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Sample records for intra-abdominal pressure hepatic

  1. Intra-abdominal pressure during swimming.

    Science.gov (United States)

    Moriyama, S; Ogita, F; Huang, Z; Kurobe, K; Nagira, A; Tanaka, T; Takahashi, H; Hirano, Y

    2014-02-01

    The present study aimed to determine the intra-abdominal pressure during front crawl swimming at different velocities in competitive swimmers and to clarify the relationships between stroke indices and changes in intra-abdominal pressure. The subjects were 7 highly trained competitive collegiate male swimmers. Intra-abdominal pressure was measured during front crawl swimming at 1.0, 1.2 and 1.4 m · s(-1) and during the Valsalva maneuver. Intra-abdominal pressure was taken as the difference between minimum and maximum values, and the mean of 6 stable front crawl stroke cycles was used. Stroke rate and stroke length were also measured as stroke indices. There were significant differences in stroke rate among all velocities (P swimming velocity. These findings do not appear to support the effectiveness of trunk training performed by competitive swimmers aimed at increasing intra-abdominal pressure. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Intra-abdominal pressure: an integrative review.

    Science.gov (United States)

    Milanesi, Rafaela; Caregnato, Rita Catalina Aquino

    2016-01-01

    There is a growing request for measuring intra-abdominal pressure in critically ill patients with acute abdominal pain to be clarified. Summarizing the research results on measurement of vesical intra-abdominal pressure and analyzing the level of evidence were the purposes of this integrative literature review, carried out based on the databases LILACS, MEDLINE and PubMed, from 2005 to July 2012. Twenty articles were identified, in that, 12 literature reviews, 4 descriptive and exploratory studies, 2 expert opinions, one prospective cohort study and one was an experience report. The vesical intra-abdominal pressure measurement was considered gold standard. There are variations in the technique however, but some common points were identified: complete supine position, in absence of abdominal contracture, in the end of expiration and expressed in mmHg. Most research results indicate keeping the transducer zeroed at the level of the mid-axillary line at the iliac crest level, and instill 25mL of sterile saline. Strong evidence must be developed. RESUMO Em pacientes críticos com quadros abdominais agudos a esclarecer é crescente a solicitação da aferição da pressão intra-abdominal. Sintetizar resultados de pesquisas sobre a mensuração da pressão intra-abdominal pela via vesical e analisar o nível de evidência foram os objetivos desta revisão integrativa da literatura, realizada nas bases LILACS, MEDLINE e PubMed, no período de 2005 a julho de 2012. Identificaram-se 20 artigos, sendo 12 revisões de literatura, 4 estudos exploratório-descritivos, 2 opiniões de especialistas, 1 estudo de coorte prospectivo e 1 relato de experiência. O método vesical para mensuração da pressão intra-abdominal foi considerado padrão-ouro. Existem variações na técnica, entretanto pontos em comum foram identificados: posição supina completa, na ausência de contratura abdominal, ao final da expiração e expressa em mmHg. A maioria indica posicionar o ponto zero do

  3. Negative pressure device for intra-abdominal pressure reduction

    Energy Technology Data Exchange (ETDEWEB)

    David, M; Geido, D; Pracca, F; Sanchez, G; Simini, F; Zoppolo, C [Nucleo de Ingenierfa Biomedica, Universidad de la Republica O. del Uruguay, Hospital de ClInicas, Av. Italia S/N, 11600, Montevideo (Uruguay)

    2007-11-15

    A device that generates negative extra-abdominal pressure (ABDOPRE) for treatment of patients with high intra-abdominal pressure was developed. It includes pressure sensors for transducing intra-abdominal pressure through an intra-vesical catheter and negative pressure in the vacuum bell which is placed over the abdomen. By means of a control system, a pattern for reducing IAP is set, according to a clinical protocol. The external negative pressure is generated using a vacuum pump connected to the bell. The system registers the values of interest for the medical history. The system is being tested over ICU patients, registering a satisfactory IAP reduction.

  4. abdominal pressure monitoring in varying intra- abdominal ...

    African Journals Online (AJOL)

    TV measurements were achieved using a manual manometer system with a Foley ... relatedness. As the test subjects were organised into related groups, we used intra- .... air before instillation of fluid, contractility of the muscular stomach wall, an exit ... TV techniques both have utility in the clinical setting, with TG pressure.

  5. A user's guide to intra-abdominal pressure measurement.

    LENUS (Irish Health Repository)

    Sugrue, Michael

    2015-01-01

    The intra-abdominal pressure (IAP) measurement is a key to diagnosing and managing critically ill medical and surgical patients. There are an increasing number of techniques that allow us to measure the IAP at the bedside. This paper reviews these techniques. IAP should be measured at end-expiration, with the patient in the supine position and ensuring that there is no abdominal muscle activity. The intravesicular IAP measurement is convenient and considered the gold standard. The level where the mid-axillary line crosses the iliac crest is the recommended zero reference for the transvesicular IAP measurement; moreover, marking this level on the patient increases reproducibility. Protocols for IAP measurement should be developed for each ICU based on the locally available tools and equipment. IAP measurement techniques are safe, reproducible and accurate and do not increase the risk of urinary tract infection. Continuous IAP measurement may offer benefits in specific situations in the future. In conclusion, the IAP measurement is a reliable and essential adjunct to the management of patients at risk of intra-abdominal hypertension.

  6. Intra-abdominal pressure correlates with extracellular water content.

    Directory of Open Access Journals (Sweden)

    Wojciech Dąbrowski

    Full Text Available Secondary increase in intra-abdominal pressure (IAP may result from extra-abdominal pathology, such as massive fluid resuscitation, capillary leak or sepsis. All these conditions increase the extravascular water content. The aim of this study was to analyze the relationship between IAP and body water volume.Adult patients treated for sepsis or septic shock with acute kidney injury (AKI and patients undergoing elective pharyngolaryngeal or orthopedic surgery were enrolled. IAP was measured in the urinary bladder. Total body water (TBW, extracellular water content (ECW and volume excess (VE were measured by whole body bioimpedance. Among critically ill patients, all parameters were analyzed over three consecutive days, and parameters were evaluated perioperatively in surgical patients.One hundred twenty patients were studied. Taken together, the correlations between IAP and VE, TBW, and ECW were measured at 408 time points. In all participants, IAP strongly correlated with ECW and VE. In critically ill patients, IAP correlated with ECW and VE. In surgical patients, IAP correlated with ECW and TBW. IAP strongly correlated with ECW and VE in the mixed population. IAP also correlated with VE in critically ill patients. ROC curve analysis showed that ECW and VE might be discriminative parameters of risk for increased IAP.IAP strongly correlates with ECW.

  7. Interaction between intra-abdominal pressure and positive-end expiratory pressure

    Directory of Open Access Journals (Sweden)

    Jamili Anbar Torquato

    2009-02-01

    Full Text Available OBJECTIVE: The aim of this study was to quantify the interaction between increased intra-abdominal pressure and Positive-End Expiratory Pressure. METHODS: In 30 mechanically ventilated ICU patients with a fixed tidal volume, respiratory system plateau and abdominal pressure were measured at a Positive-End Expiratory Pressure level of zero and 10 cm H2O. The measurements were repeated after placing a 5 kg weight on the patients' belly. RESULTS: After the addition of 5 kg to the patients' belly at zero Positive-End Expiratory Pressure, both intra-abdominal pressure (p<0.001 and plateau pressures (p=0.005 increased significantly. Increasing the Positive-End Expiratory Pressure levels from zero to 10 cm H2O without weight on the belly did not result in any increase in intra-abdominal pressure (p=0.165. However, plateau pressures increased significantly (p< 0.001. Increasing Positive-End Expiratory Pressure from zero to 10 cm H2O and adding 5 kg to the belly increased intra-abdominal pressure from 8.7 to 16.8 (p<0.001 and plateau pressure from 18.26 to 27.2 (p<0.001. Maintaining Positive-End Expiratory Pressure at 10 cm H2O and placing 5 kg on the belly increased intra-abdominal pressure from 12.3 +/- 1.7 to 16.8 +/- 1.7 (p<0.001 but did not increase plateau pressure (26.6+/-1.2 to 27.2 +/-1.1 -p=0.83. CONCLUSIONS: The addition of a 5kg weight onto the abdomen significantly increased both IAP and the airway plateau pressure, confirming that intra-abdominal hypertension elevates the plateau pressure. However, plateau pressure alone cannot be considered a good indicator for the detection of elevated intra-abdominal pressure in patients under mechanical ventilation using PEEP. In these patients, the intra-abdominal pressure must also be measured.

  8. The Diagnostic Value of Intra-abdominal Pressure in Patients with Blunt Acute Abdominal Trauma

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    Huseyin Narci

    2012-06-01

    Full Text Available Purpose:The objective of this study was to determine the diagnostic value of intra-abdominal pressure measurement in blunt abdominal trauma patients. Method: A prospective study was performed in 49 patients with blunt trauma in our university hospital for 1 years. Patients were randomly into two groups as intra-abdominal trauma (n=28 and extraabdominal trauma (n=21 groups. Intra-abdominal pressures was measured an classified as normal (10 cm H2O or less, elevated (more than 10 cm H2O determined indirectly. Results: No significant differences were found between abdominal trauma and extra-abdominal trauma groups from the point of intra-abdominal pressure (IAP. One the other hand, in abdominal trauma group; significant differences were observed between operated patients. Intra-abdominal bleeding was found in 10 patients and all of them elevated IAP values (exceeding 16 cm H2O. For determining the intra-abdominal injury, IAP had a sensitivity of 93%, specificity 38% in patients. Conclusion: IAP exceeding 16 cm H2O with blunt abdominal trauma patients abdominal trauma can be detected. It is thought that IAP, indirect monitoring of abdominal trauma patients is a reproducible, scientific guide and simple method.To determine the efficacy of the measurement of intra-abdominal pressure in blunt abdominal trauma patients, further studies should be done. [Cukurova Med J 2012; 37(3.000: 157-161

  9. Effect of hemodialysis on intra-abdominal pressure Efeito da hemodiálise sobre a pressão intra-abdominal

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    Roberta Fernandes Bonfim

    2007-01-01

    Full Text Available OBJECTIVE: To study the effect of hemodialysis on intra-abdominal pressure. METHODS: Five patients admitted between July and November of 2003 were evaluated in the intensive care unit. Intra-abdominal pressure was measured before and after hemodialysis, maintaining the ventilatory parameters except for PEEP (positive-end expiratory pressure. RESULTS: Intra-abdominal pressure was significantly reduced by hemodialysis in all the 5 patients. CONCLUSION: Hemodialysis significantly reduced intra-abdominal pressure in the 5 patients, an effect which could have influence over other organic systems. This reduction is related to the weight variation before and after hemodialysis, as well as to the loss of volume caused by this procedure.OBJETIVO: Pesquisar o efeito da hemodiálise sobre a pressão intra-abdominal. MÉTODOS: Foram avaliados cinco pacientes internados entre julho e novembro de 2003, na Unidade de Terapia Intensiva do Serviço de Nefrologia do Hospital das Clínicas de São Paulo. Mensurou-se a pressão intra-abdominal antes e após a hemodiálise, mantendo os parâmetros ventilatórios exceto a PEEP (positive end expiratory pressure. RESULTADOS: Constatou-se que a hemodiálise foi capaz de reduzir significativamente a PIA em cinco pacientes na Unidade de Terapia Intensiva CONCLUSÃO: A hemodiálise reduziu a pressão intra-abdominal numa amostra de cinco pacientes, de maneira significativa, o que poderia influenciar os demais sistemas orgânicos. Essa redução está relacionada com a variação de peso pré e pós-hemodiálise, e com a perda de volume promovida pelo procedimento.

  10. Intra-abdominal pressure and abdominal compartment syndrome in acute general surgery.

    LENUS (Irish Health Repository)

    Sugrue, Michael

    2012-01-31

    BACKGROUND: Intra-abdominal pressure (IAP) is a harbinger of intra-abdominal mischief, and its measurement is cheap, simple to perform, and reproducible. Intra-abdominal hypertension (IAH), especially grades 3 and 4 (IAP > 18 mmHg), occurs in over a third of patients and is associated with an increase in intra-abdominal sepsis, bleeding, renal failure, and death. PATIENTS AND METHODS: Increased IAP reading may provide an objective bedside stimulus for surgeons to expedite diagnostic and therapeutic work-up of critically ill patients. One of the greatest challenges surgeons and intensivists face worldwide is lack of recognition of the known association between IAH, ACS, and intra-abdominal sepsis. This lack of awareness of IAH and its progression to ACS may delay timely intervention and contribute to excessive patient resuscitation. CONCLUSIONS: All patients entering the intensive care unit (ICU) after emergency general surgery or massive fluid resuscitation should have an IAP measurement performed every 6 h. Each ICU should have guidelines relating to techniques of IAP measurement and an algorithm for management of IAH.

  11. Wireless system for monitoring Intra-abdominal pressure in patient with severe abdominal pathology

    Science.gov (United States)

    Sokolovskiy, S. S.; Shtotskiy, Y. V.; Leljanov, A. D.

    2017-01-01

    The paper discusses an experimental design of the wireless system for monitoring intra-abdominal pressure (IAP) using Bluetooth Low Energy technology. The possibility of measuring IAP via the bladder using a wireless pressure sensor with a hydrophobic bacteria filter between the liquid transmitting medium and the sensor element is grounded.

  12. A Single-Lumen Central Venous Catheter for Continuous and Direct Intra-abdominal Pressure Measurement

    NARCIS (Netherlands)

    O.J.F. van Waes (Oscar); J.B. Jaquet (Jean); W.C.J. Hop (Wim); M.J.M. Morak (Marjolein); J.N.M. IJzermans (Jan); J. Koning (Jan)

    2009-01-01

    textabstractBackground: Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality rates. Therefore, the need for a good diagnostic tool to predict intra-abdominal hypertension (IAH) and progression to ACS is paramount. Bladder pressure (BP) has been used for several years

  13. Effect of increased intra-abdominal pressure due to pneumoperitoneum on liver functions and liver histopathology in a rat model with intra-abdominal sepsis.

    Science.gov (United States)

    Youssef, Youssef Farouk; Noseer, Mona

    2008-04-01

    Intra-abdominal sepsis was induced by open cecal ligation and puncture (OCLP) technique. Sixty rats were randomly divided into three equal groups each of 20. G1 was used as a control. G2 were subjected to laparotomy and closure after 12 hours from (OCLP) via the same incision. In G3, pneumoperitoneum was induced 12 hours after OCLP and maintained at 12 mmHg for about 30 minutes. Blood samples were taken for liver functions after 12 & 24 hours from OCLP procedure, and Liver biopsies were taken for histopathological examination after 24 hours. The results showed that liver functions were markedly increased in G3 after pneumoperitoneum, compared to Gs 1 & 2. The histopathological changes in liver biopsies due to sepsis were more marked in cases exposed to pneumoperitoneum than that exposed to conventional laparotomy. The intra-abdominal sepsis affected liver functions and caused pathogenesis. The increased intra-abdominal pressure induced more liver insults, compared to that gained after open surgery.

  14. Increased Intra-Abdominal Pressure Causes Bacterial Translocation in Rabbits

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    Gokhan Yagci

    2005-04-01

    Conclusion: We propose that an intravesical pressure (IVP of 15 mmHg is the critical point for BT in patients with increased IAP. In this experimental study, BT occurred when IVP reached 20 mmHg. We suggest that IVP monitoring is desirable in the management of patients with ACS, and that decompressive laparotomy should be performed in patients with IVP > 20 mmHg.

  15. Effects of ovariohysterectomy on intra-abdominal pressure and abdominal perfusion pressure in cats.

    Science.gov (United States)

    Bosch, L; Rivera del Álamo, M M; Andaluz, A; Monreal, L; Torrente, C; García-Arnas, F; Fresno, L

    2012-12-15

    Intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) have shown clinical relevance in monitoring critically ill human beings submitted to abdominal surgery. Only a few studies have been performed in veterinary medicine. The aim of this study was to assess how pregnancy and abdominal surgery may affect IAP and APP in healthy cats. For this purpose, pregnant (n=10) and non-pregnant (n=11) queens undergoing elective spaying, and tomcats (n=20, used as controls) presented for neutering by scrotal orchidectomy were included in the study. IAP, mean arterial blood pressure (MAP), APP, heart rate and rectal temperature (RT) were determined before, immediately after, and four hours after surgery. IAP increased significantly immediately after abdominal surgery in both female groups when compared with baseline (PPregnancy did not seem to affect IAP in this population of cats, possibly due to subjects being in early stages of pregnancy.

  16. Medical and surgical management of an intra-abdominal abscess of hepatic origin in a horse.

    Science.gov (United States)

    Cypher, Elizabeth E; Kendall, Anna T; Panizzi, Luca; Stewart, Allison J; Taylor, Sarah L; Bodaan, Christa J; Riley, Chris B; Gordon, Stuart J G; Whitfield, Lisa K

    2015-07-01

    A 4-year-old Arabian-cross mare was examined because of a 48-hour history of pyrexia, lethargy, and signs of abdominal discomfort. On initial evaluation, the horse was in good body condition, but febrile, tachycardic, tachypneic, and icteric and had signs of colic. Findings on CBC and serum biochemical analysis indicated marked systemic inflammation and hepatocellular damage. Serial abdominal ultrasonographic examinations revealed progressive, localized hepatic parenchymal abnormalities in the left ventral aspect of the abdomen in proximity to the left liver lobes, and eventual identification of an irregularly marginated, hyperechoic walled region of heterogenous echogenicity consistent with an encapsulated hepatic abscess. Medical treatment was initiated with administration of doxycycline and flunixin meglumine. After 7 days, the horse's clinical signs and hematologic values improved. After 14 days, the horse was discharged from the hospital and prescribed continuation of doxycycline treatment for 14 days. One week following hospital discharge, the horse was reevaluated for recurrent signs of colic and pyrexia. The horse was sedated, and the region overlying the caudal aspect of the seventh rib was desensitized with an inverted L nerve block by local infiltration with 2% lidocaine. While the horse was standing and sedated, drainage of an encapsulated intra-abdominal abscess was followed by rib resection and removal of a portion of necrotic left lateral liver lobe. The development of a pneumothorax following rib resection represented the only major surgical complication. Twelve months later, the horse was clinically normal and had returned to its previous level of performance. Rib resection in standing sedated horses, together with appropriate medical management, should be considered an option for removal of well-encapsulated cranially located intra-abdominal abscesses that are adherent to the ventrolateral aspect of the body wall in horses.

  17. [Monitoring of intra-abdominal pressure and abdominal perfusion pressure in urgent abdominal surgery].

    Science.gov (United States)

    Raĭbuzhis, E N; Fot, E V; Gaĭdukov, K M; Kirov, M Iu

    2014-01-01

    To evaluate the changes in intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) during perioperative period in urgent abdominal surgery and to assess the relationship of these parameters with gas exchange and tissue perfusion. Twenty-four patients undergoing emergency abdominal surgery were enrolled into a prospective observational study. We recorded IAP APP, mean arterial pressure, arterial and venous blood gases after induction of anesthesia, at the end of surgery, and 6, 12, 48 and 72 h postoperatively. LAP was measured by nasogastric tube using CiMON monitor (Pulsion Medical Systems, Germany). In addition, we studied the relationship of IAP and APP with blood gases parameters. We observed perioperative increase of IAP (> 12 mm Hg) in 75% of enrolled patients, tendency to postoperative rise of IAP and transient increase of arterial lactate at 6 h after surgery. APP remained within normal values. We found positive correlation of APP with PaO2/FiO2 and ScvO2 at 72 hours after surgery. Transient perioperative increase of IAP was observed in 75% patients undergoing urgent abdominal surgery; however in parallel with intensive care the abdominal perfusion pressure remained within normal values. Abdominal perfusion is related with arterial oxygenation and central venous saturation.

  18. Effects of intra-abdominal pressure on adrenal gland function and morphology in rats.

    Science.gov (United States)

    Akkapulu, Nezih; Tirnaksiz, Mehmet Bulent; Kulac, Ibrahim; Tezel, Gaye Guler; Hayran, Mutlu; Dogrul, Ahmet Bulent; Cetinkaya, Erdinc; Yorganci, Kaya

    2015-01-01

    Intra-abdominal hypertension and abdominal compartment syndrome (IAH/ACS) are life-threatening conditions and caused by several clinical status. Although there is insufficient data regarding its effects on adrenal glands. This study aimed to identify whether elevated intra-abdominal pressure (IAP) caused any alteration on the morphology and function of adrenal glands in a rat model. Twenty four Sprague-Dawley male rats were included in the study. Animals were allocated into 4 groups. IAP was elevated to 15 mmHg for one hour and four hours in group 2 and 4. Group 1 and 3 were sham groups. Blood samples were taken for the assessment of plasma adrenaline, noradrenaline, and corticosterone levels and adrenalectomies were performed to evaluate apoptosis. Blood adrenaline, noradrenaline and corticosterone levels were significantly higher in the study groups compared with the sham groups. However, there were no significant changes in apoptotic index scores in the study groups as compared to sham groups. These results support that increased IAH leads to discharge of catecholamine and corticosterone from the adrenal glands. Failure to demonstrate similar changes in apoptotic index score may be concluded as apoptosis is not a leading pathway for impairment of adrenal glands during IAH period.

  19. Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy

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    Khan Shehtaj

    2010-01-01

    Full Text Available Background : Studies have documented the impact of intra-abdominal hypertension (IAH on virtually every organ. However, it still remains strangely underdiagnosed. The aims of the study were to assess, in patients undergoing emergency laparotomy, whether intra-abdominal pressure (IAP is an independent predictor of morbidity and mortality, to evaluate the effects of IAH, and to identify hidden cases of abdominal compartment syndrome (ACS. Materials and Methods : The study comprised 197 patients undergoing emergency laparotomy. IAP was measured preoperatively and then postoperatively at 0, 6, and 24 hours. Duration of hospital stay, occurrence of burst abdomen, and mortality were noted as outcomes. Results : At admission, incidence of IAH was 80%. No significant association was found between IAP and occurrence of burst abdomen (P > 0.1. IAP was found to be a significant predictor of mortality in patients undergoing laparotomy (P < 0.001. Elevated IAP was found to affect all the organ systems adversely. The incidence of post-op ACS was 3.05% in the general population and 13.16% in trauma patients. The mortality rate for this subgroup was 100%. Conclusions : IAP is a significant predictor of mortality in patients undergoing laparotomy. IAH has detrimental effects on various organ systems. A more frequent monitoring with prompt decompression may be helpful in decreasing the mortality rate. Further studies are required to establish a screening protocol in patients undergoing laparotomy to detect and manage cases of IAH and ACS.

  20. Low Transmission of Airway Pressures to the Abdomen in Mechanically Ventilated Patients With or Without Acute Respiratory Failure and Intra-Abdominal Hypertension.

    Science.gov (United States)

    Heijnen, Bram G A D H; Spoelstra-de Man, Angelique M E; Groeneveld, A B Johan

    2017-03-01

    Intra-abdominal pressure, measured at end expiration, may depend on ventilator settings and transmission of intrathoracic pressure. We determined the transmission of positive intrathoracic pressure during mechanical ventilation at inspiration and expiration into the abdominal compartment. We included 9 patients after uncomplicated cardiac surgery and 9 with acute respiratory failure. Intravesical pressures were measured thrice (reproducibility of 1.8%) and averaged, at the end of each inspiratory and expiratory hold maneuvers of 5 seconds. Transmission, the change in intra-abdominal over intrathoracic pressures from end inspiration to end expiration, was about 8%. End-expiratory intra-abdominal pressure was lower than "total" intra-abdominal pressure over the entire respiratory cycle by 0.34 cm H2O. It was 0.73 cm H2O higher than "true" intra-abdominal pressure over the entire respiratory cycle, taking transmission into account. The percentage error was 3% for total and 10% for true pressure. Results did not differ among patients with or without acute respiratory failure and decreased respiratory compliance or between those with (≥12 mm Hg, n = 5) or without intra-abdominal hypertension. Transmitted airway pressure only slightly affects intra-abdominal pressure in mechanically ventilated patients, irrespective of respiratory compliance and baseline intra-abdominal pressure values. End-expiratory measurements referenced against atmospheric pressure may suffice for clinical practice.

  1. Hemorrhage exacerbates bacterial translocation at low levels of intra-abdominal pressure.

    Science.gov (United States)

    Gargiulo, N J; Simon, R J; Leon, W; Machiedo, G W

    1998-12-01

    It has been shown previously that the adverse cardiopulmonary sequelae of increased intra-abdominal pressure (IAP) are worsened by hemorrhage and resuscitation. Bacterial translocation (BT) to the mesenteric lymph nodes (MLNs), liver, and spleen has also been shown to occur with increased IAP. To investigate the hypothesis that BT associated with elevated IAP would be significantly increased after hemorrhage and resuscitation. Anesthetized adult male rats had femoral artery and vein catheters placed, and an intra-abdominal catheter placed to measure IAP. Group 1 underwent surgery only and served as controls. Group 2 had IAP raised to 10 mm Hg by infused lactated Ringer's solution for 40 minutes. Group 3 had a 25% hemorrhage, followed by resuscitation by infused lactated Ringer's solution and shed blood. Group 4 first had a 25% hemorrhage, resuscitated using infused lactated Ringer's solution and shed blood, and then had IAP raised to 10 mm Hg by infused lactated Ringer's solution for 40 minutes. All groups were killed after 2 hours, and had MLNs, liver, and spleen harvested for quantitative cultures. Hemorrhage and resuscitation alone did not increase BT to the MLNs, liver, or spleen. An increase in IAP to 10 mm Hg resulted in a significant level of BT to the MLNs and liver on MacConkey II agar (PBT only to the liver on trypticase soy agar with 5% sheep's blood (PBT to the liver and spleen when IAP was increased to 10 mm Hg (PBT to the MLNs, liver, or spleen. However, hemorrhage and resuscitation increased BT to the liver and spleen when IAP was increased to 10 mm Hg. This supports the concept that prior hemorrhage and resuscitation exacerbates the effects of increased IAP.

  2. Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair.

    Science.gov (United States)

    Gaidukov, Konstantin M; Raibuzhis, Elena N; Hussain, Ayyaz; Teterin, Alexey Y; Smetkin, Alexey A; Kuzkov, Vsevolod V; Malbrain, Manu Lng; Kirov, Mikhail Y

    2013-05-04

    To determine the influence of intra-abdominal pressure (IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period. Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study. IAP monitoring was performed via both a balloon-tipped nasogastric probe [intragastric pressure (IGP), CiMON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure (IBP), UnoMeterAbdo-Pressure Kit, UnoMedical, Denmark] on five consecutive stages: (1) after tracheal intubation (AI); (2) after ventral hernia repair; (3) at the end of surgery; (4) during spontaneous breathing trial through the endotracheal tube; and (5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages. The IAP (measured via both techniques) increased on average by 12% during surgery compared to AI (P IGP and IBP (r = 0.65-0.81, P IGP was 8.0 (5.5-11.0) mmHg and the median IBP was 8.8 (5.8-13.1) mmHg. The overall r (2) value (n = 30) was 0.76 (P IGP or IBP demonstrated excellent concordance.

  3. Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm.

    Science.gov (United States)

    Coleman, Tanner J; Nygaard, Ingrid E; Holder, Dannielle N; Egger, Marlene J; Hitchcock, Robert

    2015-08-01

    The objective was to describe the intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold. Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22-59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP. There were no statistically significant differences in the mean maximal IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean maximal IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand, but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking). Our results support recommending this series of introductory Pilates exercises, including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long-term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health.

  4. Deleterious Effects of Increased Intra-Abdominal Pressure on Kidney Function

    Directory of Open Access Journals (Sweden)

    Zaher Armaly

    2014-01-01

    Full Text Available Elevated intra-abdominal pressure (IAP occurs in many clinical settings, including sepsis, severe acute pancreatitis, acute decompensated heart failure, hepatorenal syndrome, resuscitation with large volume, mechanical ventilation with high intrathoracic pressure, major burns, and acidosis. Although increased IAP affects several vital organs, the kidney is very susceptible to the adverse effects of elevated IAP. Kidney dysfunction is among the earliest physiological consequences of increased IAP. In the last two decades, laparoscopic surgery is rapidly replacing the open approach in many areas of surgery. Although it is superior at many aspects, laparoscopic surgery involves elevation of IAP, due to abdominal insufflation with carbonic dioxide (pneumoperitoneum. The latter has been shown to cause several deleterious effects where the most recognized one is impairment of kidney function as expressed by oliguria and reduced glomerular filtration rate (GFR and renal blood flow (RBF. Despite much research in this field, the systemic physiologic consequences of elevated IAP of various etiologies and the mechanisms underlying its adverse effects on kidney excretory function and renal hemodynamics are not fully understood. The current review summarizes the reported adverse renal effects of increased IAP in edematous clinical settings and during laparoscopic surgery. In addition, it provides new insights into potential mechanisms underlying this phenomenon and therapeutic approaches to encounter renal complications of elevated IAP.

  5. Effects of Altered Intra-abdominal Pressure on the Upper Airway Collapsibility in a Porcine Model

    Institute of Scientific and Technical Information of China (English)

    Shu-Lin Ren; Yan-Ru Li; Ji-Xiang Wu; Jing-Ying Ye; Rachel Jen

    2015-01-01

    Background: Obstructive sleep apnea is strongly associated with obesity, particularly abdominal obesity common in centrally obese males.Previous studies have demonstrated that intra-abdominal pressure (IAP) is increased in morbid obesity, and tracheal traction forces may influence pharyngeal airway collapsibility.This study aimed to investigate that whether IAP plays a role in the mechanism of upper airway (UA) collapsibility via IAP-related caudal tracheal traction.Methods: An abdominal wall lifting (AWL) system and graded CO2 pneumoperitoneum pressure was applied to four supine, anesthetized Guizhou miniature pigs and its effects on tracheal displacement (TD) and airflow dynamics of UA were studied.Individual run data in 3 min obtained before and after AWL and obtained before and after graded pneumoperitoneum pressure were analyzed.Differences between baseline and AWL/graded pneumoperitoneum pressure data of each pig were examined using a Student's t-test or analysis of variance.Results: Application of AWL resulted in decreased IAP and significant caudal TD.The average displacement amplitude was 0.44 mm (P < 0.001).There were three subjects showed increased tidal volume (TV) (P < 0.0l) and peak inspiratory airflow (P < 0.01);however, the change of flow limitation inspiratory UA resistance (Rua) was not significant.Experimental increased IAP by pneumoperitoneum resulted in significant cranial TD.The average displacement amplitude was 1.07 mm (P < 0.001) when IAP was 25 cmH20 compared to baseline.There were three subjects showed reduced Rua while the TV increased (P < 0.01).There was one subject had decreased TV and elevated Rua (P < 0.001).Conclusions: Decreased IAP significantly increased caudal TD, and elevated IAP significantly increased cranial TD.However, the mechanism of UA collapsibility appears primarily mediated by changes in lung volume rather than tracheal traction effect.TV plays an independent role in the mechanism of UA collapsibility.

  6. Correlation study of intra-abdominal fat accumulation and ambulatory blood pressure

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    Li ZHANG

    2012-05-01

    Full Text Available Objective  To explore the influence of intra-abdominal fat (IAF accumulation on ambulatory blood pressure (ABP. Methods  Four hundred and forty-eight hospitalized patients with cardiovascular and metabolic diseases, including 235 males and 213 females, aged 20-85 (55±12 years old, were enrolled in this study. The abdominal fatty thickness was measured with B-mode ultrasound. Simultaneously the patient received 24hABP monitoring. The patients were divided into excessive IAF group, normal group, and quintile subgroups according to the cut-off points (male 38.5mm, female 34.7mm for observing the difference in indexes of ambulatory blood pressure between different groups/subgroups. Results  The 24h mean systolic BP (24hMSBP, 24h mean BP (24hMBP, 24h mean diastolic BP (24hMDBP, daytime MSBP (dMSBP, daytime MBP (dMBP, daytime MDBP (dMDBP, nighttime MSBP (nMSBP, nighttime MBP (nMBP, night MDBP (nMDBP were significantly higher in the excessive IAF group than in the normal group (P < 0.05. However, the elevation of ABP was not a simple gradual linear elevation corresponding to a gradual increase in IAF thickness, but manifested an approximately U-shaped trend. Pearson correlation analysis showed IAF thickness was positively correlated with all the indexes of 24hABP, while partial correlation analysis after adjustment for age and sex showed IAF thickness was positively correlated with 24hSBP, 24hMBP, dMBP and nMBP. Conclusion  The relationship between IAF thickness and ABP presents a U-shaped curve, which may provide an enlightenment in controlling blood pressure by weight loss in clinical work.

  7. A systematic review on intra-abdominal pressure in severely burned patients

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    K.D. Strang; E.M.M. van Lieshout (Esther); R.S. Breederveld (Roelf S.); O.J.F. van Waes (Oscar)

    2014-01-01

    textabstractObjective Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are complications that may occur in severely burned patients. Evidenced based medicine for these patients is in its early development. The aim of this study was to provide an overview of literature rega

  8. Intra-abdominal pressure and possible ways of its drug correction after emergency laparotomy

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    Людмила Василівна Новицька-Усенко

    2015-11-01

    Full Text Available Introduction. Postoperative disorders of gastrointestinal tract (GIT motility are often after abdominal operations. Postoperative enteroparesis is usually accompanied by the raise of intra-abdominal pressure (IAP.Materials and methods. After approval of research by bioethics committee and informed consent 52 patients were prospectively divided in 2 groups depending on the type of postoperative intensive care. Patients underwent operations on abdominal cavity by laparotomy incision on the subject of peritonitis. Patient of the 1 (control group (n=27 after operation received stimulation of GIT with metoclopramide and simethicone.  In the 2 group (n=25 patients received metoclopramide and simethicone. Patients were comparable on age, sex, concomitant pathology, ASA class (IIE-IIIE and the type of operative intervention (laparotomy on the subject of peritonitis. IAP level was studied before operation and at 1,2,3 days after it. IAP was measured by indirect method trough the urinary bladder. The values recommended by the World society of abdominal compartment syndrome were considered as the normal IAP level.  Perfuse pressure (PP in abdominal cavity was calculated by formula: PP=MAP-ICP where MAP – mean arterial pressure. There were also studied indices of the central and peripheral hemodynamics, inflammation markers (leukocytes, fibrinogen level, IL-1α, TNFα, IL-10, leukocytic index of intoxication was calculated. The final point of research was 28 day after operation when we evaluated mortality and life quality on Rancho Los Amigos scale.Results and discussion. We registered the raise of IAP in 63.1% of patients. The value of intra-abdominal pressure exceeded an upper limit of the normal one by 58,5% (р <0,001. Among patients with high IAP 83% had intra-abdominal hypertension (IAH of 1 degree, 17% - of 2 degree.  The development of 3 and 4degree IAH were not observed before operation. PP remained within the normal.Correlative analysis

  9. Effects of intra-abdominal pressure on liver function assessed with the LiMON in critically ill patients.

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    Inal, Mehmet Turan; Memis, Dilek; Sezer, Y Atakan; Atalay, Meltem; Karakoc, Abdullah; Sut, Necdet

    2011-06-01

    Intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with significant morbidity and mortality in critically ill patients. Our aim was to assess the effects of IAH on liver function using the noninvasive liver function monitoring system LiMON and to assess the prognostic value of IAP in critically ill patients. We conducted a retrospective analysis of critically ill patients who were treated in the intensive care unit (ICU). The IAP and indocyanine green plasma disappearance rate (ICG-PDR) measurements were made within 24 hours after admission to the ICU and repeated 12 hours later. Intra-abdominal pressure was measured via a Foley bladder catheter, and ICG elimination tests were conducted concurrently using the LiMON. We included 30 critically ill patients (17 women and 13 men aged 28-89 yr) in our analysis. Statistical analysis showed that the baseline IAP values were significantly higher among nonsurvivors than survivors (19.38 [standard deviation; SD 2.08] v. 13.07 [SD 0.99]). The twelfth-hour IAP values were higher than baseline measurements among nonsurvivors (21.50 [SD 1.96]) and lower than baseline measurements among survivors (11.71 [SD 1.54]); the difference between groups was significant (p LiMON is a good predictor of the effects of IAP on liver function and, thus, can be recommended for the evaluation of critically ill patients.

  10. Intra-abdominal pressure alterations after large pancreatic pseudocyst transcutaneous drainage

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    Papavramidis Theodossis S

    2009-06-01

    Full Text Available Abstract Background Acute pancreatitis leads to abdominal hypertension and compartment syndrome. Weeks after the episodes pancreatic fluids sometimes organize to pseudocysts, fluid collections by or in the gland. Aims of the present study were to evaluate the intra-abdominal pressure (IAP induced by large pancreatic pseudocysts and to examine the effect of their transcutaneous drainage on IAP. Methods Twenty seven patients with a pancreatic pseudocyst were included. Nine patients with pseudocysts greater than 1l (group A had CT drainage and eighteen (volume less than 1l were the control group. The measurements of group A were taken 6 hours before and every morning after the drainage, while for group B, two measurements were performed, one at the day of the initial CT and one 7 days after. Abdominal compliance (Cabd was calculated. Data were analyzed using student's t-test. Results Baseline IAP for group A was 9.3 mmHg (S.D. 1.7 mmHg, while the first post-drainage day (PDD IAP was 5.1 mmHg (S.D. 0.7 mmHg. The second PDD IAP was 5.6 mmHg (S.D. 0.8 mmHg, the third 6.4 mmH (S.D. 1.2 mmHgg, the fourth 6.9 mmHg (S.D. 1.6 mmHg, the fifth 7.9 mmHg (S.D. 1.5 mmHg, the sixth 8.2 mmHg (S.D. 1.4 mmHg, and the seventh 8.2 mmHg (S.D. 1.5 mmHg. Group B had baseline IAP 8.0 mmHg (S.D. 1.2 mmHg and final 8.2 mmHg (S.D. 1.4 mmHg. Cabd after drainage was 185.6 ml/mmHg (SD 47.5 ml/mmHg. IAP values were reduced between the baseline and all the post-drainage measurements in group A. IAPs seem to stabilize after the 5th post-drainage day. Baseline IAP was higher in group A than in group B, while the two values, at day 7, were equivalent. Conclusion The drainage of large pancreatic pseudocyst reduces IAP. Moreover, the IAP seems to rise shortly after the drainage again, but in a way that it remains inferior to the initial value. More chronic changes to the IAP are related to abdominal cavity's properties and have to be further studied.

  11. Direct intra-abdominal pressure monitoring via piezoresistive pressure measurement: a technical note

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    Dembinski Rolf

    2009-04-01

    Full Text Available Abstract Background Piezoresistive pressure measurement technique (PRM has previously been applied for direct IAP measurement in a porcine model using two different devices. Aim of this clinical study was to assess both devices regarding complications, reliability and agreement with IVP in patients undergoing elective abdominal surgery. Methods A prospective cohort study was performed in 20 patients randomly scheduled to receive PRM either by a Coach®-probe or an Accurate++®-probe (both MIPM, Mammendorf, Germany. Probes were placed on the greater omentum and passed through the abdominal wall paralleling routine drainages. PRM was compared with IVP measurement by t-testing and by calculating mean difference as well as limits of agreement (LA. Results There were no probe related complications. Due to technical limitations, data could be collected in 3/10 patients with Coach® and in 7/10 patients with Accurate++®. Analysis was carried out only for Accurate++®. Mean values did not differ to mean IVP values. Mean difference to IVP was 0.1 ± 2.8 mmHg (LA: -5.5 to 5.6 mmHg. Conclusion Direct IAP measurement was clinically uneventful. Although results of Accurate++® were comparable to IVP, the device might be too fragile for IAP measurements in the clinical setting. Local ethical committee trial registration: EK2024

  12. Direct intra-abdominal pressure monitoring via piezoresistive pressure measurement: a technical note

    Science.gov (United States)

    Otto, Jens; Kaemmer, Daniel; Binnebösel, Marcel; Jansen, Marc; Dembinski, Rolf; Schumpelick, Volker; Schachtrupp, Alexander

    2009-01-01

    Background Piezoresistive pressure measurement technique (PRM) has previously been applied for direct IAP measurement in a porcine model using two different devices. Aim of this clinical study was to assess both devices regarding complications, reliability and agreement with IVP in patients undergoing elective abdominal surgery. Methods A prospective cohort study was performed in 20 patients randomly scheduled to receive PRM either by a Coach®-probe or an Accurate++®-probe (both MIPM, Mammendorf, Germany). Probes were placed on the greater omentum and passed through the abdominal wall paralleling routine drainages. PRM was compared with IVP measurement by t-testing and by calculating mean difference as well as limits of agreement (LA). Results There were no probe related complications. Due to technical limitations, data could be collected in 3/10 patients with Coach® and in 7/10 patients with Accurate++®. Analysis was carried out only for Accurate++®. Mean values did not differ to mean IVP values. Mean difference to IVP was 0.1 ± 2.8 mmHg (LA: -5.5 to 5.6 mmHg). Conclusion Direct IAP measurement was clinically uneventful. Although results of Accurate++® were comparable to IVP, the device might be too fragile for IAP measurements in the clinical setting. Local ethical committee trial registration: EK2024 PMID:19383161

  13. Effect of acute, slightly increased intra-abdominal pressure on intestinal permeability and oxidative stress in a rat model.

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    Yuxin Leng

    Full Text Available INTRODUCTION: Intra-abdominal hypertension (IAH is known as a common, serious complication in critically ill patients. Bacterial translocation and permeability changes are considered the pathophysiological bases for IAH-induced enterogenic endotoxemia and subsequent multiorgan failure. Nevertheless, the effects of slightly elevated intra-abdominal pressures (IAPs on the intestinal mucosa and the associated mechanisms remain unclear. METHODS: To investigate the acute effects of different nitrogen pneumoperitoneum grades on colonic mucosa, male Sprague-Dawley rats were assigned to six groups with different IAPs (0 [control], 4, 8, 12, 16, and 20 mmHg, n = 6/group. During 90 min of exposure, we dynamically monitored the heart rate and noninvasive hemodynamic parameters. After gradual decompression, arterial blood gas analyses were conducted. Thereafter, structural injuries to the colonic mucosa were identified using light microscopy. Colon permeability was determined using the expression of tight junction proteins, combined with fluorescein isothiocyanate dextran (FD-4 absorption. The pro-oxidant-antioxidant balance was determined based on the levels of malondialdehyde (MDA and antioxidant enzymes. RESULTS: IAH significantly affected the histological scores of the colonic mucosa, tight junction protein expression, mucosal permeability, and pro-oxidant-antioxidant balance. Interestingly, elevations of IAP that were lower than the threshold for IAH also showed a similar, undesirable effect. In the 8 mmHg group, mild hyponatremia, hypocalcemia, and hypoxemia occurred, accompanied by reduced blood and abdominal perfusion pressures. Mild microscopic inflammatory infiltration and increased MDA levels were also detected. Moreover, an 8-mm Hg IAP markedly inhibited the expression of tight junction proteins, although no significant differences in FD-4 permeability were observed between the 0- and 8-mmHg groups. CONCLUSIONS: Acute exposure to slightly

  14. Influence of lumbar spine rhythms and intra-abdominal pressure on spinal loads and trunk muscle forces during upper body inclination.

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    Arshad, Rizwan; Zander, Thomas; Dreischarf, Marcel; Schmidt, Hendrik

    2016-04-01

    Improved knowledge on spinal loads and trunk muscle forces may clarify the mechanical causes of various spinal diseases and has the potential to improve the current treatment options. Using an inverse dynamic musculoskeletal model, this sensitivity analysis was aimed to investigate the influence of lumbar spine rhythms and intra-abdominal pressure on the compressive and shear forces in L4-L5 disc and the trunk muscle forces during upper body inclination. Based on in vivo data, three different spine rhythms (SRs) were used along with alternative settings (with/without) of intra-abdominal pressure (IAP). Compressive and shear forces in L4-L5 disc as well as trunk muscle forces were predicted by inverse static simulations from standing upright to 55° of intermediate trunk inclination. Alternate model settings of intra-abdominal pressure and different spine rhythms resulted in significant variation of compression (763 N) and shear forces (195 N) in the L4-L5 disc and in global (454 N) and local (156 N) trunk muscle forces at maximum flexed position. During upper body inclination, the compression forces at L4-L5 disc were mostly released by IAP and increased for larger intervertebral rotation in a lumbar spine rhythm. This study demonstrated that with various possible assumptions of lumbar spine rhythm and intra-abdominal pressure, variation in predicted loads and muscles forces increase with larger flexion. It is therefore, essential to adapt these model parameters for accurate prediction of spinal loads and trunk muscle forces.

  15. Validation of a novel method for measuring intra-abdominal pressure and gastric residual volume in critically ill patients.

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    Van Stappen, Johan; Pigozzi, Chiara; Tepaske, Robert; Van Regenmortel, Niels; De Laet, Inneke; Schoonheydt, Karen; Dits, Hilde; Severgnini, Paolo; Roberts, Derek J; Malbrain, Manu L N G

    2014-01-01

    Gastric residual volume (GRV) can be measured in a variety of ways in critically ill patients, most often, the nasogastric tube is disconnected and the GRV is aspirated via a 60 mL syringe. Bladder pressure (IBP) measurement is the gold standard for intra-abdominal pressure (IAP) estimation. This study will look at the validation of a novel method combining measurement of GRV and estimation of IAP via intra-gastric pressure (IGP). In total 135 paired IAP and 146 paired GRV measurements were performed in 37 mechanically ventilated ICU patients. The IAP was estimated via the bladder (i.e. IBP) using the FoleyManometer and via the stomach (i.e. IGP) with the new device. The GRV was measured with the new device (GRVprototype) and via the classic method (GRVclassic). The devices were provided by Holtech Medical (Charlottenlund, Denmark) and data were retrospectively analysed. The number of paired measurements in each patient was 4 ± 1. The mean IBP was 10.7 ± 4.1 and mean IGP was 11.6 ± 4.1 mm Hg. Correlation between the IBP and IGP was significant, however moderate (R2 = 0.51). Analysis according to Bland and Altman showed a bias and precision of 0.8 and 2.7 mm Hg respectively, however the limits of agreement (LA) were large and ranged from -4.5 to 6.1 mm Hg. Changes in IGP correlated well with changes in IBP. The median GRVprototype was 80 mL (0-1050) and equal to the median GRVclassic of 80 mL (0-1250). Correlation between the 2 methods was excellent (R2 = 0.89). Analysis according to Bland and Altman showed a bias and precision of -0.8 and 52.3 mL respectively and the LA ranged from -103 to 102 mL. Changes in GRVclassic correlated well with changes in GRVprototype. The results of this multicentre pilot study show that GRV can be measured with the new device. Furthermore this allows simultaneous screening for intra-abdominal hypertension with IAP estimation via IGP.

  16. "EFFECTIVENESS OF ABDOMINAL WALL ELEVATOR IN REDUCING INTRA-ABDOMINAL PRESSURE AND CO2 VOLUME DURING LAPAROSCOPIC CHOLECYSTECTOMY"

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    A. Yaghoobi Notash

    2004-06-01

    Full Text Available Since CO2 pneumoperitoneum is the dominant method of laparoscopic exposure due to facility and good view, its physiologic effects are most relevant to the surgeons. CO2 pneumoperitoneum may affects hemodynamics by increased intra-abdominal pressure (IAP and the physiologic effects of absorbed CO2. The adverse effects of both mechanisms relate directly to the duration of the pneumoperitoneum and the elevation of IAP. Gasless laparoscopy involves obtaining exposure for laparoscopy by placing an internal retracting device through a small incision and lifting the anterior abdominal wall. We designed and made a mechanical wall elevator and used it in 24 patients, compared with a control group (52 cases using a conventional laparoscopic cholecystectomy. A prospective trial was undertaken in Sina Hospital, Tehran University of Medical Sciences from 1998 to 2000. The patients were assigned randomly to two groups. There was a significant decrease in IAP and CO2 consumption in the group using mechanical wall elevator as compared to conventional laparoscopic cholecystectomy, (mean IAP of 3.5 mmHg compared to 11.4 mmHg in the control group, mean CO2 volume 17 liters compared to 73 liters in the control group. We recommend this semigasless method in laparoscopy due to safety in performance and significant reduction in IAP through the surgery. This method provides a satisfactory view and easy performance without any increase in time or complications. The hospital stay and costs did not increase.

  17. Comparing intra-abdominal pressures in different body positions via a urinary catheter and nasogastric tube: a pilot study.

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    Rooban, Nirooshan; Regli, Adrian; Davis, Wendy A; De Keulenaer, Bart L

    2012-07-05

    Intra-abdominal pressure (IAP) is most commonly measured via the bladder with the patient in the supine position. In the ICU, patients are nursed with the head of the bed elevated at 30° (HOB30) to reduce the risk of ventilator-associated pneumonia. This study investigated whether gastric pressure at HOB30 can be used as a surrogate measure of IAP via the bladder in the supine position. A prospective observational study was conducted in a single-centre intensive care unit. A total of 20 patients were included. IAP was recorded simultaneously via the bladder catheter (bladder pressure, IBP) and via nasogastric tube (gastric pressures, IGP) in the supine and HOB30 position. Each patient had three sets of IAP measurements performed at least 4 h apart. In the supine position, mean IBP was 12.3 ± 4.5 mmHg compared to IGP of 11.8 ± 4.7 mmHg. The bias between the two groups was 0.5 and precision of 3.7 (LA, -6.8 to 7.5 mmHg). At 30 degrees, mean IBP was 15.8 ± 4.9 mmHg compared to IGP of 13.1 ± 6.1 mmHg. The bias between both groups was 2.7 with a precision of 5.5 (LA, -8.0 to 13.5). Comparing IBP in the supine position with IGP at 30° showed a bias of -0.8 and precision of 5.6 (LA, -10.1 to 11.6 mmHg). IAP measured via a nasogastric tube was less influenced by changing the body position from supine to HOB30 than was bladder pressure.

  18. Effects of a Belt on Intra-Abdominal Pressure during Weight Lifting.

    Science.gov (United States)

    1988-03-01

    pressure was measured using a Millar model SPC 350 Mikro -Tip catheter pressure transducer (Millar Instruments, Houston, TX) inserted nasally. The...316.16 # .33*.16 # start of pressure plateau .20*.06 # .10*.13 # a.peak pro -plateau rate of force increase -.1O’.14 -.1O*A.16 peak pre-plateau rate of...off (Nosec) 354*185 432*198 impulse: lift-off to end (NOsOc) 4904*1299 4948*1269 peak pro -plateau rate of force incr. (N/sec) 71382*15258 69482*19156

  19. Evidence for Negative Effects of Elevated Intra-Abdominal Pressure on Pulmonary Mechanics and Oxidative Stress

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    I. Davarcı

    2015-01-01

    Full Text Available Objective. To compare the effects of pneumoperitoneum on lung mechanics, end-tidal CO2 (ETCO2, arterial blood gases (ABG, and oxidative stress markers in blood and bronchoalveolar lavage fluid (BALF during laparoscopic cholecystectomy (LC by using lung-protective ventilation strategy. Materials and Methods. Forty-six patients undergoing LC and abdominal wall hernia (AWH surgery were assigned into 2 groups. Measurements and blood samples were obtained before, during pneumoperitoneum, and at the end of surgery. BALF samples were obtained after anesthesia induction and at the end of surgery. Results. Peak inspiratory pressure, ETCO2, and pCO2 values at the 30th minute were significantly increased, while there was a significant decrease in dynamic lung compliance, pH, and pO2 values in LC group. In BALF samples, total oxidant status (TOS, arylesterase, paraoxonase, and malondialdehyde levels were significantly increased; the glutathione peroxidase levels were significantly decreased in LC group. The serum levels of TOS and paraoxonase were significantly higher at the end of surgery in LC group. In addition, arylesterase level in the 30th minute was increased compared to baseline. Serum paraoxonase level at the end of surgery was significantly increased when compared to AWH group. Conclusions. Our study showed negative effects of pneumoperitoneum in both lung and systemic levels despite lung-protective ventilation strategy.

  20. Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension

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    YANG Yi; LI Yang; LIU Song-qiao; LIU Ling; HUANG Ying-zi; GUO Feng-mei; QIU Hai-bo

    2013-01-01

    Background Intra-abdominal hypertension (IAH) is common in acute respiratory distress syndrome (ARDS) patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expiratory pressure (PEEP).We investigated the effect of PEEP titrated by transpulmonary pressure (Ptp) on oxygenation and respiratory mechanics in ARDS patients with IAH compared with PEEP titrated by ARDSnet protocol.Methods ARDS patients admitted to the intensive care unit (ICU) of the Zhongda Hospital were enrolled.Patients were ventilated with volume control mode with tidal volume of 6 ml/kg under two different PEEP levels titrated by Ptp method and ARDSnet protocol.Respiratory mechanics,gas exchange and haemodynamics were measured after 30 minutes of ventilation in each round.IAH was defined as intra-abdominal pressure of 12 mmHg or more.Results Seven ARDS patients with IAH and 8 ARDS patients without IAH were enrolled.PEEP titrated by Ptp were significant higher than PEEP titrated by ARDSnet protocol in both ARDS patients with IAH ((17.3±2.6) cmH2O vs.(6.3±1.6)cmH2O and without IAH ((9.5±2.1) cmH2O vs.(7.8±1.9) cmH2O).Arterial pressure of O2/fraction of inspired oxygen (PaO2/FiO2)was much higher under PEEP titrated by Ptp when compared with PEEP titrated by ARDSnet protocol in ARDS patients with IAH ((27.2±4.0) cmHg vs.(20.9± 5.0) cmHg.But no significant difference of PaO2/FiO2 between the two methods was found in ARDS patients without IAH.In ARDS patients with IAH,static compliance of lung and respiratory system were higher under PEEP titrated by Ptp than by ARDSnet protocol.In ARDS patients with IAH,central venous pressure (CVP) was higher during PEEP titrated by Ptp than byARDSnet protocol.Conclusion Positive end expiratory pressure titrated by transpulmonary pressure was higher than PEEP titrated by ARDSnet protocol and improved oxygenation and respiratory mechanics in ARDS patients with IAH.

  1. Disseminated Intra-Abdominal Hydatidosis

    Science.gov (United States)

    Concha, Fátima; Maguiña, Ciro; Seas, Carlos

    2013-01-01

    We present the case of a 26-year-old male Peruvian patient who presented with disseminated intra-abdominal hydatidosis. The patient was treated with surgical removal of the cysts and prolonged medical treatment with albendazole. PMID:24006293

  2. ABDOPRE: dispositivo de aplicação externa para redução da pressão intra-abdominal: Experiencia clínica preliminar ABDOPRE: dispositivo de aplicación externa para reducción de presión intraabdominal: Preliminary clinical experience ABDOPRE: an external device for the reduction of intra-abdominal pressure

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    Francisco Pracca

    2011-06-01

    Full Text Available São descritos os objetivos de redução da pressão intra-abdominal e o projeto de um dispositivo que os atenda. O ABDO-PRE compreende, pela primeira vez, um mecanismo de servo-controle de aplicação externa que mede a pressão intravesical como variável de controle. São apresentados os resultados da aplicação em 4 pacientes com hipertensão intra-abdominal, produzindo uma redução de 16% a 35% em três casos e um aumento paradoxal da pressão em um dos casos, devido a um desajuste entre a geometria da câmara de vácuo e a alteração anatômica acarretada pela obesidade da paciente. Estes resultados são promissores em relação ao possível uso do ABDOPRE na prática clínica para redução da hipertensão intra-abdominal.Se describen los objetivos de reducción de la presión intraabdominal y el proyecto de un dispositivo que los cumpla. ABDOPRE comprende por primera vez un mecanismo servcocontrolado de aplicación externa que toma la presión intravesical como variable de control. Se presenta el resultado de la aplicación en 4 pacientes afectados por hipertensión intraabdominal, con el resultado de una reducción de entre 16% y 35% en tres casos y de un aumento paradojal de presión en un caso debido a desajuste de la geometría de la campana de vacío a la anatomía obesa del paciente. Estos resultados prometen el posible uso de ABDOPRE para la reducción de la hipertensión intraabdominal en la práctica clínica.This article describes a device for the reduction of intra-abdominal pressure. The device (ABDOPRE includes a unique external servo-control mechanism, based on urinary bladder pressure measurement. The results of ABDOPRE use in the first four intra-abdominal hypertension patients are reported; the device resulted in a reduction of intra-abdominal pressure between 16% and 35% in 3 cases and in a paradoxical increase of the intra-abdominal pressure in an obese woman, likely due to inappropriate chamber size for the patient

  3. 分娩前后腹腔内压的测定%Determination of intra-abdominal pressure before and after delivery

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    王艳; 梁丽霞; 邓燕红

    2015-01-01

    ObjectiveTo compare the changes of intra-abdominal pressure (IAP) and hemodynamic differences before and after delivery in the normal pregnant women.Methods24 pregnant women,who were going to deliver in the Third Affiliated Hospital of Guangzhou Medical College from November 2011 to March 2012,were divided into a single pregnancy group (20 cases) and a twin pregnancy group (4 cases) according to the pregnant categories.Then the changes of intra-abdominal pressure before and after delivery were monitored by intravesical pressure measurement,in additional,the changes of blood pressure,abdominal perfusion pressure and heart rate were observed.Results(1) In the single pregnancy group,the systolic blood pressure and diastolic blood pressure of the pregnant women after delivery were (118.05±10.12)mm Hg and (70.95±7.65)mm Hg respectively,with no significant differences from those before delivery (P>0.05);While maternal heart rate after the delivery was(83.76±11.31)/min,which was significantly decreased compared with that before delivery of (95.29±14.11)/min,and abdominal perfusion pressure increased significantly than that before delivery,and the differences were significant (P<0.01).(2)The IAP range of women with singleton pregnancy was from 14.28 to 48.96mm Hg with an average of (35.13±8.81)mm Hg before delivery, so the incidence of intra-abdominal hypertension (IAP high 12mmHg) was 100%;While IAP range after delivery was from 8.84 to 25.84 mmHg with an average of(16.16±4.61)mm Hg,so the incidence of intra-abdominal hypertension was 85.7% (18/21),there was a significant difference before and after childbirth (P<0.01).(3)The IAP of women with twin pregnancy before delivery was (38.25±10.18)mm Hg,which was in the range of intra-abdominal hypertension;While that after delivery was (22.61±10.98)mm Hg,only 75% (3/4)of those were diagnosed intra-abdominal hypertension. In short,IAP decreased significantly after delivery (P<0.01). Conclusion The IAP of normal women

  4. Surveillance of intra-abdominal pressure and intestinal barrier function in a rat model of acute necrotizing pancreatitis and its potential early therapeutic window.

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    Wei-Dong Li

    Full Text Available OBJECTIVES: To monitor intra-abdominal pressure (IAP and intestinal barrier function in a rat model of acute necrotizing pancreatitis (ANP to elucidate a potential relevant therapeutic window. METHODS: Sprague-Dawley rats were randomly divided into experimental or control groups. The ANP group (n = 40 was injected with 4.5% sodium taurocholate into the pancreatic duct to induce ANP. The controls received only abdominal opening surgery (sham-operated, SO; n = 40 or no treatment or surgery (baseline; 0 h, n = 20. The SO and ANP groups were then randomly subdivided into 3, 6, 12 and 24 h groups (n = 10 each. IAP was measured at each time point and the rats were sacrificed to measure the weight of accumulated ascites fluid and the amylase, endogenous creatinine (Cr, total bilirubin (TB, tumor necrosis factor- alpha (TNF-alpha, diamine oxidase (DAO, and D-lactate. Mortality and the development of pathological changes in the pancreas and intestines were also monitored. RESULTS: IAP showed a continuous upward trend in the ANP group, with values 2 to 3 times higher than those in the SO group at the corresponding time points and the rising rate was peaking at 6 h. The levels of plasma amylase, TNF-alpha, Cr, TB, DAO, and D-lactate also gradually increased in the ANP group over time and were significantly higher than in the SO group at 3, 6, 12 and 24 h (all P<0.05. Moreover, the rising rate of TNF-alpha, DAO, and D-lactate also peaked at 6 h. CONCLUSIONS: The ANP-induced changes in IAP, inflammatory factors and intestinal barrier that we observed in the rat model were especially obvious at 6 h post-induction, suggesting an early therapeutic window for the treatment of ANP in humans.

  5. Relación entre la presión intrabdominal en diálisis peritoneal con las hernias y fugas The link between intra-abdominal pressure in peritoneal dialysis and hernias and fugues

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    Concepción Blasco Cabañas

    2012-06-01

    ±253 ml/m². Un 23.5 % tenían una presión intrabdominal mayor a 20 cm. de H2O. En sedestación la media fue de 28±5.5 cm. de H2O y en bipedestación de 43.7±5.3 cm. de H2O. Los enfermos con presión intrabdominal > 20 cm. H2O tenían más porcentaje de hernias (50% vs 12 % y fugas pericatéter (37 % vs. 12 %. Como principales conclusiones, podemos destacar que los niveles de presión intrabdominal de nuestros pacientes son algo más elevados que en otras series. A mayor edad, mayor comorbilidad y mayor índice de masa corporal, la presión intrabdominal es más elevada. Los enfermos con presión intrabdominal elevada presentaron más episodios de hernias y fugas.Normal intra-abdominal pressure is equal to atmospheric pressure (zero. In peritoneal dialysis the introduction of intra-peritoneal liquid increases intra-abdominal pressure. In various studies it is recommended that this does not exceed 16-20cm H2O. In addition to possible abdominal discomfort, high intra-abdominal pressure can be linked to problems with the abdominal wall, such as hernias and fugues, and have implications for peritoneal transport and ultrafiltration deficit. The aims of this study were the following: to find out the intra-abdominal pressure levels in the prevalent type of patients in peritoneal dialysis, to assess the factors influencing the values for this pressure and to study the relationship between intra-abdominal pressure and the development of hernias and fugues, retrospectively. A transversal, observational and retrospective study was conducted to measure intra-abdominal pressure in the prevalent, stable patients who had been on peritoneal dialysis for more than three months. Intra-abdominal pressure was measured using the method described by Durand: patient in a supine position, with diurnal peritoneal volume. The final intra-abdominal pressure is the average of the measurements taken during inspiration and expiration, is expressed in cm H2O and the volume drained is

  6. Intra-Abdominal Hypertension and Abdominal Compartment Syndrome after Abdominal Wall Reconstruction: Quaternary Syndromes?

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    Kirkpatrick, A W; Nickerson, D; Roberts, D J; Rosen, M J; McBeth, P B; Petro, C C; Berrevoet, Frederik; Sugrue, M; Xiao, Jimmy; Ball, C G

    2017-06-01

    Reconstruction with reconstitution of the container function of the abdominal compartment is increasingly being performed in patients with massive ventral hernia previously deemed inoperable. This situation places patients at great risk of severe intra-abdominal hypertension and abdominal compartment syndrome if organ failure ensues. Intra-abdominal hypertension and especially abdominal compartment syndrome may be devastating systemic complications with systematic and progressive organ failure and death. We thus reviewed the pathophysiology and reported clinical experiences with abnormalities of intra-abdominal pressure in the context of abdominal wall reconstruction. Bibliographic databases (1950-2015), websites, textbooks, and the bibliographies of previously recovered articles for reports or data relating to intra-abdominal pressure, intra-abdominal hypertension, and the abdominal compartment syndrome in relation to ventral, incisional, or abdominal hernia repair or abdominal wall reconstruction. Surgeons should thus consider and carefully measure intra-abdominal pressure and its resultant effects on respiratory parameters and function during abdominal wall reconstruction. The intra-abdominal pressure post-operatively will be a result of the new intra-peritoneal volume and the abdominal wall compliance. Strategies surgeons may utilize to ameliorate intra-abdominal pressure rise after abdominal wall reconstruction including temporizing paralysis of the musculature either temporarily or semi-permanently, pre-operative progressive pneumoperitoneum, permanently removing visceral contents, or surgically releasing the musculature to increase the abdominal container volume. In patients without complicating shock and inflammation, and in whom the abdominal wall anatomy has been so functionally adapted to maximize compliance, intra-abdominal hypertension may be transient and tolerable. Intra-abdominal hypertension/abdominal compartment syndrome in the specific setting of

  7. Pre-eclampsia renamed and reframed: Intra-abdominal hypertension in pregnancy.

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    Sawchuck, Diane J; Wittmann, Bernd K

    2014-11-01

    This hypothesis proposes pre-eclampsia is caused by intra-abdominal hypertension in pregnancy. Sustained or increasing intra-abdominal pressure ⩾12mmHg causes impaired venous return to the heart, systemic vascular resistance, ischemia reperfusion injury, intestinal permeability, translocation of lipopolysaccharide endotoxin to the liver, cytotoxic immune response, systemic inflammatory response, pressure transmission to thoracic and intra-cranial compartments, and multi-organ dysfunction. This hypothesis is predicated on Pascal's law, evidence founded in the intra-abdominal hypertension literature, and the adapted equation ΔIAP-P=ΔIAVF/Cab, where ΔIAP-P=change in intra-abdominal pressure in pregnancy, ΔIAVF=change in intra-abdominal vector force (volume and force direction) and Cab=abdominal compliance. Factors causing increased intra-abdominal pressure in pregnancy include: progressive uterine expansion, obstetrical factors that increase intra-uterine volume excessively or acutely, maternal anthropometric measurements that affect intra-abdominal pressure thresholds, maternal postures that increase abdominal force direction, abdominal compliance that is decreased, diminished with advancing gestation, or has reached maximum expansion, habitation at high altitude, and rapid drops in barometric pressure. We postulate that the threshold for lipopolysaccharide translocation depends on the magnitude of intra-abdominal pressure, the intestinal microbiome complex, and the degree of intestinal permeability. We advance that delivery cures pre-eclampsia through the mechanism of abdominal decompression.

  8. Intra-abdominal tuberculous peritonitis

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    Schneider, G.; Ahlhelm, F.; Altmeyer, K.; Kramann, B. [Dept. of Diagnostic Radiology, University Hospital, Homburg (Germany); Hennes, P. [Dept. of Pediatrics, University Hospital, Homburg (Germany); Pueschel, W. [Dept. of Pathology, University Hospital, Homburg (Germany); Karadiakos, N. [Dept. of Pediatric Surgery, University Hospital, Homburg (Germany)

    2001-07-01

    We report the case of a 15-year-old boy suffering from progressive dyspnea on exertion and painful abdominal protrusion. Final diagnosis of intra-abdominal tuberculosis (TB), including lymphadenopathy and abdominal abscess formation, was made following elective laparotomy. This type of disease is a rare manifestation of extrapulmonary tuberculosis. The imaging findings in unenhanced and contrast-enhanced MRI and laparoscopic images are presented. Differential diagnosis of abdominal abscess formation and other fungal or bacteriological infections, as well as the imaging findings of this type of lesion, are discussed. This case demonstrates that atypical manifestation of TB may remain unrecognized; thus, awareness of this kind of manifestation of tuberculosis may prevent patients from being subjected to inappropriate therapies. (orig.)

  9. Intra-abdominal hypertension--an experimental study of early effects on intra-abdominal metabolism.

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    Skoog, Per; Hörer, Tal; Nilsson, Kristofer F; Agren, Göran; Norgren, Lars; Jansson, Kjell

    2015-01-01

    The main aim of this experimental study was to investigate the early effects of intra-abdominal hypertension (IAH) on intra-abdominal metabolism and intestinal mucosal blood flow to evaluate whether metabolites can serve as markers for organ dysfunction during IAH. A swine model was used, and the animals were anesthetized and ventilated. Fifteen animals were subjected to IAH of 30 mm Hg for 4 hr by carbon dioxide insufflation. Seven animals served as controls. Hemodynamic data, arterial blood samples, and urine output were analyzed. Intraluminal laser Doppler flowmetry measured intestinal mucosal blood flow. Glucose, glycerol, lactate, and pyruvate concentrations and lactate-to-pyruvate (l/p) ratio were measured intraperitoneally and intramurally in the small intestine and rectum using microdialysis. IAH lowered the abdominal perfusion pressure by 12-18 mm Hg, reduced the intestinal mucosal blood flow by 45-63%, and decreased urine output by 50-80%. In the intervention group, glycerol concentrations increased at all locations, pyruvate concentrations decreased, and the l/p ratio increased intraperitoneally and intramurally in the small intestine. Control animals remained metabolically stable. Glucose and lactate concentrations were only slightly affected or unchanged in both the groups. IAH reduces intestinal blood flow and urinary output and causes early metabolic changes, indicating a discrete shift toward anaerobic metabolism. Intraperitoneal microdialysis may be useful in the early detection of impaired organ dysfunction with metabolic consequences in IAH and abdominal compartment syndrome. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. A focus on intra-abdominal infections

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    Sartelli Massimo

    2010-03-01

    Full Text Available Abstract Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients. Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection. Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures. The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy. The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes. Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials. Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance. Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug

  11. Clinical evaluation of an air-capsule technique for the direct measurement of intra-abdominal pressure after elective abdominal surgery

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    Otto, Jens; Kaemmer, Daniel; Biermann, Andreas; Jansen, Marc; Dembinski, Rolf; Schumpelick, Volker; Schachtrupp, Alexander

    2008-01-01

    Background The gold standard for assessment of intraabdominal pressure (IAP) is via intravesicular pressure measurement (IVP). This accepted technique has some inherent problems, e.g. indirectness. Aim of this clinical study was to assess direct IAP measurement using an air-capsule method (ACM) regarding complications risks and agreement with IVP in patients undergoing abdominal surgery. Methods A prospective cohort study was performed in 30 patients undergoing elective colonic, hepatic, pancreatic and esophageal resection. For ACM a Probe 3 (Spiegelberg®, Germany) was placed on the greater omentum. It was passed through the abdominal wall paralleling routine drainages. To compare ACM with IVP t-testing was performed and mean difference as well as limits of agreement were calculated. Results ACM did not lead to complications particularly with regard to organ lesion or surgical site infection. Mean insertion time of ACM was 4.4 days (min-max: 1–5 days). 168 pairwise measurements were made. Mean ACM value was 7.9 ± 2.7 mmHg while mean IVP was 8.4 ± 3.0 mmHg (n.s). Mean difference was 0.4 mmHg ± 2.2 mmHg. Limits of agreement were -4.1 mmHg to 5.1 mmHg. Conclusion Using ACM, direct IAP measurement is feasible and uncomplicated. Associated with relatively low pressure ranges (<17 mmHg), results are comparable to bladder pressure measurement. PMID:18925973

  12. Clinical evaluation of an air-capsule technique for the direct measurement of intra-abdominal pressure after elective abdominal surgery

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    Dembinski Rolf

    2008-10-01

    Full Text Available Abstract Background The gold standard for assessment of intraabdominal pressure (IAP is via intravesicular pressure measurement (IVP. This accepted technique has some inherent problems, e.g. indirectness. Aim of this clinical study was to assess direct IAP measurement using an air-capsule method (ACM regarding complications risks and agreement with IVP in patients undergoing abdominal surgery. Methods A prospective cohort study was performed in 30 patients undergoing elective colonic, hepatic, pancreatic and esophageal resection. For ACM a Probe 3 (Spiegelberg®, Germany was placed on the greater omentum. It was passed through the abdominal wall paralleling routine drainages. To compare ACM with IVP t-testing was performed and mean difference as well as limits of agreement were calculated. Results ACM did not lead to complications particularly with regard to organ lesion or surgical site infection. Mean insertion time of ACM was 4.4 days (min-max: 1–5 days. 168 pairwise measurements were made. Mean ACM value was 7.9 ± 2.7 mmHg while mean IVP was 8.4 ± 3.0 mmHg (n.s. Mean difference was 0.4 mmHg ± 2.2 mmHg. Limits of agreement were -4.1 mmHg to 5.1 mmHg. Conclusion Using ACM, direct IAP measurement is feasible and uncomplicated. Associated with relatively low pressure ranges (

  13. Management of intra-abdominal hypertension and abdominal compartment syndrome: a review

    Science.gov (United States)

    2014-01-01

    Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Aim: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian. The electronic data bases Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, EMBASE, and the World Wide Web was undertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal compartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved material are discussed under the following themes: (1) etiology of intra-abdominal hypertension; (2) strategies for measuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome; and (4) the importance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function. PMID:24499574

  14. La medición de la presión intrabdominal, una herramienta diagnóstica para el médico de familia Intra-abdominal pressure measurement, a diagnostic tool for family physician

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    Nizahel Estévez Álvarez

    2010-09-01

    Full Text Available Resulta muy oportuno establecer un diagnóstico precoz de las afecciones intrabdominales agudas, por eso consideramos prudente poner en manos de nuestro personal de salud que labora en el sistema de urgencia del nivel primario, una herramienta diagnóstica más para el Médico de Familia, como es la medición de la presión intrabdominal, por no existir prácticamente experiencias de su empleo fuera de las unidades de atención al paciente grave. Es este un método perfectamente implementable en nuestro medio por su fácil aplicabilidad técnica y su alta especificidad diagnóstica, que permite inferir, en las primeras horas de evolución de los pacientes con cuadros dolorosos abdominales, cuáles resultarían potencialmente necesitados de tratamiento quirúrgico, y de esta manera, ganar en resolutividad. La imposibilidad de realizar esta técnica nunca debería de retrasar la remisión del paciente para su valoración por un especialista en cirugía general, por tanto, esta solo pudiera ser considerada como un complemento más del arsenal diagnóstico al alcance del Médico de Familia, en centros acondicionados para su implementación y con el entrenamiento previo adecuado.It is very appropriate to establish an early diagnosis of acute intra-abdominal infections, thus, authors believe cautious that our health staff working in the primary level of emergence system to count on another diagnostic tool for Family Physician, the intra-abdominal pressure measurement, due to practically the lack of experience of its job out of the care units for the severe patient. This is a method perfectly applicable in our environment by its easy technical application and its high diagnostic specificity allowing inferring during the first hours of evolution of patients presenting with abdominal painful symptoms, who will be potentially needed of surgical treatment and so to achieve a solution. The impossibility to perform this technique never must to retard the

  15. Intra-abdominal gout mimicking pelvic abscess

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    Chen, Chia-Hui; Chen, Clement Kuen-Huang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan); National Yang-Ming University, School of Medicine, Taipei (Taiwan); Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan)

    2005-04-01

    Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

  16. Continuous Non-invasive finger cuff CareTaker® comparable to invasive intra-arterial pressure in patients undergoing major intra-abdominal surgery.

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    Gratz, Irwin; Deal, Edward; Spitz, Francis; Baruch, Martin; Allen, I Elaine; Seaman, Julia E; Pukenas, Erin; Jean, Smith

    2017-03-21

    Despite increased interest in non-invasive arterial pressure monitoring, the majority of commercially available technologies have failed to satisfy the limits established for the validation of automatic arterial pressure monitoring by the Association for the Advancement of Medical Instrumentation (AAMI). According to the ANSI/AAMI/ISO 81060-2:2013 standards, the group-average accuracy and precision are defined as acceptable if bias is not greater than 5 mmHg and standard deviation is not greater than 8 mmHg. In this study, these standards are used to evaluate the CareTaker® (CT) device, a device measuring continuous non-invasive blood pressure via a pulse contour algorithm called Pulse Decomposition Analysis. A convenience sample of 24 patients scheduled for major abdominal surgery were consented to participate in this IRB approved pilot study. Each patient was monitored with a radial arterial catheter and CT using a finger cuff applied to the contralateral thumb. Hemodynamic variables were measured and analyzed from both devices for the first thirty minutes of the surgical procedure including the induction of anesthesia. The mean arterial pressure (MAP), systolic and diastolic blood pressures continuously collected from the arterial catheter and CT were compared. Pearson correlation coefficients were calculated between arterial catheter and CT blood pressure measurements, a Bland-Altman analysis, and polar and 4Q plots were created. The correlation of systolic, diastolic, and mean arterial pressures were 0.92, 0.86, 0.91, respectively (p arterial pressures, respectively with a standard deviation of 7.34, 6.47, 5.33 mmHg for systolic, diastolic, and mean arterial pressures, respectively (p pressure measured using the non-invasive CT device was shown to correlate well with the arterial catheter measurements. Larger studies are needed to confirm these results in more varied settings. Most patients exhibited very good agreement between methods. Results were

  17. Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: A prospective randomised study

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    Mario Schietroma

    2016-01-01

    Full Text Available Background: The advantages of laparoscopic adrenalectomy (LA over open adrenalectomy are undeniable. Nevertheless, carbon dioxide (CO2 pneumoperitoneum may have an unfavourable effect on the local immune response. The aim of this study was to compare changes in the systemic inflammation and immune response in the early post-operative (p.o. period after LA performed with standard and low-pressure CO2pneumoperitoneum. Materials and Methods: We studied, in a prospective randomised study, 51 patients consecutively with documented adrenal lesion who had undergone a LA: 26 using standard-pressure (12-14 mmHg and 25 using low-pressure (6-8 mmHg pneumoperitoneum. White blood cells (WBC, peripheral lymphocyte subpopulation, human leucocyte antigen-DR (HLA-DR, neutrophil elastase, interleukin (IL-6 and IL-1, and C-reactive protein (CRP were investigated. Results: Significantly higher concentrations of neutrophil elastase, IL-6 and IL-1 and CRP were detected p.o. in the standard-pressure group of patients in comparison with the low-pressure group (P < 0.05. A statistically significant change in HLA-DR expression was recorded p.o. at 24 h, as a reduction of this antigen expressed on the monocyte surface in patients from the standard group; no changes were noted in low-pressure group patients (P < 0.05. Conclusions: This study demonstrated that reducing the pressure of the pneumoperitoneum to 6-8 mmHg during LA reduced p.o. inflammatory response and averted p.o. immunosuppression.

  18. Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study.

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    L Correa-Martín

    Full Text Available Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient's risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology.Fifteen pigs were divided into three groups: a control group (n = 5 and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min.Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05. In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours.The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction.

  19. Laparoscopy and Intra-Abdominal Sepsis

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    Coyne

    2015-06-01

    Full Text Available Context Intra-abdominal sepsis has significant morbidity and mortality. In the developed world, there are many common causes originating from the lower gastrointestinal tract including diverticular disease, appendicitis, perforated cancers, and inflammatory bowel disease. It has a high cost and is associated with high levels of significant morbidity and mortality. Management options include radiologic drainage and surgical options include resection for more widespread sepsis. Laparoscopic surgery has increased and has been useful in elective setting. Its use in the emergency setting is less evaluated. Evidence Acquisition Evidence was acquired by searching online medical databases including Pubmed, Medline and Embase. Results Laparoscopic surgery has been shown to have a role in the acute setting. Studies show it has become the gold standard in the appendicitis. High quality Randomized controlled trials are in short supply but observational and cohort studies have shown equivalence and with increasing experience complication rates are reduced. Evidence is also increasing in the management of diverticular disease, crohn’s and ulcerative colitis as well as post-operative complication management and acute presentations of colorectal cancer. Conclusions Laparoscopic surgery is feasible in the management of intra-abdominal sepsis. It has become the new accepted standard in the management of appendicitis, and is safe, feasible and increasing in the management of complex diverticular disease, acute IBD and colorectal cancer in the emergency and post-operative setting.

  20. Effects of increased intra-abdominal pressure on the healing process after surgical stapling of the stomach of dogs Efeitos da elevação da pressão intra-abdominal e de seu tempo de ação na cicatrização de suturas mecânicas no estômago de cães

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    Nilson Chaves Jr

    2007-10-01

    Full Text Available PURPOSE: To assess the initial healing after surgical stapling of the stomach using a linear cutting stapler and creating pneumoperitoneum (12-14 mmHg for 60 minutes or 120 minutes, and compare it with the healing of a staple line not submitted to increased pressure. METHODS: A total of 30 dogs were divided into three groups of 10 animals each: Group I (control group - surgical stapling, Group II (surgical stapling and increased intra-abdominal pressure for 60 minutes and Group III (surgical stapling and increased intra-abdominal pressure for 120 minutes. All dogs were maintained under general anesthesia for two hours after surgical stapling. Seven days after surgery, the area around the staple line was macroscopically and microscopically examined. RESULTS: The macroscopic examination of the samples (n = 30 did not show dehiscence, fistula or abscess. Adhesions between the omentum and the staple line were observed in all animals of Groups II and III (n = 20, which were significantly different from Group I (p = 0.008*. The histopathological analysis showed normal healing up to day 7 in the control animals (n = 10. When these results were compared with those of Groups II and III (n = 20, non-parametric tests revealed that there was a significant difference with regard to certain parameters of the early stages of healing, such as fibroblast migration (p = 0.011*, edema (p OBJETIVO: Avaliar os efeitos do pneumoperitônio com CO2 sobre a fase inicial da cicatrização (7º dia de uma sutura gástrica mecânica em cães, com diferentes tempos de aumento da pressão intra-abdominal. MÉTODOS: Trinta cães foram divididos em três grupos e submetidos à laparotomia mediana e realização de uma sutura vertical na grande curvatura gástrica com grampeador linear cortante. Após a síntese abdominal, nos animais dos grupos II e III instalou-se pneumoperitônio com CO2, permanecendo os animais com pressão intra-abdominal entre 12 e 14 mmHg durante 60

  1. Correlation study of recovery degrees and intra-abdominal pressure changes for patients after ilealcolon neobladder surgery%原位回结肠新膀胱术后患者恢复程度与腹压变化的相关性研究

    Institute of Scientific and Technical Information of China (English)

    段利英

    2014-01-01

    目的:探讨原位回结肠新膀胱术后患者恢复程度与腹内压变化的相关性研究,以指导护理工作,防止并发症。方法:对60例患者根据 UBP 不同分为实验组和对照组,行膀胱全切、原位回结肠代膀胱术后患者进行 UBP 与生命体征、术后恢复程度观察指标的监测。结果:实验组患者胃肠功能恢复明显优于对照组,两组患者 MP 比较差异无统计学意义(t=1.64,P>0.05),心率、呼吸频率、疼痛三个指标,两组比较差异有统计学意义(P0. 05). There were differences in heart rate, breathing rate, and pains between the two groups (P<0. 05). The correlation analysis for the intra-abdominal pressure and postoperative recovery indices of the two groups showed that the intra-abdomi-nal pressure was positively correlated with bowel sounds recovery time, anus exhaust time, heart rate, breathing rate, and pains, but was negatively correlated with daily food intake; and the intra-abdominal pressure was also negatively correlated with the mean arterial pressure (P<0. 05). The incidence rates of abdominal distention and complications of control group were higher than those of experi-mental group, and there were statistical difference between the two groups. Conclusions: After the ilealcolon neobladder surgery, the recovery is closely related with the intra-abdominal pressure changes. Therefore, UBP for monitoring the intra-abdominal pressure is a good method for observing the patients' conditions and recovery degrees after the surgery.

  2. Effect of intra-abdominal volume increment technique for the treatment of intra-abdominal hypertension on the liver after resuscitation of hemorrhagic shock in pig

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    Zheng-gang WANG

    2012-02-01

    Full Text Available Objective  To observe the effect of vacuum sealing drainage (VSD assisted intra-abdominal volume increment (IAVI technique on the liver in the treatment of intra-abdominal hypertension (IAH following hemorrhagic shock resuscitation in pigs. Methods  Twelve healthy mini-pigs (Bama, Guangxi were selected for bloodletting from the femoral artery to reproduce hemorrhagic shock model (mean arterial blood pressure, 50mmHg, 1h, and IAH model was successfully reproduced in eight pigs by partial occlusion of portal vein. The eight pigs were randomly divided into the intra-abdominal volume increment treatment (IT group (n=4 and sham operation control (SC group (n=4. Vesical pressure (VP and inferior vena cava pressure (IVCP were observed before shock, 2h after IAH, and 22h after IAVI treatment. Aspartate aminotransferase (AST and alanine aminotransferase (ALT were measured. In addition, the ratio of the abdominal anteroposterior diameter to the transverse diameter was assessed, and the liver CT values were measured after enhanced CT scanning. The pigs were sacrificed 26h after operation. Liver specimens were collected to measure the ratio of wet weight to dry weight and pathological examination. Results  The VP in 8 IAH pigs was 21.16±4.63mmHg. The ratio of abdominal anteroposterior diameter to the transverse diameter increased remarkably 2h after IAH compared with that before shock (1.22±1.41 vs 0.96±0.08, PPvs 42.73±4.92HU, PPPvs 5.14±0.71, PConclusions  The established model could better reproduce the symptoms of IAH after hemorrhagic shock and fluid resuscitation, accompanied by liver damage. IAVI helps to relieve liver functional disturbance after IAH, which is related to decreased intra-abdominal pressure and hypoxia-ischemia of the liver.

  3. Change in Intra-Abdominal Fat Predicts the Risk of Hypertension in Japanese Americans.

    Science.gov (United States)

    Sullivan, Catherine A; Kahn, Steven E; Fujimoto, Wilfred Y; Hayashi, Tomoshige; Leonetti, Donna L; Boyko, Edward J

    2015-07-01

    In Japanese Americans, intra-abdominal fat area measured by computed tomography is positively associated with the prevalence and incidence of hypertension. Evidence in other populations suggests that other fat areas may be protective. We sought to determine whether a change in specific fat depots predicts the development of hypertension. We prospectively followed up 286 subjects (mean age, 49.5 years; 50.4% men) from the Japanese American Community Diabetes Study for 10 years. At baseline, subjects did not have hypertension (defined as blood pressure ≥140/90 mm Hg) and were not taking blood pressure or glucose-lowering medications. Mid-thigh subcutaneous fat area, abdominal subcutaneous fat area, and intra-abdominal fat area were directly measured by computed tomography at baseline and 5 years. Logistic regression was used to estimate odds of incident hypertension over 10 years in relation to a 5-year change in fat area. The relative odds of developing hypertension for a 5-year increase in intra-abdominal fat was 1.74 (95% confidence interval, 1.28-2.37), after adjusting for age, sex, body mass index, baseline intra-abdominal fat, alcohol use, smoking status, and weekly exercise energy expenditure. This relationship remained significant when adjusted for baseline fasting insulin and 2-hour glucose levels or for diabetes mellitus and pre-diabetes mellitus classification. There were no significant associations between baseline and change in thigh or abdominal subcutaneous fat areas and incident hypertension. In conclusion, in this cohort of Japanese Americans, the risk of developing hypertension is related to the accumulation of intra-abdominal fat rather than the accrual of subcutaneous fat in either the thigh or the abdominal areas.

  4. Modulação da pressão intracraniana em um modelo experimental de hipertensão abdominal e lesão pulmonar aguda Factors associated with variation in intracranial pressure in a model of intra-abdominal hypertension with acute lung injury

    Directory of Open Access Journals (Sweden)

    Fernando Godinho Zampieri

    2011-06-01

    Full Text Available OBJETIVO: Avaliar o efeito de alterações hemodinâmicas, respiratórias e metabólicas sobre a pressão intracraniana em um modelo de lesão pulmonar aguda e síndrome compartimental abdominal. MÉTODOS: Oito porcos Agroceres foram submetidos, após a instrumentação, a cinco cenários clínicos: 1 estado basal com baixa pressão intra-abdominal e pulmão sadio; 2 pneumoperitôneo, com pressão intra-abdominal de 20 mm Hg; 3 lesão pulmonar aguda induzida por lavagem pulmonar e desativação de surfactante; 4 pneumoperitôneo com pressão intra-abdominal de 20 mm Hg na vigência de lesão pulmonar aguda e com PEEP baixo; e 5 PEEP ajustado a 27 cm H2O na vigência de pneumoperitôneo e lesão pulmonar aguda. Variáveis respiratórias e hemodinâmicas foram coletadas. Análise multivariada foi realizada buscando as variáveis associadas com elevação da pressão intracraniana nos cinco cenários estudados. RESULTADOS: Após a análise multivariada, nas situações não associadas com lesão pulmonar aguda apenas a pressão de platô das vias aéreas se correlacionou positivamente com a pressão intracraniana. Nos modelos associados com lesão pulmonar aguda, a pressão de platô de vias aéreas, a pressão arterial de CO2, o CO2 no final da expiração e a pressão venosa central se correlacionaram positivamente com incrementos da pressão intracraniana. CONCLUSÃO: Em um modelo de disfunção orgânica múltipla com situações clínicas associadas com aumento da pressão torácica e abdominal, o incremento da pressão intracraniana desencadeado pela elevação da pressão abdominal parece ser decorrente da piora da complacência do sistema respiratório e da redução do gradiente para drenagem venosa cerebral ocasionado pela elevação da pressão venosa central.OBJECTIVE: To evaluate the effects of hemodynamic, respiratory and metabolic changes on intracranial pressure in a model of acute lung injury and abdominal compartment syndrome

  5. Fournier's gangrene secondary to intra-abdominal processes.

    Science.gov (United States)

    Gerber, G S; Guss, S P; Pielet, R W

    1994-11-01

    We report 2 cases of necrotizing fasciitis of the perineum, perianal area, and male genitalia (Fournier's gangrene) that arose secondary to intra-abdominal infectious processes (ruptured appendicitis and diverticulitis). Management consisted of immediate debridement of necrotic tissue, exploratory laparotomy, and diverting colostomy. The presence of an acute abdominal process was not immediately evident on initial evaluation of either patient. This demonstrates the critical importance of considering intra-abdominal infection in patients with Fournier's gangrene when the more commonly seen urinary tract, perirectal, and traumatic causes are not readily apparent.

  6. Intra-abdominal Adiposity In Preterm Infants: An Explorative Study

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    F. Taroni

    2012-12-01

    Full Text Available Objective: The aim of the present study was to compare the total body fat mass and the intra-abdominal adipose tissue between preterm infants assessed at term corrected age and full-term newborns. Methods: An observational explorative study was conducted. 25 preterm and 10 full term infants were evaluated at 0-1 month of corrected and postnatal age, respectively. The total body fat mass was assessed by means of an air displacement plethysmography system (Pea Pod COSMED, USA and the intra-abdominal adipose tissue by means of magnetic resonance imaging (software program SliceOMatic, Version 4.3,Tomovision, Canada. Results: Total body fat mass (g of preterm and term infants was 633 (±183 and 538 (±203 respectively while intra-abdominal fat mass (g was 14.2 (±4.9 and 19.9 (±11.4. Conclusions: Preterm infants, although exhibiting a total body fat mass higher than full term infants, do not show an increased intra-abdominal adipose tissue.

  7. Open abdomen management of intra-abdominal sepsis.

    Science.gov (United States)

    Adkins, Amy L; Robbins, James; Villalba, Mario; Bendick, Phillip; Shanley, Charles J

    2004-02-01

    Despite surgical advances, antimicrobial therapy, and intensive care, the morbidity and mortality of intra-abdominal sepsis remains high. The primary purpose of this study was to determine whether open abdomen management of intra-abdominal sepsis reduces intensive care unit (ICU) and hospital mortality. The records of 81 consecutive patients with open abdomen management for intra-abdominal sepsis admitted to the surgical ICU from January 1998 to April 2002 were retrospectively reviewed. Outcomes were compared to a historical control group with primary abdominal closure, also admitted to the surgical ICU with intra-abdominal sepsis and matched for sex, age, source of sepsis, and APACHE III score. ICU mortality for the open abdomen group was 25 per cent versus 17 per cent for the control group. Hospital mortality was 33 per cent and 25 per cent for the open abdomen patients and historical controls, respectively. Both ICU and hospital length of stay were significantly longer for the open abdomen group. An overall fistula rate of 14.8 per cent was demonstrated in the open abdomen patients. A significant difference in overall ICU and hospital mortality was not demonstrated between patients treated with open abdomen management and historical controls. A prospective randomized study accounting for extent of sepsis may define a role for open abdomen management in selected subgroups of patients.

  8. Is intra-abdominal drainage necessary after pancreaticoduodenectomy?

    Science.gov (United States)

    Heslin, M J; Harrison, L E; Brooks, A D; Hochwald, S N; Coit, D G; Brennan, M F

    1998-01-01

    Closed suction drains after pancreaticoduodenectomy are theoretically used to drain potential collections and anastomotic leaks. It is unknown whether such drains are effective, harmful, or affect the outcome after this operation. Eighty-nine consecutive patients underwent pancreaticoduodenectomy for presumed periampullary malignancy and were retrospectively reviewed. Thirty-eight had no intra-abdominal drains and 51 had drains placed at the conclusion of the operation. We analyzed patient, nutritional, laboratory, and operating room factors with end points being complications and length of hospital stay. Intra-abdominal complications were defined as intra-abdominal abscess and pancreatic or biliary fistula. Postoperative interventions were defined as CT-guided drainage and reoperation. Analysis was by Student's t test and chi-square test. Two of eight surgeons contributed 92% of the patients without drains. The groups were equivalent with respect to demographic, nutritional, and operative factors. Time under anesthesia was significantly shorter in the group without drains (P = 0.0001). There was no statistical difference in the rate of fistula, abscess, CT drainage, or length of hospital stay. Intra-abdominal drainage did not significantly alter the risk of fistula, abscess, or reoperation or the necessity for CT-guided intervention after pancreaticoduodenectomy. Routine use of drains after pancreaticoduodenectomy may not be necessary and should be subjected to a randomized trial.

  9. Laparoscopic Fowler Stephens orchidopexy for intra-abdominal testis

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    Papparella A.

    2013-10-01

    Full Text Available The authors reported their experience in the laparoscopic orchidopexy for intra-abdominal testis (IAT. Since 2003, 173 laparoscopy for NPT were performed for a total of 181 testicular units. In 75 patients cord structures entering the inguinal ring were observed, and 43 had an inguinal exploration. In 34 patients a blind ending vas and vessels were observed and 8 showed testicular agenesis: these patients were managed by laparoscopy only. In 62 cases an intra-abdominal testes (IAT were found: 42 had a primary orchidopexy and 22, with high IAT, were managed by a laparoscopic Fowler-Stephens (FS procedure. In 12 testes we performed a two stage procedure while 10 had one stage. There were no differences in hospitalisation and early surgical complications were not recorded. Follow up ranged from 1 to 5 years. Of 22 patients who underwent FS orchidopexy, testicular atrophy developed in 4; the remaining are in scrotal position, with normal consistency and well perfused at color doppler ultrasound. Laparoscopy is essential in the surgical and therapeutic management of non-palpable testis. FS orchidopexy is reserved to high intra-abdominal testes that have a distance more than 3 cm from the internal inguinal ring. There were no differences between the group managed by one or two step FS. The minimal morbidity with an high success rate prove to be a significant contribution to the intra-abdominal testis management.

  10. Pylephlebitis: An Uncommon Complication of Intra-Abdominal Infection

    Directory of Open Access Journals (Sweden)

    Salim R Surani

    2011-05-01

    Full Text Available We herein present a case of pylephlebitis, which is an infective suppurative thrombosis of the portal vein. Pylephlebitis is an uncommon complication of intra-abdominal infections and carries with it significant morbidity and mortality. [West J Emerg Med. 2011;12(4:575–576.

  11. Case report: Filariasis presenting as an intra-abdominal cyst

    Directory of Open Access Journals (Sweden)

    Abhay K Kapoor

    2011-01-01

    Full Text Available Filariasis is an endemic infection seen in the tropical and subtropical regions of the world, presenting with lymphatic dysfunction in the form of lymphocele, hydrocele, chyluria, or groin lymphadenovarix. We report a rare presentation of filariasis as an intra-abdominal cystic mass.

  12. Conservative management of post-appendicectomy intra-abdominal abscesses

    Directory of Open Access Journals (Sweden)

    Dhaou Mahdi

    2010-10-01

    Full Text Available Abstract Purpose Appendicitis is the most common abdominal inflammatory process in children which were sometimes followed by complications including intra-abdominal abscess. This later needs classically a surgical drainage. We evaluated the efficacy of antibiotic treatment and surgical drainage. Methods Hospital records of children treated in our unit for intra-abdominal post appendectomy abscesses over a 6 years period were reviewed retrospectively. Results This study investigates a series of 14 children from 2 to 13 years of age with one or many abscesses after appendectomy, treated between 2002 and 2007. Seven underwent surgery and the others were treated with triple antibiotherapy. The two groups were comparable. For the 7 patients who receive medical treatment alone, it was considered efficient in 6 cases (85% with clinical, biological and radiological recovery of the abscess. There was one failure (14%. The duration of hospitalization from the day of diagnosis of intra-abdominal abscess was approximately 10.28 days (range 7 to 14 days. In the other group, the efficacy of treatment was considered satisfactory in all cases. The duration of hospitalization was about 13 days (range: 9 to 20. Conclusion Compared to surgical drainage, antibiotic management of intra-abdominal abscesses was a no invasive treatment with shorter hospitalization.

  13. Antimicrobial management of intra-abdominal infections:Literature's guidelines

    Institute of Scientific and Technical Information of China (English)

    Massimo Sartelli; Fausto Catena; Federico Coccolini; Antonio Daniele Pinna

    2012-01-01

    Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial use.Two sets of guidelines for the management of intra-abdominal infections were recently published.In 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA)created guidelines for the diagnosis and management of complicated IAIs.The new SIS-IDSA guidelines replace those previously published in 2002 and 2003.The World Society of Emergency Surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug methodology.These guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.

  14. Effect of intra-abdominal hypertension on left ventricular relaxation: a preliminary animal study.

    Science.gov (United States)

    Mahjoub, Y; Lorne, E; Maizel, J; Plantefève, G; Massy, Z A; Dupont, H; Slama, M

    2012-02-01

    In the intensive care unit, intra-abdominal hypertension (IAH) is a frequently encountered, life-threatening condition. The aim of this animal study was to evaluate the effect of IAH on left ventricular (LV) relaxation (i.e. the active phase of diastole). Seven male rabbits were anaesthetized before mechanical ventilation. A 20 mm Hg increase in intra-abdominal pressure (IAP) was then induced by intraperitoneal infusion of 1.5% glycine solution. Haemodynamic parameters were recorded and the relaxation time constant tau (considered to be the best index of left ventricle relaxation) was calculated. All haemodynamic measurements were recorded at baseline and then after induction of IAH. A 20 mm Hg increase in IAP was not followed by a significant change in arterial pressure, but was associated with increases in central venous pressure (from 2 [-2 to 6] to 7 [-2 to 12] mm Hg, P= 0.03), LV end-diastolic pressure (from 7 [6-8] to 15 [11-19] mm Hg, P= 0.04) and the relaxation time constant tau (from 16 [14-18] to 43 [34-52] ms, P= 0.048). In this animal study, a 20 mm Hg increase in IAP impaired LV relaxation. Further studies are necessary to identify the causes of this impairment.

  15. Intra-abdominal Hypertension: An Important Consideration for Diuretic Resistance in Acute Decompensated Heart Failure.

    Science.gov (United States)

    Nguyen, Vinh Q; Gadiraju, Taraka V; Patel, Hiren; Park, Minnsun; Le Jemtel, Thierry H; Jaiswal, Abhishek

    2016-01-01

    Fluid accumulation is the hallmark of heart failure decompensation. Fluid overload and congestion are associated with recurrent hospitalizations, poor quality of life, and increased mortality in heart failure. Despite the use of high-dose intravenous loop diuretic therapy, acutely decompensated heart failure patients may develop diuretic resistance. Diuretic refractoriness can be a result of elevated intra-abdominal pressure (IAP) in acutely decompensated heart failure. Increased renal venous and interstitial pressures in patients with elevated IAP may lead to renal impairment and diuretic resistance. Routine approaches such as sequential nephron blockade with a combination of loop and thiazide or thiazide-like diuretics, continuous diuretic infusion, and ultrafiltration may not be sufficient. Presented here is a case illustrating the importance of recognizing intra-abdominal hypertension in patients with diuretic resistance. Lowering IAP improves renal perfusion, renal filtration, and diuresis. When elevated, IAP is an easily reversible cause of diuretic resistance. Additionally, abdominal perfusion pressure can be used to guide therapy to reverse end-organ damage and avoid permanent renal replacement therapy.

  16. Intra-abdominal hypertension complicating pancreatitis-induced acute respiratory distress syndrome in three patients on extracorporeal membrane oxygenation.

    Science.gov (United States)

    Feddy, Lee; Barker, Julian; Fawcett, Pete; Malagon, Ignacio

    2016-01-01

    Severe acute pancreatitis is associated with sever multiorgan failure from 15 to 50%, depending on the series. In some of these patients, conventional methods of ventilation and respiratory support will fail, demanding the use of extracorporeal membrane oxygenation (ECMO). Abdominal compartment syndrome is potentially harmful in this cohort of patients. We describe the successful treatment of three patients with severe acute pancreatitis who underwent respiratory ECMO and where intra abdominal pressure was monitored regularly. Retrospective review of case notes. Three patients with severe acute pancreatitis requiring ECMO suffered from increased intra abdominal pressure during their ICU stay. No surgical interventions were taken to relieve abdominal compartment syndrome. Survival to hospital discharge was 100%. Monitoring intraabdominal pressure is a valuable adjunct to decision making while caring for these high-risk critically ill patients.

  17. Hemodynamic and metabolic changes as a result of application of different degrees of non-pneumatic intra-abdominal compression in rats

    Directory of Open Access Journals (Sweden)

    Bin LIANG

    2012-05-01

    Full Text Available Objective  To assess effects of different degrees of non-pneumatic intra-abdominal high pressure on metabolism and hemodynamics for the purpose of selecting the safe range of intra-abdominal pressure in anesthetized rats. Methods  Twenty four male Wistar rats were anesthetized and randomly distributed into four groups (IAP0, IAP5, IAP10, IAP15 (n=6. All the rats underwent 30 minutes of intra-abdominal distension resulting in 0, 5, 10 or 15mmHg of intra-abdominal pressure with a non-pneumatic device. Arterial blood were collected at following 4 time points: baseline, end of insufflation, 20 and 40min after desufflation respectively for assaying arterial blood pH, PaO2, PaCO2, HCO3-, base excess (BE, lactic acid (LAC. At the end of experiment, serum alanine aminotransferase (ALT and creatinine (Cr were determined. Mean artery pressure (MAP and heart rate (HR were monitored via right carotid catheter throughout the experiment. Results  No death occurred in each group. MAP in IAP15 group decreased by 42 percent when compared with that in IAP0 group (P 0.05. The pH values at the period of insufflation and at 20min after desufflation in IAP15 group were significantly lower than those in other groups (P 0.05. Significantly higher LAC level and significantly lower HCO3- and BE level were seen in IAP15 group compared with those of IAP0, IAP5, IAP10 groups at the end of the insufflation and at 20 and 40min after desufflation (P 0.05. Conclusion Safe limit of intra-abdominal pressures is less than 10mmHg, and intra-abdominal pressure of 15mmHg should be avoided in spontaneously breathing anesthetized rats.

  18. Laparoscopic resection of intra-abdominal extralobar pulmonary sequestration.

    Science.gov (United States)

    van der Zee, David C; NMa Bax, Klaas

    2005-10-01

    The intra-abdominal localization of extralobar pulmonary sequestration (EPS) is an uncommon entity, although there are an increasing number of publications in literature on EPS over recent years. There seems to be a predominance of left-sided suprarenal positioning of the sequester and so far resection has been undertaken by way of laparotomy. This paper describes the laparoscopic resection of EPS in two patients. In both instances the procedure was successful and the postoperative course was uneventful. It is concluded that EPS should be included in the differential diagnosis of suprarenal masses, particularly on the left side. Laparoscopic resection is the method of choice for EPS.

  19. Toxicity from Intra-Abdominal Injection of Chlorfenapyr

    OpenAIRE

    Jina Lee; Jun Hyun Lee; Jong Min Baek; Do Sang Lee; Il Young Park; Jong Man Won; Ki Young Sung

    2013-01-01

    Introduction. Chlorfenapyr is commonly used for food crops in Korea. However, chlorfenapyr toxicity in humans has not yet been studied. Case. A 74-year-old man was admitted to the emergency room after he intra-abdominally injected 20 mL of chlorfenapyr in an attempt to commit suicide. Emergency surgery was performed and accumulation of approximately 500 mL of reactive fluid in the abdomen was observed. The entire small intestine showed congestion. After surgery, additional surgery to drain th...

  20. Effects of anabolic steroids on acute phase responses in intra-abdominal sepsis

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    K. Mealy

    1997-01-01

    Full Text Available The acute phase response is an important adaptive response to sepsis and injury. As anabolic steroids increase protein synthesis we postulated that these agents might also increase hepatic acute phase protein synthesis. Male Wistar rats were pretreated with testosterone or danazol for 48 h prior to caecal ligation and puncture (CLP. Thirty-six h following surgery the animals were killed and blood taken for full blood count, total protein, albumin, α, β and γ globulin fractions on serum electrophoresis, complement C3 and transferrin levels. Danazol increased the α1, α2 and β1 globulin serum protein fractions in comparison with no surgery and CLP alone groups. These results indicate that danazol increases plasma acute phase proteins, as measured by electrophoresis, in this model of intra-abdominal sepsis.

  1. Intra-Abdominal Hypertension and Gastrointestinal Symptoms in Mechanically Ventilated Patients

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    Annika Reintam Blaser

    2011-01-01

    Full Text Available Background. We aimed to describe the incidence of intra-abdominal hypertension (IAH and gastrointestinal (GI symptoms and related outcome in mechanically ventilated (MV patients. Methods. Intra-abdominal pressure (IAP and gastric residual volumes were measured at least twice daily. IAH was defined as a mean daily value of IAP≥12 mmHg. Results. 398 patients were monitored for all together 2987 days. GI symptom(s occurred in 80.2% patients. 152 (38.2% patients developed IAH. Majority (93.4% of patients with IAH had GI symptoms. The more severe IAH was associated with the higher number of concomitant GI symptoms (P<.001. 142 (35.7% patients developed both IAH and at least one GI symptom at any time in ICU, and in 77 patients they occurred simultaneously on the same day. This subgroup had the highest ICU mortality (21.8%. In contrast, the small group of patients presenting only IAH, but not GI symptoms (10 patients, had no lethal outcome. Three patients (4.4% died without showing either IAH or GI symptoms. Conclusions. GI symptoms and IAH often, but not always, occur together. The patients having IAH solely without developing GI symptoms have rather good outcome.

  2. Toxicity from intra-abdominal injection of chlorfenapyr.

    Science.gov (United States)

    Lee, Jina; Lee, Jun Hyun; Baek, Jong Min; Lee, Do Sang; Park, Il Young; Won, Jong Man; Sung, Ki Young

    2013-01-01

    Introduction. Chlorfenapyr is commonly used for food crops in Korea. However, chlorfenapyr toxicity in humans has not yet been studied. Case. A 74-year-old man was admitted to the emergency room after he intra-abdominally injected 20 mL of chlorfenapyr in an attempt to commit suicide. Emergency surgery was performed and accumulation of approximately 500 mL of reactive fluid in the abdomen was observed. The entire small intestine showed congestion. After surgery, additional surgery to drain the fluid was performed on POD 12. But immediately after administration of general anesthesia, flat rhythm was observed by electrocardiogram (ECG) monitoring, requiring cardiopulmonary resuscitation (CPR). Discussion. The color of the bowel was purple, indicating ischemic injury. This could be attributed to direct absorption of the substance through the peritoneum, leading to chemical injury to the small intestine serosa, unlike in the case of oral ingestion. This resulted in an ischemic change in the small intestine, eventually leading to sepsis. Conclusion. Only a few cases of chlorfenapyr toxicity have been reported in the literature, and death occurred in all cases, including our case. Therefore, careful and aggressive treatments are necessary. This is the first reported case of intra-abdominal injection of chlorfenapyr.

  3. Toxicity from Intra-Abdominal Injection of Chlorfenapyr

    Directory of Open Access Journals (Sweden)

    Jina Lee

    2013-01-01

    Full Text Available Introduction. Chlorfenapyr is commonly used for food crops in Korea. However, chlorfenapyr toxicity in humans has not yet been studied. Case. A 74-year-old man was admitted to the emergency room after he intra-abdominally injected 20 mL of chlorfenapyr in an attempt to commit suicide. Emergency surgery was performed and accumulation of approximately 500 mL of reactive fluid in the abdomen was observed. The entire small intestine showed congestion. After surgery, additional surgery to drain the fluid was performed on POD 12. But immediately after administration of general anesthesia, flat rhythm was observed by electrocardiogram (ECG monitoring, requiring cardiopulmonary resuscitation (CPR. Discussion. The color of the bowel was purple, indicating ischemic injury. This could be attributed to direct absorption of the substance through the peritoneum, leading to chemical injury to the small intestine serosa, unlike in the case of oral ingestion. This resulted in an ischemic change in the small intestine, eventually leading to sepsis. Conclusion. Only a few cases of chlorfenapyr toxicity have been reported in the literature, and death occurred in all cases, including our case. Therefore, careful and aggressive treatments are necessary. This is the first reported case of intra-abdominal injection of chlorfenapyr.

  4. Pylephlebitis: a rare complication of an intra-abdominal infection

    Directory of Open Access Journals (Sweden)

    Katherine Wong

    2013-07-01

    Full Text Available Pylephlebitis is defined as an inflamed thrombosis of the portal vein. It is a rare complication of an intra-abdominal infection, and the diagnosis is often missed due to its nonspecific clinical presentation. Symptoms may include abdominal pain, fever, chills, fatigue, nausea, and vomiting. It is important to consider this differential when a patient presents with signs of abdominal sepsis since it has a high mortality rate and is often diagnosed postmortem. Pylephlebitis can be diagnosed via abdominal ultrasound or CT demonstrating a thrombus in the portal vein, and it must be treated early and aggressively with broad-spectrum antibiotics. We are presenting a case of pylephlebitis as well as discussing the diagnosis and treatment of this potentially lethal condition.

  5. When and how should we measure intra- abdominal pressure?

    African Journals Online (AJOL)

    2008-11-11

    Nov 11, 2008 ... A standard water manometer is primed with normal saline ... out a detailed 'how to' description of this technique. ... 3 Clean the drainage tubing proximal to the hub of the Foley urinary catheter and cut the tubing ±5 cm from.

  6. 77 FR 59928 - Draft Guidance for Industry on Complicated Intra-Abdominal Infections: Developing Drugs for...

    Science.gov (United States)

    2012-10-01

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry on Complicated Intra-Abdominal... guidance for industry entitled ``Complicated Intra-Abdominal Infections: Developing Drugs for Treatment.'' The purpose of this guidance is to assist sponsors in the clinical development of drugs for...

  7. Effect of exercise training on in vivo lipolysis in intra-abdominal adipose tissue in rats

    DEFF Research Database (Denmark)

    Enevoldsen, L H; Stallknecht, B; Fluckey, J D

    2000-01-01

    Intra-abdominal obesity is associated with cardiovascular disease and non-insulin-dependent diabetes mellitus, and physical training has been suggested to alleviate these conditions. We compared epinephrine-stimulated lipolysis in vivo in three intra-abdominal adipose tissues (ATs: retroperitoneal...

  8. Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis.

    NARCIS (Netherlands)

    Wijck, K. van; Jong, J.R. de; Heurn, L.W.E. van; Zee, D.C. van der

    2010-01-01

    BACKGROUND: Children with perforated appendicitis have a relatively high risk of intra-abdominal abscesses. There is no evidence that prolonged antibiotic treatment after surgery reduces intra-abdominal abscess formation. We compared two patient groups with perforated appendicitis with different

  9. Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis.

    NARCIS (Netherlands)

    Wijck, K. van; Jong, J.R. de; Heurn, L.W.E. van; Zee, D.C. van der

    2010-01-01

    BACKGROUND: Children with perforated appendicitis have a relatively high risk of intra-abdominal abscesses. There is no evidence that prolonged antibiotic treatment after surgery reduces intra-abdominal abscess formation. We compared two patient groups with perforated appendicitis with different pos

  10. Nodular intra-abdominal panniculitis: an accompaniment of colorectal carcinoma and diverticular disease

    DEFF Research Database (Denmark)

    Bak, Martin

    1996-01-01

    was undertaken in order to describe the entire spectrum of the disease including primary as well as secondary cases. Eleven patients are reported, nine of which had an associated colorectal disease in direct continuity with areas of intra-abdominal panniculitis. It is concluded that intra-abdominal panniculitis...... should not be regarded as a specific nosological entity but merely a result of injury to the fat cells. Intra-abdominal panniculitis is seen more often as a secondary local phenomenon than as a primary condition, and in both cases it is associated with considerable differential diagnostic problems...

  11. The use of anti-gravity suits for the control of critical intra-abdominal hemmorhage

    Science.gov (United States)

    Kravik, S.; Landmark, K.

    1980-01-01

    The history and use as well as the physiology of the use of antigravity suits for the control of critical intra-abdominal hemorrhages is reviewed. The use of this suit is highly recommended, especially for first aid.

  12. Efficacy of tigecycline versus ceftriaxone plus metronidazole for the treatment of complicated intra-abdominal infections

    DEFF Research Database (Denmark)

    Qvist, Niels; Warren, Brian; Leister-Tebbe, Heidi;

    2012-01-01

    This randomized, open-label, multi-center trial compared tigecycline (TGC), a broad-spectrum glycylcycline, with ceftriaxone-metronidazole (CTX/MET) for the treatment of complicated intra-abdominal infections (cIAI)....

  13. Surgical Treatment of Intra-Abdominal Desmoid Tumors Resulting In Short Bowel Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Wheeler, Matthew; Mercer, David; Grant, Wendy; Botha, Jean; Langnas, Alan; Thompson, Jon, E-mail: jthompso@unmc.edu [Department of Surgery, University of Nebraska Medical Center, The Nebraska Medical Center 3280, Omaha, NE 68198 (United States)

    2012-01-19

    Advanced intra-abdominal desmoids tumors present with severe symptoms, complications or rapid growth, which lead to adverse outcomes. Our aim was to evaluate the treatment and outcome of patients with advanced intra-abdominal desmoids tumors, and develop guidelines for surgical management of these patients. We reviewed the clinical courses of 21 adult patients with advanced stage intra-abdominal desmoid tumors who presented to an intestinal rehabilitation and transplantation program. Patients with massive intestinal resection presented in two groups. The first group had a short small intestinal remnant after resection (<60 cm). These patients were poor rehabilitation candidates and eventually met criteria for transplant. The second had longer intestinal remnants and were more successfully rehabilitated and have not had complications that would lead to transplantation. Advanced intra-abdominal desmoid tumors have outcomes after resection that merit aggressive resection and planned intestinal rehabilitation and intestinal transplantation as indicated.

  14. Comparison of the relative contributions of intra-abdominal and liver fat to components of the metabolic syndrome

    DEFF Research Database (Denmark)

    Kotronen, Anna; Yki-Järvinen, Hannele; Sevastianova, Ksenia

    2011-01-01

    Abdominally obese individuals with the metabolic syndrome often have excess fat deposition both intra-abdominally (IA) and in the liver, but the relative contribution of these two deposits to variation in components of the metabolic syndrome remains unclear. We determined the mutually independent...... that both fat depots are important predictors of these components of the metabolic syndrome....... quantitative contributions of IA and liver fat to components of the syndrome, fasting serum (fS) insulin, and liver enzymes and measures of hepatic insulin sensitivity in 356 subjects (mean age 42 years, mean BMI 29.7 kg/m²) in whom liver fat and abdominal fat volumes were measured. IA and liver fat contents...

  15. Prospective observational study of the frequency and features of intra-abdominal abscesses in patients with melioidosis in northeast Thailand.

    Science.gov (United States)

    Maude, Rapeephan R; Vatcharapreechasakul, Teerapon; Ariyaprasert, Pitchayanant; Maude, Richard J; Hongsuwan, Maliwan; Yuentrakul, Prayoon; Limmathurotsakul, Direk; Koh, Gavin C K W; Chaowagul, Wipada; Day, Nicholas P J; Peacock, Sharon J

    2012-10-01

    Retrospective case series from Thailand have reported the presence of intra-abdominal abscesses in around half of patients with melioidosis, a much higher rate than our clinical experience would suggest. We performed a prospective, observational study of 230 adult patients with culture-confirmed melioidosis in which all patients underwent abdominal ultrasound. One or more abscesses were detected in the liver and/or spleen in 77 (33%) cases. These were often multiple (70%, 31/44 in hepatic abscesses and 88%, 50/57 in splenic abscesses) and clinically silent (27% of cases with abscesses presenting with abdominal pain). The mortality rate at 4 weeks post-discharge was lower in patients who were abscess-positive vs abscess-negative (10%, 8/77 vs 20%, 31/153).

  16. Complicated intra-abdominal infection caused by extended drug-resistant Achromobacter xylosoxidans.

    Science.gov (United States)

    Teng, Sing-On; Ou, Tsong-Yih; Hsieh, Yu-Chia; Lee, Wuan-Chan; Lin, Yi-Chun; Lee, Wen-Sen

    2009-04-01

    Achromobacter xylosoxidans (formerly Alcaligenes xylosoxidans) is a rare but important nosocomial pathogen. Antibiotic resistance has been increasing during the past decade. A. xylosoxidans may be confused with Pseudomonas spp. but, unlike Pseudomonas spp., this organism has peritrichous flagella. Complicated intra-abdominal infection with A. xylosoxidans has rarely been reported in the literature. This report is of an immunocompetent patient with acute cholecystitis complicated by an intra-abdominal abscess after surgery. Culture of both blood and ascites yielded extended drug-resistant A. xylosoxidans, which was only sensitive to colistin. The clinical and laboratory characteristics of A. xylosoxidans are presented.

  17. An unusual case of intra-abdominal testicular torsion: Role of laparoscopy

    Directory of Open Access Journals (Sweden)

    Alfonso Papparella

    2013-01-01

    Full Text Available The authors report a case of intra-abdominal testicular torsion, where laparoscopy has been useful for diagnosis and surgical management. A boy was presented with a left impalpable testis. Laparoscopy revealed a twisted spermatic cord at the inlet pelvis, which ended in a testicular remnant located in the sub-umbilical area. After orchiectomy, the pathologist confirmed testicular atrophy. Diagnosis of intra-abdominal testicular torsion should be considered in patients with impalpable testis and abdominal pain, but could not be excluded in those with no symptoms.

  18. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    NARCIS (Netherlands)

    Smit, M.; Buddingh, K. T.; Bosma, B.; Nieuwenhuijs, V. B.; Hofker, H. S.; Zijlstra, J. G.

    Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS, in

  19. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    NARCIS (Netherlands)

    Smit, M.; Buddingh, K. T.; Bosma, B; Nieuwenhuijs, V B; Hofker, H.S.; Zijlstra, J.G.

    2016-01-01

    INTRODUCTION: Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS

  20. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    NARCIS (Netherlands)

    Smit, M.; Buddingh, K. T.; Bosma, B.; Nieuwenhuijs, V. B.; Hofker, H. S.; Zijlstra, J. G.

    2016-01-01

    Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS, in particula

  1. Nodular intra-abdominal panniculitis: an accompaniment of colorectal carcinoma and diverticular disease

    DEFF Research Database (Denmark)

    Bak, Martin

    1996-01-01

    should not be regarded as a specific nosological entity but merely a result of injury to the fat cells. Intra-abdominal panniculitis is seen more often as a secondary local phenomenon than as a primary condition, and in both cases it is associated with considerable differential diagnostic problems...

  2. Fibrin sealant prevents gastrointestinal anastomosis dehiscence in intra-abdominal sepsis.

    Science.gov (United States)

    Wang, Xinbo; Ren, Jianan; Zhu, Weiming; Li, Ning; Li, Jieshou

    2007-01-01

    We observed the potential use of fibrin sealant as a therapeutic modality for successful resolution of gastrointestinal anastomosis dehiscence in intra-abdominal sepsis. Forty-eight patients (33 men and 15 women) suffering from intra-abdominal sepsis were subjected to prophylactic appliance of fibrin sealant during immediate primary anastomosis during the laparotomy. The perioperative management invariably involved fluid resuscitation, active suction drainage of the abdominal liquor puris, nutritional supplementation, and growth hormone. The total surgical-related success ratio was 91.7% (44/48) for primary anastomosis with fibrin sealant in intra-abdominal sepsis. Anastomotic leakage occurred in the other four patients, two of which died because of leakage complications in our hospital. The hospital stay after the operation was 30.2 +/- 12.0 days. There has been no sign of recurrence over a follow-up period of 1-15 months. It is concluded that fibrin sealant may be useful in preventing gastrointestinal anastomosis dehiscence in intra-abdominal sepsis.

  3. Diagnostic yield of EUS-guided FNA and cytology in suspected tubercular intra-abdominal lymphadenopathy

    DEFF Research Database (Denmark)

    Puri, Rajesh; Mangla, Rakhee; Eloubeidi, Mohamad

    2012-01-01

    Intra-abdominal lymphadenopathy is a common diagnostic challenge faced by clinicians. In the absence of palpable peripheral nodes, tissue is usually obtained from the abdominal nodes by image-guided biopsy or surgery. We speculate that EUS-guided FNA (EUS-FNA) avoids the morbidity of a laparotomy...

  4. The Onset of Intra-Abdominal Adhesions During Closed-Abdomen Hyperthermic Intraperitoneal Chemotherapy.

    Science.gov (United States)

    Lotti, Marco; Giulii Capponi, Michela; Campanati, Luca; Poiasina, Elia; Ansaloni, Luca; Poletti, Eugenio; Frigerio, Luigi

    2016-12-01

    Hyperthermic intraperitoneal chemotherapy (HIPEC) is delivered after cytoreductive surgery (CRS) in selected patients with peritoneal carcinomatosis. The closed-abdomen technique, preferred by many centers, prevents heat loss and drug spillage, but does not warrant homogeneous distribution of the perfusion fluid (PF). The hypothesized formation of intra-abdominal adhesions during the closed-abdomen perfusion period has never been described. From March 2014 to April 2016, 10 consecutive patients with peritoneal carcinomatosis, selected for CRS, underwent the Laparoscopy-Enhanced HIPEC technique to explore the abdominal cavity during the perfusion. The aim of the study was to investigate the incidence and the extent of intra-abdominal adhesions that are formed after CRS during the perfusion period of closed-abdomen HIPEC. During the perfusion, adhesions developed in 70% of the patients. Adhesions developed mainly in the period between the closure of the abdomen and the subsequent filling of the abdomen with the PF. After their first division, during the following perfusion period, adhesions between the bowel and the abdominal wall reformed in 3 patients (30%). Intra-abdominal adhesions are frequently formed during closed-abdomen HIPEC and can hamper the adequate circulation of the PF. The Laparoscopy-Enhanced technique enables the early detection and the division of any intra-abdominal adhesions.

  5. Waist circumference adjusted for body mass index and intra-abdominal fat mass

    DEFF Research Database (Denmark)

    Berentzen, Tina Landsvig; Angquist, Lars; Kotronen, Anna

    2012-01-01

    The association between waist circumference (WC) and mortality is particularly strong and direct when adjusted for body mass index (BMI). One conceivable explanation for this association is that WC adjusted for BMI is a better predictor of the presumably most harmful intra-abdominal fat mass (IAFM...

  6. A standardised and reproducible model of intra-abdominal infection and abscess formation in rats

    NARCIS (Netherlands)

    Bosscha, K; Nieuwenhuijs, VB; Gooszen, AW; van Duijvenbode-Beumer, H; Visser, MR; Verweij, Willem; Akkermans, LMA

    2000-01-01

    Objective: To develop a standardised and reproducible model of intra-abdominal infection and abscess formation in rats. Design: Experimental study. Setting: University hospital, The Netherlands. Subjects: 36 adult male Wistar rats. Interventions: In 32 rats, peritonitis was produced using two differ

  7. Effect of Resveratrol on the Prevention of Intra-Abdominal Adhesion Formation in a Rat Model

    Directory of Open Access Journals (Sweden)

    Guangbing Wei

    2016-06-01

    Full Text Available Background: Intra-abdominal adhesions are a very common complication following abdominal surgery. Our previous studies have demonstrated that the inhibition of inflammation at the sites of peritoneal injury can prevent the formation of intra-abdominal adhesions. Resveratrol is a natural extract with a broad range of anti-inflammatory effects. Therefore, we propose that resveratrol can reduce the formation of intra-abdominal adhesions after surgery. The aim of this study was to investigate the effect of resveratrol on intra-abdominal adhesion prevention in a rat model with surgery-induced peritoneal adhesions. Materials and Methods: The cecum wall and its opposite parietal peritoneum were abraded following laparotomy to induce intra-abdominal adhesion formation. Varying doses of resveratrol were administered to the animals. On the eighth day after surgery, the adhesion score was assessed using a visual scoring system. Picrosirius red staining and a hydroxyproline assay were used to assess the amount of collagen deposition in the adhesion tissues. The levels of serum interleukin-6 (IL-6, tumor necrosis factor (TNF-α, and transforming growth factor beta-1 (TGF-β1 were determined by an enzyme-linked immunosorbent assay (ELISA. Western blotting was performed to determine the protein expression of TGF-β1, fibrinogen, and α-smooth muscle actin (α-SMA in rat peritoneal adhesion tissue. Real-time RT-PCR was performed to quantify the mRNA expression of TGF-β1, fibrinogen, and α-SMA. Results: Resveratrol significantly reduced intra-abdominal adhesion formation and fibrin deposition in the rat model. Furthermore, resveratrol significantly reduced the serum levels of IL-6, TNF-α, and TGF-β1. The protein and mRNA expression of TGF-β1, fibrinogen, and α-SMA in the rat peritoneum and adhesion tissues were also down-regulated due to resveratrol intervention. Conclusion: Resveratrol can effectively prevent the formation of postoperative intra-abdominal

  8. Intra-abdominal fat. Part I. The images of the adipose tissue localized beyond organs.

    Science.gov (United States)

    Smereczyński, Andrzej; Kołaczyk, Katarzyna; Bernatowicz, Elżbieta

    2015-09-01

    Unaltered fat is a permanent component of the abdominal cavity, even in slim individuals. Visceral adiposity is one of the important factors contributing to diabetes, cardiovascular diseases and certain neoplasms. Moreover, the adipose tissue is an important endocrine and immune organ of complex function both when normal and pathological. Its role in plastic surgery, reconstruction and transplantology is a separate issue. The adipose tissue has recently drawn the attention of research institutes owing to being a rich source of stem cells. This review, however, does not include these issues. The identification of fat is relatively easy using computed tomography and magnetic resonance imaging. It can be more difficult in an ultrasound examination for several reasons. The aim of this paper is to present various problems associated with US imaging of unaltered intra-abdominal fat located beyond organs. Based on the literature and experience, it has been demonstrated that the adipose tissue in the abdominal cavity has variable echogenicity, which primarily depends on the amount of extracellular fluid and the number of connective tissue septa, i.e. elements that potentiate the number of areas that reflect and scatter ultrasonic waves. The normal adipose tissue presents itself on a broad gray scale: from a hyperechoic area, through numerous structures of lower reflection intensity, to nearly anechoic regions mimicking the presence of pathological fluid collections. The features that facilitate proper identification of this tissue are: sharp margins, homogeneous structure, high compressibility under transducer pressure, no signs of infiltration of the surrounding structures and no signs of vascularization when examined with the color and power Doppler. The accumulation of fat tissue in the abdominal cavity can be generalized, regional or focal. The identification of the adipose tissue in the abdominal cavity using ultrasonography is not always easy. When in doubt, the

  9. Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians

    Institute of Scientific and Technical Information of China (English)

    Jian-cang ZHOU; Hong-chen ZHAO; Kong-han PAN; Qiu-ping XU

    2011-01-01

    This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units (ICUs). A total of 108 (76.6%) questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission,ICU length of stay, acute physiology and chronic health evaluation (APACHE) Ⅱ score, and mortality were 18.2 beds,764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure (IAP). Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over-whelming majority (88.0%) only measured IAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for IAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab-domen (92%), worsening oliguria (80%), and increased ventilatory support requirement (68%). Common causes for IAH/ACS were "third-spacing from massive volume resuscitation in different settings" (88%), "intra-abdominal bleed-ing", and "liver failure with ascites" (52% for both). Though 60% respondents would recommend surgical decompres-sion when the IAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re-spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physi

  10. Modified Da-Cheng-Qi Decoction reduces intra-abdominal hypertension in severe acute pancreatitis: a pilot study

    Institute of Scientific and Technical Information of China (English)

    WAN Mei-hua; LI Juan; HUANG Wei; Rajarshi Mukherjee; GONG Han-lin; XIA Qing; ZHU Lin; CHENG Gui-lan; TANG Wen-fu

    2012-01-01

    Background Intra-abdominal hypertension (IAH) is a recognized prognostic marker for severity of severe acute pancreatitis (SAP) and has a strong impact on the clinical course of SAP.Previous studies indicate that a Da-Cheng-Qi Decoction (DCQD) is beneficial in the treatment of SAP.The purpose of this study was to evaluate the effect of modified DCQD on IAH in patients with SAP.Methods Between January 2008 and December 2008,42 patients from the West China Hospital were randomized into either the DCQD or control group (n=21 in each group).Mortality,intra-abdominal pressure (lAP),Acute Physiology and Chronic Health Evaluation II (APACHE II) score,C-reactive protein (CRP),oxygenation index,Balthazar CT score,rate of renal failure,decompression rate,intensive care unit (ICU) transfer rate,and length of hospital stay (LOS) were compared between the two groups.Results Compared to the control group,the modified DCQD treatment significantly decreased lAP (P <0.05) and APACHE Ⅱ (P <0.05) scores on days 4-8,CRP on day 8 (P <0.01 ),renal failure rate (P <0.05),and LOS (P <0.05).The oxygenation index was significantly improved in the DCQD group compared with the control group (P <0.05).No significant differences in the Balthazar CT score,shock rate,ICU transfer rate,or mortality occurred between the two groups.Conclusions The modified DCQD can effectively relieve IAH and decrease LOS for patients with SAP.Larger clinical trials are needed to confirm these findings.

  11. Laparoscopic resection of prenatally detected intra-abdominal testicular teratoma: Report of a neonatal case

    Directory of Open Access Journals (Sweden)

    Keigo Yada

    2017-08-01

    Full Text Available Prenatal detection of intra-abdominal testicular tumor is rare. In this paper, we discuss the early laparoscopic resection of prenatally detected testicular tumor of a neonate. At 33 weeks gestation, follow-up ultrasound showed the mass measuring 3 × 2 cm, on the fetal right lower quadrant. After full-term birth, we performed laparoscopic resection of the tumor, on day 14 of life. Histology of 4-cm right testicular tumor revealed immature teratoma. Postoperative course was favorable and no recurrence has occurred 3 years after operation. Prenatal diagnosis of the intra-abdominal testicular teratoma enabled the early tumor resection, and laparoscopic resection of the tumor is safe and feasible, even in a neonate.

  12. Intra-abdominal pectus bar migration – a rare clinical entity: case report

    Directory of Open Access Journals (Sweden)

    Athanasiou Thanos

    2008-07-01

    Full Text Available Abstract We present the case of a 20-year-old male who underwent successful surgical correction of pectus excavatum with the Highly Modified Ravitch Repair (HMRR. At 29 months the attempted operative removal of the Ravitch bar was unsuccessful despite the impression of adequate bar location on chest x-ray. Subsequent imaging with computed tomography was unclear in determining whether the bar was supra or infra-diaphragmatic due to the tissue distortion subsequent to initial surgery. Video assisted thoracoscopic surgery (VATS successfully retrieved the bar and revealed that it was not in the thorax, but had migrated to the intra-abdominal bare area of the liver, with no evidence of associated diaphragmatic defect or hernia. Intra-abdominal pectus bar migration is a rare clinical entity, and safe removal can be facilitated by the use of the VATS technique.

  13. In vitro activity of moxifloxacin against 923 anaerobes isolated from human intra-abdominal infections.

    Science.gov (United States)

    Goldstein, Ellie J C; Citron, Diane M; Warren, Yumi A; Tyrrell, Kerin L; Merriam, C Vreni; Fernandez, Helen

    2006-01-01

    The in vitro activity of moxifloxacin against 923 recent anaerobic isolates obtained from pretreatment cultures in patients with complicated intra-abdominal infections was studied using the CLSI M11-A-6 agar dilution method. Moxifloxacin was active against 87% (96 of 110) Bacteroides fragilis strains at accounting for most of the resistant isolates; excluding the aforementioned four resistant species, 86% (303 of 363) of Bacteroides species isolates and 94% (417 of 450) of all other genera and species were susceptible to < or = 2 microg/ml of moxifloxacin. Overall, moxifloxacin was active against 763 of 923 (83%) of strains at < or = 2 microg/ml, supporting its use as a monotherapy for some community-acquired intra-abdominal infections.

  14. Intra-abdominal infantile inflammatory myofibroblastic tumors: A report of three cases

    Directory of Open Access Journals (Sweden)

    Mala Banerjee

    2014-01-01

    Full Text Available Inflammatory myofibroblastic tumor occurring at intra-abdominal sites in children can be confused with malignancy because of its large size and location. It is a tumor classified as ′intermediate′ between benign and malignant, but usually benign, with a strong tendency for recurrence. Treatment is surgical excision. Here, we present a brief outline of three such cases presenting as abdominal mass in infants.

  15. Intra-abdominal desmoplastic small round-cell tumour: multiphase CT findings in two children

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hyoung; Goo, Hyun Woo; Yoon, Chong Hyun [Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-2 dong, Songpa-gu, Seoul, 138-736 (Korea)

    2003-06-01

    We report the multiphase CT findings of intra-abdominal desmoplastic small round-cell tumour (DSRCT) in two children. CT showed a huge heterogeneous intraperitoneal mass with or without direct invasion into solid organs such as liver or kidney, extensive intraperitoneal seeding, intratumoural calcification, ascites, and lymphadenopathy. DSRCT should be included in the differential diagnosis of malignant intraperitoneal neoplasm in children. Multiphase CT may be helpful in delineating tumour extent, vascularity and direct invasion into adjacent organs. (orig.)

  16. A Large Intra-Abdominal Hiatal Hernia as a Rare Cause of Dyspnea

    Directory of Open Access Journals (Sweden)

    Cem Sahin

    2015-01-01

    Full Text Available Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiac symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period, by compressing the left atrium and right pulmonary vein. We considered presenting this case as large hiatal hernia is a rare, intra-abdominal cause of dyspnea.

  17. Exogenous pulmonary surfactant prevents the development of intra-abdominal adhesions in rats.

    Science.gov (United States)

    Schanaider, Alberto; Cotta-Pereira, Ricardo; Silva, Paulo C; Macedo-Ramos, Hugo; Silva, Johnatas D; Teixeira, Pedro A C; Pannain, Vera L N; Rocco, Patricia R M; Baetas-da-Cruz, Wagner

    2016-04-01

    Intra-abdominal adhesions are major post-operative complications for which no effective means of prevention is available. We aimed to evaluate the efficacy of exogenous pulmonary surfactant administration in the prevention of post-operative abdominal adhesions. Rats were randomly assigned to undergo laparotomy (L) or gastroenterostomy (GE) and then treated with surfactant (groups L-S and GE-S, respectively). Intra-abdominal adhesions, collagen fibre content, metalloproteinase (MMP)-9, expression of growth factors (TGF-β, KGF and VEGF), type III procollagen (PCIII) and pro-caspase 3, as well as isolectin B4 and ED1-positive cells expressing MMP-9, were evaluated. Groups treated with surfactant (GE-S and L-S) exhibited fewer adhesions. A significant reduction in collagen fibre content was observed in GE-S compared to GE animals (P abdominal adhesions triggered by laparotomy and gastrointestinal anastomosis, thus preventing fibrosis formation at the peritoneal surfaces. This preclinical study suggests an innovative treatment strategy for intra-abdominal adhesions with surfactant and to endorse its putative mechanism of action.

  18. Laparoscopic management of intra-abdominal infections:Systematic review of the literature

    Institute of Scientific and Technical Information of China (English)

    Federico; Coccolini; Cristian; Tranà; Massimo; Sartelli; Fausto; Catena; Salomone; Di; Saverio; Roberto; Manfredi; Giulia; Montori; Marco; Ceresoli; Chiara; Falcone; Luca; Ansaloni

    2015-01-01

    AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically.RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controllingthe source.CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.

  19. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).

    Science.gov (United States)

    Sartelli, Massimo; Weber, Dieter G; Ruppé, Etienne; Bassetti, Matteo; Wright, Brian J; Ansaloni, Luca; Catena, Fausto; Coccolini, Federico; Abu-Zidan, Fikri M; Coimbra, Raul; Moore, Ernest E; Moore, Frederick A; Maier, Ronald V; De Waele, Jan J; Kirkpatrick, Andrew W; Griffiths, Ewen A; Eckmann, Christian; Brink, Adrian J; Mazuski, John E; May, Addison K; Sawyer, Rob G; Mertz, Dominik; Montravers, Philippe; Kumar, Anand; Roberts, Jason A; Vincent, Jean-Louis; Watkins, Richard R; Lowman, Warren; Spellberg, Brad; Abbott, Iain J; Adesunkanmi, Abdulrashid Kayode; Al-Dahir, Sara; Al-Hasan, Majdi N; Agresta, Ferdinando; Althani, Asma A; Ansari, Shamshul; Ansumana, Rashid; Augustin, Goran; Bala, Miklosh; Balogh, Zsolt J; Baraket, Oussama; Bhangu, Aneel; Beltrán, Marcelo A; Bernhard, Michael; Biffl, Walter L; Boermeester, Marja A; Brecher, Stephen M; Cherry-Bukowiec, Jill R; Buyne, Otmar R; Cainzos, Miguel A; Cairns, Kelly A; Camacho-Ortiz, Adrian; Chandy, Sujith J; Che Jusoh, Asri; Chichom-Mefire, Alain; Colijn, Caroline; Corcione, Francesco; Cui, Yunfeng; Curcio, Daniel; Delibegovic, Samir; Demetrashvili, Zaza; De Simone, Belinda; Dhingra, Sameer; Diaz, José J; Di Carlo, Isidoro; Dillip, Angel; Di Saverio, Salomone; Doyle, Michael P; Dorj, Gereltuya; Dogjani, Agron; Dupont, Hervé; Eachempati, Soumitra R; Enani, Mushira Abdulaziz; Egiev, Valery N; Elmangory, Mutasim M; Ferrada, Paula; Fitchett, Joseph R; Fraga, Gustavo P; Guessennd, Nathalie; Giamarellou, Helen; Ghnnam, Wagih; Gkiokas, George; Goldberg, Staphanie R; Gomes, Carlos Augusto; Gomi, Harumi; Guzmán-Blanco, Manuel; Haque, Mainul; Hansen, Sonja; Hecker, Andreas; Heizmann, Wolfgang R; Herzog, Torsten; Hodonou, Adrien Montcho; Hong, Suk-Kyung; Kafka-Ritsch, Reinhold; Kaplan, Lewis J; Kapoor, Garima; Karamarkovic, Aleksandar; Kees, Martin G; Kenig, Jakub; Kiguba, Ronald; Kim, Peter K; Kluger, Yoram; Khokha, Vladimir; Koike, Kaoru; Kok, Kenneth Y Y; Kong, Victory; Knox, Matthew C; Inaba, Kenji; Isik, Arda; Iskandar, Katia; Ivatury, Rao R; Labbate, Maurizio; Labricciosa, Francesco M; Laterre, Pierre-François; Latifi, Rifat; Lee, Jae Gil; Lee, Young Ran; Leone, Marc; Leppaniemi, Ari; Li, Yousheng; Liang, Stephen Y; Loho, Tonny; Maegele, Marc; Malama, Sydney; Marei, Hany E; Martin-Loeches, Ignacio; Marwah, Sanjay; Massele, Amos; McFarlane, Michael; Melo, Renato Bessa; Negoi, Ionut; Nicolau, David P; Nord, Carl Erik; Ofori-Asenso, Richard; Omari, AbdelKarim H; Ordonez, Carlos A; Ouadii, Mouaqit; Pereira Júnior, Gerson Alves; Piazza, Diego; Pupelis, Guntars; Rawson, Timothy Miles; Rems, Miran; Rizoli, Sandro; Rocha, Claudio; Sakakhushev, Boris; Sanchez-Garcia, Miguel; Sato, Norio; Segovia Lohse, Helmut A; Sganga, Gabriele; Siribumrungwong, Boonying; Shelat, Vishal G; Soreide, Kjetil; Soto, Rodolfo; Talving, Peep; Tilsed, Jonathan V; Timsit, Jean-Francois; Trueba, Gabriel; Trung, Ngo Tat; Ulrych, Jan; van Goor, Harry; Vereczkei, Andras; Vohra, Ravinder S; Wani, Imtiaz; Uhl, Waldemar; Xiao, Yonghong; Yuan, Kuo-Ching; Zachariah, Sanoop K; Zahar, Jean-Ralph; Zakrison, Tanya L; Corcione, Antonio; Melotti, Rita M; Viscoli, Claudio; Viale, Perluigi

    2016-01-01

    Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.

  20. A Torted Ruptured Intra-abdominal Testicular Seminoma Presenting As An Acute Abdomen.

    Science.gov (United States)

    Nickalls, Oliver James; Tan, Char Loo; Thian, Yee Liang

    2015-12-01

    The susceptibility of the undescended testis to malignant transformation is well documented. The most common location of the undescended testis is within the inguinal canal, with only a minority located within the abdominal cavity. When a testicular mass develops, the risk of torsion increases. We describe a large intra-abdominal testicular seminoma that had undergone torsion, rupture and haemorrhage, presenting as an acute abdomen. A 30 year old man presented to the emergency department with right iliac fossa pain. Computed tomography in the emergency department showed haemoperitoneum and a torted large left testicular mass, likely malignant. The patient underwent laparotomy and excision of the mass. Histologic examination revealed a grossly enlarged seminomatous testis which had torted and ruptured. While pre-operative imaging diagnosis of an intra-abdominal testicular seminoma has been published, reports are few. To the best of the author's knowledge pre-operative imaging diagnosis of a malignant testicular mass with torsion and intra-abdominal haemorrhage presenting as an acute abdomen has not been described before.

  1. [Pylephlebitis: a rare but possible complication of intra-abdominal infections].

    Science.gov (United States)

    Pérez-Bru, Susana; Nofuentes-Riera, Carmen; García-Marín, Andrés; Luri-Prieto, Paloma; Morales-Calderón, Miguel; García-García, Salvador

    2015-01-01

    Pylephlebitis or septic thrombophlebitis of the portal venous system is a rare but serious complication of intra-abdominal infections which drain into the portal venous system. Its diagnosis is based on clinical suspicion and imaging tests, mainly a computed tomography scan, given the lack of specificity of the signs and symptoms. Spread of septic emboli is the major cause of morbidity and mortality. The aim of the study was to analyse patients diagnosed in our hospital. Retrospective descriptive study of patients diagnosed with pylephlebitis in our hospital. Four patients were included, 3 men and one woman. In 3 cases it was acute cholecystitis that led to the diagnosis of pylephlebitis at the same time as the intra-abdominal infection. Emergency surgery was performed in one case, whilst the other 2 were treated conservatively. Blood cultures were performed in all cases, and empirical antibiotic treatment was used. In the only case of acute appendicitis, diagnosis of pylephlebitis was achieved during the study of postoperative fever, with empirical antibiotic treatment also being started. The haematologist was requested to start the required anticoagulation therapy in all cases. Pylephlebitis is a rare complication of intra-abdominal infections that may make lead to a worse outcome. A high level of suspicion is required as well as imaging tests to make an early diagnosis and appropriate treatment. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  2. A Torted Ruptured Intra-abdominal Testicular Seminoma Presenting As An Acute Abdomen

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    Nickalls, Oliver James; Tan, Char Loo; Thian, Yee Liang

    2015-01-01

    The susceptibility of the undescended testis to malignant transformation is well documented. The most common location of the undescended testis is within the inguinal canal, with only a minority located within the abdominal cavity. When a testicular mass develops, the risk of torsion increases. We describe a large intra-abdominal testicular seminoma that had undergone torsion, rupture and haemorrhage, presenting as an acute abdomen. A 30 year old man presented to the emergency department with right iliac fossa pain. Computed tomography in the emergency department showed haemoperitoneum and a torted large left testicular mass, likely malignant. The patient underwent laparotomy and excision of the mass. Histologic examination revealed a grossly enlarged seminomatous testis which had torted and ruptured. While pre-operative imaging diagnosis of an intra-abdominal testicular seminoma has been published, reports are few. To the best of the author’s knowledge pre-operative imaging diagnosis of a malignant testicular mass with torsion and intra-abdominal haemorrhage presenting as an acute abdomen has not been described before. PMID:27200173

  3. Continuous ambulatory peritoneal dialysis after intra-abdominally placed synthetic mesh for ventral hernia repair.

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    Schoenmaeckers, Ernst J P; Woittiez, Arend-Jan; Raymakers, Johan F T J; Rakic, S

    2011-10-01

    We present a unique experience with a patient who had undergone continuous ambulatory peritoneal dialysis (CAPD) after laparoscopic repair of ventral incisional hernia (LRVIH) with an expanded polytetrafluoroethylene (e-PTFE) mesh (DualMesh(®); WL Gore) and who later suffered from multiple episodes of CAPD-related peritonitis without any signs of mesh infection. A 48-year-old man with an open abdominal aortic reconstruction in 1994 for occlusive arterial disease presented with an incisional ventral hernia. He underwent LRVIH using an e-PTFE mesh of 30×20 cm. Postoperatively, he developed renal failure. For various reasons, the only therapeutic option was CAPD. A CAPD-catheter was implanted via laparoscopy, taking care not to compromise the mesh that was completely covered with neoperitoneum. After 3 months of uneventful CAPD, he developed a bacterial peritonitis. Antibiotic treatment failed and the CAPD-catheter was removed. The mesh was left in place and the patient recovered. Later on another CAPD-catheter was implanted via laparoscopy and used for 10 months. Again he developed peritonitis from which he recovered after catheter removal. Mesh was left in place and remained uninfected, probably protected from intra-abdominal bacteria by the neoperitoneum. The risk of secondary infection of an intra-abdominal mesh seems to diminish largely after neoperitonealization of the mesh. CAPD seems possible in a patient with an intra-abdominal mesh when it is covered with neoperitoneum.

  4. Treatment of complicated intra-abdominal infections in the era of multi-drug resistant Bacteria

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    Herzog T

    2010-11-01

    Full Text Available Abstract The management of severe intra-abdominal infections remains a major challenge facing surgeons and intensive care physicians, because of its association with high morbidity and mortality. Surgical management and intensive care medicine have constantly improved, but in the recent years a rapidly continuing emergence of resistant pathogens led to treatment failure secondary to infections with multi-drug resistant bacteria. In secondary peritonitis the rate of resistant germs at the initial operation is already 30%. The lack of effective antibiotics against these pathogens resulted in the development of new broad-spectrum compounds and antibiotics directed against resistant germs. But so far no "super-drug" with efficacy against all resistant bacteria exists. Even more, soon after their approval, reports on resistance against these novel drugs have been reported, or the drugs were withdrawn from the market due to severe side effects. Since pharmaceutical companies reduced their investigations on antibiotic research, only few new antimicrobial derivates are available. In abdominal surgery you may be in fear that in the future more and more patients with tertiary peritonitis secondary to multi-drug resistant species are seen with an increase of mortality after secondary peritonitis. This article reviews the current treatment modalities for complicated intra-abdominal infections with special reference to the antibiotic treatment of complicated intra-abdominal infections with multi-drug resistant species.

  5. Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

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    Sartelli Massimo

    2012-11-01

    Full Text Available Abstract The CIAO Study (“Complicated Intra-Abdominal infection Observational” Study is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012. Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4–98 years were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5% (163/2.152. According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation, a delayed initial intervention (a delay exceeding 24 hours, sepsis and septic shock in the immediate post-operative period, and ICU admission. Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs throughout Europe.

  6. Keratinocyte Growth Factor Combined with a Sodium Hyaluronate Gel Inhibits Postoperative Intra-Abdominal Adhesions

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    Guangbing Wei

    2016-09-01

    Full Text Available Postoperative intra-abdominal adhesion is a very common complication after abdominal surgery. One clinical problem that remains to be solved is to identify an ideal strategy to prevent abdominal adhesions. Keratinocyte growth factor (KGF has been proven to improve the proliferation of mesothelial cells, which may enhance fibrinolytic activity to suppress postoperative adhesions. This study investigated whether the combined administration of KGF and a sodium hyaluronate (HA gel can prevent intra-abdominal adhesions by improving the orderly repair of the peritoneal mesothelial cells. The possible prevention mechanism was also explored. The cecum wall and its opposite parietal peritoneum were abraded after laparotomy to induce intra-abdominal adhesion formation. Animals were randomly allocated to receive topical application of HA, KGF, KGF + HA, or normal saline (Control. On postoperative day 7, the adhesion score was assessed with a visual scoring system. Masson’s trichrome staining, picrosirius red staining and hydroxyproline assays were used to assess the magnitude of adhesion and tissue fibrosis. Cytokeratin, a marker of the mesothelial cells, was detected by immunohistochemistry. The levels of tissue plasminogen activator (tPA, interleukin-6 (IL-6, and transforming growth factor β1 (TGF-β1 in the abdominal fluid were determined using enzyme-linked immunosorbent assays (ELISAs. Western blotting was performed to examine the expression of the TGF-β1, fibrinogen and α-smooth muscle actin (α-SMA proteins in the rat peritoneal adhesion tissue. The combined administration of KGF and HA significantly reduced intra-abdominal adhesion formation and fibrin deposition and improved the orderly repair of the peritoneal mesothelial cells in the rat model. Furthermore, the combined administration of KGF and HA significantly increased the tPA levels but reduced the levels of IL-6, tumor necrosis factor α (TNF-α and TGF-β1 in the abdominal fluid. The

  7. Pressão intra-abdominal em cães

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    Ronald Paiva M. Gonçalves

    2011-09-01

    Full Text Available Sob consenso recente em pacientes humanos, os valores basais da pressão intra-abdominal (PIA e seus prováveis limiares em casos mórbidos, foram estipulados com intuito de favorecer a homogeneidade de estudos científicos, além de fornecer diretrizes para conduta diagnóstica e terapêutica destes pacientes. Valores basais e alterações na pressão intra-abdominal em animais não são ainda suficientemente conhecidos e cientificamente determinados. Médicos veterinários necessitam conhecer melhor os estados mórbidos que cursam com Hipertensão Intra-Abdominal (HIA ou Síndrome de Compartimento Abdominal (SCA. O presente estudo objetivou testar em cães a técnica já descrita sob consenso na medicina como modelo de mensuração da pressão intra-abdominal, assim como determinar os valores normais para a espécie. Foram utilizados 15 cães hígidos, machos e fêmeas, homogêneos e todos sem raça definida. A mensuração da pressão intra-abdominal foi realizada por meio da técnica indireta de sondagem vesical e utilização de coluna de água com régua graduada em cm de H2O, sendo seu valor final convertido para a unidade de mm de Hg. Foi observado valor mínimo subatmosférico (abaixo de zero mm de Hg até o valor máximo de 3,75 mmHg. Houve importante variação entre os valores encontrados individualmente em determinados cães, colocando sob discussão questões como massa corporal, freqüência/volume total de solução fisiológica a ser infundida e agitação destes pacientes no momento do exame. Os valores limítrofes encontrados são considerados fisiológicos, indicando confiabilidade da técnica e possibilidade do seu emprego clínico. A ausência de sedação e utilização de sonda uretral não inviabilizou a realização da mensuração, porém podendo culminar numa sub ou superestimativa dos valores encontrados.

  8. Predictors of "occult" intra-abdominal injuries in blunt trauma patients

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    José Gustavo Parreira

    Full Text Available Objective: to assess predictors of intra-abdominal injuries in blunt trauma patients admitted without abdominal pain or abnormalities on the abdomen physical examination. Methods: We conducted a retrospective analysis of trauma registry data, including adult blunt trauma patients admitted from 2008 to 2010 who sustained no abdominal pain or abnormalities on physical examination of the abdomen at admission and were submitted to computed tomography of the abdomen and/or exploratory laparotomy. Patients were assigned into: Group 1 (with intra-abdominal injuries or Group 2 (without intra-abdominal injuries. Variables were compared between groups to identify those significantly associated with the presence of intra-abdominal injuries, adopting p<0.05 as significant. Subsequently, the variables with p<0.20 on bivariate analysis were selected to create a logistic regression model using the forward stepwise method. Results: A total of 268 cases met the inclusion criteria. Patients in Group I were characterized as having significantly (p<0.05 lower mean AIS score for the head segment (1.0±1.4 vs. 1.8±1.9, as well as higher mean AIS thorax score (1.6±1.7 vs. 0.9±1.5 and ISS (25.7±14.5 vs. 17,1±13,1. The rate of abdominal injuries was significantly higher in run-over pedestrians (37.3% and in motorcyclists (36.0% (p<0.001. The resultant logistic regression model provided 73.5% accuracy for identifying abdominal injuries. The variables included were: motorcyclist accident as trauma mechanism (p<0.001 - OR 5.51; 95%CI 2.40-12.64, presence of rib fractures (p<0.003 - OR 3.00; 95%CI 1.47-6.14, run-over pedestrian as trauma mechanism (p=0.008 - OR 2.85; 95%CI 1.13-6.22 and abnormal neurological physical exam at admission (p=0.015 - OR 0.44; 95%CI 0.22-0.85. Conclusion Intra-abdominal injuries were predominantly associated with trauma mechanism and presence of chest injuries.

  9. Clinical Analysis for the Correlation of Intra-abdominal Organ Injury in the Patients with Rib Fracture

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    2012-01-01

    Background Although it is rare for the fracture itself to become a life threatening injury in patients suffering from rib fracture, the lives of these patients are occasionally threatened by other associated injuries. Especially, early discovery of patients with rib fracture and intra-abdominal organ injury is extremely important to the prognosis. This study analyzed the link between rib fracture and intra-abdominal injury to achieve improved treatment. Materials and Methods Among trauma patients that had visited the hospital emergency room from January 2007 to December 2009, a retrospective study was conducted on 453 patients suffering from rib fracture due to blunt trauma. Rib fracture was classified according to location (left, right, and bilateral), and according to level (upper rib fracture [1-2nd rib], middle rib fracture [3-8th rib], and lower rib fracture [9-12th rib]). The researched data was statistically compared and analyzed to investigate the correlation between the location, level, and number of rib fracture and intra-abdominal organ injury. Results Motor vehicle injury was found to be the most common mechanism of injury with 208 cases (46%). Associated injuries accompanied with rib fracture were generated in 276 cases (61%). Intra-abdominal organ injury was discovered in 97 cases (21%). Liver injury was the most common intra-abdominal injury associated with rib fracture with 39 cases (40%), followed by spleen injury, with 23 cases (23%). Intra-abdominal injury according to level of rib fracture was presented as upper rib fracture in 11 cases (11%), middle rib fracture in 31 cases (32%), and lower rib fracture in 55 cases (57%), thus verifying that intra-abdominal injuries were commonly accompanied in lower rib fractures (p=0.03). In particular, significant increase of intra-abdominal injury was presented in fractures below the 8th rib (p=0.03). The number of intra-abdominal injuries requiring emergency operations was significantly higher in patients

  10. The Incidence, Clinical Outcomes, and Risk Factors of Thrombocytopenia in Intra-Abdominal Infection Patients: A Retrospective Cohort Study.

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    Qin Wu

    Full Text Available Studies on the incidence and risk factors of thrombocytopenia among intra-abdominal infection patients remain absent, hindering efficacy assessments regarding thrombocytopenia prevention strategies.We retrospectively studied 267 consecutively enrolled patients with intra-abdominal infections. Occurrence of thrombocytopenia was scanned for all patients. All-cause 28-day mortality was recorded. Variables from univariate analyses that were associated with occurrence of hospital-acquired thrombocytopenia were included in a multivariable logistic regression analysis to determine thrombocytopenia predictors.Median APACHE II score and SOFA score of the whole cohort was 12 and 3 respectively. The overall ICU mortality was 7.87% and the 28-day mortality was 8.98%. The incidence of thrombocytopenia among intra-abdominal infection patients was 21.73%. Regardless of preexisting or hospital-acquired one, thrombocytopenia is associated with an increased ICU mortality and 28-day mortality as well as length of ICU or hospital stay. A higher SOFA and ISTH score at admission were significant hospital-acquired thrombocytopenia risk factors.This is the first study to identify a high incidence of thrombocytopenia in patients with intra-abdominal infections. Our findings suggest that the inflammatory milieu of intra-abdominal infections may uniquely predispose those patients to thrombocytopenia. More effective thrombocytopenia prevention strategies are necessary in intra-abdominal infection patients.

  11. A prospective evaluation of CT features predictive of intra-abdominal hypertension and abdominal compartment syndrome in critically ill surgical patients

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    Al-Bahrani, A.Z. [Department of Surgery, Manchester Royal Infirmary, Manchester (United Kingdom); Abid, G.H. [Department of Surgery, Manchester Royal Infirmary, Manchester (United Kingdom); Sahgal, E. [Department of Surgery, Manchester Royal Infirmary, Manchester (United Kingdom); O' Shea, S. [Department of Radiology, Manchester Royal Infirmary, Manchester (United Kingdom); Lee, S. [Department of Surgery, Manchester Royal Infirmary, Manchester (United Kingdom); Ammori, B.J. [Department of Surgery, Manchester Royal Infirmary, Manchester (United Kingdom)]. E-mail: bammori@btinternet.com

    2007-07-15

    Aim: The aim of this study was to validate the computed tomography (CT) features of intra-abdominal hypertension (IAH) by relating them to the clinical measurement of intra-abdominal pressure (IAP) in critically ill surgical patients. Materials and methods: The intra-vesical pressure was measured to reflect IAP in 24 critically ill patients. CT examinations obtained within 24 h of IAP measurement were reviewed and scored independently by two consultant radiologists. Each CT examination was scored for the seven proposed features of IAH. Images obtained during the presence of IAH were compared with those obtained in the absence of IAH. Results: Forty-eight abdominal CT examinations were evaluated, of which 18 (38%) were obtained in the presence of IAH, whereas eight (17%) were obtained in the presence of abdominal compartment syndrome (ACS). At CT, the round belly sign (RBS) and bowel wall thickening with enhancement (BWTE) were significantly more frequently detected during the presence of IAH than when the IAP was less than 12 mmHg (78 versus 20% of examinations, p < 0.001 and 39 versus 3% of examinations, p = 0.003, respectively), but only BWTE was significantly associated with the presence of ACS (40 versus 11% of examinations, p = 0.047). Conclusion: The presence of RBS and BWTE on CT images of critically ill surgical patients should alert clinicians to the possibility of presence of IAH and ACS, and prompt measurement of the IAP and consideration of suitable interventions.

  12. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

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    Hoffmann, Charles; Zak, Matthew; Avery, Lisa; Brown, Jack

    2016-01-01

    Antimicrobial stewardship programs (ASPs) focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs) commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics. PMID:27025526

  13. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

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    Charles Hoffmann

    2016-02-01

    Full Text Available Antimicrobial stewardship programs (ASPs focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics.

  14. [Intra-Abdominal Germ Cell Tumor in Persistent Mullerian Duct Syndrome].

    Science.gov (United States)

    Mishima, Takao; Harada, Jiro; Kawa, Gen; Sakurai, Takanori; Okada, Takuya

    2016-08-01

    A 46-year-old man was admitted to hospital presenting with a lower abdominal mass. The patient's testes were not palpable in the scrotum, and the levels of lactic dehydrogenase, α-fetoprotein and human chorionic gonadotropin were all elevated. Enhanced computed tomography revealed that the lumen of the mass had penetrated the prostate. Pathological analysis of biopsy tissue indicated that the mass was a seminoma. Residual tumor resection was performed after chemotherapy. On histological examination, the lumen proved to be a Mullerian structure. Our diagnosis was an intra-abdominal germ cell tumor and persistent Mullerian duct syndrome.

  15. Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review.

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    Bremer, Andrew A; Darouiche, Rabih O

    2004-01-01

    Spinal epidural abscess is a rare infectious disease. However, if left unrecognized and untreated, the clinical outcome of spinal epidural abscess can be devastating. Correctly diagnosing a spinal epidural abscess in a timely fashion is often difficult, particularly if the clinician does not actively consider the diagnosis. The most common presenting symptoms of spinal epidural abscess include backache, radicular pain, weakness, and sensory deficits. However, early in its course, spinal epidural abscess can also present with vague and nondescript manifestations. In this report, we describe a case of spinal epidural abscess presenting as abdominal pain, and review the literature describing other cases of spinal epidural abscess presenting as intra-abdominal pathology.

  16. Inhibition of cyclooxygenase-2 prevents intra-abdominal adhesions by decreasing activity of peritoneal fibroblasts

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    Wei G

    2015-06-01

    Full Text Available Guangbing Wei,1 Xin Chen,2 Guanghui Wang,1 Pengbo Jia,1,3 Qinhong Xu,2 Gaofeng Ping,1 Kang Wang,1 Xuqi Li1 1Department of General Surgery, 2Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, 3Department of General Surgery, First People’s Hospital of Xianyang City, Xianyang, People’s Republic of China Background: Postoperative intra-abdominal adhesions are common complications after abdominal surgery. The exact molecular mechanisms that are responsible for these complications remain unclear, and there are no effective methods for preventing adhesion formation or reformation. The aim of the study reported here was to investigate the preventive effects and underlying potential molecular mechanisms of selective cyclooxygenase-2 (COX-2 inhibitors in a rodent model of postoperative intra-abdominal adhesions.Materials and methods: The expression of COX-2 in postoperative intra-abdominal adhesions and normal peritoneal tissue was examined by immunohistochemistry and Western blot analysis. Assays were performed to elucidate the effect of COX-2 inhibition on hypoxia-induced fibroblast activity in vitro and on intra-abdominal adhesion formation in vivo.Results: Hypoxia-induced COX-2 expression in peritoneal fibroblasts was increased in postoperative intra-abdominal adhesions. Inhibition of COX-2 attenuated the activating effect of hypoxia on normal peritoneal fibroblasts in vitro. Data indicate that selective COX-2 inhibitor prevents in vivo intra-abdominal adhesion by inhibition of basic fibroblast growth factor and transforming growth factor-beta expression, but not through an antiangiogenic mechanism. Furthermore, using selective COX-2 inhibitors to prevent intra-abdominal adhesions did not adversely affect the weight, bowel motility, or healing of intestinal anastomoses in a rat model.Conclusion: These results show that hypoxia-induced COX-2 expression in peritoneal

  17. Biochemical analysis of cystic fluid in the diagnosis of fetal intra-abdominal masses.

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    Lecarpentier, Edouard; Dreux, Sophie; Blanc, Thomas; Schaub, Bruno; Ville, Yves; Mandelbrot, Laurent; El Ghoneimi, Alaa; Oury, Jean-François; Muller, Françoise

    2012-07-01

    The aim of the study was to evaluate a biochemical analysis of fluid sampled in utero from fetal abdominal cystic masses. A retrospective study of 42 intra-abdominal cystic masses [ovarian cysts (n = 22), cloaca (n = 8), urodigestive fistulae (n = 4), and urogenital sinuses (n = 8)] was carried out. The control group (n = 30) consisted of fetal urine. Seven biochemical markers were assayed: sodium, estradiol, β(2) -microglobulin, total proteins and digestive enzymes, gamma-glutamyl transpeptidase, aminopeptidase M, and intestinal alkaline phosphatase isoenzyme. Outcome of pregnancies and final diagnosis of intra-abdominal mass were known in all cases. Biochemical patterns allowed to demonstrate (1) an ovarian origin based on elevated level of estradiol and of total proteins (100% specificity, 100% sensitivity); (2) urodigestive fistula based on the presence of high levels of digestive enzymes (cloaca in female fetuses or recto-urethral fistula in male fetuses); and (3) a renal origin (urinary pattern with low total proteins and absence of digestive enzymes); however, a biochemical pattern could not differentiate between fetal urogenital sinus and megacystis. Etiological diagnosis of a fetal cystic abdominal mass could impact both prenatal and postnatal management providing adapted prenatal counseling by a pediatric surgeon in surgically correctable congenital anomalies. © 2012 John Wiley & Sons, Ltd.

  18. Successful treatment of intra-abdominal eumycotic mycetoma caused by Penicillium duponti in a dog.

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    Janovec, J; Brockman, D J; Priestnall, S L; Kulendra, N J

    2016-03-01

    A 2-year-old female neutered golden retriever was presented for investigation of an intra-abdominal mass. Computed tomography revealed a mass associated with the caudal pole of the right kidney. Incisional biopsy findings were consistent with eumycotic mycetoma. The mass was subsequently removed in conjunction with right ureteronephrectomy. Two years later, the dog re-presented with a splenic mass and fungal plaques located throughout the peritoneum. Splenectomy was performed and the mass was diagnosed as eumycotic mycetoma caused by Penicillium duponti. Indefinite systemic treatment with 10 mg/kg itraconazole orally once a day was initiated. Thirty-two months after the last surgery, there were no clinical signs apart from mild polydipsia. Haematology and biochemistry results were unremarkable. To the authors' knowledge, this is the first report of successful treatment of intra-abdominal eumycotic mycetoma with a combination of surgery and systemic antifungal therapy in the dog. Penicillium duponti has not apparently been reported to cause disease in animals or humans. © 2015 British Small Animal Veterinary Association.

  19. Adrenal gland volume, intra-abdominal and pericardial adipose tissue in major depressive disorder.

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    Kahl, Kai G; Schweiger, Ulrich; Pars, Kaweh; Kunikowska, Alicja; Deuschle, Michael; Gutberlet, Marcel; Lichtinghagen, Ralf; Bleich, Stefan; Hüper, Katja; Hartung, Dagmar

    2015-08-01

    Major depressive disorder (MDD) is associated with an increased risk for the development of cardio-metabolic diseases. Increased intra-abdominal (IAT) and pericardial adipose tissue (PAT) have been found in depression, and are discussed as potential mediating factors. IAT and PAT are thought to be the result of a dysregulation of the hypothalamus-pituitary-adrenal axis (HPAA) with subsequent hypercortisolism. Therefore we examined adrenal gland volume as proxy marker for HPAA activation, and IAT and PAT in depressed patients. Twenty-seven depressed patients and 19 comparison subjects were included in this case-control study. Adrenal gland volume, pericardial, intraabdominal and subcutaneous adipose tissue were measured by magnetic resonance imaging. Further parameters included factors of the metabolic syndrome, fasting cortisol, fasting insulin, and proinflammatory cytokines. Adrenal gland and pericardial adipose tissue volumes, serum concentrations of cortisol and insulin, and serum concentrations tumor-necrosis factor-α were increased in depressed patients. Adrenal gland volume was positively correlated with intra-abdominal and pericardial adipose tissue, but not with subcutaneous adipose tissue. Our findings point to the role of HPAA dysregulation and hypercortisolism as potential mediators of IAT and PAT enlargement. Further studies are warranted to examine whether certain subtypes of depression are more prone to cardio-metabolic diseases.

  20. Effect of Emodin on Preventing Postoperative Intra-Abdominal Adhesion Formation

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    Guangbing Wei

    2017-01-01

    Full Text Available Background. Postoperative intra-abdominal adhesions are a major complication after abdominal surgery. Although various methods have been used to prevent and treat adhesions, the effects have not been satisfactory. Emodin, a naturally occurring anthraquinone derivative and an active ingredient in traditional Chinese herbs, exhibits a variety of pharmacological effects. In our study, we demonstrated the effect of emodin treatment on preventing postoperative adhesion formation. Materials and Methods. A total of 48 rats were divided into six groups. Abdominal adhesions were created by abrasion of the cecum and its opposite abdominal wall. In the experimental groups, the rats were administered daily oral doses of emodin. On the seventh day after operation, the rats were euthanized, and blood and pathological specimens were collected. Abdominal adhesion formation was evaluated by necropsy, pathology, immunohistochemistry, Western blot, and enzyme-linked immunosorbent assay analyses. Results. Abdominal adhesions were markedly reduced by emodin treatment. Compared with the control group, collagen deposition was reduced and the peritoneal mesothelial completeness rate was higher in the emodin-treated groups. Emodin had anti-inflammatory effects, reduced oxidative stress, and promoted the movement of the intestinal tract (P<0.05. Conclusion. Emodin significantly reduced intra-abdominal adhesion formation in a rat model.

  1. Unexpected multiple intra-abdominal injuries after projectile fragmentation: report of three cases.

    Science.gov (United States)

    Unlü, Aytekin; Petrone, Patrizio; Karşıdağ, Tamer; Asensio, Juan A

    2012-11-01

    Explosives create and energize particles that act as projectiles prone to further fragmentation or create other secondary missiles in the body. These fragments may result in secondary injuries. This has been repeatedly described in the orthopedic and neurosurgical literature. We report the same process for abdominal injuries after fascial penetration in the military setting. This is an observational case series study. Local wound exploration as a standard approach was performed in conscious patients who sustained abdominal wall injuries. Patients with negative physical examination were excluded from the study. An intraperitoneal injury was assumed in those with a full-thickness fascial defect, and laparotomy was performed. Twenty patients met the study eligibility criteria. Of those 20 patients, 12 had negative wound exploration and were excluded from the study, while abdominal organ injuries were found in eight (40%) patients. During laparotomy, projectile-induced injuries in a sprayed distribution were found in three (38%) of these patients. These injuries were far from the predictable trajectory and in the absence of bone fragmentation. The overall mean number of peritoneal defects was 1.7, and a mean 6.8 intra-abdominal injuries for each peritoneal defect were found when through-and-through injuries were excluded.Despite a single peritoneal defect, there may be multiple intraperitoneal injuries due to further fragmentation of the projectile. Under mass casualties, wound exploration with a full-thickness fascial defect could serve as an indicator of possible intra-abdominal injuries, and consequently indicate exploratory laparotomy.

  2. Antibiotic management of complicated intra-abdominal infections in adults: The Asian perspective

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    Asok Kurup

    2014-09-01

    Full Text Available Regional epidemiological data and resistance profiles are essential for selecting appropriate antibiotic therapy for intra-abdominal infections (IAIs. However, such information may not be readily available in many areas of Asia and current international guidelines on antibiotic therapy for IAIs are for Western countries, with the most recent guidance for the Asian region dating from 2007. Therefore, the Asian Consensus Taskforce on Complicated Intra-Abdominal Infections (ACT-cIAI was convened to develop updated recommendations for antibiotic management of complicated IAIs (cIAIs in Asia. This review article is based on a thorough literature review of Asian and international publications related to clinical management, epidemiology, microbiology, and bacterial resistance patterns in cIAIs, combined with the expert consensus of the Taskforce members. The microbiological profiles of IAIs in the Asian region are outlined and compared with Western data, and the latest available data on antimicrobial resistance in key pathogens causing IAIs in Asia is presented. From this information, antimicrobial therapies suitable for treating cIAIs in patients in Asian settings are proposed in the hope that guidance relevant to Asian practices will prove beneficial to local physicians managing IAIs.

  3. Germ cells may survive clipping and division of the spermatic vessels in surgery for intra-abdominal testes

    DEFF Research Database (Denmark)

    Thorup, J M; Cortes, Dina; Visfeldt, J

    1999-01-01

    Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides adequa...... viability of the intra-abdominal testis. However, it is uncertain whether the more sensitive germ cells survive this procedure in addition to the Sertoli and interstitial cells of the human testis. Survival of germ cells is a prerequisite of later fertility potential....

  4. Common errors in the treatment of intra-abdominal infections: the irrational use of antimicrobial agents

    Directory of Open Access Journals (Sweden)

    Belinda De Simone

    2016-06-01

    Full Text Available Antimicrobial resistance (AR is a global, emergent problem because an increasing numbers of serious community acquired and nosocomial infections are caused by resistant bacterial pathogens. It is a direct consequence of the excessive and irrational use of antibiotics. The use of antimicrobial agents – aimed to decrease morbidity and mortality rate related to intra-abdominal infections – is very high, often improper, in the Departments of General and Emergency Surgery and Intensive Cure Units. Source control and empiric antibiotic therapy have to be administrated as early as possible to decrease high mortality rates in patients with severe sepsis or septic shock and, in this, the general surgeon has a crucial role. Proper antimicrobial stewardship in selecting an appropriate antibiotic and optimizing its dose and duration to cure intraabdominal infections may prevent the emergence of AR and decrease costs for antibiotics.

  5. Intra-abdominal spilled gallstones simulating peritoneal metastasis: CT and MR imaging features (2008: 1b)

    Energy Technology Data Exchange (ETDEWEB)

    Karabulut, Nevzat; Tavasli, Birnur; Kiroglu, Yilmaz [Pamukkale University Medical Center, Department of Radiology, Kinikli, Denizli (Turkey)

    2008-04-15

    Laparoscopic cholecystectomy has rapidly become the preferred treatment for symptomatic cholecystolithiasis. However, the procedure is associated with a number of complications, one of which is the spillage of gallstones into the peritoneal cavity. Unretrieved gallstones may cause a wide variety of complications such as abscess, adhesion and small-bowel obstruction, or they may remain asymptomatic and harmless. In the latter case, spilled gallstones in the peritoneal spaces may cause diagnostic difficulty or mimic peritoneal metastasis. We present the computed tomography (CT) and magnetic resonance (MR) imaging features of intra-abdominal gallstone spillage in a case with head and neck neoplasm. Awareness of radiologic features of dropped intraperitoneal gallstones is necessary as they may be mistaken for peritoneal metastases. (orig.)

  6. Intra-abdominal seminoma found incidentally during trauma workup in a man with bilateral cryptorchidism

    Directory of Open Access Journals (Sweden)

    Danielle Velez

    2015-01-01

    Full Text Available Bilateral cryptorchidism is a rare occurrence and seminoma is the most common germ cell tumor found in undescended testes when they occur. We present the case of a patient with bilateral cryptorchidism who presented to our trauma center after a motor vehicle collision and was found incidentally to have a 17-cm intra-abdominal mass. The mass was subsequently biopsied and proven to be seminoma. The patient completed three cycles of bleomycin/etoposide/cisplatin chemotherapy and successfully underwent a postchemo retroperitoneal lymph node dissection with no viable residual tumor or positive lymph nodes found in the surgical specimen. He also had an orchiopexy of the contralateral testicle. The patient recovered fully and has been found to be recurrence-free four months postoperatively. We highlight the importance of cisplatin-based chemotherapy and extensive tumor resection as the mainstay of initial cancer control.

  7. Intra-Abdominal Testicular Seminoma in a Woman with Testicular Feminization Syndrome

    Directory of Open Access Journals (Sweden)

    Darshana D. Rasalkar

    2011-01-01

    Full Text Available We report a case of intra-abdominal testicular tumor in a 36-year-old married lady presenting with chief complaints of primary amenorrhea. The patient was later diagnosed with testicular feminization syndrome, a form of male pseudohermaphroditism. This testicular tumor was histologically proven as seminoma. Due to rarity, imaging findings in patients with testicular feminization syndrome and intraabdominal testicular tumor have been poorly documented. So far, only one case report had described the combined role of CT and MR imaging in intraabdominal testicular sex-cord stromal tumor. To our knowledge, this case is first to document USG and MR imaging in addition to MR spectroscopy features in intraabdominal testicular seminoma.

  8. Implanting intra-abdominal radiotransmitters with external whip antennas in ducks

    Science.gov (United States)

    Korschgen, C.E.; Kenow, K.P.; Gendron-Fitzpatrick, A.; Green, W.L.; Dein, F.J.

    1996-01-01

    We developed and evaluated a surgical procedure for implanting intra-abdominal radiotransmitters with external whip antennas in captive mallards (Anas platyrhynchos). Transmitters were implanted in the abdominal cavity and the antennas exited through the caudal abdominal wall and skin. Birds with implanted transmitters developed mild to moderate localized air sac reactions. These reactions involved adhesions of the right anterior abdominal air sac to the liver with contractions around the transmitters and antenna catheters. The adhesions were reinforced by a proliferation of connective tissue and lined by multinucleated giant cells (foreign body reaction). Casual observation indicated that neither behavior nor activity of the birds was altered by the histological reaction to the transmitter implant. No increase in systemic lesions (particularly liver or kidney) could be correlated with the histological reactions. Our evaluations indicate that the procedure is a reliable method for radiomarking ducks and the technique has been successfully used in 2 field studies.

  9. Abdominal compartment syndrome – Intra-abdominal hypertension: Defining, diagnosing, and managing

    Science.gov (United States)

    Papavramidis, Theodossis S; Marinis, Athanasios D; Pliakos, Ioannis; Kesisoglou, Isaak; Papavramidou, Nicki

    2011-01-01

    Abdominal compartment syndrome (ACS) and intra-abdominal hypertension (IAH) are increasingly recognized as potential complications in intensive care unit (ICU) patients. ACS and IAH affect all body systems, most notably the cardiac, respiratory, renal, and neurologic systems. ACS/IAH affects blood flow to various organs and plays a significant role in the prognosis of the patients. Recognition of ACS/IAH, its risk factors and clinical signs can reduce the morbidity and mortality associated. Moreover, knowledge of the pathophysiology may help rationalize the therapeutic approach. We start this article with a brief historic review on ACS/IAH. Then, we present the definitions concerning parameters necessary in understanding ACS/IAH. Finally, pathophysiology aspects of both phenomena are presented, prior to exploring the various facets of ACS/IAH management. PMID:21769216

  10. The Challenge of Antimicrobial Resistance in Managing Intra-Abdominal Infections.

    Science.gov (United States)

    Sartelli, Massimo; Catena, Fausto; di Saverio, Salomone; Ansaloni, Luca; Coccolini, Federico; Tranà, Cristian; Kirkby-Bott, James

    2015-06-01

    In recent years, there has been a worldwide increase in infections caused by microorganisms resistant to multiple antimicrobial agents. In the past few decades, an increased prevalence of infections caused by antibiotic-resistant pathogens, including Enterococcus spp., carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella spp., carbapenemase-producing Klebsiella pneumoniae, and resistant Candida spp., also has been observed among intra-abdominal infections (IAIs). The increasing prevalence of multi-drug resistance is responsible for a substantial increase in morbidity and mortality rates associated with IAIs. It is necessary for every surgeon treating IAIs to understand the underlying epidemiology and clinical consequences of antimicrobial resistance. Emergence of drug resistance, combined with the lack of new agents in the drug development pipeline, indicates that judicious antimicrobial management will be necessary to preserve the utility of the drugs available currently.

  11. Is intra-abdominal hypertension a missing factor that drives multiple organ dysfunction syndrome?

    Science.gov (United States)

    Kirkpatrick, Andrew W; Roberts, Derek J; De Waele, Jan; Laupland, Kevin

    2014-03-19

    In a recent issue of Critical Care, Cheng and colleagues conducted a rabbit model study that demonstrated that intra-abdominal hypertension (IAH) may damage both gut anatomy and function. With only 6 hours of IAH at 25 mmHg, these authors observed an 80% reduction in mucosal blood flow, an exponential increase in mucosal permeability, and erosion and necrosis of the jejunal villi. Such dramatic findings should remind all caring for the critically ill that IAH may severely damage the normal gut barrier functions and thus may be reasonably expected to facilitate bacterial and mediator translocation. The potential contribution of IAH as a confounding factor in the efficacy of selective decontamination of the digestive tract should be considered.

  12. Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

    Directory of Open Access Journals (Sweden)

    Edivaldo Massazo Utiyama

    Full Text Available OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years; 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

  13. Clinical effect of early bowel-relaxing treatment and drainage in treatment of severe acute pancreatitis with intra-abdominal hypertension

    Directory of Open Access Journals (Sweden)

    WANG Qiang

    2017-01-01

    Full Text Available ObjectiveTo investigate the clinical effect of early bowel-relaxing treatment and drainage in the treatment of severe acute pancreatitis (SAP. MethodsA retrospective analysis was performed for the clinical data of 52 patients with SAP who were admitted to Department of Hepatopancreatobiliary Surgery, Zhuzhou Central Hospital, from January 2009 to January 2015, and these patients were divided into conventional treatment group with 22 patients and early bowel-relaxing/drainage group with 30 patients. The incidence of multiple organ dysfunction syndrome and abdominal compartment syndrome within 2 weeks, time to intra-abdominal pressure reduced to below 15 cm H2O, time to gastrointestinal function recovery, pancreatic infection rate, and mortality rate were compared between the two groups. The independent samples t-test was used for comparison of continuous data between the two groups, and the chi-square test was used for comparison of categorical data. ResultsCompared with the conventional treatment group, the early bowel-relaxing/drainage group had significant reductions in the incidence rates of multiple organ dysfunction syndrome (31.8% vs 10.0%, χ2=3.89, P=0.049 and abdominal compartment syndrome (22.7% vs 3.3%, χ2=4.68, P=0.031 within 2 weeks, pancreatic infection rate (40.9% vs 13.3%, χ2=515, P=0.023, and mortality rate (22.7% vs 3.3%, χ2=4.68, P=0.031. Compared with the conventional treatment group, the early bowel-relaxing/drainage group had significantly shortened time to intra-abdominal pressure reduced to below 15 cm H2O, time to bowel sound recovery, and time to the recovery of passing of flatus and defecation (t=1.02, 6.67, and 2.13, all P<0.01. ConclusionIn the early stage of SAP, bowel-relaxing treatment and drainage can effectively reduce intra-abdominal hypertension, protect vital organ function, alleviate the condition of SAP, reduce the incidence of complications, and thus significantly improve the prognosis of SAP.

  14. In women with polycystic ovary syndrome and obesity, loss of intra-abdominal fat is associated with resumption of ovulation

    NARCIS (Netherlands)

    Kuchenbecker, W.K.H.; Groen, H.; van Asselt, S.J.; Bolster, J.H.T.; Zwerver, J.; Slart, R.H.J.; van der Jagt, E.J.; Kobold, A.C.M.; Wolffenbuttel, B.H.R.; Land, J.A.; Hoek, A.

    2011-01-01

    BACKGROUND: It is not clear why some anovulatory women with polycystic ovary syndrome (PCOS) and obesity resume ovulation and others remain anovulatory after weight loss. The objective of this study was to compare the changes in body fat distribution and specifically intra-abdominal fat (IAF) and su

  15. Germ cells may survive clipping and division of the spermatic vessels in surgery for intra-abdominal testes

    DEFF Research Database (Denmark)

    Thorup, J M; Cortes, D; Visfeldt, J

    1999-01-01

    studied 17 nonpalpable testes in 10 patients 1 year and 7 months to 13(1/2) years old. Results of testicular biopsies of 13 intra-abdominal testes taken at stages 1 and 2 of surgery were available for histological comparison. RESULTS: Median number of spermatogonia per tubular cross section...

  16. The Epidemiology of Intra-Abdominal Flora in Critically III Patients with Secondary and Tertiary Abdominal Sepsis

    NARCIS (Netherlands)

    de Ruiter, J.; Weel, J.; Manusama, E.; Kingma, W. P.; van der Voort, P. H. J.

    2009-01-01

    Background: Different micro-organisms can be cultured from abdominal fluid obtained from patients with intra-abdominal infection resulting from a perforated digestive tract. We evaluated a cohort of patients with abdominal sepsis admitted to the intensive care with the aim of obtaining more insight

  17. Validation of the Measurement of Intra-abdominal Fat Between Ultrasound and CT Scan in Women with Obesity and Infertility

    NARCIS (Netherlands)

    Kuchenbecker, Walter K. H.; Groen, Henk; Pel, Heleen; Bolster, Johanna H. T.; Wolffenbuttel, Bruce H. R.; Land, Jolande A.; Hoek, Annemieke; Corpeleijn, Eva

    2014-01-01

    Objective: To compare the means and changes over time of intra-abdominal fat (IAF) and subcutaneous abdominal fat (SAF) measured by abdominal ultrasound (US) and computerized tomography (CT). Design and Methods: Prospective cohort study of 53 women with obesity and infertility undergoing a lifestyle

  18. The Epidemiology of Intra-Abdominal Flora in Critically III Patients with Secondary and Tertiary Abdominal Sepsis

    NARCIS (Netherlands)

    de Ruiter, J.; Weel, J.; Manusama, E.; Kingma, W. P.; van der Voort, P. H. J.

    2009-01-01

    Background: Different micro-organisms can be cultured from abdominal fluid obtained from patients with intra-abdominal infection resulting from a perforated digestive tract. We evaluated a cohort of patients with abdominal sepsis admitted to the intensive care with the aim of obtaining more insight

  19. Validation of the Measurement of Intra-abdominal Fat Between Ultrasound and CT Scan in Women with Obesity and Infertility

    NARCIS (Netherlands)

    Kuchenbecker, Walter K. H.; Groen, Henk; Pel, Heleen; Bolster, Johanna H. T.; Wolffenbuttel, Bruce H. R.; Land, Jolande A.; Hoek, Annemieke; Corpeleijn, Eva

    Objective: To compare the means and changes over time of intra-abdominal fat (IAF) and subcutaneous abdominal fat (SAF) measured by abdominal ultrasound (US) and computerized tomography (CT). Design and Methods: Prospective cohort study of 53 women with obesity and infertility undergoing a lifestyle

  20. In women with polycystic ovary syndrome and obesity, loss of intra-abdominal fat is associated with resumption of ovulation

    NARCIS (Netherlands)

    Kuchenbecker, W.K.H.; Groen, H.; van Asselt, S.J.; Bolster, J.H.T.; Zwerver, J.; Slart, R.H.J.; van der Jagt, E.J.; Kobold, A.C.M.; Wolffenbuttel, B.H.R.; Land, J.A.; Hoek, A.

    BACKGROUND: It is not clear why some anovulatory women with polycystic ovary syndrome (PCOS) and obesity resume ovulation and others remain anovulatory after weight loss. The objective of this study was to compare the changes in body fat distribution and specifically intra-abdominal fat (IAF) and

  1. Recognition and management of intra-abdominal hypertension and abdominal compartment syndrome; a survey among Dutch surgeons

    NARCIS (Netherlands)

    K.D. Strang; E.M.M. van Lieshout (Esther); R.A. Verhoeven (Roelof A.); O.J.F. van Waes (Oscar); M.H.J. Verhofstad (Michiel); Iah-Acs Study Group

    2017-01-01

    textabstractPurpose: Intra-abdominal hypertension (IAH) and Abdominal compartment syndrome (ACS) are relatively rare, but severe complications. Although many advances were made in recent years, the recognition and management remain subject of debate. The aim of this study was to determine the

  2. Postoperative antibiotic use and the incidence of intra-abdominal abscess in the setting of suppurative appendicitis: a retrospective analysis.

    Science.gov (United States)

    Bae, Esther; Dehal, Ahmed; Franz, Vanessa; Joannides, Michael; Sakis, Nicholas; Scurlock, Joshua; Nguyen, Patrick; Hussain, Farabi

    2016-12-01

    Although guidelines exist for postoperative antibiotic use in acute appendicitis that is perforated, gangrenous, or simple/uncomplicated, there are less data about its use in suppurative appendicitis. Here, we targeted this subgroup of patients to determine whether postoperative antibiotic administration affects incidence of intra-abdominal abscess formation. We retrospectively examined 1,192 patients who underwent laparoscopic appendectomy for acute appendicitis at Kaiser Permanente Fontana Hospital between August 2010 and August 2013. Suppurative appendicitis was described for 143 (12%) patients. Fifty-two patients received postoperative antibiotics for at least 1 week on discharge home, 91 did not. Of 143 patients with suppurative appendicitis, 1 (1.9%) who received postoperative antibiotics came back with an intra-abdominal abscess within 1 month. Of the 91 patients in the no antibiotic group, 1 (1.1%) came back with an intra-abdominal abscess. The administration of postoperative antibiotic in the setting of suppurative appendicitis has no effect on the rate of intra-abdominal abscess formation. Routine postoperative antibiotics may not be necessary in this patient population, and more evidence is needed to justify its use. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. 家兔长时间腹腔内高压致腹腔筋膜室综合征模型的建立及生长抑素的干预作用%Effects of somatostatin in a rabbit model of abdominal compartment syndrome induced by prolonged intra-abdominal hypertension

    Institute of Scientific and Technical Information of China (English)

    陈煜; 薛翔; 王丽; 金春华; 邹衍泰

    2012-01-01

    Objective To establish a rabbit model of abdominal compartment syndrome (ACS) induced by prolonged intra-abdominal hypertension (IAH) and evaluate the therapeutic effect of somatostatin on ACS. Methods Twelve New Zealand rabbits were randomized equally into normal saline (NS) group and somatostatin group. ACS model was established by intra-abdominal bleeding (IAB) and intra-abdominal infusion with nitrogen gas to achieve an intra-abdominal pressure of 15 mmHg. The hemodynamics (SP, HR, CVP), hepatic function (ALT), renal function (BUN), antioxidation level (SOD, MDA) and blood electrolyte level (pH, [Na+], [Cl], [Ca2+], [K+]) of the rabbits were recorded 1-6 h after establishment of IAH. Results Prolonged IAH caused decreased hemodynamic functions and antioxidation level as well as hyperkalemia and hypocalcemia (P<0.05), but these changes showed no significant differences between NS group and somatostatin group. Conclusion Prolonged IAH causes cardiovascular function damages in rabbits possibly related to acidosis, electrolyte disturbances, and oxidative damage due to tissue ischemia and hypoxia. Somatostatin produces no obvious protective effects against the occurrence and progression of ACS.%目的 制作家兔长时间腹腔内高压所致的腹腔筋膜室综合征(ACS)模型,研究较长时间的腹腔内高压征(IAH)对家兔循环功能、肝肾功能、抗氧化能力及血液电解质水平的影响,并观察生长抑素是否对ACS有防治作用.方法 将12只新西兰兔平均分为2组,分别为生理盐水对照组、生长抑素干预组.通过模拟兔腹部失血和注入氮气建立动物IAH/ACS模型.并在IAH15 mmHg后1~6h观察兔各项指标变化,包括动脉收缩压、心率、中心静脉压(CVP)、血液酸碱及电解质指标,同时测定代表肝肾功能的谷丙转氨酶和尿素氮(BUN),以及反映组织过氧化反应的超氧化物歧化酶(SOD)和丙二醛(MDA)的变化情况.结果 长时间的IAH可使机体血压下降

  4. Cecal ameboma in nasopharyngeal carcinoma patient mimicking intra-abdominal malignancy

    Directory of Open Access Journals (Sweden)

    Chih-Wei Hsu

    2016-03-01

    Full Text Available Amebiasis is quite uncommon in developed countries. Its clinical presentation can vary from an asymptomatic carrier state to fulminant colitis and colonic perforation. We presented a 39-year-old female who received combined chemotherapy and radiotherapy for nasopharyngeal carcinoma 1 year prior to admission. Thereafter, she felt acute abdominal pain and diarrhea after traveling to Hainan 3 months ago. A physical examination of the patient revealed diffused peritoneal sign. Abdominal computed tomography showed a cecal tumor and intra-abdominal abscess. A subsequent exploratory laparotomy revealed an infiltrating yellowish tumor about 7 cm over the cecum and massive serous ascites. Pathology reported ambeic colitis with undermined ulcer and abscess formation of the cecum. Ameboma can be found in developed countries, particularly in patients with risk factors and a history of traveling to areas with the developing disease. Colonoscopy with biopsy is recommended for patients with suspected ameboma, and surgical intervention is likely indicated in complicated cases although the surgical mortality rate is high.

  5. INTRA-ABDOMINAL INFECTION AND ACUTE ABDOMEN-EPIDEMIOLOGY, DIAGNOSIS AND GENERAL PRINCIPLES OF SURGICAL MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Jovanović Dušan

    2015-03-01

    Full Text Available Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic- treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections.

  6. The Effect of Postoperative Hyperbaric Oxygen Treatment on Intra-Abdominal Adhesions in Rats

    Directory of Open Access Journals (Sweden)

    Yi-Chiang Hsu

    2012-09-01

    Full Text Available Abdominal adhesions, whether caused by peritoneal trauma, radiation, infection, or a congenital condition, are associated with a wide range of complications. These complications include chronic abdominal or pelvic pain, infertility, and adhesive small bowel obstruction. Such adhesions render re-operation difficult, with attendant risks of inadvertent enterostomy and increased operation time. The purpose of this study was to investigate the potential of hyperbaric oxygen (HBO therapy in the prevention of abdominal adhesions in an experimental animal study. A laparotomy was performed on Wistar rats to induce the formation of adhesions on the cecum and the intra-abdominal area (1 ´ 2 cm. A superficial layer of the underlying muscle from the right abdominal wall was also shaved and prepared for aseptic surgery. The rats were divided into four groups according to the duration of HBO therapy; five additional groups were designated according to the conditions of HBO therapy. When the rats were evaluated according to adhesion area and grade, a statistically significant difference was observed between the control and HBO treatment groups (p < 0.005. Results from this study suggest that HBO treatment could reduce adhesion formation; and further suggest that HBO therapy may have therapeutic potential in the treatment of postoperative peritoneal adhesion.

  7. Intra-Abdominal Hypertension Causes Bacterial Growth in Lungs: An Animal Study

    Science.gov (United States)

    Papakrivou, Eleni; Manoulakas, Efstratios; Mitroudi, Magda; Tepetes, Konstantinos; Papazoglou, Konstantinos; Zakynthinos, Epaminondas

    2017-01-01

    To study the effect of intra-abdominal hypertension (IAH) on the frequency of pneumonia with an experimental study, thirteen Sprague-Dawley rats were included. Eight out of thirteen animals were randomly assigned to receive 10 ml of benzalkonium chloride 0.2% (megacolon group) and five animals received 10 ml NaCl 0.9% (controls). Animals were anaesthetized by intramuscular delivery of ketamine. The incidence of positivity for bacteria lung tissue cultures and mesenteric lymph node cultures was assessed at the 21st day after animals' sacrification, or before in case of death. All megacolon group animals presented progressive increase of the abdomen and increased IAP (≥10 mmHg) whereas the frequency of their evacuations was almost eliminated. Controls presented normal evacuations, no sign of abdominal distention, and normal IAP. In megacolon group animals, there was evidence of significant amount of bacteria in lung cultures. In contrast, no bacteria were found in control animals. PMID:28357400

  8. Laparoscopic Testicular Preservation in Adults with Intra-Abdominal Cryptorchidism: Is It Beneficial?

    Directory of Open Access Journals (Sweden)

    Fábio César Miranda Torricelli

    2012-01-01

    Full Text Available Purpose. To present the results in a midterm followup of laparoscopic testicular preservation in adults with intra-abdominal cryptorchidism. Methods. We analyzed 14 adult patients with cryptorchidism (19 testes submitted to transabdominal laparoscopic evaluation and treatment of the condition. Data was collected retrospectively from a prospective database from August 2005 to May 2010. It analyzed patient age, affected side, procedure, mean operative time, mean hospital stay, postoperative testis position, intra- and postoperative complications, presence of malignancy in the removed testis, and midterm outcomes: size of the testis, development of tumors, and fertility. Results. Mean patient age was 29 (18–54 years. Thirteen (68.4% testes were preserved. There were no intra- or postoperative complications. After a mean followup of 48.7 (20–64 months, all patients submitted to orchiopexy had the organs correctly positioned, although 2 testes were significantly smaller than before the procedure. No patient presented any signs of malignancy during the followup. Fertility was not preserved in bilateral cases. Conclusion. Laparoscopic testicular evaluation and eventual preservation are feasible and safe. In a midterm followup, testicular tumor is not a concern, and unfortunately, fertility may not be preserved in bilateral cases.

  9. Perinatal hepatic infarction in twin-twin transfusion.

    LENUS (Irish Health Repository)

    O'Sullivan, M J

    2012-02-03

    We report a case of a twin pregnancy which was complicated by a twin-twin transfusion in which the recipient twin was noted to have an intra-abdominal echogenic mass. This twin died at two days of age of hepatic infarction. The donor twin was healthy at birth, at thirty weeks\\' gestation, and did not have any subsequent problems. Fetal intra-abdominal echogenicity may be a marker of hepatic infarction.

  10. The role of routine measurement of intra-abdominal pressure in preventing abdominal compartment syndrome

    Directory of Open Access Journals (Sweden)

    G Raghavendra Prasad

    2017-01-01

    Conclusion: Routine measure of IAP facilitates early recognition of IAH. This facilitates therapeutic measures to be initiated to reduce IAP. Early decision to decompress by laparotomy/laparostomy saves lives. Hence, routine IAP measurement should be a part of standard care in pediatric abdominal surgery.

  11. [Intra-abdominal pressure as a surgery predictor in patients with acute abdominal pain].

    Science.gov (United States)

    Campos-Muñoz, Manuel Alejandro; Villarreal-Ríos, Enrique; Chimal-Torres, Mariano; Pozas-Medina, Josué Atila

    2016-01-01

    Introducción: la presión intraabdominal es el estado de equilibrio de la presión de la cavidad abdominal en reposo y puede presentar cambios durante la ventilación mecánica o espontánea. El objetivo fue determinar la presión intraabdominal como predictor de cirugía en el paciente con dolor abdominal agudo. Métodos: se llevó a cabo un estudio de casos y controles anidado en una cohorte de pacientes con dolor abdominal agudo en el servicio de urgencias de un hospital de segundo nivel, en el periodo comprendido entre abril y diciembre de 2013. Se incluyeron 37 pacientes, todos fueron intervenidos quirúrgicamente con previa toma de la presión intraabdominal. Se formaron los grupos con el resultado del estudio anatomopatológico: con evidencia de proceso inflamatorio abdominal agudo (n = 28) y sin evidencia de proceso inflamatorio abdominal agudo (n = 9). Resultados: en los casos el 100 % presentó presión intraabdominal alta con una p = 0.01, RM: 5 (IC 95 %: 2.578-9.699). En los casos la media de la presión intraabdominal fue de 11.46 y en los controles de 9.2 (p = 0.183). Conclusiones: el dolor abdominal que requiere cirugía para su resolución tiene relación directa con una presión intraabdominal > 5 mmHg.

  12. Localized intra-abdominal fibromatosis of the small bowel mimicking a gastrointestinal stromal tumor:A case report

    Institute of Scientific and Technical Information of China (English)

    Piergiuseppe Colombo; Daoud Rahal; Fabio Grizzi; Vittorio Quagliuolo; Massimo Roncalli

    2005-01-01

    Intra-abdominal fibromatosis (IAF) is a benign mesenchymal lesion that can occur throughout the gastrointestinal tract. Although rare, it is the most common primary tumor of the mesentery and can develop at any age. We describe a rare case of primary IAF involving the mesentery and small bowel which clinically, macroscopically and histologically mimicked malignant gastrointestinal stromal tumor (GIST). This report highlights the fact that benign IAF can be misdiagnosed as a malignant GIST localized in the mesentery or arising from the intestinal wall. Their diagnostic discrimination is essential because of their very different biological behaviors and the fact that the introduction of effective therapies involving tyrosine kinase inhibitor STI571 (imatinib mesylate) has greatly changed the clinical approach to intra-abdominal stromal spindle cell tumors.

  13. Effect of exercise training on in vivo insulin-stimulated glucose uptake in intra-abdominal adipose tissue in rats

    DEFF Research Database (Denmark)

    Enevoldsen, L H; Stallknecht, B; Fluckey, J D

    2000-01-01

    Intra-abdominal obesity may be crucial in the pathogenesis of the insulin-resistance syndrome, and training may alleviate this condition. We compared insulin-mediated glucose uptake in vivo in three intra-abdominal adipose tissues (ATs; retroperitoneal, parametrial, and mesenteric......]glucose and microdialysis techniques. Blood flow was measured by microspheres. Upon insulin stimulation, blood flow generally decreased in AT. Flow was higher in mesenteric tissue than in other ATs, whereas insulin-mediated glucose uptake did not differ between ATs. Training doubled the glucose infusion rate during...... hyperinsulinemia, in part, reflecting an effect in muscle. During hyperinsulinemia, interstitial glucose concentrations were lower, glucose uptake per 100 g of tissue was higher in AT in trained compared with sedentary rats, and training influenced glucose uptake identically in all ATs. In conclusion, differences...

  14. Patients with Risk Factors for Complications Do Not Require Longer Antimicrobial Therapy for Complicated Intra-Abdominal Infection.

    Science.gov (United States)

    Rattan, Rishi; Allen, Casey J; Sawyer, Robert G; Mazuski, John; Duane, Therese M; Askari, Reza; Banton, Kaysie L; Claridge, Jeffrey A; Coimbra, Raul; Cuschieri, Joseph; Dellinger, E Patchen; Evans, Heather L; Guidry, Christopher A; Miller, Preston R; O'Neill, Patrick J; Rotstein, Ori D; West, Michaela A; Popovsky, Kimberley; Namias, Nicholas

    2016-09-01

    A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay. Obese and diabetic patients had similar incidences of and days to surgical site infection, recurrent intra-abdominal infection, extra-abdominal infection, and Clostridium difficile infection. Short- and long-course patients had similar incidences of complications among patients with Acute Physiology and Chronic Health Evaluation II ≥15. However, there were fewer days to the diagnosis of surgical site infection (9.5 ± 3.4 vs 21.6 ± 6.2, P = 0.010) and extra-abdominal infection (12.4 ± 6.9 vs 21.8 ± 6.1, P = 0.029) in the short-course group. Mortality and length of stay was similar for all groups. A short course of antibiotics in complicated intra-abdominal infection with source control seems to have similar outcomes to a longer course in patients with diabetes, obesity, or increased severity of illness.

  15. CT-guided percutaneous drainage of intra-abdominal abscesses: APACHE III score stratification of 1-year results

    Energy Technology Data Exchange (ETDEWEB)

    Betsch, Angelika; Belka, Claus [Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Wiskirchen, Jakub; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Manncke, Klaus H. [Department of General Surgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany)

    2002-12-01

    Our objective was to evaluate the clinical success rates of percutaneously drained intra-abdominal abscesses using a risk stratification score for severely ill patients (APACHE III; Acute Physiology, Age, Chronic Health Evaluation). In 75 patients CT-guided percutaneous abscess drainage was performed to treat intra-abdominal abscesses. The clinical success rate based on a 1-year follow-up was correlated with abscess etiology, size, and structure, as well as with the initial APACHE III score. Clinical success, i.e., the complete removal of the abscess without surgical treatment, was observed in 62 of 75 patients (83%). Abscess size (<200 cm{sup 3}) and abscesses with a simple structure correlated with higher clinical success rates. Patients presenting with APACHE III scores below 30 were treated by percutaneous abscess drainages (PAD) alone significantly more often than patients presenting with higher APACHE scores. The percutaneous drainage of intra-abdominal abscesses shows good long-term results as long as abscesses are singular, small (<200 cm{sup 3}), and located in well accessible regions in combination with low APACHE scores (<30). (orig.)

  16. An Intra-Abdominal Desmoid Tumor, Embedded in the Pancreas, Preoperatively Diagnosed as an Extragastric Growing Gastrointestinal Stromal Tumor

    Directory of Open Access Journals (Sweden)

    Mari Mizuno

    2017-04-01

    Full Text Available A 45-year-old woman was found to have a pancreatic tumor by abdominal ultrasound performed for a medical check-up. Abdominal contrast-enhanced computed tomography showed a hypovascular tumor measuring 30 mm in diameter in the pancreatic tail. Endoscopic ultrasound-guided fine needle aspiration was performed. An extragastric growing gastrointestinal stromal tumor was thereby diagnosed preoperatively, and surgical resection was planned. Laparoscopic surgery was attempted but conversion to open surgery was necessitated by extensive adhesions, and distal pancreatectomy, splenectomy, and partial gastrectomy were performed. The histological diagnosis was an intra-abdominal desmoid tumor. A desmoid tumor is a fibrous soft tissue tumor arising in the fascia and musculoaponeurotic tissues. It usually occurs in the extremities and abdominal wall, and only rarely in the abdominal cavity. We experienced a case with an intra-abdominal desmoid tumor that was histologically diagnosed after laparotomy, which had been preoperatively diagnosed as an extragastric growing gastrointestinal stromal tumor. Although rare, desmoid tumors should be considered in the differential diagnosis of intra-abdominal tumors. Herein, we report this case with a literature review.

  17. Ceftolozane/Tazobactam: A Review in Complicated Intra-Abdominal and Urinary Tract Infections.

    Science.gov (United States)

    Scott, Lesley J

    2016-02-01

    Globally, the increasing prevalence of multidrug-resistant pathogens continues to pose major problems in healthcare systems and, at least in part, is driving an initiative to develop new antibacterials, such as ceftolozane (a cephalosporin β-lactam). Adding a β-lactamase inhibitor (e.g. tazobactam) to a β-lactam extends its spectrum of activity against β-lactamase-producing microorganisms (a key mechanism of resistance to β-lactams). Ceftolozane/tazobactam (Zerbaxa™), a β-lactam/β-lactamase inhibitor combination, is indicated for the treatment of adults with complicated intra-abdominal infections (cIAI) or complicated urinary tract infections (cUTI), including pyelonephritis. In multinational, phase 3 noninferiority trials, intravenous ceftolozane/tazobactam was an effective and generally well tolerated treatment in patients with cIAI or cUTI. In the ASPECT-cIAI trial, ceftolozane/tazobactam plus metronidazole was noninferior to meropenem in terms of clinical cure rates at the test-of-cure (TOC) visit, with clinical cure rates in subgroup analyses consistent with those in the primary analysis. In the ASPECT-cUTI trial, ceftolozane/tazobactam was superior to levofloxacin in terms of composite cure rates (clinical cure plus microbiological eradiation) at the TOC visit. Further clinical experience should help to more definitively position ceftolozane/tazobactam in the treatment of cIAI and cUTI, including in patients with renal impairment. In the meantime, given its very good in vitro activity against extended-spectrum β-lactamase-producing Enterobacteriaceae and drug-resistant Pseudomonas aeruginosa isolates, ceftolozane/tazobactam provides a potential alternative to currently approved antibacterials for empirical treatment of cIAI and cUTI in adults.

  18. Synergistic Effect of Combined Hollow Viscus Injuries on Intra-Abdominal Abscess Formation.

    Science.gov (United States)

    Paulus, Elena M; Croce, Martin A; Shahan, Charles P; Zarzaur, Ben L; Sharpe, John P; Dileepan, Amirtha; Boyd, Brandon S; Fabian, Timothy C

    2015-07-01

    The strong association between penetrating colon injuries and intra-abdominal abscess (IAA) formation is well established and attributed to high colon bacterial counts. Since trauma patients are rarely fasting at injury, stomach and small bowel colony counts are also elevated. We hypothesized that there is a synergistic effect of increased IAA formation with concomitant stomach and/or colon injuries when compared to small bowel injuries alone. Consecutive patients at a level one trauma center with penetrating small bowel (SB), stomach (S), and/or colon (C) injuries from 1996 to 2012 were reviewed. Logistic regression determined associations with IAA, adjusting for age, gender, Injury Severity Score (ISS), admission Glasgow Coma Score, transfusions, and concurrent pancreas or liver injury. A total of 1518 patients (91% male, ISS = 15.9 ± 8.4) were identified: 496 (33%) SB, 231 (15%) S, 288 (19%) C, 40 (3%) S + SB, 69 (5%) S + C, 338 (22%) C + SB, and 56 (4%) S + C + SB. 148 (10%) patients developed IAA: 4 per cent SB, 9 per cent S, 10 per cent C, 5 per cent S + SB, 22 per cent S + C, 13 per cent C + SB, and 25 per cent S + C + SB. Multiple logistic regression demonstrated that ISS, 24 hour blood transfusions, and concomitant pancreatic or liver injuries were associated with IAA. Compared with reference SB, S or S + SB injuries were no more likely to develop IAA. However, S + C, SB + C, and S + C + SB injuries were significantly more likely to have IAA. In conclusion, combined stomach + colon, small bowel + colon, and stomach, colon, + small bowel injuries have a synergistic effect leading to increased IAA formation after penetrating injuries. Heightened clinical suspicion for IAA formation is necessary in these combined hollow viscus injury patients.

  19. Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection.

    Directory of Open Access Journals (Sweden)

    François Philippart

    Full Text Available Experimental studies suggest that intra-abdominal infection (IAI induces biological alterations that may affect the risk of lung infection.To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP.We used data entered into the French prospective multicenter Outcomerea database in 1997-2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included. Patients with acute pancreatitis were not included.Of 2623 database patients meeting the inclusion criteria, 290 (11.1% had IAI and 2333 (88.9% had other infections. The IAI group had fewer patients with VAP (56 [19.3%] vs. 806 [34.5%], P<0.01 and longer time to VAP (5.0 vs.10.5 days; P<0.01. After adjustment on independent risk factors for VAP and previous antimicrobial use, IAI was associated with a decreased risk of VAP (hazard ratio, 0.62; 95% confidence interval, 0.46-0.83; P<0.0017. The pathogens responsible for VAP were not different between the groups with and without IAI (Pseudomonas aeruginosa, 345 [42.8%] and 24 [42.8%]; Enterobacteriaceae, 264 [32.8%] and 19 [34.0%]; and Staphylococcus aureus, 215 [26.7%] and 17 [30.4%], respectively. Crude ICU mortality was not different between the groups with and without IAI (81 [27.9%] and 747 [32.0%], P = 0.16.In our observational study of mechanically ventilated ICU patients with severe sepsis and/or septic shock, VAP occurred less often and later in the group with IAIs compared to the group with infections at other sites.

  20. New scoring system for intra-abdominal injury diagnosis after blunt trauma

    Directory of Open Access Journals (Sweden)

    Shojaee Majid

    2014-02-01

    Full Text Available 【Abstract】Objective: An accurate scoring system for intra-abdominal injury (IAI based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods: This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT admitted to the emergency department (ED of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β was given based on the contribution of each of them. Scoring system was developed based on the obtained total βof each factor. Results: Altogether 261 patients (80.1% male were enrolled (48 cases of IAI. A 24-point blunt abdominal trauma scoring system (BATSS was developed. Patients were divided into three groups including low (score<8, moderate (8≤score<12 and high risk (score≥12. In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%. Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%. The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%. Conclusion: The present scoring system furnishes a

  1. Jejunal diverticulitis: an unusual cause of an intra-abdominal abscess - coronal Computed Tomography reconstruction can aid the diagnosis

    Directory of Open Access Journals (Sweden)

    Jim Virjee

    2008-11-01

    Full Text Available Jejunal diverticulitis is a rare condition that can present with an acute abdomen and be referred for imaging.  We present the case of an elderly patient who at CT was diagnosed with an intra-abdominal abscess involving both jejunum and transverse colon. However, the underlying eitiology was not initially clear until small bowel barium follow-through.Pertinent points regarding CT findings in jejunal diverticulitis are discussed, and practical recommendations in small bowel diverticulum recognition and diagnosis are made. 

  2. Spectrally selective UV bactericidal effect for curative treatment of post-surgical intra-abdominal abscesses and other infections

    Science.gov (United States)

    Dudelzak, Alexander E.; Miller, Mark A.; Babichenko, Sergey M.

    2004-07-01

    Results of in-vitro studies of bactericidal effects of ultraviolet (UV) irradiation on strains causing drug-resistant endo-cavital infections (Enterococcus, Staphylococcus aureus, Pseudomonas aeruginosa, and others) are presented. An original technique to measure effects of UV-irradiation on bacterial growth at different wavelengths has been developed. Spectral dependences of the bactericidal effect have been observed, and spectral maxima of bactericidal efficiency have been found. Applications to curative treatments of wounds, post-surgical intra-abdominal abscesses and other diseases are discussed.

  3. Análise da redistribuição de calor com agentes inalatórios, em ratos submetidos a laparotomia e pneumoperitônio, através da termografia infravermelha Análisis de la redistribución de calor con agentes inhalatorios, en ratones sometidos a laparotomia y pneumoperitonio, a través de termografia infraroja Analysis of heat loss using inhalation agents in rats subjected to laparotomy and increased intra-abdominal pressure, using digital infrared thermal image

    Directory of Open Access Journals (Sweden)

    Daniel Colman

    2002-06-01

    , distribuidos en tres grupos, en que fueron utilizados: halotano, isoflurano y sevoflurano. En cada grupo hubo división en otros tres sub-grupos: I - control, II - laparotomia mediana con exposición de alzas intestinales; III - pneumoperitonio de 15 mmHg. La análisis termodinámica se realizó de dos formas: a través de la temperatura central esofágica y de la imagen digital térmica infrarroja. RESULTADOS: No hubo diferencia significativa en relación a los anestésicos inhalatorios entre los grupos I y II en relación a la pérdida de calor. En relación al grupo III, hubo diferencia entre el isoflurano y el sevoflurano, siendo el isoflurano el anestésico responsable por la mayor pérdida de temperatura en el animal. CONCLUSIONES: El sevoflurano fue el agente anestésico inhalatorio que determinó menor pérdida de calor frente al pneumoperitonio, en relación al isoflurano y halotano.BACKGROUND AND OBJECTIVES: Anesthesiology involves the handling of situations inherent to anesthetic and surgical procedures which lead to patients thermal homeostasis unbalance, with noxious physiological effects. This study aimed at qualifying and quantifying thermal redistribution in rats subjected to inhalation anesthesia, during induction and in surgical situations of laparotomy and increased intra-abdominal pressure. METHODS: The study involved 90 rats, submitted to inhalation anesthesia, which were distributed in three groups: halothane; isoflurane; sevoflurane. Each group was divided in subgroups: I - control; II - median laparotomy with bowel exposure; III - 15 mmHg Increase in intra-abdominal pressure. Heat loss was measured by an esophageal probe and infrared thermal image. RESULTS: There were no significant differences among inhalation anesthetics regarding heat loss between groups I and II. In group III, there was a difference between isoflurane and sevoflurane and isoflurane was responsible for the highest heat loss.

  4. Research study of the impact of intra-abdominal hypertension on central nervous system%腹腔高压症对中枢神经系统影响的研究进展

    Institute of Scientific and Technical Information of China (English)

    张宏光; 刘冬; 张连阳

    2014-01-01

    Intra-abdominal hypertension, a kind of disease of continuous or repeated increase of intra-abdominal pressure reaching more than 12 mmHg, not only brings abnormality to enterocoelia organs, but causes injuries of the heart, lung and central nervous system. Morbidity and mortality rate is high among severely injured patients. This study tries to clarify the images, pathologies, molecular level changes and the respective mechanisms for the central nervous system injuries, saving more patients with a craniocerebral injury.%腹腔高压症是腹腔内压持续或反复病理性升高并>12 mmHg的病理状态,不仅可以引起腹腔脏器的变化,而且会损害心、肺及中枢神经系统功能,在危重患者中发病率和死亡率高。阐明其对中枢神经系统损害的影像表现、具体病理表现、分子水平变化和引起这些变化的具体机制,可进一步提高合并有颅脑损伤患者的治愈率。

  5. Measurement of hepatic tissue hypoxia using near infrared spectroscopy: comparison with hepatic vein oxygen partial pressure.

    Science.gov (United States)

    El-Desoky, A E; Jiao, L R; Havlik, R; Habib, N; Davidson, B R; Seifalian, A M

    2000-01-01

    Hepatic hypoxia occurs during liver surgery and transplantation. The critical level associated with irreversible hepatocellular damage is unknown. Measurement of hepatic tissue oxygenation and hepatic vein oxygen partial pressure (HVPO(2)) reflects oxygen supply and consumption. Near infrared spectroscopy (NIRS) can be used to monitor hepatic oxyhaemoglobin (HbO(2)), deoxyhaemoglobin (Hb) and cytochrome oxidase (Cyt Ox) oxidation. This study compared regional hepatic tissue oxygenation (HbO(2), Hb and Cyt Ox) using NIRS with HVPO(2). The use of tissue oxygenation measured by NIRS and HVPO(2) as indicators of hepatic tissue hypoxia was also investigated. Large Landrace pigs (n = 5) underwent laparotomy and liver exposure. Systemic and hepatic haemodynamics were monitored continuously. NIRS probes were placed on the liver to record continuously HbO(2), Hb and Cyt Ox. Graded hypoxaemia was achieved by stepwise reduction of the fraction of inspired oxygen (FiO(2)) from 30% (baseline) to 4%. A significant decrease in hepatic arterial blood flow and total hepatic blood flow was seen with severe hypoxaemia while there was no significant change to portal vein blood flow. Oxygen partial pressures in the hepatic artery, portal vein and hepatic vein decreased progressively with all grades of hypoxaemia. There was an immediate reduction of hepatic HbO(2) and simultaneous increase in hepatic Hb with all grades of hypoxaemia. Hepatic Cyt Ox was reduced significantly only with FiO(2) oxygenation parameters measured by NIRS and HVPO(2). HVPO(2) measurement did not predict the reduction in intracellular tissue oxygenation demonstrated by NIRS with a decrease of Cyt Ox oxidation. In conclusion there was a good correlation between the tissue oxygenation parameters measured by NIRS and HVPO(2). However, the reduction of intracellular oxygenation found with severe hypoxaemia was demonstrated only by NIRS.

  6. Risk Stratification for Major Postoperative Complications in Patients Undergoing Intra-abdominal General Surgery Using Latent Class Analysis.

    Science.gov (United States)

    Kim, Minjae; Wall, Melanie M; Li, Guohua

    2017-08-10

    Preoperative risk stratification is a critical element in assessing the risks and benefits of surgery. Prior work has demonstrated that intra-abdominal general surgery patients can be classified based on their comorbidities and risk factors using latent class analysis (LCA), a model-based clustering technique designed to find groups of patients that are similar with respect to characteristics entered into the model. Moreover, the latent risk classes were predictive of 30-day mortality. We evaluated the use of latent risk classes to predict the risk of major postoperative complications. An observational, retrospective cohort of patients undergoing intra-abdominal general surgery in the 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program was obtained. Known preoperative comorbidity and risk factor data were entered into LCA models to identify the latent risk classes. Complications were defined as: acute kidney injury, acute respiratory failure, cardiac arrest, deep vein thrombosis, myocardial infarction, organ space infection, pneumonia, postoperative bleeding, pulmonary embolism, sepsis/septic shock, stroke, unplanned reintubation, and/or wound dehiscence. Relative risk regression determined the associations between the latent classes and the 30-day complication risks, with adjustments for the surgical procedure. The area under the curve (AUC) of the receiver operator characteristic curve assessed model performance. LCA fit a 9-class model on 466,177 observations. The composite complication risk was 18.4% but varied from 7.7% in the lowest risk class to 56.7% in the highest risk class. After adjusting for procedure, the latent risk classes were significantly associated with complications, with risk ratios (95% confidence intervals) (compared to the class with the average risk) varying from 0.56 (0.54-0.58) in the lowest risk class to 2.15 (2.11-2.20) in the highest risk class, a 4-fold difference. In models incorporating surgical

  7. Multicystic, peritoneal mesothelioma: a report with electron microscopy of a case mimicking intra-abdominal cystic hygroma (lymphangioma).

    Science.gov (United States)

    Mennemeyer, R; Smith, M

    1979-08-01

    A 27-year-old Caucasian female complained of persistent, poorly localized abdominal pain of several months' duration, found to be due to a multicystic diffuse lesion involving omentum, peritoneum and pelvic viscera. Three resections were required within a ten-month period for symptomatic control. The tumor showed many of the clinical, operative, gross and light microscopic features of intra-abdominal lymphagioma. Tissues removed at the third operation, however, were examined by electron microscopy, and found to consist of a myriad of small cysts and channels lined by mesothelial cells. In view of these findings, the lesion was regarded as a cystic peritoneal mesothelioma. Similarities between lymphangioma and peritoneal mesothelioma are discussed. It is suggested that electron microscopic examination of lining cells of cystic lesions which are considered grossly consistent with lymphagiomas may yield additional similar cases.

  8. New drugs for the treatment of complicated intra-abdominal infections in the era of increasing antimicrobial resistance.

    Science.gov (United States)

    Syue, Ling-Shan; Chen, Yen-Hsu; Ko, Wen-Chien; Hsueh, Po-Ren

    2016-04-01

    The continuing increase in multidrug-resistant organisms (MDROs) worldwide has created new challenges in treating complicated intra-abdominal infections (cIAIs). A number of novel antimicrobial agents have been developed against resistant pathogens. To target extended-spectrum β-lactamase (ESBL)-producing pathogens, novel β-lactam antibiotics, such as ceftolozane/tazobactam, ceftazidime/avibactam, aztreonam/avibactam, imipenem/relebactam and S-649266, are antimicrobial alternatives for cIAIs. Two new drugs, eravacycline and plazomicin, have activity against Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae, carbapenem-resistant Acinetobacter baumannii and ESBL-producers. New lipoglycopeptides and oxazolidinones provide feasible options against resistant Gram-positive pathogens. These novel antimicrobials may play a role in improving the clinical outcomes of cIAIs caused by MDROs.

  9. Effect of body mass index and intra-abdominal fat measured by computed tomography on the risk of bowel symptoms.

    Directory of Open Access Journals (Sweden)

    Naoyoshi Nagata

    Full Text Available This study aims to investigate the association between body mass index (BMI or intra-abdominal fat measured by computed tomography (CT and bowel symptoms.A cohort of 958 Japanese adults who underwent colonoscopy and CT and completed questionnaires after excluding colorectal diseases was analyzed. Six symptoms (constipation, diarrhea, loose stools, hard stools, fecal urgency, and incomplete evacuation using a 7-point Likert scale were evaluated between baseline and second questionnaire for test-retest reliability. Associations between BMI, visceral adipose tissue (VAT, subcutaneous adipose tissue (SAT, and symptom score were analyzed by a rank-ordered logistic model, adjusting for age, sex, smoking, and alcohol consumption, hypertension, diabetes mellitus, and dyslipidemia.Some bowel symptom scores were significantly (p<0.05 different between the age groups, sexes, smoking, and alcohol consumption. In multivariate analysis, constipation was associated with low BMI (p<0.01, low VAT area (p = 0.01, and low SAT area (p<0.01. Moreover, hard stools was associated with low BMI (p<0.01 and low SAT area (p<0.01. The remaining symptoms were not significantly associated with BMI or intra-abdominal fat. Test-retest reliability of bowel symptom scores with a mean duration of 7.5 months was good (mean kappa, 0.672.Both low BMI and low abdominal fat accumulation appears to be useful indicators of increased risk for constipation and hard stools. The long-term test-retest reliability of symptom score suggests that bowel symptoms relevant to BMI or visceral fat remain consistent over several months.

  10. Increased Resistin Levels in Intra-abdominal Sepsis: Correlation with proinflammatory cytokines & Acute Physiology & Chronic Health Evaluation II scores

    Directory of Open Access Journals (Sweden)

    Tonguç U. Yilmaz

    2014-10-01

    Full Text Available Objectives: Resistin, a hormone secreted from adipocytes and considered to be a likely cause of insulin resistance, has recently been accepted as a proinflammatory cytokine. This study aimed to determine the correlation between resistin levels in patients with intra-abdominal sepsis and mortality. Methods: Of 45 patients with intraabdominal sepsis, a total of 35 adult patients were included in the study. This study was undertaken from December 2011 to December 2012 and included patients who had no history of diabetes mellitus and who were admitted to the general surgery intensive care units of Gazi University and Bülent Ecevit University School of Medicine, Turkey. Evaluations were performed on 12 patients with sepsis, 10 patients with severe sepsis, 13 patients with septic shock and 15 healthy controls. The patients’ plasma resistin, interleukin-6 (IL-6, tumour necrosis factor alpha (TNF-α, interleukin-1 beta (IL-1β, procalcitonin, lactate and glucose levels and Acute Physiology and Chronic Health Evaluation (APACHE II scores were studied daily for the first five days after admission. A correlation analysis of serum resistin levels with cytokine levels and APACHE II scores was performed. Results: Serum resistin levels in patients with sepsis were significantly higher than in the healthy controls (P <0.001. A significant correlation was found between serum resistin levels and APACHE II scores, serum IL-6, IL-1β, TNF-α, procalcitonin, lactate and glucose levels. Furthermore, a significant correlation was found between serum resistin levels and all-cause mortality (P = 0.02. Conclusion: The levels of resistin were significantly positively correlated with the severity of disease and were a possible mediator of a prolonged inflammatory state in patients with intra-abdominal sepsis.

  11. Evaluation of adhesion formation and host tissue response to intra-abdominal polytetrafluoroethylene mesh and composite prosthetic mesh.

    Science.gov (United States)

    Matthews, Brent D; Mostafa, Gamal; Carbonell, Alfredo M; Joels, Charles S; Kercher, Kent W; Austin, Catherine; Norton, H James; Heniford, B Todd

    2005-02-01

    The purpose of this study was to measure the extent of adhesion formation to ePTFE mesh (DualMesh, W.L. Gore & Associates, Inc, Flagstaff, AZ) and two composite prosthetic materials, ePTFE and polypropylene (Bard Composix, C.R. Bard, Inc, Murray Hill, NJ) and hyaluronic acid/carboxymethylcellulose and polypropylene (Sepramesh, Genzyme Corp, Cambridge, MA) after their intra-abdominal placement on an intact peritoneum, simulating laparoscopic ventral hernia repair, and to evaluate host tissue response to the prosthetic biomaterials. Through a midline laparotomy, a 2 x 2 cm piece of mesh (n = 60) was sewn to an intact peritoneum on each side of a midline incision in 30 New Zealand white rabbits. Mesh adhesions were scored using a modified Diamond scale (0 = 0%, 1 = 1-25%, 2 = 26-50%, 3 >50%) at 1, 3, 9, and 16 weeks by serial microlaparoscopy (2 mm). All laparoscopic evaluations were videotaped for blinded scoring by three surgeons. Host tissue response was graded (1-4) for inflammation, tissue ingrowth, and mesothelialization. The predominant cell type (polymorphonuclear leukocytes versus foreign body giant cell) was recorded. Statistical differences (P value DualMesh) intra-abdominal against an intact peritoneum results in significantly fewer adhesions than the composite prosthetic meshes during a 4-month follow-up. The host tissue response is equivalent for the three prosthetic biomaterials. The long-term consequences of increased adhesion formation to the composite meshes and the ultimate biocompatibility of the nonabsorbable and absorbable barriers on the polypropylene mesh are to be determined.

  12. Efficacy of vitamin E and selenium for the prevention of intra-abdominal adhesions in rats: uterine horn models

    Directory of Open Access Journals (Sweden)

    Ali Said Durmus

    2011-01-01

    Full Text Available OBJECTIVE: This study compares the efficacies of vitamin E and selenium, both individually and in combination, for the prevention of postoperative intra-abdominal adhesions in rats. METHODS: Forty-seven female rats were divided into five groups. The sham animals (S group, n = 7 were given only laparotomies and intraperitoneally received 0.9% NaCl (2 ml. In the 40 other rats, abrasions of the left uterine horn were performed, followed by intraperitoneal administration of either 2 ml 0.9% NaCl (C group, 10 mg vitamin E (vitamin E group, 0.2 mg/kg selenium (Se group or 10 mg vitamin E with 0.2 mg/kg selenium (vitamin E + Se group, with 10 animals in each treatment group. RESULTS: Adhesion formation was significantly reduced in animals in the Se and vitamin E + Se groups (p<0.05. Tissue catalase and glutathione peroxidase activities did not significantly differ between the groups. However, catalase and glutathione peroxidase activities and reduced glutathione levels were slightly increased in the vitamin E, Se and vitamin E + Se groups. In the vitamin E group, malondialdehyde concentrations were significantly lower than in the C group (p<0.05, but no significant differences were present among the S, C, Se and vitamin E + Se groups. Levels of nitric oxide were significantly higher in the C group than in the other groups (p<0.01. CONCLUSION: Intraperitoneal administration of selenium or combined vitamin E and selenium appears to be effective in preventing intra-abdominal adhesion formation in rat models through the reduction of lipid peroxidation products.

  13. A Prospective Randomized Trial of Imipenem-Cilastatin Versus Clindamycin/Tobramycin in the Treatmentof Intra-Abdominal and Pelvic Infections

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell

    1993-01-01

    Full Text Available Objective: A Canadian multicentre clinical trial in the treatment of intra-abdominal and pelvic infections to compare the efficacy and safety of monotherapy using imipenem-cilastatin (imipenem (500 mg intravenously every 6 h versus combination therapy with clindamycin/tobramycin (clindamycin 600 mg intravenously every 6 h and tobramycin 1.7 mg/kg intravenously every 8 h.

  14. Treatment of intra-abdominal abscesses caused by Candida albicans with antifungal agents and recombinant murine granulocyte colony-stimulating factor.

    NARCIS (Netherlands)

    Vonk, A.G.; Netea, M.G.; Krieken, J.H.J.M. van; Verweij, P.E.; Meer, J.W.M. van der; Kullberg, B.J.

    2003-01-01

    The aim of the present study was to assess the influence of immunomodulation of host defense with recombinant murine granulocyte colony-stimulating factor (rmG-CSF) on intra-abdominal abscesses caused by Candida albicans. Mice received prophylaxis or therapy with 1 microg of rmG-CSF/day in the prese

  15. Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in Association with Ruptured Abdominal Aortic Aneurysm in the Endovascular Era: Vigilance Remains Critical

    Directory of Open Access Journals (Sweden)

    Matthew C. Bozeman

    2012-01-01

    In this review, we describe published experience with IAH and ACS complicating abdominal vascular catastrophes, experience with ACS complicating endovascular repair of rAAAs, and techniques for management of the abdominal wound. Vigilance and appropriate management of IAH and ACS remains critically important in decreasing morbidity and optimizing survival following catastrophic intra-abdominal vascular events.

  16. Incidence of ESBL producers amongst Gram-negative bacilli isolated from intra-abdominal infections across India (based on SMART study, 2007 data).

    Science.gov (United States)

    Chaudhuri, B N; Rodrigues, C; Balaji, V; Iyer, R; Sekar, U; Wattal, Chand; Chitnis, D S; Dhole, T N; Joshi, Sangeeta

    2011-05-01

    This study was conducted in 9 centers spread over India from January 1 to December 31, 2007 to monitor in vitro susceptibility of Gram-negative bacilli to Group I carbapenem, ertapenem and other antimicrobials in intra-abdominal infections and to identify early changes in susceptibility pattern of community or hospital acquired organisms, with a focus on ESBL producers. Gram-negative bacilli isolated from intra-abdominal samples of patients with documented intra-abdominal infections were processed for identification by conventional/ automated methods and antimicrobial susceptibility by Micro-Scan (Siemens) MIC panel against 12 antimicrobials (3rd and 4th generation cephalosporins, Groups I and II carbapenems, amikacin, levofloxacin, amoxicillin-clavulanic acid and piperacillin-tazobactam). A total of 588 isolates were identified, of which 351 (60%) were E. coli and 114 (19%) were Klebsiella spp. 79% of E. coli and 70% of Klebsiella spp. were ESBL producers in general. 110 of E. coli and 35 of Klebsiella isolates were from community-acquired intra-abdominal infections. 80% of E. coli and 63% of Klebsiella isolates from community-acquired infections were ESBL producers, against 79% of E. coli and 73% of Klebsiella isolates from hospital-acquired infections. Amongst the ESBL-positive isolates of E. coli, 94% were susceptible in vitro to ertapenem, 96% to imipenem and 76% to piperacillin-tazobactam. For ESBL-positive isolates of Klebsiella spp., the corresponding figures were 80%, 94% and 59% respectively. The study showed a high incidence of ESBL-producers amongst Enterobacteriaceae isolates from intra-abdominal infections in both community-acquired and hospital-acquired settings across India. Ertapenem was comparable with imipenem against ESBL-positive E. coli isolates, while imipenem was more effective than ertapenem against ESBL-positive Klebsiella isolates.

  17. 腹腔高压病人腹腔开放的术式选择及评价%Open abdomen for intra-abdominal hypertension,procedures and evaluation

    Institute of Scientific and Technical Information of China (English)

    朱维铭

    2012-01-01

    腹腔开放是损伤控制外科的重要组成部分,不但用于腹部外伤和感染等普外科疾病的救治,也用于救治烧伤或液体复苏过程中产生的腹腔高压.腹腔开放包括两大要素:开放腹腔和暂时性腹腔关闭,二者缺一不可.开放腹腔的主要目的是降低腹内压,暂时性腹腔关闭技术能够保护腹内脏器、引流腹腔液体,减少或避免腹壁回缩和并发症的发生.暂时性腹腔关闭方法分三类,分别为关闭皮肤法,关闭筋膜法和负压辅助关腹法.关闭皮肤法简单方便,但后期修复腹壁困难较大.负压辅助关腹技术并发症少,早期确定性腹腔关闭成功率高,应用越来越广泛.%Open abdomen plays an important role in damage control surgery, it is used not only in the treatment of intra-abdoniinal sepsis and trauma, but also in intra-abdominal hypertension refractory to medical treatment. Open abdomen consists of two elements: open the abdomen and temporary abdominal closure. Open the abdomen reduces intra-abdominal pressure, temporary abdominal closure protect the viscera, drain the intra-abdominal fluid, and prevent fascial retraction. Temporary abdominal closure is classified into skin closure technique, fascia closure technique, and vacuum assist closure technique. Skin closure technique is simple, but often lead to ventral hernia, and vacuum assist closure technique facilitate early definite closure, and is approved widely.

  18. [Clinicopathologic and immunohistochemical study of intra-abdominal non-Hodgkin B-cell lymphoma occurring in children].

    Science.gov (United States)

    Yang, Wen-ping; Zhu, Cai-di; Gong, Li-ping; Lü, Bei-bei; Zou, Yin; Zhong, Hua-sheng; Xiao, Qiang; Wu, Yan; Xu, Hong-yan; Zeng, Song-tao; Huang, Hui

    2009-11-01

    To study the clinicopathologic features, immunohistochemical findings, EBV and c-myc gene status of intra-abdominal non-Hodgkin B-cell lymphoma occurring in children. Seventy-four cases of pediatric intra-abdominal non-Hodgkin B-cell lymphoma were retrieved from the archival file. The cases were classified according to the 2008 WHO classification. Tissue microarray including tumor tissues from all the 74 cases was produced. Immunohistochemical study (SP method) for CD20, CD3, CD79a, CD10, bcl-6, MUM1, bcl-2, CD43, CD38 and Ki-67 was performed. In-situ hybridization for Epstein-Barr virus-encoded RNA (EBER) and fluorescence in-situ hybridization for c-myc gene were also carried out. Amongst the 74 cases studied, 65 of them (87.8%) were Burkitt lymphoma (BL), 4 cases (5.4%) were diffuse large B-cell lymphoma (DLBCL) and the remaining 5 cases (6.8%) showed features in-between DLBCL and BL (DLBCL/BL). The patients often presented with abdominal pain, abdominal masses, ileus and intussusception. The ileocecal bowel wall and mesenteric lymph nodes were commonly involved. The lymphoma cells were of high histologic grade and suggested an aggressive clinical behavior. The staining for CD20 and CD79a were positive in all of the cases, while CD3 was negative. The positive rates of CD10, bcl-6, bcl-2, MUM1, CD43, CD38 and EBER in BL were 96.9% (63 cases), 95.4% (62 cases), 0 (0 case), 23.1% (15 cases), 70.8% (46 cases), 96.9% (63 cases) and 41.5% (27 cases), respectively. Fifty-four cases carried translocation of c-myc gene. As for DLBCL, the positive cases of CD10, bcl-6, bcl-2, MUM1, CD43, CD38 and EBER were 3 cases, 2 cases, 3 cases, 2 cases, 2 cases, 2 cases and 0 case, respectively. One of these cases showed c-myc gene translocation. Amongst the 4 cases of DLBCL, 2 of them belonged to germinal center B-cell-like subtype, while the remaining 2 cases were of non-germinal center B-cell-like subtype. The expression rates of CD10, bcl-6, bcl-2, MUM1, CD43, CD38 and EBER in

  19. [Pathogenetic aspects of intra-abdominal hypertension in patients with abdominal sepsis].

    Science.gov (United States)

    Veliev, N A; Gasanova, D N

    2011-09-01

    The authors had offered the original estimated system with the points calculation, basing on analysis of the examination and treatment results in 150 patients, suffering abdominal sepsis. The system, alike others, includes not only determination of the inflammation factors and indices of endotoxicosis, but as well as those, concerning intraabdominal pressure, the anterior abdominal wall rigidity and the tissues elasticity. Among the important indices, needed to determine, were considered those, which categorize the syndrome of intraabdominal, intrathoracic and microregional hypertension as well as the mechanisms of endotoxicosis pathogenesis. The authors recommend to use the indices of pathological consequences of this two factors while doing assessment of the abdominal sepsis severity.

  20. Massive Intra-Abdominal Imatinib-Resistant Gastrointestinal Stromal Tumor in a 21-Year-Old Male

    Directory of Open Access Journals (Sweden)

    Ann Falor

    2013-01-01

    Full Text Available Gastrointestinal stromal tumors (GISTs in adolescence are far less common than adult GISTs and have varied GIST genotypes that present diagnostic and therapeutic challenges. Here, we discuss a 21-year-old male with diagnosis of unresectable, imatinib-resistant GIST. At initial evaluation, a neoadjuvant treatment approach was recommended. As such, the patient received imatinib over the course of one year. Unfortunately, the GIST increased in size, and a subsequent attempt at surgical resection was aborted fearing infiltration of major vascular structures. The patient was then referred to our institution, at which time imatinib therapy was discontinued. Surgical intervention was again considered and the patient underwent successful resection of massive intra-abdominal GIST with total gastrectomy and Roux-en-Y esophagojejunostomy. Since pediatric GISTs are typically resistant to imatinib, we performed genotype analysis of the operative specimen that revealed KIT mutations associated with imatinib sensitivity and resistance. Given the sequencing data and operative findings, the patient was started postoperatively on sunitinib. This case illustrates the importance of understanding both adult and pediatric GISTs when implementing appropriate treatment regimens. Since the genotype of GISTs dictates phenotypic behavior, mutational analysis is an important component of care especially for adolescents whose disease may mirror the pediatric or adult population.

  1. Not All Abdomens Are the Same: A Comparison of Damage Control Surgery for Intra-abdominal Sepsis versus Trauma.

    Science.gov (United States)

    Smith, Jason W; Nash, Nick; Procter, Levi; Benns, Matthew; Franklin, Glen A; Miller, Keith; Harbrecht, Brian G; Bernard, Andrew C

    2016-05-01

    Damage control surgery (DCS) was developed to manage exsanguinating trauma patients, but is increasingly applied to the management of peritoneal sepsis and abdominal catastrophes. Few manuscripts compare the outcomes of these surgeries on disparate patient populations. A multi-institutional three group propensity score matched case cohort study comparing penetrating trauma (PT-DCS), blunt trauma (BT-DCS), and intraperitoneal sepsis (IPS-DCS) was performed comparing patients treated with DSC between 2008 and 2013. Propensity scoring was performed using demographic and presenting physiologic data. Four hundred and twelve patients were treated with DCS across two institutions. Propensity matching for age, gender, and initial Acute Physiology and Chronic Health Evaluation II score 80 identified 80 patients per group for comparison. Rate of primary fascial closure was lowest in the IPS-DCS group, and highest in the penetrating trauma DCS group. Intra-abdominal complication rates were highest in the IPS-DCS group. IPS-DCS had increased time to definitive closure compared with the other two groups (RR 1.8; 1.3-2.2; P eight days were more than twice the risk of death at 90 days across all groups. (RR 2.15; 1.2-3.5; P abdominal closure at the earliest possible opportunity afforded the best outcome in patients managed via DCS.

  2. An Intra-Abdominal Pseudocyst around a Ventriculoperitoneal Shunt due to Streptococcus Infection 7 Years after Shunt Surgery

    Directory of Open Access Journals (Sweden)

    Arata Tomiyama

    2014-01-01

    Full Text Available In 1999, a 50-year-old woman underwent ventriculoperitoneal (VP shunt surgery for hydrocephalus after subarachnoid hemorrhage. She was hospitalized for fever and recurrent systemic seizures in November 2006. Head computed tomography (CT showed only old changes. The seizures and fever were controlled by medicinal therapy. However, in December, her consciousness level suddenly decreased, and she showed progressive lower abdominal distension. Head CT showed marked ventriculomegaly, and abdominal CT showed a giant cystic mass at the shunt-tube tip in the lower abdominal cavity. Because thick pus was aspirated from the intra-abdominal mass, we diagnosed the patient with acute obstructive hydrocephalus due to an infected abdominal pseudocyst. Laparotomy and direct cyst drainage were performed, and antibiotic therapy against Streptococcus, the causative pathogen, was administered. The VP shunt tube was replaced. The postoperative course was uneventful, and postoperative CT showed hydrocephalus improvement and no pseudocyst recurrence. Abdominal pseudocysts, which are rare after VP shunt surgeries, usually occur after the subacute postoperative course in younger cerebral hemorrhagic cases. Our case was quite rare because the cyst developed in the chronic phase in an older patient and was caused by streptococcal infection. The cyst components should be examined before cyst drainage when choosing surgical strategies.

  3. The Association between Self-Reported Energy Intake and Intra-Abdominal Adipose Tissue in Perimenopausal Women

    Directory of Open Access Journals (Sweden)

    Rasa Kazlauskaite

    2012-01-01

    Full Text Available We have previously shown that physical activity predicts intra-abdominal adipose tissue (IAT, but it is unknown whether energy intake predicts IAT independently of physical activity in a community-based, naturalistic environment. The association of energy intake with IAT was explored cross-sectionally in women, recruited between 2002 and 2005 for a study of fat patterning in midlife. IAT at L4-L5 vertebral interspace was assessed by computed tomography, energy intake by the Block Food Frequency Questionnaire, and physical activity by the Kaiser Physical Activity Survey. Linear regression models were used for the principal analyses. Among the 257 women, 48% were African American and 52% were Caucasian. Women were 52±3 years old, and 49% were postmenopausal. Every 500 kcal increase in energy intake was associated with a 6% higher IAT (P=0.02, independent of physical activity (P=0.02, after adjustment for ethnicity, menopausal status, age, smoking, income, and DXA-assessed percent body fat. Energy intake had a significant interaction with ethnicity (P=0.02, but not with physical activity. Models using the IAT to subcutaneous abdominal adipose tissue ratio as an outcome had similar associations. In conclusion, self-reported EI was associated with preferential IAT accumulation in midlife women, independent of physical activity. This association was significantly stronger in Caucasian than African American women. Future longitudinal studies are needed to explore lifestyle predictors of IAT accumulation during the menopausal transition.

  4. T helper type 2-polarized invariant natural killer T cells reduce disease severity in acute intra-abdominal sepsis.

    Science.gov (United States)

    Anantha, R V; Mazzuca, D M; Xu, S X; Porcelli, S A; Fraser, D D; Martin, C M; Welch, I; Mele, T; Haeryfar, S M M; McCormick, J K

    2014-11-01

    Sepsis is characterized by a severe systemic inflammatory response to infection that is associated with high morbidity and mortality despite optimal care. Invariant natural killer T (iNK T) cells are potent regulatory lymphocytes that can produce pro- and/or anti-inflammatory cytokines, thus shaping the course and nature of immune responses; however, little is known about their role in sepsis. We demonstrate here that patients with sepsis/severe sepsis have significantly elevated proportions of iNK T cells in their peripheral blood (as a percentage of their circulating T cells) compared to non-septic patients. We therefore investigated the role of iNK T cells in a mouse model of intra-abdominal sepsis (IAS). Our data show that iNK T cells are pathogenic in IAS, and that T helper type 2 (Th2) polarization of iNK T cells using the synthetic glycolipid OCH significantly reduces mortality from IAS. This reduction in mortality is associated with the systemic elevation of the anti-inflammatory cytokine interleukin (IL)-13 and reduction of several proinflammatory cytokines within the spleen, notably interleukin (IL)-17. Finally, we show that treatment of sepsis with OCH in mice is accompanied by significantly reduced apoptosis of splenic T and B lymphocytes and macrophages, but not natural killer cells. We propose that modulation of iNK T cell responses towards a Th2 phenotype may be an effective therapeutic strategy in early sepsis.

  5. Worsening central sarcopenia and increasing intra-abdominal fat correlate with decreased survival in patients with adrenocortical carcinoma.

    Science.gov (United States)

    Miller, Barbra S; Ignatoski, Kathleen M; Daignault, Stephanie; Lindland, Ceit; Doherty, Megan; Gauger, Paul G; Hammer, Gary D; Wang, Stewart C; Doherty, Gerard M

    2012-07-01

    Accurate prediction of survival from adrenocortical carcinoma (ACC) is difficult and current staging models are unreliable. Central sarcopenia as part of the cachexia syndrome is a marker of frailty and predicts mortality. This study seeks to confirm that psoas muscle density (PMD), lean psoas muscle area (LPMA), lumbar skeletal muscle index (LSMI), and intra-abdominal (IA) or subcutaneous fat (SC) can be used in combination to more accurately predict survival in ACC patients. PMD, LPMA, IA, and SC fat were measured on serial CT scans of patients with ACC. Clinical outcome was correlated with quantitative data from patients with ACC and analyzed. A linear regression model was used to describe the relationship between PMD, LPMA, LSMI, IA, and SC fat, time to recurrence, and length of survival according to tumor stage. One hundred twenty-five ACC patients (94 females) were treated from 2005 to 2011. Significant morphometric predictors of survival include PMD, LPMA, and IA fat (p ≤ 0.0001, ≤ 0.0024, increase in LPMA confers an 8 % lower hazard of death. LSMI does not change significantly between stages (p = 0.3196). Decreased PMD, LPMA, and increased IA fat suggest decreased survival in ACC patients and correlate with traditional staging systems. A more precise prediction of survival may be achieved when staging systems and morphometric measures are used in combination. Serial measurements of morphometric data are possible. The rate of change of these variables over time may be more important than the absolute value.

  6. Intra-Abdominal Localisation of a Buschke-Lowenstein Tumour: Case Presentation and Review of the Literature

    Directory of Open Access Journals (Sweden)

    N. E. Wester

    2013-01-01

    Full Text Available Giant condyloma acuminatum or Buschke-Lowenstein tumour is a very rare disease which usually is located in the genital, anorectal, and perianal regions. It is regarded as a type of verrucous carcinoma occurring on anogenital mucosal surfaces where it is locally invasive but displays a benign cytology. We describe a case of a 24-year-old woman with persisting condyloma acuminata progressing to a large intra-abdominal Buschke-Lowenstein tumour. To our knowledge such an advanced stage has only been reported once before. The severity and extent of the tumour both determine the treatment and patient outcome. Treatment was impeded by cachexia, an immunosuppressive state after kidney transplantation and difficulties in establishing a reliable diagnose. Interferon treatment was started which initially led to tumour reduction but was complicated by an interferon-induced pancreatitis, pneumonia, and fasciitis necroticans resulting in death. We present a literature overview on the treatment options for a Buschke-Lowenstein tumour, with emphasis on interferon therapy, with all the advantages and disadvantages.

  7. A Challenging Case of Metastatic Intra-Abdominal Synovial Sarcoma with Unusual Immunophenotype and Its Differential Diagnosis

    Directory of Open Access Journals (Sweden)

    Yi-Che Changchien

    2012-01-01

    Full Text Available The primary and metastatic gastrointestinal synovial sarcoma is rare with a wide differential diagnosis. It usually expresses cytokeratins EMA, BCL2 with an occasional CD99, and S100 positivity but not desmin. We present a case of metastatic synovial sarcoma with unusual immunophenotype causing diagnostic challenges. The tumor cells showed focal cytokeratin, EMA, and, unexpectedly, desmin positivity. Additional intranuclear TLE-1 positivity and negativity for CD34 and DOG-1 were also identified. A diagnosis of monophasic synovial sarcoma was confirmed by using FISH break-apart probe. RT-PCR revealed the SYT-SSX1 fusion gene. Intra-abdominal synovial sarcoma, either primary or metastatic, with unusual desmin positivity raises the diagnostic challenge, since a wide range of differential diagnoses could show a similar immunophenotype (leiomyosarcoma, desmoid tumor, myofibroblastic tumor, and rarely GIST etc.. Typical morphology and focal cytokeratin/EMA positivity should alert to this tumor, and FISH and RT-PCR remain the gold standard for the confirmation.

  8. Metformin reduces hepatic resistance and portal pressure in cirrhotic rats.

    Science.gov (United States)

    Tripathi, Dinesh M; Erice, Eva; Lafoz, Erica; García-Calderó, Héctor; Sarin, Shiv K; Bosch, Jaime; Gracia-Sancho, Jordi; García-Pagán, Juan Carlos

    2015-09-01

    Increased hepatic vascular resistance is the primary factor in the development of portal hypertension. Metformin ameliorates vascular cells function in several vascular beds. Our study was aimed at evaluating the effects, and the underlying mechanisms, of metformin on hepatic and systemic hemodynamics in cirrhotic rats and its possible interaction with the effects of propranolol (Prop), the current standard treatment for portal hypertension. CCl4-cirrhotic rats received by gavage metformin 300 mg/kg or its vehicle once a day for 1 wk, before mean arterial pressure (MAP), portal pressure (PP), portal blood flow (PBF), hepatic vascular resistance, and putative molecular/cellular mechanisms were measured. In a subgroup of cirrhotic rats, the hemodynamic response to acute Prop (5 mg/kg iv) was assessed. Effects of metformin ± Prop on PP and MAP were validated in common bile duct ligated-cirrhotic rats. Metformin-treated CCl4-cirrhotic rats had lower PP and hepatic vascular resistance than vehicle-treated rats, without significant changes in MAP or PBF. Metformin caused a significant reduction in liver fibrosis (Sirius red), hepatic stellate cell activation (α-smooth muscle actin, platelet-derived growth factor receptor β polypeptide, transforming growth factor-βR1, and Rho kinase), hepatic inflammation (CD68 and CD163), superoxide (dihydroethidium staining), and nitric oxide scavenging (protein nitrotyrosination). Prop, by decreasing PBF, further reduced PP. Similar findings were observed in common bile duct ligated-cirrhotic rats. Metformin administration reduces PP by decreasing the structural and functional components of the elevated hepatic resistance of cirrhosis. This effect is additive to that of Prop. The potential impact of this pharmacological combination, otherwise commonly used in patients with cirrhosis and diabetes, needs clinical evaluation.

  9. Fasting gall bladder volume and lithogenicity in relation to glucose tolerance, total and intra-abdominal fat masses in obese non-diabetic subjects

    DEFF Research Database (Denmark)

    Hendel, H W; Højgaard, L; Andersen, T

    1998-01-01

    OBJECTIVE: To investigate whether total body fat mass or fat distribution and associated metabolic disturbances in glucose and lipid metabolism influence the well known gallstone pathogenetic factors in obese subjects in order to explain why some obese subjects develop gallstones and some do not....... DESIGN: Cross sectional study of gallstone pathogenetic factors, body composition, fat distribution, glucose and lipid metabolism. SUBJECTS: 57 healthy overweight subjects (aged 26-64y, body mass index (BMI) 30-45 kg/m2). MEASUREMENTS: Total and intra-abdominal fat masses were measured by dual X...... with a specific radioimmunoassay. Insulin sensitivity was measured by the Minimal Model and glucose tolerance by an oral glucose tolerance test (OGTT). Serum lipid concentrations were measured by standard methods. RESULTS: The gallbladder volume in the fasting state increased with increasing intra-abdominal fat...

  10. Endoscopic Ultrasound-Guided Drainage of Intra-Abdominal Abscess after Gastric Perforation in a Patient Receiving Ramucirumab and Paclitaxel for Advanced Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Koichiro Mandai

    2017-01-01

    Full Text Available Gastrointestinal perforation is a serious adverse event that occurs in approximately 1% of patients receiving ramucirumab and paclitaxel. A 67-year-old man with unresectable advanced gastric cancer was admitted to our hospital and treated with ramucirumab and paclitaxel. Gastric perforation occurred during the second cycle of chemotherapy. Although the patient’s condition improved without surgery, an abscess developed in the intra-abdominal fluid collection resulting from the perforation. We performed endoscopic ultrasound-guided abscess drainage. The patient improved and was discharged in satisfactory condition. Endoscopic ultrasound-guided drainage is a treatment option for patients with intra-abdominal abscess following gastric perforation due to ramucirumab.

  11. Pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra-abdominal complications in refractory peritoneal dialysis-related peritonitis.

    Science.gov (United States)

    Hsu, Chih-Yang; Huang, Wei-Chieh; Huang, Chun-Kai; Huang, Chien-Wei; Chou, Nan-Hua; Lee, Po-Tsang; Fang, Hua-Chang; Chou, Kang-Ju; Chen, Chien-Liang

    2015-11-01

    Some patients with refractory peritoneal dialysis-related peritonitis continue to develop intra-abdominal complications despite removal of the peritoneal catheter. Repeated percutaneous drainage or open laparotomy is often required, and mortality is not uncommon. The benefits of pelvic drainage placement during catheter removal in decreasing these complications and interventions remain unproven. Forty-six patients with refractory peritonitis who underwent removal of a Tenckhoff catheter between 1991 and 2013 were reviewed retrospectively. Twelve patients had pelvic drainage using closed active suction devices during catheter removal (drainage group). The remaining 34 patients underwent catheter removal without drainage (non-drainage group). The outcomes measured were the development of intra-abdominal complications and the requirement for repeated percutaneous drainage or open laparotomy within 90 days after the catheter removal. Baseline characteristics were similar with the exception of a higher median number of previous peritonitis episodes in the drainage group compared with the non-drainage group (2 vs 0, P = 0.02). During the follow-up period, intra-abdominal complications occurred in 15 (44%) of 34 patients in the non-drainage group, compared with one (8%) of 12 patients in the drainage group (P = 0.03). Twelve (35%) patients in the non-drainage group required repeated percutaneous drainage or open laparotomy for management, compared with zero (0%) patients in the drainage group (P = 0.02). Drain tubes were removed at a median of 6 days (inter-quartile range: 5-10) without complications. In the management of refractory peritonitis, pelvic drainage during removal of dialysis catheter decreases the risk of subsequent intra-abdominal complications and invasive interventions. © 2015 Asian Pacific Society of Nephrology.

  12. Antimicrobial Susceptibilities of Aerobic and Facultative Gram-Negative Bacilli from Intra-abdominal Infections in Patients from Seven Regions in China in 2012 and 2013

    OpenAIRE

    Zhang, Hui; Yang, Qiwen; Liao, Kang; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Wang,Yong; Wu, Anhua; Feng, Xianju; Luo, Yanping; Hu, Zhidong; Chu, Yunzhuo; Chen, Shulan

    2015-01-01

    To evaluate the antimicrobial susceptibility of Gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013, we determined the susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase (ESBL) statuses of 3,540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth microdilution and interpretive standards. Most infections were caused by Escherichia coli (46.3%) ...

  13. Activities of the Oxazolidinones Linezolid and Eperezolid in Experimental Intra-Abdominal Abscess Due to Enterococcus faecalis or Vancomycin-Resistant Enterococcus faecium

    OpenAIRE

    1999-01-01

    The in vivo effectiveness of oxazolidinones eperezolid (U-100592) and linezolid (U-100766) against one strain each of Enterococcus faecalis and vancomycin-resistant Enterococcus faecium was examined in a rat model of intra-abdominal abscess. MICs of both drugs were 2 μg/ml for each strain. At doses of 25 mg/kg of body weight twice daily intravenously or orally, linezolid produced small but statistically significant reductions in abscess bacterial density for E. faecalis. The reduction in viab...

  14. Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study.

    Science.gov (United States)

    Bassetti, Matteo; Peghin, Maddalena; Carnelutti, Alessia; Righi, Elda; Merelli, Maria; Ansaldi, Filippo; Trucchi, Cecilia; Alicino, Cristiano; Sartor, Assunta; Toniutto, Pierluigi; Wauters, Joost; Laleman, Wim; Tascini, Carlo; Menichetti, Francesco; Luzzati, Roberto; Brugnaro, Pierluigi; Mesini, Alessio; Raviolo, Stefania; De Rosa, Francesco G; Lagunes, Leonel; Rello, Jordi; Dimopoulos, George; Colombo, Arnaldo L; Nucci, Marcio; Vena, Antonio; Bouza, Emilio; Muñoz, Patricia; Tumbarello, Mario; Losito, Raffaella; Martin-Loeches, Ignacio; Viscoli, Claudio

    2017-04-01

    The aim of the study was to describe the characteristics of cirrhotic patients with candidemia and intra-abdominal candidiasis (IAC) and to evaluate the risk factors associated with 30-day mortality. A multicenter multinational retrospective study including all consecutive episodes of candidemia and IAC in adult patients with liver cirrhosis in 14 European hospitals during the period 2011-2013 was performed. A total of 241 episodes (169 candidemia, 72 IAC) were included. Most Candida infections were acquired in hospital (208, 86.3%), mainly in the intensive care unit (ICU) (121, 50.2%). At clinical presentation, fever was seen in 60.6% of episodes (146/241) and septic shock in 34.9% (84/241). C. albicans was the most common species (found in 131 episodes, 54.4%), followed by C. glabrata (35, 14.5%) and C. parapsilosis (34, 14.1%). Overall, the 30-day mortality was 35.3%. Multivariable analysis identified candidemia (OR 2.2, 95% CI 1.2-4.5) and septic shock (OR 3.2, 95% CI 1.7-6) as independent factors associated with 30-day mortality. Adequate antifungal treatment (OR 0.4, 95% CI 0.3-0.9) was associated with survival benefit. A shift towards increasing prevalence of C. glabrata and C. parapsilosis species in patients with liver disease was documented. Candidemia and IAC were associated with significant mortality in cirrhotic patients. Thirty-day mortality was associated with candidemia and severe clinical presentation, whereas adequate antifungal treatment improved the prognosis.

  15. Antimicrobial susceptibility of Gram-negative bacteria causing intra-abdominal infections in China: SMART China 2011.

    Science.gov (United States)

    Zhang, Hui; Yang, Qiwen; Xiao, Meng; Chen, Minjun; Badal, Robert E; Xu, Yingchun

    2014-01-01

    The Study for Monitoring Antimicrobial Resistance Trends program monitors the activity of antibiotics against aerobic and facultative Gram-negative bacilli (GNBs) from intra-abdominal infections (IAIs) in patients worldwide. In 2011, 1 929 aerobic and facultative GNBs from 21 hospitals in 16 cities in China were collected. All isolates were tested using a panel of 12 antimicrobial agents, and susceptibility was determined following the Clinical Laboratory Standards Institute guidelines. Among the Gram-negative pathogens causing IAIs, Escherichia coli (47.3%) was the most commonly isolated, followed by Klebsiella pneumoniae (17.2%), Pseudomonas aeruginosa (10.1%), and Acinetobacter baumannii (8.3%). Enterobacteriaceae comprised 78.8% (1521/1929) of the total isolates. Among the antimicrobial agents tested, ertapenem and imipenem were the most active agents against Enterobacteriaceae, with susceptibility rates of 95.1% and 94.4%, followed by amikacin (93.9%) and piperacillin/tazobactam (87.7%). Susceptibility rates of ceftriaxone, cefotaxime, ceftazidime, and cefepime against Enterobacteriaceae were 38.3%, 38.3%, 61.1%, and 50.8%, respectively. The leastactive agent against Enterobacteriaceae was ampicillin/sulbactam (25.9%). The extended-spectrum β-lactamase (ESBL) rates among E. coli, K. pneumoniae, Klebsiella oxytoca, and Proteus mirabilis were 68.8%, 38.1%, 41.2%, and 57.7%, respectively. Enterobacteriaceae were the major pathogens causing IAIs, and the most active agents against the study isolates (including those producing ESBLs) were ertapenem, imipenem, and amikacin. Including the carbapenems, most agents exhibited reduced susceptibility against ESBL-positive and multidrug-resistant isolates.

  16. Antimicrobial susceptibility of Gram-negative bacteria causing intra-abdominal infections in China: SMART China 2011

    Institute of Scientific and Technical Information of China (English)

    Zhang Hui; Yang Qiwen; Xiao Meng; Chen Minjun; Robert E.Badal; Xu Yingchun

    2014-01-01

    Background The Study for Monitoring Antimicrobial Resistance Trends program monitors the activity of antibiotics against aerobic and facultative Gram-negative bacilli (GNBs) from intra-abdominal infections (IAIs) in patients worldwide.Methods In 2011,1 929 aerobic and facultative GNBs from 21 hospitals in 16 cities in China were collected.All isolates were tested using a panel of 12 antimicrobial agents,and susceptibility was determined following the Clinical Laboratory Standards Institute guidelines.Results Among the Gram-negative pathogens causing IAIs,Escherichia coli (47.3%) was the most commonly isolated,followed by Klebsiella pneumoniae (17.2%),Pseudomonas aeruginosa (10.1%),and Acinetobacter baumannii (8.3%).Enterobacteriaceae comprised 78.8% (1521/1929) of the total isolates.Among the antimicrobial agents tested,ertapenem and imipenem were the most active agents against Enterobacteriaceae,with susceptibility rates of 95.1% and 94.4%,followed by amikacin (93.9%) and piperacillin/tazobactam (87.7%).Susceptibility rates of ceftriaxone,cefotaxime,ceftazidime,and cefepime against Enterobacteriaceae were 38.3%,38.3%,61.1%,and 50.8%,respectively.The leastactive agent against Enterobacteriaceae was ampicillin/sulbactam (25.9%).The extended-spectrum β-lactamase (ESBL) rates among E.coli,K.pneumoniae,Klebsiella oxytoca,and Proteus mirabilis were 68.8%,38.1%,41.2%,and 57.7%,respectively.Conclusions Enterobacteriaceae were the major pathogens causing IAIs,and the most active agents against the study isolates (including those producing ESBLs) were ertapenem,imipenem,and amikacin.Including the carbapenems,most agents exhibited reduced susceptibility against ESBL-positive and multidrug-resistant isolates.

  17. The clinical significance of incidental intra-abdominal findings on positron emission tomography performed to investigate pulmonary nodules

    Directory of Open Access Journals (Sweden)

    Gill Richdeep S

    2012-01-01

    Full Text Available Abstract Background Lung cancer is a common cause of cancer-related death. Staging typically includes positron emission tomography (PET scanning, in which18F-fluoro-2-dexoy-D-glucose (FDG is taken up by cells proportional to metabolic activity, thus aiding in differentiating benign and malignant pulmonary nodules. Uptake of FDG can also occur in the abdomen. The clinical significance of incidental intraabdominal FDG uptake in the setting of pulmonary nodules is not well established. Our objective was to report on the clinical significance of incidental intra-abdominal FDG activity in the setting of lung cancer. Methods Fifteen hundred FDG-PET reports for studies performed for lung cancer were retrospectively reviewed for the presence of incidental FDG-positive intraabdominal findings. Patient charts with positive findings were then reviewed and information extracted. Results Twenty-five patients (25/1500 demonstrated incidental intraabdominal FDG uptake thought to be significant (1.7% with a mean patient age of 71 years. Colonic uptake was most common (n = 17 with 9 (52% being investigated further. Of these 9 cases, a diagnosis of malignancy was made in 3 patients, pre-malignant adenomas in 2 patients, a benign lipoma in 1 patient and no abnormal findings in the remaining patients. 8 patients were not investigated further (3 diagnosed with metastatic lung cancer and 2 were of advanced age secondary to poor prognosis. Conclusion Incidental abdominal findings in the colon on FDG-PET scan for work-up of pulmonary nodules need to be further investigated by colonoscopy.

  18. Role of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension.

    Science.gov (United States)

    Duchesne, Juan C; Kaplan, Lewis J; Balogh, Zsolt J; Malbrain, Manu L N G

    2015-01-01

    Secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are closely related to fluid resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and resuscitation, and to explore a new hypothesis with regard to damage control resuscitation, permissive hypotension and global increased permeability syndrome. Review of the relevant literature via PubMed search. The recognition of the association between the development of ACS and resuscitation urged the need for new approach in traumatic shock management. Over a decade after wide spread application of damage control surgery damage control resuscitation was developed. DCR differs from previous resuscitation approaches by attempting an earlier and more aggressive correction of coagulopathy, as well as metabolic derangements like acidosis and hypothermia, often referred to as the 'deadly triad' or the 'bloody vicious cycle'. Permissive hypotension involves keeping the blood pressure low enough to avoid exacerbating uncontrolled haemorrhage while maintaining perfusion to vital end organs. The potential detrimental mechanisms of early, aggressive crystalloid resuscitation have been described. Limitation of fluid intake by using colloids, hypertonic saline (HTS) or hyperoncotic albumin solutions have been associated with favourable effects. HTS allows not only for rapid restoration of circulating intravascular volume with less administered fluid, but also attenuates post-injury oedema at the microcirculatory level and may improve microvascular perfusion. Capillary leak represents the maladaptive, often excessive, and undesirable loss of fluid and electrolytes with or without protein into the interstitium that generates oedema. The global increased permeability syndrome (GIPS) has been articulated in patients with persistent systemic inflammation failing

  19. Prevalence and diagnosis rate of intra-abdominal hypertension in critically ill adult patients: A single-center cross-sectional study

    Institute of Scientific and Technical Information of China (English)

    Hua-Yu Zhang; Dong Liu; Hao Tang; Shi-Jin Sun; Shan-Mu Ai; Wen-Qun Yang; Dong-Po Jiang

    2015-01-01

    Purpose: To investigate the prevalence and diagnosis rate of intra-abdominal hypertension (IAH) in a mixed-population intensive care unit (ICU), and to investigate the knowledge of ICU staff regarding the guidelines published by the World Society of Abdominal Compartment Syndrome (WSACS) in 2013.Methods: A one-day cross-sectional study based on the WSACS 2013 guidelines was conducted in the general ICU of a tertiary teaching hospital in Chongqing, China.The included patients were divided into intravesical pressure (IVP) measured group and IVP unmeasured group.The epidemiologic data were recorded, and potential IAH risk factors (RFs) were collected based on the guidelines.IVP measurements were conducted by investigators every 4 h and the result was compared to that measured by the ICU staff to evaluate the diagnosis rate.Besides, a questionnaire was used to investigate the understanding of the guidelines among ICU staff.Results: Thirty-two patients were included, 14 in the IVP measured group and 18 in the IVP unmeasured group.The prevalence of IAH during the survey was 15.63% (5/32), 35.71% (5/14) in IVP measured group.Only one case of IAH had been diagnosed by the ICU physician and the diagnosis rate was as low as 20.00%.Logistic regression analysis showed that sequential organ failure assessment (SOFA) score was an independent RF for IAH (OR: 1.532, 95% CI: 1.029-2.282, p =0.036.Fourteen doctors and 5 nurses were investigated and the response rate was 67.86%.The average scores of the doctors and nurses were 27.14 ± 20.16 and 16.00 ± 8.94 respectively.None of them had studied the WSACS 2013 guidelines thoroughly.Conclusion: Patients with a higher SOFA score has a higher incidence of IAH.The IAH prevalence in 14 ICU patients with indwelling catheter was 35.71%.Strengthening the wide and rational use of WSACS guideline is important to improve the diagnosis of IAH.

  20. Blunt Abdominal Trauma Patients Are at Very Low Risk for Intra-Abdominal Injury after Emergency Department Observation

    Directory of Open Access Journals (Sweden)

    Jason S Haukoos

    2011-05-01

    Full Text Available Introduction: Patients are commonly admitted to the hospital for observation following blunt abdominal trauma (BAT, despite initially negative emergency department (ED evaluations. With the current use of screening technology, such as computed tomography (CT of the abdomen and pelvis, ultrasound, and laboratory evaluations, it is unclear which patients require observation. The objective of this study was to determine the prevalence of intra-abdominal injury (IAI and death in hemodynamically normal and stable BAT patients with initially negative ED evaluations admitted to an ED observation unit and to define a low-risk subgroup of patients and assess whether they may be discharged without abdominal/pelvic CT or observation. Methods: This was a retrospective cohort study performed at an urban level 1 trauma center and included all BAT patients admitted to an ED observation unit as part of a BAT key clinical pathway. All were observed for at least 8 hours as part of the key clinical pathway, and only minors and pregnant women were excluded. Outcomes included the presence of IAI or death during a 40-month follow-up period. Prior to data collection, low-risk criteria were defined as no intoxication, no hypotension or tachycardia, no abdominal pain or tenderness, no hematuria, and no distracting injury. To be considered low risk, patients needed to meet all low-risk criteria. Results: Of the 1,169 patients included over the 2-year study period, 29% received a CT of the abdomen and pelvis, 6% were admitted to the hospital from the observation unit for further management, 0.4% (95% confidence interval [CI], 0.1%–1% were diagnosed with IAI, and 0% (95% CI, 0%–0.3% died. Patients had a median combined ED and observation length of stay of 9.5 hours. Of the 237 (20% patients who met low-risk criteria, 7% had a CT of the abdomen and pelvis and 0% (95% CI, 0%–1.5% were diagnosed with IAI or died. Conclusion: Most BAT patients who have initially negative

  1. Prospective evaluation of new 22 gauge endoscopic ultrasound core needle using capillary sampling with stylet slow-pull technique for intra-abdominal solid masses.

    Science.gov (United States)

    Paik, Woo Hyun; Park, Yangsoon; Park, Do Hyun; Hong, Seung-Mo; Lee, Byung Uk; Choi, Jun-Ho; Lee, Sang Soo; Seo, Dong-Wan; Lee, Sung Koo; Kim, Myung-Hwan

    2015-03-01

    The aim of this study was to evaluate the adequacy and diagnostic yield of the histologic core obtained with a 22 G endoscopic ultrasound histology needle using capillary sampling with stylet slow-pull technique without on-site cytopathologist. No standard technique for new EUS histology needle has been established. A total of 125 consecutive patients with intra-abdominal solid masses were enrolled prospectively between October 2011 and March 2013. EUS-guided fine needle biopsy (EUS-FNB) with a 22 G histology needle using capillary sampling with stylet slow-pull technique was performed. A total of 133 EUS-FNB procedures targeting the pancreas, lymph node, retroperitoneal mass, ampulla of Vater, gallbladder, common bile duct, duodenum, and liver were performed in 125 patients. EUS-FNB was technically feasible in all cases, and a visible core was obtained in 128 cases (96%). Histologic core specimens suitable for pathologic assessment were reported in 111 cases (83%). There were no procedure-related adverse events. According to the determinants of malignancy with EUS-FNB, the sensitivity, specificity, positive and negative predictive values, and accuracy were 85%, 98%, 99%, 77%, and 89%, respectively. In addition, histologic architecture with or without immunohistochemical staining of the core biopsy specimens was useful for pathologic confirmation in 101 cases (76%). A 22 G EUS-FNB using capillary sampling with stylet slow-pull technique showed a high diagnostic yield and histologic core acquisition for the histologic diagnosis of various intra-abdominal masses without an on-site cytopathologist. Furthermore, a histologic core with or without immunohistochemical staining was helpful for clinical decision making in 76% of the intra-abdominal solid masses.

  2. Jávea consensus guidelines for the treatment of Candida peritonitis and other intra-abdominal fungal infections in non-neutropenic critically ill adult patients.

    Science.gov (United States)

    Pemán, Javier; Aguilar, Gerardo; Valía, Juan Carlos; Salavert, Miguel; Navarro, David; Zaragoza, Rafael

    Although the management of the invasive candidiasis has improved in the last decade, controversial issues yet remain, especially in the diagnostic and therapeutic approaches to Candida peritonitis and other forms of intra-abdominal fungal infections. We sought to identify core clinical knowledge about intra-abdominal fungal infections and to achieve high-agreement recommendations required to care for critically ill adult patients with Candida peritonitis and other forms of intra-abdominal fungal infection. A biregional Spanish survey, to elucidate the consensus about the already mentioned fungal infections by means of the Delphi technique, was conducted anonymously by e-mail with 29 multidisciplinary experts in invasive fungal infections from 14 hospitals in the Valencia and Murcia communities during 2014. Respondents included intensivists, anesthesiologists, microbiologists, pharmacologists, and infectious disease specialists, who answered 31 questions prepared by a coordination group after a strict review of the literature from the 5 previous years. The educational objectives spanned 6 categories: epidemiology, microbiological diagnosis, clinical diagnosis, antifungal treatment, de-escalation therapy, and special situations. The agreement required among the panelists for each item to be selected had to be higher than 70%. After extracting the recommendations from the selected items, a meeting at which the experts were asked to validate the previously selected recommendations in a second round of scoring took place. After the second round, 36 recommendations were validated according to the following distribution: epidemiology (5), microbiological diagnosis (4), clinical diagnosis (4), antifungal treatment (3), de-escalation therapy (4), and special situations (16). Treatment of Candida peritonitis and other forms of intra-abdominal fungal infections in ICU patients requires a broad range of knowledge application and skills that our recommendations address. Based

  3. Risk factors for intra-abdominal hypertension in children with sepsis%小儿脓毒症并腹内高压的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    张笃飞; 冯小伟; 林涛; 吴开芳

    2013-01-01

    Objective To study risk factors for the occurrence of intra-abdominal hypertension (IAH) in children with sepsis.Methods A nest case-control study was employed.According to intra-abdominal pressures (IAP) measured by cystometry,119 children with sepsis were classified into normal IAP (control,n =80) and IAH groups (n =39).Risk factors for the occurrence of IAH were investigated by monovariable and multivariable logistic regression analysis.Results Monovariable analysis showed that there were significant differences in pediatric critical illness score (PCIS),procalcitonin (PCT) level,PaCO2,blood lactate level,rates of intestinal or intra-abdominal infection,ascites,gastrointestinal dysfunction,mechanical ventilation,shock and multiple organ dysfunction syndrome (MODS) between the IAH and control groups (P < 0.05).Multivariable logistic regression analysis demonstrated that decreased PCIS,MODS,shock,gastrointestinal dysfunction and ascites were major risk factors for the occurrence of IAH.Conclusions Children with sepsis who have decreased PCIS,MODS,shock,gastrointestinal dysfunction and ascites are at risk for the occurrence of IAH.%目的 探讨小儿脓毒症并腹内高压(IAH)的危险因素,为早期诊断、及时干预治疗提供理论依据.方法 采用膀胱测压法对119例脓毒症患儿进行腹内压检测,根据腹内压检测结果将患儿分为腹内压正常组(对照组,n =80)与IAH组(n=39).采用单因素和非条件logistic回归分析对两组患儿的临床资料进行分析,以调查脓毒症患儿并发IAH的危险因素.结果 单因素分析发现小儿危重病评分(PCIS)、降钙素原(PCT)、PaCO2、血清乳酸值及肠道/腹腔感染、腹水、胃肠功能障碍、机械通气、休克和多脏器功能不全(MODS)的发生比例在IAH和对照组间比较差异均具有统计学意义(P<0.05).Logistic回归分析显示PCIS降低、MODS、休克、胃肠功能障碍和腹水是脓毒症合并IAH

  4. Nódulo umbilical metastático (nódulo da Irmã Maria José: um sinal de alerta para tumoração maligna intra-abdominal - relato de caso Sister Mary Joseph's nodule: a warning sign for intra-abdominal malignant tumors. A case report

    Directory of Open Access Journals (Sweden)

    Homero Soares Fogaça

    2003-07-01

    Full Text Available O nódulo da "Irmã Maria José" é tumor metastático que acomete a cicatriz umbilical e pode ser a primeira evidência de neoplasia intra-abdominal disseminada. Os autores relatam o caso de uma paciente com o nódulo da "Irmã Maria José" no qual o diagnóstico do tumor primário só foi possível por meio dos testes imuno-histoquímicos da lesão biopsiada da pele.The umbilical metastatic tumoral nodule, Sister Mary Joseph's nodule, is a rare clinical sign indicative of disseminated intra-abdominal tumor, and may be the first evidence of malignancy. The authors report a case of a patient with umbilical metastatic nodule in whom the diagnosis of the primary tumor was possible by immunohistochemistry of the lesion biopsy.

  5. Open abdomen in the treatment of intra-abdominal hypertension in patients with severe acute pancreatitis%重症急性胰腺炎的腹腔高压与腹腔开放治疗

    Institute of Scientific and Technical Information of China (English)

    李宁

    2010-01-01

    @@ 早在20世纪初期,就有学者注意到腹腔高压对患者心血管、肾脏等的功能产生不利影响.重症急性胰腺炎(severe acute pancreatitis,SAP)常导致腹腔高压,不仅限制腹式呼吸,减少机体氧供,而且对泌尿、循环、消化和中枢神经系统等产生一系列严重影响,如不及时治疗,将导致腹腔间室综合征(abdominal compartment syndrome,ACS).%Severe acute pancreatitis (SAP) can induce intra-abdominal hypertension, which has an adverse effect on the function of urinary, circulatory, digestive and neurological system, and finally leads to abdominal compartment syndrome (ACS) if patients were not timely treated. This article focuses on the close relationship between SAP and ACS, which included the definition, classification, pathogenesis of ACS and its pathophysiologic effects on other important organs. The different types and indications of surgical interventions of ACS were discussed in detail. For SAP patients complicated with ACS, urgent open abdomen is important to decrease the abdominal pressure and to prevent the incidence of multi-organ dysfunction syndrome. Complications after open abdomen, such as intestine fistula,abdominal sepsis, intestinal dysfunction and abdominal deficit,should be managed prudently.

  6. Ceftazidime/avibactam: a novel cephalosporin/nonbeta-lactam beta-lactamase inhibitor for the treatment of complicated urinary tract infections and complicated intra-abdominal infections

    Directory of Open Access Journals (Sweden)

    Hidalgo JA

    2016-07-01

    Full Text Available Jose A Hidalgo,1,2 Celeste M Vinluan,1–3 Nishaal Antony3 1UTEP/UT Austin Cooperative Pharmacy Program, College of Health Sciences, University of Texas at El Paso, El Paso, 2Department of Pharmacy, College of Pharmacy, The University of Texas at Austin, Austin, 3Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA Abstract: There has been greater interest in developing additional antimicrobial agents due to the increasing health care costs and resistance resulting from bacterial pathogens to currently available treatment options. Gram-negative organisms including Enterobacteriaceae and Pseudomonas aeruginosa are some of the most concerning threats due to their resistance mechanisms: extended-spectrum beta-lactamase production and Klebsiella pneumoniae carbapenemase enzymes. Ceftazidime is a third-generation broad-spectrum cephalosporin with activity against P. aeruginosa and avibactam is a novel nonbeta-lactam beta-lactamase inhibitor. Avycaz®, the trade name for this new combination antibiotic, restores the activity of ceftazidime against some of the previously resistant pathogens. Avycaz was approved in 2015 for the treatment of complicated urinary tract infections, including pyelonephritis, and complicated intra-abdominal infections with the addition of metronidazole in patients with little to no other treatment options. This review article assesses the clinical trials and data that led to the approval of this antibiotic, in addition to its spectrum of activity and limitations. Keywords: ceftazidime/avibactam, Avycaz, complicated urinary tract infections, complicated intra-abdominal infections

  7. Nodo-colonic fistula caused by intra-abdominal tuberculous lymphadenitis during treatment with anti-tuberculous medication: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Kyung Sun; Bae, Kyung Eun; Jeong, Myeong Ja; Lee, Ji Hae; Kang, Mi Jin; Kim, Jae Hyung; Kim, Soo Hyun [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2016-08-15

    Recently, the overall incidence of tuberculosis has decreased, but the incidence of an extrapulmonary manifestation in patients with tuberculosis has increased in the Republic of Korea. Although intestinal tuberculosis is not infrequent, a fistula caused by tuberculosis is a rare condition. A 23-year-old man presented with fever, diarrhea and right lower quadrant pain. A computed tomography (CT) scan revealed a lobulated, peripherally enhancing, low density mass in the mesentery. The patient underwent laparoscopic biopsy for necrotic lymph node, and intra-abdominal tuberculous lymphadenitis was diagnosed. Four months after initiating treatment with anti-tuberculous medication, the patient developed fever together with lower abdominal pain. A follow-up CT scan revealed a fistulous tract that had developed between the initially noted lymphadenopathy and the proximal ascending colon. Laparoscopic right hemicolectomy was performed as a curative treatment. This case suggests that a nodo-colonic fistula may occur as a paradoxical response in patients with intra-abdominal tuberculous lymphadenitis during treatment with anti-tuberculous medication.

  8. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: does the 'seatbelt sign' predict intra-abdominal injury after motor vehicle trauma in children?

    Science.gov (United States)

    Rentmeester, Landen

    2012-02-01

    A short cut review was carried out to establish whether the seat belt sign was a significant predictor of intra-abdominal injury in children involved in motor vehicle collisions. 51 papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that seatbelt sign appears to be associated with an increased risk of intra-abdominal injuries, especially gastrointestinal and pancreatic injuries.

  9. A comparative study to validate the use of ultrasonography and computed tomography in patients with post-operative intra-abdominal sepsis

    Energy Technology Data Exchange (ETDEWEB)

    Go, H.L.S. [Department of Radiology, Academic Medical Center, University of Amsterdam, C-1, P.O. Box 22660, 1100 DD Amsterdam (Netherlands); Department of Surgery, Academic Medical Center, University of Amsterdam, Room G4-111, P.O. Box 22700, 1100 DE Amsterdam (Netherlands); Baarslag, H.J. [Department of Radiology, Academic Medical Center, University of Amsterdam, C-1, P.O. Box 22660, 1100 DD Amsterdam (Netherlands); Vermeulen, H. [Department of Surgery, Academic Medical Center, University of Amsterdam, Room G4-111, P.O. Box 22700, 1100 DE Amsterdam (Netherlands); Lameris, J.S. [Department of Radiology, Academic Medical Center, University of Amsterdam, C-1, P.O. Box 22660, 1100 DD Amsterdam (Netherlands); Legemate, D.A. [Department of Surgery, Academic Medical Center, University of Amsterdam, Room G4-111, P.O. Box 22700, 1100 DE Amsterdam (Netherlands)]. E-mail: d.a.legemate@amc.uva.nl

    2005-06-01

    Purpose: To validate abdominal ultrasonography and helical computed tomography in detecting causes for sepsis in patients after abdominal surgery and to determine improved criteria for its use. Materials and methods: Eighty-five consecutive surgical patients primarily operated for non-infectious disease were included in this prospective study. Forty-one patients were admitted to the intensive care unit. All patients were suspected of an intra-abdominal sepsis after abdominal surgery. Both ultrasonography (US) and helical abdominal computed tomography (CT) were performed to investigate the origin of an intra-abdominal sepsis. The images of both US and CT were interpreted on a four-point scale by different radiologists or residents in radiology, the investigators were blinded of each other's test. Interpretations of US and CT were compared with a reference standard which was defined by the result of diagnostic aspiration of suspected fluid collections (re)laparotomy, clinical course or the opinion of an independent panel. Likelihood ratios and post-test probabilities were calculated and interobserver agreement was determined using {kappa} statistics. Results: The overall prevalence of an abdominal infection was 0.49. The likelihood ratio (LR) of a positive test-result for US was 1.33 (95% CI: 0.8-2.5) and for CT scan 2.53 (95% CI: 1.4-5.0); corresponding post-test probabilities for US 0.57 (95% CI: 0.42-0.70) and for CT 0.71 (95% CI: 0.57-0.83). The LR of a negative test-result was, respectively, 0.60 (95% CI: 0.3-1.3) and 0.18 (95% CI: 0.06-0.5); corresponding post-test probabilities for US 0.37 (95% CI: 0.20-0.57) and for CT 0.15 (95% CI: 0.06-0.32) were calculated. Conclusion: Computed tomography can be used as the imaging modality of choice in patients suspected of intra-abdominal sepsis after abdominal surgery. Because of the low discriminatory power ultrasonography should not be performed as initial diagnostic test.

  10. Antimicrobial Treatmdent of "Complicated" Intra-Abdominal Infections and The New IDSA Guidelines - A Commentary and an Alternative European Approach According to Clinical Definitions

    Directory of Open Access Journals (Sweden)

    Eckmann C

    2011-03-01

    Full Text Available Abstract Recently, an update of the IDSA guidelines for the treatment of complicated intraabdominal infections has been published. No guideline can cater for all variations in ecology, antimicrobial resistance patterns, patient characteristics and presentation, health care and reimbursement systems in many different countries. In the short time the IDSA guidelines have been available, a number of practical clinical issues have been raised by physicians regarding interpretation of the guidelines. The main debatable issues of the new IDSA guidelines are described as follows: The authors of the IDSA guidelines present recommendations for the following subgroups of "complicated" IAI: community-acquired intra-abdominal infections of mild-to-moderate and high severity and health care-associated intra-abdominal infections (no general treatment recommendations, only information about antimicrobial therapy of specific resistant bacterial isolates. From a clinical point of view, "complicated" IAI are better differentiated into primary, secondary (community-acquired and postoperative and tertiary peritonitis. Those are the clinical presentations of IAI as seen in the emergency room, the general ward and on ICU. Future antibiotic treatment studies of IAI would be more clinically relevant if they included patients in studies for the efficacy and safety of antibiotics for the treatment of the above mentioned forms of IAI, rather than conducting studies based on the vague term "complicated" intra-abdominal infections. The new IDSA guidelines for the treatment of resistant bacteria fail to mention many of new available drugs, although clinical data for the treatment of "complicated IAI" with new substances exist. Further-more, treatment recommendations for cIAI caused by VRE are not included. This group of diseases comprises enough patients (i.e. the entire group of postoperative and tertiary peritonitis, recurrent interventions in bile duct surgery or

  11. Fasting gall bladder volume and lithogenicity in relation to glucose tolerance, total and intra-abdominal fat masses in obese non-diabetic subjects

    DEFF Research Database (Denmark)

    Hendel, H W; Højgaard, L; Andersen, T

    1998-01-01

    OBJECTIVE: To investigate whether total body fat mass or fat distribution and associated metabolic disturbances in glucose and lipid metabolism influence the well known gallstone pathogenetic factors in obese subjects in order to explain why some obese subjects develop gallstones and some do not....... DESIGN: Cross sectional study of gallstone pathogenetic factors, body composition, fat distribution, glucose and lipid metabolism. SUBJECTS: 57 healthy overweight subjects (aged 26-64y, body mass index (BMI) 30-45 kg/m2). MEASUREMENTS: Total and intra-abdominal fat masses were measured by dual X......-ray absorptiometry and abdominal CT scanning, respectively. The lithogenic index was measured in aspirated bile. The gallbladder volume was determined by ultrasound and the gallbladder ejection fraction% by dynamic cholescintigraphy. Plasma cholecystokinin (CCK) concentrations during a meal were measured...

  12. Congenital intra-abdominal bilateral juvenile granulosa cell tumors of the testis associated with constitutional loss of material from chromosome 4.

    Science.gov (United States)

    Yu, David C; Pathak, Bhavana; Vargas, Sara O; Javid, Patrick J; Hisama, Fuki M; Wilson, Jay M; Linden, Bradley C

    2011-01-01

    Juvenile granulosa cell tumor (JGCT) is an uncommon gonadal stromal tumor that occurs rarely in the testis. We report a newborn boy with bilateral intra-abdominal JGCT presenting with abdominal distention and respiratory distress at birth. He was taken to the operating room emergently, and 2 large masses connected by gubernacula to the inguinal canals were resected. Associated abnormalities included a constitutional chromosome 4 abnormality, polymicrogyria, and renal cysts. This report describes a rare presentation of JGCT with abdominal compression and expands the literature to include bilateral testicular involvement. Additionally, it is the 1st report of JGCT associated with a chromosome 4 abnormality, highlighting a genetic region that may be important in JGCT development.

  13. The effect of aqueous extract of gross and commercial yerba mate (Ilex paraguariensis) on intra-abdominal and epididymal fat and glucose levels in male Wistar rats.

    Science.gov (United States)

    Silva, Raquel D'Agostini; Bueno, Audrin Loss Scopel; Gallon, Carin Weirich; Gomes, Luana Ferreira; Kaiser, Samuel; Pavei, Cabral; Ortega, George González; Kucharski, Luiz Carlos; Jahn, Matheus Parmegiani

    2011-09-01

    This study analyzed the plasma lipid profile, glucose levels and fat deposits in male rats treated with aqueous extract of gross yerba mate, commercial yerba mate or water. Yerba mate treatment did not change body weight gain and lipid profile. The consumption of gross yerba mate significantly increased blood glucose (6.6 mmol/L) as compared to the water (4.8 mmol/L) and commercial group (5.2 mmol/L) and decreased epididymal and intra-abdominal deposits (10.1mg/g and 23.7 mg/g of weight) as compared to the water (15.4 mg/g and 36.9 mg/g of weight) and commercial group (12.5mg/g and 28 mg/g of weight). The results suggest that gross yerba mate reduces fat more efficiently but produces a greater increase in blood glucose when compared to commercial yerba mate and water groups.

  14. Persistent Müllerian duct syndrome of mixed anatomical variant (combined male and female type with mixed germ cell tumor of left intra-abdominal testis

    Directory of Open Access Journals (Sweden)

    Manisha Mohapatra

    2016-01-01

    Full Text Available Persistent Müllerian duct syndrome (PMDS is a rare form of internal male pseudohermaphroditism characterized by retention of Müllerian duct derivatives in a phenotypically and karyotypically male patient. Deficiency of anti-Müllerian hormone (AMH secretion or resistance to AMH action due to defective AMH-II receptor is presumed to cause such syndrome in the majority of cases. About 158 PMDS cases have been reported so far, out of which 31 cases are associated with testicular neoplasms. Herein, we describe an interesting case of young male initially diagnosed and treated for inguinal hernia, but finally diagnosed as “PMDS of mixed anatomical variant (combined male and female type with mixed germ cell tumor of left intra-abdominal testis” comprising components of seminoma and yolk sac tumor and treated successfully.

  15. Activities of the oxazolidinones linezolid and eperezolid in experimental intra-abdominal abscess due to Enterococcus faecalis or vancomycin-resistant Enterococcus faecium.

    Science.gov (United States)

    Schülin, T; Thauvin-Eliopoulos, C; Moellering, R C; Eliopoulos, G M

    1999-12-01

    The in vivo effectiveness of oxazolidinones eperezolid (U-100592) and linezolid (U-100766) against one strain each of Enterococcus faecalis and vancomycin-resistant Enterococcus faecium was examined in a rat model of intra-abdominal abscess. MICs of both drugs were 2 microg/ml for each strain. At doses of 25 mg/kg of body weight twice daily intravenously or orally, linezolid produced small but statistically significant reductions in abscess bacterial density for E. faecalis. The reduction in viable cells observed would not likely be clinically relevant. Eperezolid was ineffective at this dose. At a dosage of 100 mg/kg/day, linezolid treatment led to an approximately 100-fold reduction in viable cells per gram of abscess. Against E. faecium infections, intravenous eperezolid and oral linezolid were effective, reducing densities approximately 2 log(10) CFU/g. Both oxazolidinones demonstrated activity against enterococci in this model. However, results were modest with the dosing regimens employed.

  16. Pirfenidone vs. sodium hyaluronate/carboxymethylcellulose as prevention of the formation of intra-abdominal adhesions after colonic surgery. A randomized study in an experimental model.

    Science.gov (United States)

    Bello-Guerrero, Jorge Alberto; Cruz-Santiago, César Alberto; Luna-Martínez, Javier

    2016-01-01

    Up to 93% of patients undergoing abdominal surgery will develop intra-abdominal adhesions with the subsequent morbidity that they represent. Various substances have been tested for the prevention of adhesions with controversial results; the aim of our study is to compare the capability of pirfenidone in adhesion prevention against sodium hyaluronate/carboxymethylcellulose. A randomized, prospective, longitudinal experimental study with Winstar rats. They were divided into 3 groups. The subjects underwent an exploratory laparotomy and they had a 4cm(2) cecal abrasion. The first group received saline on the cecal abrasion, and groups 2 and 3 received pirfenidone and sodium hyaluronate/carboxymethylcellulose respectively. All rats were sacrificed on the 21st day after surgery and the presence of adhesions was evaluated with the modified Granat scale. Simple frequency, central tendency and dispersion measures were recorded. For the statistical analysis we used Fisher's test. To evaluate adhesions we used the Granat's modified scale. The control group had a median adhesion formation of 3 (range 0-4). The pirfenidone group had 1.5 (range 0-3), and the sodium hyaluronate/carboxymethylcellulose group had 0 (range 0-1). There was a statistically significant difference to favor sodium hyaluronate/carboxymethylcellulose against saline and pirfenidone (P<0.009 and P<.022 respectively). The use of sodium hyaluronate/carboxymethylcellulose is effective for the prevention of intra-abdominal adhesions. More experimental studies are needed in search for the optimal adhesion prevention drug. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Assessment of the attenuation of an intra-abdominal vein by use of a silicone-polyacrylic acid gradual venous occlusion device in dogs and cats.

    Science.gov (United States)

    Wallace, Mandy L; Ellison, Gary W; Giglio, Robson F; Batich, Christopher D; Berry, Clifford R; Case, J Brad; Kim, Stanley E

    2016-06-01

    OBJECTIVE To evaluate the closure rate and completeness of closure for a silicone-polyacrylic acid gradual venous occlusion device placed around an intra-abdominal vein to simulate gradual occlusion of an extrahepatic portosystemic shunt. ANIMALS 3 purpose-bred cats and 2 purpose-bred dogs. PROCEDURES The device was surgically placed around an external (cats) or internal (dogs) iliac vein. Computed tomographic angiography was performed at the time of surgery and 2, 4, and 6 weeks after surgery. Ultrasonographic examinations of blood flow through the vein within the device were performed at the time of surgery and at weekly intervals thereafter. Dogs were euthanized 6 weeks after surgery, and the external iliac veins were harvested for histologic examination. RESULTS The prototype gradual venous occlusion device was successfully placed in all animals, and all animals recovered without complications following the placement procedure. The vessel was completely occluded in 2 cats by 6 weeks after surgery, as determined on the basis of results of CT and ultrasonography; there was incomplete occlusion with a luminal diameter of 1.5 mm in the other cat by 6 weeks after surgery. The vessel was completely occluded in both dogs by 6 weeks after surgery. Histologic examination of the external iliac veins obtained from the dogs revealed minimal inflammation of the vessel wall and no thrombus formation. CONCLUSIONS AND CLINICAL RELEVANCE The prototype device induced gradual attenuation of an intra-abdominal vessel over a 6-week period. This device may provide another option for gradual occlusion of extrahepatic portosystemic shunts.

  18. Simultaneous occurrence of hyperthyroidism and fistulizing Crohn’s disease complicated with intra-abdominal fistulas and abscess: a case report and review of the literature

    Science.gov (United States)

    Pachiadakis, Ioannis; Nakos, Andreas; Tatsi, Presvia; Moschos, John; Milias, Stefanos; Nikolopoulos, Panagiotis; Balaris, Christos; Apostolidis, Dimosthenis

    2009-01-01

    Introduction Fistula formation in patients with Crohn’s disease is a common complication during the course of the disease. Perianal and enteroenteric are the most common forms of fistulas, whereas the involvement of the upper gastrointestinal tract with gastrocolic and duodenocolic fistulas represents an extremely unusual condition. Moreover, hyperthyroidism in association with Crohn’s disease has been rarely described. Case presentation We present here a rare case of a 25-year-old male with simultaneous onset of hyperthyroidism and fistulizing Crohn’s disease. Crohn’s disease was complicated with intra-abdominal fistulas involving the upper gastrointestinal tract (duodenocolic, gastrocolic) and an intra-peritoneal abscess formation in the lesser sac. We describe the clinical presentation and therapeutic management of the patient including both medical treatment and surgical intervention. Despite intense medical treatment with total parenteral nutrition, antibiotics, aminosalicylates and corticosteroids the clinical course of the disease was suboptimal. Finally, the patient underwent laparotomy and right hemi-colectomy with ileo-transverse anastomosis performed, with simultaneous drainage of the abdominal abscess and primary closure of the upper gastrointestinal tract openings (gastric, duodenal and jejunal) at one stage operation. Although the surgical approach definitively cured the perforating complications of the disease (fistulas and abscess), the luminal disease in the colon remnant was still active and steroid-refractory. The subsequent successful treatment with infliximab, azathioprine and mesalazine resulted in the induction and maintenance of the disease remission. Thyrotoxicosis was successfully treated with methimazole and the hyperthyroidism has definitely subsided. Conclusion The management of intra-abdominal fistulas in Crohn’s disease is a complex issue, requiring a multi-disciplinary approach and ‘tailoring’ of the treatment to the

  19. 产后出血患者的液体管理及其继发腹高压的危险因素%Fluid management and risk factors of intra-abdominal hypertension secondary to postpartum hemorrhage

    Institute of Scientific and Technical Information of China (English)

    王胤佳; 李超; 李志伟; 李立

    2016-01-01

    mol/L,t=5.33]均较治疗前降低,白蛋白[(24.45±4.80)与(21.35±5.69)g/L,t=-4.47]升高,差异均有统计学意义(P值均<0.05). 结论 产后出血患者合并子痫前期、大量输液及液体出量过少,均是发生腹高压的危险因素.腹高压对肝肾功能不利,并延长住院时间.采用液体负平衡治疗能降低腹内压,改善肝肾功能.%Objective To investigate fluid management and risk factors of intra-abdominal hypertension (IAH) after postpartum hemorrhage.Methods Clinical data of 64 patients of postpartum hemorrhage who were admitted to Intensive Care Unit (ICU) of the First People's Hospital of Kunming from January 2013 to January 2015 were collected.The patients were divided into IAH group and non-IAH group based on intra-abdominal pressure on admission to ICU.Diuresis or dialysis were offered to patients whose output exceeded 1 000 ml of their input after hospitalization.The background information,including maternal age,existence of pre-eclampsia and whether hysterectomy and transcatheter arterial embolization were performed,intra-abdominal pressure,liver and renal function and length of stay in hospital between the two groups were compared.The intra-abdominal pressure and liver and renal function before and 24 h after negative fluid administration of all subjects were compared as well.Independent-samples t test,paired-samples t test,Chisquare test and logistic regression analysis were applied for statistics.Results Among all of the 64 patients,15(23,4%) presented with IAH on admission,25 (39.1%) were complicated with preeclampsia,one (1.6%) had the uterus removed,and 16 (25.0%) had transcatheter arterial embolization performed.Within 12 h before admission,the average blood loss of the 64 women was (4 022± 1 275) ml,crystal solution input was (8 894±2 597) ml,colloidal fluid input was (343 ± 87) ml,blood products input was (1 370± 346) ml,total fluid input was (10 607± 2 825) ml,total fluid output was (5 176±2 334) ml

  20. [Antimicrobial susceptibility of Gram-negative bacilli of community acquired intra-abdominal infections in a hospital at Buenos Aires, Argentina].

    Science.gov (United States)

    Morganti, L; Córdova, E; Cassini, E; Gómez, N; López Moral, L; Badía, M; Rodríguez, C

    2016-08-01

    Community acquired complicated intra-abdominal infections (cIAI) are a common condition. Few data are available about the level of antimicrobial resistance of Gram-negative bacteria isolated from community acquired cIAIs in Argentina. Retrospective-prospective observational study (March 2010 to February 2012). Gram-negative bacteria antimicrobial susceptibility of isolates from community acquired cIAIs were evaluated. During this period, a total of 85 patients were included and 138 pathogens were collected. Male sex: 58%. Median age: 33. Monomicrobial cultures were obtained in 49% of the cases. Ninety (65%) corresponded to Gram-negative organisms, and 48 (38%) to Gram-positive cocci. Gram-negative organisms most frequently observed were: Escherichia coli 76%, Klebsiella pneumoniae 8%, Pseudomonas aeruginosa 7% and Enterobacter spp. 6%. E. coli and K. pneumoniae showed a high percentage of strains resistance to ciprofloxacin of 37% and 29%, respectively. Similarly, resistance to ampicillin/sulbactam was observed in a 16% of the E. coli isolates. The prevalence of multiresistant Gram-negative organisms was 38%. A high level of resistance to antimicrobials was observed in community acquired cIAIs, mainly to ciprofloxacin and ampicillin/sulbactam two of the most used antimicrobial for empirically treatment of cIAIs in our country. In addition a significant proportion of multiresistant Gram-negative organisms were identified.

  1. Susceptibility trends and molecular characterization of Gram-negative bacilli associated with urinary tract and intra-abdominal infections in Jordan and Lebanon: SMART 2011-2013.

    Science.gov (United States)

    Hayajneh, Wail A; Hajj, Aline; Hulliel, Fawzi; Sarkis, Dolla Karam; Irani-Hakimeh, Noha; Kazan, Lama; Badal, Robert E

    2015-06-01

    To investigate phenotypic and genotypic patterns of antimicrobial resistance among Gram-negative bacilli associated with urinary tract infection (UTI) and intra-abdominal infection (IAI) in medical centres of Jordan and Lebanon. Gram-negative bacilli from the SMART study, collected between the years 2011 and 2013, were first identified at local laboratories. These isolates were shipped to a central laboratory where re-identification, susceptibility testing, and molecular characterization were performed using standard methods. Among the 523 UTI-associated isolates, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were the most frequent (70%, 14%, and 5%, respectively). E. coli, K. pneumoniae, and Pseudomonas aeruginosa were the most frequent species among the 527 IAI-associated isolates (46%, 14%, and 12%, respectively). Incidence rates of extended-spectrum beta-lactamase (ESBL) producers among UTI-associated E. coli, K. pneumoniae, and P. mirabilis were 43%, 54%, and 4%, respectively. Corresponding rates among IAI-associated isolates were 49%, 56%, and 12%, respectively. Acinetobacter baumannii and P. aeruginosa isolates showed very disturbing low susceptibility patterns. CTX-M-15 was the most prevalent ESBL produced. Seventeen isolates were non-susceptible to carbapenems (estimated prevalence of 1.6%). The alarmingly high rates of ESBL production and emergence of carbapenemases emphasize the urgent need to develop antimicrobial stewardship initiatives and to maintain antimicrobial resistance surveillance systems. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Correlation between carbapenem consumption and resistance to carbapenems among Enterobacteriaceae isolates collected from patients with intra-abdominal infections at five medical centers in Taiwan, 2006-2010.

    Science.gov (United States)

    Ho, Cheng-Mao; Ho, Mao-Wang; Liu, Yung-Ching; Toh, Han-Siong; Lee, Yu-Lin; Liu, Yuag-Meng; Huang, Chi-Chang; Lu, Po-Liang; Liu, Chun-Eng; Chen, Yen-Hsu; Ko, Wen-Chien; Tang, Hung-Jen; Yu, Kwok-Woon; Chen, Yao-Shen; Chuang, Yin-Ching; Wang, Jen-Hsien; Hsueh, Po-Ren

    2012-06-01

    We investigated the trend in resistance to carbapenems among isolates of Enterobacteriaceae that had been collected from patients with intra-abdominal infections at five medical centers in Taiwan from 2006 to 2010 and evaluated the correlation between resistance to carbapenems and consumption of said agents as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART). During the study period, the usage of ertapenem and that of total carbapenems (ertapenem, imipenem, and meropenem) increased significantly from 6.13 to 13.38 defined daily doses per 1000 patient-days for ertapenem and from 20.43 to 34.25 defined daily doses per 1000 patient-days for total carbapenems. The most common species were Escherichia coli (n = 1095), Klebsiella spp. (n = 663), and Enterobacter spp. (n = 202). The susceptibility of all isolates to ertapenem and to imipenem varied during the study period. For ertapenem, the rates of nonsusceptibility ranged from 3.5% to 10.3% and those for imipenem ranged from 3.5% to 10.7%. Although the use of carbapenems increased during the study period, there was no marked increase in resistance to carbapenems. Continuous monitoring of resistance trends is necessary so that antimicrobial prescription policies can be adjusted and infection control intervention programs can be implemented.

  3. Anaphylaxis, Intra-Abdominal Infections, Skin Lacerations, and Behavioral Emergencies: A Literature Review of Austere Analogs for a near Earth Asteroid Mission

    Science.gov (United States)

    Chough, Natacha G.; Watkins, Sharmi; Menon, Anil S.

    2012-01-01

    As space exploration is directed towards destinations beyond low-Earth orbit, the consequent new set of medical risks will drive requirements for new capabilities and more resources to ensure crew health. The Space Medicine Exploration Medical Conditions List (SMEMCL), developed by the Exploration Medical Capability element of the Human Research Program, addresses the risk of "unacceptable health and mission outcomes due to limitations of in-flight medical capabilities". It itemizes 85 evidence-based clinical requirements for eight different mission profiles and identifies conditions warranting further research and technology development. Each condition is given a clinical priority for each mission profile. Four conditions -- intra-abdominal infections, skin lacerations, anaphylaxis, and behavioral emergencies -- were selected as a starting point for analysis. A systematic literature review was performed to understand how these conditions are treated in austere, limited-resource, space-analog environments (i.e., high-altitude and mountain environments, submarines, military deployments, Antarctica, isolated wilderness environments, in-flight environments, and remote, resource-poor, rural environments). These environments serve as analogs to spaceflight because of their shared characteristics (limited medical resources, delay in communication, confined living quarters, difficulty with resupply, variable time to evacuation). Treatment of these four medical conditions in austere environments provides insight into medical equipment and training requirements for exploration-class missions.

  4. [First experience of a polyurethane foam composition "Locus" use to stop intra-abdominal hemorrhage as a result of liver damage of V degree. (An experimental study)].

    Science.gov (United States)

    Reva, V A; Litinskii, M A; Denisov, A V; Sokhranov, M V; Telitskii, S Yu; Samokhvalov, I M

    2015-04-01

    Today self-expanding polymers are considered as the most promising as means for intracavitary hemostasis in case of continuing bleeding after trauma. Testing of domestic open-cell polyurethane foam composition "Locus" was carried out on the developed experimental model simulating liver trauma of V degree. After damaging 6 experimental rabbits were injected intraperitoneally with 80 ml of the composition. 5 experimental rabbits were included into to control group (haemostatic agent was not given). Estimated blood loss was 111-124 ml. The two-hour survival rate didn't differ significantly: 3 animals survived in the experimental group; 2 animal survived in the control. Despite the 3-4-fold widening of the foam, due to open cells it absorbed 72.6 +/- 8.3 g of blood. Thus, open-cell polyurethane foam intraperitoneal administration of the composition didn't provide a temporary intra-abdominal hemostasis in liver. In order to enhance the hemostatic effect it requires changing the formulation of the polyurethane composition. For a more accurate assessment of the results it is neccessary to perform additional researches on larger animals.

  5. Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra-abdominal Infections: A Retrospective Analysis on 111 Cases.

    Science.gov (United States)

    Rausei, Stefano; Pappalardo, Vincenzo; Ruspi, Laura; Colella, Antonio; Giudici, Simone; Ardita, Vincenzo; Frattini, Francesco; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo

    2017-09-21

    Time to source control plays a determinant prognostic role in patients having severe intra-abdominal infections (IAIs). Open abdomen (OA) management became an effective treatment option for peritonitis. Aim of this study was to analyze the correlation between time to source control and outcome in patients presenting with abdominal sepsis and treated by OA. We retrospectively analyzed 111 patients affected by abdominal sepsis and treated with OA from May 2007 to May 2015. Patients were classified according to time interval from first patient evaluation to source control. The end points were intra-hospital mortality and primary fascial closure rate. The in-hospital mortality rate was 21.6% (24/111), and the primary fascial closure rate was 90.9% (101/111). A time to source control ≥6 h resulted significantly associated with a poor prognosis and a lower fascial closure rate (mortality 27.0 vs 9.0%, p = 0.04; primary fascial closure 86 vs 100%, p = 0.02). We observed a direct increase in mortality (and a reduction in closure rate) for each 6-h delay in surgery to source control. Early source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time-related conditions, particularly in case of critically ill patients.

  6. Resistance among Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal and urinary tract infections in Latin American countries: SMART 2013-2015

    Directory of Open Access Journals (Sweden)

    James A. Karlowsky

    Full Text Available ABSTRACT Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species are important etiologic agents of nosocomial infection that are frequently resistant to broad-spectrum antimicrobial agents. Gram-negative ESKAPE pathogens were collected from hospitalized patients in 11 Latin American countries from 2013 to 2015 as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART global surveillance program. In total, 2113 isolates from intra-abdominal infections (IAI and 970 isolates from urinary tract infections (UTI were tested against antimicrobial agents using standardized CLSI broth microdilution methodology. Of the agents tested, amikacin demonstrated the highest rates of susceptibility (% for K. pneumoniae (92.2, 92.3, Enterobacter spp. (97.5, 92.1, and P. aeruginosa (85.3, 75.2 isolates from both IAI and UTI, respectively. Ertapenem (68.5, 62.6 and imipenem (79.2, 75.9 showed substantially higher rates of susceptibility (% than other β-lactams, including piperacillin-tazobactam (35.9, 37.4 against ESBL-positive isolates of K. pneumoniae from IAI and UTI, respectively. Rates of susceptibility to all agents tested against A. baumannii were ≤30.9%. Gram-negative ESKAPE pathogens isolated from Latin America demonstrated compromised in vitro susceptibility to commonly prescribed broad-spectrum, parenteral antimicrobial agents. Continued surveillance is warranted. New antimicrobial agents with potent activity against Gram-negative ESKAPE pathogens are urgently needed.

  7. Antimicrobial Susceptibilities of Aerobic and Facultative Gram-Negative Bacilli from Intra-abdominal Infections in Patients from Seven Regions in China in 2012 and 2013.

    Science.gov (United States)

    Zhang, Hui; Yang, Qiwen; Liao, Kang; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Wang, Yong; Wu, Anhua; Feng, Xianju; Luo, Yanping; Hu, Zhidong; Chu, Yunzhuo; Chen, Shulan; Cao, Bin; Su, Jianrong; Gui, Bingdong; Duan, Qiong; Zhang, Shufang; Shao, Haifeng; Kong, Haishen; Badal, Robert E; Xu, Yingchun

    2015-10-19

    To evaluate the antimicrobial susceptibility of Gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013, we determined the susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase (ESBL) statuses of 3,540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth microdilution and interpretive standards. Most infections were caused by Escherichia coli (46.3%) and Klebsiella pneumoniae (19.7%). Rates of ESBL-producing E. coli (P = 0.031), K. pneumoniae (P = 0.017), and Proteus mirabilis (P = 0.004) were higher in hospital-acquired IAIs than in community-acquired IAIs. Susceptibilities of enterobacteriaceae to ertapenem, amikacin, piperacillin-tazobactam, and imipenem were 71.3% to 100%, 81.3% to 100%, 64.7% to 100%, and 83.1% to 100%, respectively, but imipenem was ineffective against P. mirabilis (Zhe) area where the rates of carbapenem resistance were also highest. Ertapenem, amikacin, piperacillin-tazobactam, and imipenem are the most efficacious antibiotics for treating IAIs in China, especially those caused by E. coli or K. pneumoniae. Resistance to cephalosporins and carbapenems is more common in the Jiang-Zhe area than in other regions in China.

  8. Amyloidosis and spontaneous hepatic bleeding, transcatheter therapy for hepatic parenchymal bleeding with massive intraperitoneal hemorrhage: a case report and review of the literature.

    Science.gov (United States)

    Mousa, Albeir Y; Abu-Halimah, Shadi; Alhalbouni, Saadi; Hass, Stephen M; Yang, Calvin; Gill, Gurpreet; AbuRahma, Ali F; Bates, Mark

    2014-10-01

    Hepatic hemorrhage can be devastating, especially in patients with underlying hepatic pathology. This is a case report of a 50-year-old man who presented to the emergency room with Stage 3 shock as evidenced by a systolic blood pressure of 90 mmHg, a heart rate of 125 beats per minute, respiration of 32, with delayed capillary refill and agitation. At this time, he was found to have a massive spontaneous intra-abdominal hemorrhage with an advanced stage of amyloidosis with multiple organ malfunctions. The initial diagnosis was based on an abdominal computed tomography scan and the patient was taken expeditiously to a hybrid angiography suite for a celiac angiogram. An intraoperative diagnosis of extravasation from amyloid related vasculopathy was made based on the angiographic appearance of hepatic circulation. Coil embolization of the feeding branch of the bleeder was achieved using the interlock coil system and a completion angiogram was done showing complete cessation of active bleeding. The postoperative phase was uneventful and the patient was discharged home on postoperative day three. His postoperative visit at five months later was unremarkable. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  9. Clinical and economic consequences of failure of initial antibiotic therapy for patients with community-onset complicated intra-abdominal infections.

    Directory of Open Access Journals (Sweden)

    Yong Pil Chong

    Full Text Available Complicated intra-abdominal infection (cIAI is infection that extends beyond the hollow viscus of origin into the peritoneal space, and is associated with either abscess formation or peritonitis. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAI. The aims of this study were to evaluate risk factors and impact on costs and outcomes of failure of initial antibiotic therapy for community-onset cIAI.A retrospective study was performed at eleven tertiary-care hospitals. Hospitalized adults with community-onset cIAI who underwent an appropriate source control procedure between August 2008 and September 2011 were included. Failure of initial antibiotic therapy was defined as a change of antibiotics due to a lack of improvement of the clinical symptoms and signs associated with cIAI in the first week.A total of 514 patients hospitalized for community-onset cIAI were included in the analysis. The mean age of the patients was 53.3 ± 17.6 years, 72 patients (14% had health care-associated infection, and 48 (9% experienced failure of initial antibiotic therapy. Failure of initial antibiotic therapy was associated with increased costs and morbidity. After adjustment for covariates, patients with unsuccessful initial therapy received an additional 2.9 days of parenteral antibiotic therapy, were hospitalized for an additional 5.3 days, and incurred $3,287 in additional inpatient charges. Independent risk factors for failure of initial antibiotic therapy were health care-associated infection, solid cancer, and APACHE II ≥13.To improve outcomes and costs in patients with community-onset cIAI, rapid assessment of health care-associated risk factors and severity of disease, selection of an appropriate antibiotic regimen accordingly, and early infection source control should be performed.

  10. Comparative pharmacoeconomics and efficacy analysis of a new antibiotic adjuvant entity and piperacillin-tazobactam for the management of intra-abdominal infections: A retrospective study

    Directory of Open Access Journals (Sweden)

    Sandip Jadhav

    2016-01-01

    Full Text Available Objective: To analyze the comparative efficacy of piperacillin-tazobactam (PIP-TAZ and ceftriaxone-sulbactam with adjuvant (CSA in the treatment of intra-abdominal infections (IAIs and to assess the costs associated with respective therapies. Methods: The present study analyzed the data collected from 94 IAI patients treated at a tertiary-care hospital. Patient characteristics, infection types, surgical procedures, antibiotic therapies, treatment durations were recorded and overall cost involved in the infections management was estimated in Indian rupee. Results: In total, 46 patients received PIP-TAZ and 48 patients received CSA. The clinical cure was seen in 39.13% patients of PIP-TAZ group and 62.50% patients of CSA group. The patients diagnosed with mixed culture (Gram-positive and negative infections, needed additional cover of clindamycin to achieve clinical success. The failure patients from PIP-TAZ group were shifted to meropenem therapy. For the patients where meropenem and CSA therapy failed, colistin was given as an additional cover. Comparative cost expenditure analysis of the two drug treatment groups revealed that, the overall treatment cost for patients cured with empirical PIP-TAZ group was 51.79% more than that of CSA therapy. The strongest predictor of the increase in treatment costs was clinical failure. Similar trends were maintained for the patients cured with clindamycin additional therapy and change of therapy, with PIP-TAZ group accounting 36.11% and 39.99% more expenditure than CSA group. Conclusions: This study demonstrates that CSA has comparatively higher efficacy as compared to PIP-TAZ when used along with metronidazole in patients with different types of IAIs. Pharmacoeconomic analysis clearly shows that starting appropriate empirical antibiotic therapy has a large impact on the cost of treatment in management of IAIs and selection of CSA, can significantly reduce the cost involved in the treatment.

  11. Tumor de pequenas células redondas desmoplásico intra-abdominal: relato de caso Intraabdominal desmoplastic small round cell tumor: case report

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    Antonio Carlos Andersson Westphalen

    2001-10-01

    Full Text Available Os autores relatam um caso de tumor de pequenas células redondas desmoplásico intra-abdominal acometendo paciente do sexo masculino, de 21 anos de idade, atendido com quadro de dor abdominal, trombose do membro inferior direito e perda da função renal, de causa obstrutiva. A investigação demonstrou volumosa lesão abdominopélvica, sólida, bocelada, com áreas císticas internas, situada posteriormente à bexiga, causando obstrução ureteral, compressão da veia ilíaca direita e oclusão parcial do reto, além de acometimento de linfonodos intra e retroperitoneais. São descritos os achados cirúrgicos, de ultra-sonografia, tomografia computadorizada e ressonância magnética, bem como aqueles do estudo macroscópico, microscopia e imuno-histoquímica.The authors report a case of intraabdominal desmoplastic small round cell tumor in a 21-year-old male patient who presented with abdominal pain, right lower limb thrombosis and obstructive loss of renal function. Initial investigation showed a large lobulated intraabdominal soft tissue mass with internal cystic cavities, located posteriorly to the bladder and causing obstruction of ureteral flow, compression of the right iliac vein and partial occlusion of the rectum. Involvement of intraperitoneal and retroperitoneal nodes was also seen. Ultrasound, computed tomography and magnetic resonance imaging findings, as well as surgical and histopathology macroscopical, microscopical and immunohistochemistry findings are described.

  12. [Influence of mydocalm on the degree of intra-abdominal hypertension and local blood circulation in the intestinal wall in experiment].

    Science.gov (United States)

    Sapegin, V I; Sapegin, I D; Il'chenko, F N

    2014-01-01

    The effect of mydocalm (tolperison, 5 mg/kg single dose) on the dynamics of intra-abdominal hypertension (IAH), blood circulation regulation, and oxygen balance in the tissues of intestinal wall were studied in acute experiments on rabbits. Using a special stand of original design, the initial IAH level was modeled at 200 mm H2O with the subsequent stopping of further receipt of liquid during 3 hours in an elastic container in the abdominal cavity. During 3-h observation without drug administration, no changes in IAH due to the tone of muscles of the frontal abdominal wall takes place, but there is progressive deceleration of local blood flow (-35.33 + 0.99%, p < 0.01), suppressed dilation (-20.02 + 0.54%, p < 0.01) and constriction (-60.45 + 1.17%, p < 0.01) reactivity of vessels, and decreased oxygen tension (-47.18 + 0.75%, p < 0.01) in the intestinal wall at the end of experiment. The introduction of mydocalm reduces the tone of muscles of the frontal abdominal wall, which leads to a decrease in IAH (maximum effect after 1.5 hours, -20.81 + 0.84%, p < 0.01) and prevents decrease in the local blood flow (-26.77 + 0.41%, p < 0.01), suppression of dilation (-16.51 + 0.34%, p < 0.01) and constriction (-37.85 + 0.61%, p < 0.01) reactivity of vessels, and reduction in oxygen tension (-36.60 + 1.18%, p < 0.01) at the end of experiment. The administration of mydocalm can extend the limits of application of a conservative therapy for patients with IAH and to improve the results.

  13. [The value of postoperative C-reactive protein in predictive diagnosis of postoperative intra-abdominal septic complications for patients with Crohn disease].

    Science.gov (United States)

    Li, Y; Zhu, W M; Gong, J F; Guo, Z; Cao, L

    2016-08-01

    To analyze the value of postoperative C-reactive protein (CRP) in predictive diagnosis of postoperative intra-abdominal septic complications (IASC) for patients with Crohn disease (CD). Clinical data of patients with CD received intestinal resection and anastomosis surgery at Research Institute of General Surgery, Jinling Hospital from January 2011 to January 2015 were analyzed. Patients were divided into two groups by whether suffer from IASC 1 month after surgery, including IASC group and no-IASC group. Propensity score matching method was used to match the general clinical data. A total of 54 patients were analyzed, including IASC 17 cases, no-IASC 37 cases. Postoperative CRP at 1-day and 3-day were compared between the two groups using t test. Receiver operator characteristic (ROC) cure was used to analyze the value of postoperative CRP in predictive diagnosis of IASC. IASC group had higher levels of CRP at 1-day ((78±13) mg/L vs. (54±19) mg/L, t=4.633, P=0.000) and 3-day ((103±19) mg/L vs. (69±21) mg/L, t=5.859, P=0.000) after surgery than no-IASC group. ROC analysis showed that the CRP 3-day after surgery cut-off point value of 81.45 mg/L, as used for the predictive diagnosis of IASC, provided a sensitivity of 94.1%, a specificity of 82.9%, an area under the curve of 0.90, better than CRP 1-day after surgery. Postoperative CRP can be used as a predictive diagnosis of IASC for CD patients received intestinal resection and anastomosis surgery.

  14. One-stage laparoscopic orchiopexy for intra-abdominal testes%腹腔镜下高位隐睾Ⅰ期下降固定术的探讨

    Institute of Scientific and Technical Information of China (English)

    郝春生; 叶辉; 李龙; 白冬升; 李旭; 管考评

    2009-01-01

    目的 探讨高位隐睾腹腔镜I期固定术的应用.方法 回顾性研究2005年1月至2008年3月间所收治的35例高位隐睾患儿,年龄1~15岁,平均年龄2.6岁.左侧20例,右侧12例,双侧3例,总计38侧.根据睾丸位置高低,腹腔镜辅助下行精索松解I期睾丸固定或Fowler-Stephens(FS)I期睾丸固定手术.结果 在35例(38侧)患儿中,有33例(34侧)为低位腹腔内隐睾(89.5%),2例4侧(10.5%)为腹腔内高位隐睾.其中的34侧腹腔内低位睾丸及1侧高位睾丸经过松解精索血管或FSI期手术,将睾丸固定于患侧阴囊内;3侧高位睾丸经过松解精索血管I期将睾丸固定于外环口外与阴囊上极之间.手术成功率为92.1%.随访3~24个月(平均6个月),100%睾丸血运好无萎缩.结论 高位隐睾腹腔镜Ⅰ期固定手术效果良好,手术微创.%Objective The aim of this study was to explore the application in one-stage laparoscopic orchiopexy for intra-abdominal testes.Methods Between January of 2005 and January of 2008,35 patients with intra-abdominal testes were retrospectively analyzed.The mean age was 2.6 years (ranging from 1 to 15 years).Twenty cases were on the left side,12 on the right side and 3 on both sides.According to the position of testes in abdomen,one-stage laparoscopic orchiopexy or one-stage Fowler-Stephens orchiopexy was performed.Results Among 35 patients(38 testicular units),33 cases(34 testicular units)were diagnosed as low intra-abdominal testes(89.5%),4 testicular units (10.5%)as high.Twenty-four cases with lOW intra-abdominal testes and 1 with high intra-abdominal testes underwent one-stage orchiopexy(including 2 Fowler-Stephens procedures).Three intra-abdominal testes in high position were fixed in the area between external inguinal ring and upper scrotum..All patients were followed up for 1 to 30 months(mean 6 months),whose testes had good blood supply without atrophy.The testes of 35 patients(92.1%)were in an acceptable scrotal position

  15. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements.

    Science.gov (United States)

    Steinlauf, A F; Garcia-Tsao, G; Zakko, M F; Dickey, K; Gupta, T; Groszmann, R J

    1999-04-01

    The hepatic venous pressure gradient (HVPG) is becoming increasingly used clinically. It is useful in the differential diagnosis of portal hypertension and provides a prognostic index in cirrhotic patients. Performance of serial measurements has been shown to be useful in guiding pharmacological therapy of portal hypertension and variceal hemorrhage. The technique is safe to perform; however, many patients are anxious and reluctant to undergo serial measurements. The effects of sedatives on portal pressure measurements have not yet been defined. The objective of this study was to evaluate the effects of midazolam on the HVPG. Twenty patients with compensated cirrhosis were included in this prospective, double-blind study. The HVPG was determined by subtracting the free hepatic venous pressure (FHVP) from the wedged hepatic venous pressure (WHVP). Patients were randomized to receive either placebo, 0.02 mg/kg midazolam, or 0.03 mg/kg midazolam, administered intravenously over 3 minutes. Immediately after drug administration and every 3 minutes thereafter, for a total of 30 or 40 minutes, measurements were repeated. Three hours later, patients were asked to state whether the sedative affected their state of comfort/relaxation. The effects of both doses of midazolam on HVPG did not differ significantly from those of placebo. Furthermore, neither dose of midazolam induced significant changes in HVPG as compared with baseline values. However, higher-dose midazolam (0.03 mg/kg) was associated with significant reductions in FHVP from baseline and a tendency for a reduction in WHVP. Both doses significantly increased patient comfort and relaxation during the test. Midazolam, used at a dose of 0.02 mg/kg, is effective in increasing patient comfort and relaxation during hepatic venous pressure measurements, without significantly affecting pressures (HVPG, WHVP, or FHVP). It is therefore an acceptable option for patients undergoing serial hepatic venous pressure measurements.

  16. 腹腔高压对重症急性胰腺炎病人预后的影响与机制初探%Effects on prognosis and mechanism of intra-abdominal hypertension in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    李磊; 闵东; 武钧; 张泓; 张如愿; 瞿洪平; 汤耀卿

    2013-01-01

    目的:分析腹腔高压对重症急性胰腺炎(severe acute pancreatitis,SAP)病人脓毒血症发生率和生存率等预后指标的影响,并从胆道压力梯度分析其发病机制.方法:回顾性分析2007年1月至2008年12月间我院外科重症监护病房收治的63例SAP病人资料.根据腹腔压力水平和持续时间,分为腹腔高压(intra-abdominal hypertension,IAH)组31例和非腹腔高压(NIAH)组32例,比较两组病人的APACHEⅡ评分、发病4周内脓毒血症发生率、转手术率和生存率.进一步将IAH组病人分为胆道高压(biliary hypertation,BH)组27例和非胆道高压(NBH)组4例,比较两组病人的上述指标.结果:IAH组病人APACHEⅡ平均评分显著高于NIAH组(P=0.007).IAH组病人发病4周内脓毒血症发生率高于NIAH组(22.6%比15.6%,P=0.28),而生存率较NIAH组降低(67.7%比100%,P<0.01).入院当天NBH组与BH组病人APECHEⅡ评分差异无统计学意义.BH组病人发病4周内脓毒血症发生率、中转手术率和生存率分别为25.9%、11.1%和62.9%,NBH组病人4周内均无需手术治疗,未并发脓毒血症,且最终全部生存(P<0.01).结论:IAH是SAP病人并发脓毒血症的原因之一,胆道压力梯度被破坏可能导致感染机会增加、预后差.%Objective To compare the incidence of sepsis and the prognosis of severe acute pancreatitis(SAP) in patients with the intra-abdominal hypertension (IAH),and to explore whether the loss of biliary pressure gradient is the mechanisms of sepsis resulting from the SAP.Methods We retrospectively enrolled sixty-three patients with SAP who were admitted to the surgical intensive care unit during Jan 2007 to Dec 2008.According to IAH and the duration,the subjects were divided into IAH group and non-IAH (NIAH) group (31 vs.32).The clinical and prognosis data were collected.The APACHE Ⅱ score on admission,the first 4 weeks sepsis and operation rates,and survival rates were compared between the two groups

  17. Abdominal Compartment Syndrome: pathophysiology and definitions

    OpenAIRE

    Cheatham Michael L

    2009-01-01

    Abstract "Intra-abdominal hypertension", the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome", the development of pressure-induced organ-dysfunction and failure, have been increasingly recognized over the past decade as causes of significant morbidity and mortality among critically ill surgical and medical patients. Elevated intra-abdominal pressure can cause significant impairment of cardiac, pulmonary, renal, gastrointestinal, hepatic, and central nervous ...

  18. Ovariectomy and overeating palatable, energy-dense food increase subcutaneous adipose tissue more than intra-abdominal adipose tissue in rats

    Directory of Open Access Journals (Sweden)

    Gloy Viktoria

    2011-05-01

    Full Text Available Abstract Background Menopause is associated with increased adiposity, especially increased deposition of intra-abdominal (IA adipose tissue (AT. This differs from common or 'dietary' obesity, i.e., obesity apparently due to environmentally stimulated overeating, in which IAAT and subcutaneous (S AT increase in similar proportions. The effect of menopause on adiposity is thought to be due to the decreased secretion of ovarian estrogens. Ovariectomy in rats and other animals is a commonly used model of menopause. It is well known that ovariectomy increases adiposity and that this can be reversed by estradiol treatment, but whether ovariectomy selectively increases IAAT has not been measured directly. Therefore, we used micro-computed tomography (microCT to investigate this question in both chow-fed and dietary-obese rats. Methods Ovariectomized, ovariectomized and estradiol treated, and sham-operated (intact rats were fed chow or chow plus Ensure (Abbott Nutrition; n = 7/group. Total (T AT, IAAT and SAT were measured periodically by microCT. Regional distribution of AT was expressed as IAAT as a percentage of TAT (%IAAT. Excesses in these measures were calculated with respect to chow-fed intact rats to control for normal maturational changes. Chemical analysis of fat was done in chow-fed intact and ovariectomized rats at study end. Data were analyzed by t-tests and planned comparisons. Results Body mass, TAT, total fat mass, fat-free body mass, and %IAAT all increased in chow-fed intact rats during the 41 d study. In chow-fed rats, ovariectomy increased excess body mass, TAT, fat mass, fat-free body mass, and SAT, but had little effect on IAAT, in chow-fed rats, leading to a decrease in %IAAT. Ensure feeding markedly increased SAT, IAAT and TAT and did not significantly affect %IAAT. Ovariectomy had similar effects in Ensure-fed rats as in chow-fed rats, although less statistically reliable. Estradiol treatment prevented all the effects of

  19. Comparative evaluation of adhesion formation, strength of ingrowth, and textile properties of prosthetic meshes after long-term intra-abdominal implantation in a rabbit.

    Science.gov (United States)

    Novitsky, Yuri W; Harrell, Andrew G; Cristiano, Joseph A; Paton, B Lauren; Norton, H James; Peindl, Richard D; Kercher, Kent W; Heniford, B Todd

    2007-06-01

    Effective laparoscopic ventral herniorrhaphy usually mandates the use of an intraperitoneal prosthetic. Visceral adhesions and changes in textile characteristics of prosthetics may complicate repairs, especially long-term. The aim of this study was to compare the adhesion formation, tissue ingrowth, and textile characteristics one year after intra-abdominal placement of the commonly used prosthetic meshes. Forty (4 x 4 cm) meshes were sutured using absorbable suture to an intact peritoneum in 20 New Zealand white rabbits. The study groups included: polypropylene (PP) [Marlex; C.R. Bard Inc, Cranston, NJ], expanded polytetrafluoroethylene (ePTFE) [DualMesh; WL Gore, Flagstaff, AZ], ePTFE and PP (ePTFE/PP) [Composix, C.R. Bard Inc], reduced weight PP and oxidized regenerated cellulose (rPP/C) [Proceed; Ethicon, Inc, Somerville, NJ]. The meshes were explanted after one year. Adhesions were scored as a percentage of explanted biomaterials' affected surface area. Prosthetic shrinkage was calculated. The strength of incorporation and mesh compliance were evaluated using differential variable reluctance transducers. Mesh ingrowth was measured as the load necessary to distract the mesh/tissue complex. Mesh compliance was calculated as the change in linear displacement of the sensors due to applied load. The groups were compared using Student's t-test and Fisher's exact test. ePTFE had significantly less adhesions (0%) than both ePTFE/PP (40%) and PP (80%) groups (P < 0.001). The mean area of adhesions for the rPP/C (10%) and the ePTFE/PP (14%) groups was less than that for the PP group (40%) (P = 0.02). Prosthetic shrinkage was greatest in the ePTFE (32%) group than in any other group (P = 0.001). There were no differences in mesh incorporation between the groups. At explantation, mesh compliance in the ePTFE group was superior to other meshes (P < 0.0001). The rPP/C mesh induced the smallest change in the compliance of the tissue adjacent to the mesh (P = 0

  20. Comparison of Three-Dimensional (3D) Conformal Proton Radiotherapy (RT), 3D Conformal Photon RT, and Intensity-Modulated RT for Retroperitoneal and Intra-Abdominal Sarcomas

    Energy Technology Data Exchange (ETDEWEB)

    Swanson, Erika L. [Department of Radiation Oncology, University of Florida, Gainesville, Florida (United States); Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org [Department of Radiation Oncology, University of Florida, Gainesville, Florida (United States); University of Florida Proton Therapy Institute, Jacksonville, Florida (United States); Louis, Debbie; Flampouri, Stella; Li, Zuofeng [University of Florida Proton Therapy Institute, Jacksonville, Florida (United States); Morris, Christopher G.; Paryani, Nitesh [Department of Radiation Oncology, University of Florida, Gainesville, Florida (United States); Slopsema, Roelf [University of Florida Proton Therapy Institute, Jacksonville, Florida (United States)

    2012-08-01

    Purpose: To compare three-dimensional conformal proton radiotherapy (3DCPT), intensity-modulated photon radiotherapy (IMRT), and 3D conformal photon radiotherapy (3DCRT) to predict the optimal RT technique for retroperitoneal sarcomas. Methods and Materials: 3DCRT, IMRT, and 3DCPT plans were created for treating eight patients with retroperitoneal or intra-abdominal sarcomas. The clinical target volume (CTV) included the gross tumor plus a 2-cm margin, limited by bone and intact fascial planes. For photon plans, the planning target volume (PTV) included a uniform expansion of 5 mm. For the proton plans, the PTV was nonuniform and beam-specific. The prescription dose was 50.4 Gy/Cobalt gray equivalent CGE. Plans were normalized so that >95% of the CTV received 100% of the dose. Results: The CTV was covered adequately by all techniques. The median conformity index was 0.69 for 3DCPT, 0.75 for IMRT, and 0.51 for 3DCRT. The median inhomogeneity coefficient was 0.062 for 3DCPT, 0.066 for IMRT, and 0.073 for 3DCRT. The bowel median volume receiving 15 Gy (V15) was 16.4% for 3DCPT, 52.2% for IMRT, and 66.1% for 3DCRT. The bowel median V45 was 6.3% for 3DCPT, 4.7% for IMRT, and 15.6% for 3DCRT. The median ipsilateral mean kidney dose was 22.5 CGE for 3DCPT, 34.1 Gy for IMRT, and 37.8 Gy for 3DCRT. The median contralateral mean kidney dose was 0 CGE for 3DCPT, 6.4 Gy for IMRT, and 11 Gy for 3DCRT. The median contralateral kidney V5 was 0% for 3DCPT, 49.9% for IMRT, and 99.7% for 3DCRT. Regardless of technique, the median mean liver dose was <30 Gy, and the median cord V50 was 0%. The median integral dose was 126 J for 3DCPT, 400 J for IMRT, and 432 J for 3DCRT. Conclusions: IMRT and 3DCPT result in plans that are more conformal and homogenous than 3DCRT. Based on Quantitative Analysis of Normal Tissue Effects in Clinic benchmarks, the dosimetric advantage of proton therapy may be less gastrointestinal and genitourinary toxicity.

  1. Molecular characteristics of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae causing intra-abdominal infections from 9 tertiary hospitals in China.

    Science.gov (United States)

    Liao, Kang; Chen, Yili; Wang, Menghe; Guo, Penghao; Yang, Qiwen; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Wang, Yong; Wu, Anhua; Feng, Xianju; Luo, Yanping; Hu, Zhidong; Chu, Yunzhuo; Chen, Shulan; Cao, Bin; Su, Jianrong; Gui, Bingdong; Duan, Qiong; Zhang, Shufang; Shao, Haifeng; Kong, Haishen; Xu, Yingchun

    2017-01-01

    Recently, the emergence of multidrug-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has raised considerable concern regarding the appropriate treatment of intra-abdominal infections (IAIs). In this study, we investigated the molecular characteristics of ESBL among clinical isolates of Escherichia coli and Klebsiella pneumoniae causing IAIs and their pattern of antimicrobial resistance, which can provide useful information about the epidemiology and risk factors associated with these infections. One hundred sixty-seven E.coli and 47 K. pneumoniae ESBL-producing strains causing IAIs were collected from 9 hospitals in China, during 2012 and 2013. The antimicrobial susceptibility profile of these strains was determined. Polymerase chain reaction and sequencing were performed to identify genes for β-lactamase (blaTEM, blaSHV, blaOXA-1-like, and blaCTX-M). The isolates were also analyzed by pulsed-field gel electrophoresis (PFGE). In 167 ESBL-producing E. coli strains, 104 strains (62.3%) were positive for CTX-M, and 9 strains (5.39%) were positive for SHV. Among the 47 K. pneumoniae strains, 35 strains (74.5%) were positive for SHV-2a, 12 strains (25.5%) were positive for CTX-M. No TEM-type and OXA-1-like strain was detected among all the ESBL-producing strains. Regarding the CTX-M-positive E. coli and K. pneumoniae strains, CTX-M-15 was the most common genotype in E. coli and K. pneumoniae strains, accounting for 28.7% and 17.0%, respectively, followed by CTX-M-55 accounting for 16.2% and 2.13%, respectively; the remaining genotypes included CTX-M-123 and CTX-M-82. PFGE showed that E.coli and K. pneumoniae ESBL-producing strains causing IAIs were diverse and that emerging resistance may not be due to the dissemination of national clones. The present study revealed that in ESBL-producing strains causing IAIs in China, the most common genotype for E.coli was CTX-M-15 and for K. pneumoniae was SHV-2a. However, there was a

  2. Optimized surgical space during low-pressure laparoscopy with deep neuromuscular blockade

    DEFF Research Database (Denmark)

    Staehr-Rye, Anne K; Rasmussen, Lars S; Rosenberg, Jacob;

    2013-01-01

    Laparoscopic cholecystectomy (LC) can be performed using low intra-abdominal pressure (space conditions using either deep, continuous muscle relaxation or moderate blockade during low-pressure (8 mm......Hg) LC. We hypothesized that a deep neuromuscular block would be associated with a higher proportion of optimal surgical space conditions....

  3. Gall overflow and intra-abdominal flushing in laparoscopic cholicystectomy%腹腔镜胆囊切除术中胆汁外溢与腹腔冲洗

    Institute of Scientific and Technical Information of China (English)

    童铭武; 仇明

    2001-01-01

    Objective:To study the causes and preventive methods ofgallbladder breakage and flow of gall into abdomen in laparoscopic cholecystectomy(LC) and to analyze relevant intra-abdominal flushing.Methods:Eighteen cases with intra-abdominal flushing and 34 cases without intra-abdominal flushing among the 52 cases of flow of bile into abdomen were observed.Results:Five cases of fever or lower abdominal disorder appear in the flushing group and 2 cases in the non-flushing group(accounting for 27.78% and 5.88% respectively).Comparison of the two groups indicates that the proportion of adverse effects in the non-flushing group is lower that in the flushing group(P<0.05).There is no postoperative infection in the non-flushing group.Conclusions:The traditional indiscriminate choice of intra-abdominal flushing for bile overflow shall be abandoned and the flushing with small-amount liquid for many times and for different locations while changing the position of the body shall be adopted for the patients with infected bile,with flow of sand-like thick bile or with bleeding which affects visual field.%目的:探讨腹腔镜胆囊切除术(LC)中胆囊破损、胆汁溢入腹腔的原因和预防及腹腔冲洗的选择与方法。方法:52例胆汁外溢中,18例腹腔冲洗,34例不冲洗。结果:冲洗组术后出现发热或下腹不适5例(27.78%),非冲洗组2例(5.88%)。全组均无腹腔残余感染发生。结论:摒弃传统对所有胆汁外溢病例不加选择进行腹腔冲洗的做法,建议选择性地对感染性胆汁、泥沙状稠厚胆溢或伴有出血影响术野者,选用改变体位的少量、多次、多部位冲洗法。

  4. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930140 Hepatocyte stimulator peptide and itsclinical significance in viral hepatitis.ZHOUWeiping(周卫平),et al.Instit Viral Hepatitis,Chongqing Med Univ,630010.Chin J InternMed 1992;31(10):626-628.Hepatocyte stimulator peptide(HSP)is anewly developed hepatic stimulator substance.Its monoclonal antibodies have been obtained inour laboratory.In this study,HSP was deter-mined in the sera of 315 subjects including pa-

  5. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    2010349 Relationships between serum hepatitis B virus load in mothers,free maternal DNA in peripheral blood of newborns and hepatitis B virus infection of newborns. WEI Junni(魏俊妮),et al. Dept Epidemiol,Shanxi Med Univ,Taiyuan 030001. Chin J Infect Dis 2010;28(5):297-300. Objective To study the relationships between serum hepatitis B virus (HBV) DNA level

  6. Association between intra-abdominal fat volume and waist circumference measured at the umbilicus level%经脐水平测定腹围与腹内脂肪体积关系的研究

    Institute of Scientific and Technical Information of China (English)

    林寰东; 颜红梅; 饶圣祥; 姚秀忠; 高鑫

    2012-01-01

    目的 比较临床常用的3种腹围测量方法与CT测定的腹内脂肪体积的关系,探讨最能反映腹内脂肪堆积程度的腹围测量方法和临床应用价值.方法 对147例18岁以上经年龄和性别匹配的成年人进行身高、体重和臀围测量,分别采用髂嵴上缘水平(WC1)、肋骨下缘和髂嵴上缘连线中点水平(WC2)和脐水平( WC3)测量腹围,与CT测量的腹内脂肪体积进行比较.结果 男性腹内脂肪体积高于女性[(1 236.0±608.4对931.0±665.0)cm3,P<0.01].相关性分析显示WC1 (r=0.634),WC2(r =0.677)和WC3(r=0.712)均与腹内脂肪体积呈正相关(均P<0.01),经性别、体重或体重指数校正后,WC3(r分别为0.488和0.432)与腹内脂肪体积的相关性优于WC1(r分别为0.347和0.293)和WC2(r分别为0.424和0.365).多元逐步线性回归分析显示WC2和WC3均与腹内脂肪体积独立相关,其中以WC3相关性最强(β=0.270,R2C=0.504,P<0.01).结论 经髂嵴上缘水平、肋骨下缘与髂嵴上缘连线中点水平以及经脐水平腹围均能反映腹内脂肪含量,其中经脐水平测量腹围是简便易行、更好地反映腹内脂肪体积的方法.%Objective To explore the best measurement of waist circumference related with intra-abdominal fat volume evaluated by CT scan.Methods Height,weight,and hip circumference were measured among 147 subjects aged over 18 years old.Waist circumference was measured at 3 different levels:the upper brim of the iliac crest ( WC1 ),the midpoint between costal brim and iliac crest ( WC2 ),and the umbilicus ( WC3 ).The intra-abdominal fat volume was evaluated by CT scan.Results Intra-abdominal fat volume was significantly higher in men than in women [ ( 1 236.0±608.4 vs 931.0±665.0)cm3,P<0.01 ].Correlation analysis showed that WC1 ( r =0.634),WC2( r=0.677),and WC3 (r =0.712)were positively correlated with intra-abdominal fat volume ( all P<0.01 ).Partial correlation analysis adjusted by gender,weight,or body mass index

  7. Study of direct percutaneous Pig-tail drainage tube for intra-abdominal abscess under CT guidance%CT引导下应用直接穿刺型猪尾巴导管组引流腹腔脓肿

    Institute of Scientific and Technical Information of China (English)

    孟宪平; 朱建新; 顾娅婷; 谢旭刚; 陈则君; 王林

    2013-01-01

    Objective To evaluate the safety and efficacy of direct percutaneous Pig-tail drainage tube for intra-abdominal abscess under CT guidance.Methods Seven cases of postoperative secondary intra-abdominal abscess were implanted with direct percutaneous Pig-tail drainage tube under CT guidance.Results Nine drainage tubes were placed.Two abscesses were deep-positioned and near the spleen,pancreas,colon and other important organs,so that trocar,guide wire and dilator were used before Pig-tail drainage tube.The other 5 cases were administered direct percutaneous pig-tail drainage tube.One postoperative patient with colon cancer was operated after 3days drainage due to a large fistulae.The other 6 cases were drained for 5-14 days with an average of 9 days.Body temperatures got normal within 2 days.Six patients were healed.Conclusion The usage of CT guided direct percutaneous Pig-tail drainage tube for postoperative secondary intra-abdominal abscess is safe,minimal invasive,accurate and efficient.%目的 探讨CT引导下应用直接穿刺型猪尾巴导管组引流腹腔脓肿的疗效及安全性.方法 对7例术后继发腹腔脓肿的患者行CT引导下直接穿刺型猪尾巴导管组置管引流.结果 7例患者均一次性置管成功,共放置引流管9根.2例因脓肿位置较深,置管路径邻近脾脏、胰腺和结肠等重要器官,于应用套管针、导丝、逐步扩张器后,再置下猪尾巴导管引流;余5例应用直接穿刺型猪尾巴导管组引流.1例结肠癌术后瘘口较大,引流3d后行再次手术治疗.其余6例引流时间为5~14d,平均9d,体温在2d内恢复正常,均治愈出院.结论 CT引导下应用直接穿刺型猪尾巴导管组引流术后继发腹腔脓肿安全、微创、精确,疗效确切.

  8. The use of body circumferences for the prediction of intra-abdominal fat in obese women with polycystic ovary syndrome El uso de circunferencias corporales para la predicción de la grasa intra-abdominal en mujeres obesas con el síndrome del ovario poliquístico

    Directory of Open Access Journals (Sweden)

    F. Rodrigues de Oliveira Penaforte

    2012-10-01

    Full Text Available Introduction: Computerizd tomography (CT is the gold standard for the evaluation of intra- (IAF and total (TAF abdominal fat; however, the high cost of the procedure and exposure to radiation limit its routine use. Objective: To develop equations that utilize anthropometric measures for the estimate of IAF and TAF in obese women with polycystic ovary syndrome (PCOS. Methods: The weight, height, BMI, and abdominal (AC, waist (WC, chest (CC, and neck (NC circumferences of thirty obese women with PCOS were measured, and their IAF and TAF were analyzed by CT. Results: The anthropometric variables AC, CC, and NC were chosen for the TAF linear regression model because they were better correlated with the fat deposited in this region. The model proposed for TAF (predicted was: 4.63725 + 0.01483 x AC - 0.00117 x NC - 0.00177 x CC (R² = 0.78; and the model proposed for IAF was: IAF (predicted = 1.88541 + 0.01878 x WC + 0.05687 x NC -0.01529 x CC (R²=0.51. AC was the only independent predictor of TAF (p Introducción: La tomografia computarizada (TC es el estándar de oro para la evaluación de la grasa intra-abdominal (GIA y abdominal total (GAT, pero los altos costos y la exposición a la radiación limitan su uso rutinario. Objetivo: Desarrollar ecuaciones para la estimación de la GIA y la GAT en mujeres obesas con el sindrome del ovario poliquistico, utilizando medidas antropométricas. Métodos: Se evaluó el peso, la altura, el IMC y las circunferencias abdominal (CA, cintura (CC, pecho (CP y cuello (Ccu de 30 mujeres obesas con SOP. La GIA y GAT fueron analizados por la TC. Resultados: El modelo propuesto fue: GAT = 4,63725 + 0,01483 x CA - 0.00117 x CCu - 0,00177 x CP (R² = 0,78; y para la GIA fue: GIA = 1, 88541 + 0, 01878 x CC + 0,05687 x CCu - 0,01529 x CP (R² = 0,51. La CA fue La única variable predictora independiente de la GAT (p < 0,01. Conclusión: Las equaciones propuestas correlacionaronse bien con el valor real, medido a trav

  9. Hepatitis

    Science.gov (United States)

    ... inflammation of the liver.” This inflammation can be caused by a wide variety of toxins, drugs, and metabolic diseases, as well as infection. There are at least 5 hepatitis viruses. Hepatitis A is contracted when a child eats food or drinks water that is contaminated with the virus or has ...

  10. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970349 Primary structure and variability of partialsequences in nonstructural gene 5 region of hepatitis Gvirus, CHANG Jinhong(常锦红), et al. Hepatol Instis,People’s Hosp, Beijing Med Univ, Beijing, 100044. NatlMed J China 1997; 77(3): 178-182. Objective: To sequence partial genome of hepatitis G

  11. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009209 Effects of chronic hepatitis B virus infection on human hepatic cytochrome P450 2C9.ZHO Fuping(周福平),et al.Dept Infect Dis,Shanghai Changzheng Hosp,Shanghai 200003.Chin J Infect Dis,2009;27(2):94-98.

  12. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920691 The determination of serum hepa-titis B virus DNA by polymerase chain rea-ction in hepatitis B patients treated withalpha-interferon. XU. Jianye(徐建业), et al.Centr Lab, Chongqing Cancer Instit, 630030.Chin J Intern Med, 1992; 31(5): 278-280. To clarify the status of HBV in serum of

  13. In Vitro Activity of Ceftazidime-Avibactam against Isolates in a Phase 3 Open-Label Clinical Trial for Complicated Intra-Abdominal and Urinary Tract Infections Caused by Ceftazidime-Nonsusceptible Gram-Negative Pathogens.

    Science.gov (United States)

    Stone, Gregory G; Bradford, Patricia A; Newell, Paul; Wardman, Angela

    2017-02-01

    The in vitro activity of ceftazidime-avibactam was evaluated against 341 Gram-negative isolates from 333 patients in a randomized, phase 3 clinical trial of patients with complicated urinary tract or intra-abdominal infections caused by ceftazidime-nonsusceptible pathogens (NCT01644643). Ceftazidime-avibactam MIC90 values against Enterobacteriaceae and Pseudomonas aeruginosa (including several class B or D enzyme producers that avibactam does not inhibit) were 1 and 64 μg/ml, respectively. Overall, the ceftazidime-avibactam activity against ceftazidime-nonsusceptible isolates was comparable to the activity of ceftazidime-avibactam previously reported against ceftazidime-susceptible isolates. (This study has been registered at ClinicalTrials.gov under identifier NCT01644643.).

  14. Variation in immune state of mesenteric lymph node induced by intra-abdominal infection in sepsis rats%脓毒症大鼠肠系膜淋巴结细胞免疫功能的变化

    Institute of Scientific and Technical Information of China (English)

    喻文立; 崔乃强; 杜洪印; 傅强; 刘洪斌; 李东华

    2009-01-01

    Objective To investigate the variation in the immune state of mesenteric lymph node (MLN) during intra-abdominal infection in sepsis rats. Methods Ninety-six male Wistar rats weighing 200-250 g were randomly divided into 2 groups (n = 48 each): sham operation group and intra-abdominal infection group. Intra-abdominal infection was induced by cecum ligation and puncture (CLP). Eight rats in each group were killed after collection of blood and MLN samples at 0 (T_0), 6 (T_1), 12 (T_2), 24 (T_3),48 (T_4) and 72 h (T_5) after CLP. Plasma concentrations of endotoxin were detected. The ratio of T helper cells 1/T helper cells 2 (Th1/Th2) and the percentage of regulatory T cells (Treg) in CD4~+ T cells in MLN were determined by flow cytometry. Results The levels of endotoxin were significantly higher at T_2, T_3, T_4 and T_5 in group CLP than in sham operation group. The ratios of Th1/Th2 were significantly higher at T_1 and lower at T_2,T_3,T_4 and T_5 in group CLP than in sham operation group, while the percentage of Treg in CD4~+ T cells was significantly lower at T_1 and higher at T_2, T_3, T_4 and T_5 in group CLP than in sham operation group. There was a negative correlation between the ratio of Th1/Th2 and the percentage of Treg (r=-0.87, P<0.05). Conclusion Cellular immune function of MLN is suppressed during intra-abdominal infection by increasing the percentage of Treg in MLN.%目的 探讨脓毒症大鼠肠系膜淋巴结细胞免疫功能的变化.方法 雄性Wistar大鼠96只,体重200~250 g,随机分为假手术组(S组)和盲肠结扎穿孔致脓毒症组(CLP组),每组48只.分别于CLP后即刻、6、12、24、48、72 h(T_(1~5))时随机取8只大鼠抽取腹主动脉血,采用鲎试剂偶氮显色法测定血浆内毒素水平;取肠系膜淋巴结组织,流式细胞仪测定肠系膜淋巴结组织Th1/Th2比值和调节性T淋巴细胞(Treg)占CD4~+细胞的比例(Treg比例).结果 与S组比较,CLP组T_(2~5)时血浆内毒素水平升高,T_1

  15. Clinical characteristics of tumor patients with complicated intra-abdominal infections%肿瘤患者腹腔复杂感染的临床特点分析

    Institute of Scientific and Technical Information of China (English)

    章宝云; 赵擎宇; 方翼; 徐大志; 顾葆春; 王慧

    2015-01-01

    目的 分析肿瘤患者腹腔复杂感染的特点 ,为医院感染预防控制提供参考依据.方法 回顾性分析2009年1月-2014年12月144例肿瘤患者腹腔感染的临床资料 ,用SPSS19 .0统计软件进行数据录入和分析.结果 144例腹腔复杂感染肿瘤患者中有114例行手术治疗 ,其余30例为化疗或放疗等非手术治疗 ;共有102例患者发展为脓毒症 ,发生率为70 .8% ,20例发展为严重脓毒症 ,发生率为13 .9% ,22例发展为脓毒症休克 ,发生率为15 .3% ,死亡25例病死率为17 .4% ;所有患者感染标本共检出病原菌253株 ,检出革兰阴性菌最高占46 .1% ,其次革兰阳性菌占29 .5% 、真菌占24 .4% .结论 肿瘤患者腹腔复杂感染以术后吻合口瘘导致的感染常见 ,且易发展为严重的腹腔感染 ,预后较差 ;感染多由肠道混合菌群感染所致 ,其耐药率较高.%OBJECTIVE To investigate the characteristics of the tumor patients with complicated intra-abdominal in-fections so as to provide guidance for control and prevention of the nosocomial infections .METHODS The clinical data of 144 tumor patients with intra-abdominal infections who were treated from Jan 2009 to Dec 2014 were retro-spectively analyzed , and the statistical analysis of data was performed with the use of SPSS 19 .0 software . RESULTS Of the 144 tumor patients with complicated intra-abdominal infections ,114 received the postoperarive treatment and the rest of 30 cases received the non-surgical procedures such as chemotherapy and radiotherapy ;102 cases developed to sepsis ,with the incidence rate of 70 .8% ;20 cases developed to severe sepsis ,with the in-cidence rate of 13 .9% ;22 cases developed to septic shock ,with the incidence rate of 15 .3% ,and 25 cases died , with the mortality rate of 17 .4% .A total of 253 strains of pathogens were isolated from all of the specimens ,of which 46 .1% were gram-negative bacteria , 29 .5% were gram-positive bacteria , and 24 .4% were

  16. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005226 Characteristics of peripheral blood T lymphocyte subsets in hepatitis B patients. FAN Zhen-ping(范振平),et al. Center Bio Ther, Instit Infect Dis, 302 Hosp Chin PLA, Beijing 100039. World Chin J Digestol, 2005;13(2): 194-197. Objective: To characterize the T-lymphocyte subsets in peripheral blood of patients with acute and chronic hepatitis B, and to explore their relations with the disease state. Methods: Peripheral blood

  17. Noninvasive Ambient Pressure Estimation using Ultrasound Contrast Agents -- Invoking Subharmonics for Cardiac and Hepatic Applications

    Science.gov (United States)

    Dave, Jaydev K.

    Ultrasound contrast agents (UCAs) are encapsulated microbubbles that provide a source for acoustic impedance mismatch with the blood, due to difference in compressibility between the gas contained within these microbubbles and the blood. When insonified by an ultrasound beam, these UCAs act as nonlinear scatterers and enhance the echoes of the incident pulse, resulting in scattering of the incident ultrasound beam and emission of fundamental (f0), subharmonic (f0/2), harmonic (n*f0; n ∈ N) and ultraharmonic (((2n-1)/2)*f0; n ∈ N & n > 1) components in the echo response. A promising approach to monitor in vivo pressures revolves around the fact that the ultrasound transmit and receive parameters can be selected to induce an ambient pressure amplitude dependent subharmonic signal. This subharmonic signal may be used to estimate ambient pressure amplitude; such technique of estimating ambient pressure amplitude is referred to as subharmonic aided pressure estimation or SHAPE. This project develops and evaluates the feasibility of SHAPE to noninvasively monitor cardiac and hepatic pressures (using commercially available ultrasound scanners and UCAs) because invasive catheter based pressure measurements are used currently for these applications. Invasive catheter based pressure measurements pose risk of introducing infection while the catheter is guided towards the region of interest in the body through a percutaneous incision, pose risk of death due to structural or mechanical failure of the catheter (which has also triggered product recalls by the USA Food and Drug Administration) and may potentially modulate the pressures that are being measured. Also, catheterization procedures require fluoroscopic guidance to advance the catheter to the site of pressure measurements and such catheterization procedures are not performed in all clinical centers. Thus, a noninvasive technique to obtain ambient pressure values without the catheterization process is clinically

  18. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008312 Impact of hepatitis B virus infection on the activity of hematopoietic stem cell.SHI Yanmei(石雁梅),et al.Dept Infect Dis,1st Clin Coll,Harbin Med Univ,Harbin 150001.Chin J Infect Dis 2008;26(4):197-201.Objective To study the impact of hepatitis B virus (HBV)infection on the activity of cord hematopoieticstem cells.Methods CD34+cells were isolated from healthy human cord blood by mini MACS.Cells were

  19. Effects of Intravenous Fluid Restriction on Hepato-Nephro Function in Elderly Patients Undergoing Intra-Abdominal Surgery%限制性输液对老年开腹手术患者肝肾功能的影响

    Institute of Scientific and Technical Information of China (English)

    江朝秀; 倪玉霞; 刘春东; 刘敬臣

    2013-01-01

    目的探讨围术期限制性输液对老年开腹手术患者肝、肾功能的影响。方法将60岁以上择期行腹部手术患者60例按随机数字表法分为两组:S组30例为常规输液组,围术期按常规补液方案进行补液;R组30例为限制性补液组,麻醉诱导前至进腹1 h内补累积缺失量的1/2,之后每15 min测1次中心静脉压( CVP),维持CVP的数值在5~7 cm H2 O,输液速度约为4 ml· kg -1· h-1。两组晶、胶体输入比均为2∶1。比较两组术前、术后24 h肝、肾功能指标以及术后并发症、胃肠道恢复时间和术后住院时间。结果 R组液体输入总量显著少于S组(P<0.05)。 R组术后血谷草转氨酶(AST)水平高于术前(P<0.05),但尚处于正常范围;两组术后血谷丙转氨酶(ALT)、尿素氮、肌酐水平与术前比较,差异均无统计学意义(P>0.05);与S组比较,R组术后并发症发生率低,胃肠道功能恢复时间快,术后住院时间短( P均<0.05)。结论老年人腹部手术中采用限制性输液方案是安全可行的。%Objective To explore the effects of intravenous fluid restriction on hepato-nephro function in eld-erly patients undergoing intra-abdominal operation .Methods Sixty patients older than 60 years who were undergoing elective operation on abdominal region were randomly divided into two groups ,30 cases in the standard group ( Group S) while 30 cases in the restriction group ( Group R) .In the standard group ,fluid management according to the stand-ard fluid administration was performed .In the restriction group ,patients were administered a half of accumulative fluid loss within one hour before anaesthesia induction , and their central venous pressure ( CVP ) , which ranged from 5 cmH2 O to 7 cmH2 O,was measured once every 15 minutes,the initial infusion rate was 4 ml· kg -1 · h -1 .The ratio of crystals input to colloid input was 2:1 in both groups .A

  20. Two clinically relevant pressures of carbon dioxide pneumooperitoneum cause hepatic injury in a rabbit model

    Institute of Scientific and Technical Information of China (English)

    Jun Li; Ying-Hai Liu; Zhan-Yong Ye; He-Nian Liu; Shan Ou; Fu-Zhou Tian

    2011-01-01

    AIM: To observe the hepatic injury induced by carbon dioxide pneumoperitoneum (CDPP) in rabbits, compare the effffects off low- and high-pressure pneumoperitoneum, and to determine the degree off hepatic injury induced by these two clinically relevant CDPP pressures. METHODS: Thirty healthy male New Zealand rabbits weighing 3.0 to 3.5 kg were randomly divided into three groups (n = 10 ffor each group) and subjected to the ffollowing to CDPP pressures: no gas control, 10 mmHg, or 15 mmHg. Histological changes in liver tissues were observed with hematoxylin and eosin staining and transmission electron microscopy. Liver ffunction was evaluated using an automatic biochemical analyzer. Adenine nucleotide translocator (ANT) activity in liver tissue was detected with the atractyloside-inhibitor stop technique. Bax and Bcl-2 expression levels were detected by western blotting. RESULTS: Liver ffunctions in the 10 mmHg and 15 mmHg experimental groups were significantly disturbed compared with the control group. Affter CDPP, the levels off alanine transaminase and aspartate transaminase were 77.3 ± 14.5 IU/L and 60.1 ± 11.4 IU/L, respectively, in the 10 mmHg experimental group and 165.1 ± 19.4 IU/L and 103.8 ± 12.3 IU/L, respectively, in the 15 mmHg experimental group, which were all higher than those off the control group (PP < 0.05). There was no difffference in pre-albumin concentration between the 10 mmHg experimental group and the control group, but the pre-albumin level off the 15 mmHg experimental group was significantly lower than that of the control group (< 0.05). No significant differences were observed in the levels off total bilirubin or albumin among the three groups. Affter 30 and 60 min off CDPP, pH was reduced (PP < 0.05) and PPaCO2 was elevated (< 0.05) in the 10 mmHg group compared with controls, and these changes were more pronounced in the 15 mmHg group. Hematoxylin and eosin staining showed no significant change in liver morphology, except ffor mild

  1. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008449 A cross-sectional survey of occult hepatitis B virus infection in HIV-infected patients. MA Jianxin(马建新), et al.Dept Infect Dis, Shanghai Public Health Clin Center, Shanghai 201508. Chin J Intern Med 2008;47(7):574-577. Objective To assess the prevalence of occult HBV infection in HIV-infected patients.

  2. Prognostic value of procalcitonin and endotoxin concentrations for intra-abdominal sepsis%降钙素原及内毒素对腹腔感染脓毒症患者预后的评估

    Institute of Scientific and Technical Information of China (English)

    黄凤楼; 刁孟元; 钱海飞; 秦保东; 仲人前

    2014-01-01

    目的:探讨降钙素原(procalcitonin,PCT)及内毒素对于腹腔感染脓毒症患者预后的评估价值。方法回顾性分析腹腔感染脓毒症86例的临床资料,根据预后(存活和死亡)和病情严重程度(局部感染、脓毒症、严重脓毒症及脓毒症休克)分组,比较不同组别之间的PCT及内毒素水平,比较PCT和内毒素同急性生理和慢性健康状况评分Ⅱ( acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)和脓毒症相关器官功能障碍评分( sepsis-related organ failure assessment score ,SO-FA)的相关性,并比较PCT、内毒素和两个临床评分系统对于患者预后的评估价值。结果根据不同评分及预后分组,各组之间PCT水平差异具有统计学意义,而内毒素水平差异无统计学意义。 PCT与两个评分系统具有很好的相关性,而内毒素与评分系统无显著相关。 PCT、内毒素、APACHE Ⅱ和SOFA评分对于预后的受试者工作特征曲线( ROC 曲线)下面积分别为85.7%、56.3%、86.7%和86.0%。结论 PCT较内毒素能更好地评价腹腔感染脓毒症患者的预后。%Objective To evaluate the value of serum procalcitonin and endotoxin concentrations in prognosis of intra -abdom-inal sepsis.Methods A total of 86 patients with intra-abdominal sepsis were included into the study .We compared PCT and endotoxin concentrations according to classification of different outcomes ( survivors and nonsurvivors ) and intra-abdominal sepsis ( local infec-tions,sepsis,severe sepsis and septic shock ).The correlation of PCT or endotoxin concentrations to APACHE Ⅱ or SOFA score were also analyzed ,then see their function in judging the prognosis of sepsis .Results Nonsurvivors had a higher level of PCT than survi-vors.PCT concentrations was higher in patients with severe sepsis and septic shock than that with sepsis or local infections .PCT concen-trations was associated with

  3. Antimicrobial susceptibility of gram-negative pathogens isolated from patients with complicated intra-abdominal infections in South African hospitals (SMART Study 2004-2009): impact of the new carbapenem breakpoints.

    Science.gov (United States)

    Brink, Adrian J; Botha, Roelof F; Poswa, Xoliswa; Senekal, Marthinus; Badal, Robert E; Grolman, David C; Richards, Guy A; Feldman, Charles; Boffard, Kenneth D; Veller, Martin; Joubert, Ivan; Pretorius, Jan

    2012-02-01

    The Study for Monitoring Antimicrobial Resistance Trends (SMART) follows trends in resistance among aerobic and facultative anaerobic gram-negative bacilli (GNB) isolated from complicated intra-abdominal infections (cIAIs) in patients around the world. During 2004-2009, three centralized clinical microbiology laboratories serving 59 private hospitals in three large South African cities collected 1,218 GNB from complicated intra-abdominal infections (cIAIs) and tested them for susceptibility to 12 antibiotics according to the 2011 Clinical Laboratory Standards Institute (CLSI) guidelines. Enterobacteriaceae comprised 83.7% of the isolates. Escherichia coli was the species isolated most commonly (46.4%), and 7.6% of these were extended-spectrum β-lactamase (ESBL)-positive. The highest ESBL rate was documented for Klebsiella pneumoniae (41.2%). Overall, ertapenem was the antibiotic most active against susceptible species for which it has breakpoints (94.6%) followed by amikacin (91.9%), piperacillin-tazobactam (89.3%), and imipenem-cilastatin (87.1%), whereas rates of resistance to ceftriaxone, cefotaxime, ciprofloxacin, and levofloxacin were documented to be 29.7%, 28.7%, 22.5%, and 21.1%, respectively. Multi-drug resistance (MDR), defined as resistance to three or more antibiotic classes, was significantly more common in K. pneumoniae (27.9%) than in E. coli (4.9%; p<0.0001) or Proteus mirabilis (4.1%; p<0.05). Applying the new CLSI breakpoints for carbapenems, susceptibility to ertapenem was reduced significantly in ESBL-positive E. coli compared with ESBL-negative isolates (91% vs. 98%; p<0.05), but this did not apply to imipenem-cilastatin (95% vs. 99%; p=0.0928). A large disparity between imipenem-cilastatin and ertapenem susceptibility in P. mirabilis and Morganella morganii was documented (24% vs. 96% and 15% vs. 92%, respectively), as most isolates of these two species had imipenem-cilastatin minimum inhibitory concentrations in the 2-4 mcg/mL range, which

  4. Study on preventive effect of volatile oil extracted from Foeniculum vulgare Mill. Seeds on postoperative intra-abdominal adhesions%小茴香挥发油对术后腹腔黏连的预防作用探讨

    Institute of Scientific and Technical Information of China (English)

    滕光寿; 王成果; 毛峰峰; 张琰; 刘兴友; 杨鹏; 石磊; 刘曼玲

    2011-01-01

    Objective To study the preventive effect of volatile oil extracted from Foeniculum vulgare Mill. Seeds on the formation of postoperative intra-abdominal adhesion. Methods Thirty-eihgt SD rats were randomly divided into sham operation group (10), operation group (14) and volatile oil treated group (14):sham operation group was only operated by abdominal incision, the rest two groups were established animal model of abdominal adhesion by rubbing the procussus vermiformis of cecum with dry sterile gauze, clamping and scuffing abdominal wall. Half of rats were separately killed on day 7 and day 14 after surgery, respectively.The degree of adhesion was evaluated according to Phillips 5-scale grade and the feature of this model. Results The scores of intra-abdominal adhesion were significantly lower in the carbachol group than those in operation group both on 7 d and 14 d(P<0.01 ). Conclusion Volatile oil extracted from Foeniculum vulgare Mill. Seeds may take a significant role in the prevention of postoperative abdominal adhesion in rats.%目的 探讨小茴香挥发油对术后腹腔黏连的预防作用.方法 将38只雄性SD大鼠按随机数字表法分为假手术组(10只)、手术对照组(14只)及小茴香挥发油组(14只).假手术组只开腹,后两组开腹后无菌干纱布摩擦大鼠盲肠蚓突部,以钳夹和刮伤腹壁法制作大鼠腹腔黏连动物模型.各组于术后第7 d、14 d各处死一半动物,参考Phillips 5级分类法并结合本模型特点进行大体黏连程度分级评分.结果 小茴香挥发油组第7 d、14 d大体黏连程度评分均明显低于手术对照组,差异有统计学意义(P<0.01).结论 小茴香挥发油可预防大鼠腹腔黏连形成.

  5. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008079 Relationship of HBV genotype and bcp and pc mutations with HBV DNA rebound after lamivudine therapy. SU Minghua(苏明华), et al. Dept Infect Dis Clin Hosp, Guangxi Med Univ, Nanning 530027. World Chin J Digestol 2007;15(33):3507-3513. Objective To investigate the relationship of HBV gene mutations with HBV DNA rebound after lamivudine therapy. Methods Twenty-seven hepatitis B patients with HBV DNA rebound after

  6. Epidemiology and trends in the antibiotic susceptibilities of Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region, 2010-2013.

    Science.gov (United States)

    Chang, Ya-Ting; Coombs, Geoffrey; Ling, Thomas; Balaji, V; Rodrigues, Camilla; Mikamo, Hiroshige; Kim, Min-Ja; Rajasekaram, Datin Ganeswrie; Mendoza, Myrna; Tan, Thean Yen; Kiratisin, Pattarachai; Ni, Yuxing; Barry, Weinman; Xu, Yingchun; Chen, Yen-Hsu; Hsueh, Po-Ren

    2017-06-01

    This study was conducted to investigate the epidemiology and antimicrobial susceptibility patterns of Gram-negative bacilli (GNB) isolated from intra-abdominal infections (IAIs) in the Asia-Pacific region (APR) from 2010-2013. A total of 17 350 isolates were collected from 54 centres in 13 countries in the APR. The three most commonly isolated GNB were Escherichia coli (46.1%), Klebsiella pneumoniae (19.3%) and Pseudomonas aeruginosa (9.8%). Overall, the rates of extended-spectrum β-lactamase (ESBL)-producing E. coli and K. pneumoniae were 38.2% and 24.3%, respectively, and they were highest in China (66.6% and 38.7%, respectively), Thailand (49.8% and 36.5%, respectively) and Vietnam (47.9% and 30.4%, respectively). During 2010-2013, the rates of ESBL-producing E. coli and K. pneumoniae isolates causing community-associated (CA) IAIs (collected 80%) causing IAIs, except for Acinetobacter calcoaceticus-baumannii (ACB) complex (30.9% for HA-IAI isolates). All of the antimicrobial agents tested exhibited <45% in vitro activity against ACB complex. Antimicrobial resistance is a persistent threat in the APR and continuous monitoring of evolutionary trends in the susceptibility patterns of GNB causing IAIs in this region is mandatory. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  7. 晚期糖基化终末产物受体在腹腔感染脓毒症中的研究进展%Recent progress of RAGE in sepsis induced by intra-abdominal infection

    Institute of Scientific and Technical Information of China (English)

    廖延年(综述); 黄骞; 黎介寿(审校)

    2015-01-01

    Sepsis caused by complicated intra-abdominal infection has a poor prognosis since the mechanism of sepsis has not been fully clarified .Research about the effect of Receptor of Advanced Glycation Endproducts on sepsis was paid extensive attention . In this paper , the construction and function of RAGE , the relationship between RAGE and inflammation and action of RAGE during sepsis are summarized .%严重腹腔感染导致的脓毒症预后不佳,与其机制的未充分阐明有关。近年来关于晚期糖基化终末产物受体( re-ceptor of advanced glycation endproducts , RAGE)在脓毒症中的作用的研究受到广泛关注。文中就RAGE的结构与功能,RAGE与炎症的关系以及RAGE在腹腔感染脓毒症中的作用等问题作一综述。

  8. Dairy Foods in a Moderate Energy Restricted Diet Do Not Enhance Central Fat, Weight, and Intra-Abdominal Adipose Tissue Losses nor Reduce Adipocyte Size or Inflammatory Markers in Overweight and Obese Adults: A Controlled Feeding Study

    Directory of Open Access Journals (Sweden)

    Marta D. Van Loan

    2011-01-01

    Full Text Available Background. Research on dairy foods to enhance weight and fat loss when incorporated into a modest weight loss diet has had mixed results. Objective. A 15-week controlled feeding study to determine if dairy foods enhance central fat and weight loss when incorporated in a modest energy restricted diet of overweight and obese adults. Design. A 3-week run-in to establish energy needs; a 12-week 500 kcal/d energy reduction with 71 low-dairy-consuming overweight and obese adults randomly assigned to diets: ≤1 serving dairy/d (low dairy, LD or ≤4 servings dairy/d (adequate dairy, AD. All foods were weighed and provided by the metabolic kitchen. Weight, fat, intra-abdominal adipose tissue (IAAT, subcutaneous adipose tissue (SAT macrophage number, SAT inflammatory gene expression, and circulating cytokines were measured. Results. No diet differences were observed in weight, fat, or IAAT loss; nor SAT mRNA expression of inflammation, circulating cytokines, fasting lipids, glucose, or insulin. There was a significant increase (P=0.02 in serum 25-hydroxyvitamin D in the AD group. Conclusion. Whether increased dairy intake during weight loss results in greater weight and fat loss for individuals with metabolic syndrome deserves investigation. Assessment of appetite, hunger, and satiety with followup on weight regain should be considered.

  9. Differential effect of gender on hepatic fat

    Energy Technology Data Exchange (ETDEWEB)

    Gilsanz, Vicente [Children' s Hospital Los Angeles, USC, Keck School of Medicine, Department of Radiology, MS 81, Los Angeles, CA (United States); Children' s Hospital Los Angeles, USC, Keck School of Medicine, Department of Pediatrics, Los Angeles, CA (United States); Chung, Sandra A. [Children' s Hospital Los Angeles, USC, Keck School of Medicine, Department of Radiology, MS 81, Los Angeles, CA (United States); Kaplowitz, Neil [USC, Keck School of Medicine, USC Research Center for Liver Disease, Los Angeles, CA (United States)

    2011-09-15

    There are discrepant data on whether men or women have a higher risk for hepatic steatosis. To examine the influence of gender on hepatic adiposity in teenagers and young adults. We measured subcutaneous abdominal fat (SAF), intra-abdominal fat (IAF) and hepatic tissue density (a surrogate measure of hepatic fat) using CT in 505 healthy teenagers and young adults (254 males, 251 females; ages 15-22.9 years). Overall, compared to men, women had higher values of SAF (P < 0.0001) but similar measures of IAF and liver tissue density (P = 0.09 and 0.92, respectively). However, when compared to overweight/obese men, overweight/obese women had strikingly similar IAF values (P = 0.85) but lower hepatic fat (P = 0.009). Multiple regression analyses indicated that, after adjusting for age and SAF, IAF independently predicted hepatic density in males (P < 0.0001) but not in females (P = 0.36). Hepatic fat increased with body mass in males from lean to overweight and obese (P < 0.0001) but not in females (P > 0.05). When compared to overweight and obese young women, overweight and obese young men are at greater risk for hepatic steatosis, independent of IAF. (orig.)

  10. Sildenafil does not influence hepatic venous pressure gradient in patients with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Jens Otto Clemmesen; Annamaria Giraldi; Peter Ott; Kim Dalhoff; Bent Adel Hansen; Fin Stolze Larsen

    2008-01-01

    AIM: To investigate if sildenafil increases splanchnic blood flow and changes the hepatic venous pressure gradient (HVPG) in patients with cirrhosis. Phosphodiesterase type-5 inhibitors are valuable in the treatment of erectile dysfunction and pulmonary hypertension in patients with end-stage liver disease. However, the effect of phosphodiesterase type-5 inhibitors on splanchnic blood flow and portal hypertension remains essentially unknown. METHODS: Ten patients with biopsy proven cirrhosis (five females/five males, mean age 54±8 years) and an HVPG above 12 mmHg were studied after informed consent. Measurement of splanchnic blood flow and the HVPG during liver vein catheterization were done before and 80 min after oral administration of 50 mg sildenafil. Blood flow was estimated by use of indocyanine green clearance technique and Fick's principle, with correction for non-steady state. RESULTS: The plasma concentration of sildenafil was 222±136 ng/mL 80 min after administration. Mean arterial blood pressure decreased from 77±7 mmHg to 66±12 mmHg, P=0.003, while the splanchnic blood flow and oxygen consumption remained unchanged at 1.14±0.71 L/min and 2.3±0.6 mmol/ min, respectively. Also the HVPG remained unchanged (18±2 mmHg vs 16±2 mmHg) with individual changes ranging from-8 mmHg to+2 mmHg. In seven patients, HVPG decreased and in three it increased. CONCLUSION: In spite of arterial blood pressure decreases 80 min after administration of the phosphodiesterase type-5 inhibitor sildenafil, the present study could not demonstrate any clinical relevant influence on splanichnic blood flow, oxygen consumption or the HVPG.

  11. Antimicrobial susceptibility and extended-spectrum beta-lactamase rates in aerobic gram-negative bacteria causing intra-abdominal infections in Vietnam: report from the Study for Monitoring Antimicrobial Resistance Trends (SMART 2009-2011).

    Science.gov (United States)

    Biedenbach, Douglas J; Bouchillon, Samuel K; Hoban, Daryl J; Hackel, Meredith; Phuong, Doan Mai; Nga, Tran Thi Thanh; Phuong, Nguyen Tran My; Phuong, Tran Thi Lan; Badal, Robert E

    2014-08-01

    Treatment options for multidrug-resistant pathogens remain problematic in many regions and individual countries, warranting ongoing surveillance and analysis. Limited antimicrobial susceptibility information is available for pathogens from Vietnam. This study determined the bacterial susceptibility of aerobic gram-negative pathogens of intra-abdominal infections among patients in Vietnam during 2009-2011. A total of 905 isolates were collected from 4 medical centers in this investigation as part of the Study for Monitoring Antimicrobial Resistance Trends. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) rates among the appropriate species were determined by a central laboratory using Clinical and Laboratory Standards Institute methods. Among the species collected, Escherichia coli (48.1% ESBL-positive) and Klebsiella pneumoniae (39.5% ESBL-positive) represented the majority (46.4%) of the isolates submitted for this study. Ertapenem MIC90 values were lowest for these 2 species at 0.12 and 0.25μg/mL and remained unchanged for ESBL-positive isolates. Imipenem MIC90 values were also the same for all isolates and ESBL-positive strains at 0.25 and 0.5μg/mL, respectively. Ertapenem MIC90 values for additional species with sufficient numbers for analysis, including Enterobacter cloacae, Proteus mirabilis, Acinetobacter baumannii, and Pseudomonas aeruginosa, were 1, 0.06, >4, and >4μg/mL, respectively. Analysis of beta-lactamases in a subset of 132 phenotypically ESBL-positive Enterobacteriaceae demonstrated that CTX-M variants, particularly CTX-M-27 and CTX-M-15, were the predominant enzymes. High resistance rates in Vietnam hospitals dictate continuous monitoring as antimicrobial inactivating enzymes continue to spread throughout Asia and globally.

  12. Surveillance of antimicrobial susceptibility of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections in China: the 2002-2009 Study for Monitoring Antimicrobial Resistance Trends (SMART).

    Science.gov (United States)

    Yang, Qiwen; Wang, Hui; Chen, Minjun; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Hu, Yunjian; Ye, Huifen; Badal, Robert E; Xu, Yingchun

    2010-12-01

    The objective of this study was to investigate the distribution and susceptibility of aerobic and facultative Gram-negative bacilli (GNB) isolated from patients with intra-abdominal infections (IAIs) in China. From 2002 to 2009, minimum inhibitory concentrations of 14 antibiotics for 3420 aerobic and facultative GNB from up to eight hospitals in six cities were determined by the broth microdilution method. Enterobacteriaceae comprised 82.9% (2834/3420) of the total isolates, with Escherichia coli (49.2%) being the most commonly isolated species followed by Klebsiella pneumoniae (17.0%), Enterobacter cloacae (5.8%) and Citrobacter freundii (2.3%). Amongst the antimicrobial agents tested, the three carbapenems (ertapenem, imipenem and meropenem) were the most active agents against Enterobacteriaceae, with susceptibility rates of 96.1-99.6% (2002-2009), 98.2-100% (2002-2009) and 99.6-100% (2002-2004), respectively, followed by amikacin (86.8-95.1%) and piperacillin/tazobactam (84.5-94.3%). Susceptibility rates of all tested third- and fourth-generation cephalosporins against Enterobacteriaceae declined by nearly 30%, with susceptibility rates of 40.2%, 39.1%, 56.3% and 51.8% in 2009 for ceftriaxone, cefotaxime, ceftazidime and cefepime, respectively. The occurrence of extended-spectrum β-lactamases increased rapidly, especially for E. coli (from 20.8% in 2002 to 64.9% in 2009). Susceptibility of E. coli to ciprofloxacin decreased from 57.6% in 2002 to 24.2% in 2009. The least active agent against Enterobacteriaceae was ampicillin/sulbactam (SAM) (25.3-44.3%). In conclusion, Enterobacteriaceae were the major pathogens causing IAIs, and carbapenems retained the highest susceptibility rates over the 8-year study period. Third- and fourth-generation cephalosporins, fluoroquinolones and SAM may not be ideal choices for empirical therapy of IAIs in China.

  13. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis☆

    Science.gov (United States)

    Ripoll, Cristina; Groszmann, Roberto J.; Garcia-Tsao, Guadalupe; Bosch, Jaime; Grace, Norman; Burroughs, Andrew; Planas, Ramon; Escorsell, Angels; Garcia-Pagan, Juan Carlos; Makuch, Robert; Patch, David; Matloff, Daniel S.

    2013-01-01

    Background/Aims A total of 213 patients with compensated cirrhosis, portal hypertension and no varices were included in a trial evaluating beta-blockers in preventing varices. Predictors of the development of hepatocellular carcinoma (HCC), including hepatic venous pressure gradient (HVPG) were analyzed. Methods Baseline laboratory tests, ultrasound and HVPG measurements were performed. Patients were followed prospectively every three months until development of varices or variceal bleeding or end of the study in 09/02. The endpoint was HCC development according to standard diagnostic criteria. Univariate and multivariate Cox regression models were developed to identify predictors of HCC. Results In a median follow-up of 58 months 26/213 (12.2%) patients developed HCC. Eight patients were transplanted and 28 patients died without HCC. Twenty-one (84%) HCC developed in patients with HCV. On multivariate analysis HVPG (HR 1.18; 95%CI 1.08–1.29), albumin (HR 0.34; 95%CI 0.14–0.83) and viral etiology (HR 4.59; 95%CI 1.51–13.92) were independent predictors of HCC development. ROC curves identified 10 mmHg of HVPG as the best cutoff; those who had an HVPG above this value had a 6-fold increase in the HCC incidence. Conclusions Portal hypertension is an independent predictor of HCC development. An HVPG >10 mmHg is associated with a 6-fold increase of HCC risk. PMID:19303163

  14. Clinical analysis of antimicrobial resistance of Gram-negative bacilli isolated from patients with intra-abdominal infections%腹腔感染革兰阴性细菌耐药性临床分析

    Institute of Scientific and Technical Information of China (English)

    田文广; 黄文祥; 贾蓓; 辛小娟; 李崇智; 郑行萍; 史方静

    2011-01-01

    Objective To investigate epidemiological characteristics of Gram-negative bacilli (GNB) isolated from patients with non-recurrent intra-abdominal infections in our hospitals from 2008 to 2010, and to analyze antimicrobial resistance of GNB to common antibiotics and ESBLs-producing ratio of GNB. Methods A total of 290 cases of GNB were isolated from patients with intra-abdominal infections from 2008 to 2010. In antimicrobial susceptibility test, agar dilution method was applied for MIC determination according to NCCLS guidelines. All the data were analyzed using WHONET 5. 4 and SPSS 13. 0. Results In the total of 290 GNB, enterobacteriaceae accounted for 82. 7% and non-fermentative bacteria accounted for 17. 93%. There were six types of common bacteria in which E. Coli accounted for 55. 3% , and the ratio of Acinetobacter baumannii complex increased apparently (7. 96%). The positive rates of ESBLs production in E. Coli and Klebsiella spp were 74. 38% and 55. 56% , respectively. E. Coli was highly sensitive to carbapenems, piperacillin/tazobaetam and amikacin, but not to the third-generation cephalosporins and cefepime. The non-ESBLs-producing Klebsiella spp was sensitive to the twelve common anti-GNB antibiotics, while ESBLs-producing Klebsiella spp was sensitive to amikacin, piperacillin/tazobaetam and carbapenems. The susceptibility rates of Pseudomonas aerltgillosa to imipenem, piperacillin/tazobaetam and amikacin were all above 90% and to cefepime and two quinolones were 80% to 90% , but the susceptibility rate to ceftazidime decreased below 80%. The drug resistance rate of Acinetobacter baumannii to carbapenems was above 80%. Multidrug resistant (MDR) strains accounted for 32% , mainly including Acinetobacter baumannii complex and Pseudomonas aerltgillosa.Eighty percent MDR strains were resistant to almost all commonly used antibiotics. Conclusion The antimicrobial resistance of GNB isolated from patients with intra-abdominal infections increases apparently

  15. Hepatic ischemia

    Science.gov (United States)

    ... or oxygen, causing injury to liver cells. Causes Low blood pressure from any condition can lead to hepatic ischemia. ... leading to reduced blood flow (vasculitis) Symptoms If low blood pressure continues for a long time, you may feel ...

  16. Postpartum intra-abdominal haemorrhage: Case report

    Directory of Open Access Journals (Sweden)

    Tubić-Pavlović Aleksandra

    2010-01-01

    Full Text Available Introduction. The most frequent cause of gynaecological haemoperitoneum is ruptured ectopic pregnancy. Haemoperitoneum after a normal vaginal delivery is rare and it is associated with high maternal mortality. Case report. A 22-year-old primipara had a normal vaginal delivery. She experinced acute abdominal pain and hypovolemic shock ten hours after the delivery and was referred to our hospital twenty one hours after the delivery. An urgent ultrasound profile was done, which revealed free fluid in pelvis and in the whole abdomen. An immediate laparotomy was done and 2 litres of blood were found within the peritoneal cavity. The uterine wall was intact. We found a haematoma on the anterior wall of rectum and livid colours of broad ligament. The peritoneal cavity was cleaned and revised. Any injury of the spleen or liver was excluded. Discussion and conclusion. Haematoperitoneum after a normal vaginal delivery is rare but life threatening to mothers. It is important to recognize this condition to avoid delay in diagnosis and treatment because of high maternal mortality. Our patient was bleeding from superficial rectal vessels. Only a few cases with undefined aetiologies have been reported in literature.

  17. Intra-abdominal benign multicystic peritoneal mesothelioma.

    OpenAIRE

    Jouvin, Ingrid; Dohan, Anthony; Gergi, P.; Pocard, Marc

    2014-01-01

    International audience; : Benign multicystic peritoneal mesotheliomas are rare: pre-operative diagnosis relies on proper imaging. The differential diagnosis includes pseudomyxoma peritonei and other peritoneal cysts. Absence of previous surgical resection offers the best chance of success when complete resection is performed in a specialized center. We report the case of a 43 year-old man with benign multicystic peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intrape...

  18. Intra-abdominal benign multicystic peritoneal mesothelioma.

    Science.gov (United States)

    Jouvin, I; Dohan, A; Gergi, P; Pocard, M

    2014-04-01

    Benign multicystic peritoneal mesotheliomas are rare: pre-operative diagnosis relies on proper imaging. The differential diagnosis includes pseudomyxoma peritonei and other peritoneal cysts. Absence of previous surgical resection offers the best chance of success when complete resection is performed in a specialized center. We report the case of a 43 year-old man with benign multicystic peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. Antimicrobial susceptibility of Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal and urinary tract infections in Asia-Pacific countries: SMART 2013-2015.

    Science.gov (United States)

    Karlowsky, James A; Hoban, Daryl J; Hackel, Meredith A; Lob, Sibylle H; Sahm, Daniel F

    2017-01-01

    Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) are responsible for increases in antimicrobial-resistant infections worldwide. We determined in vitro susceptibilities to eight parenteral antimicrobial agents using Clinical and Laboratory Standards Institute broth microdilution methodology for Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal infections (IAIs) (n=3052) and urinary tract infections (UTIs) (n=1088) in 11 Asia-Pacific countries/regions from 2013 to 2015. Amikacin (98.3, 96.4 %), imipenem (97.1, 95.5 %) and ertapenem (95.3, 93.2 %) demonstrated the highest rates of susceptibility for isolates of K. pneumoniae from IAI and UTI, respectively, whereas susceptibility to advanced-generation cephalosporins was <84 and <71 %, respectively. K. pneumoniae with an extended-spectrum β-lactamase-positive phenotype were more common in UTI (27.1 %) than IAI (16.2 %). Imipenem and amikacin were the most active agents against extended-spectrum β-lactamase-positive K. pneumoniae from IAI (95.1, 91.8 %) and UTI (94.9, 92.3 %), respectively, whereas <54 % were susceptible to piperacillin-tazobactam. Against Enterobacter spp. and P. aeruginosa, amikacin demonstrated the highest rates of susceptibility for isolates from IAI (99.7, 95.5 %) and UTI (90.9, 91.5 %), respectively. K. pneumoniae, Enterobacter spp. and P. aeruginosa from urine demonstrated lower susceptibility to levofloxacin (74.1, 81.8 and 73.8 %) than from IAI (87.6, 91.8 and 85.4 %). For A. baumannii, rates of susceptibility to all agents tested were <43 %. We conclude that the studied Gram-negative ESKAPE pathogens demonstrated reduced susceptibility to commonly prescribed advanced-generation cephalosporins, piperacillin-tazobactam and levofloxacin, while amikacin and carbapenems were the most active. Ongoing surveillance to monitor evolving resistance trends and

  20. A multicenter trial of the efficacy and safety of tigecycline versus imipenem/cilastatin in patients with complicated intra-abdominal infections [Study ID Numbers: 3074A1-301-WW; ClinicalTrials.gov Identifier: NCT00081744

    Directory of Open Access Journals (Sweden)

    Babinchak Timothy

    2005-10-01

    Full Text Available Abstract Background Complicated intra-abdominal infections (cIAI remain challenging to treat because of their polymicrobial etiology including multi-drug resistant bacteria. The efficacy and safety of tigecycline, an expanded broad-spectrum glycylcycline antibiotic, was compared with imipenem/cilastatin (IMI/CIS in patients with cIAI. Methods A prospective, double-blind, multinational trial was conducted in which patients with cIAI randomly received intravenous (IV tigecycline (100 mg initial dose, then 50 mg every 12 hours [q12h] or IV IMI/CIS (500/500 mg q6h or adjusted for renal dysfunction for 5 to14 days. Clinical response at the test-of-cure (TOC visit (14–35 days after therapy for microbiologically evaluable (ME and microbiological modified intent-to-treat (m-mITT populations were the co-primary efficacy endpoint populations. Results A total of 825 patients received ≥ 1 dose of study drug. The primary diagnoses for the ME group were complicated appendicitis (59%, and intestinal (8.8% and gastric/duodenal perforations (4.6%. For the ME group, clinical cure rates at TOC were 80.6% (199/247 for tigecycline versus 82.4% (210/255 for IMI/CIS (95% CI -8.4, 5.1 for non-inferiority tigecycline versus IMI/CIS. Corresponding clinical cure rates within the m-mITT population were 73.5% (227/309 for tigecycline versus 78.2% (244/312 for IMI/CIS (95% CI -11.0, 2.5. Nausea (31.0% tigecycline, 24.8% IMI/CIS [P = 0.052], vomiting (25.7% tigecycline, 19.4% IMI/CIS [P = 0.037], and diarrhea (21.3% tigecycline, 18.9% IMI/CIS [P = 0.435] were the most frequently reported adverse events. Conclusion This study demonstrates that tigecycline is as efficacious as imipenem/cilastatin in the treatment of patients with cIAI.

  1. Hepatic artery pseudoaneurysm after surgical treatment for pancreatic cancer: Minimally invasive angiographic techniques as the preferred treatment

    Directory of Open Access Journals (Sweden)

    Sucandy Iswanto

    2014-01-01

    Full Text Available Background: Delayed intra-abdominal bleeding related to hepatic artery pseudoaneurysm is a potentially lethal complication after pancreaticoduodenectomy for pancreatic cancer. Locally advanced tumors, which result in vessel erosion or extensive operative skeletonization, may contribute to weakness of the arterial wall. Reoperation is often technically difficult with high rate of mortality; therefore, alternative less invasive options are ideal. Aims: The study was to present an alternative endovascular treatment of a large hepatic artery pseudoaneurysm after pancreatic resection for locally advanced multicystic adenocarcinoma. Materials and Methods: Transcatheteric mesenteric angiography with deployment of detachable coils in the pseudoaneurysm sac was utilized to manage the hepatic artery pseudoaneurysm. Results: Completion angiography confirmed cessation of contrast enhancement in the pseudoaneurysm sac with preservation of normal antegrade hepatic artery flow. Conclusion: Minimally invasive angiographic technique is the preferred treatment for hepatic artery pseudoaneurysm after pancreatic resections.

  2. Risk Factors for Postoperative Intra-abdominal Septic Complications in Crohn ’s Disease%克罗恩病术后腹腔感染性并发症的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    左芦根; 朱维铭; 李毅; 龚剑峰; 曹磊; 顾立立; 李宁; 黎介寿

    2014-01-01

    Background:As postoperative intra-abdominal septic complications( IASCs)in Crohn’s disease( CD)are difficult to manage,it is of great importance to prevent this condition in CD patients after surgery. Till now,there are no large sample studies on risk factors for postoperative IASCs in CD in China. Aims:To determine the risk factors for postoperative IASCs in CD for guiding the formulation of preventive strategies. Methods:This retrospective study was based on a computerized database of CD patients who had undergone surgery for CD complications between 1999 and 2014 at Nanjing General Hospital of Nanjing Military Command,PLA. Patients were divided into IASCs group and non-IASCs group. Thirty potential variables were selected,and both univariate and multivariate( Logistic regression)analyses were performed to identify the risk factors for IASCs after surgery. Results:Seven hundred and sixteen operations were reviewed,and IASCs occurred in 41 cases(5. 7%). By univariate and multivariate analyses,IASCs were significantly associated with one stage anastomosis(OR=1. 656,95% CI:1261-3. 279),preoperative low albumin level( 10 mg/L)(OR=8. 641,95% CI:3. 376-16. 364),preoperative steroids use ≥3 months(OR=3. 785,95% CI:1. 237-4. 671)and presence of intra-abdominal abscess or infection at the time of surgery(OR=1. 784,95% CI:1. 155-3. 826). However,enterostomy(OR =0. 125,95% CI:0. 062-0. 561)and preoperative enteral nutrition ≥ 1 month( OR =0. 147,95% CI:0. 078-0. 781 ) were found to be the independent protective factors. Conclusions:Malnutrition,active CD and preoperative long-term steroids use increase the risk of postoperative IASCs in CD. Patients with these risk factors should not receive immediate surgery. If surgery is inevitable, enterostomy instead of resection and anastomosis should be the first choice. Preoperative enteral nutrition is helpful for reducing the occurrence of IASCs after surgery.%背景:克罗恩病( CD)术

  3. Effect of nutritional counselling on hepatic, muscle and adipose tissue fat content and distribution in non-alcoholic fatty liver disease

    Institute of Scientific and Technical Information of China (English)

    E Louise Thomas; Audrey E Brynes; Gavin Hamilton; Nayna Patel; Adam Spong; Robert D Goldin; Gary Frost; Jimmy D Bell; Simon D Taylor-Robinson

    2006-01-01

    AIM: To assess the effectiveness of the current UK clinical practice in reducing hepatic fat (IHCL).METHODS: Whole body MRI and 1H MRS were obtained, before and after 6 mo nutritional counselling,from liver, soleus and tibialis muscles in 10 subjects with non-alcoholic fatty liver disease (NAFLD).RESULTS: A 500 Kcal-restricted diet resulted in an average weight loss of 4% (-3.4 kg,) accompanied by significant reductions in most adipose tissue (AT)depots, including subcutaneous (-9.9%), abdominal subcutaneous (-10.2%) and intra-abdominalAT (-11.4%). Intramyocellular lipids (IMCL) were significantly reduced in the tibialis muscle (-28.2%).Decreases in both IHCL (-39.9%) and soleus IMCL (-12.2%) content were also observed, although these were not significant. Several individuals showed dramatic decreases in IHCL, while others paradoxically showed increases in IHCL content. Changes in body composition were accompanied by improvements in certain liver function tests: serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Significant correlations were found between decreases in IHCL and reductions in both intra-abdominal and abdominal subcutaneous AT. Improvements in liver function tests were associated with reductions in intra-abdominal AT,but not with changes in IHCL.CONCLUSION: This study shows that even a very modest reduction in body weight achieved through lifestyle modification can result in changes in body fat depots and improvements in LFTs.

  4. Body Fat Patterning, Hepatic Fat and Pancreatic Volume of Non-Obese Asian Indians with Type 2 Diabetes in North India: A Case-Control Study.

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    Anoop Misra

    Full Text Available To evaluate body fat patterning and phenotype including hepatic fat and pancreatic volume of non-obese (BMI: < 25 kg/m2 Asian Indians with type 2 diabetes residing in North India.Non-obese patients with type 2 diabetes (n = 93 and non-obese, normo-glycemic subjects (n = 40 were recruited. BMI, waist & hip circumferences, skinfold thickness at 8 sites, body fat, lean mass and detailed abdominal fat evaluation [total abdominal fat, total subcutaneous fat (superficial, deep, anterior, and posterior, total intra-abdominal fat (intra-peritoneal, retroperitoneal], liver span, grades of fatty liver and pancreatic volume were compared.Waist circumference, subscapular skinfolds and total truncal fat (on DEXA were higher whereas calf, total peripheral skinfolds and total leg fat (on DEXA lower in patients. Specifically, the following volumes were higher in cases as compared to controls; total abdominal fat (19.4%, total intra-abdominal fat (49.7%, intra-peritoneal fat (47.7%, retroperitoneal fat (70.7%, pancreatic volume (26.6%, pancreatic volume index (21.3% and liver span (10.8%. In cases, significant positive correlations were observed for pancreatic volume with BMI, waist and hip circumferences, W-HR, subscapular, abdominal and total truncal skinfolds, truncal, total subcutaneous, total intra-abdominal, intra-peritoneal, retroperitoneal fat depots, liver span and fatty liver.In non-obese Asian Indians with type 2 diabetes, subcutaneous and intra-abdominal obesity, including fatty liver, and pancreatic volume were higher and peripheral subcutaneous adiposity was lower than BMI matched non-diabetic subjects. Importantly, increased pancreatic volume in patients was highly correlated with multiple measures of abdominal obesity and liver fat.

  5. Delayed intra-abdominal bleeding following trans-vaginal ultrasonography guided oocyte retrieval for in vitro fertilization in patients at risk for thrombo-embolic events under anticoagulant therapy [v1; ref status: indexed, http://f1000r.es/1uf

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    Roy Mashiach

    2013-09-01

    Full Text Available We report herein, two cases of massive delayed (2 and 4 days intra abdominal hemorrhage following ovum pick-up (OPU, in patients at risk for thrombo-embolic events, who concomitantly used therapeutic doses of low molecular weight heparin (LMWH. We discuss the possible mechanisms involved in causing the aforementioned delayed bleeding, and call for re-evaluation of the presently accepted anticoagulant co-treatment regimen. These case reports should direct physicians' attention and keep them alert, while conducting IVF treatment to this subgroup of high risk patients.

  6. Delayed intra-abdominal bleeding following trans-vaginal ultrasonography guided oocyte retrieval for in vitro fertilization in patients at risk for thrombo-embolic events under anticoagulant therapy [v2; ref status: indexed, http://f1000r.es/24f

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    Roy Mashiach

    2013-10-01

    Full Text Available We report herein, two cases of massive delayed (2 and 4 days intra abdominal hemorrhage following ovum pick-up (OPU, in patients at risk for thrombo-embolic events, who concomitantly used therapeutic doses of low molecular weight heparin (LMWH. We discuss the possible mechanisms involved in causing the aforementioned delayed bleeding, and call for re-evaluation of the presently accepted anticoagulant co-treatment regimen. These case reports should direct physicians' attention and keep them alert, while conducting IVF treatment to this subgroup of high risk patients.

  7. Epidemiological evaluation of hepatic trauma victims undergoing surgery

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    Mitre Kalil

    2016-02-01

    Full Text Available Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01. The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05. Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

  8. Diagnosis and treatment of liver trauma complicated with intra-abdominal infections%肝脏外伤并发腹腔感染的分析及诊治

    Institute of Scientific and Technical Information of China (English)

    张雯雯; 何蕾; 万涛; 吕少诚; 徐明月; 刘同友; 路辉; 史宪杰

    2013-01-01

    OBJECTIVE To explore the measures for diagnosis and treatment of liver trauma complicated with intraabdominal infections so as to guide the prevention and treatment of intra-abdominal infections.METHODS We retrospectively analyzed the clinical data of 64 patients with liver trauma between Jan 2000 and Sep 2012,including 7 cases of conservative treatment and 57 cases of surgical treatment,and all the cases were treated with prevention of infections,liver protection,and nutritional support.RESULTS Of the 64 cases of patients,there were 23 cases of peritoneal infections with the infection rate of 35.9 %.No simple liver trauma patients suffered from complicating intrabdominal infection,while among the patients with gastrointestinal trauma the incidence of peritoneal infections was 85.7%,and the incidence of the patients with the AAST grading Ⅳ was 51.5%.Totally 41 strains of pathogens were isolated,among which there were 15 (36.6%) strains of Escherichia coli,10 (24.4%) strains of Enterococcus faecalis,and 8 (19.5%) strains of Enterococcus faecium,which ranked the top three species of the pathogens.Of totally 23 cases of patients with peritoneal infections,22 cases were cured with the cure rate of 95.65 %.CONCLUSION The incidence of intraabdominal infections is high in the patients with complex liver trauma,especially the patients with multi-organ trauma.The integrated treatment with micro-invasive operations on the basis of trauma-control surgery idea can effectively cure the intraabdominal infections and decrease the mortality.%目的 探讨肝脏外伤并发腹腔感染的诊治方法,以期为肝脏外伤并发腹腔感染的预防治疗起到指导作用.方法 回顾性分析医院2000年1月-2012年9月64例肝脏外伤患者的临床资料,其中7例行保守治疗,57例行手术治疗,均予预防性抗感染、保肝、营养等治疗方法.结果 64例患者中23例出现腹腔感染,感染率为35.9%,其中单纯性肝脏外伤患者无

  9. 二氧化碳气腹对妊娠大鼠妊娠结局的影响%The influence of Intra-abdominal pressure of carbon dioxide on pregnancy outcome and malformation ratio in pregnant rats

    Institute of Scientific and Technical Information of China (English)

    张颖; 苏晓峰

    2010-01-01

    Objective To study the influence of carbon dioxide pneumoperitoneum on the pregnancy outcome and newborn rat malformation in pregnancy rats. Methods SD rats were randomly divided into control group (group A and group B) and the experimental group (group C; group D; group E). There were 10 rats in each group, the general situation,abortion rate, premature delivery rate,newborn rats numbers,weights and lengths and malformation rates were recorded. Results There was no malformation in newborn rats in all groups (P > 0. 05 ). Conclusion It was safe to undergo laparoscope operation in metaphase pregnancy with low CO2 pneumoperitoneum,which has no influence on abortion rate and malformation rate.%目的 探讨妊娠中期不同二氧化碳(CO2)气腹压力及时间对大鼠流产率和仔鼠畸形率、存活个数、发育情况的影响.方法 SD大鼠随机分为对照组(A及B组)和实验组(C、D及E组),每组各10只.观察各组大鼠一般情况、气腹后流产和早产率、仔鼠个数及体质量、身长、畸形率.结果 各组均未发现仔鼠畸形,各组仔鼠体质量及身高差异无统计学意义(P>0.05).结论 妊娠中期大鼠在低CO2气腹组下行腹腔镜手术是安全的,时间越短影响越小;妊娠期腹腔镜手术易引起损伤,特别易误穿入子宫内,应注意避免.

  10. Assessment of hepatic VX2 tumors of rabbits with second harmonic imaging under high and low acoustic pressures

    Institute of Scientific and Technical Information of China (English)

    Wen-Hua Du; Wei-Xiao Yang; Xiang Wang; Xiu-Qin Xiong; Yi Zhou; Tao Li

    2003-01-01

    AIM: To investigate the possible clinical application value of second harmonic imaging under low acoustic pressure.METHODS: Six New Zealand rabbits, averaging 2.7±0.4kg, were selected and operated upon to construct hepatic VX2 tumor carrier model. Hepatic VX2 tumors were imaged with B mode Ultrasonography (US), and second harmonic imaging (SHI) under high mechanic index (1.6) and low mechanic index (0.1). Echo agent was intravenously injected through ear vein at a dose of 0.01 mL/kg under B mode US and high MI SHI, and 0.05 mL/kg under low MI SHI, and then the venous channel was cleaned with sterilized saline.All the images were recorded by magnetic optics (MO),and they were analyzed further by at least two independent experienced sonographers.RESULTS: Totally 6 hypoechoic and 3 hyperechoic lesions were found in the six carrier rabbits with a mean size about 2.1±0.4 under B mode ultrasound, they were oval or round in shape with a clear outline or a hypoechoic halo at the margin of the lesions. Contrast agent could not change the echogenicity of the lesions under B mode US and SHI under high acoustic pressure. However, it could greatly increase the real time visualization sensitivity of the lesions with SHI under low acoustic pressure.CONCLUSION: Our results suggest that contrast enhanced SHI with low MI and a bubble non-destructive method would be much more helpful than conventional SHI in our future clinical applications.

  11. Bile peritonitis due to intra-hepatic bile duct rupture.

    Science.gov (United States)

    Lochan, R; Joypaul, B V

    2005-11-14

    Generalized biliary peritonitis is a serious intra-abdominal emergency. Most of them occur due to duodenal ulcer perforation and rapidly evolve into bacterial peritonitis due to contamination by gut organisms and food. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one. We describe a rare case of biliary peritonitis due to rupture of an intra-hepatic biliary radical. Unusual causes of peritonitis do interrupt our daily routine emergency surgical experience. Rapid recognition of the presence of peritonitis, adequate resuscitation, recognition of operative findings, establishment of biliary anatomy, and performance of a meticulous surgical procedure resulted in a good outcome.

  12. Bile peritonitis due to intra-hepatic bile duct rupture

    Institute of Scientific and Technical Information of China (English)

    R Lochan; BV Joypaul

    2005-01-01

    Generalized biliary peritonitis is a serious intra-abdominal emergency. Most of them occur due to duodenal ulcer perforation and rapidly evolve into bacterial peritonitis due to contamination by gut organisms and food. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one.We describe a rare case of biliary peritonitis due to rupture of an intra-hepatic biliary radical. Unusual causes of peritonitis do interrupt our daily routine emergency surgical experience. Rapid recognition of the presence of peritonitis, adequate resuscitation, recognition of operative findings, establishment of biliary anatomy, and performance of a meticulous surgical procedure resulted in a good outcome.

  13. A prospective, multi centre, randomized clinical study to compare the efficacy and safety of Ertapenem 3 days versus Ampicillin - Sulbactam 3 days in the treatment of localized community acquired intra-abdominal infection. (T.E.A. Study: Three days Ertapenem vs three days Ampicillin-sulbactam

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    Gazzotti Filippo

    2011-04-01

    Full Text Available Abstract Background The recommendations outlined in the latest guidelines published by the Surgical Infection Society (SIS and the Infectious Disease Society of America (IDSA regarding the proper duration of antibiotic therapy in patients with intra-abdominal infections are limited and non-specific. This ambiguity is due mainly to the lack of clinical trials on the topic of optimal duration of therapy. It is well known that the overuse of antibiotics has several important consequences such as increased treatment costs, reduced clinical efficacy, and above all, the increased emergence of antibiotic-resistant pathogens. Ampicillin-Sulbactam is a commonly used "first line" antibiotic for intra-abdominal infections. Ertapenem and Ampicillin-sulbactam are recommended as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. Methods/Design This study is a prospective multi-center randomized investigation. The study will be performed in the Departments of General, Emergency, and Transplant Surgery of Sant'Orsola-Malpighi University Hospital in Bologna, Italy, in the General Surgery Department of the Ospedali Riuniti of Bergamo, Italy, and in the Trauma and Emergency Surgery Department of Maggiore Hospital in Bologna, Italy, and will be conducted by all surgeons willing to participate in the study. The inclusion period of the study will take approximately two years before the planned number of 142 enrolled patients is reached. Discussion Ertapenem and Ampicillin-sulbactam are recommended both as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. As one of the discussed topic is the optimal duration of the antibiotic therapy and this ambiguity is due mainly to the lack of clinical trials on the topic, the present study aims for obtain precise data. Trial Registration ClinicalTrials.gov: NCT00630513

  14. Pressure Measurement Techniques for Abdominal Hypertension: Conclusions from an Experimental Model

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    Sascha Santosh Chopra

    2015-01-01

    Full Text Available Introduction. Intra-abdominal pressure (IAP measurement is an indispensable tool for the diagnosis of abdominal hypertension. Different techniques have been described in the literature and applied in the clinical setting. Methods. A porcine model was created to simulate an abdominal compartment syndrome ranging from baseline IAP to 30 mmHg. Three different measurement techniques were applied, comprising telemetric piezoresistive probes at two different sites (epigastric and pelvic for direct pressure measurement and intragastric and intravesical probes for indirect measurement. Results. The mean difference between the invasive IAP measurements using telemetric pressure probes and the IVP measurements was −0.58 mmHg. The bias between the invasive IAP measurements and the IGP measurements was 3.8 mmHg. Compared to the realistic results of the intraperitoneal and intravesical measurements, the intragastric data showed a strong tendency towards decreased values. The hydrostatic character of the IAP was eliminated at high-pressure levels. Conclusion. We conclude that intragastric pressure measurement is potentially hazardous and might lead to inaccurately low intra-abdominal pressure values. This may result in missed diagnosis of elevated abdominal pressure or even ACS. The intravesical measurements showed the most accurate values during baseline pressure and both high-pressure plateaus.

  15. Sildenafil does not influence hepatic venous pressure gradient in patients with cirrhosis

    DEFF Research Database (Denmark)

    Clemmesen, Jens-Otto; Giraldi, Annamaria; Ott, Peter

    2008-01-01

    disease. However, the effect of phosphodiesterase type-5 inhibitors on splanchnic blood flow and portal hypertension remains essentially unknown. METHODS: Ten patients with biopsy proven cirrhosis (five females/five males, mean age 54 +/- 8 years) and an HVPG above 12 mmHg were studied after informed...... consent. Measurement of splanchnic blood flow and the HVPG during liver vein catheterization were done before and 80 min after oral administration of 50 mg sildenafil. Blood flow was estimated by use of indocyanine green clearance technique and Fick's principle, with correction for non-steady state....... RESULTS: The plasma concentration of sildenafil was 222 +/- 136 ng/mL 80 min after administration. Mean arterial blood pressure decreased from 77 +/- 7 mmHg to 66 +/- 12 mmHg, P = 0.003, while the splanchnic blood flow and oxygen consumption remained unchanged at 1.14 +/- 0.71 L/min and 2.3 +/- 0.6 mmol...

  16. Acute Hepatitis E-Associated Acute Pancreatitis: A Single Center Experience and Literature Review.

    Science.gov (United States)

    Raj, Mithun; Kumar, Kundan; Ghoshal, Uday C; Saraswat, Vivek A; Aggarwal, Rakesh; Mohindra, Samir

    2015-11-01

    Because acute pancreatitis (AP) associated with acute hepatitis E is rarely reported, we present such a case series. Records of patients admitted with AP to our institution between May 2007 and December 2013 were reviewed. Diagnosis of AP and acute hepatitis E was based on high serum amylase and/or lipase (>3 times the upper normal limit) and abdominal imaging and presence of serum IgM antibodies against hepatitis E virus, respectively. Other causes of AP were excluded by appropriate evaluation. Of 790 patients with AP, 16 (2.1%; median [range] age, 25 [16-54] years; 15 males) had hepatitis E and no other cause of AP; coexistent hepatitis A and B were present in two and one of them, respectively. Acute pancreatitis began (median [range], 8 [0-35] days) after acute hepatitis and was mild in 10 and severe in 6. Complications included intra-abdominal collections (5), acute renal failure (4), and acute lung injury (2). Median (range) bilirubin, alanine aminotransferase, and prothrombin time were 9.8 (0.4-25) mg/dL, 822 (54-4009) IU/L, 14.6 (9.7-27.4) seconds, respectively. Acute liver failure occurred in 1 patient only. No patient needed surgical, endoscopic, or percutaneous intervention. Acute pancreatitis associated with hepatitis E is not uncommon and usually has good prognosis.

  17. Hepatitis C

    Science.gov (United States)

    ... Events Follow Us Home Health Information Liver Disease Hepatitis (Viral) Hepatitis C Related Topics English English Español Section Navigation Hepatitis (Viral) What Is Viral Hepatitis? Hepatitis A Hepatitis B ...

  18. Hepatic, renal and inflammatory biomarkers are positively associated with blood pressure changes in healthy pregnant women: a prospective cohort.

    Science.gov (United States)

    Kac, Gilberto; Mendes, Roberta H; Farias, Dayana R; Eshriqui, Ilana; Rebelo, Fernanda; Benaim, Camila; Vilela, Ana Amélia F; Lima, Natália S; Peres, Wilza A F; Salles, Gil F

    2015-05-01

    This article evaluates the association of hepatic, renal, and inflammatory biomarkers with changes in systolic (SBP) and diastolic (DBP) blood pressure (BP) during healthy pregnancies.A prospective cohort study with 225 healthy pregnant women was conducted in Rio de Janeiro, Brazil. SBP and DBP were evaluated throughout pregnancy (5th-13th, 20th-26th, and 30th-36th gestational weeks) and were the outcomes. The following biomarkers were measured at the first trimester and analyzed according to tertiles of the sample distribution and were considered the main independent predictors: alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA), creatinine (Cr), and C-reactive protein (CRP) concentrations. The statistical analysis included 3 stages of modeling with the longitudinal linear mixed-effects procedures: Model 1 was adjusted for gestational age and quadratic gestational age; Model 2 included interactions between the biomarkers and gestational age; and Model 3 was adjusted for self-reported skin color, education, parity, early-pregnancy body mass index (BMI) (under/normal change in SBP and DBP during pregnancy (interaction term with gestational age βSBP = -0.004; 95% CI: -0.007 to -0.001; P = 0.02; βDBP = -0.003; 95% CI: -0.006 to -0.001; P = 0.01). Higher UA concentrations were associated with higher SBP levels only in overweight/obese women (β = 3.878; 95% CI: 0.687-7.068), whereas higher CRP concentrations (≥2.6 mg/L) were associated with higher DBP in under/normal weight women (β =2.252; 95% CI: 0.267-4.236).ALP, ALT, and Cr concentrations were positively associated with BP levels, whereas ALP was associated with a lower rate of change in BP. The associations of UA and CRP with BP differ according to the early-pregnancy BMI.

  19. Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review

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    Cleva Roberto de

    2001-01-01

    Full Text Available We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.

  20. Perforated second trimester appendicitis with abdominal compartment syndrome managed with negative pressure wound therapy and open abdomen.

    Science.gov (United States)

    Turnock, Adam R; Fleischer, Brian P; Carney, Martin J; Vanderlan, Wesley B

    2016-06-14

    Abdominal compartment syndrome (ACS) is a known complication of laparotomy; however, the literature is lacking in regards to treatment of this entity in pregnant patients. We present a case of acute perforated appendicitis in a second trimester primagravida, complicated by gangrenous necrosis of the contiguous bowel with subsequent development of ACS and intra-abdominal sepsis. This was treated with a novel approach, using non-commercial negative pressure wound therapy and open abdomen technique. Gestational integrity was preserved and the patient went on to experience a normal spontaneous vaginal delivery. At 5 years post-delivery the patient has had no surgical complications and her baby has met all developmental milestones.

  1. Application of pelvis free liquid deepness measured by ultrasound in evaluating intra-abdominal hemorrhage volume in ectopic pregnancy patients%超声测盆腔积液深度在评估异位妊娠腹腔内出血量中的应用

    Institute of Scientific and Technical Information of China (English)

    刘岿然; 王昌霆; 杨雨; 张淑兰

    2012-01-01

    Objective To compare the pelvis free liquid quantity deepness measured by ultrasound and actual blood volume in abdominal cavity observed during operation in ectopic pregnancy patients, so as to predict the pre-operation intra-abdominal hemorrhage volume. Methods Five hundred patients with ectopic pregnancy receiving emergent operation were included in the present study. The patients took lithotomy position and were examined by vaginal probe before operation. The pelvis free liquid quantity measured by ultrasound (x) and the actual blood volume in abdominal cavity (y) observed during operation were subjected to statistical analysis using SPSS 16. 0 software. Results The pelvis free liquid measured by ultrasound and the actual quantity of blood in abdominal cavity accorded with the following equation: y=i3. 306 e0.74x, R2 = 0. 983, P<0.05. The actual volume of blood in pelvis could be calculated by the equation. When the quantities of free liquid in pelvis were 3 cm, 3. 5 cm, 4. 0 cm, and 4. 5 cm, the actual volumes of blood in pelvis were 357. 91 ml, 508. 92 ml, 732. 64 ml, and 1 028. 95 ml, respectively. Conclusion The quantity of intra-abdominal hemorrhage can be predicted by the pelvis free liquid deepness in ectopic pregnancy patients, which may pave a way for more effective treatment of the patients.%目的 通过比对异位妊娠患者术前盆腔积液深度的彩色超声测量结果与术中记录的实际腹腔内积血量,建立估测术前腹腔内出血量的方法.方法 选择2008年1月至2009年12月在本院诊断为异位妊娠并行急诊手术的患者500例.术前患者取半卧截石位,行阴式超声检查.按彩超提示盆腔积液深度(x)和术中记录与之对应的腹腔内实际出血量(y),利用SPSS 16.0统计软件行统计学分析并建立方程.结果 盆腔积液深度(x)与腹腔内实际出血量(y)符合方程:y=43.306 e0.704x,R2 =0.983,P<0.05.按此方程推算腹腔内实际出血量,当盆腔积液深度为3、3.5

  2. Pancreatic and biliary drainage for the treatment of bile leakage and severe intra-abdominal infection after pancreatiduodenectomy due to severe trauma%急诊胰十二指肠切除术后并发胆胰漏的处理

    Institute of Scientific and Technical Information of China (English)

    朱耀明

    2012-01-01

    目的 探讨因腹部外伤行急诊胰十二指肠切除术( pancreaticoduodenectomy,PD)后胆胰漏的发生及并发严重腹腔感染需再次手术时的处理策略.方法 回顾分析10年来因腹部外伤而急诊行PD手术病人共35例,术后发生胆胰漏12例,发生率为34.3%.经保守治疗、调整腹腔引流管或穿刺引流后治愈3例,另9例发生严重腹腔感染,再次手术行腹腔清洗和置管引流.结果 再手术者中8例未行胆胰管支撑引流,其中6例术后胆胰漏之积液区未有效局限,腹腔感染持续并加重,3例并发腹腔出血;均行第3次手术,于胰管和(或)胆管内置管外引流,感染区留置双套管术后冲洗腹腔并负压引流;6例均存活,6个月后行决定性手术.结论 胰十二指肠外伤行PD术后胆胰漏发生率高,再次手术时行胰管和(或)胆管内置支撑管外引流,可迅速有效地控制腹腔感染,降低死亡率.%Objective The objective of this study was to investigate the incidence and the operation strategy of biliary and pancreatic leakage and related severe intra-abdominal infection after pancre-aticoduodenectomy (PD) due to abdominal trauma. Methods A total of 35 patients who underwent e-mergent PD in our department due to severe abdominal trauma during past ten years were retrospectively analyzed. Results Postoperative biliary and pancreatic leakages developed in 12 cases with an incidence of 34.3 %, in which 3 patients were cured by non-operating treatment, including peritoneal drainage tube,and other 9 patients had severe abdominal infectious complications and needed re-operation. In these patients who required re-operations without biliary and pancreatic drainage, bile and pancreatic secreting fluid were not limited effectively, resulting in severe intraperitoneal infection in 6 cases, in which 3 patients needed to be re-operated for the third time due to a massive bleeding. Other 6 patients were treated with effectively drainage by

  3. Modified sliding rectus abdominus myofascial flap for huge planned abdominal hernia after intra-abdominal volume increment%改良腹直肌推徙术治疗腹腔扩容术后巨大计划性腹疝

    Institute of Scientific and Technical Information of China (English)

    孙士锦; 杨越涛; 吴文元; 马柏强; 谭浩; 王韬; 李英才; 张连阳

    2014-01-01

    目的 探讨改良腹直肌推徙术治疗腹腔扩容术后巨大计划性腹疝的效果. 方法 回顾性分析7例巨大计划性腹疝患者的临床资料,其中男4例,女3例;平均年龄43.4岁.合并造口4例,胰瘘1例,肠瘘1例,胆囊炎1例.所有患者均接受改良腹直肌推徙术治疗,行确定性腹壁重建,计划性腹疝至确定性重建的平均时间为6.4个月. 结果 7例均救治成功.平均手术时间180 min,术中平均失血量150 ml.术后发生皮下血清肿1例,皮缘坏死1例,均经引流治愈,无严重感染并发症.无复发性腹腔间隙综合征发生,无脏器功能障碍等发生.腹直肌功能恢复良好,无其他不适症状.随访l ~21个月,平均12.3个月,轻度复发l例,暂时观察中. 结论 改良腹直肌推徙术治疗巨大计划性腹疝,效果良好,为腹腔扩容术后巨大计划性腹疝患者临床治疗提供了新的可供选择的手术方法.%Objective To examine the effect of modified sliding myofascial flap of the rectus abdominis to intervene the huge planned hernia following intra-abdominal volume increment.Methods A retrospective review was made on 7 cases (4 males and 3 females at mean age of 43.4 years).Colostomy or ileumstomy co-occurred in 4 cases,pancreatic fistula in 1,intestinal fistula in 1,cholecystitis in 1.Definite abdominal wall reconstruction was performed using the modified sliding rectus abdominus myofascial flap and mean delay time was 6.4 months.Results Surgical success rate was 100%.Mean operation time was 180 minutes and mean intraoperative blood loss was 150 ml.One case of subcutaneous hematoma and one skin marginal necrosis were noted after operation,but cured later by volume drainage.There were no postoperative complications such as infection,reproductive abdominal compartment syndrome (ACS),and organ function impairment.Rectus abdominis functioned well without any other symptoms.At the follow-up of 1-21 months (mean,12.3 months),1 case had mild relapse

  4. Etiology, extended-spectrum β-lactamase rates and antimicrobial susceptibility of gram-negative bacilli causing intra-abdominal infections in patients in general pediatric and pediatric intensive care units--global data from the Study for Monitoring Antimicrobial Resistance Trends 2008 to 2010.

    Science.gov (United States)

    Badal, Robert E; Bouchillon, Samuel K; Lob, Sibylle H; Hackel, Meredith A; Hawser, Stephen P; Hoban, Daryl J

    2013-06-01

    Antimicrobial resistance has been increasing for several years and is often higher in intensive care units (ICUs) than in other facilities. The spread of extended-spectrum β-lactamases (ESBLs) in particular has profoundly impacted antimicrobial efficacy and usage. The Study for Monitoring Antimicrobial Resistance Trends has monitored the in vitro activity of ertapenem and several comparators against aerobic gram-negative bacteria from intra-abdominal infections (IAIs) for many years. This report summarizes susceptibility levels and epidemiology for key IAI pathogens cultured from general pediatric medical wards and pediatric ICUs globally. 1248 gram-negative bacteria were collected from pediatric IAIs by 113 labs in 40 countries from 2008 to 2010. Susceptibility was determined by Clinical and Laboratory Standards Institute broth microdilution. Susceptibility rates (%S) were determined for species with ≥10 isolates. Sixty-two percent of isolates came from general pediatric wards and 38% from pediatric ICUs. The overall ESBL-positive rate was 11.0% for Escherichia coli and 38.9% for Klebsiella pneumoniae; the ESBL-positive rate for E. coli was twice as high in ICU as non-ICU. Most study drugs inhibited >90% of ESBL-negative isolates, but only the carbapenems inhibited >90% of ESBL-positive E. coli and only imipenem inhibited >90% of ESBL-positive K. pneumoniae. Amikacin, imipenem and ertapenem were the most active against gram-negative bacteria from pediatric IAIs, followed closely by the fluoroquinolones and cefepime. Other cephalosporins were often <90% active. ESBL rates were 38.9% for K. pneumoniae and 11.0% for E. coli. Therapy for pediatric IAIs should take into consideration local ESBL rates because only carbapenems inhibited most of these pathogens.

  5. Clinical efficacy of high-dose induction therapy by maintenance with recombinant human erythropoietin (rhEPO) in intestinal fistula patients complicated with intra-abdominal infection with anemia%rhEPO大剂量冲击维持疗法治疗肠瘘合并腹腔感染病人贫血的临床研究

    Institute of Scientific and Technical Information of China (English)

    洪之武; 任建安; 刘颂; 顾国胜; 袁玉杰; 周波; 闫冬升; 黎介寿

    2012-01-01

    目的 探讨重组人红细胞生成素(recombinant human erythropoietin,rhEPO)大剂量冲击维持疗法治疗肠瘘合并腹腔感染病人贫血的临床价值.方法 选择2010年9月至2011年12月南京军区南京总医院肠瘘治疗病区114例肠瘘致腹腔感染伴贫血且资料完整的病例,按照机体含铁量情况分为机体铁含量正常组和机体铁缺乏组,同时铁含量正常组再次随机分为单纯营养支持治疗(enteral nutrition/parenteral nutrition,EN/PN)组和EN/PN联合大剂量rhEPO冲击维持治疗组(各30例);铁缺乏组分为EN/PN联合铁剂(iron)组和EN/PN联合iron、大剂量rhEPO冲击维持治疗组(各27例).入组病例全部给予足量EN/PN、rhEPO和(或)蔗糖铁注射剂治疗并进行疗效观察.结果 两组病人治疗前后血红蛋白(Hb)比较,治疗前Hb差异无统计学意义(P>0.05).体内含铁量正常病人,在rhEPO治疗组2周后Hb明显高于未实施rhEPO干预组(P<0.05);体内含铁缺乏病人,铁剂联合rhEPO治疗组2周后Hb明显高于未实施rhEPO治疗组(P<0.05).大多数病人耐受良好.结论 肠瘘致腹腔感染伴贫血病人给予皮下注射rhEPO大剂量冲击维持疗法可有效快速提高病人的红细胞(RBC)及Hb水平,改善病人的贫血状况.该疗法耐受性较好,值得进一步扩大临床研究.%Objective To study clinical efficacy of recombinant human erythropoietin (rhEPO) in intestinal fistula patients complicated with intra-abdominal infection with anemia. Methods One hundred and fourteen patients with intestinal fistula complicated with intra-abdominal infection with anemia admitted from September 2010 to December 2011 in General Hospital of Nanjing Military Command were enrolled. In accordance with the iron content of the body the patients were divided into the group with the normal iron content in the body and the group with the deficient iron content. The normal iron content group was randomly divided into nutrition support

  6. Distribution and antibiotic resistance of pathogen isolated from intra-abdominal infection associated sepsis in surgical intensive care unit%外科重症监护病房腹腔感染相关脓毒症病原菌分布及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    殷娜; 邓小明

    2014-01-01

    目的:了解上海交通大学医学院附属新华医院外科重症监护病房(S IC U )近5年腹腔感染相关脓毒症患者的病原菌分布以及耐药性,为临床经验用药提供参考依据。方法收集2008年1月至2012年12月入住该院S IC U的65例腹腔感染相关脓毒症患者的腹腔引流液标本,进行病原菌分析和药敏监测。结果共分离出151株病原菌,其中革兰阴性菌104株(68.9%),革兰阳性菌29株(19.2%),真菌18株(11.9%)。在所有病原菌中分离率名列前5位的分别是大肠埃希菌(23.2%)、鲍曼不动杆菌(15.2%)、屎肠球菌(13.2%)、铜绿假单胞菌(8.6%)、肺炎克雷伯菌(7.9%)。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶菌株分离率分别为80.0%和33.3%,对碳青霉烯类抗菌药物耐药率低;鲍曼不动杆菌中56.5%为多重耐药菌株,30.4%为泛耐药菌株。结论腹腔感染相关脓毒症患者分离的病原菌耐药率高,及早、合理的经验性抗感染治疗有利于控制细菌耐药的产生和播散。%Objective To investigate the distribution and antibiotic resistance of clinical pathogen isolated from patients of intra-abdominal infection associated sepsis in surgical intensive care unit (SICU ) during recent 5 years ,then instruct clinical application of antibiotics reasonably .Methods Abdominal drainage of 65 patients of intra-abdominal infection associated sepsis were collected from January 2008 to December 2012 .All the specimens were analyzed for pathogen distribution and drug susceptibility .Results A total of 151 strains of pathogenic bacteria was isolated ,in which Gram-negative bacteria were the most popular pathogen (104 strains ,68 .9% ) ,whereas Gram-positive bacteria and fungi accounted for 19 .2% (29 strains) and 11 .9% (18 strains) ,respectively . The five most common pathogens were Escherichia coli(23 .2

  7. Localised abdominal compartment syndrome: bladder-over-gastric pressure ratio (B/G ratio) as a clue to diagnosis.

    Science.gov (United States)

    Malbrain, M L N G; De Laet, I E; Willems, A; Van Regenmortel, N; Schoonheydt, K; Dits, H

    2010-01-01

    Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been identified as a cause of organ dysfunction and mortality in critically ill patients. The diagnosis of IAH/ACS depends on accurate intra-abdominal pressure (IAP) measurement, which is usually performed via the bladder or the stomach.The aim of this study was to describe cases where intragastric pressure (IGP) and intrabladder pressure (IBP) were measured simultaneously. After review of medical records, four patients admitted to our ICU department where both IGP and IBP were measured, could be identified. IGP was measured using the Spiegelberg catheter and IBP was measured using the FoleyManometer LV. In all patients, the bladder-over-gastric pressure ratio (B/G ratio) was calculated. In two of four patients, IGP and IBP differed significantly. In one patient the B/G ratio was lower than 1 suggesting a diagnosis of epigastric ACS and in one patient B/G ratio was greater than 1 leading to a diagnosis of pelvic ACS. The latter patient was spared a decompressive laparotomy due to the additional IGP measurement and the subsequent diagnosis of localized ACS. The preferred methods for IAP measurement are via the bladder and via the stomach. In some patients, IGP and IBP may differ significantly and this may have clinical implications. Clinicians should be aware of the possibility of localized ACS. In order to identify risk factors and to recommend treatment for localized ACS, further study of simultaneous IGP and IBP measurements are needed.

  8. Minimally invasive treatment of hepatic adenoma in special cases

    Energy Technology Data Exchange (ETDEWEB)

    Nasser, Felipe; Affonso, Breno Boueri; Galastri, Francisco Leonardo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Odisio, Bruno Calazans [MD Anderson Cancer Center, Houston (United States); Garcia, Rodrigo Gobbo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2013-07-01

    Hepatocellular adenoma is a rare benign tumor that was increasingly diagnosed in the 1980s and 1990s. This increase has been attributed to the widespread use of oral hormonal contraceptives and the broader availability and advances of radiological tests. We report two cases of patients with large hepatic adenomas who were subjected to minimally invasive treatment using arterial embolization. One case underwent elective embolization due to the presence of multiple adenomas and recent bleeding in one of the nodules. The second case was a victim of blunt abdominal trauma with rupture of a hepatic adenoma and clinical signs of hemodynamic shock secondary to intra-abdominal hemorrhage, which required urgent treatment. The development of minimally invasive locoregional treatments, such as arterial embolization, introduced novel approaches for the treatment of individuals with hepatic adenoma. The mortality rate of emergency resection of ruptured hepatic adenomas varies from 5 to 10%, but this rate decreases to 1% when resection is elective. Arterial embolization of hepatic adenomas in the presence of bleeding is a subject of debate. This observation suggests a role for transarterial embolization in the treatment of ruptured and non-ruptured adenomas, which might reduce the indication for surgery in selected cases and decrease morbidity and mortality. Magnetic resonance imaging showed a reduction of the embolized lesions and significant avascular component 30 days after treatment in the two cases in this report. No novel lesions were observed, and a reduction in the embolized lesions was demonstrated upon radiological assessment at a 12-month follow-up examination.

  9. Pathogenesis of Intra-abdominal and pelvic adhesion development.

    Science.gov (United States)

    Imudia, Anthony N; Kumar, Sanjeev; Saed, Ghassan M; Diamond, Michael P

    2008-07-01

    Abdominal and pelvic adhesions are a frequent occurrence and are responsible for significant morbidity resulting in abdominal and pelvic pain, infertility, and small bowel obstruction. The process of adhesion development begins when damage to peritoneal surfaces from any source (operative trauma, infection, foreign bodies, desiccation, irradiation, allergic reaction, or chemical injury) induces a series of biochemical/molecular biologic cascades involving different elements. These elements include peritoneal fluid, neutrophils, leukocytes, macrophages, cytokines, mesothelial cells, and tissue and coagulation factors, which teleologically have the intention of peritoneal repair; however, these processes also result in adhesion development. Major pathways that play significant roles in the healing process of peritoneal damage leading to adhesion development are the fibrinolytic system, extracellular matrix deposition, growth factor and cytokines, cell adhesion molecules, angiogenesis, apoptosis and proliferation, and remesothelialization. Greater understanding of the regulation and interaction of these processes provides the potential for reduction of postoperative adhesion development.

  10. Primary intra-abdominal synovial sarcoma: a case report.

    Science.gov (United States)

    Travaglini, Grazia; Biagetti, Simona; Alfonsi, Simona; Bearzi, Italo; Marmorale, Cristina

    2013-09-03

    Il caso clinico che vi presentiamo riguarda la straordinaria localizzazione intra-addominale di un sinovial-sarcoma. Questo tumore dei tessuti molli generalmente interessa le piccole e grandi articolazioni. Sono state descritte altre localizzazioni a livello intra-addominale e retroperitoneale. La nostra paziente si ricovera per una tumefazione dolente dell’addome, alla TC addome si evidenzia una voluminosa massa intra-addominale che comprime e disloca i parenchimi e visceri circostanti e che affiora ai tessuti più superficiali della parete addominale. La biopsia eco-guidata della lesione, insieme allo studio immunoistochimico, permette di porre la diagnosi di sinovial-sarcoma. La paziente viene candidata ad un trattamento chemioterapico a scopo neoadiuvante. Per il sopraggiungere di anemizzazione da sanguinamento della neoplasia, valutata anche la risposta parziale al trattamento sistemico, si pone indicazione all’intervento chirurgico. La massa con peduncolo vascolare maggiore costituito dai vasi gastroepiploici di destra, viene completamente asportata. L’esame definitivo conferma la diagnosi di Sinovial-Sarcoma bifasico. L’indagine genetica condotta sul campione conservato in formalina non ha permesso, a causa della difficoltà di estrarre ed amplificare un quantitativo adeguato di RNA, di identificare la traslocazione (X; 18) (p 11.2; q 11.2) specifica del Sinovial-Sarcoma. La paziente è stata dimessa dopo un decorso clinico regolare. Il follow-up ad un anno non ha mostrato ripresa di malattia ma dopo 18 mesi alla TC torace-addome di rivalutazione si evidenzia la ripresa di malattia a livello intra-addominale e la presenza di metastasi polmonari bilaterali.

  11. Abdominal Tuberculosis Mimicking Intra-abdominal Malignancy: A ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    The chest X-ray was a normal study. The ... Patients diabetes mellitus was controlled with insulin. ... unpasteurized milk in some in low resource .... Other ancillary investigations such as full .... genetic based testing to identify Tb is limited.

  12. [Procalcitonin as a marker of intra-abdominal infection].

    Science.gov (United States)

    Domínguez-Comesaña, Elías; Ballinas-Miranda, Julio Roberto

    2014-01-01

    Antecedentes: la procalcitonina es un marcador bastante específico de infección y en los últimos años se ha demostrado su superioridad, con respecto a otros marcadores de inflamación como la proteína C reactiva, para el diagnóstico y vigilancia de una gran variedad de infecciones. Objetivo: resumir los datos actualmente existentes y discutir la utilidad de la procalcitonina en diversas infecciones intrabdominales, incluidas las postoperatorias. Conclusiones: los resultados de estudios hasta ahora publicados son variables, lo que genera controversia en relación con su utilidad.

  13. Intra-Abdominal Actinomycosis Mimicking Malignant Abdominal Disease

    Directory of Open Access Journals (Sweden)

    Ali Ridha

    2017-01-01

    Full Text Available Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003. This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms.

  14. Intra-abdominal metastasis in osteosarcoma: survey and literature review.

    Science.gov (United States)

    Rejin, Kebudi; Aykan, Ozgüven A; Omer, Görgün; Ensar, Yekeler; Bilge, Bilgiç; Inci, Ayan; Harzem, Ozger

    2011-10-01

    Extrapulmonary metastasis, particularly abdominal metastasis from osteogenic sarcoma, are rare and generally appear as a solid mass of calcification as the primary tumor. The aim of this case report is to document the incidence, characteristics, treatment, and prognosis of abdominal metastasis in osteosarcomas in a single institution and to review the literature. From September 1989 to December 2002, 94 children ≤16 years of age with osteosarcomas were diagnosed and treated in the Division of Pediatric Oncology, Oncology Institute, Istanbul University. Patients with abdominal metastasis were assessed. Two girls of 94 patients (2.1%) with osteosarcoma developed abdominal metastasis. One had pulmonary metastasis at diagnosis and the other had developed lung metastasis 15 months after diagnosis. They developed abdominal metastasis 4 and 3 years after diagnosis during therapy or relapse at a median duration of 16 months (1-70 months) from initial diagnosis. All patients had metastasis to various sites, mostly lung, at the time the abdominal metastasis were detected. Treatment included surgery, chemotherapy, and radiotherapy in one and only surgery in the other patient. Both patients died at a median time of 4 months (2-6 months) from the time of abdominal metastasis with progressive disease. Abdominal metastasis in osteosarcoma is a rare event, but abdomen should be investigated in case of recurrence from osteosarcoma. The outcome for these patients is dismal in this series and in the literature.

  15. Intra-Abdominal Actinomycosis Mimicking Malignant Abdominal Disease

    Science.gov (United States)

    Oguejiofor, Njideka; Al-Abayechi, Sarah; Njoku, Emmanuel

    2017-01-01

    Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003). This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms. PMID:28299215

  16. Spontaneous intra-abdominal bleeding in twin pregnancy: Case report

    Directory of Open Access Journals (Sweden)

    Berisavac Milica

    2008-01-01

    Full Text Available INTRODUCTION Spontaneous rupture of utero-ovarian vessels is a rare cause of haemoperitoneum in pregnancy, leading to significant maternal and foetal morbidity and mortality. Aetiopathogenesis of this condition is still unclear. Establishing clinical diagnosis of this condition is difficult, but very important. Clinical symptoms are nonspecific, and the diagnosis is usually made at laparotomy. CASE OUTLINE We report a case of spontaneous haematoperitoneum in the third trimester of twin pregnancy. Differential diagnosis included uterine rupture and placental abruption. Due to the deteriorated condition of the patient, it was decided to perform laparotomy which established the diagnosis of ruptured venous varices on the posterior uterine wall. Delivery was performed by caesarean section. The postoperative period was uneventful. CONCLUSION The clinical presentation of spontaneous rupture of utero-ovarian blood vessels is not specific and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. Once the diagnosis of spontaneous haematoperitoneum in pregnancy is established, emergency laparotomy is indicated. Following caesarean delivery, it is necessary to establish surgical haemostasis. There are some authors who suggest leaving the pregnancy intact in cases when the fetus is not viable, although one must have in mind the possibility of recurrent bleeding. The safety of this procedure requires further investigation. It is necessary to have in mind the possibility of blood vessel rupture in all cases of abdominal pain and hypotension of unknown origin during pregnancy.

  17. Cystic Echinococcosis: A Case of Extrahepatic Intra-Abdominal Involvement

    Science.gov (United States)

    Carvalho, André; Fernandes, Teresa; Gonçalves, José

    2017-01-01

    Hydatid disease, or echinococcal disease, is a parasitic infestation caused by the larval stage of the Echinococcus tapeworm and it primarily affects the liver and lung but involvement of other organs is also possible secondary to peritoneal seeding or hematogeneous dissemination. We describe a rare case of extensive abdominal disease, with lesions affecting the liver, peritoneum, and lesser omentum, requiring aggressive surgical intervention. Complementary diagnostic exams were crucial to reach the diagnosis and evaluate the extension of the disease. PMID:28194292

  18. Original Research Intra-abdominal fat: Comparison of computed ...

    African Journals Online (AJOL)

    same BMI may have different body composition and BMI is particularly influenced by muscle bulk .... adhesive ECG electrodes around the abdomen at the level of the umbilicus. ..... The Sheffield data collection system. Brown B H and Seagar ...

  19. Metabolic effects of intra-abdominal fat in GHRKO mice

    Science.gov (United States)

    Masternak, Michal M.; Bartke, Andrzej; Wang, Feiya; Spong, Adam; Gesing, Adam; Fang, Yimin; Salmon, Adam B.; Hughes, Larry F.; Liberati, Teresa; Boparai, Ravneet; Kopchick, John J.; Westbrook, Reyhan

    2011-01-01

    SUMMARY Mice with targeted deletion of the growth hormone receptor (GHRKO mice) are GH resistant, small, obese, hypoinsulinemic, highly insulin sensitive and remarkably long-lived. To elucidate the unexpected coexistence of adiposity with improved insulin sensitivity and extended longevity, we examined effects of surgical removal of visceral (epididymal and perinephric) fat on metabolic traits related to insulin signaling and longevity. Comparison of results obtained in GHRKO mice and in normal animals from the same strain revealed disparate effects of visceral fat removal (VFR) on insulin and glucose tolerance, adiponectin levels, accumulation of ectopic fat, phosphorylation of insulin signaling intermediates, body temperature and respiratory quotient (RQ). Overall, VFR produced the expected improvements in insulin sensitivity and reduced body temperature and RQ in normal mice and had opposite effects in GHRKO mice. Some of the examined parameters were altered by VFR in opposite directions in GHRKO and normal mice, others were affected in only one genotype or exhibited significant genotype × treatment interactions. Functional differences between visceral fat of GHRKO and normal mice were confirmed by measurements of adipokine secretion, lipolysis and expression of genes related to fat metabolism. We conclude that in the absence of GH signaling the secretory activity of visceral fat is profoundly altered and unexpectedly promotes enhanced insulin sensitivity. The apparent beneficial effects of visceral fat in GHRKO mice may also explain why reducing adiposity by calorie restriction fails to improve insulin signaling or further extend longevity in these animals. PMID:22040032

  20. Rectal 13N-ammonia test (13N-liver/heart ratio), hepatic sinusoidal pressure and prevailing portal flow direction in cirrhosis of the liver.

    Science.gov (United States)

    Hazenberg, H J; Gips, C H; Beekhuis, H; Kruizinga, K

    1976-01-01

    The 20 minutes' liver/heart activity ratio after rectal administration of 13N-ammonia was abnormally low (less than 2.25) in 12 of 26 patients with cirrhosis of the liver. An abnormal conventional rectal arterial ammonia test (porta-systemic shunts), an abnormally low urea index (prevailing hepatofugal portal venous flow direction), marked portal hypertension (hepatic sinusoidal pressure greater than or equal to 8 mm Hg), ascites and extreme enlargement of the spleen occurred significantly more often in the patients with an abnormally low 13N-liver/heart ratio than in those with a ratio greater than or equal to 2.25. There was no correlation between the 13N-liver/heart ratio and absence or presence of oesophageal varices. The non-invasive rectal 13N-ammonia test appears to be an easy to perform, informative test in cirrhosis of the liver.

  1. 儿童腹腔非霍奇金B细胞淋巴瘤的临床病理及免疫表型分析%Clinicopathologic and immunohistochemical study of intra-abdominal non-Hodgkin B-cell lymphoma occurring in children

    Institute of Scientific and Technical Information of China (English)

    杨文萍; 曾松涛; 黄慧; 朱才娣; 宫丽平; 吕蓓蓓; 邹音; 钟华生; 肖强; 吴艳; 徐红艳

    2009-01-01

    intra-abdominal non-Hodgkin B-cell lymphoma occurring in children. Methods Seventy-four cases of pediatric intra-abdominal non-Hodgkin B-cell lymphoma were retrieved from the archival file. The cases were classified according to the 2008 WHO classification. Tissue microarray including tumor tissues from all the 74 cases was produced. Immunohistochemical study ( SP method) for CD20, CD3, CD79a, CDIO, bcl-6, MUM1, bcl-2, CD43, CD38 and Ki-67 was performed. In-situ hybridization for Epstein-Barr virus-encoded RNA (EBER) and fluorescence in-situ hybridization for c-myc gene were also carried out. Results Amongst the 74 cases studied, 65 of them (87.8%) were Burkitt lymphoma (BL), 4 cases (5.4%) were diffuse large B-cell lympboma (DLBCL) and the remaining 5 cases (6.8% ) showed features in-between DLBCL and BL (DLBCL/BL). The patients often presented with abdominal pain, abdominal masses, ileus and intussusception. The ileocecal bowel wall and mesenteric lymph nodes were commonly involved. The lymphoma cells were of high histologic grade and suggested an aggressive clinical behavior. The staining for CD20 and CD79a were positive in all of the cases, while CD3 was negative. The positive rates of CD10, bcl-6, bcl-2, MUM1, CD43, CD38 and EBER in BL were 96.9% (63 cases), 95.4% (62 cases), 0 (0 case), 23.1% (15 cases), 70.8% (46 cases), 96.9% (63 cases) and 41.5% (27 cases) , respectively. Fifty-four cases carried translocation of c-myc gene. As for DLBCL, the positive cases of CD10, bcl-6, bcl-2, MUM1, CD43, CD38 and EBER were 3 cases, 2 cases, 3 cases, 2 cases,2 cases, 2 cases and 0 case, respectively. One of these cases showed c-myc gene translocation. Amongst the 4 cases of DLBCL, 2 of them belonged to germinal center B-cell-like subtype, while the remaining 2 cases were of non-germinal center B-cell-like subtype. The expression rates of CD10, bcl-6, bcl-2, MUM1, CD43, CD38 and EBER in DLBCL/BL were 5/5, 4/5, 0,3/5,5/5,3/5 and 0, respectively. Three of the cases were

  2. Tracking the evolution of multiple in vitro hepatitis C virus replicon variants under protease inhibitor selection pressure by 454 deep sequencing.

    Science.gov (United States)

    Verbinnen, Thierry; Van Marck, Herwig; Vandenbroucke, Ina; Vijgen, Leen; Claes, Marijke; Lin, Tse-I; Simmen, Kenneth; Neyts, Johan; Fanning, Gregory; Lenz, Oliver

    2010-11-01

    Resistance to hepatitis C virus (HCV) inhibitors targeting viral enzymes has been observed in in vitro replicon studies and during clinical trials. The factors determining the emergence of resistance and the changes in the viral quasispecies population under selective pressure are not fully understood. To assess the dynamics of variants emerging in vitro under various selective pressures with TMC380765, a potent macrocyclic HCV NS3/4A protease inhibitor, HCV genotype 1b replicon-containing cells were cultured in the presence of a low, high, or stepwise-increasing TMC380765 concentration(s). HCV replicon RNA from representative samples thus obtained was analyzed using (i) population, (ii) clonal, and (iii) 454 deep sequencing technologies. Depending on the concentration of TMC380765, distinct mutational patterns emerged. In particular, culturing with low concentrations resulted in the selection of low-level resistance mutations (F43S and A156G), whereas high concentrations resulted in the selection of high-level resistance mutations (A156V, D168V, and D168A). Clonal and 454 deep sequencing analysis of the replicon RNA allowed the identification of low-frequency preexisting mutations possibly contributing to the mutational pattern that emerged. Stepwise-increasing TMC380765 concentrations resulted in the emergence and disappearance of multiple replicon variants in response to the changing selection pressure. Moreover, two different codons for the wild-type amino acids were observed at certain NS3 positions within one population of replicons, which may contribute to the emerging mutational patterns. Deep sequencing technologies enabled the study of minority variants present in the HCV quasispecies population present at baseline and during antiviral drug pressure, giving new insights into the dynamics of resistance acquisition by HCV.

  3. Hepatitis A FAQs

    Science.gov (United States)

    ... Policy and Programs Resource Center Viral Hepatitis Hepatitis A Questions and Answers for the Public Recommend on ... Hepatitis C. What is the difference between Hepatitis A, Hepatitis B, and Hepatitis C? Hepatitis A , Hepatitis ...

  4. Application of small intestine double stoma and succus entericus reinfusion in the patients with severe intra-abdominal infection%小肠双造口和肠液回输在重度腹腔感染患者的应用

    Institute of Scientific and Technical Information of China (English)

    朱晋国; 王健; 和源; 庄海文; 杨金云

    2015-01-01

    Objective To evaluate the application of small intestine double stoma and succus entericus reinfusion in the patients with severe intra-abdominal infection. Methods Ten patients with high intestinal perforation from February 2005 to November 2014 were enrolled in the study. All the cases received emergency operation. Small bowel with intestinal perforation was resected, and double stoma was applied in the proximal and distal small intestine. When abdominal infection under control, total enteral nutrition was successfully administered from nasogastric tube. The succus entericus from the proximal intestine was collected and transfused back to the distal intestine. Stool was collected and fecal nitrogen, fat and carbohydrate contents were determined. Related serum protein levels were measured. Results As compared to pre-reinfusion, the absorption rate of carbohydrate [(90.9±7.8)% vs. (82.7± 15.2)%], fat [(87.6±6.4)% vs. (59.1±10.8)%], and nitrogen [(82.4±9.8)% vs. (67.2±15.4)%] increased after succus entericus reinfusion (P<0.05). The serum protein levels increased significantly as well[fibronectin:(285.6±3.6) vs. (157.0±22.6) mg/L, P<0.01﹔transferrin:(4.86±0.21) vs. (3.60± 0.25) g/L,P<0.05﹔pre-albumin:(291.3±112.5) vs. (199.1±53.3) mg/L, P<0.05]. Conclusion Small intestine double stoma and succus entericus reinfusion are effective in improving the absorption of carbohydrate, fat and nitrogen in the patients with severe intra-abdominal infection.%目的:探讨小肠双造口和肠液回输在重度腹腔感染患者中的临床应用。方法将2005年2月至2014年11月间淮安市第二人民医院收治的10例高位小肠穿孔致重度腹腔感染的患者纳入研究。所选病例均为急诊手术,行小肠部分切除加小肠远近端肠管双造口术。术后待肠道功能基本恢复、腹腔感染得到基本控制后,经鼻胃管实施肠内营养,将近端造口引出的肠液回输入远端肠襻。分别测定肠液回输前后机

  5. Hepatitis A

    Science.gov (United States)

    ... care, food, or sewage industry Other common hepatitis virus infections include hepatitis B and hepatitis C. Hepatitis A is the least serious and mildest of these diseases. Symptoms ... most often show up 2 to 6 weeks after being exposed to the hepatitis A virus. They are most often mild, but may last ...

  6. Blunt abdominal injury with rupture of giant hepatic cavernous hemangioma and laceration of the spleen.

    Science.gov (United States)

    Kang, Lung-Yun; Huang, Fong-Dee; Liu, Yuan-Yuarn

    2015-02-01

    A 41-year-old woman with blunt abdominal trauma due to a motor vehicle accident presented to our emergency department. The patient had a history of a giant hepatic cavernous hemangioma. Emergency exploratory laparotomy was performed for suspected intra-abdominal bleeding with abdominal compartment syndrome, and more than 4 liters of blood and blood clots were removed. An active bleeding laceration (5 cm) of a hepatic cavernous hemangioma was detected in segment III of the liver. The bleeding was controlled by sutures, Teflon patches and tamponade. The abdomen was closed temporarily using the vacuum-assisted method. Because of the presence of persistent fresh blood through abdominal drainage at a rate of >1 L/h, splenectomy was performed to control the bleeding again by sutures and Teflon patches. Finally, the abdomen was closed using a biologic mesh. The patient was discharged home 30 days after trauma. Bleeding of trauma-caused hepatic hemangioma is rare, but splenic injury due to blunt abdominal trauma is common. An in-depth investigation is necessary to avoid second intervention.

  7. Haemostatic agents of the gelatin matrix for a large liver wound by percutaneous injection without pressure under the guidance of contrast-enhanced ultrasound

    Institute of Scientific and Technical Information of China (English)

    YU Teng-fei; L(U) Fa-qin; LI Zhi-yan; LIU Ling; LIU Qiang; LIU Ai-jun; HUANG Ya-qin; TANG Jie

    2011-01-01

    Background The non-operation treatment of intra-abdominal trauma guided contrast enhanced ultrasound (CEUS) is one of the hottest research topic. Gelatin/thrombin/calcium (GTC) was developed as a novel haemostatic agent for non-operable intra-abdominal trauma. We hypothesized that GTC can achieve haemostasis (without the use of pressure)within a short time in a large wound model by percutaneous injection under CEUS guidance.Methods Forty Wister rats received large liver injuries by haemostatic clamp and were randomly divided into four groups, according to the haemostatic agent used. These included normal saline (NS) group A, lyophilising thrombin powder (LTP) group B, GTC group C, and absorbable α-cyanoacrylate (ACNA) group D. Each injury site was treated with one of the above materials and total bleeding time was recorded. All liver wounds were evaluated using CEUS at three periods: pre-injury, injury and post-treatment. The liver wounds were also evaluated by histology 3, 6, and 9 days after injury and the extents of abdominal adhesions were recorded.Results The sensitivity of CEUS (100%) in detecting blunt traumatic liver lesions was significantly higher than conventional ultrasound (42.5%). Bleeding times at the injury site in the GTC group C ((129.3±14.0) seconds) and ACNA group D ((5.2±1.0) seconds) were significantly shorter than those in the NS group A ((369.5±48.8) seconds, P <0.01) and LTP group B ((324.7±52.22) seconds, P <0.01). The LTP group B showed no significant difference compared with the NS group A. Gross examination of liver tissue revealed that there were fewer intra-abdominal adhesions in the GTC group C (10%) than in the ACNA group D (100%). Histopathologic examination showed that GTC was completely absorbed after nine days.Conclusions GTC, delivered by percutaneous injection under CEUS, may achieve haemostasis (without the use of pressure) within a short time in a large wound model. GTC is absorbable and may prevent intra-abdominal

  8. Hepatitis E

    Science.gov (United States)

    ... sheets Fact files Questions & answers Features Multimedia Contacts Hepatitis E Fact sheet Updated July 2016 Key facts ... et al. Lancet 2012;380:2095-2128. World Hepatitis Day Know hepatitis - Act now Event notice Key ...

  9. Portal hypertension in patients with cirrhosis: indirect assessment of hepatic venous pressure gradient by measuring azygos flow with 2D-cine phase-contrast magnetic resonance imaging.

    Science.gov (United States)

    Gouya, Hervé; Grabar, Sophie; Vignaux, Olivier; Saade, Anastasia; Pol, Stanislas; Legmann, Paul; Sogni, Philippe

    2016-07-01

    To measure azygos, portal and aortic flow by two-dimensional cine phase-contrast magnetic resonance imaging (2D-cine PC MRI), and to compare the MRI values to hepatic venous pressure gradient (HVPG) measurements, in patients with cirrhosis. Sixty-nine patients with cirrhosis were prospectively included. All patients underwent HVPG measurements, upper gastrointestinal endoscopy and 2D-cine PC MRI measurements of azygos, portal and aortic blood flow. Univariate and multivariate regression analyses were used to evaluate the correlation between the blood flow and HVPG. The performance of 2D-cine PC MRI to diagnose severe portal hypertension (HVPG ≥ 16 mmHg) was determined by receiver operating characteristic curve (ROC) analysis, and area under the curves (AUC) were compared. Azygos and aortic flow values were associated with HVPG in univariate linear regression model. Azygos flow (p cine PC MRI is a promising technique to evaluate significant portal hypertension in patients with cirrhosis. • Noninvasive HVPG assessment can be performed with MRI azygos flow. • Azygos MRI flow is an easy-to-measure marker to detect significant portal hypertension. • MRI flow is more specific that varice grade to detect portal hypertension.

  10. Measurement of intravesical and rectal pressures simultaneously with electromyography of anal sphincter in children with myelomeningocele.

    Science.gov (United States)

    van Gool, J D; de Ridder, A L; Kuijten, R H; Donckerwolcke, R A; Tiddens, H A

    1976-06-01

    This paper reports a technique for simultaneous measurement of intravesical pressure, intra-abdominal pressure, electromyographic activity of the external and sphincter and urinary flow. Using this technique during filling of the bladder and during micturition in 38 children with myelomeningocele and neurogenic bladder disturbance, it was possible to identify four main types of bladder dysfunction in these children. Once the type of bladder dysfunction is established for each child, adequate management can be planned far in advance of the detection of inherent upper urinary tract damage. This is particularly important in children with upper somatomotor lesions of bladder innervation in which detrusor-spincter dyssynergia may be present; this dyssynergia always causes some degree of obstruction at the level of the external urethral sphincter and is a constant threat to renal function.

  11. NOD样受体通路在急性腹腔感染早期对大鼠肠屏障的作用机制初探%Effect mechanism of NOD like receptor signaling pathway on intestinal mucosal barrier of rat during early phase of acute intra-abdominal infection

    Institute of Scientific and Technical Information of China (English)

    肖元廷; 李国逊; 王西墨

    2013-01-01

    Objective To initially investigate the expressing regularity and effect of enterocyte NOD like receptors on gut mucosal barrier during early phase of acute intra-abdominal infection.Methods Sprague-Dawley (SD) rats were randomly allocated into control group (n=6) and experimental group (n=24).Acute intra-abdominal infection model was induced by cecal ligation and puncture (CLP).The level of NOD2 and NOD like receptor 3 (NLRP3) mRNA expression in gut mucosa was determined using fluorescent polymerase chain reaction (PCR) ; the expression of caspase-1 and tight junction protein was determined by Western blotting; the activity of nuclear factor-κB (NF-κB) was determined by electrophoretic mobility shift assay (EMSA) ; the level of serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) was determined by enzyme linked immunosorbent assay (ELISA).The dead cell percentage of enterocyte was observed by terminaldeoxynucleoitidyl transferase mediated nick end labeling,and the gut mucosal permeability using an in situ loop preparation of gut with fluorescence isothiocyanate-conjugated dextran was determined.Results NOD2 mRNA expression was quickly increased to a very high apex at 2 hours after operation,compared with the control group,the difference was statistically significant (75.50 ± 13.03 vs.1.00 ± 0.00,P<0.01),and quickly descended at 6 hours,and then slowing descended.The expression of NLRP3 mRNA was decreased at 2 hours after the operation,then increased gradually,and peaked at 12 hours,which was significantly higher than that in control group (4.03 ± 0.71 vs.1.00 ± 0.00,P<0.05).The level of caspase-1 was significantly higher than that in control group at 2 hours (3.56 ± 0.14 vs.2.10 ± 0.11,P<0.01) and then gradually increased.The levels of Occludin,ZO-1 and Claudin-4 were obviously lowered than that in control group at 2-6 hours (2 hours Occludin:7.24 ± 1.13 vs.12.72 ± 1.34,6 hours ZO-1:0.47 ± 0.09 vs.1.57 ± 0.17,2 hours Claudin-4:1.63

  12. Genetic Diversity and Selective Pressure in Hepatitis C Virus Genotypes 1–6: Significance for Direct-Acting Antiviral Treatment and Drug Resistance

    Science.gov (United States)

    Cuypers, Lize; Li, Guangdi; Libin, Pieter; Piampongsant, Supinya; Vandamme, Anne-Mieke; Theys, Kristof

    2015-01-01

    Treatment with pan-genotypic direct-acting antivirals, targeting different viral proteins, is the best option for clearing hepatitis C virus (HCV) infection in chronically infected patients. However, the diversity of the HCV genome is a major obstacle for the development of antiviral drugs, vaccines, and genotyping assays. In this large-scale analysis, genome-wide diversity and selective pressure was mapped, focusing on positions important for treatment, drug resistance, and resistance testing. A dataset of 1415 full-genome sequences, including genotypes 1–6 from the Los Alamos database, was analyzed. In 44% of all full-genome positions, the consensus amino acid was different for at least one genotype. Focusing on positions sharing the same consensus amino acid in all genotypes revealed that only 15% was defined as pan-genotypic highly conserved (≥99% amino acid identity) and an additional 24% as pan-genotypic conserved (≥95%). Despite its large genetic diversity, across all genotypes, codon positions were rarely identified to be positively selected (0.23%–0.46%) and predominantly found to be under negative selective pressure, suggesting mainly neutral evolution. For NS3, NS5A, and NS5B, respectively, 40% (6/15), 33% (3/9), and 14% (2/14) of the resistance-related positions harbored as consensus the amino acid variant related to resistance, potentially impeding treatment. For example, the NS3 variant 80K, conferring resistance to simeprevir used for treatment of HCV1 infected patients, was present in 39.3% of the HCV1a strains and 0.25% of HCV1b strains. Both NS5A variants 28M and 30S, known to be associated with resistance to the pan-genotypic drug daclatasvir, were found in a significant proportion of HCV4 strains (10.7%). NS5B variant 556G, known to confer resistance to non-nucleoside inhibitor dasabuvir, was observed in 8.4% of the HCV1b strains. Given the large HCV genetic diversity, sequencing efforts for resistance testing purposes may need to be

  13. Genetic Diversity and Selective Pressure in Hepatitis C Virus Genotypes 1–6: Significance for Direct-Acting Antiviral Treatment and Drug Resistance

    Directory of Open Access Journals (Sweden)

    Lize Cuypers

    2015-09-01

    Full Text Available Treatment with pan-genotypic direct-acting antivirals, targeting different viral proteins, is the best option for clearing hepatitis C virus (HCV infection in chronically infected patients. However, the diversity of the HCV genome is a major obstacle for the development of antiviral drugs, vaccines, and genotyping assays. In this large-scale analysis, genome-wide diversity and selective pressure was mapped, focusing on positions important for treatment, drug resistance, and resistance testing. A dataset of 1415 full-genome sequences, including genotypes 1–6 from the Los Alamos database, was analyzed. In 44% of all full-genome positions, the consensus amino acid was different for at least one genotype. Focusing on positions sharing the same consensus amino acid in all genotypes revealed that only 15% was defined as pan-genotypic highly conserved (≥99% amino acid identity and an additional 24% as pan-genotypic conserved (≥95%. Despite its large genetic diversity, across all genotypes, codon positions were rarely identified to be positively selected (0.23%–0.46% and predominantly found to be under negative selective pressure, suggesting mainly neutral evolution. For NS3, NS5A, and NS5B, respectively, 40% (6/15, 33% (3/9, and 14% (2/14 of the resistance-related positions harbored as consensus the amino acid variant related to resistance, potentially impeding treatment. For example, the NS3 variant 80K, conferring resistance to simeprevir used for treatment of HCV1 infected patients, was present in 39.3% of the HCV1a strains and 0.25% of HCV1b strains. Both NS5A variants 28M and 30S, known to be associated with resistance to the pan-genotypic drug daclatasvir, were found in a significant proportion of HCV4 strains (10.7%. NS5B variant 556G, known to confer resistance to non-nucleoside inhibitor dasabuvir, was observed in 8.4% of the HCV1b strains. Given the large HCV genetic diversity, sequencing efforts for resistance testing purposes may

  14. Hepatitis C and Incarceration

    Science.gov (United States)

    HEPATITIS C & INCARCERATION What is hepatitis? “Hepatitis” means inflammation or swelling of the liver. The liver is an important ... viral hepatitis: Hepatitis A, Hepatitis B, and Hepatitis C. They are all different from each other and ...

  15. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... of terms Donate Today Enroll in 123 What is Hepatic Encephalopathy? Hepatic Encephalopathy, sometimes referred to as portosystemic encephalopathy or PSE, is a condition that causes temporary worsening of brain ...

  16. Hepatitis A

    Science.gov (United States)

    ... an inflammation of the liver. One type, hepatitis A, is caused by the hepatitis A virus (HAV). The disease spreads through contact with ... washed in untreated water Putting into your mouth a finger or object that came into contact with ...

  17. Hepatitis B

    Science.gov (United States)

    ... information on hepatitis, both in the context of HIV coinfection and as a separate illness. NATAP provides coverage of key conferences, maintains a selection of hepatitis articles, and features an ask-the-expert forum on ...

  18. Hepatitis B

    Science.gov (United States)

    ... personal items (such as toothbrush, razor, and nail clippers) with a person who has the virus Were ... B virus Digestive system Aggressive hepatitis Gianotti-Crosti syndrome on the leg Hepatitis B References Kim DK, ...

  19. Dissemination of bacteria labeled with technetium-99m after laparotomy and abdominal insufflation with different CO2 pressures on rats; Disseminacao de bacterias marcadas com tecnecio-99m apos laparotomia e insuflacao com diferentes pressoes de CO2 em ratos

    Energy Technology Data Exchange (ETDEWEB)

    Pitombo, Marcos Bettini; Faria, Clarice Abreu dos Santos Albuquerque de; Steinbruck, Klaus [Universidade do Estado, Rio de Janeiro, RJ (Brazil). Escola de Medicina]. E-mail: mpitombo@urbi.com.br; Bernardo, Luciana Camargo; Bernardo Filho, Mario[Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes (IBRAG). Lab. de Radiofarmacia Experimental

    2008-01-15

    Purpose: To asses the dissemination of bacteria labeled with technetium-99m (99mTc) from peritoneal cavity after different surgical procedures. Methods: Bacteria of the Escherichia coli species labeled with 99mTc were used in a concentration of 108 units of colony-makers for ml (UFC/ml) and 1 ml was inoculated through intra-peritoneal via. Forty-eight rats were divided into four groups: control, laparotomy, pneumoperitoneum with 10 mmHg and pneumoperitoneum with 20 mmHg of CO2. Procedures were performed 20 min after injection of the inoculum and lasted 30 min. Animals were sacrificed after six hours (Group 1) and 24 hours (Group 2). Samples of blood, liver and spleen were collected for radioactivity counting. Results: After six hours, indirect detection of the bacteria in different organs was uniform in all groups. After 24 hours, a larger detection of technetium was observed in the livers of animals of the group insufflated with 20 mmHg of CO2, when compared with those of control group (p<0.01). The other groups did not present statistically significant variations. Conclusions: The use of a higher intra-abdominal pressure was associated with a higher bacterial dissemination to the liver. The application of lower intra-abdominal pressures may be associated with a lower dissemination of the infectious status during laparoscopic approach of peritonitis status. (author)

  20. Hepatitis C

    Science.gov (United States)

    ... an inflammation of the liver. One type, hepatitis C, is caused by the hepatitis C virus (HCV). It usually spreads through contact with ... childbirth. Most people who are infected with hepatitis C don't have any symptoms for years. If ...

  1. Correlation between hepatic CT perfusion imaging and portal vein pressure in normal Beagles%肝脏CT灌注成像与门静脉压力相关性的动物实验研究

    Institute of Scientific and Technical Information of China (English)

    林元为; 陈伟建; 张启瑜; 梁盼; 杨博洋

    2011-01-01

    目的:探讨正常比格犬门静脉压力与肝脏CT血流灌注参数的相关性.方法:采用螺旋CT对24只犬行肝脏灌注成像扫描,去卷积法计算肝脏血流灌注参数,包括血流量(blood flow,BF)、血容量(blood volume,BV)、平均通过时间(mean transit time,MTT)、肝动脉分数(hepatic arterial fraction,HAF)、肝动脉灌注量(hepatic arterial perfusion,HAP)、门静脉灌注量(portal venous perfusion,PVP).扫描后3 d内开腹,采用玻璃水柱法测定门静脉压力.利用直线回归与相关分析门静脉压力与肝脏CT血流灌注参数的相关性.结果:(1)正常比格犬实测门静脉压力值为(13.57±1.15)cmH2O.(2)正常比格犬门静脉压力与BF、PVP呈负相关,与HAF呈正相关,其中以PVP相关性最显著(r=-0.764,P<0.05),两者关系的直线回归方程为Y=16.507-0.037X.结论:肝脏CT灌注成像为无创、有效监测门静脉压力提供了一种新途径.%Objective To evaluate the correlation between the parameters of spiral CT perfusion imaging and portal vein pressure in normal Beagles. Methods Twenty-four normal beagles were selected to receive hepatic spiral CT perfusion imaging. The parameters of hepatic perfusion , including blood flow (BF) , blood volume (BV) ,mean transit time ( MTT) , hepatic arterial fraction ( HAF) , hepatic arterial perfusion ( HAP) , and portal venous perfusion (PVP) , were calculated hy the method of deconvolution. The portal vein pressure was measured by glass column method in laparotomy surgery three days after CT imaging. Results Portal vein pressure of the beagles were ( 13.57 ± 1.15) cmH2O. Portal vein pressure was negatively correlated with the BF and PVP , but was positively correlated with HAF. PVP was the most significant parameter that correlated with portal vein pressure (r = -0.764,P<0.05) , and their linear regression equation was Y = 16.507-0.037X. Conclusion CT perfusion imaging is a new non-invasive and eff'ective method for assessing portal vein

  2. Hypoksisk hepatitis

    DEFF Research Database (Denmark)

    Amadid, Hanan; Schiødt, Frank Vinholt

    2014-01-01

    Hypoxic hepatitis (HH), also known as ischaemic hepatitis or shock liver, is an acute liver injury caused by hepatic hypoxia. Cardiac failure, respiratory failure and septic shock are the main underlying conditions. In each of these conditions, several haemodynamic mechanisms lead to hepatic...... hypoxia. A shock state is observed in only 50% of cases. Thus, shock liver and ischaemic hepatitis are misnomers. HH can be a diagnostic pitfall but the diagnosis can be established when three criteria are met. Prognosis is poor and prompt identification and treatment of the underlying conditions...

  3. Hepatitis A through E (Viral Hepatitis)

    Science.gov (United States)

    ... Nutrition Clinical Trials Primary Sclerosing Cholangitis Wilson Disease Hepatitis (Viral) View or Print All Sections What is Viral Hepatitis? Viral hepatitis is an infection that causes liver inflammation ...

  4. Autoantibodies and immunoglobulins in patients with alcoholic cirrhosis. Relation to measurements of hepatic function and hemodynamics

    DEFF Research Database (Denmark)

    Gluud, C; Tage-Jensen, Ulrik Viggo; Rubinstein, E;

    1984-01-01

    elimination capacity, indocyanine green clearance, hepatic blood flow and wedged-to-free hepatic vein pressure. Hepatic scan score correlated directly (rho = 0.38, p less than 0.05) to IgA concentrations; wedged-to-free hepatic vein pressure correlated directly to IgG concentrations (rho = 0.35, p less than 0...

  5. [Autoimmune hepatitis].

    Science.gov (United States)

    Ostojić, Rajko

    2003-01-01

    Autoimmune hepatitis is an unresolving, hepatocellular inflammation of unknown cause that is characterized by the presence of periportal hepatitis on histologic examination, tissue autoantibodies in serum, and hypergammaglobulinemia. By international consensus, the designation autoimmune hepatitis has replaced alternative terms for the condition. Three types of autoimmune hepatitis have been proposed based on immunoserologic findings. Type 1 autoimmune hepatitis is characterized by the presence of antinuclear antibodies (ANA) or smooth muscle antibodies (SMA) (or both) in serum. Seventy percent of patients with type 1 of autoimmune hepatitis are women. This type is the most common form and accounts for at least 80% of cases. Type 2 is characterized by the presence of antibodies to liver-kidney microsome type 1 (anti-LKM1) in serum. Patients with this type of autoimmune hepatitis are predominantly children. Type 3 autoimmune hepatitis is characterized by the presence of antibodies to soluble liver antigen (anti-SLA) in serum. There are no individual features that are pathognomonic of autoimmune hepatitis, and its diagnosis requires the confident exclusion of other conditions. The large majority of patients show satisfactory response to corticosteroid (usually prednisone or prednisolone) therapy. For the past 30 years it has been customary to add azathioprine as a "steroid sparing" agent to allow lower doses of steroids to be used and remission, once achieved, can be sustained in many patients with azathioprine alone after steroid withdrawal. Patients with autoimmune hepatitis who have decompensated during or after corticosteroid therapy are candidates for liver transplantation.

  6. Hepatitis B and Hepatitis C in Pregnancy

    Science.gov (United States)

    ... and hepatitis C infections during pregnancy? • How is hepatitis B virus infection spread? • What is acute hepatitis B virus infection? • What is chronic hepatitis B virus infection? • Can ...

  7. Feature Hepatitis: Hepatitis Can Strike Anyone

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Feature Hepatitis Hepatitis Can Strike Anyone Past Issues / Spring 2009 Table ... from all walks of life are affected by hepatitis, especially hepatitis C, the most common form of ...

  8. 男性腹型肥胖患者腹部脂肪面积与胰岛素抵抗的相关性分析%The correlation of intra-abdominal fat area with insulin resistance in male with abdominal obesity

    Institute of Scientific and Technical Information of China (English)

    刘德丰; 陆强; 丁伟利; 马宁; 刘兰祥

    2014-01-01

    Objective To investigate the relationship between intra-abdominal fat area(IAFA)in male with abdominal obesity and glycometabolism related indicators. Methods Ninety-four obesity males,aged from 21 to 62 years old,were selected as our subjects. They were divided into abdominal obesity group(n = 70)and non-abdominal obesity group( n = 24). The general information of all subjects was recorded. The indexes of height,weight,waist circumference,hip circumference,body mass index(BMI)were measured. The fasting oral glucose tolerance test was performed. The levels of blood glucose(0,1,2 h)and insulin(0,1,2 h)were measured,and insulin resistance index was calculated. MRI measurement was applied to calculate the IAFA. Compared the difference between the two groups in term of the level of blood glucose,insulin and insulin resistance index,and analyzed the correlation between glycometabolism related indicators and IAFA. Results BMI,waist circumference,hip circumference,insulin resistance index and IAFA in abdominal obesity group were (28. 67 ± 4. 20)kg/ m2 ,(99. 75 ± 4. 07)cm,(104. 42 ± 7. 62)cm,2. 60 ± 1. 80,(153. 06 ± 53. 23)cm2 respectively,higher than those in non-abdominal obesity group((21. 80 ± 1. 97)kg/ m2 ,(79. 50 ± 10. 05)cm, (91. 86 ± 4. 49)cm,1. 52 ± 0. 73,(71. 78 ± 25. 48)cm2 ),and the differences were statistically significant(t= - 7. 704,- 9. 583,- 7. 618,- 2. 877,- 7. 184,P < 0. 05). The level of blood glucose at 0,1,2 h of patient in abdominal obesity group were(5. 89 ± 1. 36)mmol/ L,(10. 55 ± 3. 07)mmol/ L,and(8. 41 ± 3. 63) mmol/ L,higher than that in non-abdominal obesity group((5. 29 ± 0. 53)mmol/ L,(8. 76 ± 1. 96)mmol/ L, (6. 54 ± 1. 50)mmol/ L). Meanwhile,The insulin at 0,1,2 h of man in abdominal obesity group were(9. 71 ± 5. 05)mU/ L,(83. 29 ± 64. 51)mU/ L,(63. 56 ± 21. 09)mU/ L),significantly higher than those in non-abdominal obesity group((6. 42 ± 2. 96)mU/ L,(33. 00 ± 19. 82)mU/ L,(63. 56 ± 21. 09)mU/ L),and the differences

  9. Hepatitis (For Parents)

    Science.gov (United States)

    ... of three viruses: the hepatitis A virus the hepatitis B virus the hepatitis C virus In some rare cases, ... also called serum hepatitis) is caused by the hepatitis B virus (HBV). HBV can cause a wide range of ...

  10. Travelers' Health: Hepatitis C

    Science.gov (United States)

    ... 3 - Hepatitis B Chapter 3 - Hepatitis E Hepatitis C Deborah Holtzman INFECTIOUS AGENT Hepatitis C virus (HCV), ... to child. Map 3-05. Prevalence of hepatitis C virus infection 1 PDF Version (printable) 1 Disease ...

  11. Hepatitis (For Parents)

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Hepatitis KidsHealth > For Parents > Hepatitis Print A A A ... to Call the Doctor en español Hepatitis About Hepatitis The word hepatitis simply means an inflammation of ...

  12. Travelers' Health: Hepatitis B

    Science.gov (United States)

    ... Chapter 3 - Hepatitis A Chapter 3 - Hepatitis C Hepatitis B Francisco Averhoff INFECTIOUS AGENT Hepatitis B is ... their exposures. Map 3-04. Prevalence of chronic hepatitis B virus infection among adults PDF Version (printable) ...

  13. Travelers' Health: Hepatitis C

    Science.gov (United States)

    ... Chapter 3 - Hepatitis B Chapter 3 - Hepatitis E Hepatitis C Deborah Holtzman INFECTIOUS AGENT Hepatitis C virus ( ... human blood Map 3-05. Global epidemiology of hepatitis C virus infection 1 PDF Version (printable) 1 ...

  14. Hepatitis A

    Science.gov (United States)

    ... inflammation of the liver.” This inflammation can be caused by a wide variety of toxins, drugs, and metabolic diseases, as well as infection. There are at least 5 hepatitis viruses. Hepatitis A is contracted when a child eats food or drinks water that is contaminated with the virus or has ...

  15. Comparison of arterial pressure and plethysmographic waveform-based dynamic preload variables in assessing fluid responsiveness and dynamic arterial tone in patients undergoing major hepatic resection

    NARCIS (Netherlands)

    Vos, J. J.; Kalmar, A. F.; Struys, M. M. R. F.; Wietasch, J. K. G.; Hendriks, H. G. D.; Scheeren, T. W. L.

    2013-01-01

    Dynamic preload variables to predict fluid responsiveness are based either on the arterial pressure waveform (APW) or on the plethysmographic waveform (PW). We compared the ability of APW-based variations in stroke volume (SVV) and pulse pressure (PPV) and of PW-based plethysmographic variability in

  16. Comparison of arterial pressure and plethysmographic waveform-based dynamic preload variables in assessing fluid responsiveness and dynamic arterial tone in patients undergoing major hepatic resection

    NARCIS (Netherlands)

    Vos, J. J.; Kalmar, A. F.; Struys, M. M. R. F.; Wietasch, J. K. G.; Hendriks, H. G. D.; Scheeren, T. W. L.

    Dynamic preload variables to predict fluid responsiveness are based either on the arterial pressure waveform (APW) or on the plethysmographic waveform (PW). We compared the ability of APW-based variations in stroke volume (SVV) and pulse pressure (PPV) and of PW-based plethysmographic variability

  17. Comparison of arterial pressure and plethysmographic waveform-based dynamic preload variables in assessing fluid responsiveness and dynamic arterial tone in patients undergoing major hepatic resection

    NARCIS (Netherlands)

    Vos, J. J.; Kalmar, A. F.; Struys, M. M. R. F.; Wietasch, J. K. G.; Hendriks, H. G. D.; Scheeren, T. W. L.

    2013-01-01

    Dynamic preload variables to predict fluid responsiveness are based either on the arterial pressure waveform (APW) or on the plethysmographic waveform (PW). We compared the ability of APW-based variations in stroke volume (SVV) and pulse pressure (PPV) and of PW-based plethysmographic variability in

  18. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Symptoms to look for Caregiver Support Caregiver Stories Home › What is Hepatic Encephalopathy? Why Your Liver is ... questions about HE, one step at a time. Home About Us Ways to Give Contact Us Privacy ...

  19. Hepatitis A

    Science.gov (United States)

    ... Hepatitis A is more common in parts of Africa, Asia, Central and South America, and Eastern Europe ... la salud en español Health Statistics Healthy Moments Radio Broadcast Clinical Trials For Health Professionals Diabetes Discoveries & ...

  20. Autoimmune hepatitis.

    Science.gov (United States)

    Heneghan, Michael A; Yeoman, Andrew D; Verma, Sumita; Smith, Alastair D; Longhi, Maria Serena

    2013-10-26

    Autoimmune hepatitis is a disease of the hepatic parenchyma that can present in acute or chronic forms. In common with many autoimmune diseases, autoimmune hepatitis is associated with non-organ-specific antibodies in the context of hepatic autoimmunity. This dichotomy has made definition of a unifying hypothesis in the pathophysiology of the disease difficult, although data from the past 8 years have drawn attention to the role of regulatory T cells. Several triggers have been identified, and the disease arises in genetically susceptible individuals. Clinical and biochemical remission is achievable in up to 85% of cases. For the remaining patients, alternative immunosuppression strategies are an option. Liver transplantation provides an excellent outcome for patients with acute liver failure or complications of end-stage liver disease, including hepatocellular carcinoma. Variant or overlapping syndromes are worthy of consideration when unexpected disease features arise.

  1. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Get Worse? How is HE Diagnosed? Prior to Treatment Who treats HE? Preparing for your Medical Appointment Hepatic Encephalopathy Treatment Options Treatment Basics Treatment Medications Importance of Adhering ...

  2. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... is a condition that causes temporary worsening of brain function in people with advanced liver disease. When ... travel through your body until they reach your brain, causing mental and physical symptoms of HE. Hepatic ...

  3. Hepatitis B

    Science.gov (United States)

    ... using an infected person’s razor, toothbrush, or nail clippers You can’t get hepatitis B from being ... personal items such as toothbrushes, razors, or nail clippers using a latex or polyurethane condom during sex ...

  4. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Get Worse? How is HE Diagnosed? Prior to Treatment Who treats HE? Preparing for your Medical Appointment Hepatic Encephalopathy Treatment Options Treatment Basics Treatment Medications Importance of Adhering ...

  5. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... the Stages of Hepatic Encephalopathy? What Triggers or Can Cause HE to Get Worse? How is HE ... liver disease. When your liver is damaged it can no longer remove toxic substances from your blood. ...

  6. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... to Treatment Who treats HE? Preparing for your Medical Appointment Hepatic Encephalopathy Treatment Options Treatment Basics Treatment ... treatment. Being a fully-informed participant in your medical care is an important factor in staying as ...

  7. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... is a condition that causes temporary worsening of brain function in people with advanced liver disease. When ... travel through your body until they reach your brain, causing mental and physical symptoms of HE. Hepatic ...

  8. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Hepatic Encephalopathy so you can tell your doctor right away if you think you may have it. ... American Liver Foundation © 2017 American Liver Foundation. All rights reserved. Funding for the HE123 - Diagnosis, Treatment and ...

  9. Hepatitis autoinmune.

    OpenAIRE

    LOJA OROPEZA, David; VILCA VASQUEZ, Maricela; AVILES GONZAGA, Roberto

    2013-01-01

    Three patients with autoinmune hepatitis type 1 diagnosed at the Hospital Nacional Arzobispo Loayza in Lima-Perú, between 1993 and 1995, are here reported, emphasis is made on the clinical, histological and therapeutical aspects.

  10. Hepatitis B Foundation

    Science.gov (United States)

    ... worldwide 2 Billion People have been infected with Hepatitis B Worldwide The Hepatitis B Foundation is working on ... of people living with hepatitis B. Learn About Hepatitis B in 11 Other Languages . Resource Video See More ...

  11. Hepatitis A Test

    Science.gov (United States)

    ... be limited. Home Visit Global Sites Search Help? Hepatitis A Testing Share this page: Was this page ... HAV-Ab total; Anti-HAV Formal name: Viral Hepatitis A Antibody Related tests: Hepatitis B Testing ; Hepatitis ...

  12. Hepatitis Risk Assessment

    Science.gov (United States)

    ... Requirements for Viral Hepatitis Liver Cancer and Viral Hepatitis Viral Hepatitis and Young Persons Who Inject Drugs National Academies’ ... Sources for IG & HBIG About the Division of Viral Hepatitis Contact Us Anonymous Feedback File Formats Help: How ...

  13. Travelers' Health: Hepatitis A

    Science.gov (United States)

    ... 3 - Helminths, Soil-Transmitted Chapter 3 - Hepatitis B Hepatitis A Noele P. Nelson, Trudy V. Murphy INFECTIOUS ... hepatitis/HAV Table 3-02. Vaccines to prevent hepatitis A VACCINE TRADE NAME (MANUFACTURER) AGE (Y) DOSE ...

  14. Delta agent (Hepatitis D)

    Science.gov (United States)

    Hepatitis D virus ... Hepatitis D virus (HDV) is found only in people who carry the hepatitis B virus. HDV may make liver ... B virus but who never had symptoms. Hepatitis D infects about 15 million people worldwide. It occurs ...

  15. Feature Hepatitis: Hepatitis Symptoms, Diagnosis, Treatment & Prevention

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Feature Hepatitis Hepatitis: Symptoms, Diagnosis, Treatment & Prevention Past Issues / Spring 2009 ... No appetite Fever Headaches Diagnosis To check for hepatitis viruses, your doctor will test your blood. You ...

  16. Emodin Decreases Hepatic Hypoxia-Inducible Factor-1[Formula: see text] by Inhibiting its Biosynthesis.

    Science.gov (United States)

    Ma, Feifei; Hu, Lijuan; Yu, Ming; Wang, Feng

    2016-01-01

    Hypoxia-inducible factor-1 (HIF-1) is an [Formula: see text] dimeric transcription factor. Because HIF-1[Formula: see text] is instable with oxygen, HIF-1 is scarce in normal mammalian cells. However, HIF-1[Formula: see text] is expressed in pathological conditions such as cancer and obesity. Inhibiting HIF-1[Formula: see text] may be of therapeutic value for these pathologies. Here, we investigated whether emodin, derived from the herb of Rheum palmatum L, which is also known as Chinese rhubarb, and is native to China, regulates HIF-1[Formula: see text] expression. Male C57BL/6 mice without or with diet-induced obesity were treated with emodin for two weeks, while control mice were treated with vehicle. HIF-1[Formula: see text] expression was determined by Western blot. We found that emodin inhibited obesity-induced HIF-1[Formula: see text] expression in liver and skeletal muscle but did not regulate HIF-1[Formula: see text] expression in the kidneys or in intra-abdominal fat. In vitro, emodin inhibited HIF-1[Formula: see text] expression in human HepG2 hepatic cells and Y1 adrenocortical cells. Further, we investigated the mechanisms of HIF-1[Formula: see text] expression in emodin-treated HepG2 cells. First, we found that HIF-1[Formula: see text] had normal stability in the presence of emodin. Thus, emodin did not decrease HIF-1[Formula: see text] by stimulating its degradation. Importantly, emodin decreased the activity of the signaling pathways that led to HIF-1[Formula: see text] biosynthesis. Interestingly, emodin increased HIF-1[Formula: see text] mRNA in HepG2 cells. This may be a result of feedback in response to the emodin-induced decrease in the protein of HIF-1[Formula: see text]. In conclusion, emodin decreases hepatic HIF-1[Formula: see text] by inhibiting its biosynthesis.

  17. Weight loss enhances hepatic antioxidant status in a NAFLD model induced by high fat diet.

    Science.gov (United States)

    Mendes, Iara Karise Santos; Matsuura, Cristiane; Aguila, Marcia Barbosa; Daleprane, Julio Beltrame; Martins, Marcela Anjos; Mury, Wanda Vianna; Brunini, Tatiana Marlowe Cunha

    2017-08-23

    Nonalcoholic fatty liver disease (NAFLD) is a benign condition that can progress to more severe liver damage in a process mediated, in part, by disturbances in redox balance. Additionally, some argue that it is set to become the main cause of end-stage liver disease in the near future. Here, we investigated whether a diet-induced weight loss is able to reverse hepatic lipid accumulation and to reduce oxidative stress in liver from C57BL/6 mice fed a high-fat (HF) diet. Male C57BL/6 mice were divided into four groups: SC (standard chow, 10% energy from fat, 16 wk); HF (high fat diet, 50% energy from fat, 16 wk); SC-HF (SC 8 wk followed by HF 8 wk); and HF-SC (HF 8 wk followed by SC 8 wk). The HF diet during 8 (SC-HF) and 16 weeks (HF) downregulated mRNA levels and protein expression of Nrf2 and endogenous antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase) in the liver, caused liver steatosis, affected liver function markers, increased intra-abdominal and subcutaneous adipose tissue, and induced glucose intolerance and hypercholesterolemia compared to controls (SC). Diet-induced weight loss significantly reduced the intrahepatic lipid accumulation, improved glucose tolerance, and restored both gene and protein expression of the antioxidant enzymes. Our findings suggest that a dietary intervention aimed to induce weight loss may exert protective effects in NAFLD as it can reduce hepatic oxidative stress and intrahepatic lipid accumulation, which can hinder the progression of this condition to more severe states.

  18. Hepatitis C: Diet and Nutrition

    Science.gov (United States)

    ... with Hepatitis » Daily Living: Diet and Nutrition Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For ... have high cholesterol and have fatty liver. How hepatitis C affects diet If you have hepatitis, you ...

  19. Liver Cancer and Hepatitis B

    Science.gov (United States)

    ... Our Accomplishments Annual Reports Our Videos What Is Hepatitis B? What Is Hepatitis B? The ABCs of Viral Hepatitis Liver Cancer and Hepatitis B Hepatitis Delta Coinfection Hepatitis C Coinfection HIV/AIDS ...

  20. Autoimmune hepatitis

    Directory of Open Access Journals (Sweden)

    F Motamed

    2014-04-01

    Full Text Available Autoimmune hepatitis is (AIH is a chronic hepatitis that occurs in children and adults of all ages. It is characterized by immunologic and autoimmune features, including circulating auto antibodies and high serum globulin concentrations. It was first described in the 1950s by term of chronic active hepatitis. It has 2 types with different auto antibodies. Diagnosis is based upon serologic and histologic findings and exclusion of other forms of chronic liver disease.   A scoring system should be used in assessment based upon: 1 Auto anti bodie titer 2 Serum IgG level  3 Liver histology 4 Absence of viral and other causes of hepatitis. Clear indications for treatment: 1   rise of aminotrasferases 2   clinical symptoms of liver disease 3   histological features in liver biopsy 4   Children with AIH initial treatment involve glucocorticoid with or without azathioprine. For patients with fulminant hepatitis liver transplantation, should be kept in mind.   Remission is defined by: 1   Resolution of symptoms 2   Normalization of serum trasaminases 3   Normalization of serum bilirubin and gamma globuline levels. 4   Improvement in liver histology 5   Treatment is continued for at least 2-5 years, glucocorticoids are with drawn first, by tapering over six weeks. Azathioprine will be with drawn.  

  1. [Chronic hepatitis].

    Science.gov (United States)

    Figueroa Barrios, R

    1995-01-01

    Medical literature about chronic hepatitis is reviewed. This unresolving disease caused by viruses, drugs or unknown factors may progress to in cirrhosis and hepatocarcinoma. A classification based on liver biopsy histology into chronic persistent and chronic active types has been largely abandoned and emphasis is placed on recognizing the etiology of the various types. One is associated with continuing hepatitis B virus infection; another is related to chronic hepatitis C virus infection and the third is termed autoinmune, because of the association with positive serum autoantibodies. A fourth type with similar clinical functional and morphologic features is found with some drug reactions. Long term corticoesteroid therapy is usually successful in autoinmune type. Associations between antibodies to liver-kidney microsomes and the hepatitis C virus can cause diagnostic difficulties. Antiviral treatment of chronic hepatitis B and C with interpheron alfa is employed, controlling symptoms and abnormal biochemistry and the progression to cirrhosis and liver cancer in 30 to 40% patients. Alternative therapies or combinations with interpheron are being evaluated waiting for final results.

  2. Establishment of a hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol.

    Science.gov (United States)

    Wang, Lei; He, Fu-Liang; Liu, Fu-Quan; Yue, Zhen-Dong; Zhao, Hong-Wei

    2015-08-28

    To determine the feasibility and safety of establishing a porcine hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol. Twenty-one healthy Guizhou miniature pigs were randomly divided into three experimental groups and three control groups. The pigs in the three experimental groups were subjected to hepatic arterial perfusion with 7, 12 and 17 mL of 80% alcohol, respectively, while those in the three control groups underwent hepatic arterial perfusion with 7, 12 and 17 mL of saline, respectively. Hepatic arteriography and direct portal phlebography were performed on all animals before and after perfusion, and the portal venous pressure and diameter were measured before perfusion, immediately after perfusion, and at 2, 4 and 6 wk after perfusion. The following procedures were performed at different time points: routine blood sampling, blood biochemistry, blood coagulation and blood ammonia tests before surgery, and at 2, 4 and 6 wk after surgery; hepatic biopsy before surgery, within 6 h after surgery, and at 1, 2, 3, 4 and 5 wk after surgery; abdominal enhanced computed tomography examination before surgery and at 6 wk after surgery; autopsy and multi-point sampling of various liver lobes for histological examination at 6 wk after surgery. In experimental group 1, different degrees of hepatic fibrosis were observed, and one pig developed hepatic cirrhosis. In experimental group 2, there were cases of hepatic cirrhosis, different degrees of increased portal venous pressure, and intrahepatic portal venous bypass, but neither extrahepatic portal-systemic bypass circulation nor death occurred. In experimental group 3, two animals died and three animals developed hepatic cirrhosis, and different degrees of increased portal venous pressure and intrahepatic portal venous bypass were also observed, but there was no extrahepatic portal-systemic bypass circulation. It is feasible to establish an animal model of hepatic cirrhosis and

  3. Diagnosis and Management of Hepatic Encephalopathy in Fulminant Hepatic Failure.

    Science.gov (United States)

    Kodali, Sudha; McGuire, Brendan M

    2015-08-01

    Hepatic encephalopathy (HE) is associated with cerebral edema (CE), increased intracranial pressure (ICP), and subsequent neurologic complications; it is the most important cause of morbidity and mortality in fulminant hepatic failure. The goal of therapy should be early diagnosis and treatment of HE with measures to reduce CE. A combination of clinical examination and diagnostic modalities can aid in prompt diagnosis. ICP monitoring and transcranial Doppler help diagnose and monitor response to treatment. Transfer to a transplant center and intensive care unit admission with airway management and reduction of CE with hypertonic saline, mannitol, hypothermia, and sedation are recommended as a bridge to liver transplantation.

  4. Autoimmune hepatitis.

    Science.gov (United States)

    Strassburg, Christian P

    2010-10-01

    Autoimmune hepatitis is a chronic inflammatory disease of the liver with a dismal prognosis when left untreated. Key for the improvement of prognosis is a timely diagnosis before cirrhosis has developed. This is reached by the exclusion of other causes of hepatitis, elevated immunoglobulin G, autoantibody profile and histological assessment. Treatment achieves remission rates in 80% of individuals and consists of immunosuppression with corticosteroids and azathioprine. A recent randomised controlled multicenter trial has added budesonide to the effective treatment options in non-cirrhotic patients and leads to a reduction of unwanted steroid side effects. Autoimmune hepatitis is an autoimmune disease of unknown aetiology. Association studies of major histocompatibility complex and other genes demonstrate an influence of immunogenetics. However, apart from the autoimmune polyglandular syndrome type 1, in which 10% of patients suffer from an autoantibody-positive autoimmune hepatitis linked to mutations of the autoimmune regulator gene, there is no clear evidence for a hereditary aetiology of this disease. Copyright © 2010 Elsevier Ltd. All rights reserved.

  5. Hepatitis A vaccine associated with autoimmune hepatitis

    Institute of Scientific and Technical Information of China (English)

    PA Berry; G Smith-Laing

    2007-01-01

    To describe a case of probable relapsing autoimmune hepatitis associated with vaccination against hepatitis A virus (HAV). A case report and review of literature were written concerning autoimmune hepatitis in association with hepatitis A and other hepatotropic viruses. Soon after the administration of formalin-inactivated hepatitis A vaccine, a man who had recently recovered from an uncharacterized but self-limiting hepatitic illness,experienced a severe deterioration (AST 1687 U/L, INR 1.4). Anti-nuclear antibodies were detectable, and liver biopsy was compatible with autoimmune hepatitis. The observation supports the role of HAV as a trigger of autoimmune hepatitis. Studies in helper T-cell activity and antibody expression against hepatic proteins in the context of hepatitis A infection are summarized, and the concept of molecular mimicry with regard to other forms of viral hepatitis and autoimmunity is briefly explored.

  6. ASSOCIATION OF BLOOD PRESSURE IN ADULTS WITH SELECTED ANTHROPOMETRIC PARAMETERS AND CRP: A HOSPITAL BASED CROSS SECTIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Katta Subraya

    2016-06-01

    Full Text Available BACKGROUND Hypertension is a major public health problem and a known risk factor for cardiovascular disease. Epidemiological studies from different populations have reported significant association between different anthropometric indicators and hypertension. AIMS AND OBJECTIVES The present study was carried out to examine the relationship between C-reactive protein, different anthropometric indices and blood pressure in adults. MATERIALS AND METHODS This is a hospital-based cross-sectional study done among 250 patients over 40 years of age, attending Medicine OPD of a tertiary care institution selected based on their willingness and eligibility to participate. Anthropometric measurements, blood pressure examination and laboratory investigations were done and used for this study. RESULTS Increased blood pressure was found in both obese and non-obese individuals. BMI, waist circumference, neck circumference, sagittal abdominal diameter and CRP was higher in hypertensive males than normotensives and it was statistically significant. Karl Pearson correlation showed that BMI, WC, HC, NC, SAD and CRP had a positive correlation with systolic and diastolic blood pressure and it was found to be statistically significant. CONCLUSION In this study CRP, SAD, HC, WC and NC showed a positive correlation with both systolic and diastolic blood pressure, which means that WC and SAD can be used to get information about visceral obesity in an individual. This also suggests that decrease in intra-abdominal fat could decrease the blood pressure.

  7. Hepatic amebiasis

    Directory of Open Access Journals (Sweden)

    José Maria Salles

    2003-04-01

    Full Text Available Amebiasis can be considered the most aggressive disease of the human intestine, responsible in its invasive form for clinical syndromes, ranging from the classic dysentery of acute colitis to extra-intestinal disease, with emphasis on hepatic amebiasis, unsuitably named amebic liver abscess. Found worldwide, with a high incidence in India, tropical regions of Africa, Mexico and other areas of Central America, it has been frequently reported in Amazonia. The trophozoite reaches the liver through the portal system, provoking enzymatic focal necrosis of hepatocytes and multiple micro-abscesses that coalesce to develop a single lesion whose central cavity contains a homogeneous thick liquid, with typically reddish brown and yellow color similar to "anchovy paste". Right upper quadrant pain, fever and hepatomegaly are the predominant symptoms of hepatic amebiasis. Jaundice is reported in cases with multiple lesions or a very large abscess, and it affects the prognosis adversely. Besides chest radiography, ultrasonography and computerized tomography have brought remarkable contributions to the diagnosis of hepatic abscesses. The conclusive diagnosis is made however by the finding of Entamoeba histolytica trophozoites in the pus and by the detection of serum antibodies to the amoeba. During the evolution of hepatic amebiasis, in spite of the availability of highly effective drugs, some important complications may occur with regularity and are a result of local perforation with extension into the pleural and pericardium cavities, causing pulmonary abscesses and purulent pericarditis, respectively The ruptures into the abdominal cavity may lead to subphrenic abscesses and peritonitis. The treatment of hepatic amebiasis is made by medical therapy, with metronidazole as the initial drug, followed by a luminal amebicide. In patients with large abscesses, showing signs of imminent rupture, and especially those who do not respond to medical treatment, a

  8. Hepatic autoregulation

    DEFF Research Database (Denmark)

    Staehr, Peter; Hother-Nielsen, Ole; Beck-Nielsen, Henning

    2007-01-01

    The effect of increased glycogenolysis, simulated by galactose's conversion to glucose, on the contribution of gluconeogenesis (GNG) to hepatic glucose production (GP) was determined. The conversion of galactose to glucose is by the same pathway as glycogen's conversion to glucose, i.e., glucose 1......-phosphate --> glucose 6-phosphate --> glucose. Healthy men (n = 7) were fasted for 44 h. At 40 h, hepatic glycogen stores were depleted. GNG then contributed approximately 90% to a GP of approximately 8 micromol.kg(-1).min(-1). Galactose, 9 g/h, was infused over the next 4 h. The contribution of GNG to GP...... declined from approximately 90% to 65%, i.e., by approximately 2 micromol.kg(-1).min(-1). The rate of galactose conversion to blood glucose, measured by labeling the infused galactose with [1-(2)H]galactose (n = 4), was also approximately 2 micromol.kg(-1).min(-1). The 41st h GP rose by approximately 1...

  9. Hepatitis C Test

    Science.gov (United States)

    ... products and services. Advertising & Sponsorship: Policy | Opportunities Hepatitis C Testing Share this page: Was this page helpful? Also known as: Hepatitis C Antibody; Anti-HCV; HCV-PCR; HCV-RNA; Hepatitis ...

  10. HIV and Hepatitis B

    Science.gov (United States)

    ... AIDS-Related Opportunistic Infections and Coinfections HIV and Hepatitis B (Last updated 8/31/2016; last reviewed ... should be treated for both diseases. What is hepatitis B? Hepatitis B is a liver disease caused ...

  11. Drug-induced hepatitis

    Science.gov (United States)

    Toxic hepatitis ... to get liver damage. Some drugs can cause hepatitis with small doses, even if the liver breakdown ... liver. Many different drugs can cause drug-induced hepatitis. Painkillers and fever reducers that contain acetaminophen are ...

  12. HIV and Hepatitis C

    Science.gov (United States)

    ... AIDS-Related Opportunistic Infections and Coinfections HIV and Hepatitis C (Last updated 8/31/2016; last reviewed ... the medicines for any side effects. What is hepatitis C? Hepatitis C is a liver disease caused ...

  13. Hepatitis B Test

    Science.gov (United States)

    ... helpful? Also known as: HBV Tests; Hep B; anti-HBs; Hepatitis B Surface Antibody; HBsAg; Hepatitis B Surface ... including "HBV carrier" state. Hepatitis B surface antibody (anti-HBs) Detects antibody produced in response to HBV surface ...

  14. Preventing hepatitis A

    Science.gov (United States)

    Hepatitis A is inflammation (irritation and swelling) of the liver caused by the hepatitis A virus. You can take several steps to ... reduce your risk of spreading or catching the hepatitis A virus: Always wash your hands thoroughly after ...

  15. Travelers' Health: Hepatitis E

    Science.gov (United States)

    ... Chapter 3 - Hepatitis C Chapter 3 - Histoplasmosis Hepatitis E Chong-Gee Teo INFECTIOUS AGENT Infection is caused ... for infection. Map 3-06. Distribution of hepatitis E virus infection 1 PDF Version (printable) 1 Disease ...

  16. Hepatitis B virus (image)

    Science.gov (United States)

    Hepatitis B is also known as serum hepatitis and is spread through blood and sexual contact. It is ... population. This photograph is an electronmicroscopic image of hepatitis B virus particles. (Image courtesy of the Centers for ...

  17. Hepatitis C.

    Science.gov (United States)

    Sharara, A I; Hunt, C M; Hamilton, J D

    1996-10-15

    To review the virology, epidemiology, pathogenesis, natural history, clinical manifestations, and current treatment of hepatitis C virus (HCV) infection. The MEDLINE database (1966 to 1996) was searched for English-language articles and abstracts on HCV and non-A, non-B hepatitis. Papers cited in relevant primary articles were also reviewed. More than 500 original and review articles were evaluated, and the most relevant were selected. Data were extracted and reviewed by all authors. In most patients, HCV infection results in chronic hepatitis. The disease is insidious and subclinical but may progress over decades into end-stage liver disease and hepatocellular carcinoma, which makes HCV cirrhosis a leading indication for orthotopic liver transplantation. Current diagnostic methods are highly sensitive and specific, and quantitative assessment of viral load may help to predict and monitor response to treatment. The only available therapeutic option is interferon, and this agent is effective in only a small subset of patients. Infection with HCV is a significant public health problem that has important clinical and financial consequences. The tailoring of specific therapy according to viral load or genotype, better patient selection, and use of combination drug regimens may improve the chance of viral clearance and sustained biochemical and histologic response. Further understanding of the basic virology of HCV and the exact mechanisms of viral persistence and tissue injury is needed to help define future therapeutic and preventive strategies.

  18. [Hepatitis E].

    Science.gov (United States)

    Scotto, Gaetano; Bulla, Fabio; Campanale, Francesca; Tartaglia, Alessandra; Fazio, Vincenzina

    2013-09-01

    Hepatitis E virus (HEV) represents the main aetiological agent of enteric non-A hepatitis and is the only member of a new virus, Hepevirus, belonging to the family of Hepeviridae. HEV is the single most important cause of acute clinical hepatitis among adults in many areas of the developing world, specifically the Indian subcontinent and Southeast Asia, the Middle East and North Africa, where it is a common cause of sporadic and epidemic waterborne outbreaks and results in a high rate of morbidity and death, especially in pregnant women. Once thought of as an infection confined to developing countries, it is now recognized as a geographically widely distributed disease. In low-endemic regions (Western countries), sporadic cases of locally-acquired HEV infection are reported, acquired possibly through zoonotic transmission from pigs, wild boars or deer. In persons with pre-existing chronic liver disease, HEV superinfection can present as acute-on-chronic liver disease. In European countries, chronic infection, which may progress to liver cirrhosis, has been reported among immunosuppressed persons. Two testing vaccines proved to be highly effective in preventing the disease; these vaccines should be of particular use in groups that are at high risk of HEV infection.

  19. Hepatic Resection Using a Water Jet Dissector

    Science.gov (United States)

    Stain, S. C.; Guastella, T.; Maddern, G. J.; Blumgart, L. H.

    1993-01-01

    The mortality and morbidity in major hepatic resection is often related to hemorrhage. A high pressure, high velocity water jet has been developed and has been utilized to assist in hepatic parenchymal transection. Sixty-seven major hepatic resections were performed for solid hepatic tumors. The tissue fracture technique was used in 51 patients (76%), and the water jet dissector was used predominantly in 16 patients (24%). The extent of hepatic resection using each technique was similar. The results showed no difference in operative duration (p = .499). The mean estimated blood loss using the water jet was 1386 ml, and tissue fracture technique 2450 ml (p = .217). Transfusion requirements were less in the water jet group (mean 2.0 units) compared to the tissue fracture group (mean 5.2 units); (p = .023). Results obtained with the new water dissector are encouraging. The preliminary results suggest that blood loss may be diminished. PMID:8387808

  20. Hepatitis Information for the Public

    Science.gov (United States)

    ... Requirements for Viral Hepatitis Liver Cancer and Viral Hepatitis Viral Hepatitis and Young Persons Who Inject Drugs National ... Recommend on Facebook Tweet Share Compartir What is Viral Hepatitis? The word "hepatitis" means inflammation of the liver . ...

  1. Hepatitis B Vaccine

    Science.gov (United States)

    ... a combination product containing Haemophilus influenzae type b, Hepatitis B Vaccine) ... combination product containing Diphtheria, Tetanus Toxoids, Acellular Pertussis, Hepatitis B, Polio Vaccine)

  2. Prolonged acute hepatitis A mimicking autoimmune hepatitis

    Institute of Scientific and Technical Information of China (English)

    Rintaro Mikata; Osamu Yokosuka; Fumio Imazeki; Kenichi Fukai; Tatsuo Kanda; Hiromitsu Saisho

    2005-01-01

    AIM: We report a case with a prolonged course of hepatitisA, with alanine aminotransferase (ALT) higher than 500 IU/Lfor more than 2 mo.METHODS: A middle-aged woman had an elevated IgG level of more than 2 000 mg/dL, positive arti-nudear antibodies (ANA) and anti-smooth muscle antibodies (ASMA), but no evidence of persistent hepatitis A virus (HAV) infection. Liver biopsy findings were compatible with prolonged acute hepatitis, although acute onset of autoimmune hepatitis could not be ruled out.RESULTS: It was assumed that she developed a course of hepatitis similar to autoimmune hepatitis triggered by HAV infection. Ursodeoxycholic acid (UDCA) treatment was initiated and a favorable outcome was obtained. CONCLUSION: We describe a case of a middle-aged woman who showed a prolonged course of acute hepatitis A mimicking autoimmune hepatitis. Treatment with UDCAproved to be effective.

  3. Visceral adiposity, not abdominal subcutaneous fat area, is associated with high blood pressure in Japanese men: the Ohtori study.

    Science.gov (United States)

    Koh, Hideo; Hayashi, Tomoshige; Sato, Kyoko Kogawa; Harita, Nobuko; Maeda, Isseki; Nishizawa, Yoshiki; Endo, Ginji; Fujimoto, Wilfred Y; Boyko, Edward J; Hikita, Yonezo

    2011-05-01

    Visceral adiposity is considered to have a key role in cardiometabolic diseases. The purpose of this study is to investigate cross-sectionally the association between intra-abdominal fat area (IAFA) measured by computed tomography (CT) and high blood pressure independent of abdominal subcutaneous fat area (ASFA) and insulin resistance. Study participants included 624 Japanese men not taking oral hypoglycemic medications or insulin. Abdominal, thoracic and thigh fat areas were measured by CT. Total fat area (TFA) was calculated as the sum of abdominal, thoracic and thigh fat area. Total subcutaneous fat area (TSFA) was defined as TFA minus IAFA. Hypertension and high normal blood pressure were defined using the 1999 criteria of the World Health Organization. Multiple-adjusted odds ratios of hypertension for tertiles of IAFA were 2.64 (95% confidence interval, 1.35-5.16) for tertile 2, and 5.08 (2.48-10.39) for tertile 3, compared with tertile 1 after adjusting for age, fasting immunoreactive insulin, diabetes status, ASFA, alcohol consumption, regular physical exercise and smoking habit. IAFA remained significantly associated with hypertension even after adjustment for ASFA, TSFA, TFA, body mass index or waist circumference, and no other measure of regional or total adiposity was associated with the odds of hypertension in models, which included IAFA. Similar results were obtained for the association between IAFA and the prevalence of high normal blood pressure or hypertension. In conclusion, greater visceral adiposity was associated with a higher odds of high blood pressure in Japanese men.

  4. The terminology of hepatitis*

    Science.gov (United States)

    1973-01-01

    It is proposed that the diseases formerly known as “infectious hepatitis” and “serum hepatitis” be referred to as viral hepatitis type A and viral hepatitis type B, respectively. It is further recommended that the “Australia” antigen be referred to as hepatitis B antigen (HB Ag) and the corresponding antibody as hepatitis B antibody (HB Ab). PMID:4544683

  5. Hepatitis A and HIV

    Science.gov (United States)

    ... Hepatitis B and Hepatitis C . Hepatitis A and HIV Hepatitis A is preventable with a vaccine, and ... Notice Network blog.aids.gov • locator.aids.gov • HIV/AIDS Service Locator Locator Widgets • Instructions • API Find ...

  6. Hepatitis B (HBV)

    Science.gov (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Hepatitis B (HBV) KidsHealth > For Teens > Hepatitis B (HBV) Print A A A What's in this ... poisons). There are several different types of hepatitis . Hepatitis B is a type that can move from one ...

  7. Hepatitis B (HBV)

    Science.gov (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Hepatitis B (HBV) KidsHealth > For Teens > Hepatitis B (HBV) A A A What's in this article? ... poisons). There are several different types of hepatitis . Hepatitis B is a type that can move from one ...

  8. Angiogenesis Research to Improve Therapies for Vascular Leak Syndromes, Intra-Abdominal Adhesions, and Arterial Injuries

    Science.gov (United States)

    2009-04-01

    inhibitors of the matrix metallo- proteinase protein family and have been used to reduce tissue degradation in arthritis and periodontal disease (9... periodontal disease (5). Doxycycline, a tetracycline derivative, has been shown to inhibit angiogenesis in both humans (6) and animal models (7); however...types and is often associated with a poor prognosis and survival rate. We chose the intrasplenic model for induction of liver metastasis, in which the

  9. Large Gastric Teratoma: A Rare Intra-abdominal Mass of Infancy.

    Science.gov (United States)

    Hasan, Roumina; Monappa, Vidya; Kumar, Sandeep; Kumar, Vijay

    2016-05-01

    Amongst the varied, diverse causes of intraabdominal masses in infancy and early childhood, gastric teratomas (GTs) account for a very small proportion. A worldwide literature search reveals only around one hundred cases of GT and also supports the fact that its preoperative diagnosis remains elusive. Here we report the case of a two-month-old male who presented to the pediatric surgery outpatient department of Kasturba Medical College and Hospital, Karnataka, India, with progressive distension of abdomen since birth. Clinically, a large firm, non-mobile and non-tender mass involving all four quadrants of the abdomen was seen. Ultrasound revealed a large solid-cystic mass with internal septations extending from the epigastrium up to the pelvis. Computed tomography revealed a large intraperitoneal fat containing solid-cystic mass lesion showing curvilinear and chunky areas of calcification, with the mass focally indenting the posterior gastric wall and showing focal polypoidal intragastric extension. Exploratory laparotomy revealed a large cystic tumor with a solid component, arising from lesser curvature of the stomach, showing focal intraluminal extension across the posterior gastric wall, and occupying the whole lesser sac and abdominal cavity. The tumor was excised in toto along with the body of the stomach. Histopathological examination showed mature tissue derived from all three germ cell layers and confirmed the diagnosis of mature gastric teratoma. The patient was disease free at one-year follow-up.

  10. Medical image of the week: massive spontaneous intra-abdominal bleeding

    Directory of Open Access Journals (Sweden)

    Alzoubaidi M

    2014-02-01

    Full Text Available A 67 year-old female with rheumatoid arthritis, on anti-TNF and corticosteroids, was admitted to the ICU with severe shock, likely hemorrhagic. She was on coumadin for atrial fibrillation. She was found to have severe coagulopathy and diffuse spontaneous abdominal bleeding (Figure 1. She also developed left popliteal artery thrombosis, with compartment syndrome requiring surgical intervention. Disseminated intravascular coagulation was her final diagnosis.

  11. A case of intra-abdominal hemorrhage secondary to peliosis hepatis

    Directory of Open Access Journals (Sweden)

    Ross O. Downes

    2015-01-01

    Conclusion: We examine the literature and subsequently discuss the etiology and management of peliosis. Peliosis is a rare vascular condition of the liver characterized by the presence of cystic blood filled cavities. Causes are associated with a number of conditions, however, etiology is largely unknown. Management is overwhelmingly conservative except in a handful of cases.

  12. Angiogenesis Research to Improve Therapies for Vascular Leak Syndromes, Intra-Abdominal Adhesions, and Arterial Injuries

    Science.gov (United States)

    2006-02-01

    stimulators from the blood.’’ (VEGF has a half - life of ¨3.5 min in the circulation.) Folkman formulated this hypothesis after reading Noel Bouck’s first...day) compared to 60% for endostatin alone [65]. This is another example that increasing the half - life of circulating endostatin increases its efficacy...were pre- medicated with glycopyrrolate and buprenorphine , induced with 3-4% isoflurane and placed under general endotracheal anesthesia. A 5 cm

  13. An adipose segmentation and quantification scheme for the intra abdominal region on minipigs

    Science.gov (United States)

    Engholm, Rasmus; Dubinskiy, Aleksandr; Larsen, Rasmus; Hanson, Lars G.; Christoffersen, Berit Østergaard

    2006-03-01

    This article describes a method for automatic segmentation of the abdomen into three anatomical regions: subcutaneous, retroperitoneal and visceral. For the last two regions the amount of adipose tissue (fat) is quantified. According to recent medical research, the distinction between retroperitoneal and visceral fat is important for studying metabolic syndrome, which is closely related to diabetes. However previous work has neglected to address this point, treating the two types of fat together. We use T1-weighted three-dimensional magnetic resonance data of the abdomen of obese minipigs. The pigs were manually dissected right after the scan, to produce the "ground truth" segmentation. We perform automatic segmentation on a representative slice, which on humans has been shown to correlate with the amount of adipose tissue in the abdomen. The process of automatic fat estimation consists of three steps. First, the subcutaneous fat is removed with a modified active contour approach. The energy formulation of the active contour exploits the homogeneous nature of the subcutaneous fat and the smoothness of the boundary. Subsequently the retroperitoneal fat located around the abdominal cavity is separated from the visceral fat. For this, we formulate a cost function on a contour, based on intensities, edges, distance to center and smoothness, so as to exploit the properties of the retroperitoneal fat. We then globally optimize this function using dynamic programming. Finally, the fat content of the retroperitoneal and visceral regions is quantified based on a fuzzy c-means clustering of the intensities within the segmented regions. The segmentation proved satisfactory by visual inspection, and closely correlated with the manual dissection data. The correlation was 0.89 for the retroperitoneal fat, and 0.74 for the visceral fat.

  14. Angiogenesis Research to Improve Therapies for Vascular Leak Syndromes, Intra-abdominal Adhesions, and Arterial Injuries

    Science.gov (United States)

    2008-04-01

    glioma, skin cancer prevention, basal cell nevus syndrome, Barrett’s oesophagus, hepatocellular, oesophogael, prostate, cervical, colorectal, head...HARVARD MEDICAL SCHOOL In this issue of Blood, Shi and colleagues examine the endostatin binding of nucleo - lin on angiogenic endothelial cells, as...relationship of nucleo - lin to other cell-surface endostatin-binding proteins can be uncovered, particularly 51. Will this endostatin-nucleolin connec

  15. Intra-Abdominal Actinomycetoma in a Dog Caused by Actinomyces hordeovulneris

    Directory of Open Access Journals (Sweden)

    S Valentini, R Tamburro, M Zanatta, B Brunetti, M Gruarin, RG Zanoni, M Cipone and M Pietra

    2014-01-01

    Full Text Available A 4-year-old, male French Brittany weighing 18 kg was presented for continuous disorexia associated with a large palpable mass in the cranial abdomen. Radiographic and ultrasonographic examination showed the presence of a mass close to the gastric wall. Percutaneous needle aspiration of the mass revealed pyogranulomatous inflammation. An exploratory laparotomy was performed in order to remove the mass. Actinomiycotic mycetoma was revealed after surgery by positive culture. After a three months antibiotic therapy, nine months follow up showed complete remission.

  16. Laparoscopic repair of intra-abdominal bladder perforation in preschool children

    Science.gov (United States)

    Deshpande, Aniruddh V.; Michail, Peter; Gera, Parshotam

    2017-01-01

    Intraperitoneal bladder rupture is uncommon in very young children, but its incidence may increase with increasing use of seat and lap belts. To the best of our knowledge, there are no prior reports of laparoscopic repair of this injury in children. We describe two recent cases and discuss useful technical points that facilitate a successful laparoscopic repair. Both our patients were preschool age girls who sustained seat and lap belt injuries. Contrast computed tomography scan suggested a large amount of free peritoneal fluid and cystogram confirmed intraperitoneal bladder perforation (isolated injury). The injury was repaired using delayed absorbable sutures and intracorporeal suturing (continuous in 1, interrupted in 1) using a 3 port laparoscopic technique. Meticulous peritoneal lavage was carried out to minimise urinary peritonitis and the bladder as well as the peritoneal cavity were drained. Check cystograms (day 7) revealed no leaks. Young girls appear to be at risk of intraperitoneal bladder injuries following lap belt injuries. After exclusion of life-threatening injuries and concurrent abdominal injuries which need rapid control or preclude pneumoperitoneum, a laparoscopic repair can be safely performed. PMID:27143696

  17. Laparoscopic repair of intra-abdominal bladder perforation in preschool children

    Directory of Open Access Journals (Sweden)

    Aniruddh V Deshpande

    2017-01-01

    Full Text Available Intraperitoneal bladder rupture is uncommon in very young children, but its incidence may increase with increasing use of seat and lap belts. To the best of our knowledge, there are no prior reports of laparoscopic repair of this injury in children. We describe two recent cases and discuss useful technical points that facilitate a successful laparoscopic repair. Both our patients were preschool age girls who sustained seat and lap belt injuries. Contrast computed tomography scan suggested a large amount of free peritoneal fluid and cystogram confirmed intraperitoneal bladder perforation (isolated injury. The injury was repaired using delayed absorbable sutures and intracorporeal suturing (continuous in 1, interrupted in 1 using a 3 port laparoscopic technique. Meticulous peritoneal lavage was carried out to minimise urinary peritonitis and the bladder as well as the peritoneal cavity were drained. Check cystograms (day 7 revealed no leaks. Young girls appear to be at risk of intraperitoneal bladder injuries following lap belt injuries. After exclusion of life-threatening injuries and concurrent abdominal injuries which need rapid control or preclude pneumoperitoneum, a laparoscopic repair can be safely performed.

  18. Adjuvant Therapy for the Reduction of Postoperative Intra-abdominal Adhesion Formation

    Directory of Open Access Journals (Sweden)

    Jason PY Cheung

    2009-07-01

    Conclusions: Only a limited number of adjuvant treatment methods are currently available for the reduction of postoperative adhesions. Seprafilm has been proven to be the efficacious method to reduce adhesions. Investigations into the novel therapies are showing promising results in experimental studies and clinical studies before their wider application.

  19. Diagnostic and therapeutic dilemmas in intra-abdominal desmoid tumors: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Austin D. Williams, MD MSEd

    2016-01-01

    Conclusion: DTs present a clinical challenge in their diagnosis and management, and despite providing standard medical and surgical treatment, recurrence rates are high and continued surveillance is crucial.

  20. A case report: Giant intra-abdominal liposarcoma presenting acute renal failure

    Directory of Open Access Journals (Sweden)

    Kazim Duman

    2016-12-01

    Conclusion: A detailed history should be obtained other abdominal solid organs should also be considered while performing a careful physical examination, the amount of urinary output in particular should be questioned and this sytemic questioning should be supported by specific laboratory tests.

  1. Bilateral adrenal haemorrhage secondary to intra-abdominal sepsis: a case report.

    LENUS (Irish Health Repository)

    Egan, Aoife M

    2012-01-31

    INTRODUCTION: Bilateral adrenal haemorrhage is a rare cause of adrenal failure. Clinical features are non-specific and therefore a high index of suspicion must be maintained in patients at risk. Predisposing factors include infection, malignancy and the post-operative state. CASE PRESENTATION: We report the case of a patient who underwent a left hemicolectomy with primary anastomosis and formation of a defunctioning loop ileostomy for an obstructing colon carcinoma at the splenic flexure. En-bloc splenectomy was performed to ensure an oncologic resection. The patient developed a purulent abdominal collection post-operatively and became septic with hypotension and pyrexia. This precipitated acute bilateral adrenal haemorrhage with consequent adrenal insufficiency. Clinical suspicion was confirmed by radiological findings and a co-syntropin test. Following drainage of the collection, antibiotic therapy and corticosteroid replacement, the patient made an excellent recovery. CONCLUSION: This case highlights the importance of prompt diagnosis and treatment of adrenal failure. In their absence, this condition can rapidly lead to death of the patient.

  2. [Paravertebral and intra-abdominal abscess due to oxygen-ozone therapy for lower back pain].

    Science.gov (United States)

    Menéndez, P; García, A; Peláez, R

    2014-01-01

    Complications secondary to oxygen-ozone therapy are rare, but they have been described in medical literature. There are only two cases of infectious complications after oxygen-ozone therapy. Our aim is to describe a rare case of purulent complication that was secondary to oxygen-ozone therapy for the treatment of lower back pain. We report the clinical improvement with conservative treatment for a local complication after percutaneous oxygen-ozone treatment. According to the clinical improvement of our patient, conservative treatment should be considered before any aggressive surgery.

  3. Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma.

    Science.gov (United States)

    Chua, T C; Yan, T D; Deraco, M; Glehen, O; Moran, B J; Sugarbaker, P H

    2011-01-01

    This study was undertaken to measure survival of patients with multicystic peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy through a multi-institutional collaboration. A multi-institutional data registry, established by the Peritoneal Surface Oncology Group, was used to identify patients with peritoneal mesothelioma and the subgroup with multicystic tumours, treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Outcomes for this subgroup are reported. The primary endpoint was overall survival. A secondary endpoint was the incidence of treatment-related complications. Of 405 patients with peritoneal mesothelioma, 26 (6·4 per cent) had multicystic tumours. There were 20 women and six men with a mean(s.d.) age of 42(12) years. The median peritoneal carcinomatosis index (PCI) was 14 (range 6-39). There was no perioperative mortality. Six patients developed grade III or IV complications. After a median follow-up of 54 (range 5-129) months, all 26 patients were still alive. Multicystic peritoneal mesothelioma appears to be a distinct subtype of peritoneal mesothelioma, where long-term survival may be achieved through cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  4. [Abdominal pregnancy: hormon concentrations during the postpartal period with placenta remaining intra-abdominal (author's transl)].

    Science.gov (United States)

    Gethmann, U; Mönkemeier, D

    1977-07-01

    It is reported of an abdominal pregnancy at term. The placenta was left in situ because of the high risk of intraabdominal bleedings. Thereby it was possible to measure hormon concentrations of the fetoplacental unit without the fetal compartment. Within 10 days after delivery we determined the plasma levels of estradiol-17 beta, estriol, progesterone, HCS, alpha1fetoprotein, and the excretion of the total estrogens in the urines. There was near the same decrease of hormon concentrations in the post partal time comparable with that of a normal pregnancy. Only the HCS concentrations didn't change in the first 9 days after delivery.

  5. Isolated free intra-abdominal fluid on CT in blunt trauma: The continued diagnostic dilemma

    Institute of Scientific and Technical Information of China (English)

    Victor Y.Kong; Damon Jeetoo; Leah C.Naidoo; George V.Oosthuizen; Damian L.Clarke

    2015-01-01

    Purpose: The clinical significance of isolated free fluid (FF) without solid organ injury on computed tomography (CT) continues to pose significant dilemma in the management of patients with blunt abdominal trauma (BAT).Methods: We reviewed the incidence of FF and the clinical outcome amongst patients with blunt abdominal trauma in a metropolitan trauma service in South Africa.We performed a retrospective study of 121 consecutive CT scans over a period of 12 months to determine the incidence of isolated FF and the clinical outcome of patients managed in a large metropolitan trauma service.Results: Of the 121 CTs, FF was identified in 36 patients (30%).Seven patients (6%) had isolated FF.Of the 29 patients who had free fluid and associated organ injuries, 33 organ injuries were identified.86% (25/ 29) of all 29 patients had a single organ injury and 14% had multiple organ injuries.There were 26 solid organ injuries and 7 hollow organ injuries.The 33 organs injured were: spleen, 12: liver, 8;kidney, 5;pancreas, 2;small bowel, 4;duodenum, 1.Six (21%) patients required operative management for small bowel perforations in 4 cases and pancreatic tail injury in 2 cases.All 7 patients with isolated FF were initially observed, and 3 (43%) were eventually subjected to operative intervention.They were found to have an intra-peritoneal bladder rupture in 1 case, a non-expanding zone 3 haematoma in 1 case, and a negative laparotomy in 1 case.Four (57%) patients were successfully managed without surgical interventions.Conclusions: Isolated FF is uncommon and the clinical significance remains unclear.Provided that reliable serial physical examination can be performed by experienced surgeons, an initial non-operative approach should be considered.

  6. Spontaneous Rupture of a Leiomyoma Causing Life-Threatening Intra-Abdominal Hemorrhage

    Science.gov (United States)

    Powell, Kristin

    2017-01-01

    Background. Uterine fibroids are common benign tumors in women. Clinical manifestations are well known. Acute complications necessitating emergent surgical intervention are rare. Case. We report a case of a 53-year-old woman with a history of uterine fibroids presenting with acute-onset severe abdominal pain. Imaging indicated massive free fluid and a large partially solid uterine mass. Vitals were consistent with hypovolemic shock. Examination revealed a surgical abdomen. She underwent an emergent laparotomy and total hysterectomy. Surgery revealed 4.5 L of hemoperitoneum and a 15 cm degenerated uterine fibroid with active bleeding. Pathology was consistent with intraoperative findings. She required transfusion of numerous blood products perioperatively. Her postoperative course was uncomplicated. Conclusion. It is rare for a uterine fibroid to spontaneously rupture. However, prompt recognition of this severe complication is critical for expeditious, life-saving surgical management. PMID:28127487

  7. Angiogenesis Research to Improve Therapies for Vascular Leak Syndromes, Intra-Abdominal Adhesions, and Arterial Injuries

    Science.gov (United States)

    2007-02-01

    Progenitor Cells for Cardiovascular Tissue-Engineering Juan Melero-Martin, Seminar, Centro Andaluz de Biologia Molecular y Medicina Regenerativa...process of angiogenesis as an ‘organizing principle’ in biology, intriguing insights into the molecular mechanisms of seemingly unrelated phenomena...principle is that it permits connections between seemingly unrelated phenomena. For example, discovery of a molecular mechanism for one phenomenon

  8. Multiple intra-abdominal serosal myxosarcomas in two koalas (Phascolarctos cinereus).

    Science.gov (United States)

    Astudillo, V González; Schaffer-White, A; Allavena, R; Palmieri, C

    2015-01-01

    Two adult koalas (Phascolarctos cinereus) were presented for necropsy examination without any clinical history. A diffuse, severe gelatinous effusion was found in the abdominal cavity, while numerous 1-3 mm diameter, round, well-demarcated, multifocal to coalescing, raised, firm nodules containing a clear gelatinous fluid were scattered on the surface of the parietal peritoneum, diaphragm, liver, gastrointestinal tract and mesentery. Microscopically, the nodular lesions consisted of spindle-shaped to stellate neoplastic cells, with scant eosinophilic cytoplasm and moderate anisocytosis and anisokaryosis. The neoplastic cells were admixed with and surrounded by abundant acellular pale eosinophilic material that was stained by Alcian blue and only weakly by the periodic acid-Schiff reaction. Serosal proliferations are described rarely in koalas and to the authors' knowledge this is the first reported case of serosal myxosarcoma. The significance and pathogenesis of this condition in the koala population is unknown. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Non-Invasive Monitoring of Intra-Abdominal Bleeding Rate Using Electrical Impedance Tomography

    Science.gov (United States)

    2009-09-01

    reconstructed data using a tSVD truncation index (k) of 12. Administered dialysate mass is shown Figure 6 Hemiarray images before 0.3 min (top-left...during (top-right, 13.9 minutes), (bottom-left, 29 min) and after (bottom-right, 36.8 minutes) (bottom-right) dialysate infusion. in g on the...lower panel. QI values clearly correlate with amount of dialysate administered. Figure 7. Example plot of (top) image data represented as post

  10. Large Gastric Teratoma: A Rare Intra-abdominal Mass of Infancy

    Directory of Open Access Journals (Sweden)

    Roumina Hasan

    2016-05-01

    Full Text Available Amongst the varied, diverse causes of intraabdominal masses in infancy and early childhood, gastric teratomas (GTs account for a very small proportion. A worldwide literature search reveals only around one hundred cases of GT and also supports the fact that its preoperative diagnosis remains elusive. Here we report the case of a two-month-old male who presented to the pediatric surgery outpatient department of Kasturba Medical College and Hospital, Karnataka, India, with progressive distension of abdomen since birth. Clinically, a large firm, non-mobile and non-tender mass involving all four quadrants of the abdomen was seen. Ultrasound revealed a large solid-cystic mass with internal septations extending from the epigastrium up to the pelvis. Computed tomography revealed a large intraperitoneal fat containing solid-cystic mass lesion showing curvilinear and chunky areas of calcification, with the mass focally indenting the posterior gastric wall and showing focal polypoidal intragastric extension. Exploratory laparotomy revealed a large cystic tumor with a solid component, arising from lesser curvature of the stomach, showing focal intraluminal extension across the posterior gastric wall, and occupying the whole lesser sac and abdominal cavity. The tumor was excised in toto along with the body of the stomach. Histopathological examination showed mature tissue derived from all three germ cell layers and confirmed the diagnosis of mature gastric teratoma. The patient was disease free at one-year follow-up.

  11. Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position

    Science.gov (United States)

    2014-01-01

    Background The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established. Methods 70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n = 38) and laparoscopic cholecystecomy (head-up position, n = 32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared. Results There was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26 ± 3 to 32 ± 6 and 27 ± 3 to 33 ± 5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal tumor resection respectively (both p < 0.001). The head-down tilt further increased cuff pressure from 33 ± 5 to 35 ± 5 cmH2O (p < 0.001). There six patients undergoing colorectal tumor resection (18.8%) and eight patients undergoing cholecystecomy (21.1%) had a total increase of cuff pressure more than 10 cm H2O (18.8%). There was no significant correlation between increase of cuff pressure and either the patient's body mass index or the common range of intra-abdominal pressure (10-15 mmHg) used in laparoscopic surgery. Conclusions An increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position. PMID:25210501

  12. Bile peritonitis due to intra-hepatic bile duct rupture

    OpenAIRE

    Lochan, R.; Joypaul, BV

    2005-01-01

    Generalized biliary peritonitis is a serious intra-abdominal emergency. Most of them occur due to duodenal ulcer perforation and rapidly evolve into bacterial peritonitis due to contamination by gut organisms and food. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one. We describe a rare case of biliary peritonitis...

  13. Diabetes and Hepatitis B Vaccination

    Science.gov (United States)

    Diabetes and Hepatitis B Vaccination Information for Diabetes Educators What is hepatitis B? Hepatitis B is a contagious liver disease that results from infection with the hepatitis B virus. When first infected, a person can develop ...

  14. Clinical and Anamnestic Features of Hepatic Steatosis in Children

    Directory of Open Access Journals (Sweden)

    N.Yu. Zavgorodnia

    2015-11-01

    Full Text Available The article is devoted to the study of clinical and anamnestic features of hepatic steatosis in children. The results of a comparative analysis of survey data of patients with evidence of hepatic steatosis and patients without steatosis were shown. The presence and degree of hepatic steatosis was found using FibroScan-touch-502 by measuring controlled attenuation parameter (CAP. The features of lifestyle and nutrition of children with steatosis were determined: hypodynamic lifestyle, the prevalence of fast food habits, insufficient consumption of liquid. It was established that hepatic steatosis is closely associated with obesity and hypothalamic disorders, increased both blood pressure and serum levels of atherogenic lipids.

  15. Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors' comfort.

    Science.gov (United States)

    Warlé, M C; Berkers, A W; Langenhuijsen, J F; van der Jagt, M F; Dooper, Ph M; Kloke, H J; Pilzecker, D; Renes, S H; Wever, K E; Hoitsma, A J; van der Vliet, J A; D'Ancona, F C H

    2013-01-01

    Nowadays, laparoscopic donor nephrectomy (LDN) has become the gold standard to procure live donor kidneys. As the relationship between donor and recipient loosens, it becomes of even greater importance to optimize safety and comfort of the surgical procedure. Low-pressure pneumoperitoneum has been shown to reduce pain scores after laparoscopic cholecystectomy. Live kidney donors may also benefit from the use of low pressure during LDN. To evaluate feasibility and efficacy to reduce post-operative pain, we performed a randomized blinded study. Twenty donors were randomly assigned to standard (14 mmHg) or low (7 mmHg) pressure during LDN. One conversion from low to standard pressure was indicated by protocol due to lack of progression. Intention-to-treat analysis showed that low pressure resulted in a significantly longer skin-to-skin time (149 ± 86 vs. 111 ± 19 min), higher urine output during pneumoperitoneum (23 ± 35 vs. 11 ± 20 mL/h), lower cumulative overall pain score after 72 h (9.4 ± 3.2 vs. 13.5 ± 4.5), lower deep intra-abdominal pain score (11 ± 3.3 vs. 7.5 ± 3.1), and a lower cumulative overall referred pain score (1.8 ± 1.9 vs. 4.2 ± 3). Donor serum creatinine levels, complications, and quality of life dimensions were not significantly different. Our data show that low-pressure pneumoperitoneum during LDN is feasible and may contribute to increase live donors' comfort during the early post-operative phase.

  16. Microbiological diagnostics of viral hepatitis

    OpenAIRE

    HASDEMİR, Ufuk

    2016-01-01

    Viral hepatitis is an infection that primarily affects the liverbut may also have systemic clinical manifestations. The vastmajority of viral hepatitis are caused by one of five hepatotropicviruses: hepatitis A virus (HAV), hepatitis B virus (HBV),hepatitis C virus (HCV), hepatitis D (delta) virus (HDV), andhepatitis E virus (HEV) (Table I) [1]. HBV, HCV, and HDValso cause chronic hepatitis, whereas HAV does not. HEVcauses acute hepatitis in normal hosts but can cause protractedand chronic he...

  17. Microbiological diagnostics of viral hepatitis

    OpenAIRE

    HASDEMİR, Ufuk

    2016-01-01

    Viral hepatitis is an infection that primarily affects the liverbut may also have systemic clinical manifestations. The vastmajority of viral hepatitis are caused by one of five hepatotropicviruses: hepatitis A virus (HAV), hepatitis B virus (HBV),hepatitis C virus (HCV), hepatitis D (delta) virus (HDV), andhepatitis E virus (HEV) (Table I) [1]. HBV, HCV, and HDValso cause chronic hepatitis, whereas HAV does not. HEVcauses acute hepatitis in normal hosts but can cause protractedand chronic he...

  18. negative pressure wound therapy (npwt) for the management of ...

    African Journals Online (AJOL)

    active removal of exudate, we used NPWT to manage five patients with complex intra-abdominal sepsis ... a gauze sheet and a suction tube placed between the gauze sheets after the first ... if the vacuum seal was broken. This was continued.

  19. Construct hepatic analog by cell-matrix controlled assembly technology

    Institute of Scientific and Technical Information of China (English)

    LIU Haixia; YAN Yongnian; WANG Xiaohong; CHENG Jie; LIN Feng; XIONG Zhuo; Wu Rendong

    2006-01-01

    A mixture of hepatic cells and chitosan/gelatin solution was deposited to construct a hepatic analog by way of layer-by-layer deposition technique using a home-made devise. The size and cell concentration of the analogs can be controlled freely. Approximately 90% of the hepatic cells remained viable under 0.2 Mpa extrusion pressure. Cultured in vitro 8 weeks before animal test, hepatic cells in structure maintained their phenotype and kept proliferating, and albumin and other secretion of the cells increased. Cords and hepaton-like structures were observed after culture for 20 d. These results indicate that hepatic cells could be assembled directly into a 3D viable structure and expanded to form a hepatic organoid. This accomplishment is considered to be an interesting means for the fabrication of liver replacements.

  20. Hepatitis C FAQs for the Public

    Science.gov (United States)

    ... Requirements for Viral Hepatitis Liver Cancer and Viral Hepatitis Viral Hepatitis and Young Persons Who Inject Drugs National ... Hepatitis Contact Us Anonymous Feedback Quick Links to Hepatitis … A | B | C | D | E Viral Hepatitis Home Statistics & ...

  1. Hepatitis B Foundation Newsletter: B Informed

    Science.gov (United States)

    ... Our Accomplishments Annual Reports Our Videos What Is Hepatitis B? What Is Hepatitis B? The ABCs of Viral Hepatitis Liver Cancer and Hepatitis B Hepatitis Delta Coinfection Hepatitis C Coinfection HIV/AIDS ...

  2. Hepatitis B - children

    Science.gov (United States)

    ... care provider will perform blood tests called the hepatitis viral panel . These tests can help diagnose: A new ... 07, 2016. Jensen MK, William F, Balistreri WF. Viral hepatitis. In: Kliegman RM, Stanton BF, St Geme JW ...

  3. Hepatitis Foundation International

    Science.gov (United States)

    ... million people globally. admin / 03/17/2015 Viral Hepatitis An estimated 4.4 million Americans from all ... Events section below. EVENTS FULL CALENDAR Loading… VIRAL HEPATITIS DISPARITIES HARD TO REACH, HARD TO TREAT™ AFRICAN ...

  4. Hepatitis B Vaccination Protection

    Science.gov (United States)

    Fact Sheet Hepatitis B Vaccination Protection Hepatitis B virus (HBV) is a pathogenic microorganism that can cause potentially life- threatening disease in humans. HBV infection is transmitted through exposure ...

  5. Hepatitis C (image)

    Science.gov (United States)

    Hepatitis C is a virus-caused liver inflammation which may cause jaundice, fever and cirrhosis. Persons who are most at risk for contracting and spreading hepatitis C are those who share needles for injecting drugs ...

  6. Hepatitis virus panel

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003558.htm Hepatitis virus panel To use the sharing features on this page, please enable JavaScript. The hepatitis virus panel is a series of blood tests used ...

  7. Morgagni hernia with respiratory failure aggravated by noninvasive positive pressure ventilation: a case report and overview of the literature.

    Science.gov (United States)

    Tone, Kazuya; Kiryu, Ikumi; Yoshida, Masahiro; Tsuboi, Kazuto; Takagi, Masamichi; Kuwano, Kazuyoshi

    2014-05-01

    An elderly woman diagnosed with multiple myeloma (MM) in 2007 had improved with chemotherapy. She had severe kyphosis and a diaphragmatic hernia (DH), but no respiratory symptoms. In 2011, because of thoracic deformity and emaciation, we advised her to continue the previously prescribed domiciliary noninvasive positive pressure ventilation (NPPV) therapy for chronic type II respiratory failure. However, she refused to continue NPPV. She was later admitted for deterioration in respiratory status and carbon dioxide (CO2) narcosis. We believed her low adherence to domiciliary NPPV caused CO2 narcosis; hence, we advised her to continue domiciliary NPPV and she complied. In May 2012, the now 79-year-old patient was admitted for acute exacerbation of chronic respiratory failure and CO2 narcosis. Chest imaging suggested that DH had caused a deterioration of her status. She underwent laparoscopic diaphragmatic hernia repair. Operative findings revealed a retrosternal hernia sac, and she was diagnosed as having a Morgagni hernia (MH). Her respiratory status subsequently improved. We hypothesize that NPPV increased intra-abdominal pressure, thereby worsening the MH and exacerbating respiratory failure. We believe that clinicians should be cautious when prescribing NPPV for MH patients.

  8. Hepatitis C and HIV

    Science.gov (United States)

    ... Hepatitis A and Hepatitis B . Hepatitis C and HIV About 25% of people living with HIV in ... Notice Network blog.aids.gov • locator.aids.gov • HIV/AIDS Service Locator Locator Widgets • Instructions • API Find ...

  9. Hepatitis B and HIV

    Science.gov (United States)

    ... Hepatitis A and Hepatitis C . Hepatitis B and HIV About 10% of people living with HIV in ... Notice Network blog.aids.gov • locator.aids.gov • HIV/AIDS Service Locator Locator Widgets • Instructions • API Find ...

  10. What Is Hepatitis?

    Science.gov (United States)

    ... عربي 中文 English Français Русский Español What is hepatitis? Online Q&A Reviewed July 2016 Q: What ... Question and answer archives Submit a question World Hepatitis Day Know hepatitis - Act now Event notice Key ...

  11. Hepatic (Liver) Function Panel

    Science.gov (United States)

    ... 1- to 2-Year-Old Blood Test: Hepatic (Liver) Function Panel KidsHealth > For Parents > Blood Test: Hepatic (Liver) Function Panel Print A A A What's in ... Is The hepatic function panel, also known as liver function tests, is a group of seven tests ...

  12. Estudo da função hepática de ratos espontaneamente hipertensos submetidos a diferentes pressões de pneumoperitônio com CO2 Study of the hepatic function in spontaneously hipertensive rats submitted to different pressures of the CO2 pneumoperitoneum

    Directory of Open Access Journals (Sweden)

    Valéria Vieira Chida

    2003-01-01

    Full Text Available OBJETIVOS: Avaliar a função hepática de ratos hipertensos submetidos a baixa ou alta pressão de pneumoperitônio. MÉTODOS: Foram utilizados 60 ratos, distribuídos em dois grupos (n= 30, de acordo com a pressão de pneumoperitônio de 4 e 10mmHg, sendo 15 animais da linhagem EPM-1 Wistar e 15 animais da linhagem SHR. Logo após a pesagem, os animais foram submetidos à anestesia com cetamina e xilazina intramuscular e, em seguida, submetidos a pneumoperitônio, durante 1 hora e desinsuflação por mais 1 hora. Foram coletadas amostras sangüíneas logo após a realização do cateterismo da artéria femoral esquerda, após uma hora de insuflação, assim como, depois de uma hora de desinsuflação. Estas amostras foram encaminhadas para a avaliação das enzimas hepáticas (AST, ALT, DHL e bilirrubinas (total, direta e indireta. O nível de significância estatístico foi estabelecido em 5%. RESULTADOS: Com pneumoperitônio de 4mmHg a AST e ALT apresentaram níveis iniciais menores do que após insuflação e desinsuflação enquanto a DHL, a BT e a BD não se alteraram; em ambas as linhagens. Na pressão de 10mmHg a AST e a DHL não se alteraram nos ratos normotensos e aumentaram nos hipertensos, a BD não se alterou, a ALT e a BT aumentaram para ambas as linhagens. CONCLUSÃO: A função hepática mostrou-se alterada e a medida do tempo após a desinsuflação foi curta para evidenciar uma eventual reversão dessas alterações, tanto nos animais hipertensos, como em animais hígidos.PURPOSE: In order to determine the behavior of the hepatic function in spontaneously hipertensive Rats Which underiwent low pressure and high pressure pneumoperitoneum. METHODS: 60 rats were studied two groups of 30 rats, each formed by 15 Wistar EPM-1 and 15 SHR, were subjmitted to 4mmHg and 10mmHg pressure respectively, for 1 hour plus peritoneal pressure normalization time of 1 hour. Immediately after being weighed the rats were given an anesthetic

  13. VIRAL HEPATITIS E DIAGNOSTICS

    Directory of Open Access Journals (Sweden)

    E. Yu. Malinnikova

    2013-01-01

    Full Text Available Abstract. The results of clinical and epidemiological studies conducted in the M.P. Chumakov’ Research Institute of Poliomyelitis and Viral Encephalitis and in the different research institutions of the world have been summarized in the current article. Data on etiology, pathogenesis, clinical symptoms, epidemiology and prevention of hepatitis E are presented. Increasing of significance of this infection for health care system in Russia is emphasized . The actual problems of hepatitis E (autochthonic hepatitis E, hepatitis E as zoonosis, chronic hepatitis E are discussed.

  14. Pathogenesis of Hepatic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Irena Ciećko-Michalska

    2012-01-01

    Full Text Available Hepatic encephalopathy can be a serious complication of acute liver failure and chronic liver diseases, predominantly liver cirrhosis. Hyperammonemia plays the most important role in the pathogenesis of hepatic encephalopathy. The brain-blood barrier disturbances, changes in neurotransmission, neuroinflammation, oxidative stress, GABA-ergic or benzodiazepine pathway abnormalities, manganese neurotoxicity, brain energetic disturbances, and brain blood flow abnormalities are considered to be involved in the development of hepatic encephalopathy. The influence of small intestine bacterial overgrowth (SIBO on the induction of minimal hepatic encephalopathy is recently emphasized. The aim of this paper is to present the current views on the pathogenesis of hepatic encephalopathy.

  15. Aferição simultânea da pressão abdominal na avaliação ultra-sonográfica de mulheres com incontinência urinária de esforço Intraabdominal pressure measurement during ultrasound assessment of female patients with stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Frederico Teixeira Brandt

    2006-04-01

    Full Text Available OBJETIVO: Determinar a influência da aferição da pressão intra-abdominal na avaliação ultra-sonográfica da junção uretrovesical (JUV e da uretra proximal (UP em pacientes com incontinência urinária de esforço (IUE. MATERIAIS E MÉTODOS: Estudo prospectivo de corte transversal realizado na Unidade de Pesquisa em Incontinência Urinária da Universidade Federal de Pernambuco, de janeiro de 2002 a janeiro de 2005. Trinta e seis pacientes com queixas de IUE foram submetidas a ultra-sonografia perineal para avaliação da JUV e da UP com a bexiga praticamente vazia (OBJECTIVE: To determine the influence of intraabdominal pressure in the ultrasonographic evaluation of the urethrovesical junction (UVJ and proximal urethra (PU in patients with stress urinary incontinence (SUI. MATERIALS AND METHODS: A prospective, cross-sectional study was conducted at the Urinary Incontinence Research Unit of "Universidade Federal de Pernambuco", Brazil, from January 2002 to January 2005. Perineal ultrasounds of the UVJ and PU were performed in thirty-six women complaining of SUI with the bladder virtually empty (< 50 ml; simultaneous measurement of the intraabdominal pressure was also performed. An ultrasound machine with a computer chip and a high-resolution photographic camera connected to a 7 MHz vaginal probe was used for the evaluation. In order to measure the intraabdominal pressure, an urodynamic equipment with a 10fr rectal catheter connected to a pressure sensitive balloon was used. RESULTS: The age of the patients ranged from 25 to 69 years (mean 46.4 ± 10.2 years. On Valsava maneuver, the intra-abdominal pressure ranged from 7 to 193 cmH2O (mean: 99.3 ± 51.8 cmH2O; median: 99.5 cmH2O. Eight out of 31 (25.8% patients with UVJ hypermobility had an intraabdominal pressure lower than 60 cmH2O. There was no statistically significant association between intraabdominal pressure and the ultrasound parameters studied. CONCLUSION: There is a specific

  16. Validation of an Endoscopic Fibre-Optic Pressure Sensor for Noninvasive Measurement of Variceal Pressure

    Directory of Open Access Journals (Sweden)

    Bin Sun

    2016-01-01

    Full Text Available In this study, the authors have developed endoscopic fibre-optic pressure sensor to detect variceal pressure and presented the validation of in vivo and in vitro studies, because the HVPG requires catheterization of hepatic veins, which is invasive and inconvenient. Compared with HVPG, it is better to measure directly the variceal pressure without puncturing the varices in a noninvasive way.

  17. [Effect of dopamine on the portal pressure].

    Science.gov (United States)

    Benko, H; Peschl, L; Schüller, J; Neumayr, A

    1975-01-01

    1. An infusion of 3 gamma/kg/min dopamine causes a significant increase in the renal plasma flow and the glomerulum filtration rate. This dosage does not cause a change of the mean systolic and arterial pressure. This effect may also be observed in patients with hepatic cirrhosis. 2. The wedged hepatic vein pressure, an indicator for the portal pressure, only shows a slight increase (9,46 +/- 9,41%) as compared to the initial pressure produced by the mentioned dose. Measurements of the spleen pulpa pressure, which likewise indicates the portal pressure, showed an increase of pressure up to 100% due to pressing or coughing. 3. If in the case of bleeding oesophageal varices acute renal failure might develop, the advantage of the effect of dopamine in stimulating the blood flow through the kidneys may be considered more important than the minute danger of a slight increase of the portal pressure, which might provoke haemorrhage.

  18. Long-term AICAR administration reduces metabolic disturbances and lowers blood pressure in rats displaying features of the insulin resistance syndrome.

    Science.gov (United States)

    Buhl, Esben S; Jessen, Niels; Pold, Rasmus; Ledet, Thomas; Flyvbjerg, Allan; Pedersen, Steen B; Pedersen, Oluf; Schmitz, Ole; Lund, Sten

    2002-07-01

    The insulin resistance syndrome is characterized by several risk factors for cardiovascular disease. Chronic chemical activation of AMP-activated protein kinase by the adenosine analog 5-aminoimidazole-4-carboxamide-1-beta -D-ribofuranoside (AICAR) has been shown to augment insulin action, upregulate mitochondrial enzymes in skeletal muscles, and decrease the content of intra-abdominal fat. Furthermore, acute AICAR exposure has been found to reduce sterol and fatty acid synthesis in rat hepatocytes incubated in vitro as well as suppress endogenous glucose production in rats under euglycemic clamp conditions. To investigate whether chronic AICAR administration, in addition to the beneficial effects on insulin sensitivity, is capable of improving other phenotypes associated with the insulin resistance syndrome, obese Zucker (fa/fa) rats (n = 6) exhibiting insulin resistance, hyperlipidemia, and hypertension were subcutaneously injected with AICAR (0.5 mg/g body wt) daily for 7 weeks. Obese control rats were either pair-fed (PF) (n = 6) or ad libitum-fed (AL) (n = 6). Lean Zucker rats (fa/-) (n = 8) served as a reference group. AICAR administration significantly reduced plasma triglyceride levels (P < 0.01 for AICAR vs. AL, and P = 0.05 for AICAR vs. PF) and free fatty acids (P < 0.01 for AICAR vs. AL, and P < 0.05 for AICAR vs. PF) and increased HDL cholesterol levels (P < 0.01 for AICAR vs. AL and PF). AICAR treatment also lowered systolic blood pressure by 14.6 +/- 4.3 mmHg (P < 0.05), and AICAR-treated animals exhibited a tendency toward decreased intra-abdominal fat content. Furthermore, AICAR administration normalized the oral glucose tolerance test and decreased fasting concentrations of glucose and insulin close to the level of the lean animals. Finally, in line with previous findings, AICAR treatment was also found to enhance GLUT4 protein expression and to increase maximally insulin-stimulated glucose transport in primarily white fast-twitch muscles. Our

  19. Autophagy in Hepatic Fibrosis

    Directory of Open Access Journals (Sweden)

    Yang Song

    2014-01-01

    Full Text Available Hepatic fibrosis is a leading cause of morbidity and mortality worldwide. Hepatic fibrosis is usually associated with chronic liver diseases caused by infection, drugs, metabolic disorders, or autoimmune imbalances. Effective clinical therapies are still lacking. Autophagy is a cellular process that degrades damaged organelles or protein aggregation, which participates in many pathological processes including liver diseases. Autophagy participates in hepatic fibrosis by activating hepatic stellate cells and may participate as well through influencing other fibrogenic cells. Besides that, autophagy can induce some liver diseases to develop while it may play a protective role in hepatocellular abnormal aggregates related liver diseases and reduces fibrosis. With a better understanding of the potential effects of autophagy on hepatic fibrosis, targeting autophagy might be a novel therapeutic strategy for hepatic fibrosis in the near future.

  20. Hepatic venous outflow obstruction: Three similar syndromes

    Institute of Scientific and Technical Information of China (English)

    Ulas Darda Bayraktar; Soley Seren; Yusuf Bayraktar

    2007-01-01

    Our goal is to provide a detailed review of venoocclusive disease (VOD), Budd-Chiari syndrome (BCS),and congestive hepatopathy (CH), all of which results in hepatic venous outflow obstruction. This is the first article in which all three syndromes have been reviewed,enabling the reader to compare the characteristics of these disorders. The histological findings in VOD, BCS,and CH are almost identical: sinusoidal congestion and cell necrosis mostly in perivenular areas of hepatic acini which eventually leads to bridging fibrosis between adjacent central veins. Tender hepatomegaly with jaundice and ascites is common to all three conditions.However, the clinical presentation depends mostly on the extent and rapidity of the outflow obstruction.Although the etiology and treatment are completely different in VOD, BCS, and CH; the similarities in clinical manifestations and liver histology may suggest a common mechanism of hepatic injury and adaptation in response to increased sinusoidal pressure.

  1. Hepatitis isquémica Ischemic hepatitis

    Directory of Open Access Journals (Sweden)

    Marcos Amuchástegui (h

    2006-10-01

    Full Text Available La hepatitis isquémica es una complicación sumamente infrecuente de cirugía cardiovascular. Las biopsias muestran necrosis centrolobulillar. El término de "hepatitis" fue propuesto debido al aumento de transaminasas similar a aquellas de origen infeccioso, e "isquémica" por falla en la perfusión hepática. Posteriormente se definió el término de hepatitis isquémica como cuadro de elevación aguda y reversible (dentro de las 72 horas de transaminasas de hasta 20 veces el valor normal, asociado a trastornos en la perfusión hepática, luego de haber excluido otras causas de hepatitis aguda o daño hepatocelular. Se describe el caso de un paciente de 53 años que consulta por dolor epigástrico de 12 h de evolución sin fiebre, náuseas ni vómitos, resistente a la medicación. Tenía antecedentes inmediatos de reemplazo de válvula aórtica, y estaba anticoagulado. Evolucionó con shock y fallo multiorgánico. El examen evidenció marcada ictericia y signos de taponamiento pericárdico, asociado a un aumento considerable de enzimas hepáticas. Un ecocardiograma informó signos de taponamiento cardíaco y ausencia de disección aórtica. Se decidió pericardiocentesis, extrayéndose 970 cc. de líquido sanguinolento, y hemodiálisis, con notable mejoría de su estado hemodinámico. Los valores enzimáticos disminuyeron. Los marcadores virales fueron negativos.Ischemic hepatitis is an uncommon cardiovascular surgery complication. Hepatic biopsies show centrolobulillar necrosis. The term "hepatitis" was proposed because of a raise in hepatic enzymes similar with infectious disease, and "ischemic" because of failure in hepatic perfusion. Ischemic hepatitis was then defined as an acute and reversible elevation of hepatic enzymes (within 72 h, associated with disturbance in hepatic perfusion after excluding other causes of acute hepatitis. A 53 year-old male presented complaining of a 12 h epigastric pain, without nausea or vomiting, resistant

  2. Preventing hepatitis B or C

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000401.htm Preventing hepatitis B or C To use the sharing features on this page, please enable JavaScript. Hepatitis B and hepatitis C infections cause irritation and swelling ...

  3. Hepatitis C Virus Genotypes

    OpenAIRE

    Kayhan Azadmanesh; Safie Amini; Seyed-Moayed Alavian; Malek Hossein Ahmadipour

    2005-01-01

    IntroductionHepatitis C virus (HCV) is an important cause of chronic liver disease. HCV causes 20% of acute hepatitis cases, 70% of all chronic hepatitis cases, 40% of all cases of liver cirrhosis, 60% of hepatocellular carcinomas, and 30% of liver transplants in Europe(1). It is also recognized as the leading cause of liver transplantation in the world(2). Only 20% of infected individuals will recover from this viral infection, while the rest become chronically infected(3). While the majorit...

  4. Quasispecies of Hepatitis B Virus

    Institute of Scientific and Technical Information of China (English)

    Jun; Cheng; Min; Quan; Min; Li; Shun-ai; Liu; Qi; Wang

    2012-01-01

    Hepatitis B virus(HBV) circulates in blood and replicates in the presence of quasispecies. During HBV replication, HBV DNA polymerase lacks fidelity and proofreading function partly because its exonuclease activity is either absent or deficient. Therefore, HBV genome is mutated with unusually high frequency. And these mutations can affect more than one open reading frame due to overlapping genes. Otherwise, natural substitutions, deletions or insertions involving the Cp/ENⅡ locus in the X gene can significantly alter the extent of viral replication activity. Particular selection pressures such as host immune system and antiviral therapy readily select out escape mutants from this pre-existing quasispecies pool. Antiviral drug resistance in chronic hepatitis B(CHB) can be caused by the viral mutation frequency, the intrinsic mutability of the antiviral target site, the selective pressure exerted by the drug, the magnitude and rate of virus replication, the overall replication fitness of the mutant, the genetic barrier of the compound and the availability of replication space. Potent inhibition of HBV replication could be able to prevent the development of drug resistance because mutagenesis is replication dependent. Viral load may decline to a point where the continued production of quasispecies with the potential to resist new drug treatments no longer occurs, if viral replication can be suppressed for a sufficient length of time.

  5. Variables predicting elevated portal pressure in alcoholic liver disease. Results of a multivariate analysis

    DEFF Research Database (Denmark)

    Krogsgaard, K; Christensen, E; Gluud, C;

    1987-01-01

    In 46 alcoholic patients the association of wedged-to-free hepatic-vein pressure with other variables (clinical, histologic, hemodynamic, and liver function data) was studied by means of multiple regression analysis, taking the wedged-to-free hepatic-vein pressure as the dependent variable. Four...... variables showed significant independent association with the wedged-to-free hepatic-vein pressure: indocyanine green clearance (p = 0.031), degree of necrosis (p = 0.023), degree of hepatic architectural destruction (graded as: preserved architecture, nodules alternating with preserved architecture......, totally destroyed architecture) (p = 2.3 X 10(-6) and sex (p = 0.0024), male sex being associated with higher wedged-to-free hepatic-vein pressure. The multiple coefficient of determination (R2) was 0.63; thus, 63% of the variation in the wedged-to-free hepatic-vein pressure was 'explained' by variation...

  6. Predicting total, abdominal, visceral and hepatic adiposity with circulating biomarkers in Caucasian and Japanese American women.

    Directory of Open Access Journals (Sweden)

    Unhee Lim

    Full Text Available BACKGROUND: Characterization of abdominal and intra-abdominal fat requires imaging, and thus is not feasible in large epidemiologic studies. OBJECTIVE: We investigated whether biomarkers may complement anthropometry (body mass index [BMI], waist circumference [WC], and waist-hip ratio [WHR] in predicting the size of the body fat compartments by analyzing blood biomarkers, including adipocytokines, insulin resistance markers, sex steroid hormones, lipids, liver enzymes and gastro-neuropeptides. METHODS: Fasting levels of 58 blood markers were analyzed in 60 healthy, Caucasian or Japanese American postmenopausal women who underwent anthropometric measurements, dual energy X-ray absorptiometry (DXA, and abdominal magnetic resonance imaging. Total, abdominal, visceral and hepatic adiposity were predicted based on anthropometry and the biomarkers using Random Forest models. RESULTS: Total body fat was well predicted by anthropometry alone (R(2 = 0.85, by the 5 best predictors from the biomarker model alone (leptin, leptin-adiponectin ratio [LAR], free estradiol, plasminogen activator inhibitor-1 [PAI1], alanine transaminase [ALT]; R(2 = 0.69, or by combining these 5 biomarkers with anthropometry (R(2 = 0.91. Abdominal adiposity (DXA trunk-to-periphery fat ratio was better predicted by combining the two types of predictors (R(2 = 0.58 than by anthropometry alone (R(2 = 0.53 or the 5 best biomarkers alone (25(OH-vitamin D(3, insulin-like growth factor binding protein-1 [IGFBP1], uric acid, soluble leptin receptor [sLEPR], Coenzyme Q10; R(2 = 0.35. Similarly, visceral fat was slightly better predicted by combining the predictors (R(2 = 0.68 than by anthropometry alone (R(2 = 0.65 or the 5 best biomarker predictors alone (leptin, C-reactive protein [CRP], LAR, lycopene, vitamin D(3; R(2 = 0.58. Percent liver fat was predicted better by the 5 best biomarker predictors (insulin, sex hormone binding globulin [SHBG], LAR, alpha-tocopherol, PAI1; R(2 = 0

  7. Cytomegalovirus Hepatitis During Pregnancy

    Directory of Open Access Journals (Sweden)

    Ying Chan

    1995-01-01

    Full Text Available Background: Although cytomegalovirus (CMV is an uncommon cause of viral hepatitis during pregnancy, a definitive diagnosis is important because of the potential for congenital CMV. In the case reported here, a diagnosis of hepatitis caused by CMV was made after the more common viral pathogens had been ruled out.

  8. Hepatic angiosarcoma: CT findings

    Institute of Scientific and Technical Information of China (English)

    余日胜; 章士正; 华建明

    2003-01-01

    @@ Hepatic angiosarcoma is a rare malignant vascular tumor. Accurate preoperative diagnosis of this tumor is very difficult if the patient does not have any history of exposure to specific carcinogens including thorotrast, arsenicals and vinyl chloride monomer. We describe CT findings in two cases of hepatic angiosarcoma in combination with a review of the literature.

  9. Hepatitis E og graviditet

    DEFF Research Database (Denmark)

    Mannheimer, Ebba Elisabeth; Harritshøj, Lene Holm; Katzenstein, Terese Lea

    2016-01-01

    Hepatitis E virus (HEV) infection among pregnant women is severe, often leading to fulminant hepatic failure and death, with mortality rates up to 15-25%. Studies suggest that differences in genotypes/subgenotypes, hormonal and immunological changes during pregnancy may contribute to the severe...

  10. Hepatitis G virus

    Institute of Scientific and Technical Information of China (English)

    Vasiliy Ivanovich Reshetnyak; Tatiana Igorevna Karlovich; Ljudmila Urievna Ilchenko

    2008-01-01

    A number of new hepatitis viruses (G,TT,SEN) were discovered late in the past century.We review the data available in the literature and our own findings suggesting that the new hepatitis G virus (HGV),disclosed in the late 1990s,has been rather well studied.Analysis of many studies dealing with HGV mainly suggests the lymphotropicity of this virus.HGV or GBV-C has been ascertained to influence course and prognosis in the HIV-infected patient.Until now,the frequent presence of GBV-C in coinfections,hematological diseases,and biliary pathology gives no grounds to determine it as an "accidental tourist" that is of no significance.The similarity in properties of GBV-C and hepatitis C virus (HCV) offers the possibility of using HGV,and its induced experimental infection,as a model to study hepatitis C and to develop a hepatitis C vaccine.

  11. Posterior reversible encephalopathy syndrome in alcoholic hepatitis: Hepatic encephalopathy a common theme

    Science.gov (United States)

    John, Elizabeth S; Sedhom, Ramy; Dalal, Ishita; Sharma, Ranita

    2017-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiologic diagnosis that has become more widely recognized and reported over the past few decades. As such, there are a number of known risk factors that contribute to the development of this syndrome, including volatile blood pressures, renal failure, cytotoxic drugs, autoimmune disorders, pre-eclampsia, and eclampsia. This report documents the first reported case of PRES in a patient with severe alcoholic hepatitis with hepatic encephalopathy and delves into a molecular pathophysiology of the syndrome. PMID:28127211

  12. Autoimmune hepatitis triggered by acute hepatitis A

    Institute of Scientific and Technical Information of China (English)

    Hiroto Tanaka; Hiroto Tujioka; Hiroki Ueda; Hiroko Hamagami; Youhei Kida; Masakazu Ichinose

    2005-01-01

    The patient was a 57-year-old woman presenting with jaundice as the chief complaint. She began vomiting on July 10, 2003.Jaundice was noted and admitted to our hospital for thorough testing. Tests on admission indicated severe hepatitis, based on: aspartate aminotransferase (AST), 1 076 IU/L; alanine aminotransferase (ALT), 1 400 IU/L; total bilirubin (TB), 20.9 mg/dL; and prothrombin time rate (PT%), 46.9%. Acute hepatitis A (HA) was diagnosed based on negative hepatitis B surface antigen and hepatitis C virus RNA and positive immunoglobulin (Ig) M HA antibody, but elevation of anti-nuclear antigen (×320) and IgG (3 112 mg/dL) led to suspicion of autoimmune hepatitis (AIH). Plasma exchange was performed for 3 d from July 17, and steroid pulse therapy was performed for 3 d starting on July 18, followed by oral steroid therapy. Liver biopsy was performed on August 5, and the results confirmed acute hepatitis and mild chronic inflammation. Levels of AST and ALT normalized,so dose of oral steroid was markedly reduced. Steroid therapy was terminated after 4 mo, as the patient had glaucoma. Starting 3 mo after cessation of steroid therapy,levels of AST and ALT began to increase again. Another liver biopsy was performed and AIH was diagnosed based on serum data and biopsy specimen. Oral steroid therapy was reinitiated. Levels of AST and ALT again normalized.The present case was thus considered to represent AIH triggered by acute HA.

  13. Occult hepatitis B among Iranian hepatitis C patients

    OpenAIRE

    Ahmad shavakhi; Babak Norinaier; Fatomeh Esteghamat; Mohamad Seghatoleslami; Mahsa Khodadustan; Mohamad hossein Somi; Mohsen Masoodi; Mohamad reza Zali

    2009-01-01

    • BACKGROUND: Occult hepatitis B is defined as presence of HBV DNA in tissue or serum without hepatitis B surface antigen. The aim of this study is to determine frequency of occult hepatitis B among hepatitis C patients in Tehran and compare the route of transmission and liver enzymes between positive and negative HBV DNA patients.
    • METHODS: In a cross sectional study, serum of 103 hepatitis C cas...

    • [The ABC of viral hepatitis].

      Science.gov (United States)

      Van Bambeke, F

      2008-03-01

      Viral hepatitis has long been under-diagnosed. Hepatitis A is an acute disease, while patients infected by hepatitis B and hepatitis C viruses are likely to develop chronical infections and severe complications (cancer, cirrhosis). The current treatment of hepatitis B and C consists in alpha interferon (preferably under its pegylated form), in combination with ribavirin for hepatitis C. The frequent and severe adverse effects of interferon-based therapy constitute, however, a major limiting factor (reactions at the injection site, flu-like syndrome, neurological disorders, ...). For hepatitis B, two alternatives are available so far, namely lamivudine and adefovir (used as a prodrug with highe oral bioavailability).

    • 危重患者腹腔内高压的发生率及其影响因素%Incidence and risk factors of high intraabdominal pressure in critically ill patients

      Institute of Scientific and Technical Information of China (English)

      杨飞

      2013-01-01

      目的:观察危重患者腹腔内高压(IAH)的发生率及其影响因素.方法:采用前瞻性队列研究方法,选择我院重症监护病房(ICU)的患者341例,采用经膀胱尿管间接测定方法,每日监测患者IAP,连续监测7d,按IAH的有无分组并进行临床资料比较,计量资料用t检验,计数资料用x2检验,危险因素以单因素及多因素Logistic回归模型进行分析.结果:341例患者中88例(25.8%)患者发生腹腔内高压(IAH),15例(4.5%)患者发生腹腔间室综合征(ACS).腹腔感染,大量液体复苏,肠梗阻,感染性休克,肝功能不全与IAH的发生密切相关(P=0.000,0.000,0.007,0.000,0.000).结论:IAH的发生在危重患者中较常见,腹腔感染,大量液体复苏,感染性休克,肝功能不全可能是IAH发生的独立危险因素.%Objective:To investigate the incidence and risk factors of high intra abdominal pressure(IAP) in critically ill patients in intensive care unit(ICU). Method:This was a prospective cohort study. This study was conducted at the intensive care unit in Changshu No. 2 people's hospital. The enrolled patients included all those consecutively admitted during 9 months. Intraabdominal pressure was continuously monitored twice daily for 7 days. Result:Of 341 patients,88 patients (25. 8%)had intra-abdominal hypertension and 15 patients(4. 5%) had ACS. Independent risk factors for IAH were abdominal infection, fluid resuscitation, sepsis shock and liver dysfunction. Conclusion: IAH was frequent in Intensive Care Unit. Abdominal infection, fluid resuscitation,sepsis shock and liver dysfunction were independent risk factors for IAH.

    • Transient elastography with the XL probe rapidly identifies patients with nonhepatic ascites

      Directory of Open Access Journals (Sweden)

      Mueller S

      2012-05-01

      Full Text Available Anna Kohlhaas1, Esteban Durango1, Gunda Millonig1, Cecile Bastard2, Laurent Sandrin2, Mohammad Golriz3, Arianeb Mehrabi3, Markus W Büchler3, Helmut Karl Seitz1, Sebastian Mueller11Department of Medicine and Center for Alcohol Research, Liver Disease and Nutrition, Salem Medical Center, University of Heidelberg, Heidelberg, Germany; 2Department of Research and Development, Echosens, Paris, France; 3Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, GermanyBackground: In contrast with other elastographic techniques, ascites is considered an exclusion criterion for assessment of fibrosis stage by transient elastography. However, a normal liver stiffness could rule out hepatic causes of ascites at an early stage. The aim of the present study was to determine whether liver stiffness can be generally determined by transient elastography through an ascites layer, to determine whether the ascites-mediated increase in intra-abdominal pressure affects liver stiffness, and to provide initial data from a pilot cohort of patients with various causes of ascites.Methods and results: Using the XL probe in an artificial ascites model, we demonstrated (copolymer phantoms surrounded by water that a transient elastography-generated shear wave allows accurate determination of phantom stiffness up to a water lamella of 20 mm. We next showed in an animal ascites model that increased intra-abdominal pressure does not affect liver stiffness. Liver stiffness was then determined in 24 consecutive patients with ascites due to hepatic (n = 18 or nonhepatic (n = 6 causes. The cause of ascites was eventually clarified using routine clinical, imaging, laboratory, and other tools. Valid (75% or acceptable (25% liver stiffness data could be obtained in 23 patients (95.8% with ascites up to an ascites lamella of 39 mm. The six patients (25% with nonhepatic causes of ascites (eg, pancreatitis, peritoneal carcinomatosis had a

    • Feature Hepatitis: The Dangers of Hepatitis: What you should know from A to E

      Science.gov (United States)

      ... Navigation Bar Home Current Issue Past Issues Feature Hepatitis The Dangers of Hepatitis: What you should know from A to E ... drugs. In some cases, hepatitis lasts a lifetime. Hepatitis: Acute or Chronic? Acute hepatitis is the initial ...

    • Viral hepatitis and hepatitis B antigen: recent advances

      Science.gov (United States)

      Krugman, Saul

      1974-01-01

      Recent advances in hepatitis research have shed new light on the etiology, pathogenesis, epidemiology and prevention of type B hepatitis infection. The so-called ‘Dane’ particle is probably the complete hepatitis B virion; its outer coat is the hepatitis B (Australia) antigen (HB Ag) and its inner core is an immunologically distinct particle. Subtypes of HB Ag (a, d, y, w and r) are useful indices for epidemiological surveys. Concepts of epidemiology have changed: type B hepatitis is transmissible by contact as well as by inoculation. The presence of HB Ag in blood is indicative of the presence of hepatitis B virus. Tests to detect antigen and use of voluntary blood donors have played a major role in the decreased incidence of post transfusion hepatitis. A special hepatitis B gammaglobulin preparation and a heat-inactivated hepatitis B vaccine have proved to be effective in preliminary studies. PMID:4219230

    • Hepatic microcirculatory disturbances in patients with chronic hepatitis B

      Institute of Scientific and Technical Information of China (English)

      郝菁华; 石军; 任万华; 韩国庆; 朱菊人; 王书运; 谢英渤

      2002-01-01

      Objective To document morphological changes in hepatic microcirculation in liver tissue with hepatitis B and the pathogenesis of hepatic microcirculatory disturbances. Methods Liver tissue samples were obtained from patients with hepatitis B by liver biopsy. These samples were examined with a light microscope and transmission electron microscope. Results Hepatic microcirculatory disturbances existed in patients with hepatitis B, including those with normal liver function, manifested by red blood cell aggregation in sinusoids seen under light microscope and sinusoidal capillarization seen under electron microscope. Weibel-Palade bodies in sinusoidal endothelial cells were seen in 26 out of 53 cases. Intimate contacts were found between lymphocyte/Kupffer cells and sinusoidal endothelial cells. Conclusions Hepatic microcirculatory disturbances exist in patients with hepatitis B .The appearance of Weibel-Palade bodies in sinusoidal endothelial cells may be a key step in the development of hepatic microcirculatory disturbances.

    • Comparative evaluation of central venous pressure and sonographic inferior vena cava variability in assessing fluid responsiveness in septic shock

      Directory of Open Access Journals (Sweden)

      Manjri Garg

      2016-01-01

      Full Text Available Objective: Fluid infusion, the most critical step in the resuscitation of patients with septic shock, needs preferably continuous invasive hemodynamic monitoring. The study was planned to evaluate the efficacy of ultrasonographically measured inferior vena cava collapsibility index (IVC CI in comparison to central venous pressure (CVP in predicting fluid responsiveness in septic shock. Materials and Methods: Thirty-six patients of septic shock requiring ventilatory support (invasive/noninvasive were included. Patients with congestive heart failure, raised intra-abdominal pressure, and poor echo window were excluded from the study. They were randomly divided into two groups based on mode of fluid resuscitation - Group I (CVP and Group II (IVC CI. Primary end-points were mean arterial pressure (MAP of ≥65 mmHg and CVP >12 mmHg or IVC CI <20% in Groups I and II, respectively. Patients were followed till achievement of end-points or maximum of 6 h. Outcome variables (pulse rate, MAP, urine output, pH, base deficit, and ScvO 2 were serially measured till the end of the study. Survival at 2 and 4 weeks was used as secondary end-point. Results: Primary end-point was reached in 31 patients (15 in Group I and 16 in Group II. Fluid infusion, by either method, had increased CVP and decreased IVC CI with resultant negative correlation between them (Pearson correlation coefficient -0.626. There was no significant difference in the amount of fluid infused and time to reach end-point in two groups. Comparison in outcome variables at baseline and end-point showed no significant difference including mortality. Conclusion: CVP and IVC CI are negatively correlated with fluid resuscitation, and both methods can be used for resuscitation, with IVC CI being noninferior to CVP.