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1.
Vet Q ; 40(1): 51-57, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31955661

RESUMO

Abomasal ulcers are difficult to diagnose clinically with limited therapeutic approach to combat the disease. Omental bursitis (OB) and local peritonitis (LP) are known sequelae of abomasal ulcer in cows. In this study, differentiation between OB and LP in regard to clinical symptoms, biochemical analyses and the response to treatment in Buffaloes was done. Twenty buffaloes (Bubalus bubalis) were admitted with a history of intermittent appetite, wasting and mild abdominal distension during the period between March 2016 and August 2018. All cases were female (12 recently calved, 2 pregnant, 6 non-pregnant) aging from 3 to 9 years and weighing 350-600 kg. For comparison, 10 apparently healthy non-pregnant female buffaloes were used as controls. Abdominal ultrasonography confirmed the presence of 11 OB and 9 LP in admitted cases. Laboratory analysis revealed hyperproteinemia and hypoalbuminemia in OB. Hypokalemia and hypochloremia were detected in both OB and LP. Ultrasonography showed hypo-anechoic content with echoic stippling surrounded by echogenic wall in OB, whereas echogenic strands interspersed with anechoic fluid was reported in LP. Intra-lesional lavage by normal saline was applied several times under ultrasongraphic guidance followed by gentamicin 10% intramuscular and H2 antagonist intravenous for 5 days as well as parenteral and enteral fluid therapy. Seven cases of OB clinically improved, whereas no improvements were found in LP cases. OB secondary to abomasal ulcer has a good prognosis in contrast to LP. Ultrasonography provides a useful diagnostic tool and therapeutic guidance for such diseases.


Assuntos
Búfalos , Bursite/veterinária , Peritonite/veterinária , Úlcera Gástrica/veterinária , Animais , Autopsia/veterinária , Bursite/complicações , Bursite/terapia , Estudos de Casos e Controles , Progressão da Doença , Egito , Feminino , Peritonite/complicações , Peritonite/terapia , Gravidez , Úlcera Gástrica/complicações , Úlcera Gástrica/terapia , Resultado do Tratamento
2.
PLoS One ; 15(1): e0227870, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978190

RESUMO

INTRODUCTION: Brazil ranks second in the absolute number of transplantations in the world. Despite improvements in graft survival, many patients will progress to graft loss and return to dialysis. Concerns exist regarding adverse clinical outcomes in this population when undergone peritoneal dialysis (PD). OBJECTIVE: To compare the occurrence of mortality, technique failure, and peritonitis among incident patients in PD coming from either Tx or pre-dialysis treatment. METHODOLOGY: A retrospective study in which 47 adult patients with Tx failure (Tx group) were matched for age, gender, diabetes mellitus (DM), modality and start year of PD, with 1:1 predialysis patient (nTx group). The Fine-Gray competing risk model was used to analyze mortality and technique failure. RESULTS: Compared to nTx, the Tx group had a lower body mass index, serum potassium, and albumin concentrations. A higher ferritin level, transferrin saturation and the number of patients with positive serology for viral hepatitis were also observed in the Tx group. In the multivariate analysis, patients of the Tx group had 4.4-times higher risk of death (p = 0.007), with infection as the main cause. Technique failure and peritonitis were similar in both groups. CONCLUSION: Previous Tx is a risk factor for mortality but not for technique failure or peritonitis in incident patients on a PD program.


Assuntos
Falência Renal Crônica/epidemiologia , Transplante de Rim/efeitos adversos , Diálise Peritoneal , Peritonite/epidemiologia , Adulto , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Feminino , Rejeição de Enxerto/complicações , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/patologia , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Peritonite/terapia , Fatores de Risco , Taxa de Sobrevida
4.
J Surg Res ; 246: 560-567, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668604

RESUMO

BACKGROUND: The objective of this study was to assess whether a zinc-impregnated polypropylene mesh (ZnMesh) has better antibacterial properties in a contaminated environment compared with a regular polypropylene mesh. MATERIALS AND METHODS: Thirty-eight Wistar Han rats underwent cecal ligation and puncture to induce peritonitis 24 h before implantation of an intraperitoneal ZnMesh or a regular polypropylene mesh. Primary outcome was the number of colony forming units (CFU) per sample (mesh and abdominal wall). Secondary outcomes were macroscopic (incorporation of mesh, abscesses, and adhesions on mesh surface) and histological (inflammatory cell reaction, mesh-specific parameters, and collagen deposition) parameters. All outcomes were evaluated after 30 and 90 d. RESULTS: After 30 d, no significant difference in CFU per sample was present between the ZnMesh and control groups. After 90 d, a lower number of CFU per sample was present in the ZnMesh group compared with the control group (trypticase soy agar with 5% sheep blood: 0 log10 CFU/sample IQR: 0-1.40 versus 1.58 log10 CFU/sample IQR: 0-4.30, P = 0.012; MacConkey: 0 log10 CFU/sample IQR: 0-2.65 versus 1.18 log10 CFU/sample IQR: 0-4.04, P = 0.438). After 90 d, the percentage of adhesions on mesh surface was significantly higher in the ZnMesh group (95% IQR: 60%-100% versus 50% IQR: 23%-75%, P = 0.029). No differences were seen in other macroscopic outcomes or histology. CONCLUSIONS: A significantly lower number of CFU per sample was found in the ZnMesh group after 90 d. After 30 d, no statistically significant differences in CFU per sample were seen. This result suggests that the ZnMesh group has better antibacterial properties in a contaminated environment. However, this is at the cost of a significantly higher percentage of adhesions.


Assuntos
Hérnia Ventral/prevenção & controle , Peritonite/cirurgia , Telas Cirúrgicas , Infecção da Ferida Cirúrgica/prevenção & controle , Aderências Teciduais/epidemiologia , Zinco/administração & dosagem , Parede Abdominal/cirurgia , Animais , Bactérias/isolamento & purificação , Contagem de Colônia Microbiana/estatística & dados numéricos , Modelos Animais de Doenças , Humanos , Masculino , Teste de Materiais , Peritonite/complicações , Peritonite/microbiologia , Polipropilenos , Ratos , Ratos Wistar , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Aderências Teciduais/etiologia , Cicatrização
5.
Med. leg. Costa Rica ; 36(2): 108-114, sep.-dic. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1040451

RESUMO

Resumen La diálisis peritoneal es uno de los métodos de reemplazo renal para pacientes con enfermedad renal crónica avanzada. Las infecciones representan la segunda causa de muerte y corresponden a gran morbilidad en este grupo de pacientes. La peritonitis asociada a diálisis peritoneal es una patología prevenible y es la principal complicación de este procedimiento. En la mayoría de ocasiones, la etiología es secundaria a bacterias Gram positivas colonizadoras de la piel, aunque no se puede subestimar la importancia de las bacterias Gram negativas. El diagnóstico se basa tanto en el criterio clínico como microbiológico. El tratamiento corresponde en antibióticos por un periodo de por lo menos dos semanas. Esta revisión de tema permite informar al personal de salud, pacientes y cuidadores sobre esta frecuente complicación con el fin de prevenirla, y en su defecto, un diagnóstico y tratamiento temprano con el fin de reducir la morbimortalidad y las complicaciones de dicho cuadro clínico.


Abstract Peritoneal dialysis is one of the main renal replacement therapies for end-stage renal disease. Infections represent the second leading cause of death and correspond to great morbidity in this group of patients. Peritonitis associated with peritoneal dialysis is a preventable disease, and it is also the main complication of this procedure. Most cases are secondary to Gram-positive bacteria skin colonizers; although the importance of Gram-negative bacteria cannot be underestimated. Diagnosis is based both on clinical and microbiological criteria. Treatment consists on at least a two-week period antibiotic scheme. This topic review allows health care providers, patients and caregivers to be informed about this usual complication in order to prevent it, diagnose it and initiate early treatment with the intention to minimize its morbidity, mortality and complications.


Assuntos
Humanos , Cavidade Peritoneal , Peritonite/complicações , Diálise Peritoneal , Terapia de Substituição Renal , Insuficiência Renal Crônica
6.
Ulus Travma Acil Cerrahi Derg ; 25(6): 575-579, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31701503

RESUMO

BACKGROUND: A rare cause of acute abdomen or intestinal obstruction, the abdominal cocoon syndrome is also described in the literature as sclerosing peritonitis or sclerosing encapsulating peritonitis. Abdominal cocoon is characterized by the total or partial wrapping of the abdominal organs by a fibrous membrane. Although it is usually observed in young women, the etiology is unknown. The diagnosis is usually made during laparotomy. In this case series, we aimed to present seven patients diagnosed with abdominal cocoon syndrome during operation. METHODS: The records of patients who underwent laparotomy for abdominal pain and/or intestinal obstruction in our hospital and diagnosed as abdominal cocoon during operation between January 2012 and November 2018 were retrospectively reviewed. The demographic characteristics of the patients, etiologic factors, surgical procedures, operative findings and follow-up of the patients were recorded. RESULTS: Four out of seven patients who were operated for abdominal cocoon were male and 3 of them were female. The median age of patients was 61 (57-63) years in male and 39.6 (28-49) years in female. Six of the patients were operated in emergency conditions with the diagnosis of an acute abdomen or ileus. One of the patients was operated with the diagnosis of an intra-abdominal mass in elective conditions. In five out of seven patients, all of the small intestines were wrapped with a fibrous collagen capsule, while two of the patient intestines were partially wrapped with a fibrous collagen capsule. Four of the patients had no underlying disease, while one of the patients had Familial Mediterranean Fever (FMF), one had Endometriosis and one had beta-blocker medication. One patient who had small bowel necrosis and septic peritonitis were observed during the operation and died post operative 6th days. Postoperative complications were not observed in the follow-up of other patients and reoperation was not required due to recurrence. CONCLUSION: Abdominal cocoon is a condition that is usually diagnosed during operation in patients that were operated for reasons, such as the acute abdomen or intestinal obstruction. When the diagnose delayed, death can be seen due to small bowel necrosis and septic complications. High clinical suspicion and radiological imaging are important in the preoperative diagnosis. Treatment is required adhesiolysis and excision of the fibrous membranes.


Assuntos
Abdome Agudo/etiologia , Fibrose Peritoneal , Peritonite , Dor Abdominal/etiologia , Adulto , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Fibrose Peritoneal/complicações , Fibrose Peritoneal/diagnóstico , Fibrose Peritoneal/cirurgia , Peritonite/complicações , Peritonite/diagnóstico , Peritonite/cirurgia , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 98(39): e17079, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574807

RESUMO

Advancements in diagnostic modalities have improved the diagnosis of meconium peritonitis (MP) both in utero and ex utero. This study aimed to determine the efficacy of prompt prenatal and postnatal diagnoses of MP on the postnatal outcomes of these patients.We conducted a retrospective chart review of neonates with MP admitted to the Mackay Memorial Hospital Systems from 2005 to 2016. The prenatal diagnoses, postnatal presentations, surgical indications, operative methods, types of MP, operative findings, associated anomalies, morbidities, patient outcomes, and survival rates were analyzed. Morbidities included postoperative adhesion ileus, bacteremia, and short bowel syndrome. We also performed subgroup analyses of the morbidity and survival rates of prenatally versus postnatally diagnosed patients, as well as inborn versus outborn neonates.Thirty-seven neonates with MP were enrolled. Of this number, 24 (64.9%) were diagnosed prenatally. Twenty-two (59.5%) were born preterm. The most common prenatal sonographic findings included fetal ascites followed by dilated bowel loops. Abdominal distention was the most frequent postnatal symptom. Thirty-four (91.9%) neonates underwent surgery, whereas 3 were managed conservatively. Volvulus of the gastrointestinal tract was the most frequent anatomic anomaly. The total morbidity and survival rates were 37.8% and 91.9%, respectively. The morbidity and survival rates did not differ significantly between prenatally and postnatally diagnosed patients (37.5% vs 33.3%, P = 1.00; 91.7% vs 92.3%, P = 1.00, respectively). Inborn and outborn patients did not differ in terms of morbidity and survival rates (27.3% vs 53.3%, P = .17; 100% vs 80.0%, P = .06, respectively).Although not statistically significant, inborn MP neonates had higher survival rates when compared with outborn MP neonates. Prompt postnatal management at tertiary centers seemed crucial.


Assuntos
Mecônio , Peritonite/diagnóstico por imagem , Ultrassonografia Pré-Natal , Ascite/etiologia , Dilatação Patológica/etiologia , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Volvo Intestinal/etiologia , Intestinos/patologia , Avaliação de Resultados da Assistência ao Paciente , Peritonite/complicações , Peritonite/mortalidade , Peritonite/terapia , Gravidez , Estudos Retrospectivos , Taxa de Sobrevida , Tempo para o Tratamento
8.
Khirurgiia (Mosk) ; (9): 66-72, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532169

RESUMO

OBJECTIVE: The purpose of the study is to determine the correlation of changes in the humoral and tissue components of the hemostasis system with lipid metabolism in case of various urgent surgical diseases, on the basis of which the systemic coagulopathic distress syndrome can be used as the scientific basis for the definition of a new syndrome. MATERIAL AND METHODS: The work includes the results of experimental and clinical laboratory tests. Experiments on dogs: in the first group (n=18) destructive pancreatitis; in the second (n=18) - fecal peritonitis; in the third (n=15), acute obstructive intestinal obstruction; in the fourth (n=16) fecal peritonitis, in the postoperative period, Remaxol (15 ml/kg) was included in the therapy. The analysis of 55 patients with acute peritonitis, operated on for acute appendicitis, perforated gastric or duodenal ulcer, acute intestinal obstruction, acute destructive cholecystitis. In the study group (n=28), Remaxol is included in the postoperative therapy. The state of the humoral and tissue (in the experiment, the tissues of the liver, intestines, kidneys, heart, lungs, pancreas, in the clinic - tissues of the resected organs) components of the hemostasis system was evaluated, a number of lipid metabolism indicators were determined, etc. RESULTS: In the early periods of all investigated urgent diseases of the abdomen, pronounced changes in the system of both humoral and tissue components of the hemostasis system were revealed. The modification of the coagulation system is registered not only in the tissues of the lesion organs, but also in the target organs (system tissue hemocoagulation modifications). The research established one of the most important processes - the trigger of the hemostatic cascade reaction - is membrane-destabilizing (the source of tissue thromboplastin), which is determined by changes in the phospholipid composition of various organs tissues (involved in the pathological process or not in it). Changes in lipid metabolism are due to the activation of phospholipases and membrane lipid peroxidation in tissues. The factual material was the scientific basis for the establishment of a new syndrome. Systemic coagulopathic distress syndrome is a set of pathological processes of the body, the most important component of which is a violation of the phospholipid bilayer of blood cell membranes and organ cells due to oxidative and phospholipase induced phenomena, leading to a coagulopathic condition. It changes understanding of the prevention of thrombohemorrhagic complications, proving the effectiveness of complex therapy, including not only anticoagulants, but also drugs with membrane-stabilizing activity, in particular, Remaxol.


Assuntos
Transtornos da Coagulação Sanguínea/prevenção & controle , Doenças do Sistema Digestório/complicações , Infecções Intra-Abdominais/complicações , Substâncias Protetoras/administração & dosagem , Succinatos/administração & dosagem , Doença Aguda , Animais , Apendicite/complicações , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/fisiopatologia , Colecistite Aguda/complicações , Doenças do Sistema Digestório/fisiopatologia , Cães , Doenças Hematológicas/etiologia , Doenças Hematológicas/fisiopatologia , Doenças Hematológicas/prevenção & controle , Hemostasia/fisiologia , Humanos , Obstrução Intestinal/complicações , Infecções Intra-Abdominais/fisiopatologia , Metabolismo dos Lipídeos/fisiologia , Pancreatite/complicações , Úlcera Péptica Perfurada/complicações , Peritonite/complicações , Síndrome
9.
Mayo Clin Proc ; 94(9): 1799-1806, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31400909

RESUMO

OBJECTIVE: To examine whether baseline model for end-stage liver disease (MELD) score in patients with cirrhosis and ascites predicts the future development of first spontaneous bacterial peritonitis (SBP) episode. METHODS: A retrospective case-control study was performed at three academic centers to select patients admitted with first SBP episode (cases) and those with ascites admitted for decompensation without SBP (controls). Medical records from these centers were reviewed between January 1, 2008, and December 31, 2013. Cases and controls were matched (1:2) for age, sex, and race. Conditional logistic recession models were built to determine whether baseline MELD score (within a month before hospitalization) predicts first SBP episode. RESULTS: Of 697 patients (308, 230, and 159 from centers A, B, and C, respectively), cases and controls were matched in 94%, 89%, and 100% at three respective centers. In the pooled sample, probability of SBP was 11%, 31%, 71%, and 93% at baseline MELD scores less than or equal to 10, from 11 to 20, from 21 to 30, and greater than 30, respectively. Compared with MELD score less than or equal to 10, patients with MELD scores from 11 to 20, 21 to 30, and greater than 30 had six- (3- to 11-), 29- (12- to 69-), and 115- (22- to 598-) folds (95% CI) risk of SBP, respectively. Based on different MELD score cutoff points, MELD score greater than 17 was most accurate in predicting SBP occurrence. Analyzing 315 patients (152 cases) with available data on ascitic fluid protein level controlling for age, sex, and center, MELD score but not ascitic fluid protein associated with first SBP episode with respective odds ratios of 1.20 (1.14 to 1.26) and 0.88 (0.70 to 1.11). CONCLUSION: Baseline MELD score predicts first SBP episode in patients with cirrhosis and ascites.


Assuntos
Infecções Bacterianas/complicações , Mortalidade Hospitalar , Cirrose Hepática/complicações , Falência Hepática/complicações , Peritonite/complicações , Centros Médicos Acadêmicos , Idoso , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/mortalidade , Estudos de Casos e Controles , Progressão da Doença , Feminino , Seguimentos , Humanos , Modelos Lineares , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Cirrose Hepática/terapia , Falência Hepática/diagnóstico , Falência Hepática/terapia , Masculino , Pessoa de Meia-Idade , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
10.
Rev Bras Enferm ; 72(4): 1114-1118, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432973

RESUMO

OBJECTIVE: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. METHOD: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. RESULTS: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. CONCLUSION: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Hipotermia Induzida/métodos , Peritonite/complicações , Dor Abdominal/etiologia , Adolescente , Apendicite/complicações , Apendicite/cirurgia , Regulação da Temperatura Corporal/fisiologia , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Feminino , Febre/etiologia , Humanos , Peritonite/cirurgia , Tomografia Computadorizada por Raios X/métodos , Vômito/etiologia
11.
In Vivo ; 33(4): 1329-1332, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31280226

RESUMO

BACKGROUND/AIM: The aim of this study was to identify a critical predictor of postoperative sepsis in patients with peritonitis due to colorectal perforation. PATIENTS AND METHODS: Between 2009 and 2014, fifty-three patients who underwent emergency surgery for peritonitis due to colorectal perforation in our hospital were examined retrospectively to identify the critical predictor of postoperative sepsis. Between 2016 and 2017, twelve patients with peritonitis due to colorectal perforation were enrolled in a prospective study to validate the critical predictor obtained by the previous retrospective study. RESULTS: Mechanical ventilation for more than two days after surgery seemed to be a critical predictor of postoperative sepsis. In the prospective study, six patients who were withdrawn from mechanical ventilation within one day after surgery did not develop sepsis. CONCLUSION: Respiratory disorders at the end of surgery for peritonitis due to colorectal perforation seem to be a critical predictor of postoperative sepsis.


Assuntos
Perfuração Intestinal/complicações , Perfuração Intestinal/cirurgia , Peritonite/complicações , Peritonite/cirurgia , Complicações Pós-Operatórias , Doenças Respiratórias/etiologia , Sepse/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia/efeitos adversos , Colectomia/métodos , Neoplasias Colorretais/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Prognóstico , Respiração Artificial , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/terapia , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/terapia , Resultado do Tratamento
12.
Blood Purif ; 48(3): 272-275, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291617

RESUMO

Peritoneal dialysis (PD)-related peritonitis is one of the most important factors affecting the long-term success of PD. Adrenal insufficiency is a clinical manifestation of inadequate production of glucocorticoids with accompanying deficiency of mineralocorticoids and adrenal androgens. We present a 58-year-old PD patient who admitted to hospital with fever, abdominal pain, vomiting, and confusion. The patient was treated with cephazolin and ceftazidime after the confirmation of peritonitis. Despite the resolution of peritonitis after 2 weeks with appropriate antibiotic treatment, the patient continued to suffer from vomiting, hypotension, and confusion. After the evaluation of basal serum cortisol and 250 µg ACTH stimulation test, the patient had been diagnosed as adrenal insufficiency and treated with fludrocortisone 0.1 mg/day. Patients remaining vomiting, hypotension, and confusion symptoms were corrected after the fludrocortisone therapy. Following 2 months of successful treatment of adrenal insufficiency, the patient had adherence problem with fludrocortisone for 3-4 weeks. On an outpatient visit, serum ACTH and cortisol levels were normal despite the discontinuation of fludrocortisone and so the patient had been evaluated as partial adrenal insufficiency secondary to PD-related peritonitis. In conclusion, adrenal insufficiency should be kept in mind in PD patients suffering from hypotension and peritonitis.


Assuntos
Insuficiência Adrenal/etiologia , Peritonite/complicações , Insuficiência Adrenal/tratamento farmacológico , Antibacterianos/uso terapêutico , Fludrocortisona/uso terapêutico , Humanos , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Peritonite/tratamento farmacológico , Peritonite/etiologia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(26): e16016, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261505

RESUMO

Spontaneous bacterial peritonitis (SBP) is one of the most frequent and severe complications in patients with decompensated cirrhosis. Early antibiotic therapy is extremely important for successful treatment and reducing mortality. Prostaglandin E2 (PGE2) is a regulator of the immune response and infection. This study aimed to explore whether ascitic PGE2 could be used as a marker for diagnosing SBP and predicting in-hospital mortality.Patients with cirrhosis and ascites undergoing abdominal paracentesis were enrolled in our study. Demographic, clinical, and laboratory parameters were recorded at the time of paracentesis and ascitic PGE2 levels were determined by ELISA. The correlation between ascitic PGE2 level and SBP as well as in-hospital mortality were analyzed.There were 224 patients enrolled, 29 (13%) patients diagnosed as SBP based on the current guideline criteria. The ascitic PGE2 level of patients with SBP [32.77 (26.5-39.68) pg/mL] was significantly lower than that of patients without SBP [49.72 (37.35-54.72) pg/mL]. In ROC analysis, the AUC of ascitic PGE2 for the diagnosis of SBP was 0.75, and the AUC of ascitic PGE2 combined with WBC and ascitic PGE2 combined with neutrophils were 0.90 and 0.90, respectively, which were significantly higher than that of ascitic PGE2. In multivariate analysis, ascites PGE2≤32.88 pg/mL (OR: 9.39; 95% CI: 1.41-67.44, P = .026), hepatic encephalopathy (OR: 18.39; 95% CI: 3.00-113.13, P = .002) and a higher MELD score (OR: 1.25; 95% CI: 1.05-1.40, P = .009) remained independent predictors of in-hospital mortality.Ascitic PGE2 level is likely to be a valuable marker in prediction of in-hospital mortality in patients with decompensated cirrhosis, and its value in diagnosis of SBP was not superior to other inflammatory indicators.


Assuntos
Líquido Ascítico/metabolismo , Infecções Bacterianas/metabolismo , Dinoprostona/metabolismo , Mortalidade Hospitalar , Cirrose Hepática/complicações , Peritonite/metabolismo , Área Sob a Curva , Ascite/complicações , Ascite/metabolismo , Ascite/mortalidade , Infecções Bacterianas/complicações , Infecções Bacterianas/mortalidade , Biomarcadores/metabolismo , Feminino , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Peritonite/mortalidade , Prognóstico , Estudos Prospectivos , Curva ROC
14.
Int J Mol Sci ; 20(13)2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31277406

RESUMO

Cutaneous metastases from internal malignancies are uncommon. Umbilical metastasis, also known as Sister Joseph nodule (SJN), develops in patients with carcinomatous peritonitis or superficial lymphadenopathy, while non-SJN skin metastases develop after surgery, injury, and lymphadenopathy. In this review, the possible mechanisms of skin metastases are discussed. SJNs develop by the contiguous or lymphatic spread of tumor cells. After surgery and injury, tumor cells spread by direct implantation or hematogenous metastasis, and after lymphadenopathy, they spread by extranodal extension. The inflammatory response occurring during wound healing is exploited by tumor cells and facilitates tumor growth. Macrophages are crucial drivers of tumor-promoting inflammation, which is a source of survival, growth and angiogenic factors. Angiogenesis is promoted by the vascular endothelial growth factor (VEGF), which also mediates tumor-associated immunodeficiency. In the subcutaneous tissues that surround metastatic lymph nodes, adipocytes promote tumor growth. In the elderly, age-associated immunosuppression may facilitate hematogenous metastasis. Anti-VEGF therapy affects recurrence patterns but at the same time, may increase the risk of skin metastases. Immune suppression associated with inflammation may play a key role in skin metastasis development. Thus, immune therapies, including immune checkpoint inhibitors reactivating cytotoxic T-cell function and inhibiting tumor-associated macrophage function, appear promising.


Assuntos
Linfadenopatia/complicações , Peritonite/complicações , Neoplasias Cutâneas/secundário , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Humanos , Nódulo da Irmã Maria José/patologia , Nódulo da Irmã Maria José/secundário , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia
15.
Ann Ital Chir ; 90: 258-263, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31354156

RESUMO

AIM: Laparoscopic lavage /drainage (LALA) or surgical resection are both methods of treatment for perforated diverticulitis with purulent peritonitis (Hinchey Stage III). In case of associated abdominal aortic aneurysm (AAA), laparoscopic lavage/drainage could be an interesting bridge option to treat sepsis before endovascular exclusion of the aneurysm and resection of the sigmoid. We performed LALA as a bridge treatment of peritonitis before elective, staged endovascular exclusion of the aneurysm (EE) and elective resection of the colon. MATERIAL AND METHODS: Seven patients presenting a perforated diverticulitis with purulent peritonitis (Hinchey III), associated with an uncomplicated AAA of a mean diameter of 6 cm, underwent LALA followed by staged EE and resection. They were retrospectively reviewed for a case-control study. The mean length of follow-up after completing all the procedures was 28 months. Primary endpoints were mortality and morbidity of each procedure, complications related to each procedure and to the untreated disease in the interval between each one of them, late outcome and complications related to each treatment method. As secondary endpoints, the mean length of surgery for resection, of stay in the hospital, of the interval between each procedure, and of time required for the treatment of both the diseases were considered. RESULTS: Postoperative mortality was absent. Morbidity consisted of a sigmoido-vescical fistula 18 days after resolution of peritonitis and sepsis, not hindering EE,and a delayed healing of the surgical wound for access to the common femoral artery (28.6%). No complications of untreated disease in the interval between each procedure were observed. No late complications of both diseases occurred. The mean interval between LALA and EE,and between EE and resection was, respectively, 19 days and 18 days. Both the diseases were treated within a mean delay of 37 days after LALA (range, 24-61 days). CONCLUSIONS: LALA, as a bridge treatment, before EE and resection, in patients presenting a perforated diverticulitis with purulent peritonitis, associated with an uncomplicated AAA, may be an effective treatment option. KEY WORDS: Perforated diverticulitis, Purulent peritonitis, Abdominal aortic aneurysm.


Assuntos
Diverticulite/cirurgia , Drenagem/métodos , Perfuração Intestinal/cirurgia , Laparoscopia , Peritonite/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Estudos de Casos e Controles , Diverticulite/complicações , Feminino , Humanos , Perfuração Intestinal/complicações , Masculino , Peritonite/complicações , Estudos Retrospectivos , Supuração/complicações , Supuração/cirurgia , Irrigação Terapêutica/métodos
16.
J Surg Res ; 244: 492-501, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31330293

RESUMO

BACKGROUND: Although there are well-established small-animal sepsis models, the longitudinal assessment of hemodynamic variables, laboratory values, and blood culture in a single living sepsis model is limited. Therefore, we aimed to comprehensively characterize fecal peritonitis-induced sepsis in a porcine model. MATERIALS AND METHODS: Autologous feces (1 g/kg) was administered into the peritoneum of 11 male pigs (49 ± 8 kg). The pigs were monitored up to 12 h with full fluid and vasopressor support to maintain the mean arterial pressure at >65 mm Hg. Longitudinal blood culture and laboratory values were obtained at defined time intervals. The cytokine levels in plasma were analyzed. Furthermore, a clinical registry of sepsis patients at a single emergency department was used to compare the Sepsis-related Organ Failure Assessment scores with those of the porcine model. RESULTS: The hyperdynamic phase of increasing cardiac output with decreasing systemic vascular resistance was maintained until 2 h, followed by the reverse (hypodynamic phase). With the escalating requirement for fluid and vasopressor, the lactate level progressively increased while the platelet count, urine output, and serum albumin level consistently decreased. Bacteremia developed 7 h (median) after the administration of feces, and Escherichia coli was the most common pathogen. The pattern of Sepsis-related Organ Failure Assessment scores with prominent cardiovascular failure was comparable to clinical data. CONCLUSIONS: We implemented a porcine fecal peritonitis-induced sepsis model that demonstrates culture-proven bacteremia and multiple organ failure, particularly cardiovascular system failure. This model could facilitate the development of technologies for the early diagnosis of bacterial pathogens in blood.


Assuntos
Fezes/microbiologia , Peritonite/complicações , Sepse/etiologia , Animais , Citocinas/sangue , Modelos Animais de Doenças , Masculino , Escores de Disfunção Orgânica , Sepse/fisiopatologia , Suínos
17.
Cir. pediátr ; 32(3): 158-163, jul. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183737

RESUMO

Objetivo: Evaluar la importancia del diagnóstico ecográfico prenatal del feto portador de periorquitis meconial y su relevancia predictiva del seguimiento y pronóstico fetal en el contexto de una enfermedad intestinal fetal aguda. Material y métodos: En los últimos 5 años en la Unidad de Medicina Fetal se han diagnosticado tres fetos varones de periorquitis meconial cuyos diagnósticos ecográficos prenatales fueron: tumor testicular (n=1); y periorquitis meconial con perforación intestinal aguda fetal (n=2). La edad gestacional al diagnóstico fue de 33, 34 y 35 semanas. Los signos ecográficos al diagnóstico fueron: a nivel escrotal, aumento del tamaño, lesiones hiperecogénicas y permanencia del conducto peritoneo-vaginal; a nivel abdominal pueden existir signos ecográficos de enfermedad intestinal con o sin peritonitis meconial (lesiones hiperecogénicas, edemas de asas y ascitis). Los tres neonatos fueron evaluados postnatalmente mediante ecografía comparativa de los hallazgos prenatales e indicación terapéutica. Resultados: Los hallazgos ecográficos fetales influyeron en la evolución y finalización de la gestación. El diagnóstico de periorquitis meconial fue confirmado postnatalmente en los tres casos: en el 1er caso a término, se descartó patología tumoral escrotal y no requirió cirugía abdominal; en los otros dos pacientes se indicó finalizar la gestación tras el diagnóstico prenatal y se realizó cirugía inguino-escrotal y abordaje intestinal por la peritonitis meconial. Conclusión: El diagnóstico ecográfico prenatal de periorquitis meconial obliga a un seguimiento ecográfico estricto del feto al ser un marcador específico de perforación intestinal, que puede conllevar la finalización de la gestación y evitar la aparición de una peritonitis meconial complicada


Objective: To assess the importance of prenatal ultrasound diagnosis of the fetus carrying meconium periorchitis and its predictive relevance for fetal monitoring and prognosis in the context of acute fetal intestinal disease. Material and methods: Three male fetuses have been diagnosed of meconium periorchitis in our Unit of Fetal Medicine in the last 5 years. Their prenatal ultrasound diagnoses were: testicular tumor (n=1); Meconium periorchitis with acute fetal intestinal perforation (n=2). Gestational age at diagnosis was 33, 34 and 35 weeks. Ultrasound signs at diagnosis were: Increased size of scrotal zone, with hyperechogenic lesions inside and permanence of peritoneum-vaginal canal; at abdominal zone, echographic signs of intestinal disease with or without meconium peritonitis were found (hyperechogenic lesions, edema of intestinal loops and ascites). All three neonates were assessed postnatally by ultrasound and therapeutic indication. Results: Fetal ultrasound findings influenced both evolution and termination of pregnancy. The diagnosis of meconium periorchitis was confirmed postnatally in all cases: in the 1st case, delivered at term, scrotal tumoral pathology was ruled out and did not require abdominal surgery; the other 2 patients were delivered at the same week of prenatal diagnosis and an inguinal-scrotal surgery with intestinal approach because of meconium peritonitis was performed. No patient underwent orchiectomy, maintaining the teste-epididymal binomial intact. Conclusion: Prenatal ultrasound diagnosis of meconium periorchitis requires a strict ultrasound follow-up of the fetus as it is a specific marker of intestinal perforation, which can lead to the termination of pregnancy and avoid appearance of complicated meconium peritonitis


Assuntos
Humanos , Feminino , Gravidez , Adulto , Diagnóstico Pré-Natal , Orquite/diagnóstico por imagem , Mecônio/diagnóstico por imagem , Feto/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Orquite/terapia , Doenças Fetais/diagnóstico por imagem , Idade Gestacional , Neoplasias Testiculares/diagnóstico por imagem , Perfuração Intestinal/complicações , Peritonite/complicações , Peritonite/cirurgia
18.
Rev Gastroenterol Peru ; 39(1): 55-63, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31042237

RESUMO

INTRODUCTION: Liver cirrhosis decompensated due to bacterial infections is one of the main diagnoses of admission to hospitalization, taking into account that the risk per se in it is higher than in non-cirrhotic patients, leading to high mortality rates. OBJECTIVE: The present study sought to determine the predictors of infection and mortality in patients with liver cirrhosis, as well as the epidemiological-clinical characteristics of patients with cirrhosis. MATERIAL AND METHODS: Prospective data were collected from hospitalized cirrhotic patients in the Gastroenterology and Internal Medicine Service of the Hospital High Complexity "Virgen de la Puerta", from 2015 to June 2018. RESULTS: The study included 66 patients. The infection frequency was of 37.88%, being more frequent the spontaneous bacterial peritonitis (21.2%) and the total mortality was of 12.12%. When performing binary logistic regression and ROC curve, the MELD value> 13.5 (p=0.003), TP >18.26 (p=0.003) and the Child Pugh C stage were obtained as predictors of mortality (p=0.02, IC 95% EXP(B) 0.13-0.365). The variables that predict absence of mortality were a platelet value ≥74 500 /mm3 (p=0.01) and sodium ≥133 (p=0.019). The predictors of infection, MELD value ≤14.5 (p=0.0004) and sodium level ≥134.5 (AUC 0.696, p=0.028), to predict absence of infection. CONCLUSIONS: High MELD is a predictor of both mortality and infection. Child Pugh C and high values of Prothrombin time are predictors of mortality. The normal sodium level is a predictor of absence of mortality and infection, as well as platelet values discreetly low are predictors of absence of mortality.


Assuntos
Cirrose Hepática/mortalidade , Idoso , Alcoolismo/complicações , Infecções Bacterianas/complicações , Feminino , Hepatite Viral Humana/complicações , Mortalidade Hospitalar , Humanos , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Peritonite/complicações , Peritonite/microbiologia , Peru , Estudos Prospectivos , Curva ROC , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária
20.
BMC Infect Dis ; 19(1): 463, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122192

RESUMO

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a serious complication and common cause of death in patients with liver cirrhosis. This study was conducted to compare the microbiological characteristics, drug resistance, and treatment outcomes for nosocomial SBP and community-acquired SBP. METHODS: A retrospective study was performed on 334 patients with culture-positive SBP at Beijing Youan Hospital, China, between January 2012 and December 2016. The medical records for these patients were reviewed, and their clinical and laboratory data were analyzed. RESULTS: A total of 155 (46.4%) patients with nosocomial SBP and 179 (53.6%) with community-acquired SBP were included in this study. From the patients' ascitic fluids, 334 pathogenic strains, including 178 Gram-negative bacterial strains, 138 Gram-positive bacterial strains and 18 other microbial strains were isolated. E. coli was the major pathogen (24.3%), followed by Klebsiella pneumoniae (12.0%) and Enterococcus faecium (10.5%). The proportion of Enterococcus was significantly higher in the patients with nosocomial SBP (6.1% vs. 27.7%, P < 0.001) than in the patients with community-acquired SBP. The main pathogens isolated from the nosocomial infections were significantly more resistant to the first-line recommended drug. Compared with community-acquired SBP, nosocomial SBP had a poorer outcome (36.8% vs. 24.6%; P = 0.016). The independent predictors for 30-day mortality included nosocomial infection, Child-Pugh classification, hepatocellular carcinoma, renal failure and hepatic encephalopathy. CONCLUSION: Gram-negative bacteria were the major pathogens involved in SBP in the cirrhotic patients. The strains isolated from the patients with nosocomial SBP displayed higher drug resistance than those isolated from patients with community-acquired SBP. Compared with community-acquired SBP, nosocomial SBP had a poorer outcome. When choosing drug treatments, the acquisition site of infection and the local epidemiological situation should be taken into account.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecção Hospitalar/diagnóstico , Cirrose Hepática/patologia , Peritonite/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana/efeitos dos fármacos , Enterococcus/efeitos dos fármacos , Enterococcus/isolamento & purificação , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Peritonite/tratamento farmacológico , Peritonite/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
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