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PubMed1993

Analysis of complications in a chronic peritoneal dialysis pediatric patient population. The Italian Registry of Pediatric Chronic Peritoneal Dialysis.

During the period 1986-1991, the Italian Registry of Pediatric Chronic Peritoneal Dialysis collected data from 140 patients younger than 15 years at the start of chronic peritoneal dialysis (CPD). In this study we review the Registry's complications and patient hospitalization data. A total of 395 complications directly related to CPD were registered during 2722 dialysis-months. There were 176 episodes of peritonitis (44.5%), 161 catheter-related complications (40.7%) (103 exit-site infections, 17 leakages, 15 obstructions, 15 cuff extrusions, 5 hemoperitoneum, and 6 other complications), and 58 technique-related complications (14.8%) (39 abdominal hernias, 10 hydroceles, 5 with abdominal pain, 4 hydrothorax complications). The patient hospitalization rate during the period 1989-1991 was evaluated; the analysis referred to 106 patients who underwent treatment for a total of 1520.5 dialysis-months. Patients starting CPD in the year and patients already on CAPD spent 5.8 and 2.1 days per patient-month in the hospital, respectively; the difference was not statistically significant. The evaluation of complications (both technical and systemic) causing patient hospitalization showed that peritonitis was responsible for 43.2% of patient admissions and 36.3% of days hospitalized, catheter-related complications for 22% and 19.8%, technique-related complications for 8.3% and 5.1%, and other clinical complications for 26.5% and 38.8%, respectively.

Catheters, Indwelling↗
PubMed1995

[Respiratory failure after surgery for esophageal cancer and hypercoagulability].

Operation of esophageal cancer accompanies a big surgical stress and postoperative pulmonary complications such as respiratory failure are observed at high frequencies. On the other hand, when a big stress is added to a body, a state of hypercoagulation in which blood coagulation mechanism is abnormally enhanced appears and this state is closely related to organ failures but has many unknown points. So, we examined 39 patients given excision of esophageal cancer with respect to occurrence of postoperative respiratory failures, participation of coagulopathy in aggravation and their degrees before and after the operation to find out the relationship between postoperative respiratory failure and the state of hypercoagulation. We gave a diagnosis of respiratory failure to the patients whose respiratory index exceeded 1.5 on the day after operation but did not show atelectasis or hydrothorax. As a result, respiratory failures were observed in 7 out of 39 cases (17.9%). When a risk score (RS) of postoperative respiratory failure was determined using multivalent analysis (quantification type II) with preoperative factors such as age and function of heart, lung, liver, and kidney as well as preoperative blood coagulation factors, RS = 2.87 (antithrombin-III (AT-III) less than 75%) +1.89 (age over 70 years) +1.78 (respiratory index over 0.15) +1.44 (serum albumin less than 3.0 mg/dl) +1.28 (cardiac index less than 3.0 l/min/m2) was obtained and a drop in preoperative AT-III was considered a risk for occurrence of post operative respiratory failure. In contrast, referring changes in postoperative value of blood coagulation factors, a distinct rise in fibrinogen (FBG) appeared in early stage after operation in the respiratory failure group compared to the control group (p < 0.01). Moreover, recovery in AT-III of blood coagulation factors and in plasminogen and antiplasmin of fibrinolytic factors was delayed (p < 0.05) indicating promotion of postoperative hypercoagulation state and delay in recovery of coagulation-fibrinolysis factors. However, participation of platelet factors was absent.

Age Factors↗
PubMed1995

Influence of aflatoxin and fumonisin B1-containing culture material on growing barrows.

Aflatoxin (AF)-contaminated and fumonisin B1 (FB1)-contaminated (culture material from Fusarium moniliforme) diets were fed singly and in combination to growing cross-bred barrows. Six barrows (3 replicates of 2 each; mean body weight, 17.5 kg) per group were fed: 0 mg of AF and 0 mg of FB1/kg of feed (control); 2.5 mg of AF/kg of feed; 100 mg of FB1/kg of feed; or 2.5 mg of AF plus 100 mg of FB1/kg of feed for 35 days. The effects on production performance, serum biochemical, hematologic, immunologic, and pathologic measurements were evaluated. Body weight, gain, and feed consumption were significantly (P < 0.05) decreased by AF and AF plus FB1 diets. The FB1 diet decreased feed consumption, and although body weight was numerically decreased, it was not statistically significant. Aflatoxin increased serum gamma-glutamyltransferase (GGT) activity and total iron concentration and decreased urea nitrogen concentration and unsaturated iron-binding capacity. The FB1-alone diet increased serum GGT activity, whereas the AF plus FB1 diet increased serum aspartate transaminase, cholinesterase, alkaline phosphatase, and GGT activities, increased RBC count, triglycerides, and total iron concentrations, and decreased unsaturated iron-binding capacity and urea nitrogen concentration. For the most part, the effects of the AF plus FB1 diet on body weight and hematologic measurements could be considered additive. However, the effect of the AF plus FB1 diet on cholinesterase and alkaline phosphatase activities was greater than additive and was a synergistic response. One pig in the FB1-diet group and 2 pigs in the combination-diet group died. Postmortem lesions in pigs of the FB1-diet group consisted of ascites and increased liver weight. Observations at necropsy for pigs of the AF plus FB1-diet group consisted of hydrothorax, ascites, pulmonary edema, gastric erosions and ulceration, and increased liver and spleen weights. The AF diet increased relative liver weight and resulted in liver that was pale, rubbery, and resistant to cutting. Histologic lesions consisted of hepatic necrosis or degeneration, or both, with variable degrees of bile duct proliferation in barrows of the AF-diet groups. Renal tubular nephrosis was observed in barrows of the FB1-diet group, but this was not consistent in the AF plus FB1-diet group. Cell-mediated immunity, as measured by mitogen-induced lymphoblastogenic stimulation index, was decreased in barrows of the AF and FB1-diet groups, and values in barrows given the combination diet were significantly decreased from those in barrows given the single toxin diets. It was concluded that AF and FB1 (from culture material), singly or in combination, can adversely affect clinical performance, serum biochemical, hematologic, and immunologic values and induce lesions in growing barrows. For most of the variables we evaluated under our study conditions and dosages of toxins, measurements were affected more by the combination diet than by either single toxin diet, and the toxic responses could be described as additive or more than additive, particularly for induction of liver disease.

Aflatoxins↗
PubMed1996

Pleuroperitoneal migration of intraperitoneal phosphorus-32-chromic phosphate therapy for stage I ovarian carcinoma.

A patient with postoperative Stage I ovarian carcinoma received 15 mCi of 32P-chromic phosphate suspension in normal saline intraperitoneally as part of her therapy. The following day, a portion of the infused radiopharmaceutical and normal saline had passed transdiaphragmatically into the patient's right pleural cavity. Thoracentesis removed as much fluid as possible and this fluid contained radioactive material. In the ensuing 4 yr, the patient has not manifested any detectable pleural or pulmonary abnormalities attributable to the radioactivity. Retrospective review of 100 consecutive patients receiving 32P-chromic phosphate intraperitoneal therapy resulted in 43 patients in whom the hemithoraces could be evaluated scintigraphically. Three of the 43 patients (7%) had right pleural fluid radioactivity. This is similar to the percentages reported in patients with cirrhosis with ascites in whom hepatic hydrothorax is identified.

Chromium Compounds↗
PubMed1996

Characterization of intraperitoneal cytokines and nitrites in women with severe ovarian hyperstimulation syndrome.

OBJECTIVE: To assess the potential involvement of cytokines and nitrites in the hyperpermeability characterizing the ovarian hyperstimulation syndrome (OHSS). DESIGN: A controlled clinical study comparing peritoneal fluid (PF) from patients with severe OHSS and from non-OHSS controls. SETTING: Women hospitalized with severe OHSS in three tertiary medical centers. PATIENTS: Twelve patients with severe OHSS necessitating paracentesis and 20 non-OHSS controls. INTERVENTIONS: The criteria for ultrasound-guided paracentesis were tense ascites, hydrothorax, hemoconcentration, or oliguria. MAIN OUTCOME MEASURES: Interleukin (IL) 1 beta IL-1 receptor agonist, IL-2, IL-6, IL-8, and tumor necrosis factor alpha (TNF alpha) levels in PF were assayed by ELISA; nitrites were measured by the "Griess" reaction. Estradiol and P were determined by RIA. RESULTS: Ovarian hyperstimulation syndrome patients had significantly higher PF IL-6 (3,523 versus 30 pg/mL), TNF alpha (14 versus 4.2 pg/mL), and IL-8 (1,695 versus 900 pg/mL). In the serum, only IL-6 levels were significantly higher (375 versus 11 pg/mL). Conversely, nitrite levels were significantly lower in PF of OHSS patients (0.5 versus 34 nmol/mL). Interleukin 1 levels were higher and IL-1 receptor antagonist levels were lower in OHSS patients, suggesting potentially increased biologic potency of IL-1. CONCLUSION: These findings suggest that these substances could be involved in mediating the capillary hyperpermeability characterizing this syndrome.

Ascitic Fluid↗
PubMed1996

A chronic cardiomyopathy in feedlot cattle attributed to toxic levels of salinomycin in the feed.

The clinical signs and pathology in an outbreak of toxicity in feedlot cattle attributed to the ingestion of toxic levels of the ionophore antibiotic salinomycin over an extended period of 11 weeks are described. Thirty-nine out of 380 cattle developed signs consistent with cardiac failure and 8 of these died. Clinical signs included dyspnoea, tachypnoea, tachycardia and exercise intolerance. Two cattle were necropsied and in one there were macroscopic lesions suggestive of congestive heart failure, namely pulmonary oedema, hydrothorax and hepatomegaly. Histopathology revealed a chronic cardiomyopathy characterised principally by extensive myocardial fibre atrophy with multifocal hypertrophy and interstitial and replacement fibrosis. Hepatic and pulmonary lesions were consistent with those of congestive cardiac failure. The myocardial lesions in this outbreak were similar to those encountered in cases of a chronic toxicity associated with the ingestion of litter derived from poultry rations containing ionophores (ionophore-associated poultry litter toxicity). Hence, the clinical and pathological findings in this outbreak indicate that in cattle, the prolonged ingestion of ionophores over several weeks may result in the development of chronic myocardial lesions comparable to those of IAPLT but significantly different from those encountered in the more traditional acute outbreaks of ionophore toxicity as described in the literature.

Animal Feed↗
PubMed1996

[HELP syndrome and anesthetic management].

From January 1990 to December 1994, 24 parturients were diagnosed as having HELLP syndrome alone or combined with preeclampsia/eclampsia among 8,224 patients who were delivered at our institution. They consisted of 14 primiparous and 10 multiparous patients. Mean maternal age was 28.9 +/- 3.3 and gestational age was 34.8 +/- 5.6 weeks. Of 24 parturients, 8 had vaginal delivery and the remaining 16 were delivered by caesarean section. Serious maternal morbidity included eclampsia (n = 3), preeclampsia (n = 18), renal failure (n = 5), hydrothorax (n = 4), and DIC (n = 1). There was no maternal death. There were 3 intrauterine fetal deaths and two neonatal deaths. Perinatal deaths were 2 (0.9%, 2/26). Three caesarean sections were performed under general anesthesia, and 13 under spinal anesthesia. In cases with apparent bleeding tendency, spinal and epidural anesthesia should be avoided. In providing general anesthesia, hypertension should be controlled, and the uterus is preferably dilated before the delivery and contracted there-after.

Adult↗
PubMed1977

Cirrhotic pleural effusion in the absence of ascites.

A 61-year-old female presented with a right transudative pleural effusion in the absence of ascites and other stigmata of chronic liver disease. A diagnosis of cirrhosis with a secondary hydrothorax was eventually established; however, ascites could never be demonstrated clinically or radiographically until just before her death, when hypertonic saline was administered for symptomatic hyponatremia. Based on the autopsy finding of a 1-mm hole in the right diaphragm and her clinical course, a mechanism for the production of a cirrhotic pleural effusion in the absence of asictes is proposed.

Ascites↗
PubMed1996

[A case report of Takayasu's arteritis with aortic pseudoaneurysm caused by aortic perforation].

A 47-year-old man presented with hemoptysis. From around June 20, 1995, he had symptoms of a common cold, but hemoptysis suddenly occurred on July 1 and he was brought to hospital. The chest X-ray film showed pleural effusion and enlargement of the mediastinum. CT scans showed calcification of the aorta, with a pseudoaneurysm 8 cm in diameter anterior to the descending aorta. When thoracotomy was performed under partial extracorporeal circulation, the thoracic cavity was found to be filled with bloody hydrothorax and hematoma, and the lower lobe of the left lung was adherent to the descending aorta. After a longitudinal incision was made in the aorta, a perforation 7 mm in diameter was identified in the posterior wall, and this was assumed to be the cause of the pseudoaneurysm. This part of the aorta was replaced with a Woven Dacron graft. Takayasu's arteritis was diagnosed by histological examination of the resected specimen, and the changes in the aortic wall at the site of perforation were considered to be chronic. About 30% of patients with this disease have aortic ectasia, but only a few pseudoaneurysms have been reported. Since the pseudoaneurysm occurred in our patient after reduction in the dose of medication, the development of perforation was suggested to be related to this change. In the future, this patient will require careful follow up for anastomotic aneurysm.

Aneurysm, False↗
PubMed1996

Experimental toxicity of verbesina encelioides in sheep and isolation of galegine.

Verbesina encelioides is a widely distributed weed in Argentina. Although it has been suspected as poisonous, there seem to be no previous reports of its toxicity in this country. Its biological activity was evaluated through an experiment in sheep. Four 5-y-old sheep, averaging 33 kg in body weight, were given a single dose of 1.0, 3.2, 5.0 or 6.3 g of dried plant material (17.9% dry matter)/kg body weight orally in a water suspension. Forty-eight hours later, the animals given 5.0 g or 6.3 g showed dullness and lack of appetite. The higher dosed sheep became recumbent a few hours later and died 60 h after dosing without showing further signs. The other animals showed no signs. Necropsy of the dead sheep showed severe lesions in different organs: liver, kidneys, lungs, lymph nodes and digestive tract. Hydrothorax was also observed. The animal receiving 5.0 g/kg was sacrificed after 72 h to determine the degree of recovery or lesions. Microscopically, severe glomerulonephrosis and congestion in the liver, with cellular degeneration and fatty changes were observed. Additionally, hemorrhagic lymph nodes, and hemorrhagic and edematous lungs were noted. No gross nor microscopic lesions were found in the sheep receiving 5.0 g/kg. Mice injected ip with the chromatographic extract died in less than 15 min. Galegine was identified in the plant material. The minimum toxic dose of 5-6 g/kg indicates a high toxicity when compared to other poisonous plants of the southeastern area of Buenos Aires province, Argentina.

Administration, Oral↗
PubMed1996

[Contribution of Doppler color ultrasonography to the screening and surveillance of ovarian hyperstimulation syndrome].

Color and power Doppler producing ovarian vascular mapping allows to realize a new functional approach of ovarian hyperstimulation syndrome (OHS); local vascular factors (ovarian angiogenesis, increase in cappillary permeability) released by hCG injection (LH effect) have in fact an important part in this syndrome. Vaginal Doppler sonography allows: -before induction, to predict potential risk of hyperstimulation: polycystic ovaries, spontaneous stromal hypervascularization; -in monitoring of ovulation stimulation, to reduce risk of multiple pregnancy and to detect early hyperstimulation, decision of hCG injection depends on number of follicles able to be fertilized (> 15 mm) and luteinized (> 10 mm); -to assess severity of OHS and search complications: ascites, hydrothorax, ovarian torsion and deep venous thrombosis. So OHS prevention imposes a monitoring by Doppler sonography and estradiol assay of all cycles induced by gonadotropins.

Female↗
PubMed1996

[Unilateral post-bilobectomy pulmonary edema originating from thrombosis of the pulmonary vein].

Foucart (1875) and Ortner (1899) were the first to describe unilateral pulmonary edema as a complication of drainage of hydrothorax. Although various causes have been reported for this entity, it continues to be rare. We report a case of right unilateral pulmonary edema due to thrombosis of the superior pulmonary vein that was detected while a patient was in the recovery room after bilateral lobectomy for pulmonary tumors. The possible pathophysiological mechanisms contributing to pulmonary edema are discussed.

Fatal Outcome↗
PubMed1997

Transjugular intrahepatic portosystemic shunt as a form of treatment for portal hypertension: indications and contraindications.

The TIPS clearly has had a major impact on the treatment of complications of portal hypertension in the cirrhotic patient. Currently, TIPS is performed in community hospitals as well as university centers in the United States. While the shunt is placed under local anesthesia in a nonoperative fashion, it must be remembered that it does function as a highly effective side-to-side shunt with its attendant complications including hepatic encephalopathy and occasional liver failure. Early reports of clinical and hemodynamic results after TIPS have clearly demonstrated it to be an effective bridge to liver transplantation. Nonetheless, transplantation candidates who experience their initial episode of variceal hemorrhage still should be managed with sclerotherapy or variceal band ligation. However, if bleeding recurs during a course of treatment or cannot be acutely controlled, TIPS has proved invaluable in stabilizing patients prior to liver transplantation. Refractory variceal bleeding in Child's class C patients, in whom the perioperative mortality associated with surgical shunts is high, is also reasonable indication for TIPS. Potential, but less well-proved indications for TIPS include refractory ascites, hepatic hydrothorax, and the Budd-Chiari syndrome. Refractory variceal hemorrhage in Child's class A or B patients, bleeding from portal hypertensive gastropathy, and HRS represent possible, but unproved, indications. Preoperative reduction in portal hypertension prior to liver transplantation does not appear to represent an appropriate indication for TIPS. In spite of the wide acceptance of TIPS, it will be important to continue to study its indications and its complications so that it can be optimally used in the treatment of patients with portal hypertension.

Algorithms↗
PubMed1996

[Evaluation of the diagnostic usefulness for ultrasonographic and echocardiographic lethal markers in fetal pulmonary hypoplasia. Analysis of 11 cases].

Results of ultrasonographic and echocardiographic studies of 11 fetuses were analysed retrospectively in relation to their pulmonary hypoplasia. Congenital malformations, quality of hydramnios and echocardiographical measurements of fetal chest were estimated. The best symptoms of pulmonary hypoplasia were: oligo/ahydramnios, absence of fetal breathing movements and malformations in fetal chest cavity (diaphragmatic hernia, cardiomegaly, hydrothorax). Systemic malformations were present in each case. The measurements such as CC, CA, HA, (CA-HA) x 100/CA were not accurate enough and we did not find any statistical differences between the control and the studied group. Finding several factors predisposing to lung hypoplasia means that its lethal form may be present in fetus.

Abnormalities, Multiple↗
PubMed1977

Oak poisoning of cattle in Ohio.

Fourteen cases of oak poisoning were diagnosed at the Ohio Veterinary Diagnostic Laboratory, Reynoldsburg, Oh, in the fall of 1976. The poisoning was attributed to ingestion of oak shrubs, oak leaves, and acorns. Clinical signs included anorexia, rumen atony, hemorrhagic diarrhea, subcutaneous edema, and abnormal renal function. Perirenal edema and hemorrhage, ascites, hydrothorax, and hemorrhagic enteritis were frequently encountered pathologic changes. Histologic examination of the kidney revealed multifocal necrosis of the proximal convoluted tubules, which is a characteristic feature of this type of poisoning.

Animals↗
PubMed1997

[Electrical impedance tomography in pulmonology].

Application of a modern method of introscopy--electroimpedance tomography (EIT) for diagnosis of different types of lung diseases is described. The EIT system including measurement and collecting data devices, 16-electrodes array and IBM PC 486 computer was used. The results of analysis of electrotomograms have demonstrated that the EIT-system can be introduced for detecting abnormal lung fluid levels, pulmonary edema, diagnosis of lung cancer, emphysema, pleuritis, hydrothorax, sarcoidosis. The method provides high sensitivity to the changes in the body physiological state. Other advantages are: safety, fast measurements, ease of equipment transportation and maintenance, low cost.

Adult↗
PubMed1977

[Critical evaluation of clinical and hormonal parameters for the optimal timing of induction of ovulation with gonadotropins (author's transl)].

In 9 hypogonadotrophic, normoprolactinemic women with primary or secondary amenorrhea, who were infertile, 16 treatment cycles with menopausal gonadotropin and chorionic gonadotropin (HMG-HCG) were carried out. Nine treatment cycles were monitored indirectly with the cervical factor and hormonal cytology. The concomitant serum estradiol and progesterone values were later determined by radioimmunoassays. The other 7 treatment cycles were monitored by daily serum estradiol determinations. There were 4 pregnancies. Successful induction of ovulation with subsequent pregnancies was only obtained in the treatment cycles monitored by serum estradiol determinations (pregnancy rate 60%). Classical signs of overstimulation with ascites and hydrothorax occurred twice in treatment cycles which were monitored by clinical means only. Neither the maturation index nor the cervical factor reflected a quantitative overstimulation of the ovaries. The daily radioimmunological determination of estradiol prevented overstimulation of the ovaries, and permitted optimal timing of the induction of ovulation with HCG. In our experience, the maturation index determined from vaginal cytology and the clinical determination of the cervical factor are inappropriate parameters to monitor individually a successful induction of ovulation with HMG-HCG.

Adult↗
PubMed1997

Leiomyoma causing massive ascites, right pleural effusion and respiratory distress. A case report.

BACKGROUND: Pseudo-Meigs' syndrome, or atypical Meigs' syndrome, occurs when a pelvic mass other than an ovarian fibroma is present with hydrothorax and ascites. Leiomyomas rarely cause this condition. CASE: An otherwise healthy 31-year-old woman presented to the emergency department in acute respiratory distress with massive ascites, pleural effusion and a pedunculated leiomyoma. After receiving mechanical ventilation, she underwent myomectomy and recovered fully within four weeks. CONCLUSION: This unique presentation of pseudo-Meigs' syndrome should be included with malignancy in the differential diagnosis of a pelvic mass with ascites.

Adult↗