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1.
Pan Afr Med J ; 38: 136, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33912306

RESUMO

Sclerosing encapsulating peritonitis is a very rare pathological entity. It is a chronic fibroinflammatory disease affecting the peritoneum and leading to the formation of diffuse egg-shell-shaped fibrous capsule which totally or locally encapsulate the abdominal viscera, in particular the digestive tract. Clinical signs are little specific and misleading. Medical imaging, including computed tomography, can help clinicians to make a diagnosis, by highlighting a thin peritoneal membrane encompassing an agglutination of digestive loops. Secondary types (postperitoneal dialysis, tuberculosis, medications, postintraperitoneal chemotherapy) are quite common, however idiopathic sclerosing encapsulating peritonitis is very rare and few cases have been reported in the literature. We here report the case of a 53-year-old woman with idiopathic sclerosing encapsulating peritonitis.


Assuntos
Fibrose Peritoneal/diagnóstico por imagem , Peritônio/diagnóstico por imagem , Peritonite/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Fibrose Peritoneal/fisiopatologia , Peritônio/fisiopatologia , Peritonite/fisiopatologia , Tomografia Computadorizada por Raios X
2.
Ann R Coll Surg Engl ; 103(5): e151-e155, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33930284

RESUMO

The diagnosis of visceral perforation during pregnancy is often delayed and the management complex. A 32-year-old primigravid woman in her second trimester presented with abdominal pain and a pre-existing ileoanal pouch. Initial imaging was negative but later imaging was suggestive of serious pathology. At laparotomy, a caesarean section was performed. Peritonitis was encountered secondary to two discrete perforations in the small bowel separate from her pouch. Histology found an ischaemic perforation secondary to a pressure effect from the gravid uterus. In pregnancy, ileoanal pouches may make the interconnected bowel vulnerable to the pressure effect of the gravid uterus and perforation. Pregnant women with such a surgical history who develop symptoms suggestive of bowel perforation should have rapid imaging and their clinical team should consider early definitive surgical intervention.


Assuntos
Bolsas Cólicas , Doenças Inflamatórias Intestinais/complicações , Perfuração Intestinal , Isquemia , Complicações na Gravidez , Dor Abdominal , Adulto , Cesárea , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Intestino Delgado/cirurgia , Isquemia/diagnóstico , Isquemia/cirurgia , Laparotomia , Peritonite/diagnóstico , Peritonite/cirurgia , Gravidez
3.
J Am Vet Med Assoc ; 258(9): 991-998, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33856865

RESUMO

OBJECTIVE: To compare the rate of postoperative dehiscence on the basis of intraoperative anastomotic leak test results (ie, positive or negative for leakage or testing not performed) between dogs that underwent hand-sewn anastomosis (HSA) or functional end-to-end stapled anastomosis (FEESA) of the small intestine. ANIMALS: 131 client-owned dogs that underwent 144 small intestinal anastomoses (94 FEESA and 50 HSA). PROCEDURES: Medical records were searched to identify dogs that had undergone a small intestinal anastomosis (HSA or FEESA) from January 2008 through October 2019. Data were collected regarding signalment, indication for surgery, location of the anastomosis, surgical technique, the presence of preoperative septic peritonitis, performance of intraoperative leak testing, development of postoperative dehiscence, and duration of follow-up. RESULTS: Intraoperative leak testing was performed during 62 of 144 (43.1%) small intestinal anastomoses, which included 26 of 94 (27.7%) FEESAs and 36 of 50 (72.0%) HSAs. Thirteen of 144 (9.0%) anastomoses underwent dehiscence after surgery (median, 4 days; range, 2 to 17 days), with subsequent septic peritonitis, including 10 of 94 (10.6%) FEESAs and 3 of 50 (6.0%) HSAs. The incidence of postoperative dehiscence was not significantly different between FEESAs and HSAs; between anastomoses that underwent intraoperative leak testing and those that did not, regardless of anastomotic technique; or between anastomoses with positive and negative leak test results. Hand-sewn anastomoses were significantly more likely to undergo leak testing than FEESAs. Preoperative septic peritonitis, use of omental or serosal reinforcement, preoperative serum albumin concentration, and surgical indication were not significantly different between anastomotic techniques. CONCLUSIONS AND CLINICAL RELEVANCE: Performance of intraoperative anastomotic leak testing, regardless of the anastomotic technique, was not associated with a reduction in the incidence of postoperative anastomotic dehiscence.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Doenças do Cão , Peritonite , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/veterinária , Animais , Procedimentos Cirúrgicos do Sistema Digestório/veterinária , Doenças do Cão/cirurgia , Cães , Intestino Delgado/cirurgia , Peritonite/veterinária , Técnicas de Sutura/veterinária
4.
Pan Afr Med J ; 38: 48, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33854677

RESUMO

The stercoral perforation is a mortal condition. It affects elderly patients who have a long history of chronic and severe constipation as well as constitutes a surgical emergency whose prognosis, often grim, depends on the early diagnosis and treatment. We report the case of a stercoral colon perforation which occurred in an 89-year-old patient. The clinical symptomatology was that of an acute peritonitis evolving for four days. The diagnosis was only made intraoperatively and the surgical gesture was a resection of the involved left colon segment and Bouilly Volkmann colostomy. The consequences were unfortunately marked by a resistant septic shock resulting in the death of the patient on the 1st postoperative day. The diagnosis of stercoral colon perforation, which is often difficult and delayed, must be known by all physicians who manage an increasingly older patient population.


Assuntos
Colo/lesões , Constipação Intestinal/complicações , Perfuração Intestinal/etiologia , Choque Séptico/etiologia , Idoso de 80 Anos ou mais , Doença Crônica , Colo/cirurgia , Colostomia , Evolução Fatal , Humanos , Perfuração Intestinal/cirurgia , Masculino , Peritonite/etiologia
5.
Wiad Lek ; 74(3 cz 1): 508-511, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813459

RESUMO

OBJECTIVE: The aim: To clarify the efficacy of probiotics use as a preventive measure for post-antibiotic treatment in acute peritonitis and increase staff awareness related to antibiotic and probiotic use. PATIENTS AND METHODS: Materials and methods: The study design included determination of the proper antibiotic and probiotic strain combination and clinical application of probiotic strains. The control group consisted of 63 (48.46%) patients who underwent traditional multimodal treatment of peritonitis and the study group of 67 (51.54%) individuals, with inclusion of different antibiotic/probiotic combinations. RESULTS: Results: Prior to antimicrobial therapy 67.7% patients of both groups' patients had severe dysbiosis, proving dysbiosis as a sign of peritonitis. S. boulardii showed widest resistance spectrum and was used for probiotic therapy in study group. Intestinal dysbiosis grades distribution in control group significantly worsened, while in study group ratio of severe dysbiosis significantly dropped from 58.2% to 38.8% with significant growth of grade II dysbiosis to 61.2%. No visible differences in disease course and clinical picture, duration or complications rate between study and control groups were observed. CONCLUSION: Conclusions: Most of probiotic strains lack antibacterial resistance that makes meaningless their use during systemic antibiotic therapy of acute peritonitis. It is characterized by harsh changes of intestinal microbiota (severe intestinal dysbiosis). While probiotic strains showed antibiotic tolerance, their use presented no significant clinical efficacy, though high level of positive influence on intestinal dysbiosis was observed.


Assuntos
Microbioma Gastrointestinal , Peritonite , Probióticos , Antibacterianos/uso terapêutico , Disbiose/tratamento farmacológico , Humanos , Peritonite/tratamento farmacológico , Peritonite/prevenção & controle , Probióticos/uso terapêutico
7.
Medicine (Baltimore) ; 100(12): e25268, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761729

RESUMO

INTRODUCTION: In patients with malignant distal bile duct obstruction and normal gastrointestinal anatomy, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is indicated when endoscopic retrograde cholangiopancreatography (ERCP) fails. The ERCP drainage route passes through the tumor, whereas the EUS-CDS route does not. Therefore, EUS-CDS is expected to have a longer stent patency than ERCP. However, for first-line biliary drainage, it remains unclear whether EUS-CDS or ERCP is superior in terms of stent patency. To reduce the frequency of highly adverse events (AEs) such as bile peritonitis or stent migration following EUS-CDS, we developed an antimigration metal stent with a thin delivery system for tract dilatation. This study is designed to assess whether EUS-CDS with this novel stent is superior to ERCP with a traditional metal stent in terms of stent patency when the two techniques are used for first-line drainage of malignant distal biliary obstruction. METHODS/DESIGN: This study is a multicenter single-blinded randomized controlled trial (RCT) involving 95 patients in four tertiary centers. Patients with malignant distal biliary obstruction that is unresectable or presents a very high surgical risk and who pass the inclusion and exclusion criteria will be randomized to EUS-CDS or ERCP in a 1:1 proportion. The primary endpoint is the stent patency rate 180 days after stent insertion. Secondary outcomes include the rates of technical success, clinical success, technical success in cases not requiring fistulous-tract dilation (only EUS-CDS group), procedure-related AEs, re-intervention success, patients receiving post-drainage chemotherapy, procedure time, and overall survival time. DISCUSSION: If EUS-CDS is superior to ERCP in terms of stent patency and safety for the first-line drainage of malignant distal biliary obstruction, it is expected that the first-line drainage method will be changed from ERCP to EUS-CDS, and that interruption of chemotherapy due to stent dysfunction can be avoided. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000041343. Registered on August 6, 2020. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047201Version number: 1.2, December 7, 2020.


Assuntos
Neoplasias dos Ductos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Coledocostomia , Colestase , Endossonografia/métodos , Peritonite , Complicações Pós-Operatórias , Stents , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/patologia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocostomia/efeitos adversos , Coledocostomia/instrumentação , Coledocostomia/métodos , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase/cirurgia , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Peritonite/etiologia , Peritonite/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Falha de Prótese , Cirurgia Assistida por Computador/métodos
8.
Nat Commun ; 12(1): 1770, 2021 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-33741914

RESUMO

Inflammation generally leads to recruitment of monocyte-derived macrophages. What regulates the fate of these cells and to what extent they can assume the identity and function of resident macrophages is unclear. Here, we show that macrophages elicited into the peritoneal cavity during mild inflammation persist long-term but are retained in an immature transitory state of differentiation due to the presence of enduring resident macrophages. By contrast, severe inflammation results in ablation of resident macrophages and a protracted phase wherein the cavity is incapable of sustaining a resident phenotype, yet ultimately elicited cells acquire a mature resident identity. These macrophages also have transcriptionally and functionally divergent features that result from inflammation-driven alterations to the peritoneal cavity micro-environment and, to a lesser extent, effects of origin and time-of-residency. Hence, rather than being predetermined, the fate of inflammation-elicited peritoneal macrophages seems to be regulated by the environment.


Assuntos
Diferenciação Celular/genética , Inflamação/genética , Macrófagos Peritoneais/metabolismo , Macrófagos/metabolismo , Cavidade Peritoneal/patologia , Animais , Células Cultivadas , Citocinas/metabolismo , Feminino , Fator de Transcrição GATA6/genética , Fator de Transcrição GATA6/metabolismo , Perfilação da Expressão Gênica , Inflamação/metabolismo , Macrófagos/citologia , Macrófagos Peritoneais/citologia , Masculino , Camundongos Congênicos , Camundongos Endogâmicos C57BL , Peritonite/genética , Peritonite/metabolismo
9.
Int J Mol Sci ; 22(5)2021 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-33668084

RESUMO

The interaction of macrophages with apoptotic cells is required for efficient resolution of inflammation. While apoptotic cell removal prevents inflammation due to secondary necrosis, it also alters the macrophage phenotype to hinder further inflammatory reactions. The interaction between apoptotic cells and macrophages is often studied by chemical or biological induction of apoptosis, which may introduce artifacts by affecting the macrophages as well and/or triggering unrelated signaling pathways. Here, we set up a pure cell death system in which NIH 3T3 cells expressing dimerizable Caspase-8 were co-cultured with peritoneal macrophages in a transwell system. Phenotype changes in macrophages induced by apoptotic cells were evaluated by RNA sequencing, which revealed an unexpectedly dominant impact on macrophage proliferation. This was confirmed in functional assays with primary peritoneal macrophages and IC-21 macrophages. Moreover, inhibition of apoptosis during Zymosan-induced peritonitis in mice decreased mRNA levels of cell cycle mediators in peritoneal macrophages. Proliferation of macrophages in response to apoptotic cells may be important to increase macrophage numbers in order to allow efficient clearance and resolution of inflammation.


Assuntos
Apoptose , Proliferação de Células , Macrófagos Peritoneais/citologia , Peritonite/patologia , Animais , Células Cultivadas , Técnicas de Cocultura , Macrófagos Peritoneais/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Peritonite/induzido quimicamente , Peritonite/metabolismo , Fagocitose , Zimosan/toxicidade
10.
Medicine (Baltimore) ; 100(8): e24794, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663096

RESUMO

RATIONALE: Sclerosing encapsulated peritonitis (SEP) is a rare chronic peritoneal inflammation with unknown etiology, and is also known as abdominal cocoon. This occurs when the intestinal annulus is enveloped in the peritoneal cavity, resulting in intestinal obstruction. Its preoperative diagnosis and treatment strategy remains a challenge. PATIENT CONCERNS: The study reports a 53-year-old male, who presented with a 4-day history of paroxysmal abdominal pain, without the adverse reaction of nausea, vomiting, or diarrhea. DIAGNOSIS: The accurate diagnosis of SEP was made after the emergency diagnostic laparoscopy. INTERVENTIONS: The laparoscopic exploration revealed that the small intestine was wrapped by a layer of peritoneum. Then, the abdominal fibrous membrane was removed surgically, and adhesiolysis were performed. The patient recovered well, and gradually recovered by the 10th post-operative day. OUTCOMES: The patient was discharged uneventfully after 10 days, and the patient recovered well. After the 12-month follow-up, no symptoms of recurrence or complications were observed. LESSONS: The preoperative diagnosis of SEP remains difficult, and the onset of SEP has exhibited a younger trend. The diagnosis of SEP should remain on the list of differential diagnosis for paroxysmal abdominal pain. single-photon emission computed tomography/computed tomography and laparoscopic exploration have been proven to be helpful for establishing the diagnosis. In the early stage of intestinal obstruction caused by SEP, surgical intervention was immediately carried out in emergency department, and the patient recovered well after the operation. The present study also presents a review of the literature for other cases of SEP. The external evidence was helpful in making clinical decisions for patient care.


Assuntos
Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Peritonite/complicações , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade
11.
BMC Surg ; 21(1): 135, 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33726727

RESUMO

BACKGROUND: The best treatment for perforated colonic diverticulitis with generalized peritonitis is still under debate. Concurrent strategies are resection with primary anastomosis (PRA) with or without diverting ileostomy (DI), Hartmann's procedure (HP), laparoscopic lavage (LL) and damage control surgery (DCS). This review intends to systematically analyze the current literature on DCS. METHODS: DCS consists of two stages. Emergency surgery: limited resection of the diseased colon, oral and aboral closure, lavage, vacuum-assisted abdominal closure. Second look surgery after 24-48 h: definite reconstruction with colorectal anastomosis (-/ + DI) or HP after adequate resuscitation. The review was conducted in accordance to the PRISMA-P Statement. PubMed/MEDLINE, Cochrane central register of controlled trials (CENTRAL) and EMBASE were searched using the following term: (Damage control surgery) AND (Diverticulitis OR Diverticulum OR Peritonitis). RESULTS: Eight retrospective studies including 256 patients met the inclusion criteria. No randomized trial was available. 67% of the included patients had purulent, 30% feculent peritonitis. In 3% Hinchey stage II diverticulitis was found. In 49% the Mannheim peritonitis index (MPI) was greater than 26. Colorectal anastomosis was constructed during the course of the second surgery in 73%. In 15% of the latter DI was applied. The remaining 27% received HP. Postoperative mortality was 9%, morbidity 31% respectively. The anastomotic leak rate was 13%. 55% of patients were discharged without a stoma. CONCLUSION: DCS is a safe technique for the treatment of acute perforated diverticulitis with generalized peritonitis, allowing a high rate of colorectal anastomosis and stoma-free hospital discharge in more than half of the patients.


Assuntos
Doença Diverticular do Colo , Peritonite , Anastomose Cirúrgica , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/cirurgia , Humanos , Peritonite/complicações , Peritonite/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
13.
BMC Cancer ; 21(1): 200, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33637083

RESUMO

BACKGROUND: Mesothelin is a 40-kDa glycoprotein that is highly overexpressed in various types of cancers, however molecular mechanism of mesothelin has not been well-known. Amatuximab is a chimeric monoclonal IgG1/k antibody targeting mesothelin. We recently demonstrated that the combine therapy of Amatuximab and gemcitabine was effective for peritonitis of pancreatic cancer in mouse model. METHODS: We discover the role and potential mechanism of mesothelin blockage by Amatuximab in human pancreatic cells both expressing high or low level of mesothelin in vitro experiment and peritonitis mouse model of pancreatic cancer. RESULTS: Mesothelin blockage by Amatuximab lead to suppression of invasiveness and migration capacity in AsPC-1 and Capan-2 (high mesothelin expression) and reduce levels of pMET expression. The combination of Amatuximab and gemcitabine suppressed proliferation of AsPC-1 and Capan-2 more strongly than gemcitabine alone. These phenomena were not observed in Panc-1 and MIA Paca-2 (Mesothelin low expression). We previously demonstrated that Amatuximab reduced the peritoneal mass in mouse AsPC-1 peritonitis model and induced sherbet-like cancer cell aggregates, which were vanished by gemcitabine. In this study, we showed that the cancer stem cell related molecule such as ALDH1, CD44, c-MET, as well as proliferation related molecules, were suppressed in sherbet-like aggregates, but once sherbet-like aggregates attached to peritoneum, they expressed these molecules strongly without the morphological changes. CONCLUSIONS: Our work suggested that Amatuximab inhibits the adhesion of cancer cells to peritoneum and suppresses the stemness and viability of those, that lead to enhance the sensitivity for gemcitabine.


Assuntos
Anticorpos Monoclonais/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Ductal Pancreático/tratamento farmacológico , Desoxicitidina/análogos & derivados , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Proteínas Ligadas por GPI/antagonistas & inibidores , Proteínas de Neoplasias/antagonistas & inibidores , Células-Tronco Neoplásicas/efeitos dos fármacos , Neoplasias Pancreáticas/tratamento farmacológico , Animais , Anticorpos Monoclonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Carcinoma Ductal Pancreático/prevenção & controle , Carcinoma Ductal Pancreático/secundário , Adesão Celular/efeitos dos fármacos , Agregação Celular/efeitos dos fármacos , Divisão Celular/efeitos dos fármacos , Movimento Celular/efeitos dos fármacos , Autorrenovação Celular/efeitos dos fármacos , Desoxicitidina/administração & dosagem , Desoxicitidina/farmacologia , Sinergismo Farmacológico , Feminino , Proteínas Ligadas por GPI/biossíntese , Proteínas Ligadas por GPI/genética , Proteínas Ligadas por GPI/imunologia , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Invasividade Neoplásica , Proteínas de Neoplasias/biossíntese , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/imunologia , Células-Tronco Neoplásicas/patologia , Tamanho do Órgão/efeitos dos fármacos , Neoplasias Pancreáticas/patologia , Neoplasias Peritoneais/prevenção & controle , Neoplasias Peritoneais/secundário , Peritônio/efeitos dos fármacos , Peritônio/metabolismo , Peritônio/patologia , Peritonite/tratamento farmacológico , Peritonite/patologia
14.
J Forensic Leg Med ; 78: 102089, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33596513

RESUMO

Acute stomach disease in elderly patients often lacks characteristic clinical manifestations. Presentations may differ from those in younger patients and are often complicated by concomitant diseases, delayed presentation, and misdiagnosis. Incorrect diagnosis and treatment can lead to medical-related death claims. We investigated eight cases of elderly fatality due to acute abdominal diseases in forensic autopsy cases. Although most fatalities were unwitnessed, possibly due to the characteristics of elderly individuals, recent social backgrounds, and involvement with health care, some cases of possible misdiagnosis suggested that physicians should carefully consider atypical clinical manifestations and the characteristics of elderly individuals when the managing abdominal symptoms, particularly in primary health care. Our investigation of these forensic autopsy cases indicated the particular importance of peritoneal adhesions as an unexpected cause of acute abdomen in the elderly due to strangulation ileus, even among those with no history of abdominal surgery or trauma. Diagnosis of acute stomach symptoms can be difficult in elderly patients. Pathophysiological examination and autopsy analyses can thus contribute to early-stage diagnosis and prevention of acute stomach symptoms in elderly patient populations.


Assuntos
Abdome Agudo/etiologia , Dor Abdominal/etiologia , Idoso Fragilizado , Gastropatias/diagnóstico , Abdome/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Autopsia , Causas de Morte , Feminino , Humanos , Íleus/fisiopatologia , Pulmão/diagnóstico por imagem , Masculino , Peritonite/fisiopatologia
15.
JAMA Netw Open ; 4(2): e2036518, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33538825

RESUMO

Importance: Infection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown. Objective: To determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites. Design, Setting, and Participants: A multicenter retrospective cohort study was conducted at 7 academic neonatal intensive care units between January 1, 2010, and December 31, 2019. Participants included 653 preterm (<33 weeks) very low-birth-weight infants. Exposures: Late-onset (>72 hours of life) infection including bacteremia, fungemia, or surgical peritonitis. Main Outcomes and Measures: The primary outcome was late-onset infection episode mortality. The nSOFA scores from survivors and nonsurvivors with confirmed late-onset infection were compared at 9 time points (T) preceding and following event onset. Results: In the 653 infants who met inclusion criteria, median gestational age was 25.5 weeks (interquartile range, 24-27 weeks) and median birth weight was 780 g (interquartile range, 638-960 g). A total of 366 infants (56%) were male. Late-onset infection episode mortality occurred in 97 infants (15%). Area under the receiver operating characteristic curves for mortality in the total cohort ranged across study centers from 0.71 to 0.95 (T0 hours), 0.77 to 0.96 (T6 hours), and 0.78 to 0.96 (T12 hours), with utility noted at all centers and in aggregate. Using the maximum nSOFA score at T0 or T6, the area under the receiver operating characteristic curve for mortality was 0.88 (95% CI, 0.84-0.91). Analyses stratified by sex or Gram-stain identification of pathogen class or restricted to infants born at less than 25 weeks' completed gestation did not reduce the association of the nSOFA score with infection-related mortality. Conclusions and Relevance: The nSOFA score was associated with late-onset infection mortality in preterm infants at the time of evaluation both in aggregate and in each center. These findings suggest that the nSOFA may serve as the foundation for a consensus definition of sepsis in this population.


Assuntos
Bacteriemia/mortalidade , Fungemia/mortalidade , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Positivas/mortalidade , Sepse Neonatal/mortalidade , Escores de Disfunção Orgânica , Peritonite/mortalidade , Bacteriemia/microbiologia , Bacteriemia/fisiopatologia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Infecções Relacionadas a Cateter/fisiopatologia , Feminino , Fungemia/microbiologia , Fungemia/fisiopatologia , Idade Gestacional , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/fisiopatologia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/fisiopatologia , Mortalidade Hospitalar , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Perfuração Intestinal , Masculino , Sepse Neonatal/fisiopatologia , Peritonite/microbiologia , Peritonite/fisiopatologia , Prognóstico , Medição de Risco
16.
Intern Med ; 60(3): 353-356, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33518609

RESUMO

Objective In patients on peritoneal dialysis (PD), it was reported that colonoscopy, but not upper gastrointestinal endoscopy, could cause peritonitis as a complication. A guideline of the International Society for Peritoneal Dialysis recommends preemptive intravenous antibiotics administration of ampicillin and aminoglycoside with or without metronidazole, to prevent colonoscopy-associated peritonitis. In this study, we retrospectively evaluated the effects of preemptive antibiotics therapy by oral administration instead of intravenous administration. Methods We investigated the incidence of colonoscopy-associated peritonitis in a single center. In 170 patients undergoing PD between January 2010 and December 2019, 50 colonoscopies were performed, including 49 with oral administration of amoxicillin and ciprofloxacin and/or metronidazole as preemptive therapy 1 hour before the colonoscopy procedure, and 1 without. Results We observed no incidence of colonoscopy-associated peritonitis. Conclusion Generally, oral administration of preemptive antibiotics is less painful and more convenient than intravenous administration, especially in outpatient procedures, such as a colonoscopy. Our results suggest that oral antibiotic administration might be effective for preventing colonoscopy-associated peritonitis in PD patients.


Assuntos
Diálise Peritoneal , Peritonite , Antibacterianos/uso terapêutico , Colonoscopia , Humanos , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Peritonite/etiologia , Peritonite/prevenção & controle , Estudos Retrospectivos
18.
Khirurgiia (Mosk) ; (2): 27-31, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570351

RESUMO

OBJECTIVE: To compare the most common prognostic systems in patients with peritonitis. MATERIAL AND METHODS: The study included 352 patients with secondary peritonitis. At admission, sepsis was diagnosed in 15 (4.3%) patients, septic shock - in 4 (1.1%) cases. Mortality was associated with the following main causes: purulent intoxication and/or sepsis - 51 cases (87.9%), cancer-induced intoxication - 4 (6.9%) cases, acute cardiovascular failure - 3 cases (5.2%). We analyzed the efficacy of Manheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors. RESULTS: Age of a patient, malignant tumor, exudate nature, sepsis (septic shock) and organ failure not associated with peritonitis are the most important criteria in predicting fatal outcome. ROC analysis was used to assess prognostic value of various prediction systems. Standard error was less than 0.05 for all scales. Therefore, all prediction systems can be considered accurate for prediction of mortality in patients with peritonitis. CONCLUSION: PPS (AUC 0.942) has the greatest accuracy in predicting fatal outcome in patients with advanced secondary peritonitis, APACHE II (AUC 0.840) - minimum accuracy. MPI had predictive accuracy > 90% too.


Assuntos
Peritonite , Sepse , Índice de Gravidade de Doença , APACHE , Humanos , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/mortalidade , Prognóstico , Curva ROC , Medição de Risco , Sepse/diagnóstico , Sepse/etiologia , Sepse/mortalidade , Choque Séptico/diagnóstico , Choque Séptico/etiologia , Choque Séptico/mortalidade
19.
Arq Bras Cir Dig ; 33(3): e1546, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470376

RESUMO

BACKGROUND: Mortality after emergency surgery in randomized controlled trials. The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. AIM: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. METHOD: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. RESULTS: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. CONCLUSION: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.


Assuntos
Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Diverticulite/complicações , Diverticulite/cirurgia , Perfuração Intestinal/cirurgia , Peritonite/etiologia , Anastomose Cirúrgica/métodos , Colostomia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Diverticulite/patologia , Humanos , Ileostomia/efeitos adversos , Perfuração Intestinal/patologia , Peritonite/cirurgia , Complicações Pós-Operatórias , Resultado do Tratamento
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