Acute Diffuse Peritonitis Research Articles

对一例急性弥漫性腹膜炎病人初始抗感染治疗的分析与评价

对一例急性弥漫性腹膜炎病人初始抗感染治疗的分析与评价

Effects of body mass index (BMI) on surgical outcomes: a nationwide survey using a Japanese web-based database.

To define the effects of body mass index (BMI) on operative outcomes for both gastroenterological and cardiovascular surgery, using the National Clinical Database (NCD) of the Japanese nationwide web-based database. The subjects of this study were 288,418 patients who underwent typical surgical procedures between January 2011 and December 2012. There were eight gastroenterological procedures, including esophagectomy, distal gastrectomy, total gastrectomy, right hemicolectomy, low anterior resection, hepatectomy of >1 segment excluding the lateral segment, pancreaticoduodenectomy, and surgery for acute diffuse peritonitis (n = 232,199); and five cardiovascular procedures, including aortic valve replacement, total arch replacement (TAR), descending thoracic aorta replacement (descending TAR), and on- or off-pump coronary artery bypass grafting (n = 56,219). The relationships of BMI with operation time and operative mortality for each procedure were investigated, using the NCD. Operation times were longer for patients with a higher BMI. When a BMI cut-off of 30 was used, the operation time for obese patients was significantly longer than that for non-obese patients, for all procedures except esophagectomy (P < 0.01). The mortality rate based on BMI revealed a U-shaped distribution, with both underweight and obese patients having high mortality rates for almost all procedures. This Japanese nationwide study provides solid evidence to reinforce that both obesity and excessively low weight are factors that impact operative outcomes significantly.

Risk Models of Operative Morbidities in 16,930 Critically Ill Surgical Patients Based on a Japanese Nationwide Database.

The aim of the study was to evaluate preoperative variables predictive of lethal morbidities in critically ill surgical patients at a national level.There is no report of risk stratification for morbidities associated with mortality in critically ill patients with acute diffuse peritonitis (ADP).We examined data from 16,930 patients operated during 2011 and 2012 in 1546 different hospitals for ADP identified in the National Clinical Database of Japan. We analyzed morbidities significantly associated with operative mortality. Based on 80% of the population, we calculated independent predictors for these morbidities. The risk factors were validated using the remaining 20%.The operative mortality was 14.1%. Morbidity of any grade occurred in 40.2% of patients. Morbidities correlated with mortality, including septic shock, progressive renal insufficiency, prolonged ventilation >48 hours, systemic sepsis, central nervous system (CNS) morbidities, acute renal failure and pneumonia, and surgical site infection (SSI), were selected for risk models. A total of 18 to 29 preoperative variables were selected per morbidity and yielded excellent C-indices for each (septic shock: 0.851; progressive renal insufficiency: 0.878; prolonged ventilation >48 h: 0.849; systemic sepsis: 0.839; CNS morbidities: 0.848; acute renal failure: 0.868; pneumonia: 0.830; and SSI: 0.688).We report the first risk stratification study on lethal morbidities in critically ill patients with ADP using a nationwide surgical database. These risk models will contribute to patient counseling and help predict which patients require more aggressive surgical and novel pharmacological interventions.

National Clinical Database feedback implementation for quality improvement of cancer treatment in Japan: from good to great through transparency.

The National Clinical Database (NCD) of Japan was established in April, 2010 with ten surgical subspecialty societies on the platform of the Japan Surgical Society. Registrations began in 2011 and over 4,000,000 cases from more than 4100 facilities were registered over a 3-year period. The gastroenterological section of the NCD collaborates with the American College of Surgeons’ National Surgical Quality Improvement Program, which shares a similar goal of developing a standardized surgical database for surgical quality improvement, with similar variables for risk adjustment. Risk models of mortality for eight procedures; namely, esophagectomy, partial/total gastrectomy, right hemicolectomy, low anterior resection, hepatectomy, pancreaticoduodenectomy, and surgery for acute diffuse peritonitis, have been established, and feedback reports to participants will be implemented. The outcome measures of this study were 30-day mortality and operative mortality. In this review, we examine the eight risk models, compare the procedural outcomes, outline the feedback reporting, and discuss the future evolution of the NCD.

Physiology and pathophysiology of the lymphatic system. Research results and further prospects

The review summarizes own research and literature on the role of the lymphatic system in a number of physiological and pathological conditions. The typical reaction of lymph circulation seen in shock, acute diffuse peritonitis, in postoperative period is the lymph flow volumetric rate increase. Mobilization of the lymphatic system, extravascular fluid and proteins in well-studied emergencies is explained considering the role of the lymphatic system as a natural source of circulating blood volume regulation and serum proteins replacement («autotransfusion»). These pathological processes are associated with progression of lymphatic failure on the late terms. The principle of lymph circulation targeted stimulation as a way to detoxify the body using hormones and procaine (Novocain) blockade of splanchnic nerves and the borderline sympathetic trunks was proposed based on modeled acute peritonitis. Increased microcirculation and central lymph flow, alterations in resorption, transport and filtration barrier function of the lymphatic system, as well as morphologic and functional reorganization of the lymph nodes were revealed in fever of different duration. Of particular interest are studies on the role of the lymphatic system in the immediate and long-term body adaptation to physical stress. Activation of central lymph circulation in adequate dynamic loads correlated with changes in the system lymph microcirculation (acceleration of lymph flow, increased peristalsis of the lymph microvessels walls and contractile activity of their valves). Extreme physical exhaustion was accompanied by expressed lymphovascular, extravascular and intravascular changes in the microvasculature. Lymphatic failure, as well as structural microcirculation impairments in a trained body occur only in extreme physical stress. Thus, the lymphatic system is involved in many physiological and pathological processes; its functional condition affects the course and outcome of the disease. Therefore, the treatment of the diseases requires, among other measures, correction of lymph formation and circulation (stimulation or inhibition, endolymphatic treatment, thoracic duct drainage, lymphosorption, blockade of nodal pathways and other methods - depending on the specific disease).

Surgical risk model for acute diffuse peritonitis based on a Japanese nationwide database: an initial report on the surgical and 30-day mortality

Acute diffuse peritonitis (ADP) is an important surgical complication associated with high morbidity and mortality; however, the risk factors associated with a poor outcome have remained controversial. This study aimed in collecting integrated data using a web-based national database system to build a risk model for mortality after surgery for ADP. We included cases registered in the National Clinical Database in Japan. After data cleanup, 8,482 surgical cases of ADP from 1,285 hospitals treated between January 1 and December 31, 2011 were analyzed. The raw 30-day and surgical mortality rates were 9.0 and 14.1 %, respectively. The odds ratios (>2.0) for 30-day mortality were as follows: American Society of Anesthesiologists (ASA) class 3, 2.69; ASA class 4, 4.28; ASA class 5, 8.65; previous percutaneous coronary intervention (PCI), 2.05; previous surgery for peripheral vascular disease (PVD), 2.45 and disseminated cancer, 2.16. The odds ratios (>2.0) for surgical mortality were as follows: ASA class 3, 2.27; ASA class 4, 4.67; ASA class 5, 6.54, and disseminated cancer, 2.09. The C-indices of 30-day and surgical mortality were 0.851 and 0.852, respectively. This is the first report of risk stratification after surgery for ADP using a nationwide surgical database. This system could be useful to predict the outcome of surgery for ADP and for evaluations and benchmark performance studies.

Multiple Organ Failure Syndrome In Patients With Acute Diffuse Peritonitis

The results of the surgical treatment of 123 patients with acute diffuse peritonitis have been analyzed. The dynamics of necrotic processes activity in the mucous membrane of the small intestine according to its affection marker I-FABP, the liver – LFABP and of the heart – H-FABP in preoperative period and on 1, 3, 5, 7 day after the operation. Due to the level of multiple organ failure according to G.R. Bernard et al. scale (1995) and the level of bacterial contamination of the abdominal cavity during the operative treatment of patients with acute diffuse peritonitis, the choice of the method (closed and open) of intestinal intubation, programmed laparostomia is indicated. The methods of pharmacological (inotropic, antibacterial, infusion) correction of multiple organ failure syndrome during a comprehensive treatment of patients in toxic and terminal stages of acute diffuse peritonitis are worked out enabling to reduce the frequency of post-operational complications from 73,6% to 39,1%, and to reduce the level of post-operational lethal outcome from 14,1% to 8,5%.

Acute generelized peritonitis. Laparostomy or planned relaparotomy?

The results of surgical treatment of 131 patients with acute diffuse peritonitis are studied. The method of laparostomy with perforated films, PVC tubing bundle is introduced. Intra-abdominal pressure is found not to rise to critical levels even in the presence of postoperative paresis. Closing of laparostomy was performed in successive steps on 7-10 days after surgery (according to clinical and sonographic criteria) and relaparotomy was not required. Attention is drawn to the fact that laparostomy should not be opposed to the planned relaparotomy.

The Evaluation of Small Intestinal Volvulus Caused by Pathogenic microorganisms in a Thoroughbred Mare

Background: Small intestinal (SI) volvulus is defined as a rotation of greater than 180 degrees about its mesentery of a segment of jejunum or ileum. Horses of all ages have been affected. There is typically an acute onset of signs of mild to severe pain. Objectives: The objective of this study was to evaluate the microbial pathogens of the duodenum, ileum, cecum, colon and rectum (feces) in associated with volvulus horse, and to determine whether rectal (fecal) samples are representative of proximal segments of the gastrointestinal tract. Materials and Methods: A brown 26 years old mare, BCS (body condition score) 4 was found dead in stall in the morning. It was moved to a suitable area to conduct a post-mortem exam. The mare was examined in hanging position and then left lateral-recumbent. Advanced abdominal tympany was present. Clinical signs, laboratory data, surgical or necropsy findings, clinic-histopathological findings and outcome for horse with SI volvulus was obtained from medical records, and identified by manual review. Horsefeces and colon were collected in autopsy. Fecal material was scooped from the center of a freshly defecated bolus into sterile sample cups, which were placed into plastic anaerobe jars with PackAnaero sachets (Mitsubishi Gas Co. via Remel, Lenexa, KS) and transported to the laboratory. Alternatively, colon contents were collected from horse at the autopsy by direct incision into the colon immediately after the horse was autopsied. The samples were transported anaerobically to the laboratory. Results: On opening the abdominal cavity; a large quantity of sanguineous, foul-smelling fluid with pus exited the perforated bowel wall (hemoperitoneum). Additionally, signs of an acute diffuse peritonitis were visible. The blood vessels of the stomach and intestines were distended. Small intestinal volvulus was observed in several segments (360 degree rotation involving the mesentery). This information may aid diagnosis and prognosis and guide to decision making for horses with this condition. ??????

Diagnosis and treatment of extraperitoneal pneumatosis caused by perforation of rectal diverticulum

Rectal diverticulum is rarely seen in clinical practice.Perforation or rupture of rectal diverticulum with symptoms and signs of acute diffuse peritonitis makes it easily be misdiagnosed as appendicitis,rectal neoplasms,intestinal obstruction and other abdominal diseases.In this article,a retrospective analysis of the clinical data of one patient with extraperitoneal pneumatosis caused by perforation of rectal diverticulum was performed to investigate the diagnosis and treatment of the disease. Key words: Rectal diverticulum, performation ; Extraperitoneal pneumatosis

The opioid system is involved in the analgesic effects of Tactivin

130 At present, a new line of research, which takes into account the interaction of the nervous and immune systems, is developed intensely in neurobiology (1). It is supposed that the immune system is involved in the functioning of the stresslimiting system (2). The cen� tral organ of the immune system is the thymus. Its function is carried out with the help of hormones and peptides synthesized by this gland. In the early 1970s, Tactivin, a drug with proven immunomodulatory activ� ity containing lowmolecularweight peptides and polypeptides, was derived from the thymus (3). The drug was effective in multimodality therapy of many diseases accompanied by immunodeficiency states, as well as in heroin addiction and alcoholism (4). It was shown in animal studies that the administra� tion of Tactivin in acute diffuse peritonitis caused by Gramnegative microflora and in burning injury led not only to the restoration of immune system parame� ters in rats, but also to elimination of the signs of intoxication (5). In subacute and chronic benzene poisoning, Tactivin normalized the liver enzyme activ� ity (6). It was recently demonstrated that Tactivin pre� vents the neurotoxic effect of lead and cobalt on learn� ing and memory of rats (7). The stimuli causing pain as a signal of danger to the integrity of the body formed in the course of evolution are universally recognized stressors. Postulation of the fact that thymus is involved in the stresslimiting sys� tem (2) logically leads to the assumption about the effect of thymus polypeptides on pain sensitivity. Therefore, we tested this assumption experimen� tally and analyzed the possible role of the opioid sys� tem in the analgesic effects of Tactivin. MATERIALS AND METHODS Experiments were carried out on 70 male Wistar rats weighing 180-200 g. The rats were kept in plastic cages at a 12 : 12 h light-darkness regimen with free access to water and food. The animals from the exper� imental group were injected for five days with Tactivin at a dose of 0.5 mg/kg dissolved in 0.5 mL saline; the animals from the control group, only with 0.5 mL of saline. Tactivin was derived using the standard tech� nique developed in the Laboratory of Molecular Immunology and Biochemistry of the Research Insti�

Perioperative fluid therapy of gastrointestinal surgery

Fluid therapy has been the focus of attention and dispute. In this paper, there are three aspects including postoperative bowel function, surgical prognosis, and acute diffuse peritonitis. Colloidal supplement and appropriate crystal/colloid ratio should be noted in low perfusion conditions. The different types of fluid in recent studies did not show a significant difference in the long term. The new evidence will be noted in fluid therapy among 2012 SSC Severe Sepsis and Septic Shock Guideline update (unpublished).

The effectiveness of Bioleikin in complex treatment of patients with acute diffuse peritonitis

оиск оптимальных подходов и принципов хирургиче-ского лечения больных с острым разлитым перитони-том длится не один десяток лет и складывается впечатление, что нередко далек от абсолютного совершенства. Адекватно подобранные и патогенетически обоснованные компонен-ты комплексной терапии существенно предупреждают возможность возникновения необратимых осложнений, а иногда способствуют своевременной их коррекции за счет восстановления компенсаторных резервов путем под-держивания баланса биоадаптации различных органов и систем [2,7,9] . Многочисленные источники специализированной литера-туры [1,4,5,8] обоснованно убедили практиков и научных работников в особом значении динамических изменений иммунной системы у пациентов с острым разлитым пери-тонитом, своевременная трактовка которых способствует и обуславливает необходимость последовательного изучения ключевых особенностей патогенеза заболевания с учетом современных достижений медицинской и фармацевтиче-ской цитиндустрии и поиска новых средств и медицинских препаратов для предупреждения негативных острымтенденций протекания ветствиизаболевания. ЦЕЛЬ РАБОТЫ Оценить эффективность применения препарата Биолей-кин (рекомбинантного интерлейкина-2 человека, производ-ства корпорации Arterium, Украина) в комплексном лечении пациентов с острым разлитым перитонитом. ПАЦИЕНТЫ И МЕТОДЫ ИССЛЕДОВАНИЯРабота выполнена на кафедре медицины неотложных состояний Национальной медицинской академии последи-пломного образования имени П.Л. Шупика МЗ Украины. В исследовании приняли участие 48 пациентов, среди них 41 женщина и 7 мужчин, которые госпитализированы в ургентном порядке в хирургические отделения Киевской городской больницы скорой медицинской помощи. Воз-раст пациентов – от 34 до 79 лет. У 19 больных причиной госпитализации была острая кишечная непроходимость, в 12 – острая сегментарная сосудистая недостаточность кишечника, у 10 – перфоративная язва желудка или двенад-цатиперстной кишки, 7 – острый деструктивный аппенди-. Работаосновананарезультатахлеченияпациентовсразлитымперитонитом, состояниекоторыхвсоот-сМангеймскимперитонеальныминдексомбыло

Efficacy of NPWT with Acute Diffuse Peritonitis due to Lower Gastrointestinal Perforation

Efficacy of NPWT with Acute Diffuse Peritonitis due to Lower Gastrointestinal Perforation

„Unklare“ Anämie bei einer hochbetagten Patientin

A gastroenterologic examination was performed on an 83-year-old woman due to unexplained anemia; however, no bleeding site could be identified. Because of the advanced age of the patient, no further diagnostic efforts were made and iron-deficiency anemia was suspected. After 3weeks, an emergency laparotomy was performed for acute diffuse peritonitis, which was diagnosed as perforation of the jejunum by a wooden foreign body. After extraction of the foreign body and closure of the perforation in the small intestine, healing proceeded without complications.

A rare perforated gastrointestinal stromal tumor in the jejunum: A case report

We herein report a 45-year-old Chinese male with a perforated jejunal gastrointestinal stromal tumor causing acute diffuse peritonitis and incomplete intestinal obstruction. At urgent laparotomy, a perforated tumor was found in the jejunum about 40 cm from the Treitz's ligament, and the upper small intestine was twisted 1080°. The clinical symptom of this case is extremely rare, and has not been reported in the literature previously.

Acute abdomen due to vaginal impalement

Acute abdomen is a common and often complicated condition inthe emergency department. Etiology may vary from harmless toextremely severe causes, any of which can present the samenonspecific symptoms. Impalement or penetrating injuries of thelower genital tract are rare and frequently related to unusual sexualhabits [2]. Evaluating the mechanism of trauma may be difficult aspatients are often unwilling or unable to provide the necessaryinformation.An 18-year-old woman presented at the emergency departmentwith sudden and severe lower abdominal pain in the early morning.Initial history did not reveal trauma or previous illness.Physical examination showed a tense abdomen with diffuseguarding and rare bowel sounds. Laboratory evaluation showed awhite blood cell count of 25.7/nL and C-reactive protein of 84 mg/L.Urinalysis exhibited 150 Ery/μL, 100 leukocytes/μL, and a negativepregnancytest. Abdominal ultrasound was normal but X-rayrevealedair in the peritoneal cavity.Laparoscopy was performed for suspected gastrointestinal perfo-ration. Turbid and blood-stained perihepatic fluid was found andhyperemia of the parietal peritoneum was suggestive of earlyperitonitis. No perforation was found in the upper abdomen. In therectovaginal pouch there was a 4-cm wide laceration through thevagina vault, with transvaginal loss of carbon dioxide gas.Following irrigation with 5 liters of warm saline, repair wasperformed laparoscopically with a continuous PDS II suture (3-0,Lahodny) and fixed with two resorbable clips. Intravenous cephazolin(3×2 g) and metronidazole (2×500 mg) were administered to thepatient for 7 days. Review of the gynecologic history revealed forcefulsexual intercourse as the cause of the injury. The patient's recoveryfrom surgery was uneventful.Impalement injuries of the vagina are seldom described in theliteratureandincludesevereinjuriesoftherectum,bladder,peritoneal,duodenum, diaphragm, and lung [1–3].The most common symptom in women with vaginal impale-ment injury is vaginal bleeding after coitus with no history ofcongenital abnormalities, gynecologic operation, pregnancy, orbirth [4]. Careful gynecologic history is necessary and should beaccompanied by vaginal examination and ultrasound or radiogra-phy when indicated.Vaginal bleeding as the classical symptom was absent in thepresent case and the clinical aspect was that of an acute abdomenwith diffuse peritonitis. In such cases, full evaluation may lead tolaparoscopy.Conflict of interestNo conflicts of interest exist.References

Clinical and ultrasonographic differences between cattle and buffaloes with various sequelae of traumatic reticuloperitonitis

This study was performed to document the clinical and ultrasonographic differences between cattle and buffaloes with various sequelae of traumatic reticuloperitonitis (TRP) and the importance of ultrasonography in detection of such sequelae. Twenty nine cows and 33 buffaloes with TRP were investigated. By using ultrasonography and some confirmatory techniques as paracentesis, laparotomy and necropsy, the various sequelae of TRP in both species were clarified. Acute local peritonitis, chronic local peritonitis, acute diffuse peritonitis, reticular abscesses, thoracic abscesses and pericarditis have been detected as sequelae of TRP in both cattle and buffaloes. The clinical findings of all sequelae are described. The results of the present study indicate that the classical symptom of pain and systemic reactions were common in most sequelae of TRP in cattle and less common in buffaloes. No specific findings have been recorded for reticular abscesses in both species. Brisket oedema and distended jugular veins have been shown in both cattle and buffaloes with pericarditis and also in four buffaloes with thoracic abscesses. Hence, it is important to use ultrasonography for early detection of TRP especially in buffaloes and to discriminate between different sequelae which have the same clinical findings.

Comparative study of plasma proteins including haptoglobin and serum amyloid A in different types of traumatic reticuloperitonitis in cattle

Traumatic reticuloperitonitis (TRP) is a relatively common disorder in adult cattle which could appear in various forms including local peritonitis, diffuse peritonitis, acute pericarditis, and chronic peritonitis. The objective of the present study was to compare the changes of plasma proteins including haptoglobin (Hp) and serum amyloid A (SAA) as acute phase proteins (APPs) in various types of TRP in cattle. Blood samples were collected from 73 cows: 53 cases of TRP and 20 healthy control subjects. Measurements of plasma proteins were done using validated methods. Results showed that SAA and Hp had very similar pattern and magnitude of changes in various types of TRP and revealed significant increase in acute diffuse peritonitis (312.4 μg/mL and 2.16 g/L, respectively) compared with other types of the disease (P < 0.05). Fibrinogen (660 mg/dL), alpha-globulin (24.5 g/L), and total protein (87.7 g/L) had their maximal increase in acute diffuse peritonitis too. Beta- and gamma-globulins increased significantly in traumatic pericarditis and chronic peritonitis, respectively. Albumin revealed significant decrease in acute local peritonitis (20.9 g/L), but it was increased significantly in acute diffuse peritonitis (34.5 g/L) compared with other groups (P < 0.05). The results of the present work showed that patterns of changes in plasma proteins including APPs might be different according to the type of TRP studied. This could be taken into consideration in clinical practice where it might be of potential benefit in correct diagnosis of the specific type of TRP.

A Case of Acute Diffuse Peritonitis due to Perforated Pseudocyst of Gastric Ectopic Pancreas

A Case of Acute Diffuse Peritonitis due to Perforated Pseudocyst of Gastric Ectopic Pancreas