RESUMEN
Pancreaticoduodenectomy (PD) is recognized as one of the most intricate abdominal surgical procedures, often accompanied by high morbidity rates. The occurrence of an anastomotic ulcer at the gastrojejunal anastomosis post-pancreaticoduodenectomy surgery is a relatively uncommon complication, albeit potentially leading to severe, life-threatening consequences. The predominant symptomatology manifests as acute abdominal pain accompanied by peritonitis. Conventionally, diagnosis is achieved through computed tomography (CT) scans, facilitating subsequent management, and surgical management is recommended in the majority of instances. Herein, we present a rare case of a patient who experienced ulcer perforation at the gastrojejunal anastomosis site after undergoing pancreaticoduodenectomy with stomach preservation, and we reviewed the available literature to gain more comprehension of this rare complication of this type of surgical intervention.
Asunto(s)
Anastomosis Quirúrgica , Pancreaticoduodenectomía , Tomografía Computarizada por Rayos X , Humanos , Pancreaticoduodenectomía/efectos adversos , Anastomosis Quirúrgica/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Dolor Abdominal/etiología , Masculino , Úlcera Péptica Perforada/cirugía , Úlcera Péptica Perforada/etiología , Peritonitis/etiología , Peritonitis/cirugía , Peritonitis/diagnóstico , Yeyuno/cirugía , Persona de Mediana Edad , Estómago/cirugíaRESUMEN
Background: Limited availability and side effects of opioids have led to an increased use of non-opioid analgesia in animal disease models. However, by affecting the immune-inflammatory reactions, analgesia may disrupt the resolution of the host inflammation and modulate the survival in septic animals. This study used a clinically relevant sepsis mouse model of peritoneal contamination and infection (PCI) to investigate the antinociceptive and anti-inflammatory properties of two non-opioid analgesics. Methods: Adult C57BL/6J mice were intraperitoneally injected with a human feces suspension and received either no analgesics (Non-A), Meloxicam, or Metamizole orally. The mice were monitored for pain and illness. Mortality was assessed at 7 days post-PCI. A separate group of mice was sacrificed 24 hours after infection. Blood, peritoneal lavage fluid (PLF), liver, and spleen were harvested for pathogen load quantification via qPCR, macrophage phenotyping, neutrophil infiltration/activation, and systemic/tissue cytokine release by flow cytometry. Results: Meloxicam but not Metamizole reduced the mortality of septic mice by 31% on day 7 compared to the Non-A group. Both analgesics effectively alleviated pain but did not affect illness severity, body weight, and temperature. Meloxicam quadrupled the bacterial burden in the blood and PLF. In high IL-6 responders, Meloxicam treatment was associated with reduced circulating IL-10 and IL-1ß compared to the Non-A septic group. In low IL-6 responders, Meloxicam increased circulating MCP-1 levels and decreased PGE2 levels compared to Non-A septic mice. Notably, Meloxicam reduced spleen neutrophil infiltration by 20% compared to two other sepsis groups. Conclusion: Metamizole and Meloxicam effectively relieved pain and increased the animals' basal activity in the PCI sepsis model. Meloxicam prolonged survival yet triggered maladaptive responses due to its immunosuppressive features that decreased tissue bacterial clearance during sepsis. In contrast, Metamizole constitutes a safe and effective non-opioid alternative for analgesic control in the non-surgical PCI sepsis model.
Asunto(s)
Dipirona , Modelos Animales de Enfermedad , Meloxicam , Ratones Endogámicos C57BL , Sepsis , Animales , Meloxicam/uso terapéutico , Sepsis/tratamiento farmacológico , Sepsis/inmunología , Sepsis/mortalidad , Dipirona/uso terapéutico , Dipirona/farmacología , Ratones , Analgésicos/uso terapéutico , Analgésicos/farmacología , Inmunomodulación/efectos de los fármacos , Antiinflamatorios no Esteroideos/uso terapéutico , Antiinflamatorios no Esteroideos/farmacología , Masculino , Citocinas/metabolismo , Citocinas/sangre , Peritonitis/tratamiento farmacológico , Peritonitis/inmunología , Peritonitis/microbiología , Peritonitis/mortalidad , HumanosRESUMEN
OBJECTIVE: Aim: To determine the effect of the developed complex treatment of patients with peritonitis on the dynamics of humoral factors of nonspecific reactivity in the course of the disease. PATIENTS AND METHODS: Materials and Methods: The study included 124 patients with toxic and terminal stages of peritonitis, who were divided into 3 groups. Group I (main) included 39 patients whose complex treatment included cytochrome C. Group II (main) included 41 patients whose complex treatment included cytochrome C and a solution containing levocarnitine and arginine hydrochloride. The comparison group comprised 44 patients who did not receive the specified drugs. The patients underwent determination of the levels of fibronectin, ceruloplasmin, and procalcitonin in the serum during the course of the disease. RESULTS: Results: In patients of the I and II main groups, the use of the proposed treatment contributed to the optimization of the production of acute phase proteins: a decrease in procalcitonin production during the study, optimization of ceruloplasmin and fibronectin production, especially in the II main group. In patients of the comparison group, decompensation in the production of humoral inflammatory factors was determined, associated with a significant increase in fibronectin production, a decrease in ceruloplasmin content, and an increase in procalcitonin throughout the entire period. CONCLUSION: Conclusions: The use of cytochrome C and a solution containing levocarnitine and arginine hydrochloride in the complex treatment of patients with disseminated peritonitis helps to optimize the production of acute phase proteins, which leads to a decrease in inflammation and the preservation of factors of nonspecific humoral activity at a subcompensated level.
Asunto(s)
Proteínas de Fase Aguda , Ceruloplasmina , Peritonitis , Polipéptido alfa Relacionado con Calcitonina , Humanos , Peritonitis/tratamiento farmacológico , Peritonitis/sangre , Femenino , Masculino , Persona de Mediana Edad , Ceruloplasmina/metabolismo , Proteínas de Fase Aguda/metabolismo , Polipéptido alfa Relacionado con Calcitonina/sangre , Fibronectinas/sangre , Citocromos c/sangre , Citocromos c/metabolismo , Periodo Posoperatorio , Arginina/sangre , Adulto , AncianoRESUMEN
OBJECTIVE: Aim: To evaluate the peculiarities of the course of complications and the provision of care for portal hypertension associated with the development of diureticresistant ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and variceal bleeding. PATIENTS AND METHODS: Materials and Methods: This research is based on a review of the literature in PubMed, CrossRef, Google Scholar sources on complicated portal hypertension. Such complications of portal hypertension as spontaneous bacterial peritonitis, ascites, hepatorenal sÑndrome, variceal bleeding caused by sinistral portal hypertension are considered. The effectiveness of interventional treatment methods and laparoscopic surgical interventions has been demonstrated. CONCLUSION: Conclusions: Diagnosis and treatment of patients with complicated portal hypertension requires a multidisciplinary approach, which is due to the diverse pathophysiological process of portal hypertension. The possibilities of providing emergency care to this category of patients depend on the level of medical training of the staff, the possibilities of medical and technical support in the provision of interventional care, the ineffectiveness of which necessitates surgical treatment using minimally invasive technologies.
Asunto(s)
Ascitis , Hipertensión Portal , Humanos , Hipertensión Portal/terapia , Hipertensión Portal/complicaciones , Ascitis/terapia , Ascitis/etiología , Síndrome Hepatorrenal/terapia , Síndrome Hepatorrenal/etiología , Síndrome Hepatorrenal/diagnóstico , Peritonitis/terapia , Peritonitis/etiología , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Servicios Médicos de Urgencia , Várices Esofágicas y Gástricas/terapia , Várices Esofágicas y Gástricas/etiologíaRESUMEN
Peritoneal dialysis-associated peritonitis is a serious complication of peritoneal dialysis, and the prevention and treatment of this condition are important for improving the long-term survival and quality of life of patients. However, peritoneal dialysis-associated peritonitis due to Mycobacterium tuberculosis infection is relatively rare and not easily diagnosed. Here, we present a case of peritoneal dialysis-associated peritonitis caused by Mycobacterium tuberculosis identified by pathogenic microbial DNA high-throughput genetic sequencing. This case demonstrates that pathogenic microbial DNA high-throughput genetic sequencing could be used to improve the detection rate of pathogenic microorganisms in patients with complex conditions, thereby allowing for earlier initiation of treatment.
Asunto(s)
ADN Bacteriano , Secuenciación de Nucleótidos de Alto Rendimiento , Mycobacterium tuberculosis , Diálisis Peritoneal , Peritonitis Tuberculosa , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Diálisis Peritoneal/efectos adversos , ADN Bacteriano/análisis , Peritonitis Tuberculosa/diagnóstico , Masculino , Peritonitis/microbiología , Peritonitis/diagnóstico , Persona de Mediana Edad , FemeninoRESUMEN
The penetration of a peritoneal dialysis catheter into the intestinal cavity is a clinically rare complication. In the present retrospective clinical case series, 11 patients with uraemia who received continuous ambulatory peritoneal dialysis and attended hospital between 2019 and 2023 are described. The median patient age was 61.91 ± 11.33 years. All patients had previously experienced peritoneal dialysis-related peritonitis and were clinically cured by infusing sensitive antibiotics into the abdominal cavity. Colonoscopy was utilised to locate the penetrating catheter and close the perforation with a titanium clip once the catheter had been removed via an external approach. Following a 2-4-week fast, the perforations healed in all 11 patients. The present authors' experience illustrates that directly removing the catheter and clamping the perforation opening under the guidance of colonoscopy is simple to operate with few complications compared with traditional open surgery.
Asunto(s)
Diálisis Peritoneal Ambulatoria Continua , Humanos , Persona de Mediana Edad , Masculino , Femenino , Anciano , Estudios Retrospectivos , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Diálisis Peritoneal Ambulatoria Continua/instrumentación , Catéteres de Permanencia/efectos adversos , Colonoscopía/métodos , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Peritonitis/etiología , Peritonitis/diagnóstico , Diálisis Peritoneal/instrumentación , Diálisis Peritoneal/efectos adversos , AdultoRESUMEN
BACKGROUND: Peritoneal dialysis (PD) is a home-based kidney replacement therapy (KRT) performed in people with kidney failure. PD can be performed by manual filling and draining of the abdominal cavity, i.e. continuous ambulatory PD (CAPD), or using a device connected to the PD catheter that is programmed to perform PD exchanges, i.e. automated PD (APD). APD is considered to have several advantages over CAPD, such as a lower incidence of peritonitis, fewer mechanical complications, and greater psychosocial acceptability. Acknowledging the increasing uptake of APD in incident and prevalent patients undergoing PD, it is important to re-evaluate the evidence on the comparative clinical and patient-reported outcomes of APD compared to CAPD. This is an update of a Cochrane review published in 2007. OBJECTIVES: To compare clinical and patient-reported outcomes of APD to CAPD in people with kidney failure. SEARCH METHODS: In this update, we searched the Cochrane Kidney and Transplant Register of Studies until 29 August 2024. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing APD with CAPD in adults (≥ 18 years) with kidney failure. DATA COLLECTION AND ANALYSIS: Two authors independently screened the search results and extracted data. Data synthesis was performed using random-effects meta-analyses, expressing effect estimates as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data and mean differences (MD) with 95% CIs for continuous data. Certainty in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: Two RCTs (131 randomised people) comparing APD with CAPD were included in this update. One RCT had a follow-up of six months, and one RCT had a follow-up of 24 months. The risk of bias in the included studies was mostly low, except for the high risk of performance bias for subjective outcomes. The evidence is very uncertain about the effect of APD compared to CAPD on death, hospitalisations, PD-related peritonitis, change of dialysis modality, residual kidney function, health-related quality of life (HRQoL), overhydration, blood pressure, exit-site infections, tunnel infections, mechanical complications, PD catheter removal, or dialysis adequacy measures. These results were largely based on low to very low certainty evidence; hence, caution is warranted when drawing conclusions. AUTHORS' CONCLUSIONS: Insufficient evidence exists to decide between APD and CAPD in kidney failure patients with regard to clinical and patient-reported outcomes. Therefore, current evidence is insufficient as a guide for clinical practice. Given that the sample sizes of existing studies are generally small with insufficient follow-up, there is a need for large-scale, multicentre studies. Future research should focus on possible differences between APD and CAPD in residual kidney function, euvolaemia, and patient-reported outcomes such as HRQoL, symptoms, patient satisfaction and life participation.
Asunto(s)
Diálisis Peritoneal Ambulatoria Continua , Diálisis Peritoneal , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Diálisis Peritoneal/métodos , Peritonitis/etiología , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , Insuficiencia Renal/terapia , Sesgo , Medición de Resultados Informados por el Paciente , Adulto , AutomatizaciónRESUMEN
BACKGROUND: Incremental peritoneal dialysis (IPD) refers to the use of less than standard full-dose peritoneal dialysis (SPD) in end-stage renal disease patients. While the use of IPD is being reported in the literature, its safety and efficacy vs. SPD is unclear. We hereby performed a systematic review of studies comparing mortality, peritonitis, technique survival, anuria-free survival and residual renal function (RRF) between IPD and SPD. METHODS: All comparative studies published on PubMed, Embase, CENTRAL, Scopus, and Web of Science databases from inception to 5th September 2023 and reporting on given outcomes were eligible. RESULTS: Ten studies were included. Definitions of IPD were heterogenous and hence mostly a qualitative synthesis was undertaken. Majority of studies found no difference in patient survival between IPD and SPD. Meta-analysis of crude mortality data also presented no significant difference. Peritonitis and technique survival were also not significantly different between IPD and SPD in the majority of studies. Data on RRF was conflicting. Some studies showed that IPD was associated with the preservation of RRF while others found no such difference. CONCLUSION: IPD may be a safe alternative to SPD in incident dialysis patients. There seems to be no difference in patient survival, peritonitis, and technique survival between the two modalities. However, the impact of IPD on RRF is still questionable. Evidence is heterogeneous and conflicting to derive firm conclusions.
Asunto(s)
Fallo Renal Crónico , Diálisis Peritoneal , Peritonitis , Humanos , Fallo Renal Crónico/terapia , Fallo Renal Crónico/mortalidad , Peritonitis/etiología , Resultado del Tratamiento , Tasa de Supervivencia , Anuria/terapiaRESUMEN
Peritonitis is a common and life-threatening inflammatory disease. Myeloid cells are elevated in the peripheral blood and contribute to peritonitis, but their circulating dynamics are not clear. In vivo flow cytometry (IVFC) is a noninvasive technique for monitoring the dynamics of circulating cells in live animals. It has been extensively used to detect circulating tumor cells, but rarely for monitoring immune cells. Here, we describe a method adapting an intravital microscope for IVFC so that we can monitor LysM-EGFP-labeled circulating myeloid cells in a tumor necrosis factor (TNF) α-induced peritonitis mouse model. Using this IVFC method, we quantified the blood flow velocity and cell concentration in circulation. We observed a significant increase in LysM-EGFP+ cells in circulation after TNFα intraperitoneal (i.p.) injection, which reached a plateau in ~20 min. Conventional cytometry analysis showed that most LysM-EGFP+ cells were neutrophils. Increasing blood neutrophils were accompanied by neutrophil recruitment to the peritoneal cavity and neutrophil emigration from the bone marrow. We then monitored neutrophil CD64 expression in vivo and found a significant increase in TNFα-induced peritonitis. We also found that CD18 blockade doubled the circulating neutrophil number in TNFα-induced peritonitis, suggesting that CD18 is critical for neutrophil recruitment in peritonitis. Overall, we demonstrate that IVFC techniques are useful for studying the circulating dynamics of immune cells during inflammatory diseases.
Asunto(s)
Citometría de Flujo , Células Mieloides , Peritonitis , Factor de Necrosis Tumoral alfa , Animales , Peritonitis/inducido químicamente , Peritonitis/sangre , Citometría de Flujo/métodos , Ratones , Factor de Necrosis Tumoral alfa/metabolismo , Factor de Necrosis Tumoral alfa/sangre , Células Mieloides/metabolismo , Neutrófilos/metabolismo , Ratones Endogámicos C57BL , Modelos Animales de Enfermedad , Proteínas Fluorescentes Verdes/metabolismo , Proteínas Fluorescentes Verdes/genéticaRESUMEN
PURPOSE: Bioactive molecules are relevant to fight cancer and associated conditions. Quinoxaline is a privileged N-heterocycle, notably as anticancer agents. Herein, we report the evaluation of the quinoxaline derivatives DEQX and OAQX as anticancer agents, as well as in function of their anti-inflammatory and analgesic activities. METHODS: Quinoxalines were synthesized and tested as anticancer agents based on cell viability and Annexin V-FITC apoptosis. Anti-inflammatory activity was evaluated from mouse carrageenan peritonitis and levels of interleukin (IL)-1ß and tumor necrosis factor (TNF)-alfa for enzyme-linked immunosorbent assay. Hot-plate and acetic acid-induced writing test were employed to investigate analgesia. RESULTS: Both reduced the Ht-29 cell viability in a dependent-concentration manner (p < 0.001). Total apoptosis was detected for cells treated with 12.5 and 25 µg/mL of both the compounds for 24 and 48 h (all doses, p < 0.0001). DEQX (all doses, p < 0.01) and OAQX (all doses, p < 0.001) acted in leukocyte migration and decreased the IL-1ß and TNF-ß levels (p < 0.05). DEQX (all doses, p < 0.05) and OAQX (5mg/kg, p < 0.001) showed peripheral analgesic effect. CONCLUSIONS: In-vitro and in-vivo results suggest that these quinoxalines are promising for application in pharmacological area due to their anticancer, anti-inflammatory, and peripheric analgesia.
Asunto(s)
Analgésicos , Antiinflamatorios , Antineoplásicos , Apoptosis , Supervivencia Celular , Quinoxalinas , Animales , Quinoxalinas/farmacología , Quinoxalinas/uso terapéutico , Analgésicos/farmacología , Analgésicos/uso terapéutico , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéutico , Antineoplásicos/farmacología , Ratones , Apoptosis/efectos de los fármacos , Humanos , Supervivencia Celular/efectos de los fármacos , Interleucina-1beta/metabolismo , Factor de Necrosis Tumoral alfa/análisis , Masculino , Células HT29 , Ensayo de Inmunoadsorción Enzimática , Peritonitis/tratamiento farmacológicoRESUMEN
Neutrophil extracellular traps (NETs) function to control infectious agents as well as to propagate inflammatory response in a variety of disease conditions. DNA damage associated with chromatin decondensation and NACHT domain-leucine-rich repeat-and pyrin domain-containing protein 3 (NLRP3) inflammasome activation have emerged as crucial events in NET formation, but the link between the two processes is unknown. In this study, we demonstrate that poly(ADP-ribose) polymerase-1 (PARP-1), a key DNA repair enzyme, regulates NET formation triggered by NLRP3 inflammasome activation in neutrophils. Activation of mouse neutrophils with canonical NLRP3 stimulants LPS and nigericin induced NET formation, which was significantly abrogated by pharmacological inhibition of PARP-1. We found that PARP-1 is required for NLRP3 inflammasome assembly by regulating post-transcriptional levels of NLRP3 and ASC dimerization. Importantly, this PARP-1-regulated NLRP3 activation for NET formation was independent of inflammasome-mediated pyroptosis, because caspase-1 and gasdermin D processing as well as IL-1ß transcription and secretion remained intact upon PARP-1 inhibition in neutrophils. Accordingly, pharmacological inhibition or genetic ablation of caspase-1 and gasdermin D had no effect on NLRP3-mediated NET formation. Mechanistically, PARP-1 inhibition increased p38 MAPK activity, which was required for downmodulation of NLRP3 and NETs, because concomitant inhibition of p38 MAPK with PARP-1 restored NLRP3 activation and NET formation. Finally, mice undergoing bacterial peritonitis exhibited increased survival upon treatment with PARP-1 inhibitor, which correlated with increased leukocyte influx and improved intracellular bacterial clearance. Our findings reveal a noncanonical pyroptosis-independent role of NLRP3 in NET formation regulated by PARP-1 via p38 MAPK, which can be targeted to control NETosis in inflammatory diseases.
Asunto(s)
Trampas Extracelulares , Inflamasomas , Proteína con Dominio Pirina 3 de la Familia NLR , Neutrófilos , Poli(ADP-Ribosa) Polimerasa-1 , Piroptosis , Animales , Proteína con Dominio Pirina 3 de la Familia NLR/metabolismo , Trampas Extracelulares/metabolismo , Ratones , Poli(ADP-Ribosa) Polimerasa-1/metabolismo , Inflamasomas/metabolismo , Neutrófilos/metabolismo , Neutrófilos/inmunología , Ratones Endogámicos C57BL , Nigericina/farmacología , Ratones Noqueados , Peritonitis/metabolismo , Peritonitis/inmunología , Lipopolisacáridos/farmacología , Caspasa 1/metabolismoRESUMEN
The NLRP3 inflammasome is a multiprotein complex that is a component of the innate immune system, involved in the production of pro-inflammatory cytokines. Its abnormal activation is associated with many inflammatory diseases. In this study, we designed and synthesized a series of NLRP3 inflammasome inhibitors based on pyridazine scaffolds. Among them, P33 exhibited significant inhibitory effects against nigericin-induced IL-1ß release in THP-1 cells, BMDMs, and PBMCs, with IC50 values of 2.7, 15.3, and 2.9 nM, respectively. Mechanism studies indicated that P33 directly binds to NLRP3 protein (KD = 17.5 nM), inhibiting NLRP3 inflammasome activation and pyroptosis by suppressing ASC oligomerization during NLRP3 assembly. Additionally, P33 displayed excellent pharmacokinetic properties, with an oral bioavailability of 62%. In vivo efficacy studies revealed that P33 significantly ameliorated LPS-induced septic shock and MSU crystal-induced peritonitis in mice. These results indicate that P33 has great potential for further development as a candidate for treating NLRP3 inflammasome-mediated diseases.
Asunto(s)
Inflamasomas , Proteína con Dominio Pirina 3 de la Familia NLR , Peritonitis , Piridazinas , Choque Séptico , Proteína con Dominio Pirina 3 de la Familia NLR/antagonistas & inhibidores , Proteína con Dominio Pirina 3 de la Familia NLR/metabolismo , Peritonitis/tratamiento farmacológico , Animales , Choque Séptico/tratamiento farmacológico , Humanos , Inflamasomas/antagonistas & inhibidores , Inflamasomas/metabolismo , Ratones , Piridazinas/química , Piridazinas/farmacología , Piridazinas/farmacocinética , Piridazinas/síntesis química , Piridazinas/uso terapéutico , Administración Oral , Masculino , Ratones Endogámicos C57BL , Células THP-1 , Relación Estructura-Actividad , Descubrimiento de Drogas , Interleucina-1beta/metabolismo , Interleucina-1beta/antagonistas & inhibidores , Lipopolisacáridos/farmacologíaRESUMEN
Pseudomyxoma peritonei (PMP) is a rare neoplastic condition characterised by gelatinous ascites, which generally arise from mucin-producing appendiceal tumours. Presentation is variable but requires prompt recognition to ensure appropriate specialist management due to risk of malignancy.A male in his 40s presented with a 1-day history of sudden onset, non-migratory abdominal pain, worse in the right iliac fossa. He had no significant medical history nor known drug allergies. Examination revealed right iliac fossa peritonism and blood tests revealed raised inflammatory markers. CT scan showed a right-sided abdominal collection. Intraoperatively, a diagnostic laparoscopy was performed, which revealed extensive mucin in the abdominal cavity. This was washed out and a laparoscopic appendectomy was performed; histopathology confirmed PMP from the ruptured appendix.
Asunto(s)
Neoplasias Peritoneales , Peritonitis , Seudomixoma Peritoneal , Tomografía Computarizada por Rayos X , Humanos , Masculino , Seudomixoma Peritoneal/diagnóstico , Seudomixoma Peritoneal/cirugía , Seudomixoma Peritoneal/complicaciones , Peritonitis/diagnóstico , Peritonitis/cirugía , Peritonitis/etiología , Neoplasias Peritoneales/diagnóstico , Neoplasias Peritoneales/cirugía , Neoplasias Peritoneales/complicaciones , Adulto , Apendicectomía , Laparoscopía , Dolor Abdominal/etiología , Neoplasias del Apéndice/diagnóstico , Neoplasias del Apéndice/cirugía , Neoplasias del Apéndice/complicaciones , Diagnóstico DiferencialRESUMEN
RATIONALE: Complications after endoscopic retrograde cholangiopancreatography (ERCP) are diverse and usually treated with nonoperative management or percutaneous drainage; however, there are still some rare, life-threatening complications. This is an extremely rare case of biliary peritonitis caused by rupture of the intrahepatic bile duct after ERCP. PATIENT CONCERNS: A 63-year-old male underwent ERCP for common bile duct stones. On the second day after the procedure, the patient developed sepsis and abdominal distention. Contrast-enhanced computed tomography revealed a subcapsular hepatic fluid collection attached to the bile duct of segment VII. DIAGNOSES: Sepsis resulted in liver parenchyma rupture and intrahepatic bile duct injury after ERCP. Intraoperative cholangiography revealed a connection between a hole in the liver parenchymal surface and the intrahepatic bile duct. INTERVENTIONS: Surgeons performed the cholecystectomy, inserted a T-tube into the common bile duct stones, sutured the defect, and put 2 drainage tubes around the lesion. OUTCOMES: Postoperative recovery was uneventful, and the patient was discharged on the 17th postoperative day. LESSONS: Intrahepatic bile duct perforation after ERCP can lead to rupture of the liver parenchyma, biloma, or abdominal peritonitis. Multidisciplinary management is necessary to achieve favorable outcomes.
Asunto(s)
Conductos Biliares Intrahepáticos , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Masculino , Persona de Mediana Edad , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Conductos Biliares Intrahepáticos/cirugía , Conductos Biliares Intrahepáticos/diagnóstico por imagen , Cálculos Biliares/cirugía , Complicaciones Posoperatorias/etiología , Peritonitis/etiología , Peritonitis/cirugía , Tomografía Computarizada por Rayos X , Drenaje/métodos , Rotura/etiología , Rotura/cirugíaRESUMEN
BACKGROUND: Spontaneous bacterial peritonitis (SBP) represents a critical and potentially lethal condition that typically develops in individuals with liver cirrhosis. This meta-analysis aimed to assess diabetes mellitus (DM) as a risk factor for SBP in liver cirrhotic patients. METHODS: Following PRISMA guidelines, fifteen studies were included, for a total of 76 815 patients. The risk of bias was assessed using the Newcastle-Ottawa scale (NOS). We represented the results as risk ratios (RR) with the corresponding 95% confidence intervals (CI) using RevMan software. Additionally, we pooled the hazard ratios (HR) for developing SBP in patients with DM from the included studies. RESULTS: The meta-analysis shows a significantly increased risk of SBP in cirrhotic patients with DM (HR: 1.26; 95% CI [1.05-1.51], P=.01; HR: 1.70; 95% CI [1.32-2.18], P<.001). CONCLUSIONS: The study signifies that DM is an independent risk factor for SBP, emphasizing the need for targeted preventive measures in this specific population.
Asunto(s)
Infecciones Bacterianas , Cirrosis Hepática , Peritonitis , Humanos , Peritonitis/microbiología , Peritonitis/epidemiología , Peritonitis/etiología , Cirrosis Hepática/complicaciones , Factores de Riesgo , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/complicaciones , Diabetes Mellitus/epidemiología , Complicaciones de la Diabetes/epidemiologíaRESUMEN
AIM: In terms of early-term mortality, there may be variability in terms of factors belonging to age groups. While some risk factors apply to all patients undergoing colorectal cancer surgery, some factors may come to the fore in terms of age. There have been very few studies on factors that increase the risk of early-term mortality, especially for geriatric patients. It was aimed to compare factors influencing prognosis and mortality within the first 30 postoperative days between geriatric patients and those <65 years of age, and to identify factors that increase the risk of anastomotic leakage and early-term mortality, particularly in geriatric patients. METHODS: Clinical, laboratory, and pathology findings from 341 patients (186 geriatric) who underwent surgery for colorectal cancer between January 2016 and December 2019 were collected and analyzed. In terms of categorical variables, comparisons between groups were made with Pearson's Chi Square test and Fisher's Exact Test. Risk coefficients of variables in terms of anastomotic leakage and early-term mortality were determined by logistic regression analysis. The results were evaluated within the 95% Confidence interval, and p < 0.05 values were considered significant. RESULTS: Anastomotic leakage was detected in 7% of patients, and 6.2% of the patients died within the first 30 postoperative days. The 30-day postoperative mortality rate was significantly higher in geriatric patients with hypertension (p = 0.003), those undergoing emergency surgery (p = 0.007), those with stage 4 tumors (p < 0.001), those with ostomy-related complications (p = 0.042), those who developed intraabdominal abscess or peritonitis (p < 0.001), those with respiratory failure (p = 0.009), and those with perforation (p = 0.001). In patients <65 years of age, groups stratified by these variables did not differ significantly in terms of early-term mortality rate (p > 0.05 for each). CONCLUSIONS: These findings show that lack of bowel preparation and development of intraabdominal abscess/peritonitis significantly increase early-term mortality rates in both <65 and geriatric patients. Additionally, hypertension, emergency surgery, advanced tumor stage, development of ostomy-related complications, respiratory failure, and perforation significantly increase early-term mortality solely in geriatric patients.
Asunto(s)
Fuga Anastomótica , Neoplasias Colorrectales , Humanos , Fuga Anastomótica/etiología , Fuga Anastomótica/epidemiología , Fuga Anastomótica/mortalidad , Anciano , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/mortalidad , Masculino , Femenino , Factores de Riesgo , Persona de Mediana Edad , Factores de Edad , Anciano de 80 o más Años , Estudios Retrospectivos , Factores de Tiempo , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/epidemiología , Pronóstico , Hipertensión/complicaciones , Peritonitis/mortalidad , Peritonitis/etiología , Absceso Abdominal/etiología , Absceso Abdominal/mortalidadRESUMEN
Background and Objectives: Spontaneous bacterial peritonitis (SBP) is a life-threatening disease that requires early diagnosis and treatment. It is known that a positive culture result for SBP, which is a common reason for admission to the emergency department, is related to the severity and prognosis of the disease. However, as it is not possible to determine the culture result in the early stage of the disease, different methods are required to predict prognosis in the emergency department. This study was conducted to evaluate the success of the SII, SIRI, NLR and PLR in predicting culture results, intensive care needs and mortality in patients with SBP admitted to the emergency department. Materials and Methods: This study was a retrospective, observational study. Patients with SBP who applied to the emergency department were included in this study. Pregnant women, patients with a malignancy, patients with another infection and patients with liver failure were excluded from this study. Data were analyzed in terms of culture results, the need for intensive care and mortality development. Analyses were performed using SPSS version 26. Results are presented with a 95% confidence interval. A p value less than 0.05 was considered statistically significant. Participant data were analyzed using the independent samples t-test or the Mann-Whitney U test based on normality, and ROC analyses were conducted to assess test accuracies and determine cut-off values. Results: A total of 275 patients were included in this study. Although the culture results of 183 patients were positive, 92 were negative. The SII, NLR and PLR were found to be significantly higher in culture-positive patients (p < 0.001, p = 0.013 and p = 0.002, respectively). The SII and NLR were found to be significantly higher in patients with high mortality (p < 0.001 and p = 0.017, respectively). Conclusions: This study showed that the SII, NLR and PLR may be useful in predicting culture positivity and prognosis in SBP patients in the emergency department.
Asunto(s)
Servicio de Urgencia en Hospital , Linfocitos , Neutrófilos , Peritonitis , Humanos , Femenino , Estudios Retrospectivos , Masculino , Peritonitis/microbiología , Peritonitis/sangre , Peritonitis/inmunología , Persona de Mediana Edad , Pronóstico , Adulto , Anciano , Plaquetas , Valor Predictivo de las Pruebas , Infecciones Bacterianas/sangre , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/mortalidad , Curva ROC , Inflamación/sangreRESUMEN
PURPOSE: Peritoneal infection, due to anastomotic leakage, after resection for colorectal cancer have been shown to associate with increased cancer recurrence and mortality, as well as cardiovascsular morbidity. Alterations in circulating protein levels could help shed light on the underlying mechanisms, prompting this exploratory study of 64 patients operated for colorectal cancer with anastomosis. METHODS: Thirty-two cases who suffered a postoperative peritoneal infection were matched with 32 controls who had a complication-free postoperative stay. Proteins in serum samples at their first postoperative visit and at one year after surgery were analysed using proximity extension assays and enzyme-linked immunosorbent assays. Multivariate projection methods, adjusted for multiple testing, were used to compare levels between groups, and enrichment and network analyses were performed. RESULTS: Seventy-seven proteins, out of 270 tested, were differentially expressed at a median sampling time of 41 days postoperatively. These proteins were all normalised one year after surgery. Many of the differentially expressed top hub proteins have known involvement in cancer progression, survival, invasiveness and metastasis. Over-represented pathways were related to cardiomyopathy, cell-adhesion, extracellular matrix, phosphatidylinositol-3-kinase/Akt (PI3K-Akt) and transforming growth factor beta (TGF-ß) signaling. CONCLUSION: These affected proteins and pathways could provide clues as to why patients with peritoneal infection might suffer increased cancer recurrence, mortality and cardiovascular morbidity.
Asunto(s)
Neoplasias Colorrectales , Humanos , Masculino , Femenino , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/patología , Anciano , Persona de Mediana Edad , Peritonitis/sangre , Peritonitis/cirugía , Peritonitis/etiología , Estudios de Casos y Controles , Fuga Anastomótica/sangre , Fuga Anastomótica/etiología , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Colectomía/efectos adversosRESUMEN
The characteristic feature of chronic peritoneal damage in peritoneal dialysis (PD) is a decline in ultrafiltration capacity associated with pathological fibrosis and angiogenesis. The pathogenesis of peritoneal fibrosis is attributed to bioincompatible factors of PD fluid and peritonitis. Uremia is associated with peritoneal membrane inflammation that affects fibrosis, neoangiogenesis, and baseline peritoneal membrane function. Net ultrafiltration volume is affected by capillary surface area, vasculopathy, peritoneal fibrosis, and lymphangiogenesis. Many inflammatory cytokines induce fibrogenic growth factors, with crosstalk between macrophages and fibroblasts. Transforming growth factor (TGF)-ß and vascular endothelial growth factor (VEGF)-A are the key mediators of fibrosis and angiogenesis, respectively. Bioincompatible factors of PD fluid upregulate TGF-ß expression by mesothelial cells that contributes to the development of fibrosis. Angiogenesis and lymphangiogenesis can progress during fibrosis via TGF-ß-VEGF-A/C pathways. Complement activation occurs in fungal peritonitis and progresses insidiously during PD. Analyses of the human peritoneal membrane have clarified the mechanisms by which encapsulating peritoneal sclerosis develops. Different effects of dialysates on the peritoneal membrane were also recognized, particularly in terms of vascular damage. Understanding the pathophysiologies of the peritoneal membrane will lead to preservation of peritoneal membrane function and improvements in technical survival, mortality, and quality of life for PD patients.
Asunto(s)
Diálisis Peritoneal , Fibrosis Peritoneal , Peritoneo , Humanos , Diálisis Peritoneal/efectos adversos , Fibrosis Peritoneal/etiología , Fibrosis Peritoneal/patología , Fibrosis Peritoneal/metabolismo , Peritoneo/patología , Peritoneo/metabolismo , Factor de Crecimiento Transformador beta/metabolismo , Animales , Neovascularización Patológica , Factor A de Crecimiento Endotelial Vascular/metabolismo , Peritonitis/etiología , Peritonitis/patología , Peritonitis/metabolismoRESUMEN
We present gallbladder rupture following trauma. A 9-year-old boy admitted in 1.5 hours after injury. Considering clinical and ultrasound data, we diagnosed traumatic damage to the spleen and hemoperitoneum, biliary dyskinesia, cholestasis, sludge. Hemostatic therapy was carried out. After 3 days, signs of peritonitis appeared. Follow-up ultrasound revealed gallbladder enlargement with heterogeneous content, fluid in all parts of abdominal cavity. Intraoperatively, the gallbladder was enveloped in omentum soaked in bile. After mobilization of the gallbladder, we found longitudinal linear tear up to 3 cm clogged with omentum. Cholecystectomy was performed. Thus, we present a patient with combined injury and damage to the spleen. However, gallbladder wall thickening and heterogeneous content were interpreted as concomitant pathology. Delayed manifestation of peritonitis was due to gallbladder enveloped in omentum. The last one soaked in bile partially entered the gallbladder through perforation and prevented bile leakage into abdominal cavity. Timely diagnosis of gallbladder damage presents certain difficulties, especially in case of combined injury. Ultrasound signs of traumatic gallbladder rupture in this case were wall thickening, heterogeneous content and gradual gallbladder enlargement. It is necessary to analyze all organs at the damage site including computed tomography in patients with combined trauma.