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1.
Biochim Biophys Acta Proteins Proteom ; 1870(7): 140796, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35661691

RESUMO

BACKGROUND: Peritoneal dialysis-associated peritonitis (PDAP) is the most common complication in peritoneal dialysis patients. We propose screening for characteristic expressed proteins in the dialysate of PDAP patients to provide clues for the diagnosis of PDAP and its therapeutic targets. METHODS: Dialysate samples were collected from patients with a first diagnosis of PDAP (n = 15) and from patients who had not experienced peritonitis (Control, n = 15). Data-independent acquisition (DIA) proteomic analysis was used to screen for differentially expressed proteins (DEPs). Co-expression networks were constructed via weighted gene co-expression network analysis (WGCNA) for detection of gene modules. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were used for functional annotation of DEPs and gene modules. Hub proteins were validated using the parallel reaction monitoring (PRM) method. RESULTS: A total of 142 DEPs in the dialysate of PDAP patients were identified. 70 proteins were upregulated and 72 proteins were downregulated. GO and KEGG analysis showed that DEPs were mainly enriched in cell metabolism, glycolysis/glycogenesis and hypoxia-inducible factor-1 signaling pathway. Subsequently, a co-expression network was constructed and four gene modules were detected. Myeloperoxidase (MPO) and myeloperoxidase (HP) were the key proteins of the blue and turquoise modules, respectively. Additionally, PRM analysis showed that the expression of MPO and HP was significantly upregulated in the PDAP group compared to the non-peritonitis group, which was consistent with our proteomics data. CONCLUSION: MPO and HP were differentially expressed in the dialysate of PDAP patients and may be potential diagnostic and therapeutic targets for PDAP.


Assuntos
Diálise Peritoneal , Peritonite , Soluções para Diálise , Humanos , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Peroxidase , Proteômica
3.
Int J Clin Pract ; 2022: 6524717, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685587

RESUMO

Objective: This study aimed to explore follow-up mode changes for peritoneal dialysis (PD) patients and their effects on PD quality during the COVID-19 pandemic. Methods: A retrospective single-center study was conducted. All patients who received PD treatment at the Second Affiliated Hospital of Soochow University between January 2018 and March 2020 were enrolled in this study. Patient data during the first quarter of 2018 (Q1-2018), the first quarter of 2019 (Q1-2019), and the first quarter of 2020 (Q1-2020) were collected. Results: No significant differences were observed for any serum examinations in different follow-up periods (P > 0.05). A significantly reduced outpatient follow-up rate was observed in Q1-2020 compared with Q1-2018 and Q1-2019 (71.6% Vs 78.9% Vs 84.7%, P < 0.001), accompanied by a significantly increased remote follow-up rate (28.4% Vs 21.1% Vs 15.3%, P < 0.001). Compared with Q1-2018 and Q1-2019, the hospitalization rate (27.7% Vs 30.9% Vs 15.7%, P < 0.001) and the incidence of peritonitis (0.162 Vs 0.186 Vs 0.08 per patient-year, P < 0.001) decreased significantly in Q1-2020. PD patients had a significant decline in the drop-out rate for Q1-2020 compared with Q1-2019 (4.4% Vs 7.3% Vs 2.2%, P < 0.001). No differences in the incidence of catheter-related infections were observed. No significant differences were observed for any peritoneal dialysis key performance indicators (KPIs) between outpatient follow-up and remote follow-up patients. Conclusion: During the COVID-19 pandemic (Q1-2020), our center practiced more remote follow-up procedures in PD patients. The hospitalization rate and peritonitis incidence were significantly decreased compared with the same time in previous years. No statistical differences were observed in other KPIs for peritoneal dialysis. This study shows that telehealth methods are a reasonable alternative to in-person care in the care/management of PD patients.


Assuntos
COVID-19 , Falência Renal Crônica , Diálise Peritoneal , Peritonite , Telemedicina , COVID-19/epidemiologia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Pandemias , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/métodos , Peritonite/epidemiologia , Peritonite/etiologia , Estudos Retrospectivos
4.
World J Surg Oncol ; 20(1): 188, 2022 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-35676687

RESUMO

INTRODUCTION: Peritonitis associated with fungal species Curvularia lunata seldom occurs with only five cases reported in the literature, all in middle-age patients with comorbidities undergoing dialysis. CASE REPORT: A 21-year-old female who was referred to surgical oncology OPD with a diagnosis of ovarian malignancy, based on raised cancer antigen 125 (CA 125) and suspected tubo-ovarian mass (TOM) on magnetic resonance imaging (MRI). A review of the MRI showed a pelvic collection with TOM, suggestive of infective pathology. Fungal culture and mass spectroscopy of the cystic collection identified the presence of Curvularia lunata. She was treated with oral itraconazole which showed symptomatic improvement and radiological response. In the follow-up period, the patient developed chest wall swelling, aspiration and geneXpert® revealed multidrug-resistant (MDR) tuberculosis, and treatment was started. CONCLUSIONS: Unusual causes of TOM and raised CA 125 should be kept in mind when dealing with young patients, as the possibility of epithelial ovarian cancer in this age is very low.


Assuntos
Neoplasias Ovarianas , Peritonite , Adulto , Antígeno Ca-125 , Curvularia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/complicações , Peritonite/microbiologia , Adulto Jovem
5.
J Assoc Physicians India ; 70(6): 11-12, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35702843

RESUMO

BACKGROUND: Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. This is a retrospective observational study that aims to determine bacterial etiology, susceptibility patterns of SAI, and its correlation with model for end-stage liver disease-sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) score. MATERIALS AND METHODS: The present study was conducted on 274 consecutive cases admitted in Bombay Hospital and Medical Research Centre, Mumbai, India. Cases of cirrhosis (irrespective of etiology) with ascites between the ages of 18-85 years were included in this study. Ascitic fluid of every patient was aspirated under all aseptic measures and was sent for biochemical, culture, and cytological analysis. RESULTS: Of the 274 patients studied, 34 (12.4%) patients were diagnosed to have SAI. Culture-negative neutrocytic ascites (CNNA) was present in 27 patients, spontaneous bacterial peritonitis (SBP) was present in six patients, and monomicrobial bacteriascites was seen in one patient. Mean age of patients enrolled was 56.05 ± 2.47 years. Eighty-two percent were males and 18% were females. Alcohol (45.45%) was the leading cause of cirrhosis followed by nonalcoholic steatohepatitis (NASH) related cirrhosis (26.47.7%) and hepatitis C virus (HCV) related cirrhosis (11.46%) and cryptogenic cirrhosis (8.82%). Average MELD-Na score was 25 and the CTP class C was most common. Klebsiella pneumoniae was the most commonly isolated organism followed by Escherichia coli. The various factors that predispose to development of SBP include low ascitic fluid protein concentration, a high level of serum bilirubin, deranged serum creatinine, high Child-Pugh score, and high MELD-Na score. CONCLUSION: Ascitic fluid analysis remains the single most important test for identifying and assessing a course of SBP. Early diagnosis and treatment will reduce the mortality rate in these patients.


Assuntos
Infecções Bacterianas , Doença Hepática Terminal , Peritonite , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/epidemiologia , Ascite/etiologia , Líquido Ascítico/microbiologia , Infecções Bacterianas/complicações , Infecções Bacterianas/epidemiologia , Citidina Trifosfato , Escherichia coli , Feminino , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Peritonite/epidemiologia , Peritonite/microbiologia , Índice de Gravidade de Doença , Adulto Jovem
6.
BMC Nephrol ; 23(1): 207, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690721

RESUMO

BACKGROUND: Technique failure is more likely to occur during the first 12 months after peritoneal dialysis (PD) initiation, which is a great challenge encountered in PD patients. The aim of this study was to investigate the incidence and risk factors associated with technique failure within the first year of PD patients in Southern China. METHODS: Incident PD patients who were followed up for at least one year at The First Affiliated Hospital of Sun Yat-sen University from January 1, 2006 to December 31, 2015 were included. Technique failure was defined as transferring to hemodialysis (HD) for more than 30 days or death within the first year after start of PD. A competitive risk regression analysis was used to explore the incidence and risk factors of the technique failure. RESULTS: Overall, 2,290 incident PD patients were included in this study, with a mean age of 48.2 ± 15.7 years, 40.9% female and 25.2% with diabetes. A total of 173 patients (7.5%) had technique failure during the first year of PD. Among them, the patient death account for 62.4% (n = 108) and transferring to HD account for 37.6% (n = 65). The main reasons for death were cardiovascular diseases (n = 32, 29.6%), infection (n = 15, 13.8%) and for conversion to HD were mechanical cause (n = 28, 43.1%), infection cause (n = 22, 33.8%). The risk factors for the technique failure included advanced age (HR 2.78, 95%CI 1.82-4.30), low body mass index (BMI < 18.5 kg/m2: HR 1.77, 95%CI 1.17-2.67), history of congestive heart failure (HR 2.81, 95%CI 1.58-4.98), or time on HD before PD ≤ 3 months (HR 1.49, 95%CI 1.05-2.10), peritonitis (HR 2.02, 95%CI 1.36-3.01);while higher serum albumin (HR 0.93, 95%CI 0.89-0.96) and using employee medical insurance to pay expenses (HR 0.47, 95%CI 0.32-0.69) were associated with reduced risk. CONCLUSIONS: Advanced age, poor nutritional status, history of HD or congestive heart failure, and peritonitis are related factors that increase the risk of technique failure in the first year of PD, while patients' type of medical insurance may also have an influence on early technique failure.


Assuntos
Insuficiência Cardíaca , Falência Renal Crônica , Diálise Peritoneal , Peritonite , Adulto , China/epidemiologia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Incidência , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
7.
Comput Intell Neurosci ; 2022: 8658999, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35669660

RESUMO

Objective: To explore the prenatal ultrasonographic characteristics and pregnancy outcomes of fetal meconium peritonitis (FMP). Methods: Nine patients diagnosed with FMP by routine prenatal examination between January 2015 and December 2020 were identified. Both prenatal ultrasonographic characteristics and pregnancy outcomes associated with these patients were retrospectively analyzed. Results: The mean gestational age at the time of FMP diagnosis was 31.3 ± 4.8 weeks, and the mean gestational age of delivery was 35.1 ± 5.1 weeks. Prenatal ultrasonographic findings at the time of diagnosis in these patients included intestinal dilatation (9/9, 100%), intraperitoneal calcification (8/9, 88.9%), fetal ascites (5/9, 55.6%), intraperitoneal pseudocyst (5/9, 55.6%), and polyhydramnios (6/9, 66.7%). Analyses of the etiological basis for meconium peritonitis in 5 of the 8 live births that underwent surgical treatment revealed 4 cases of congenital volvulus and 1 case of jejunal atresia. Conclusion: The prenatal ultrasound manifestations of fetal meconium peritonitis are diverse, and the different grades of prenatal ultrasound manifestations can provide important information for the treatment of perinatal infants.


Assuntos
Doenças Fetais , Mecônio , Peritonite , Feminino , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/cirurgia , Humanos , Lactente , Recém-Nascido , Mecônio/diagnóstico por imagem , Peritonite/diagnóstico por imagem , Peritonite/cirurgia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal
8.
Khirurgiia (Mosk) ; (6): 80-87, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35658140

RESUMO

THE PURPOSE OF THE WORK: Based on the determination of the mechanisms of negative manifestations of surgical aggression in open interventions, compared with laparoscopic, to determine ways to optimize the early postoperative period when using them. MATERIAL AND METHODS: The work is based on clinical and laboratory analysis of 147 patients with acute appendicitis complicated by acute peritonitis. In the first group (n=58), patients were operated with traditional laparotomy access. In the second group (n=47) - laparoscopic interventions were used. In the first and second groups, traditional therapy was carried out according to clinical recommendations. In the third group (n=42), patients were operated with traditional laparotomy access, and in the early postoperative period, their therapy included remaxol (intravenous injections of 800.0 ml of the drug in the first two days, then within three days - 400.0 ml). Laboratory and instrumental studies were carried out in patients, including the level of hydrophilic and hydrophobic toxins in the blood, the intensity of peroxidation of membrane lipids and antioxidant enzyme potential, the activity of phospholipase A2. The functional status of the intestine and liver was assessed. RESULTS: It was found that the most important manifestation of the reduction of surgical aggression in the early stages after surgery, which is characteristic of laparoscopic operations, are significantly low phenomena of endogenous intoxication against the background of a significant decrease in the activity of peroxidation of membrane lipids and phospholipase systems - triggers of catabolic phenomena and lesions of various organs and systems, including the intestine and liver. The inclusion of remaxol in complex therapy for patients who have undergone open surgical operations leads to a number of positive clinical and laboratory effects. The most important of them is the reduction of endogenous intoxication. This beneficial effect is associated with the restoration of the functional status of the intestine and liver, as well as a decrease in the severity of catabolic phenomena. The effectiveness of complex therapy with remaxol was marked by reducing the number of postoperative complications and the length of the patient's stay in the hospital. CONCLUSION: The use of remaxol in patients with acute peritonitis complicated by peritonitis who have undergone open surgical interventions, due to the relatively rapid restoration of the functional status of the intestine and liver, reduction of catabolic phenomena, reduces the severity of endogenous intoxication syndrome, which was the basis for a significant improvement in the course of the early postoperative period, bringing it closer to that when using laparoscopic technology.


Assuntos
Apendicite , Laparoscopia , Peritonite , Apendicite/cirurgia , Humanos , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Lipídeos de Membrana , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/cirurgia
9.
BMJ Case Rep ; 15(6)2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35667698

RESUMO

Melioidosis is an emerging infectious disease with highest predominance in Southeast Asia, but it has a significantly lower incidence across other parts of the globe. The most common systemic involvement seen in melioidosis is pulmonary, followed by multiple visceral and cutaneous abscesses. Infrequently, melioidosis manifests with atypical presentations such as spontaneous bacterial peritonitis (SBP), acute pyogenic meningitis or septic arthritis. Our primary case discusses an extremely rare presentation of melioidosis with SBP. There have not been any cases of SBP reported secondary to melioidosis infection. The second case exhibits development of acute pyogenic meningitis from haematogenous dissemination of this organism, while the final case demonstrates musculoskeletal melioidosis as an uncommon presentation. Of note, this case series also discusses the guidelines of management of melioidosis and illustrates the tremendous impact of appropriate and timely antibiotic therapy on mortality and morbidity secondary to melioidosis.


Assuntos
Artrite Infecciosa , Burkholderia pseudomallei , Melioidose , Meningite , Peritonite , Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Humanos , Melioidose/complicações , Melioidose/diagnóstico , Melioidose/tratamento farmacológico , Meningite/tratamento farmacológico , Peritonite/tratamento farmacológico
10.
Pan Afr Med J ; 41: 222, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35721632

RESUMO

Jejunal diverticulitis is an uncommon and underdiagnosed condition. Due to the rarity of This disease, diagnosis is often difficult and delayed. Medical treatment is usually sufficient for jejunal diverticulitis without peritonitis. Surgery is required in case of generalized peritonitis or voluminous abscess complicating diverticulitis. We report the case of a 76-year-old woman who suffered from recent abdominal pain. Diagnosis of uncomplicated jejunal diverticulitis was based on computed tomography (CT) scan. The evolution was favorable after antibiotic treatment. Jejunal diverticulitis have to be evoked among the differential diagnosis of patients with abdominal pain especially in the elderly and it is important for clinicians and radiologists to have awareness about this disease.


Assuntos
Diverticulite , Doenças do Jejuno , Peritonite , Dor Abdominal/complicações , Idoso , Diverticulite/complicações , Diverticulite/diagnóstico , Diverticulite/cirurgia , Feminino , Humanos , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/cirurgia , Jejuno , Peritonite/etiologia
11.
Pan Afr Med J ; 41: 228, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35721645

RESUMO

Introduction: mortality among surgical admissions is a global phenomenon, but the rates, pattern and factors that predict such deaths vary from region to region and even in one region, it varies among institutions. The aim was to document the pattern and factors that influence mortality in the general surgery unit of our institution. Methods: this was a seven-year retrospective, case-control study. All general surgery admissions managed at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria from January 2013 to December 2019 were included. Data were retrieved from case files of those managed during the period. Pattern and factors associated with increased mortality were analyzed and presented in tabular and descriptive forms. Results: of 4,898 general surgery admissions, 481 deaths were recorded, giving a crude mortality rate of 9.8%. Though highest number of deaths occurred in those in the 16-45 years age range, crude mortality rate was highest in elderly patients (>65 years). Generalized peritonitis was the most common cause of death, representing 38.9% of all deaths followed by cancers (22.9%), then abdominal injuries (16.8%). Of the 110 deaths from cancers, breast cancer (40, 36.4%) was the most important cause followed by colorectal cancers (29, 26.4%). Overall, 78.2% of the deaths occurred in emergency cases. In the logistic regression analysis, the following were significantly associated with mortality: advanced age, comorbidities, emergency presentation, high ASA scores (III-V) and delayed presentation. Conclusion: significant mortality occurs in our general surgery unit and is higher in older patients, and in those with generalized peritonitis, abdominal trauma and cancers.


Assuntos
Peritonite , Idoso , Estudos de Casos e Controles , Mortalidade Hospitalar , Humanos , Nigéria/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária
12.
Niger J Clin Pract ; 25(5): 690-694, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35593614

RESUMO

Background: Acute peritoneal dialysis (PD) is the modality of choice to manage children with acute kidney injury (AKI). However, its use remains underutilized, despite the unquestionable advantages. Aims: This study, therefore, aimed to audit the complications, outcomes, and challenges encountered with PD as well as indications for PD and causes of AKI among under-5 children that had PD in a Nigerian tertiary hospital over a decade. . Patients and Methods: : A retrospective study of children with AKI, aged 0 to 5 years, managed with PD. In all the children, a PD catheter was inserted at the bedside by surgeons. PD was performed manually. Data were presented in descriptive statistics and a P value <0.05 was considered significant. Results: Twenty-nine (29) children had PD over a decade (January 2009 to December 2018). There were 12 males and 17 females aged 4-60 months (mean ± SD 18.8 ± 16.9). The PD yearly frequency was 2-7 times/year, mean of 2.9/year. The major identified indication for PD was difficulty of vascular access (86.2%) while the causes of AKI were sepsis 21 (43.8%); gastroenteritis 11 (22.9%); severe malaria 9 (18.8%); toxins/herbal medications 5 (10.4%); multiple congenital anomalies 2 (4.2%). Multiple causes of AKI occurred in some children. The major observed PD complications were catheter lockage 9 (37.5%); dialysate fluid retention 4 (16.7%); and peritonitis 4 (16.7%). The short-term outcome of the 29 children that had PD showed 20 (69%) discharged and 9 (31%) deaths over the period. The major challenge encountered was PD-related sepsis evidenced by the prevalence of peritonitis and catheter site infection. Conclusion: The predominant PD complications were catheter-related, mostly catheter blockage in a manually performed PD while the leading cause of AKI in our center was sepsis, affecting a large population of children requiring PD.


Assuntos
Injúria Renal Aguda , Diálise Peritoneal , Peritonite , Sepse , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Criança , Feminino , Humanos , Masculino , Diálise Peritoneal/efeitos adversos , Estudos Retrospectivos , Sepse/complicações
13.
Nan Fang Yi Ke Da Xue Xue Bao ; 42(4): 546-553, 2022 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-35527490

RESUMO

OBJECTIVE: To develop and validate a risk prediction model of treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP). METHODS: We retrospectively analyzed the data of patients undergoing peritoneal dialysis (PD) in 3 dialysis centers in Jilin Province who developed PDAP between January 1, 2013 and December 31, 2019. The data collected from the Second Hospital of Jilin University and Second Division of First Hospital of Jilin University) were used as the training dataset and those from Jilin Central Hospital as the validation dataset. We developed a nomogram for predicting treatment failure using a logistic regression model with backward elimination. The performance of the nomogram was assessed by analyzing the C-statistic and the calibration plots. We also plotted decision curves to evaluate the clinical efficacy of the nomogram. RESULTS: A total of 977 episodes of PDAP were included in the analysis (625 episodes in the training dataset and 352 episodes in the validation dataset). During follow-up, 78 treatment failures occurred in the training dataset and 35 in the validation dataset. A multivariable logistic regression prediction model was established, and the predictors in the final nomogram model included serum albumin, peritoneal dialysate white cell count on day 5, PD duration, and type of causative organisms. The nomogram showed a good performance in predicting treatment failure, with a C-statistic of 0.827 (95% CI: 0.784-0.871) in the training dataset and of 0.825 (95% CI: 0.743-0.908) in the validation dataset. The nomogram also performed well in calibration in both the training and validation datasets. CONCLUSION: The established nomogram has a good accuracy in estimating the risk of treatment failure in PDAP patients.


Assuntos
Diálise Peritoneal , Peritonite , Humanos , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Peritonite/terapia , Estudos Retrospectivos , Falha de Tratamento , Resultado do Tratamento
14.
Artigo em Inglês | MEDLINE | ID: mdl-35523167

RESUMO

Sclerosing encapsulating peritonitis is a rare and not well-recognized disease in veterinary medicine. A 14-month-old female intact mixed-breed dog was diagnosed with sclerosing encapsulating peritonitis (SEP) at the age of 5 months after a routine work-up including biopsies from an exploratory laparotomy. Symptomatic treatment with an immunosuppressive dose of prednisolone was started, but dose reduction was unsuccessful. Combined treatment with tamoxifen, a selective estrogen receptor modulator used for its TGF-ß1 suppression of fibroblasts was discussed; the owner was informed about the risk for developing a pyometra. About one year later the owner wanted to spay her dog and an ovariectomy was recommended, especially due to the extensive adhesions. A laparoscopic approach was chosen to reduce the amount of intraoperative tissue manipulation and inflammation, as well as to minimize the size of the incision. The dog continues to be doing well one year after surgery and prednisolone could be reduced to a low maintenance dose after surgery; so far, the addition of tamoxifen was not required. In selected cases, laparoscopy appears as a safe alternative in patients with adhesions, but the surgeon should always be prepared to convert in case of impaired vision, especially in the absence of tactile sensation. This case report is the first description of laparoscopy in a dog with SEP. Laparoscopy may serve as an easily accomplished minimally invasive method to diagnose SEP, but further studies are required.


Assuntos
Doenças do Cão , Laparoscopia , Peritonite , Animais , Doenças do Cão/cirurgia , Cães , Feminino , Laparoscopia/efeitos adversos , Laparoscopia/veterinária , Ovariectomia/efeitos adversos , Ovariectomia/veterinária , Peritonite/tratamento farmacológico , Peritonite/cirurgia , Peritonite/veterinária , Prednisolona/uso terapêutico
15.
BMC Nephrol ; 23(1): 173, 2022 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-35513793

RESUMO

BACKGROUND: This study aims to evaluate the impact of multidisciplinary pre-dialysis care (MDPC) on the risks of peritonitis, technique failure and mortality in peritoneal dialysis (PD) patients. METHODS: Incident end-stage kidney disease patients who received peritoneal dialysis (PD) for more than 90 days were recruited in this study from 1 January 1, 2007 to December 31, 2018. Patients were classified into two groups, the MDPC group and the control group, that received the usual care by nephrologists. Risks of the first episode of peritonitis, technique failure and mortality were compared between the two groups. RESULTS: There were 126 patients under the usual care and 546 patients under the MDPC. Patients in the MDPC group initiated dialysis earlier than those in the non-MDPC group. There was no significant difference between these two groups in time to the first episode of peritonitis. Compared to the non-MDPC group, the MDPC group was at similar risks of technique failure (adjusted HR = 0.85, 95% CI = 0.64-1.15) and mortality (adjusted HR = 0.66, 95% CI = 0.42-1.02). Among patients with diabetes, the risk of mortality was significantly reduced in the MDPC group with an adjusted HR of 0.45 (95% CI = 0.25-0.80). CONCLUSIONS: There was no significant difference in time to develop the first episode of peritonitis, and risks of technique failure and mortality between these two groups. Diabetic PD patients under MDPC had a lower risk of mortality than those under the usual care.


Assuntos
Diabetes Mellitus , Falência Renal Crônica , Diálise Peritoneal , Peritonite , Diabetes Mellitus/etiologia , Diálise , Feminino , Humanos , Masculino , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Peritonite/etiologia , Diálise Renal , Estudos Retrospectivos , Fatores de Risco
16.
World J Emerg Surg ; 17(1): 25, 2022 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-35619144

RESUMO

BACKGROUND: Secondary peritonitis is a severe condition with a 20-32% reported mortality. The accepted treatment modalities are vacuum-assisted closure (VAC) or primary closure with relaparotomy on-demand (ROD). However, no randomised controlled trial has been completed to compare the two methods potential benefits and disadvantages. METHODS: This study will be a randomised controlled multicentre trial, including patients aged 18 years or older with purulent or faecal peritonitis confined to at least two of the four abdominal quadrants originating from the small intestine, colon, or rectum. Randomisation will be web-based to either primary closure with ROD or VAC in blocks of 2, 4, and 6. The primary endpoint is peritonitis-related complications within 30 or 90 days and one year after index operation. Secondary outcomes are comprehensive complication index (CCI) and mortality after 30 or 90 days and one year; quality of life assessment by (SF-36) after three and 12 months, the development of incisional hernia after 12 months assessed by clinical examination and CT-scanning and healthcare resource utilisation. With an estimated superiority of 15% in the primary outcome for VAC, 340 patients must be included. Hospitals in Denmark and Europe will be invited to participate. DISCUSSION: There is no robust evidence for choosing either open abdomen with VAC treatment or primary closure with relaparotomy on-demand in patients with secondary peritonitis. The present study has the potential to answer this important clinical question. TRIAL REGISTRATION: The study protocol has been registered at clinicaltrials.gov (NCT03932461). Protocol version 1.0, 9 January 2022.


Assuntos
Laparotomia , Tratamento de Ferimentos com Pressão Negativa , Peritonite , Reoperação , Cavidade Abdominal/cirurgia , Humanos , Laparotomia/efeitos adversos , Estudos Multicêntricos como Assunto , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Peritonite/cirurgia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/efeitos adversos
17.
Exp Clin Transplant ; 20(Suppl 3): 112-114, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35570613

RESUMO

Encapsulated peritoneal sclerosis is a rare complication of long-term peritoneal dialysis that has a high rate of morbidity and mortality. We present an 18-year-old female patient who was first diagnosed with renal failure at 8 years of age and who had 7 years of peritoneal dialysis and then hemodialysis before kidney transplant from a deceased donor. Before transplant, the patient developed encapsulated peritoneal sclerosis and was treated with tamoxifen and steroids. Three years after transplant, the patient presented with complaints of vomiting, abdominal pain, and abdominal distension and was again diagnosed with encapsulated peritoneal sclerosis. The patient required excretory paracentesis, pulse steroid treatment for 3 days, and treatment with methylprednisone and tamoxifen, which resulted in regression of signs and symptoms. Factors such as long-term peritoneal dialysis, a history of bacterial peritonitis, and use of high-concentration dialysate may cause encapsulated peritoneal sclerosis, but symptoms can recur after transplant, as shown in our patient. Thus, it is important to recognize that encapsulated peritoneal sclerosis may cause graft loss due to the various complications that it can cause.


Assuntos
Transplante de Rim , Diálise Peritoneal , Fibrose Peritoneal , Peritonite , Adolescente , Feminino , Humanos , Transplante de Rim/efeitos adversos , Diálise Peritoneal/efeitos adversos , Fibrose Peritoneal/diagnóstico por imagem , Fibrose Peritoneal/etiologia , Esclerose/complicações , Tamoxifeno , Resultado do Tratamento
18.
BMC Surg ; 22(1): 191, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35578267

RESUMO

BACKGROUND: Traditionally, patients with peritonitis Hinchey III and IV due to perforated diverticulitis were treated with Hartmann's procedure. In the past decade, resection and primary anastomosis have gained popularity over Hartmann's procedure and recent guidelines recommend Hartmann's procedure in two situations only: critically ill patients and in selected patients with multiple comorbidity (at high risk of complications). The protective stoma (PS) is recommended after resection with primary anastomosis, however its interest has never been studied. The aim of this trial is to define the role of systematic PS after resection and primary anastomosis for peritonitis Hinchey III and IV due to perforated diverticulitis. METHODS/DESIGN: This DIVERTI 2 trial is a multicenter, randomized, controlled, superiority trial comparing resection and primary anastomosis with (control group) or without (experimental group) PS in patients with peritonitis Hinchey III and IV due to perforated diverticulitis. Primary endpoint is the overall 1 year morbidity according to the Clavien-Dindo classification of surgical complications. All complications occurring during hospitalization will be collected. Late complications occurring after hospitalization will be collected during follow-up. In order to obtain 80% power for a difference given by respective main probabilities of 67% and 47% in the protective stoma and no protective stoma groups respectively, with a two-sided type I error of 5%, 96 patients will have to be included in each group, hence 192 patients overall. Expecting a 5% rate of patients not assessable for the primary end point (lost to follow-up), 204 patients will be enrolled. Secondary endpoints are postoperative mortality, unplanned reinterventions, incisional surgical site infection (SSI), organ/space SSI, wound disruption, anastomotic leak, operating time, length of hospital stay, stoma at 1 year after initial surgery, quality of life, costs and quality-adjusted life years (QALYs). DISCUSSION: The DIVERTI 2 trial is a prospective, multicenter, randomized, study to define the best strategy between PS and no PS in resection and primary anastomosis for patients presenting with peritonitis due to perforated diverticulitis. TRIAL REGISTRATION: ClinicalTrial.gov: NCT04604730 date of registration October 27, 2020. https://clinicaltrials.gov/ct2/show/NCT04604730?recrs=a&cond=Diverticulitis&draw=2&rank=12 .


Assuntos
Doença Diverticular do Colo , Diverticulite , Perfuração Intestinal , Peritonite , Anastomose Cirúrgica/efeitos adversos , Colostomia/efeitos adversos , Diverticulite/complicações , Diverticulite/cirurgia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/cirurgia , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/cirurgia , Peritonite/complicações , Peritonite/cirurgia , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
19.
Lakartidningen ; 1192022 05 20.
Artigo em Sueco | MEDLINE | ID: mdl-35603538

RESUMO

Peritonitis is a serious complication associated with high morbidity and mortality in patients with peritoneal dialysis (PD). We present a case of PD-associated peritonitis caused by the unusual pathogen Rhizobium. After therapy failure and bacterial growth despite treatment with vancomycin and tobramycin, the treatment was changed to meropenem intravenously and ciprofloxacin intraperitoneally according to antimicrobial susceptibility testing. The patient subsequently recovered without having the PD-catheter removed. To conclude, patients with PD are one of many patient groups at a greater risk of infections with unusual microbial agents, and pathogens that normally do not cause disease should be considered as potential causes of pathology when antibiotic treatment failure occurs.


Assuntos
Diálise Peritoneal , Peritonite , Rhizobium , Antibacterianos/uso terapêutico , Humanos , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Peritonite/microbiologia
20.
Eur J Anaesthesiol ; 39(6): 540-548, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35608877

RESUMO

BACKGROUND: Optimal management of community-acquired intra-abdominal infections (IAI) requires timely surgical source control and adequate anti-infective treatment. OBJECTIVE: To describe the initial management of community-acquired IAI admitted to the emergency department and assess the association between the length of time to either diagnosis or therapeutic procedures and patient outcomes. DESIGN: A prospective, multicentre, observational study. SETTING: Thirteen teaching hospitals in France between April 2018 and February 2019. PATIENTS: Two hundred and five patients aged at least 18 years diagnosed with community-acquired IAI. MAIN OUTCOME MEASURES: The primary outcome was hospital length of stay. The secondary outcome was hospital mortality. RESULTS: Patients had a mean age of 56 (± 21) years and a median [interquartile] SAPS II of 26 [17 to 34]. Among the study cohort, 18% were postoperatively transferred to intensive care unit and 7% had died by day 28. Median [IQR] time to imaging, antibiotic therapy and surgery were 4 [2 to 6], 7.5 [4 to 12.5] and 9 [5.5 to 17] hours, respectively. The length of time to surgical source control [0.99, 95% confidence interval (CI), 0.98 to 0.99], SOFA greater than 2 [0.36 (95% CI, 0.26 to 0.651)], age greater than 60 years [0.65 (95% CI, 0.45 to 0.94)], generalized peritonitis [0.7 (95% CI, 0.56 to 0.89)] and laparotomy surgery [0.657 (95% CI, 0.42 to 0.78)] were associated with longer hospital length of stay. The duration of time to surgical source control [1.02 (95% CI, 1.01 to 1.04)], generalized peritonitis [2.41 (95% CI, 1.27 to 4.61)], and SOFA score greater than 2 [6.14 (95% CI, 1.40 to 26.88)] were identified as independent risk factors for 28-day mortality. CONCLUSION: This multicentre observational study revealed that the time to surgical source control, patient severity and generalized peritonitis were identified as independent risk factors for increased hospital LOS and mortality in community-acquired IAI. Organisational strategies to reduce the time to surgical management of intra-abdominal infections should be further evaluated. STUDY REGISTRATION: ClinicalTrials.gov on 1 April 2018, NCT03544203.


Assuntos
Infecções Intra-Abdominais , Peritonite , Adolescente , Adulto , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Infecções Intra-Abdominais/diagnóstico , Infecções Intra-Abdominais/tratamento farmacológico , Tempo de Internação , Pessoa de Meia-Idade , Peritonite/diagnóstico , Peritonite/cirurgia , Estudos Prospectivos
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