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At least 847 records · Page 47Linked to original sources
PubMed1999

Hemodialysis together with peritoneal dialysis is one of the simplest ways to maintain adequacy in continuous ambulatory peritoneal dialysis.

When long-term peritoneal dialysis (PD) is performed without change in the dialysis prescription, uremic symptoms appear owing to insufficient dialysis dose. In such cases, an increase in dialysate volume is required, but this increase is difficult to obtain in all patients owing to limitations in abdominal volume, lifestyle, or body weight. A combination of PD and hemodialysis (HD) is the simplest method of overcoming these limitations. Combination therapy--HD once per week for 4 hours and PD 6 days per week--was performed in our patients. The total weekly dialysis dose (urea) was calculated as follows: to convert the dialysis dose by HD to that of continuous treatment, the equivalent renal urea clearance (EKR) was calculated and added to the dialysis dose by PD. Combination therapy was performed in 12 patients. The reasons for the combination therapy included ultrafiltration (UF) loss in 2 patients, uremic symptoms in 3 patients, poor fluid management in 5 patients, umbilical hernia in 1 patient, and hydrothorax in 1 patient. Total Kt/V per week was increased from 1.61 +/- 0.19 to 2.05 +/- 0.25 in these patients. In the 2 patients with UF loss, weight control became easier after the combination therapy was started, and this control was possible with hypotonic dialysate alone. In patients with uremic symptoms, the symptoms improved; furthermore, dermal pigmentation improved in these patients. In summary, the dialysis dose was increased and body fluids became controllable after inducing combination therapy, resulting in improvement uremic symptoms and increased quality of life.

Adult↗
PubMedDate not supplied

[Meigs' syndrome: its clinical picture and treatment].

Meigs' syndrome is a rare clinical entity characterised with ovarian benign tumour, ascites and hydrothorax. Between January '94-September '98 we observed three patients with: ovarian neoformation, light (1 patient), moderate (2 patients) monolateral pleural effusion, moderate (2 patients) and considerable (1 patient) ascites. In all patients the preoperative evaluation (sero-haematologic routine, Ca 125 and other oncologic markers, chest X-ray, abdominal and pelvic ultrasonography, total-body Tc, cytological analysis of pleural and abdominal effusion) was suggestive for malignancy but not confirmed it. So an explorative laparotomy with histological extemporary analysis was performed. The results were: 1 fibrothecomas, 1 fibroma, 1 ovarian inflammation with cystic luteinization areas and fibromatosis uterine. All three patients had a good postoperative course. The symptomatology and the effusions disappeared 7-10 days after operation. The first two cases were diagnosed as classic Meigs' syndrome, the third one, instead, as a pseudo-Meigs's syndrome. In conclusion the A.A., according to literature and their experiences, underline: 1) an ovarian mass with pleural and abdominal effusion not always represents an advanced malignancy; 2) even if elevated Ca 125 value is usually associated to a ovarian malignancy, there are some benign lesions in which we observed elevated level of this marker 3) the removal of the ovarian mass is the only resolutive treatment for these patients.

Aged↗
PubMed2000

Contralateral reexpansion pulmonary edema.

Reexpansion pulmonary edema (RPE) is an unusual complication of thoracentesis. Significant morbidity can result, and death is reported in 20% of cases. It is typically manifested as edema within a lung that has recently been reexpanded. Few reports document contralateral edema formation. We present a case of recurrent left-sided pulmonary edema after repeated drainage of a right-sided pleural effusion due to hepatic hydrothorax. We believe this is the first reported case of recurrence and only the fifth overall case of contralateral RPE. We also review the pathophysiology, treatment, and case reports of contralateral RPE. Physicians should be aware of the complications of thoracentesis, particularly RPE, given the significant morbidity and mortality associated with it.

Cough↗
PubMed2000

[Infectious endocarditis in intravenous drug abusers].

Clinical course of infectious endocarditis (IE) was analysed for 43 intravenous drug abusers. 42 of them had primary IE, one patient--secondary. Acute course and high activity of the disease were registered in 86% of the patients. IE was provoked by Staphylococcus aureus (50%), Staphylococcus epidermidis 920%), Staphylococcus haemolyticus (11%), E. coli (8%), Pseudomonas aeruginosa (2%), Candida albicans (2%), mixed microflora (7%). Vegetations were detected on the tricuspid, mitral and aortic valves (52, 23 and 19%, respectively), on more than one valve (6%). Pneumonia, pleuricy, hydrothorax, enlargement of the liver, spleen, nephritis and anemia were found in 76, 44, 9, 100, 75, 70 and 88% of the patients, respectively. Cardiac failure aggravated the disease in half of the patients, lethality was 18%. Thus, IE in intravenous drug abusers is characterized by a primary form, acute active course, prevalent damage to the tricuspid valve, polyorganic involvement, high lethality. IE cure in such patients is feasible only in adequate antibacterial therapy, timely surgical correction and giving up drug abuse.

Acute Disease↗
PubMed2000

Demonstration of Mycoplasma capricolum subsp. Capripneumoniae and Mycoplasma mycoides subsp. mycoides, small colony type in outbreaks of caprine pleuropneumonia in eastern Tanzania.

An outbreak of caprine pleuropneumonia involving about 1200 goats in the Coast and Morogoro regions of eastern Tanzania is reported. The major clinical findings were severe respiratory distress, fever, mucopurulent nasal discharge and high mortality involving all age groups and both sexes of goats. The morbidity and mortality rates were 45%-90% and 14%-50%, respectively. The principal pathological lesions were confined to the thoracic cavity and comprised hydrothorax and serofibrinous pleuropneumonia. The histopathological features consisted of a necrotizing fibrinous pleuropneumonia characterized by different degrees of vasculitis, and fibrinocellular exudation into the alveolar septae and lumina, and into interlobular septae and pleura. Mycoplasma capricolum subsp. capripneumoniae, Mycoplasma mycoides subsp. mycoides, Small Colony type Mycoplasma ovipneumoniae and Mycoplasma arginini were isolated from some of the examined goats including a case with a sequestrum which yielded Mycoplasma mycoides subsp. mycoides, Small Colony type. This work reports the first description of an outbreak of caprine pleuropneumonia in Tanzania in which M. capripneumoniae and M. mycoides subsp. mycoides, Small Colony type were concurrently isolated.

Animals↗
PubMed2000

Unusual bilateral peritoneopleural communication associated with cirrhotic ascites: detected by TC-99m sulphur colloid peritoneoscintigraphy.

Hydrothorax is an infrequent but well-recognized complication in patients on continuous ambulatory peritoneal dialysis (CAPD) and patients with cirrhotic ascites. It is usually found on the right side; an incidence on both sides is rarely reported. We describe the scintigraphic diagnosis of unusual bilateral peritoneopleural communication in a patient with cirrhotic ascites.

Ascites↗
PubMed1995

Microanatomy of the rat diaphragm with special reference to the lymphatics and mesothelial stomata.

The three-dimensional microstructure of the rat diaphragm was studied in order to reveal morphological bases which permit peritoneal fluids to pass across the diaphragm to enter the pleural cavity. The methods used include scanning electron microscopy of either intact or alkali-treated tissues, enzyme-histochemistry, and confocal laser scanning microscopy (CLSM). The peritoneal and pleural surfaces of the diaphragm are covered with mesothelial cells studded with numerous microvilli. There are many round gaps between mesothelial cells on the peritoneal side of the diaphragm. The subperitoneal connective tissue contains voluminous, irregularly shaped lymphatics which extended many funnel-shaped projections of the endothelia towards the pored region of the mesothelium. On coming into contact with the mesothelium, many of the lymphatic projections are perforated at their ends, thus giving rise to stomata connecting the peritoneal cavity and lymphatic lumen. Some projections ended blindly while plugging the mesothelial pores, thereby making visible some intercellular gaps in this contact. The subperitoneal sheet of collagen fiber network possesses clusters of pores which tightly fit the passage of the lymphatic projections. CLSM of the diaphragm after intraperitoneal injection of FITC-dextran has demonstrated the tracer both in the lymphatic lumen and in the connective tissue spaces. The tracer has also been detected in the lymphatics located in the subpleural connective tissue space. These results indicate that peritoneal fluid is allowed to flow into the lymphatics directly through the stomata and indirectly through the intercellular gaps between endothelia and mesothelial cells, and then drain into the subpleural lymphatics. Discussions were made on the probable mechanisms by which a hydrothorax may occur during continuous ambulatory peritoneal dialysis.

Animals↗
PubMed2001

[Assessment of the therapy for the recurrent lung cancer after pulmonary operation].

As is generally known, pulmonary carcinomas have not good prognosis. Even though a post-operative p-stage is the first, the 5-year survival may be only about 70%. Therefore, the opportunity to encounter recurrent cases after pulmonary operations is increasing more and more. In this research we compared the three groups, group A; re-operations were performed for recurrent pulmonary cancers (eleven cases), group B; chemo- and/or irradiation-therapy were performed (eleven cases), group C; only conservative therapies were received (twenty-one cases). The result showed group A and group B were statistically better than group C on mean survival months (p < 0.001). From that conclusion we could indicate the therapeutic policy for recurrent pulmonary carcinomas as follows. in contralateral recurrent case, lesser resection (wedge/segment) with VATS as possible even if the same side recurrent case, aggressive removal of cancer (GRF glue is useful for protection against air leakage.) without lymph node dissection, as the same concept of metastatic lung tumor in case of non-operative indication, consideration of chemotherapy and/or irradiation, (especially hypotonic therapy was effective against carcinomatous hydrothorax.) in a difficult case for chemotherapy and/or irradiation, BAI is one of methods which ought to be tried.

Aged↗
PubMed2001

[Staphylococcus aureus sepsis--still life threatening disease].

We report an analysis of clinical course of 18 patients presenting with Staphylococcus aureus sepsis. Community acquired infection was caused by Methicillin susceptible S. aureus (MSSA) in 11 patients. MSSA in 3 and Methicillin Resistant S. aureus strains (MRSA) in 4 patients, were the etiologic factor in 7 patients with nosocomial infection. From anamnestic data patients presented with: elevated body temperature--18/18, arthralgia and myalgia--9/18, headache--8/18, nausea--6/18, chills--2/18. Physical examination on admission revealed: meningismus--12/18, hepatomegaly--11/18, purulent and haemorrhagic skin lesions--7/18 and impaired neurological status (Glasgow Coma Scale < or = 12)--6/18. The mean APACHE III score, calculated from data collected at diagnosis of sepsis was 47 (7-114). Several complications had been observed: endocarditis--10, purulent meningitis--5, focal CNS lesions--5, pneumonia--8, pulmonary abscess--3, hydrothorax--1, abscesses of the spleen--5, renum--4, osteomyelitis--2. 11/18 patients required ICU treatment. Ventilator assistance of respiration was necessary in 7/18. Acute thrombocytopenia (< 100,000/ml) was diagnosed in 60%. In 5 patients suppurative meningitis had been diagnosed with a mean pleocytosis-837 (173-1898) microL. The results of treatment were satisfactory in 11 patients, 3 patients required further surgical treatment (2--cardiosurgery, 1--orthopedic surgery), 4 patients died. Infection caused by community acquired MSSA strains had been characterized by severe clinical course with increased incidence of endocarditis, organ failure and abscess forming. We conclude that Staphylococcus aureus sepsis is still a life-threatening disease, which should be treated at centers with immediate access to imaging techniques of CNS and circulatory system as well as intensive care and cardiosurgery. Community acquired S. aureus sepsis compared with nosocomial infection is characterized by more severe clinical course and higher mortality, despite of a great susceptibility to most antibiotics of causative S. aureus strains.

APACHE↗
PubMed1999

[Clinical observation on treatment of postcardiotomic complications with Chinese herbal medicine based on syndrome differentiation with angiocardiopathy].

OBJECTIVE: To study the effect of Chinese herbal medicine (CHM) based on Syndrome Differentiation on postcardiotomic complications in patients with angiocardiopathy. METHODS: Aimed at the frequently encountered postcardiotomic complications including fever, cough and expectoration, belching, abdominal distension, palpitation, short breath, etc. CHM treatment was applied in combination with routine western drugs treatment (cardiac tonic, diuretics, vascular dilatator and anticoagulant). RESULTS: Twenty out of 22 patients with protracted fever and irresponsive to multi-antibiotics therapy were cured, the other one with hydrothorax received other therapy and the another one with drug fever was natural cured after stopping medication. Among 23 patients complicated mainly with respiratory symptoms, 17 were cured and 6 improved, among 15 with digestive symptoms, 12 cured and 3 improved, and among 7 with cardiovascular symptoms, 3 cured, 2 improved and 2 ineffective. CONCLUSION: CHM has good effect on postcardiotomic complications, it could improve the functional recovery of heart and lung.

Adolescent↗
PubMed2001

[A case of severe HELLP syndrome associated with multiple organ insufficiency].

A case of severe HELLP sd. Was associated with cerebral oedema, anuria, retinal ablation, ascites and hydrothorax. The mother survived after intensive care and therapy, including 10 times haemodialysis. The acute fatty liver of pregnancy (M. Sheehan II) with a much poorer prognosis should be excluded. A diagnostical corticosteroids and prompt delivery is pointed out.

Adrenal Cortex Hormones↗
PubMed2001

[Osteogenesis imperfecta - diagnostic challenges].

Osteogenesis imperfecta (OI) is one of the commonest skeletal disorders with an incidence about one in 10,000. It is characterized by clinical and genetic heterogeneity. Congenital lethal OI (OI type II) is the most severe from with a possibility of the early prenatal sonographic diagnosis. The authors present two clinical cases of antenatal diagnosis of OI in 26 and 24 weeks of gestation. The pregnancies were terminated. The accurate specific diagnosis was based on the clinical examination and radiographic features. In case N 2 additional findings were ascites and hydrothorax, that may occasionally be found in literature. The accurate prenatal sonographic diagnosis of lethal skeletal dysplasias and particularly of OI is possible and based on the specific sonographic findings during the second trimester of pregnancy. Ultrasound screening of all pregnant women in early second trimester is an efficient method for detection of many fetal malformations. It requires a participation of the both clinician sonographer and geneticist in a team in order to achieve a specific genetic diagnosis.

Abortion, Induced↗
PubMed1979

The dosing schedule dependent toxicities of adriamycin in beagle dogs and rhesus monkeys.

The toxic effects of Adriamycin were studied following i.v. administration of from 10.0 mg/kg to 0.039 mg/kg (200--0.780 mg/m2) to beagle dogs, and from 5.83 mg/kg to 0.625 mg/kg (49.9--7.5 mg/m2) in rhesus monkeys by a variety of short and long term treatment schedules. 5 daily doses and 1 dose every 3 weeks were given for both species and, only in dogs, as single injections, 10 daily treatments and 5 daily doses followed by 9 days rest, repeated 3 times. In both species, short term administration of toxic doses caused weight losses, anorexia, diarrhea, atypical oesophageal and intestinal mucosa, bone marrow hypoplasia, lymphoid atrophy and alopecia. Specific adverse responses seen only in monkeys were hypocalcemia, hypomagnesemia, atypical buccal mucosa and reddish urinary pigmentation. Testicular degeneration and prostatic atrophy were produced in dogs. The triweekly treatment schedule caused an additional toxicity at lower doses. In both species a cardiotoxicity syndrome developed with pulmonary oedema and centrolobular hepatic necrosis, plus focal necrosis and vacuolization in cardiac myocytes. Clinical signs of cardiac dysfunction were EKG arrhythmias in dogs, and peripheral oedema, ascites and hydrothorax in monkeys.

Animals↗
PubMed2001

[Association between renin activity, angiotensin II and ovarian hyperstimulation syndrome].

OBJECTIVE: To investigate the association between renin-like activity (RA) and angiotensin II (A II) and the ovarian hyperstimulation syndrome (OHSS). METHODS: Blood samples were taken from 42 patients undergoing in vitro fertilization (IVF). According to the ovarian stimulating response, the patients were divided into 4 groups: group I, low responders, 7 cases; group II, moderate responders, 8 cases; group III a high responders without using albumin, 7 cases, group III b, high responders with albumin, 10 cases; group IV, severe and moderate OHSS, 10 cases. 5 patients for intrauterin insemination with natural cycle as control. Follicular fluid (FF) was collected at oocyte retrieval from 28 IVF patients (including 7 OHSS patients). Fluid from ascites and hydrothorax was obtained from 3 OHSS patients, and peritoneal fluid obtained from 5 infertility patients by laparoscopy and ascitic fluid obtained from 6 ovarian carcinoma patients served as control. RA and A II levels were measured by radioimmunoassay. RESULTS: Plasma RA and A II levels at mid-luteal phase from OHSS patients [(19.9 +/- 19.0) micrograms.L-1.h-1 and (397.0 +/- 378.2) ng/L] were significantly higher than those from the other patients (P < 0.01-0.05), also the levels at mid-luteal phase from IVF patients were significantly higher than those at late-follicular phase [(4.1 +/- 2.9)-(4.9 +/- 3.2) micrograms.L-1.h-1 Vs (1.5 +/- 0.9)-(1.9 +/- 1.0) micrograms.L-1.h-1, (85.5 +/- 49.5)-(109.4 +/- 46.0) ng/L Vs (33.6 +/- 15.9)-(37.0 +/- 17.1) ng/L, P < 0.01-0.05]. RA and A II levels in FF were significant higher than those in plasma (P < 0.01-0.05). A II in ascitic fluid in OHSS patients was 4 to 8 times higher than that in plasma, while RA in ascitic fluid was 1.5 to 3 times higher than that in plasma, but the levels of A II and RA in controls were very low. The plasma RA and A II levels dropped very significantly along with clinical improvement (P < 0.01). CONCLUSION: These findings suggest that RA and A II are associated with the pathogenesis of capillary leakage in OHSS.

Angiotensin II↗
PubMed2002

[Clinical analysis of 74 cases with ovarian thecoma].

OBJECTIVE: To study the clinical pathologic characteristics, treatment and prognostic factors of ovarian thecoma. METHODS: From 1958 approximately 1998, a total of 74 patients with benign and malignant thecoma were retrospectively analyzed. RESULTS: The reviewed diagnosis were 8 patients with malignant thecoma, 66 patients were benign thecoma. Nine of 66 patients with benign thecoma appeared cell proliferative activity. The mean age was 52 years. The most frequent symptoms were abdominal-pelvic masses (56.8%), metromenorrhagia and abnormal vaginal bleeding, other symptoms were abdominal pain, infertility followed. Twenty-two of 66 patients had ascites, only 1 patient with ascites and hydrothorax simultaneously. Thirty-nine patients with diseases which associate with excessive estrogenic stimulation, including 1 endometrial adenocarcinoma and 1 endometrial dysplasia and other diseases such as: myoma; endometrial hyperplasia and polyp. Fifteen patients with benign thecoma were evaluated blood serum CA(125), the CA(125) were elevated in 9 of 15 patients. In 2 of 9 patients with cell proliferative activity, the tumors invaded adjacent tissues or relapsed, after received operation and pelvic radiotherapy, they are alive 11 years and 27 years respectively. Among 8 patients with malignant thecoma, 4 patients without postoperation therapy or with non-standard chemotherapy died in 2 years postoperation, the other 4 patients received operation, postoperational radiotherapy or (and) chemotherapy, 1 of 4 patients died of irradiation intestinal fistule 4 years later; two patients are alive without disease more than 10 years, another one for 2 years. CONCLUSIONS: Theca cell tumor of ovary have good prognosis, but we should pay attention to thecomas with proliferative activity. The prognosis of malignant thecomas is poor, postoperative systemic chemotherapy or radiotherapy to the patients with malignant thecomas can improve their survival.

Adolescent↗
PubMed2002

[Pneumoperitoneum without perforation of the digestive tract].

The authors present an account on 9 patients who were detected in their department during the nine-year period from 1991-2000 with the finding of pneumoperitoneum where perforation of the digestive tract was not proved. In 4 of them (44%) conservative treatment was used, in the remaining 5 patients (56%) the condition called for surgical revision. The latter was made as an acute operation in four patients because of signs of peritoneal irritation, in one only after 4 days because of suspected tumours intestinal disease. As to the site of the assumed source of the non-perforation pneumoperitoneum we included 6 of them into the group abdominal area, (1x pneumatosis cystoides intestinalis, 1x aerogenic infection from a perforated abscess of the right liver lobe, 2x microtraumas of the wall of the cardio-esophageal transition with massive vomiting, 1x microtraumas of the lesser curvature of the stomach during extreme distension of the stomach after incorrect intubation and resuscitation, 1x passage of gas through the inflamed distended colonic wall in colitis), two patients into the thoracic area (1x in conjunction with pneumothorax, 1x with hydrothorax), 1 patient in the urogenital area (by the gynaecological route after repeated coitus and orogenital practices). The authors summarize on the basis of data in the literature and their own experience diagnostic and therapeutic possibilities of this relatively rare finding.

Adult↗
PubMed2002

[Surgical treatment of pleural metastases in breast cancer].

Pleural metastases of breast cancer is a severe progression of the disease and the treatment is difficult. Distant metastases are mainly treated by chemo-, radio- or hormone therapy, but in recent years surgical intervention is increasingly important. Between the 1st of January 1992 and 31st of December 2001 in the 2nd Department of Surgery University of Debrecen Medical and Health Science Center Medical School of Medicine 43 patients with breast cancer were operated on because of pleural metastases. In these patients biopsy and pleurodesis with talcum insufflation were performed. The surgical treatment was followed by chemotherapy. Pleurodesis was successful at 76.7 percent. The 6, 12 and 24 months survival was 58.1, 39.5 and 16.3 percent. Based on literature data and own experience we conclude that surgical intervention with adjuvant therapy extends life expectancy for patients with pleural metastases. Pleurodesis can prevent or delay hydrothorax, it improves vital functions and the quality of life for patients with pleural metastases.

Adult↗