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1.
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
2.
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
3.
Niger J Clin Pract ; 24(1): 132-134, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33473039

RESUMO

Peritonitis is a common and serious complication of peritoneal dialysis and often primary factor of change over to hemodialysis treatment. Raoultella planticola is known as as environmental bacterium and rarely causes infections in humans. We present a case of peritoneal dialysis related peritonitis due to Raoultella planticola and review the clinical manifestations and treatment options of this microorganism. As far as we know, this is the third case of Raoultella planticola peritonitis in the literature.


Assuntos
Infecções por Enterobacteriaceae , Diálise Peritoneal , Peritonite , Antibacterianos/uso terapêutico , Enterobacteriaceae , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/tratamento farmacológico , Humanos , Peritonite/tratamento farmacológico , Peritonite/etiologia
4.
Medicine (Baltimore) ; 100(2): e23673, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466123

RESUMO

ABSTRACT: We aimed to investigate the hypothesis that serum triglyceride (TG) may be an independent predictor of early-onset peritonitis and prognosis in incident continuous ambulatory peritoneal dialysis (CAPD) patients.In this retrospective, observational study, we screened 291 adults admitted to the PD center of the Wuhan No. 1 hospital from August 1, 2013 to November 31, 2017. All biochemical data were collected at the first 1 to 3 months after the initiation of CAPD. Early-onset peritonitis was defined as peritonitis occurring within 6 months after the initiation of PD. All of PD patients were followed up to July 31, 2018. The primary endpoint was the incidence of early-onset peritonitis while the second endpoints included overall mortality and technical failure.A total of 38 patients occurred early-onset PD peritonitis and the Lasso logistic regression selected TG and age in the final model for early-onset peritonitis. We divided patients into two groups based on the median baseline TG levels: TG ≥ 1.4mmo/L group (n = 143) and TG < 1.4mmol/L group (n = 148). There were 34 (11.7%) patients died and 33 (11.3%) patients transferred to hemodialysis during the follow-up, Moreover, a level of TG ≥ 1.4mmol/L at the initiation of CAPD was associated with a significantly increased probability of technical failure (hazard ratio, HR, 1.30; 95% confidence interval, 95% CI, 1.09 to 2.19, P = .043) and overall mortality (HR, 2.33; 95% CI, 1.16-4.72, P = .018).Serum TG levels measured at the initiation of PD therapy is an independent predictor of early-onset peritonitis and prognosis of CAPD patients.


Assuntos
Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/sangue , Peritonite/etiologia , Triglicerídeos/sangue , Adulto , Fatores Etários , Idoso , Biomarcadores , Índice de Massa Corporal , Feminino , Taxa de Filtração Glomerular , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Peritonite/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos
6.
Cochrane Database Syst Rev ; 12: CD012913, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320346

RESUMO

BACKGROUND: Urgent-start peritoneal dialysis (PD), defined as initiation of PD within two weeks of catheter insertion, has been emerging as an alternative mode of dialysis initiation for patients with chronic kidney disease (CKD) requiring urgent dialysis without established permanent dialysis access. Recently, several small studies have reported comparable patient outcomes between urgent-start and conventional-start PD. OBJECTIVES: To examine the benefits and harms of urgent-start PD compared with conventional-start PD in adults and children with CKD requiring long-term kidney replacement therapy. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 25 May 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. For non-randomised controlled trials, MEDLINE (OVID) (1946 to 27 June 2019), EMBASE (OVID) (1980 to 27 June 2019), Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov (up to 27 June 2019) were searched. SELECTION CRITERIA: All randomised controlled trials (RCTs) and non-RCTs comparing the outcomes of urgent-start PD (within 2 weeks of catheter insertion) and conventional-start PD ( ≥ 2 weeks of catheter insertion) treatment in children and adults CKD patients requiring long-term dialysis were included. Studies without a control group were excluded. DATA COLLECTION AND ANALYSIS: Data were extracted and quality of studies were examined by two independent authors. The authors contacted investigators for additional information. Summary estimates of effect were examined using random-effects model and results were presented as risk ratios (RR) with 95% confidence intervals (CI) as appropriate for the data. The certainty of evidence for individual outcome was assessed using the GRADE approach. MAIN RESULTS: A total of 16 studies (2953 participants) were included in this review, which included one multicentre RCT (122 participants) and 15 non-RCTs (2831 participants): 13 cohort studies (2671 participants) and 2 case-control studies (160 participants). The review included unadjusted data for analyses due to paucity of studies reporting adjusted data. In low certainty evidence, urgent-start PD may increase dialysate leak (1 RCT, 122 participants: RR 3.90, 95% CI 1.56 to 9.78) compared with conventional-start PD which translated into an absolute number of 210 more leaks per 1000 (95% CI 40 to 635). In very low certainty evidence, it is uncertain whether urgent-start PD increases catheter blockage (4 cohort studies, 1214 participants: RR 1.33, 95% CI 0.40 to 4.43; 2 case-control studies, 160 participants: RR 1.89, 95% CI 0.58 to 6.13), catheter malposition (6 cohort studies, 1353 participants: RR 1.63, 95% CI 0.80 to 3.32; 1 case-control study, 104 participants: RR 3.00, 95% CI 0.64 to 13.96), and PD dialysate flow problems (3 cohort studies, 937 participants: RR 1.44, 95% CI 0.34 to 6.14) compared to conventional-start PD. In very low certainty evidence, it is uncertain whether urgent-start PD increases exit-site infection (2 cohort studies, 337 participants: RR 1.43, 95% CI 0.24 to 8.61; 1 case-control study, 104 participants RR 1.20, 95% CI 0.41 to 3.50), exit-site bleeding (1 RCT, 122 participants: RR 0.70, 95% CI 0.03 to 16.81; 1 cohort study, 27 participants: RR 1.58, 95% CI 0.07 to 35.32), peritonitis (7 cohort studies, 1497 participants: RR 1.00, 95% CI 0.68 to 1.46; 2 case-control studies, participants: RR 1.09, 95% CI 0.12 to 9.51), catheter readjustment (2 cohort studies, 739 participants: RR 1.27, 95% CI 0.40 to 4.02), or reduces technique survival (1 RCT, 122 participants: RR 1.09, 95% CI 1.00 to 1.20; 8 cohort studies, 1668 participants: RR 0.90, 95% CI 0.76 to 1.07; 2 case-control studies, 160 participants: RR 0.92, 95% CI 0.79 to 1.06). In very low certainty evidence, it is uncertain whether urgent-start PD compared with conventional-start PD increased death (any cause) (1 RCT, 122 participants: RR 1.49, 95% CI 0.87 to 2.53; 7 cohort studies, 1509 participants: RR 1.89, 95% CI 1.07 to 3.3; 1 case-control study, 104 participants: RR 0.90, 95% CI 0.27 to 3.02; very low certainty evidence). None of the included studies reported on tunnel tract infection. AUTHORS' CONCLUSIONS: In patients with CKD who require dialysis urgently without ready-to-use dialysis access in place, urgent-start PD may increase the risk of dialysate leak and has uncertain effects on catheter blockage, malposition or readjustment, PD dialysate flow problems, infectious complications, exit-site bleeding, technique survival, and patient survival compared with conventional-start PD.


Assuntos
Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/etiologia , Tratamento de Emergência/efeitos adversos , Diálise Peritoneal/efeitos adversos , Insuficiência Renal Crônica/terapia , Estudos de Casos e Controles , Estudos de Coortes , Soluções para Diálise , Tratamento de Emergência/métodos , Hemorragia/etiologia , Humanos , Diálise Peritoneal/métodos , Diálise Peritoneal/mortalidade , Peritonite/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Cicatrização
7.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(12): 1740-1746, 2020 Dec 30.
Artigo em Chinês | MEDLINE | ID: mdl-33380390

RESUMO

OBJECTIVE: To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving long-term peritoneal dialysis. METHODS: The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively. According to the duration of dialysis, the patients were divided into long-term (≥36 months) and short-term (< 36 months) dialysis groups for comparison of the clinical data, treatment outcomes and long-term prognostic events. RESULTS: A total of 625 patients with PDAP were enrolled, including 93 on long-term and 532 on short-term dialysis. Compared with those on short-term dialysis, the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred (P < 0.05), were more susceptible to gram-negative bacterial infections (P < 0.05), and had significantly lower initial treatment response rate (P=0.009) and complete cure rate (P=0.018) and higher extubation rate (P=0.017). Multivariate logistic regression analysis showed that in patients on long-term dialysis, the risks of extubation and treatment failure for the first episode of PDAP were 3.05 times (OR: 3.05, 95%CI: 1.35-6.91, P=0.008) and 2.81 times (OR: 2.81, 95%CI: 1.45-5.44, P=0.002) those in patients with short-term dialysis, respectively. Fungal infection (OR: 45.40, 95%CI: 1.488-1385.5, P=0.029) and mixed bacterial infection (OR: 16.50, 95%CI: 1.106-246.123, P=0.042) were independent risk factors for treatment failure of the first episode of PDAP in patients on long-term dialysis. Maintenance peritoneal dialysis, technical failure, or all-cause mortality did not differ significantly between the two groups. Multivariate Cox regression analysis suggested that long-term dialysis was not an independent risk factor for technical failure (OR: 1.36, 95%CI: 0.84-2.19, P=0.206) or all-cause mortality (OR: 1.51, 95%CI: 0.97-2.35, P=0.068) in patients with PDAP. CONCLUSIONS: Compared with those on short-term dialysis, patients on long-term dialysis are prone to gram-negative bacterial infection when the first episode of PDAP occurs with worse treatment outcomes but similar long-term outcomes. Long-term dialysis is an independent risk factor of extubation and treatment failure for the first episode of PDAP, and fungal and mixed bacterial infections are independent risk factors for treatment failure of the first PDAP in patients with long-term dialysis.


Assuntos
Falência Renal Crônica , Diálise Peritoneal , Peritonite , Humanos , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Peritonite/etiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
Mar Drugs ; 18(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33348729

RESUMO

Edwardsiella tarda can cause fatal gastro-/extraintestinal diseases in fish and humans. Overuse of antibiotics has led to antibiotic resistance and contamination in the environment, which highlights the need to find new antimicrobial agents. In this study, the marine peptide-N6 was amidated at its C-terminus to generate N6NH2. The antibacterial activity of N6 and N6NH2 against E. tarda was evaluated in vitro and in vivo; their stability, toxicity and mode of action were also determined. Minimal inhibitory concentrations (MICs) of N6 and N6NH2 against E. tarda were 1.29-3.2 µM. Both N6 and N6NH2 killed bacteria by destroying the cell membrane of E. tarda and binding to lipopolysaccharide (LPS) and genomic DNA. In contrast with N6, N6NH2 improved the stability toward trypsin, reduced hemolysis (by 0.19% at a concentration of 256 µg/mL) and enhanced the ability to penetrate the bacterial outer and inner membrane. In the model of fish peritonitis caused by E. tarda, superior to norfloxacin, N6NH2 improved the survival rate of fish, reduced the bacterial load on the organs, alleviated the organ injury and regulated the immunity of the liver and kidney. These data suggest that the marine peptide N6NH2 may be a candidate for novel antimicrobial agents against E. tarda infections.


Assuntos
Antibacterianos/farmacologia , Peptídeos Catiônicos Antimicrobianos/farmacologia , Edwardsiella tarda/efeitos dos fármacos , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/virologia , Doenças dos Peixes/tratamento farmacológico , Animais , Antibacterianos/química , Peptídeos Catiônicos Antimicrobianos/química , Membrana Celular/efeitos dos fármacos , Infecções por Enterobacteriaceae/microbiologia , Doenças dos Peixes/microbiologia , Doenças dos Peixes/patologia , Proteínas de Peixes , Rim/patologia , Fígado/patologia , Testes de Sensibilidade Microbiana , Norfloxacino/uso terapêutico , Peritonite/tratamento farmacológico , Peritonite/etiologia , Relação Estrutura-Atividade , Análise de Sobrevida
9.
Eur Rev Med Pharmacol Sci ; 24(21): 11402-11408, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33215462

RESUMO

OBJECTIVE: The study aimed to explore the best follow-up management strategy for patients undergoing peritoneal dialysis (PD) during the novel coronavirus pneumonia (NCP) epidemic. PATIENTS AND METHODS: Patients undergoing PD who were followed up during the NCP epidemic by our hospital were enrolled in this study. Because of the need to control the epidemic, a follow-up system was established during the epidemic period, with WeChat, QQ, and the telephone as the main methods of communication. Outpatient and emergency follow-ups were carried out to ensure the safety of dialysis and the prevention and control of the epidemic. The follow-up strategy included response measures related to the epidemic situation, prevention of peritonitis related to PD, water and salt control, exercise guidance, and psychological care. According to the patient's condition, the appointment system was implemented, with one consulting room and one process for each patient. The emergency patients were isolated in accordance with the epidemic situation. RESULTS: Since January 2020, among the 580 patients undergoing PD who were followed up in our department and their families, none had NCP infection. During the epidemic period, the standard hemoglobin level and the inpatient rate decreased. Complications related to PD, such as peritonitis, cardiovascular complications caused by volume overload, and pulmonary infection, did not significantly increase, and the withdrawal rate and mortality rate decreased compared with those in the same period last year. CONCLUSIONS: The patient follow-up strategy during the epidemic period had a significant positive effect on preventing and controlling the epidemic. Furthermore, during the epidemic period, encouraging patients and caregivers to pay attention to protection at home, avoid going out, strengthen self-management, and other measures were beneficial to the control of kidney disease itself, which is worth promoting. The close relationship between doctors and patients during the epidemic had a positive effect on the occurrence of complications related to patients undergoing PD.


Assuntos
Assistência ao Convalescente/métodos , Infecções por Coronavirus/prevenção & controle , Hemodiálise no Domicílio/normas , Falência Renal Crônica/terapia , Pandemias/prevenção & controle , Diálise Peritoneal/normas , Pneumonia Viral/prevenção & controle , Assistência ao Convalescente/normas , Betacoronavirus/patogenicidade , Cuidadores/psicologia , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Seguimentos , Hemodiálise no Domicílio/efeitos adversos , Hemodiálise no Domicílio/psicologia , Humanos , Educação de Pacientes como Assunto , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/psicologia , Peritonite/epidemiologia , Peritonite/etiologia , Relações Médico-Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Autogestão/psicologia , Telemedicina/normas , Resultado do Tratamento
10.
Khirurgiia (Mosk) ; (10): 49-59, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047586

RESUMO

OBJECTIVE: To analyze the role of mesoappendixectomy in the development of intra-abdominal surgical site infection (IAB SSI) after LAE. MATERIAL AND METHODS: A prospective randomized non-blind multiple-center registered (ClinicalTrials.gov NCT03754777) study has been performed for the period from 2016 to 2018. The study was devoted to effectiveness and safety of the modified enhanced recovery protocol in LAE. In the main group, this protocol (n=56) included routine mesoappendixectomy, restrictive strategy for abdominal drainage and postoperative antibiotic prevention. In the control group (n=71), mesoappendixectomy was performed only in case of necrotic changes. Both groups were comparable by demographic parameters and severity of comorbidities. RESULTS: In the main group, significant decrease in the incidence of IAB SSI was found (0% versus 9.8%). Moreover, the main group was characterized by reduced length of hospital-stay (1.43±1.34 d versus 2.94±2, 43 days). CONCLUSION: Mesoappendixectomy should be evaluated in further research as a potential factor in prevention of IAB SSI.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Mesocolo/cirurgia , Peritonite/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/administração & dosagem , Apendicectomia/efeitos adversos , Apendicite/tratamento farmacológico , Drenagem , Recuperação Pós-Cirúrgica Melhorada , Humanos , Peritonite/etiologia , Estudos Prospectivos , Infecção da Ferida Cirúrgica/etiologia
11.
Khirurgiia (Mosk) ; (10): 68-72, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047588

RESUMO

OBJECTIVE: To evaluate the role of various perioperative risk factors on the incidence of abdominal wound dehiscence. MATERIAL AND METHODS: A retrospective controlled randomized trial of the risk factors of abdominal wound dehiscence was conducted in 62 patients for the period 2013- 2018. The research was performed at the Perm City Clinical Hospital No. 4. All patients were divided into two groups: the main one (n=31) with abdominal wound dehiscence in early postoperative period and the control group (n=31) without this event. Both groups were comparable by gender, age and surgical abdominal diseases. Between-group differences in numerical indicators were analyzed using Mann-Whitney U-test, qualitative variables were analyzed using contingency tables. Differences were significant at p-value <0.05. RESULTS: Incidence of abdominal wound dehiscence was similar in patients who admitted in emergency and elective fashion (p=0.54). Anemia upon admission (p=0.71), diabetes mellitus type 2 (p=1.00), COPD (p=0.13) and obesity (p=0.76) were not significant predictors of abdominal wound dehiscence. There were significant between-group differences in CRP level (p=0.04). Among intraoperative risk factors, duration of surgery (p=0.78), surgical approach (p=1.00), aponeurosis suturing technique (p=0.39) and stoma (p=0.71) did not significantly affect the incidence of abdominal wound dehiscence. In early postoperative period, abdominal wound dehiscence correlated with peritonitis (p=0.04), SSI (p<0.01) and redo laparotomy (p=0.02). CONCLUSION: Despite the variety of pre-, intra- and postoperative risk factors, only infectious postoperative complications (SSI, peritonitis) and redo surgical interventions influenced the development of abdominal wound dehiscence. Thus, the concept of abdominal wound dehiscence prevention should be inextricably associated with the concept of prevention of postoperative infectious complications from the abdominal wall and abdominal cavity.


Assuntos
Laparotomia/efeitos adversos , Peritonite/etiologia , Reoperação/efeitos adversos , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologia , Proteína C-Reativa/análise , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Fatores de Risco , Deiscência da Ferida Operatória/sangue
13.
BMC Infect Dis ; 20(1): 717, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993529

RESUMO

BACKGROUND: Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). CASE PRESENTATION: An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable. CONCLUSION: H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.


Assuntos
Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/diagnóstico , Peritonite/etiologia , Administração Intravenosa , Administração Oral , Idoso de 80 Anos ou mais , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Ásia , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Feminino , Histoplasmose/tratamento farmacológico , Histoplasmose/microbiologia , Humanos , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Falência Renal Crônica/terapia , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Resultado do Tratamento
14.
Nephrol Nurs J ; 47(4): 343-346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32830940

RESUMO

Peritoneal dialysis transfer sets (extension lines) are replaced every six to nine months to minimize peritoneal dialysis catheter complications. The aim of this study was to compare a revised non-bag transfer set exchange procedure with the standard bag exchange procedure on nursing time, costs, and safety. Thirty-three people were randomized to two groups - a standard bag exchange procedure group (n = 16) and a non-bag transfer set exchange procedure group (n = 17). The standard bag exchange procedure took a median of 32 minutes (interquartile range [IQR] 25 to 38 minutes) compared to the non-bag transfer set exchange procedure of 6 minutes (IQR 4 to 8 minutes) (p Ò 0.0001). There was one episode of peritonitis in each group within the 72-hour follow-up period. The average cost of the non-bag transfer set exchange procedure was $24.54 lower, a 37% cost reduction. This study has shown the revised non-bag transfer set replacement procedure appears to be safe, consume less participant and staff time, and decreases costs.


Assuntos
Diálise Peritoneal/métodos , Diálise Peritoneal/enfermagem , Cateterismo/efeitos adversos , Custos e Análise de Custo , Humanos , Pesquisa em Avaliação de Enfermagem , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/economia , Peritonite/etiologia , Peritonite/prevenção & controle , Resultado do Tratamento , Carga de Trabalho/estatística & dados numéricos
15.
Med Clin North Am ; 104(4): 647-662, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505258

RESUMO

Hospitalists often care for patients with liver disease, including those with acute liver injury and failure and patients with complications of decompensated cirrhosis. Acute liver failure is a true emergency, requiring intensive care and oftentimes transfer of the patient to a liver transplant center. Patients with decompensated cirrhosis have complications of portal hypertension, including variceal hemorrhage, ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy. These complications increase the risk of mortality among patients with decompensated cirrhosis. Comanagement by the hospitalist with gastroenterology/hepatology can optimize care, especially for patients being considered for liver transplant evaluation.


Assuntos
Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Cirrose Hepática/terapia , Falência Hepática Aguda/etiologia , Ascite/epidemiologia , Ascite/etiologia , Varizes Esofágicas e Gástricas/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Humanos , Hipertensão Portal/epidemiologia , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Falência Hepática Aguda/epidemiologia , Transplante de Fígado , Peritonite/epidemiologia , Peritonite/etiologia
16.
Zhonghua Gan Zang Bing Za Zhi ; 28(5): 372-376, 2020 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-32536050

RESUMO

The rare complications of cirrhosis, such as chylous ascites, hepatic hydrothorax, spontaneous bacterial peritonitis, cirrhotic cardiomyopathy, portopulmonary hypertension, cirrhotic nervous system damage, etc., have not yet been fully understood and/or promptly and effectively diagnosed and treated by clinicians. Therefore, this article aims to introduce the above-mentioned rare complications, clinical features, treatment and prognosis of liver cirrhosis in an attempt to improve the clinicians' understanding and level of diagnosis and treatment.


Assuntos
Infecções Bacterianas , Hidrotórax , Cirrose Hepática , Peritonite , Ascite/etiologia , Infecções Bacterianas/etiologia , Humanos , Hidrotórax/etiologia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/terapia , Peritonite/etiologia , Prognóstico
17.
J UOEH ; 42(2): 209-216, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32507844

RESUMO

Ventriculoperitoneal (VP) shunt placement is commonly performed for the treatment of hydrocephalus, and several complications of this procedure are well known. Radiating shoulder tip pain after VP shunt placement has been reported as an unusual complication in a few cases, associated with dislocation of the peritoneal catheter. We described the case of a 9-year-old girl who presented with recurrent radiating shoulder tip pain after VP shunt placement. The pain recurred after peritoneal catheter repositioning because of peritoneal inflammation and adhesion due to peritonitis with Propionibacterium acnes (P. acnes). This bacterium was isolated using 16S ribosomal RNA gene polymerase chain reaction (16S rRNA gene PCR), and anaerobic and prolonged culture tests. After antibacterial treatment, ventriculoarterial (VA) shunt placement was successfully performed. Hemidiaphragm irritation by the peritoneal catheter leads to radiating shoulder tip pain, and peritoneal inflammation and adhesion caused by infectious peritonitis may cause recurrence of this despite catheter repositioning. Clinicians should be aware of shoulder pain as a complication of VP shunt placement, and should consider VA shunt placement as an alternative treatment if this symptom recurs after catheter repositioning. Furthermore, 16S rRNA gene PCR and anaerobic and prolonged culture tests should be considered to detect P. acnes infection.


Assuntos
Dor Pós-Operatória/etiologia , Peritonite/etiologia , Peritonite/microbiologia , Propionibacterium acnes , Recidiva , Derivação Ventriculoperitoneal/efeitos adversos , Feminino , Humanos
18.
Khirurgiia (Mosk) ; (5): 20-26, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500685

RESUMO

OBJECTIVE: To evaluate the results of laparoscopic treatment of patients with advanced appendicular peritonitis. MATERIAL AND METHODS: There were 271 patients with acute appendicitis complicated by peritonitis. The main group consisted of patients who underwent laparoscopic appendectomy after diagnostic laparoscopy (n=231), the control group - diagnostic laparoscopy followed by conversion to median laparotomy (n=36). Four extremely ill patients were operated through laparotomy and excluded from the further analysis. RESULTS: Diagnostic laparoscopy was performed in 267 patients with advanced appendicular peritonitis. Laparoscopic appendectomy, debridement and abdominal drainage were performed in 231 (85.2%) patients. Mean age of patients was 44±18.5 years, duration of disease - 36.2±20.3 hours. Diffuse peritonitis was diagnosed in 219 (82%) patients, advanced peritonitis - in 48 (16.5%) cases. Incidence of conversion was 13.5%. Mortality was absent in both groups. Postoperative morbidity was significantly higher in the conversion group (72.2% vs. 29.4%, p<0.0001). CONCLUSION: Laparoscopic interventions for common appendicular peritonitis are feasible, effective and reduce postoperative morbidity.


Assuntos
Apendicite/cirurgia , Peritonite/cirurgia , Doença Aguda , Adulto , Apendicectomia , Apendicite/complicações , Desbridamento , Drenagem , Humanos , Laparoscopia , Pessoa de Meia-Idade , Peritonite/etiologia , Estudos Retrospectivos , Adulto Jovem
19.
Khirurgiia (Mosk) ; (5): 27-33, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500686

RESUMO

OBJECTIVE: To identify the most important high risk criteria for predicting course of disease, as well as optimal preoperative preparation and surgical strategy in patients with secondary peritonitis. MATERIAL AND METHODS: A prospective study enrolled 43 patients with diffuse secondary peritonitis. RESULTS: Significant predictors were Charlson's comorbidity index (p=0.001) and SOFA score of organ dysfunction within 3 days after admission. Rapid regression of organ dysfunction (SOFA1 - p=0.0001, SOFA2 - p=0.012, SOFA3 - p=0.017) and reduced time of examination and preoperative preparation (threshold value - 520 min after admission) are predictors of favorable outcome in patients with diffuse secondary peritonitis. There was no reliable correlation between the treatment outcome and preoperative preparation (infusion volume p=0.23, duration p=0.37, absence/presence of antibacterial therapy p=0.26). Elimination or control of infection is the fundamental principle of the management of patients with diffuse secondary peritonitis.


Assuntos
Peritonite/terapia , Sepse/terapia , Comorbidade , Hospitalização , Humanos , Escores de Disfunção Orgânica , Gravidade do Paciente , Peritonite/etiologia , Peritonite/cirurgia , Cuidados Pré-Operatórios , Prognóstico , Estudos Prospectivos , Sepse/etiologia , Sepse/cirurgia
20.
Gan To Kagaku Ryoho ; 47(4): 706-708, 2020 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-32389991

RESUMO

Previous studies have reported that perforations of the small intestine caused by metastatic tumors prior to the diagnosis of primary lung cancer are very rare. A 79-year-old man was admitted to our hospital with acute lower abdominal pain. Abdominal computed tomography revealed intraperitoneal free air around the bowel wall thickening in the small intestine. The patient was diagnosed with acute peritonitis caused by perforation of the small intestine, and an emergency operation was performed. Laparotomy revealed perforation in the jejunum without any palpable tumor in the abdomen. Partial resection of the jejunum revealed an ulcerating lesion at the perforation site. Histological examination indicated small intestinal metastasis secondary to lung adenocarcinoma. Positron emission tomography performed after discharge showed a small reticular opacity with intense accumulation of FDG in the left lung. The patient was diagnosed with perforation of the small intestine metastasis secondary to lung adenocarcinoma. The postoperative course was uneventful; the patient received chemotherapy, and is alive 6months after the operation.


Assuntos
Adenocarcinoma de Pulmão/secundário , Perfuração Intestinal/etiologia , Neoplasias Pulmonares , Peritonite , Idoso , Humanos , Intestino Delgado , Masculino , Peritonite/etiologia
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