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At least 1,225 records · Page 68Linked to original sources
PubMed2005

Selective macrophage suppression during sepsis.

Polymicrobial sepsis induces suppression of macrophage function as determined by a reduction of pro-inflammatory cytokine production upon re-exposure to lipopolysaccharide (LPS) in vitro. We examined whether macrophages were refractory to only LPS challenge or if they were immunoparalyzed and unable to respond to other stimuli such as lipoteichoic acid (LTA) or zymosan (ZYM). This study evaluated the capacity of peritoneal macrophages to produce pro-inflammatory and anti-inflammatory cytokines as well as chemokines following mild or severe sepsis induced by cecal ligation and puncture (CLP). Peritoneal macrophages were isolated 29 h after CLP and challenged with different stimuli. LPS was a more potent stimulus for cytokine induction than LTA or ZYM in both mild and severe sepsis. In mild sepsis, the macrophage cytokine response to LPS was selective and less refractory than in severe sepsis. While production of IL-6 and KC was reduced, secretion of TNF-alpha and MIP-1alpha was enhanced in those cells isolated from mice with mild sepsis. Production of IL-10 and the IL-1 receptor antagonist , MIP-2, and MCP-1 in response to LPS stimulation was equivalent to the amount produced by naive macrophages. Our results indicate that macrophages are not immunoparalyzed during sepsis and may still be induced to secrete some inflammatory mediators.

Animals↗
PubMed2004

A study of parenteral versus enteral nutrition following caecal ligation and puncture in the rat: Influence on survival and tissue protein turnover.

BACKGROUND & AIMS: Methods of nutritional management in abdominal sepsis remain controversial. METHODS: Sprague Dawley rats were either fed via a central line in the right internal jugular vein or duodenally via a gastrostomy tube, and were randomised to undergo either caecal ligation and puncture (CLP) or laparotomy only. Post-operatively, animals received either parenteral nutrition, enteral nutrition or saline only (parenteral and enteral nutrition protocols were isocaloric and isonitrogenous). After 72 h, fractional rate of protein synthesis (Ks, %/day) was measured in gastrocnemius muscle and liver, and protein breakdown was measured in incubated epitrochlearis muscles. Serum insulin-like growth factor-I (IGF-I), acid-labile subunit (ALS) and IGF binding protein-1 (IGFBP-1) levels were determined by specific radioimmunoassay methods. RESULTS: After CLP, when compared with starved animals, only enteral nutrition resulted in a significant decrease in survival to 72 h (P < 0.001). Parenteral nutrition, but not enteral nutrition, increased muscle (P = 0.02) and liver (P < 0.001) Ks, IGF-I (P < 0.001) and ALS levels (P < 0.001), whereas both parenteral and enteral nutrition reduced IGFBP-1 levels (P < 0.001). Neither enteral nor parenteral nutrition reduced protein breakdown in septic animals. CONCLUSIONS: In this model of severe abdominal sepsis where gut function cannot be assessed, enteral nutrition was associated with increased mortality and was less effective than parenteral nutrition in augmenting muscle and liver protein synthesis.

Animals↗
PubMed2006

The usefulness of CT guided drainage of abscesses caused by retained appendicoliths.

OBJECTIVES: To determine the utility of percutaneous computed tomography (CT) guided drainage of abscesses formed secondary to retained appendicoliths. MATERIALS AND METHODS: A retrospective review was conducted over a 5-year period to identify patients who underwent CT guided drainage of abscesses related to retained appendicoliths. Inclusion criteria were a history of prior proven appendicitis treated by laparoscopic appendicectomy, identification of a post-operative abscess related to a visualised retained appendicolith and initial treatment by CT guided drainage. Data regarding initial technical success as well as long-term outcome was recorded in each case. RESULTS: In total, five patients were identified who underwent CT guided abscess drainage related to retained appendicoliths. There were three males and two females (age range 12-54 years). Initial drainage under CT guidance was technically successful in all cases with successful catheter placement and resolution of the abscess cavity. In all five cases however, there was recurrence of abscess formation following catheter removal. In one case, a second attempt with CT guided drainage was performed. Again this was initially successful with abscess recurrence following catheter removal. In all five cases, formal surgical drainage with removal of retained appendicolith resulted in a successful outcome. CONCLUSION: CT guided percutaneous drainage of intra abdominal abscess secondary to retained appendicoliths is only successful in the short term. Formal surgical drainage and removal of the appendicolith is required for long-term success.

Abscess↗
PubMed2006

Reduced postoperative intra-abdominal adhesions using Carbylan-SX, a semisynthetic glycosaminoglycan hydrogel.

OBJECTIVE: To compare the efficacy of crosslinked Carbylan-SX (Carbylan BioSurgery, Inc., Palo Alto, CA) hydrogel films and sprayable gels as physical barriers in reducing postoperative intra-abdominal adhesions in the rat cecum-abdominal wall and rat uterine horn models. DESIGN: Pre-formed crosslinked Carbylan-SX films and sprayable in situ crosslinkable Carbylan-SX gels were evaluated in rat cecum-abdominal wall and rat uterine horn models and compared with commercially available and clinically used Seprafilm. SETTING: University animal research facility. ANIMALS: Female Wistar rats. INTERVENTION(S): Abrasions were made with the foot-pedal-operated Flex-shaft (Dremel, Racine, WI) on both the cecum and abdominal wall (each area 10 mm in diameter) in female rats as one model and on both uterine horns (3 x 10 mm) in female rats as the other model. In each of the two adhesion models, four groups were assigned with eight rats in each group: (1) untreated control, (2) treated with Seprafilm (Genzyme Corporation, Cambridge, MA), (3) treated with preformed Carbylan-SX hydrogel films, and (4) treated with sprayable Carbylan-SX gel. MAIN OUTCOME MEASURE(S): Extent and severity of postoperative adhesions between the cecum and the abdominal wall in rat cecum-abdominal wall model and between the uterine horns in rat uterine horn model. RESULT(S): The Carbylan-SX film and the Carbylan-SX sprayable gel led to fewer adhesions than Seprafilm in both rat adhesion models. Interestingly, a single physical form was not optimal for both models: the Carbylan film was more efficacious in the rat uterine horn model, whereas Carbylan gel gave the best results in the rat cecum-abdominal wall model. CONCLUSION(S): Both Carbylan-SX film and gel were efficacious in reducing postoperative intra-abdominal adhesion formation in rat cecum-abdominal wall and uterine horn models.

Abdomen↗
PubMed2005

Colonoscopic diagnosis of mucocele of the appendix.

BACKGROUND: Appendiceal mucoceles are uncommon cystic neoplasms characterized by distension of the appendiceal lumen with mucus. There have been no reported series of colonoscopically diagnosed mucoceles with clinicopathologic correlation. METHODS: A retrospective review of colonoscopies performed at our institution over the past 14 years was undertaken with patient demographics, clinical data, surgical outcomes, and histopathology obtained from hospital records. OBSERVATIONS: Seven patients (6 women) with mucocele of the appendix were identified at colonoscopy. Three had complained of right lower quadrant pain. All 7 patients underwent surgical resection. Histopathology demonstrated mucinous cystadenoma in all. No cases revealed carcinoma, and there have been no deaths related to the mucocele. CONCLUSIONS: Appendiceal mucoceles may be recognized at colonoscopy as a smooth bulbous submucosal lesion of the cecum with an impression formed by the appendiceal orifice. Recognition at colonoscopy is important because it enables accurate diagnosis and directs management. Surgery is recommended in all cases given the risk of malignancy or perforation with resultant pseudomyxoma peritonei.

Adult↗
PubMed2006

Increased risk of ischemic bowel complications during treatment with bevacizumab after pelvic irradiation: report of three cases.

PURPOSE: To assess the rate of severe bowel complications during treatment with the anti-vascular endothelial growth factor monoclonal antibody bevacizumab. METHODS AND MATERIALS: We performed a retrospective evaluation of bevacizumab-associated severe intestinal adverse events from our institutional database. RESULTS: A total of 33 patients started treatment with bevacizumab at our institution during the first 6 months after its approval in Germany. Three patients (9%) presented with severe bowel complications: two with acute ischemic colitis and one with gastrointestinal perforation with a fatal outcome. All 3 patients had undergone radiotherapy directed to the pelvis before treatment with bevacizumab. None of the 30 patients without bowel complications had been pretreated with infradiaphragmatic irradiation. Histologic evaluation of bowel biopsies and resection specimens revealed severe ischemic bowel damage as the pathophysiologic background of the clinical findings. CONCLUSION: This report contributes to the pathophysiologic clarification of bevacizumab-induced bowel complications and points to a potentially increased risk of severe ischemic damage during treatment with bevacizumab in patients who have undergone previous radiotherapy.

Adult↗
PubMed2006

Mucocele of the appendix: an important clinical rarity.

Mucocele is an uncommon pathology of the vermiform appendix that can be confused with acute appendicitis. We present a case of an appendiceal mucocele associated with subacute, intermittent right lower quadrant discomfort. The diagnosis of appendiceal mucocele is an important one in that it can be associated with malignancies and other serious gastrointestinal, ovarian, and urological complications.

Abdominal Pain↗
PubMed2004

Needle perforation of the bowel in childhood.

Accidental ingestion of foreign bodies occurs frequently in childhood. The majority of them are passed spontaneously, and conservative management generally is recommended for foreign bodies in the stomach and duodenum. However, in some cases, operative intervention should be considered to prevent undesirable complications, such as intestinal perforation. Two cases of intestinal perforation owing to accidental ingestion of a needle are reported.

Abdomen, Acute↗
PubMed2004

Cecal volvulus: a report of two cases occurring after the antegrade colonic enema procedure.

BACKGROUND: Many children with chronic constipation and fecal incontinence have benefited from the antegrade colonic enema (ACE) procedure. Routine antegrade colonic lavage often allows such children to avoid daytime soiling. This report describes 2 children in whom the ACE procedure was complicated by a cecal volvulus. METHODS: A retrospective review of 164 children with an ACE procedure was conducted. Two instances of cecal volvulus were identified. RESULTS: The first child presented with abdominal pain and difficulty intubating the ACE site. Over the subsequent day, his pain worsened, and radiographs depicted a colonic obstruction. At laparotomy, a cecal volvulus resulting in bowel necrosis was observed, and resection of the affected bowel and appendix (in the right lower quadrant) and end ileostomy was required. He subsequently had the stoma closed and a new ACE constructed with a colon flap. The second child presented with shock and evidence of an acute abdomen. At laparotomy, a cecal volvulus was noted, and ileocolic resection including the ACE stoma (located at the umbilicus) and an ileostomy and Hartmann pouch was performed. He had a protracted hospital course requiring ventilator and inotropic support. He currently is well and still has an ileostomy stoma. CONCLUSIONS: A high index of suspicion for a potentially life-threatening cecal volvulus should be maintained in children undergoing an ACE procedure who present with abdominal pain, evidence of bowel obstruction, or difficulty in advancing the ACE irrigation catheter.

Anus, Imperforate↗