standard of care for acute appendicitis. Focusing on the incidence of postoperative intra-abdominal abscess after a laparoscopic appendectomy, discordant data have been reported ranging from 1.5 to 20%. Besides, evidence advocating advantages from peritoneal irrigation over suction only are lacking. Most studies are burdened by a high level of heterogeneity regarding the severity of the appendicitis and modalities of peritoneal irrigation. One of the main drawbacks is the lack of an accepted classification for different degrees of appendicitis and peritoneal contamination. The aim of the study is to introduce a classification to clarify the relationship between grade of appendicitis, contamination, and postoperative incidence of IAA considering the surgeon's attitude toward irrigation or suction alone. Preoperative, intra-operative, and postoperative predictive factors for infectious complication will also be assessed. This study is meant to be the first Italian multicenter resident-based observational study. Methods: Patients suffering from acute appendicitis will be enrolled during a 1-year period, according to inclusion and exclusion criteria. Participants will fill an online form reporting all clinical and intra-operative data of each patient undergoing a laparoscopic appendectomy. General surgery residents will be responsible for data collection. Our proposal of classification is based on the histological grade of appendicitis and intra-operative degree of peritoneal contamination. For each grade, a progressively increasing score is assigned. Discussion: The observational nature of this study is mandatory to examine surgeons' attitude toward peritoneal contamination during laparoscopic appendectomy for appendicitis. Identification of different severity grades of acute appendicitis and their relationship with the development of postoperative abscesses is necessary. The resulting classification and score, even considering peritoneal lavage or suction alone, will define risk classes of peri-appendiceal contamination each one related to a specific incidence rate of postoperative IAA. Nowadays, maximum effort should be made to reach the best procedural standardization and surgical decision-making should be supported by solid evidence, especially in an emergency surgery setting.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Lavagem Peritoneal/métodos , Apendicectomia/classificação , Apendicite/classificação , Apendicite/epidemiologia , Humanos , Incidência , Itália , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
6.
Isr Med Assoc J ; 5(21): 330-332, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140225

RESUMO

BACKGROUND: Selective management of stable patients with anterior abdomen stab wounds (AASWs) has become a gold standard management approach throughout the world. Evidenced-based options for supporting selective management include clinical follow-up, local wound exploration with or without diagnostic peritoneal lavage, diagnostic laparoscopy, and abdominal computerized tomography. The presence of multiple AASWs might signify a more aggressive attack and limit the safety of a selective management approach. OBJECTIVES: To evaluate whether multiple AASWs are associated with an increased risk of intra-abdominal injury requiring emergency surgery. METHODS: We retrospectively reviewed all AASW patients admitted to Assaf Harofeh Medical Center, Zerifin, Israel, and Hillel Yaffe Medical Center in Hadera, Israel, from 2007 to 2015. Patients were divided into two groups based on the number of stab wounds: single or multiple. Data were coded for demographics, severity of injury, presence of intra-abdominal injury, laparotomy rate, length of hospital stay (LOS), length of stay in the intensive care unit (LICU), and survival. RESULTS: The study included 169 patients. Of these, 143 patients had a single AASW and 26 had multiple AASWs. There were no differences between the groups regarding demographics, severity of injury, intra-abdominal penetration, specific organ injury, LOS, or LICU. There was no difference in the percentage of patients requiring laparotomy. The overall mortality was 2.36% (4/169). There was no significant difference in the mortality rate between the groups (P = 0.11). CONCLUSIONS: The presence of multiple AASWs is not a risk factor for increased frequency and severity of intra-abdominal injury.


Assuntos
Traumatismos Abdominais , Ferimentos Perfurantes , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/terapia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Israel/epidemiologia , Laparoscopia/métodos , Laparotomia/métodos , Laparotomia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Mortalidade , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Lavagem Peritoneal/métodos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Ferimentos Perfurantes/diagnóstico , Ferimentos Perfurantes/mortalidade , Ferimentos Perfurantes/terapia
7.
Ther Apher Dial ; 23(3): 237-241, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31025830

RESUMO

Cell-free and concentrated ascites reinfusion therapy (CART) by internal filtration pressure method (internal method) and external filtration pressure method (external method) using the same cancerous ascites was performed. The rate of rise in circuit pressure and recovered components were compared between the two methods. The factors related to circuit pressure rise were also researched. In both methods, circuit pressure rose in 50% of cases. The recovery rates of IgG, IgA, IgM, and haptoglobin were significantly higher for the internal method than for the external method, whereas the recovery rate of α1 -antitrypsin was significantly lower in the internal method than in the external method. The levels of IL-6, haptoglobin, α1 -antitrypsin, and fibrinogen/fibrindegradation products (FDP) in the original ascites were significantly higher in the group wherein circuit pressure rose than in that without circuit pressure rise. These proteins might be related to the rise in circuit pressure.


Assuntos
Ascite/terapia , Sistema Livre de Células , Segurança do Paciente , Lavagem Peritoneal/métodos , Neoplasias Peritoneais/complicações , Idoso , Ascite/patologia , Líquido Ascítico/patologia , Estudos de Coortes , Feminino , Filtração/métodos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Lavagem Peritoneal/instrumentação , Neoplasias Peritoneais/patologia , Pressão , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
8.
Pancreas ; 48(4): 519-525, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30946232

RESUMO

OBJECTIVES: The prognostic implications of intraoperative peritoneal washing cytology (IPWC) in patients with pancreatic ductal adenocarcinoma (PDAC) remains incompletely understood. METHODS: A meta-analysis was conducted to investigate the impact of IPWC status on the clinicopathologic features and survival outcomes in potentially resectable, locally advanced, and metastatic PDAC. Hazard ratio (HR) and 95% confidence interval (CI) were used as the pooled estimates. RESULTS: A total of 12 studies qualified for inclusion with 3751 PDAC patients. In resectable PDAC, the postoperative 5-year overall survival was significantly better in negative IPWC than in positive IPWC patients, with a pooled HR of 2.47 (95% CI, 1.90-3.21; P < 0.001; I = 69%) in a random-effects model. Likely, combined outcome showed a significantly longer survival benefit in the negative IPWC group (HR, 2.80; 95% CI, 1.94-4.04; P < 0.001) in terms of recurrence-free survival. The presence of positive IPWC did not significantly alter survival outcomes in those PDAC patients with locally advanced or metastatic disease. CONCLUSIONS: This systematic review and meta-analysis demonstrated that a positive IPWC status in patients with clinically resectable PDAC predicts a poor prognosis. Patients with positive IPWC should be regarded as a specific subgroup, with intensive adjuvant chemotherapy that seems to be warranted for further evaluation.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Citodiagnóstico/métodos , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Lavagem Peritoneal/métodos , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/tratamento farmacológico , Humanos , Período Intraoperatório , Metástase Neoplásica , /estatística & dados numéricos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/tratamento farmacológico , Análise de Sobrevida
9.
Ther Apher Dial ; 23(3): 242-247, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31033167

RESUMO

Cell-free and concentrated ascites reinfusion therapy (CART) is used to treat malignant ascites. However, the qualities of albumin in malignant ascites, such as antioxidative activity, may decrease owing to oxidative stress caused by cancer cells and inflammatory reactions. We investigated the fraction percentages of mercaptalbumin (HMA%, reduced form) and non-mercaptalbumin (HNA%, oxidized form) in malignant ascites from 21 patients who received CART and compared the HMA% in the malignant ascites and human serum albumin (HSA) preparations. HMA% of albumin in malignant ascites (22.5%) was significantly lower than that in HSA preparation (42.2%). To ensure a high HMA%, we added L-cysteine to the paracentesis-treated ascites followed by dialysis 1 h later. As a result, the HMA% of albumin in malignant ascites was increased to 59.1%. Our results suggest that using this method in CART will improve patient's albumin quality.


Assuntos
Ascite/patologia , Sistema Livre de Células , Lavagem Peritoneal/métodos , Neoplasias Peritoneais/complicações , Albumina Sérica Humana/análise , Idoso , Ascite/etiologia , Líquido Ascítico/patologia , Estudos de Coortes , Feminino , Filtração/métodos , Hospitais Universitários , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/patologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
10.
JAMA Surg ; 154(7): 610-616, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30916742

RESUMO

Importance: Peritoneal metastasis is the most frequent pattern of postoperative recurrence in patients with gastric cancer. Extensive intraoperative peritoneal lavage (EIPL) is a new prophylactic strategy for treatment of peritoneal metastasis of locally advanced gastric cancer; however, the safety and efficacy of EIPL is currently unknown. Objective: To evaluate short-term outcomes of patients with advanced gastric cancer who received combined surgery and EIPL or surgery alone. Design, Setting, and Participants: From March 2016 to November 2017, 662 patients with advanced gastric cancer receiving D2 gastrectomy were enrolled in a large, multicenter, randomized clinical trial from 11 centers across China. In total, 329 patients were randomly assigned to receive surgery alone, and 333 patients were randomly assigned to receive surgery plus EIPL. Clinical characteristics, operative findings, and postoperative short-term outcomes were compared between the 2 groups in the intent-to-treat population. Main Outcomes and Measures: Short-term postoperative complications and mortality. Results: The present analysis included data from 550 patients, 390 men and 160 women, with a mean (SD) age of 60.8 (10.7) years in the surgery alone group and 60.6 (10.8) in the surgery plus EIPL group. Patients assigned to the surgery plus EIPL group exhibited reduced mortality (0 of 279 patients) compared with those assigned to surgery alone (5 of 271 patients [1.9%]) (difference, 1.9%; 95% CI, 0.3%-3.4%; P = .02). A significant difference in the overall postoperative complication rate was observed between patients receiving surgery alone (46 patients [17.0%]) and those receiving surgery plus EIPL (31 patients [11.1%]) (difference, 5.9%; 95% CI, 0.1%-11.6%; P = .04). Postoperative pain occurred more often following surgery alone (48 patients [17.7%]) than following surgery plus EIPL (30 patients [10.8%]) (difference, 7.0%; 95% CI, 0.8%-13.1%; P = .02). Conclusions and Relevance: Inclusion of EIPL can increase the safety of D2 gastrectomy and decrease postoperative short-term complications and wound pain. As a new, safe, and simple procedure, EIPL therapy is easily performed anywhere and does not require any special devices or techniques. Our study suggests that patients with advanced gastric cancer appear to be candidates for the EIPL approach. Trial Registration: ClinicalTrials.gov identifier: NCT02745509.


Assuntos
Gastrectomia/métodos , Estadiamento de Neoplasias , Lavagem Peritoneal/métodos , Neoplasias Gástricas/terapia , China/epidemiologia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida/tendências , Resultado do Tratamento
11.
Diagn Cytopathol ; 47(7): 670-674, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30821430

RESUMO

BACKGROUND: Intraperitoneal malignant cells detection in patients with gastric cancer is associated with a significant decrease in overall survival. The overall accuracy of cytological examination of peritoneal lavages, however, is quite low, and intraperitoneal recurrence has been observed even in patients with negative cytology. Immunocytochemistry and molecular techniques have been investigated to improve high-risk patients' identification with variable results. The aim of this study was to compare the performance of different laboratory methods applied to peritoneal washing, to improve the cytological identification of malignant cells. METHODS: We prospectively evaluated 21 patients who underwent surgery and peritoneal lavage for gastric cancer. Among them, 18 had negative cytology and three were positive for malignant cells. For each patient, immunohistochemistry with BerEP4 antibody was performed on seriate sections of cellblock preparation at different levels, using the method reported for sentinel nodes in other types of cancer. Paired frozen quotes of washing fluids were evaluated by qRT-PCR with primer for mRNA of Ceacam5. RESULTS: In 4 of 18 patients with previous negative routine cytology, isolated neoplastic cells in seriate sections of the cellblock inclusion have been found. Results showed to be coherent with molecular analysis for CEA mRNA. CONCLUSION: The sensitivity and specificity of peritoneal washing analyses should be notably improved by immunohistochemistry applied to multilevel cellblock sectioning. The method is less expensive and more widely applicable than molecular analysis, in each laboratory setting. This approach allows detection of minimum peritoneal seeding in patients with gastric cancer.


Assuntos
Líquido Ascítico/patologia , Biomarcadores Tumorais/metabolismo , Lavagem Peritoneal/métodos , Neoplasias Gástricas/patologia , Líquido Ascítico/metabolismo , Biomarcadores Tumorais/genética , Antígeno Carcinoembrionário/genética , Antígeno Carcinoembrionário/metabolismo , Proteínas Ligadas por GPI/genética , Proteínas Ligadas por GPI/metabolismo , Humanos , Lavagem Peritoneal/normas , Sensibilidade e Especificidade , Neoplasias Gástricas/metabolismo
12.
Pancreas ; 48(3): 343-349, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30789387

RESUMO

OBJECTIVES: This study aimed to compare the efficacy of percutaneous drainage (PCD) versus peritoneal lavage (PL) for the treatment for severe acute pancreatitis patients with pancreatic ascites (PAs). METHODS: Severe acute pancreatitis patients with PAs were randomly assigned within 3 days of onset of symptoms to receive either PL or PCD. The primary end point was a composite of mortality or major complications during hospitalization and within 1 month of discharge. Per-protocol analyses were performed. RESULTS: Between September 2011 and June 2014, 86 patients were randomly assigned to intervention with PL or PCD. Ultimately, 41 patients in the PCD group and 39 patients in the PL group completed the study. The primary end point occurred in 15 (36.6%) of 41 patients in the PCD group and in 17 (43.6%) of 39 patients in the PL group (risk ratio, 0.84; 95% confidence interval, 0.49-1.44; P = 0.27). Mortality or major complications did not differ between the groups. Percutaneous drainage reduced intra-abdominal hypertension; however, PL reduced the incidence of deep venous thrombosis and pancreatic encephalopathy and was associated with a reduced need for intervention. CONCLUSIONS: In our study, the PCD was not superior to the PL in reducing mortality or major complications in severe acute pancreatitis patients with PAs.


Assuntos
Ascite/terapia , Drenagem/métodos , Pancreatopatias/terapia , Pancreatite/terapia , Lavagem Peritoneal/métodos , Doença Aguda , Adulto , Ascite/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pancreatite/complicações , Pancreatite/patologia , Estudos Prospectivos , Índice de Gravidade de Doença , Análise de Sobrevida
13.
Pathol Res Pract ; 215(2): 392-394, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30392916

RESUMO

Genetic screening for BRCA mutations should be offered to all women diagnosed with epithelial ovarian, fallopian tube, and/or peritoneal cancers given the implications for treatment options and cancer risk assessments. Yet, while germline breast cancer susceptibility gene 1 (BRCA1) and breast cancer susceptibility gene 2 (BRCA2) testing is commonly performed, BRCA1/2 somatic mutations testing is rather challenging since the poor quality of DNA extracted from formalin fixed paraffin embedded (FFPE) samples can significantly impair this process. Peritoneal lavage is routinely performed in surgeries of suspected ovarian malignancies. We have analyzed fresh tumor, peritoneal lavage and blood samples from ten patients and we have found an excellent agreement (88%) between fresh tumor and peritoneal lavage for BRCA mutation testing. Importantly, 112 of the 114 genomic alterations detected in fresh tumor samples were also found in peritoneal lavage fluids. Our data suggest that peritoneal washings can indeed streamline BRCA genes mutation testing procedures.


Assuntos
Proteína BRCA1/genética , Proteína BRCA2/genética , Cistadenocarcinoma Seroso/genética , Análise Mutacional de DNA/métodos , Neoplasias Ovarianas/genética , Lavagem Peritoneal/métodos , Proteína BRCA1/análise , Proteína BRCA2/análise , Biomarcadores Tumorais/análise , Feminino , Humanos
14.
J Pediatr Surg ; 54(4): 728-732, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30025605

RESUMO

PURPOSE: The utility of irrigation at the time of appendectomy for acute appendicitis has been debated, with recent studies showing no benefit to irrigation. In our practice, two techniques have been used; one in which irrigation was at the discretion of the surgeon, and one in which irrigation was standardized. The standardized irrigation technique involved large volume (3-12 l) irrigation in small, focused, directed aliquots to achieve optimal dilution. We sought to retrospectively assess whether the standardized large volume irrigation technique was associated with measurably reduced intraabdominal infection. We hypothesized that there would be no difference in intraabdominal infection rate. METHODS: Medical records for cases of appendectomies performed for acute appendicitis, years 2007 through 2017, were reviewed (n = 432). Rate of subsequent abdominal infection was compared between patients who underwent the standardized large volume irrigation technique compared to those who did not using Fisher's exact test; p < 0.05 was considered significant. RESULTS: For patients that underwent the standardized large volume irrigation technique there were no (0/140) subsequent abdominal infections within the study period, compared with a rate of 6.2% (18/292) for all other patients (p value 0.001). Among cases that had a perforated appendix (n = 105), the rates were 0% (0/31) compared to 18.9% (14/74; p value 0.009). CONCLUSIONS: Utilization of a standardized large volume irrigation technique with the objective of serial dilution is associated with a significantly lower rate of subsequent abdominal infection, even among cases with a perforated appendix. Prospective studies are needed to evaluate this technique. LEVEL OF EVIDENCE: Level III. TYPE OF STUDY: Treatment study.


Assuntos
Abscesso Abdominal/prevenção & controle , Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/efeitos adversos , Lavagem Peritoneal/métodos , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/etiologia , Doença Aguda , Adolescente , Apendicectomia/efeitos adversos , Criança , Pré-Escolar , Humanos , Lactente , Laparoscopia/métodos , Padrões de Referência , Estudos Retrospectivos , Adulto Jovem
15.
J Cancer Res Ther ; 14(Supplement): S1129-S1134, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30539858

RESUMO

Background: The factors associated with the survival and prognosis of peritoneal cytology (CY)-positive pancreatic cancer patients who undergo curative resection followed by adjuvant chemotherapy have not been established. Patients and Methods: Both overall survival (OS) and recurrence-free survival (RFS) were examined in 23 peritoneal CY-positive pancreatic cancer patients who underwent curative resection followed by adjuvant chemotherapy between 2005 and 2015. Results: When the length of OS was evaluated using a log-rank test, significant differences were observed in the number of metastatic lymph nodes. In addition, univariate and multivariate analyses demonstrated that the number of metastatic lymph nodes was a significant independent risk factor for OS and a marginally significant risk factor for RFS. The 3-year OS rate was 20.2% in patients with ≤8 metastatic lymph nodes, and it was 0% in those with the ≥9 metastatic lymph nodes (P = 0.017). The 3-year RFS rate was 6.3% in patients with ≤8 metastatic lymph nodes, whereas it was 0% in those with ≥9 metastatic lymph nodes (P = 0.062). Conclusions: The number of metastatic lymph nodes is the most important prognostic factor for OS and RFS in peritoneal CY-positive pancreatic cancer patients who underwent curative resection followed by adjuvant chemotherapy. To improve the survival of these patients, it is necessary to establish optimal treatments.


Assuntos
Antineoplásicos/uso terapêutico , Linfonodos/patologia , Pancreatectomia , Neoplasias Pancreáticas/mortalidade , Idoso , Biópsia/métodos , Quimioterapia Adjuvante/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pâncreas/patologia , Pâncreas/cirurgia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Lavagem Peritoneal/métodos , Prognóstico , Taxa de Sobrevida , Resultado do Tratamento
16.
Indian Pediatr ; 55(10): 909-910, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30426960

RESUMO

BACKGROUND: Clinical presentations of intestinal lymphangiectasia include pitting edema, chylous ascites, pleural effusion, diarrhea, malabsorption and intestinal obstruction. CASE CHARACTERISTICS: An 8-year-old male child presented to the emergency department with clinical features of peritonitis, raising suspicion of appendicular or small bowel perforation. INTERVENTION/OUTCOME: Diagnosis of chylous ascites with primary intestinal lymphangiectasia made on laparotomy. MESSAGE: Acute peritonitis may be a presentation of primary intestinal lymphangiectasia and chylous ascites.


Assuntos
Abdome Agudo/etiologia , Ascite Quilosa/etiologia , Linfangiectasia Intestinal/diagnóstico , Abdome Agudo/cirurgia , Criança , Ascite Quilosa/cirurgia , Diagnóstico Diferencial , Drenagem/métodos , Humanos , Laparotomia/métodos , Linfangiectasia Intestinal/complicações , Linfangiectasia Intestinal/cirurgia , Masculino , Mesentério/patologia , Lavagem Peritoneal/métodos
17.
Surg Infect (Larchmt) ; 19(7): 723-728, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30260766

RESUMO

BACKGROUND: Peritoneal lavage is often used for peritonitis, however, the volume and type of lavage fluid varies. Saline or Ringer's solution are used most often and lavage is performed until the fluid is clear. However, at present there is no irrigation fluid for peritoneal lavage with residual antiseptic activity. Because the combination of aqueous polyhexamethylenbiguanid-hydrochlorid (PHMB) and egg phosphatidylcholine containing oil/water emulsions (Lipofundin® MCT 20%, B. Braun AG, Melsungen, Germany) protect mammalian cells without neutralizing the antiseptic effect of PHMB, it seemed promising to investigate such human cell protecting, yet antibacterial combination for peritoneal lavage in a murine sepsis model. METHODS: After induction of colon ascendens stent peritonitis (CASP) in mice, the foci were eradicated by re-laparotomy, followed by twofold lavage with 2 × 3 mL of the tested emulsion. The following lavage fluids were investigated blindly: 10% Lipofundin/0.05% PHMB, 100% Lipofundin, 0.05% PHMB, and 0.9% saline. After 24 hours the animals were euthanized and organs, blood, and lavage fluid were examined for cytokine levels (tumor necrosis factor [TNF]-α, interferon [IFN]-γ, interleukin [IL]-6, IL-10), liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], gamma-glutamyltransferase [gamma-GT], glutamate dehydrogenase [GLDH]), creatinine, and bacterial density. RESULTS: Only the combination of Lipofundin/PHMB (n = 23) increased the survival rate. Compared with saline alone, PHMB alone decreased the survival rate. Twenty-four hours after induction of peritonitis, the lowest number of colony forming units (CFU) was observed after lavage with PHMB/Lipofundin in all examined organs, blood, and lavage fluid (p < 0.01). Alanine aminotransferase, AST, and creatinine levels were increased after lavage with PHMB compared with the other lavage fluids (p < 0.05). CONCLUSIONS: Peritoneal lavage using 0.05% aqueous PHMB alone resulted in no survival benefit in a CASP murine model. The increase of liver enzymes and creatinine seem to be a toxic side effect of PHMB. However, an emulsion of 0.05% PHMB/10% Lipofundin decreased cytotoxicity while maintaining antiseptic efficiency. The advantage for survival was explained by decrease of bacterial load in organs, blood, and lavage fluid. The results provide a new option for the treatment of peritonitis using peritoneal lavage with the combination of PHMB/Lipofundin.


Assuntos
Biguanidas/uso terapêutico , Desinfetantes/uso terapêutico , Lavagem Peritoneal/métodos , Peritonite/terapia , Sepse/prevenção & controle , Animais , Carga Bacteriana/efeitos dos fármacos , Biguanidas/administração & dosagem , Citocinas/metabolismo , Modelos Animais de Doenças , Desinfetantes/administração & dosagem , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Peritonite/complicações , Sepse/terapia
18.
Tumori ; 104(5): 361-368, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30185117

RESUMO

INTRODUCTION:: Survival in gastric cancer is often limited by peritoneal carcinomatosis, which supposedly develops from serosal tumor infiltration or tumor cell spread during gastrectomy with lymphadenectomy. To eliminate peritoneal tumor cells, extensive intraperitoneal lavage (EIPL) has been suggested. Impressive results have been achieved in Japanese trials. In this trial, we assessed EIPL in Western patients. METHODS:: This prospective trial included patients with non-metastatic gastric adenocarcinoma undergoing gastrectomy with D2 lymphadenectomy. Peritoneal fluid samples at laparotomy, after lymphadenectomy, and after EIPL were analyzed for tumor cells using cytology and EpCAM antibodies. The primary endpoint was peritoneal conversion rate (PCR; proportion of patients in whom EIPL eliminated tumor cells after lymphadenectomy). Secondary endpoints were peritoneal release rate (PRR; proportion of patients with peritoneal tumor cells after gastrectomy/lymphadenectomy among all patients without cells before gastrectomy/lymphadenectomy) and prevalence of peritoneal tumor cells before resection. EIPL was considered ineffective if PCR ⩽ 0.2 and warranted further exploration if PCR ⩾ 0.5. Clinicaltrials.gov identifier is NCT01476553. RESULTS:: The trial was stopped early because tumor cells after gastrectomy/lymphadenectomy were detected in only 3/27 (11.1%) patients. In none of these did EIPL eliminate tumor cells (PCR 0, 95% confidence interval [CI] 0%-12.5%). In 8/27 (29.6%) patients, tumor cells were detected after EIPL. PRR was 11.1% (95% CI 2.4%-29.2%). There were no perioperative complications higher than Clavien-Dindo grade 3a. CONCLUSIONS:: In Western patients, free peritoneal tumor cells after gastrectomy with D2 lymphadenectomy for gastric cancer were detected only sporadically. Although based on few cases, the findings suggest that EIPL spreads tumor cells into the peritoneal cavity, thus being potentially harmful. Therefore, EIPL cannot be generally recommended.


Assuntos
Gastrectomia , Excisão de Linfonodo , Lavagem Peritoneal/métodos , Neoplasias Gástricas/terapia , Irrigação Terapêutica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
20.
J Vis Exp ; (138)2018 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-30124642

RESUMO

Activated neutrophils release neutrophil extracellular traps (NETs), which can capture and destroy microbes. Recent studies suggest that NETs are involved in various disease processes, such as autoimmune disease, thrombosis, and tumor metastases. Here, we show a detailed in vitro technique to detect NET activity during the trapping of free tumor cells, which grow after attachment to NETs. First, we collected low density neutrophils (LDN) from postoperative peritoneal lavage fluid from patients who underwent laparotomies. Short-term culturing of LDN resulted in massive NET formation that was visualized with green fluorescent nuclear and chromosome counterstain. After co-incubation of human gastric cancer cell lines MKN45, OCUM-1, and NUGC-4 with the NETs, many tumor cells were trapped by the NETs. Subsequently, the attachment was completely abrogated by the degradation of NETs with DNase I. Time-lapse video revealed that tumor cells trapped by the NETs did not die but instead grew vigorously in a continuous culture. These methods may be applied to the detection of adhesive interactions between NETs and various types of cells and materials.


Assuntos
Armadilhas Extracelulares/genética , Neoplasias/metabolismo , Neutrófilos/imunologia , Lavagem Peritoneal/métodos , Proliferação de Células , Humanos , Neoplasias/patologia
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