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At least 649 records · Page 36Linked to original sources
PubMed2000

Vanishing bile duct syndrome associated with chronic EBV infection.

We reported here an adult patient with vanishing bile duct syndrome due to chronic EBV infection. A 22-year-old male was admitted to a nearby hospital complaining of a sore throat and jaundice. He received a high dose of prednisolone for bile stasis of acute viral hepatitis. However, the hepatitis did not improve, and he was transferred to our hospital. He had exhibited jaundice for one year as well as hemophagocytic syndrome and intestinal perforation. Subtotal intestinal resection was successfully performed. Three follow-up biopsied liver specimens indicated vanishing bile duct syndrome. Positive results of EBV-DNA in his serum and mRNA of EBV by in situ hybridization of his liver indicated that massive doses of prednisolone caused chronic EBV infection and vanishing bile duct syndrome.

Adult↗
PubMedDate not supplied

[Free perforation in Crohn's disease].

Free perforation in abdominal cavity in patients with Crohn's disease is a rare entity as attested from the data reported in the literature. It is a very dangerous event and requires a surgical urgency management. The Authors reported two cases of free perforation, in patients with Crohn' disease, undergoing surgical operation in urgency. Analyzing pathogenesis, difficulty in diagnosis making and therapeutic choices, they underline that CT is very useful in the diagnosis, while resection of the perforated intestinal tract represent the best surgical treatment.

Adult↗
PubMed2000

Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants.

BACKGROUND: Chronic lung disease (CLD) remains a major problem in neonatal intensive care units. Persistent inflammation in the lungs is the most likely underlying pathogenesis. Corticosteroids have been used to either prevent or treat CLD because of their potent anti-inflammatory effects. OBJECTIVES: To determine if postnatal corticosteroid treatment is of benefit in the prevention of chronic lung disease (CLD) in the preterm infant. This review examines the outcome of trials where preterm infants at risk of CLD were given postnatal steroids within 96 hours after birth. SEARCH STRATEGY: Randomised controlled trials of postnatal corticosteroid therapy were sought from the Oxford Database of Perinatal Trials, the Cochrane Controlled Trials Register, Medline, hand searching paediatric and perinatal journals, examining previous review articles and information received from practising neonatologists. SELECTION CRITERIA: Randomised controlled trials of postnatal corticosteroid treatment within 96 hours of birth (early) in high risk preterm infants were selected for this review. DATA COLLECTION AND ANALYSIS: Data regarding clinical outcomes including mortality, failure to extubate, pulmonary air leak, survival without chronic lung disease, CLD defined at 28 days postnatal age and 36 weeks post menstrual age, patent ductus arteriosus (PDA), severe intraventricular hemorrhage (IVH), infection, hyperglycaemia, hypertension, severe retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), gastrointestinal bleeding and longterm outcome were abstracted and analysed using Revman 4.0.4. MAIN RESULTS: Fifteen randomised controlled trials of early postnatal corticosteroid treatment of preterm babies at risk of developing CLD were identified. A meta-analysis of these trials demonstrates benefits as regards earlier extubation, decreased risks of CLD at both 28 days and 36 weeks, death or CLD at 28 days, and PDA. There was an almost significant reduction in the risk of pulmonary air leak and in death or CLD at 36 weeks in the babies treated with early corticosteroids. There were no differences in the rates of neonatal mortality, infection, severe ROP, severe IVH, NEC and pulmonary haemorrhage. Gastrointestinal bleeding and intestinal perforation were important adverse effects and the risks of hyperglycaemia and hypertension were also increased. Several adverse neurological effects were found at follow-up examinations of survivors treated with early steroids: abnormal neurological examination, cerebral palsy and developmental delay. REVIEWER'S CONCLUSIONS: The benefits of early postnatal corticosteroid treatment (< 96 hours) may not outweigh the known or potential adverse effects of this treatment. Gastrointestinal effects early in the neonatal period and neurological effects seen at follow-up mean that current use of early postnatal steroids needs to be reconsidered. There is a compelling need for the long term follow-up and reporting of late outcomes, especially neurologic and developmental outcomes, among surviving infants who participated in all randomized trials of early postnatal corticosteroid treatment. The role of inhaled steroids remains to be elucidated.

Anti-Inflammatory Agents↗
PubMed1997

Risk of late perforation in intestinal contusions caused by explosive blast.

BACKGROUND: Despite the predominance of superficial injuries after explosive blast exposure, major morbidity or mortality among immediate survivors is caused by delayed perforation of intestinal mural contusions. Previous studies have suggested that small bowel and colonic contusions larger than 10 mm in diameter are at high risk. This experimental study aimed to identify contusions at high risk of late perforation. METHODS: Histological features of injury were classified in 188 blast-induced intestinal contusions in 16 anaesthetized Large White pigs. RESULTS: Some 16 per cent of small bowel and 12 per cent of colonic contusions were at high risk of late perforation. Small bowel contusions larger than 15 mm in diameter had a worse histological grading than those smaller than 15 mm (chi 2 = 0.09, 2 d.f., P = 0.01). Contusions that extended over more than half the bowel circumference (chi 2 = 14.79, 2 d.f., P = 0.0006) and those affecting the mesenteric border (chi 2 = 7.5, 2 d.f., P = 0.024) were more severe injuries. Colonic contusions larger than 20 mm in diameter had a worse histological grading than smaller ones (chi 2 = 14.95, 2 d.f., P = 0.0006). Confluent, rather than diffuse, colonic contusions were more severe injuries (chi 2 = 6.37, 2 d.f., P = 0.04). CONCLUSION: Once identified at laparotomy, the number of small bowel contusions requiring excision may be reduced from 86 to 60 per cent; similarly, excision of colonic contusions can be reduced from 73 to 27 per cent if small bowel contusions smaller than 15 mm in diameter and colonic contusions of less than 20 mm are managed conservatively.

Animals↗
PubMed1985

Nontraumatic perforations of the small intestine.

Nontraumatic perforation of the small intestine is very rarely found as a cause of acute abdominal disease. A series of 15 adult patients admitted to our hospital from 1973 to 1983 is reviewed. Underlying conditions were primary neoplasia (three patients), adhesions (three patients), intraluminal foreign bodies (two patients), metastases (two patients) and diverticulum (one patient). In four patients, the pathogenesis remained unclear (idiopathic perforations). As surgical therapy, resection and anastomosis is preferred in order to make a thorough histologic examination of the perforated bowel possible. A possible role of local drug toxicity in the pathogenesis of perforations has been discussed herein. No anastomotic leakage was observed. Four patients died (27 percent).

Adolescent↗
PubMed2004

A very rare consequence of steroid therapy: ileal perforation in a patient with familial mediterranean fever.

Intestinal perforation rarely occurs in children with familial Mediterranean fever (FMF). When this does happen, it is the result of untreated intestinal obstruction caused by compression from peritoneal adhesions. Intestinal perforation is a well-known complication of steroid therapy in all ages. The duodenum is affected most frequently, but perforation may also occur in other parts of the small intestine and, very rarely, the colon. Intestinal wall changes that occur in chronic FMF may promote the harmful effects of steroids. Here we present an unexpected complication, ileal perforation, in an 8-year-old boy who was taking prednisolone for FMF-related arthritis.

Child↗
PubMed2006

Prenatal rectal perforation: an unsuspected cause of isolated ascites.

In fetal intestinal perforation, inflammation leads to production of ascites. Small bowel is usually involved by perforation with the distal ileum the most frequent site. We report the first case of prenatal perforation of the intraperitoneal part of the rectum, which presented as severe ascites at a 37 weeks' gestation antenatal ultrasonography. As none of the reported causes of intestinal perforation were identified in our case, its etiology remained idiopathic.

Adult↗
PubMed1984

Necrotising enterocolitis experience with 54 neonates.

Fifty-four neonates transferred to the neonatal surgical unit because of acute necrotising enterocolitis (N.E.C.) are presented. Eleven died (20.4%), of whom seven were treated conservatively and four by operation. Ten patients required surgical exploration because of intestinal perforation, obstruction or suspected perforation. Another five neonates presented with intestinal perforation and were treated by percutaneous catheter drainage of the peritoneal cavity because of their extreme prematurity. Nine patients developed a colonic stricture diagnosed between six weeks and a year after the onset of the disease. Another six patients showed a segment of colonic narrowing detected on barium enema radiography without clinical evidence of bowel obstruction. They were treated conservatively and showed complete resolution at follow up studies.

Enterocolitis, Pseudomembranous↗
PubMed2006

Typhoid colonic perforation in childhood: a ten-year experience.

BACKGROUND: Intestinal perforation resulting from a complication of typhoid fever has always been of concern because of its high morbidity and mortality rates. Most perforations occur in the terminal ileum. METHODS: Between May 1995 and June 2005, 24 children with typhoid colonic perforations receiving operations were retrospectively reviewed. The patients were 5 months to 86 months of age (mean: 25.1+/-17.5 months). Surgical management consisted of primary closure of the perforation with ileostomy (70.8%), wedge resection and simple closure (20.8%), and partial colectomy with colostomy (4.2%). For the 11 patients with solitary cecal perforation, 6 received simple closure with ileostomy (group I), and wedge resection and simple closure was performed in the remaining 5 patients (group C). After operation, total parenteral nutrition (TPN) was instituted in each patient. RESULTS: Solitary cecal perforation is the most common type (45.8%). The length of hospital stay (LOS) varied from 12 days to 73 days, and the mean duration was 24.5+/-14.7 days. The LOS showed no significant difference with regard to the location and the number of perforations. No mortality was noted in the entire series, but 19 patients had one or more complications, which may have prolonged the LOS; anemia and wound infections were the two most common problems. Group C had the shorter LOS (16.4+/-3.4 days, versus 40.2+/-22.6 days for group I) and fewer complications (0.6+/-0.5, versus 3.25+/-1.7 for group I). Any readmission for secondary operation to restore intestinal continuity in group C was therefore avoided. CONCLUSIONS: To understand thoroughly the clinical course of typhoid fever is important. The typically high rate of complications after intestinal perforation secondary to typhoid fever may be reduced if operation is undertaken earlier. Solitary cecal perforation can be managed safely with wedge resection and simple closure without bowel exterioration. Routine usage of TPN may reduce the mortality associated with complications resulting from typhoid perforations.

Age Factors↗
PubMed1996

Nontraumatic perforations of the small intestine.

Nontraumatic perforation of the small intestine is very rarely found as a cause of abdominal disease. A series of 8 patients admitted to our hospital from 1990-1994 was reviewed. Underlying conditions were typhoid ulcers, (two patients), adhesions (two patients), hemorrhagic ileitis, (one patient), radiation enteritis (one patient) and SLE (one patient). The cause remained unclear in one patient (idiopathic). As surgical therapy, resection and anastomosis were preferred in order to make thorough histologic examination of the perforated bowel possible. One anastomosis leakage with spontaneous closure was observed. There was no operative mortality.

Adolescent↗
PubMed1984

[Necrotizing enterocolitis of the newborn infant].

The experience at the Hospital for Pediatric Surgery in Dortmund with 47 cases of necrotizing enterocolitis in 16 years are reviewed. 43 patients had been transferred from pediatric hospitals for immediate operation. 7 newborns had developed gastric perforation, 25 previously intestinal perforation. 4 patients had undergone laparotomy for other indication before. The chance to survive the necrotizing process is smaller in case of inflammation of the small bowel than of the large bowel. The current knowledge about necrotizing enterocolitis is summarized, including modern aspects about the indication to operate.

Birth Weight↗