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PubMedDate not supplied

Typhoid and paratyphoid fever: a retrospective study.

Sixty-eight proved cases of typhoid and paratyphoid fever were reviewed in a retrospective study covering 5 years (1986-1990). Patients within the age range of 10 to 39 years constituted 82.3 per cent of cases and there was equal incidence in both sexes. The mean duration of illness before presentation was 9.67 days. The major clinical features were fever (97%), abdominal tenderness (-9.4%), headache and abdominal pain (70.58%) each). Intestinal perforation was the commonest complication (27.9%) with a male preponderance (M:F-3:1). Perforation occurred after the first week of illness in 73.7 per cent of cases. Fourteen out of the nineteen patients who perforated were not on therapy at the time of perforation and they constituted 80 per cent of those cases of mortality in which perforation played a role. Surgical management of perforation gave better results than conservative management (mortality rates of 16.7% and 40% respectively). Salmonella was sensitive to Chloramphenicol in all the cases where the organism was grown. There were 10 recorded deaths (14.9%) of whom 60 per cent (i. e. 6 patients) presented after two weeks of illness.

Adolescent↗
PubMed1992

Prospective evaluation of a peritoneal dialysis catheter system for large volume paracentesis.

Large volume paracentesis is becoming a popular form of therapy for patients with massive ascites and cirrhosis. Although the physiologic effects of the removal of large amounts of ascitic fluid have been well described, the techniques utilized to perform the procedure are either not well documented or not currently available. Over a 13-month period, 52 patients with moderate to severe ascites have undergone 73 large volume paracenteses with a peritoneal dialysis catheter system. The mean volume of ascitic fluid removed was 7.6 L, with a mean time of removal of 129 min. Total paracentesis was accomplished within 1 h in 38% of procedures. The most common site for paracentesis was the left lower quadrant. Complications related to the procedure were few, the most common being a self-limited ascitic fluid leak at the sight of paracentesis. No patient experienced intestinal perforation, peritonitis, or a significant change in serum creatinine after the procedure. The widely available peritoneal dialysis catheter system represents a safe and rapid technique for the removal of large quantities of ascitic fluid.

Ascites↗
PubMed2003

[Ultrasound-guided hydrostatic reduction for the treatment of idiopathic intestinal invagination].

The more extended conservative treatment in intussusception consists of the accomplishment of fluoroscopy guided neumoenema. The development of the echography has allowed to introduce this as alternative in diagnosis and treatment of intussusception. Our objective is to analyze the therapeutic value of echography during resolution of intussusception with saline solution enema in pediatric patients. Intestinal intussusception was diagnosed in 183 patients by echography during a period of 7 years. Patients are classified in three groups according to treatment by means of opaque enema, radioscopy guided neumoenema or echography guided hydrostatic reduction enema. The results of the three series are analyzed: rate of failure of the procedure, the recurrences or the presence of complications. We exclude n = 18 patients that were operated on directly after the diagnosis. The reduction rate was 81.25% (9/16) with opaque enema; 94.6% (103/110) with neumoenema and 96.4% (27/28) with echography guided saline enema. Complications appeared in n = 2 cases of intestinal perforation, 1 with barium and 1 with air 2. Recurrences were n = 3, n = 2 with neumoenema and n = 1 with echography guided enema. Echography guide saline enema has a high security and effectiveness (96.4%), similar to the other methods, avoiding the exposition to ionic radiation. The technique is safe and it does not increase the rate of recurrences.

Child, Preschool↗
PubMedDate not supplied

[Spontaneous bacterial peritonitis and bacteraemia due to Aeromonas hydrophila].

Bacterial peritonitis is a frequent complication in cirrhotic patients. Amongst the aetiological germs, Aeromonas is very infrequent. We present the clinical case of a cirrhotic patient with peritonitis and bacteraemia due to Aeromonas hydrophila. This micro-organism is a Gram-negative bacillus of the Vibrionaceae family. It very frequently produces gastroenteritis in the human being. Exceptionally it can give rise to extraintestinal infections, especially in immunodepressed patients. Peritonitis due to Aeromonas has been described in association with spontaneous bacterial peritonitis in cirrhotic patients, in patients on peritoneal dialysis and in cases of peritonitis secondary to intestinal perforation.

Aeromonas hydrophila↗
PubMed1992

[Diffuse large cell lymphoma with spontaneous regression in the lung and lymph nodes. Case report].

An 84-year-old woman was admitted to our hospital because of swelling of the cervical lymph nodes and multiple tumorous lesions observed on radiographic studies. Transcutaneous lung biopsy was performed, but necrosis of the tissue was too marked to make a diagnosis. The diagnosis of diffuse large-cell lymphoma was made based on a biopsy of the pretracheal lymph node. During the first two months after admission, the left cervical lymph nodes and most of the pulmonary lesions regressed not withstanding of special treatment for lymphoma. The patient eventually died of generalized peritonitis. At autopsy, metastasis of systemic organs by malignant lymphoma was observed. Most of the lung regions were cicatrized, but clusters of atypical lymphocytes were observed in the necrotic tissue. The tumor in the mucosa of the small intestine showed necrosis, which accounted for the intestinal perforation. The total clinical course after admission was about six months. Spontaneous regression of diffuse large cell lymphoma is rare, and this is the second reported case in Japan.

Aged↗
PubMedDate not supplied

Ischemic necrosis of small bowel following laparoscopic surgery.

BACKGROUND AND OBJECTIVE: Small bowel ischemia following laparoscopy was described recently as a rare fatal complication of the CO2 pneumoperitoneum. Of the 8 cases reported in the surgical literature, 7 were fatal, 1 was not. In this report, we describe the first gynecological case. METHODS: A 34-year-old woman who underwent laparoscopy with extensive adhesiolysis and myolysis was re-admitted with an acute abdomen on postoperative day 4. Immediate laparotomy revealed acute peritonitis, extensive adhesions, and a 3-cm defect in the small bowel. Tissue examination showed ischemic necrosis of edematous, but essentially normal, bowel mucosa. The postoperative course was extremely complicated. She was discharged after a 2-month hospital stay in the intensive care unit for rehabilitation. RESULTS: Data are available on 7 patients (including ours). All procedures were described as uneventful. The intraabdominal pressure was set at 15 mm Hg when specified. Some abdominal pain occurred in all, nausea and vomiting in 4, diarrhea in 2, abdominal distention in 1, fever in none. Quick reintervention laparotomy was performed in 2 and delayed in 5 (up to 4 days). DISCUSSION: The CO2 pneumoperitoneum is a predisposing factor for intestinal ischemia as it reduces cardiac output and splanchnic blood flow. However, critical ischemia relies on underlying vasculopathy or an inciting event. CONCLUSION: Patient selection, maintaining intraabdominal pressure at 15 mm Hg or less, and intermittent decompression of the gas represent the best options for preventing this complication.

Adult↗
PubMed2003

Emergencies in rheumatology.

Rheumatological conditions can sometimes present as emergencies. These can occur due to the disease process or may be iatrogenic. Some of the important articular emergencies are septic arthritis, acute polyarthritis and atlanto-axial dislocation. Classical polyarteritis nodosa may present with massive gastro-intestinal bleeding, intestinal perforation or acute pancreatitis. Adult respiratory distress syndrome, bilateral pneumonitis and diffuse alveolar haemorrhage due to systemic lupus erythematosus or systemic necrotising vasculitis and ventilatory failure due to polymyositis are some of the respiratory emergencies. Scleroderma is well known to cause renal crisis which can be fatal if not diagnosed and managed promptly. Microscopic polyangiitis and Wegener's granulomatosis may cause rapidly progressive renal failure. Cerebrovascular accident, cortical vein thrombosis, seizures and acute psychosis are important neurological complications of rheumatic disease. Cardiac emergencies include tamponade, acute myocarditis and acute myocardial infarction. Vision can be threatened in Behcet's disease, temporal arteritis and seronegative spondylarthritis. Catastrophic antiphospholipid syndrome is a devastating emergency. The management of above emergencies includes critical care, immunosuppression when indicated and withdrawal of the offending drug. Anticoagulants have to be used in the management of antiphospholipid syndrome. A good understanding of these conditions is of paramount importance for proper management.

Cardiovascular Diseases↗
PubMed2005

ICU management of patients with suspected positive findings of diagnostic peritoneal lavage following blunt abdominal trauma.

OBJECTIVE: To explore the management for blunt abdominal trauma victims with probable positive diagnostic peritoneal lavage (DPL) findings. METHODS: Data of 76 patients with probable positive DPL findings accepted to ICU in previous 10 years were reviewed. After admission, the patients were evaluated in a settled time according to the protocols of Advanced Trauma Life Support (ATLS). Vital signs were continuously monitored and DPL, ultrasound and/or CT scan were repeated when necessary. RESULTS: Eighteen (24%) of 76 patients presented positive DPL findings after repeated DPL. Surgical findings confirmed 7 cases of spleen rupture, 3 hepatorrhexis (infra-Glisson capsule), 4 intestinal perforation, 2 gastric perforation, 1 colon perforation and 1 injured mesentery. CONCLUSIONS: Patients with probable positive DPL findings were admitted to ICU with vital signs continuously monitored. Repeated DPL with supplemental ultrasound and/or CT scan can work together to increase the sensitivity and accuracy of the diagnosis, reduce the rate of exploratory laparotomy, ensure patients' safety and provide a reliable basis for therapeutic operations.

Abdominal Injuries↗
PubMedDate not supplied

[Surgical complications after kidney transplantation].

Chronic renal failure needs substitutive treatment such as haemodialysis and peritoneal dialysis for the patient to survive. Kidney transplantation (KTx) improves survival of the patient with chronic renal failure. Since the first KTx, performed by Merrill in Boston in 1959, advances in medical therapy, immunosuppressive therapy and refinements in surgical technique have improved the quality of life of the transplant patient. We present a review of the incidence, diagnosis and therapy of surgical complications after KTx reported in the literature and a retrospective analysis of 297 consecutive cadaveric donor kidney transplants done in our institution from September 1993 to September 2002. Vascular complications represent 5-10% of postoperative complications. Our experience showed an incidence of 1.7% renal artery thrombosis, 1.4% renal vein thrombosis, 1.7% renal artery stenosis, 1.4% arterial rupture due to fungal arteritis, 0.7% spontaneous graft ruptures and 12% lymphoceles. Urological complications account for 10-15% of postoperative complications. In our series we found an incidence of 7.4% urinary leakage, 2.7% urinary obstruction and 3% urinary reflux. Gastrointestinal complications represent 16% of postoperative complications. Our series showed 1% pancreatitis with an overall mortality of 33% and an incidence of 1.7% intestinal perforations. Surgical complications still represent a challenge that increments morbidity and mortality among kidney transplant recipients. Data shown may offer some guidance on how to deal with early and late post-transplant surgical complications.

Arteritis↗
PubMed2005

[The abdominal compartment syndrome].

In two patients, a man aged 67 and a woman aged 80, an abdominal compartment syndrome was diagnosed. The man had been treated surgically for an abdominal aortic aneurysm; he recovered after re-operation. The woman had been treated by sigmoidectomy because of ileus. A Bogota bag and a vacuum-assisted wound-closure system were applied to the abdominal wound. Her condition deteriorated, an intestinal perforation became apparent, of which she did not recover and died. An abdominal compartment syndrome should always be kept in mind when a patient at risk presents with increased intra-abdominal pressure and at least one of the following symptoms: oliguria, decreased cardiac output, increased pulmonary-artery pressure, hypotension and acidosis. Measurement of the bladder pressure remains the method of choice to establish the abdominal pressure level. However, there is a lack of correlation between the measured pressure and the clinical condition of the patient. Therefore, the combination of clinical findings and the observed trend in serial measurements of the bladder pressure is preferred to a single pressure measurement.

Abdomen↗
PubMed1992

[Jejuno-ileal diverticula (Meckel excluded). Apropos of 10 cases].

The authors report ten cases of small bowel diverticulosis revealed by a complication in four cases. Aetiologic, pathological, clinical and therapeutic characteristics of this rare disease are reviewed. Main complications are perforations, intestinal obstruction and hemorrhage. The treatment was the resection of the segment of small intestine involved by complicated diverticula. Resection was followed by anastomosis or temporary enterostomy if there was an acute peritonitis. Uncomplicated diverticulae must be respected and left in place.

Aged↗
PubMed1992

An outbreak of multiresistant Salmonella typhi in South Africa.

Typhoid fever caused by Salmonella typhi remains endemic to many parts of South Africa, including Natal and KwaZulu, Northern Transvaal and the Transkei. Until recently, the majority of S. typhi isolates from South Africa have remained susceptible to ampicillin/amoxycillin and chloramphenicol, and only three cases of typhoid due to multi-antibiotic resistant strains of S. typhi have been documented. Ampicillin/amoxycillin and chloramphenicol are, therefore, still recommended as first line therapy for patients with typhoid fever in this country. We describe a cluster of six cases of typhoid caused by S. typhi that was resistant to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. All these patients presented over a 3-month period; the patients were from three adjacent districts in the Northern Natal area of South Africa. The high rate of intestinal perforation (two of six) was a direct consequence of inappropriate antibiotic treatment. Failure of surgical intervention, renal impairment as well as delay in starting appropriate antibiotic treatment were factors contributing to the high mortality (three of six). The good clinical outcome in the remaining three patients probably resulted from treatment with appropriate antibiotics; however, mild disease in two of these patients may have been a contributing factor. All isolates showed high minimal inhibitory concentrations (MIC) of greater than or equal to 256 micrograms/ml to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. The isolates were all highly sensitive to the third generation cephalosporins (MIC less than or equal to 0.06 micrograms/ml) and quinolones (MIC less than or equal to 0.03 micrograms/ml). Conjugation studies suggest a genetic transfer of resistance, probably plasmid mediated. The presence of beta-lactamase and chloramphenicol acetyl transferase enzymes in all six isolates tested would account for the resistance to ampicillin and chloramphenicol respectively. The transfer of such plasmids to erstwhile sensitive strains could conceivably occur in this typhoid-endemic area, where sanitary conditions are poor and living conditions crowded, thus further exacerbating the problem. It is recommended that in areas where such multiresistant strains are encountered, the third generation cephalosporins or quinolones be used as empiric therapy for typhoid fever.

Adult↗