Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.953
Filtrar
1.
Ann Ital Chir ; 91: 235-238, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877383

RESUMO

The present pandemic caused by the SARS COV-2 coronavirus is still ongoing, although it is registered a slowdown in the spread for new cases. The main environmental route of transmission of SARS-CoV-2 is through droplets and fomites or surfaces, but there is a potential risk of virus spread also in smaller aerosols during various medical procedures causing airborne transmission. To date, no information is available on the risk of contagion from the peritoneal fluid with which surgeons can come into contact during the abdominal surgery on COVID-19 patients. We have investigated the presence of SARS-CoV-2 RNA in the peritoneal cavity of patients affected by COVID-19, intraoperatively and postoperatively. KEY WORDS: Covid-19, Laparotomy, Surgery.


Assuntos
Líquido Ascítico/virologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Perfuração Intestinal/cirurgia , Laparotomia , Pandemias , Pneumonia Viral/transmissão , Doenças do Colo Sigmoide/cirurgia , Viremia/transmissão , Aerossóis , Idoso de 80 Anos ou mais , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Divertículo/complicações , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/sangue , Perfuração Intestinal/complicações , Perfuração Intestinal/virologia , Período Intraoperatório , Nasofaringe/virologia , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , RNA Viral/isolamento & purificação , Risco , Soro/virologia , Doenças do Colo Sigmoide/sangue , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/virologia , Viremia/virologia
4.
Int J Colorectal Dis ; 35(9): 1797-1800, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32458395

RESUMO

INTRODUCTION: Since the outbreak of novel coronavirus (2019-nCoV), it became evident that a proportion of patients may present with gastrointestinal symptoms. CASE: We report the case of a Covid-19-infected patient who, during recovery from the pulmonary pneumonia, had gastrointestinal symptoms followed by a diastasic right colon perforation due to acute over distension of the bowel. CONCLUSION: This case highlights the importance of paying attention to initial gastrointestinal symptoms in order to prevent possible complications.


Assuntos
Colectomia/métodos , Infecções por Coronavirus/complicações , Perfuração Intestinal/complicações , Perfuração Intestinal/diagnóstico por imagem , Pneumonia Viral/complicações , Síndrome Respiratória Aguda Grave/complicações , Anastomose Cirúrgica/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Emergências , Seguimentos , Humanos , Perfuração Intestinal/cirurgia , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Cuidados Pós-Operatórios/métodos , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
5.
J Surg Res ; 252: 231-239, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32299011

RESUMO

BACKGROUND: Standard treatment for diffuse peritonitis due to colorectal perforation may be insufficient to suppress inflammatory reaction in sepsis. Thus, developing new treatments is important. This study aimed to examine whether intraperitoneal irradiation by artificial sunlight suppresses inflammatory reaction in a lipopolysaccharide (LPS)-induced peritonitis model after surgical treatments. MATERIALS AND METHODS: Mice were divided into naive, nontreatment (NT), and phototherapy (PT) groups. In the latter two groups, LPS was intraperitoneally administered to induce peritonitis and removed by intraperitoneal lavage after laparotomy. The PT group was irradiated with artificial sunlight intraperitoneally. We evaluated the local and systemic inflammatory reactions. Murine macrophages were irradiated with artificial sunlight after stimulation by LPS, and cell viability and expression of tumor necrotizing factor-α (TNF-α) were evaluated. RESULTS: As a local inflammatory reaction, the whole cell count, the expression of interleukin-6 and TNF-α in the intra-abdominal fluid, and the peritoneal thickness were significantly lower in the PT group than in the NT group. As a systematic inflammatory reaction, the expression of serum TNF-α, granulocyte macrophage colony-stimulating factor, monocyte chemotactic protein-1, macrophage inflammatory protein (MIP)-1α, and MIP-1ß were significantly lower in the PT group than in the NT group. Irradiation by artificial sunlight suppressed the expression of TNF-α in murine macrophages without affecting cell viability. CONCLUSIONS: Intraperitoneal irradiation by artificial sunlight could suppress local and systemic inflammatory reactions in the LPS-induced peritonitis murine model. These effects may be associated with macrophage immune responses.


Assuntos
Perfuração Intestinal/complicações , Peritônio/efeitos da radiação , Peritonite/terapia , Fototerapia/métodos , Luz Solar , Animais , Modelos Animais de Doenças , Humanos , Mediadores da Inflamação/metabolismo , Perfuração Intestinal/imunologia , Lipopolissacarídeos/administração & dosagem , Lipopolissacarídeos/imunologia , Macrófagos Peritoneais/imunologia , Macrófagos Peritoneais/metabolismo , Macrófagos Peritoneais/efeitos da radiação , Masculino , Camundongos , Peritônio/imunologia , Peritonite/imunologia , Células RAW 264.7
10.
Ann Surg ; 271(5): 827-833, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31567357

RESUMO

OBJECTIVES: A randomized controlled trial was conducted to test the hypothesis that povidone-iodine (PVI) irrigation versus no irrigation (NI) reduces postoperative intra-abdominal abscess (IAA) in children with perforated appendicitis. METHODS: A 100 patient pilot randomized controlled trial was conducted. Consecutive patients with acute perforated appendicitis were randomized (1:1) to PVI or NI from April 2016 to March 2017 and followed for 1 year. Patients and postoperative providers were blinded to allocation. The primary endpoint was 30-day image-confirmed IAA. Secondary outcomes included initial and total 30-day length of stay (LOS), emergency department (ED) visits, and readmissions. Intention-to-treat analyses were performed to estimate the probability of clinical benefit using Bayesian regression models (an optimistic prior for the primary outcome and neutral priors for secondary outcomes). Frequentist statistics were also used. RESULTS: Baseline characteristics were similar between treatment arms. The PVI arm had 12% postoperative IAA versus 16% in the NI arm (relative risk 0.72, 95% credible interval 0.38-1.23). Bayesian analysis estimates 89% probability that PVI reduces IAA. High probability of benefit was seen in all secondary outcomes for the PVI arm: fewer ED visits and readmissions, and shorter initial and total 30-day LOS. The probability of benefit in reduction of total 30-day LOS in PVI patients was 96% and was significant (P = 0.05) on frequentist analysis. CONCLUSIONS: PVI irrigation for perforated appendicitis in children demonstrated a strong probability of reduction in postoperative IAA with a high probability of decreased LOS. With the favorable probability of benefit in all outcomes, this pilot study serves as evidence to continue a definitive trial.


Assuntos
Abscesso Abdominal/prevenção & controle , Anti-Infecciosos Locais/uso terapêutico , Apendicite/cirurgia , Perfuração Intestinal/cirurgia , Lavagem Peritoneal , Complicações Pós-Operatórias/prevenção & controle , Povidona-Iodo/uso terapêutico , Adolescente , Apendicite/complicações , Teorema de Bayes , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Análise de Intenção de Tratamento , Perfuração Intestinal/complicações , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Projetos Piloto , Texas
11.
J Dig Dis ; 21(2): 63-68, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31875348

RESUMO

OBJECTIVE: Acute perforated diverticulitis is frequently observed and spans a spectrum in the severity of its presentation. Emergency surgery is required in patients with generalized peritonitis; however, a large proportion of patients are clinically stable with localized peritonitis. This article aimed to examine this specific group of patients by reviewing the outcomes of their conservative management. METHODS: A systematic literature search was performed on the MEDLINE and PubMed databases. The management outcomes of patients undergoing non-operative treatment for acute perforated diverticulitis were synthesized and tabulated. RESULTS: Of 479 patients, 407 (85%) were successfully managed non-operatively. In total 70 (14.6%) patients failed non-operative treatment and underwent operative surgical management, and two (0.4%) died. Emergency surgery includes a Hartmann's operation (40%) and resection with anastomosis with or without stoma (24%), laparoscopic lavage (16%) and surgical drainage (20%). The success rate of conservative management was 94.0% and 71.4% for patients with pericolic and distant free air, respectively. Treatment failure was associated with a high volume of free air, distant free air and the presence of abscess. CONCLUSIONS: Conservative management is safe and successful in patients with acute perforated diverticulitis without generalized peritonitis. The early recognition of patients who show clinical signs of persistent perforation is important to ensure the success of this strategy.


Assuntos
Tratamento Conservador/métodos , Diverticulite/terapia , Perfuração Intestinal/terapia , Doença Aguda , Adulto , Idoso , Diverticulite/complicações , Feminino , Humanos , Perfuração Intestinal/complicações , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/terapia , Resultado do Tratamento
12.
Ann Ital Chir ; 90: 427-431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31814597

RESUMO

AIM: Acute appendicitis is one of the most common pathology requiring emergency operations, and if perforated, can cause morbidity and mortality. The serum bilirubin levels were studied to see whether an elevation predicted perforation. MATERIAL AND METHODS: In a retrospective cohort study the medical files of 221 patients who were operated for acute appendicitis were reviewed. RESULTS: Total and indirect bilirubin levels were significantly higher in patients with a perforated appendicitis compared with patients with simple appendicitis. Elevated serum bilirubin had a sensitivity of 50.00 (95% CI 29.93 to 70.07) and a specificity of 80.73 (95% CI 74.43 to 86.05) when predicting a perforated appendicitis. CONCLUSIONS: Appendiceal perforation may be accompanied with elevated serum bilirubin level. Assessment of bilirubin levels must be a part of the initial evaluation of a suspected appendicitis in the emergency room. KEY WORDS: Acute appendicitis, Gangrenous appendicitis, Perforated appendicitis, Serum bilirubin, Total Hyperbilirubinemia.


Assuntos
Apendicite/sangue , Bilirrubina/sangue , Hiperbilirrubinemia/etiologia , Perfuração Intestinal/sangue , Adolescente , Adulto , Idoso , Alanina Transaminase/sangue , Apendicectomia , Apendicite/complicações , Apendicite/cirurgia , Aspartato Aminotransferases/sangue , Biomarcadores , Emergências , Endotoxemia/sangue , Endotoxemia/etiologia , Feminino , Gangrena/etiologia , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
13.
BMC Pediatr ; 19(1): 473, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31795969

RESUMO

BACKGROUND: In the last century, meconium peritonitis(MP)was once a highly fatal gastrointestinal. disease With the development of fetal radiological technology, abnormal signs, such as pseudocysts, can. be detected during the fetal period so that more patients can be diagnosed prenatally and receive surgery. in the early stage of life. The survival rate of MP has increased up to 80% in recent years. According to. a review of the treatment and outcomes of patients diagnosed with MP, we evaluated the influence of. early operation on survival rate and discussed the risk factors of prognosis. METHODS: We collected 79 cases of patients diagnosed with MP who were treated in our department. from October 2001 to December 2017. They were divided into 2 groups. Patients in group A were born. in our hospital. Patients in group B were born in a local hospital with suspicion of MP and then transferred. to our department. RESULTS: The birth weight (BW) and gestational age (GA) of patients were higher in group A than in. group B. There was no significant difference in the proportion of premature and low birth weight (LBW). patients between the two groups (p = 0.422, p = 0.970). Their age at the time of surgery was younger in. group A than in group B (1.4 ± 2.0 vs. 6.9 ± 14.9, p < 0.001). The overall survival rate of group A was higher. than that of group B (95.0% vs. 79.5%, p = 0.038). The prognosis of premature patients was worse than. that of full-term infants for both groups (p = 0.012). CONCLUSIONS: Prematurity is a significant risk factor related to death for MP patients. The survival rate. of MP patients can be improved by early operation during the neonatal period.


Assuntos
Doenças do Prematuro/cirurgia , Perfuração Intestinal/cirurgia , Mecônio , Peritonite/cirurgia , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Perfuração Intestinal/complicações , Imagem por Ressonância Magnética , Masculino , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/mortalidade , Diagnóstico Pré-Natal , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Tempo para o Tratamento , Ultrassonografia Pré-Natal
15.
BMJ Case Rep ; 12(11)2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31780621

RESUMO

Enteric duplication cysts are a rare cause of intestinal obstruction in the neonatal period. We present the unusual case of an in utero ileal volvulus secondary to an enteric duplication cyst causing an acute abdomen in a 35-week estimated gestational age newborn female delivered to a mother in preterm labour.


Assuntos
Abdome Agudo/etiologia , Cistos/congênito , Cistos/complicações , Doenças do Íleo/congênito , Doenças do Íleo/complicações , Perfuração Intestinal/congênito , Perfuração Intestinal/complicações , Volvo Intestinal/congênito , Volvo Intestinal/complicações , Trabalho de Parto Prematuro , Feminino , Humanos , Recém-Nascido , Gravidez
19.
Rev Esp Enferm Dig ; 111(11): 891-892, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31657602

RESUMO

We present the case of a male with generalized abdominal pain of sudden onset in the right hemiabdomen, associated with defense and leukocytosis. The study of contrast CT identified a foreign body with a linear and sharp morphology that crossed the wall of a small bowel loop (Fig. 1). The patient underwent a segmental resection of the ileum, which showed a Meckel's diverticulum perforated by a chicken bone.


Assuntos
Dor Abdominal/etiologia , Corpos Estranhos/complicações , Perfuração Intestinal/etiologia , Divertículo Ileal/complicações , Humanos , Perfuração Intestinal/complicações , Masculino
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA