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Intra abdominal sepsis

Paula Ferrada, Luke Wolfe, Juan Duchesne, Gustavo P Fraga, Elizabeth Benjamin, Agustin Alvarez, Andre Campbell, Christopher Wybourn, Alberto García, Carlos Morales, Julieta Correa, Bruno M Pereira, Marcelo Ribeiro, Martha Quiodettis, Gregory Peck, Juan C Salamea, Vitor F Kruger, Rao Ivatury, Thomas Scalea
INTRODUCTION: The operative management of duodenal trauma remains controversial. Our hypothesis is that a simplified operative approach could lead to better outcomes. METHODS: We conducted an international multicenter study, involving thirteen centers. We performed a retrospective review from January 2007 to December of 2016. Data on demographics, mechanism of trauma, blood loss, operative time, and associated injured organs were collected. Outcomes included post-operative intra-abdominal sepsis, leak, need for unplanned surgery, length of stay, renal failure and mortality...
December 6, 2018: Journal of Trauma and Acute Care Surgery
Hassan Zafar, Milton H Saier
The communities of beneficial bacteria that live in our intestines, the gut microbiome, are important for the development and function of the immune system. Bacteroides species make up a significant fraction of the human gut microbiome, and can be probiotic and pathogenic, depending upon various genetic and environmental factors. These can cause disease conditions such as intra-abdominal sepsis, appendicitis, bacteremia, endocarditis, pericarditis, skin infections, brain abscesses and meningitis. In this study, we identify the transport systems and predict their substrates within seven Bacteroides species, all shown to be probiotic; however, four of them (B...
2018: PloS One
David A Talan, Darin J Saltzman, Daniel A DeUgarte, Gregory J Moran
BACKGROUND: Meta-analyses and a recent guideline acknowledge that conservative management of uncomplicated appendicitis with antibiotics can be successful for patients who wish to avoid surgery. However, guidance as to specific management does not exist. METHODS: PUBMED and EMBASE search of trials describing methods of conservative treatment was conducted according to PRISMA guidelines. RESULTS: Thirty-four studies involving 2944 antibiotic-treated participants were identified...
December 3, 2018: Journal of Trauma and Acute Care Surgery
Ilaria Alice Crippa, Carles Subirà, Jean-Louis Vincent, Rafael Fernandez Fernandez, Silvia Cano Hernandez, Federica Zama Cavicchi, Jacques Creteur, Fabio Silvio Taccone
BACKGROUND: Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. METHODS: We studied 100 adult patients with sepsis (July 2012-March 2017) (age = 62 [52-71] years; Acute Physiology and Chronic Health Evaluation II score on admission = 21 [15-26])...
December 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
Liliana Clara, Viviana M Rodríguez, Pablo Saúl, Cecilia Domínguez, Mercedes Esteban
Intra-abdominal infections represent a group of intra and retroperitoneal processes, ranging from localized infections to complicated ones, sepsis and septic shock, associated with a significant mortality rate. They are the third most commonly identified cause of sepsis and the second cause of death in the intensive care unit. Although antimicrobial therapy must be started as soon as possible, especially in critically ill patients, the source control procedure is highly relevant. On account of the importance of this subject, members of the Argentine Society of Infectious Diseases (SADI) and intensive care specialists joined to develop recommendations on diagnosis, treatment, and prevention of intra-abdominal infections...
2018: Medicina
Matthew G R Allaway, Kristenne Clement, Guy D Eslick, Michael R Cox
BACKGROUND: Intra-abdominal abscess (IAA) complicates 2-3% of patients having an appendicectomy. The usual management is prolonged antibiotics and drainage of the IAA. From 2006, our unit chose to use early re-laparoscopy and washout in patients with persistent sepsis following appendicectomy. The aims of this study were to assess the outcomes of early laparoscopic washout in patients with features of persistent intra-abdominal sepsis and compare those with percutaneous drainage and open drainage of post-appendicectomy IAA...
November 26, 2018: World Journal of Surgery
Gaik S Quah, Guy D Eslick, Michael R Cox
PURPOSE: Over the last 3 decades, laparoscopic procedures have emerged as the standard treatment for many elective and emergency surgical conditions. Despite the increased use of laparoscopic surgery, the role of laparoscopic repair for perforated peptic ulcer remains controversial among general surgeons. The aim of this study was to compare the outcomes of laparoscopic versus open repair for perforated peptic ulcer. METHODS: A systemic literature review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines...
November 21, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Tihitena Negussie, Abay Gosaye, Belachew Dejene
BACKGROUND: Early relaparotomy is defined as relaparotomy within the first 30 days following surgery. The aim of this study is to explore the indications, outcomes and factors associated with relaparotomy in our pediatric population. METHODS: We performed a retrospective study of pediatric surgical patients (< 13 yrs.) who underwent relaparotomy at Tikur Anbessa Teaching Hospital between September 1, 2011 and August 31, 2016. All children who had relaparotomy within the first 30 days of the initial surgery were included...
November 16, 2018: BMC Surgery
Huiying Zhao, Qi Wang, Peihua Wu, Guangjie Wang, Huixia Wang, Fengxue Zhu, Youzhong An
OBJECTIVE: To investigate the clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit (ICU). METHODS: The patients with candidemia admitted to ICU of Peking University People's Hospital from January 2010 to December 2017 were enrolled. The general clinical data, indicators related to Candidia infection and prognosis were collected, and the clinical characteristics, infection characteristics and prognosis of patients with candidiasis were analyzed...
October 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Luca Moraldi, Benedetta Pesi, Lapo Bencini, Marco Farsi, Mario Annecchiarico, Andrea Coratti
Pancreatic fistula is the main post-operative complication of distal pancreatectomy associated with other further complications, such as intra-abdominal abscesses, wound infection, sepsis, electrolyte imbalance, malabsorption and hemorrhage. Surgeons have tried various techniques to close the stump of the remaining pancreas, but the controversy regarding the impact of stapler closure and suture closure of the pancreatic stump is far from resolved. In this study, we reported our technique and results of robotic assisted distal pancreatectomy with ultrasound identification and consequent selective closure of pancreatic duct...
November 14, 2018: Updates in Surgery
Hiroji Shinkawa, Hideo Yasunaga, Kiyoshi Hasegawa, Hiroki Matsui, Nobuaki Michihata, Kiyohide Fushimi, Norihiro Kokudo
BACKGROUND: Whether patients undergoing hemodialysis have greater risks of mortality and morbidity after pancreatoduodenectomy remains unknown. METHODS: We used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify patients who underwent pancreatoduodenectomy from July 2010 to March 2015. We conducted propensity-score-matching analyses to compare the outcomes, including postoperative complications and 30- and 90-day mortality after pancreatoduodenectomy between patients with and without hemodialysis...
November 10, 2018: Surgery
Iain McPherson, Stephen T McSorley, Elizabeth Cannings, Christopher J Shearer, Andrew Bc Crumley
INTRODUCTION: Dropped gallstones are gallstones lost in the abdominal cavity during cholecystectomy. They are a rare occurrence and often cause minimal long-term issues. However, it is recognised that dropped stones can cause intra- or extra-abdominal sepsis. We present three cases below which highlight this. CASES: All three cases describe patients presenting for laparoscopic cholecystectomy, Cases 1 and 2 post-gallstone pancreatitis and Case 3 for gallbladder stones...
October 29, 2018: Scottish Medical Journal
Marta Climent, Marta Pascual, Sandra Alonso, Silvia Salvans, M ª José Gil, Luís Grande, Miguel Pera
INTRODUCTION: Diverting stomata are recommended in patients with low anterior resection and risk factors in order to reduce the severity of anastomotic leaks. Usually, a radiology study is performed prior to the closure of the stoma to detect subclinical leaks. The aim of the present study is to assess the clinical utility of the radiology study. METHODS: A prospective cohort study of patients undergoing anterior rectal resection for rectal cancer and those who underwent stoma closure without contrast enema...
October 19, 2018: Cirugía Española
Faraz Shafiq, Muhammad Faisal Khan, Muhammad Ali Asghar, Faisal Shamim, Muhammad Sohaib
Background and Objective: Acute pancreatitis (AP) is an inflammatory disease. Patients presenting with severe disease may require intensive care unit (ICU) admission. Factors predicting mortality and morbidity need to be identified for improving outcome. The objective of this study was to see the outcome of these patient presented to single center over a period of ten years. The secondary objective was to identify the factors responsible for adverse outcome. Methods: The medical records of adult patients from year 2006 to 2016 requiring ICU admission for AP were reviewed retrospectively...
September 2018: Pakistan Journal of Medical Sciences Quarterly
Silvia Marchesi, Fracisco Ortiz Nieto, Kerstin Magdalena Ahlgren, Agneta Roneus, Ricardo Feinstein, Miklos Lipcsey, Anders Larsson, Håkan Ahlström, Goran Hedenstierna
Diffusion-weighted magnetic resonance imaging (DW-MRI) uses water as contrast and enables the study of perfusion in many organs simultaneously in situ. We used DW-MRI in a sepsis model, comparing abdominal organs perfusion with global hemodynamic measurements and inflammation. Sixteen anesthetized piglets were randomized into 3 groups: HighMAP (mean arterial pressure, MAP > 65 mmHg), LowMAP (MAP between 50 and 60 mmHg) and Healthy Controls (HC). Sepsis was obtained with endotoxin and the desired MAP maintained with noradrenaline...
October 18, 2018: American Journal of Physiology. Gastrointestinal and Liver Physiology
Saleh Abdel-Kader, Massimo Sartelli, Fikri M Abu-Zidan
INTRODUCTION: The World Society of Emergency Surgery (WSES) has recently developed and validated a sepsis severity score for complicated intra-abdominal infections (cIAIs). We aimed to prospectively study the validity of this score in our local setting and compare it with global findings. METHODS: In a prospective study of 100 consecutive adult patients with cIAIs treated at Al-Ain Hospital, United Arab Emirates, from October 2014 to January 2016, we studied the demography of patients, disease, risk factors, WSES Sepsis Severity Score, management, hospital stay and mortality...
October 10, 2018: Singapore Medical Journal
Nicholas P McKenna, Elizabeth B Habermann, Amy E Glasgow, Eric J Dozois, Amy L Lightner
BACKGROUND: Intra-abdominal sepsis complicates <10% of ileocolic resections for Crohn's disease, but the impact of combination immunosuppression and repeat resection on its development remains unknown. OBJECTIVE: The purpose of this study was to determine risk factors for intra-abdominal sepsis after ileocolic resection, specifically examining the role of combination immunosuppression and repeat intestinal resection. DESIGN: This was a retrospective review of patient records from 2007 to 2017...
December 2018: Diseases of the Colon and Rectum
Jia Rui Kwan, Keith Sheng Hng Low, Rahul Lohan, Vishal G Shelat
Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report on a 76-year-old lady with recurrent pyogenic cholangitis and PTBD catheter fracture. She had hepatitis B virus-related Child-Pugh class A liver cirrhosis, hypothyroidism, hyperlipidaemia, and previous atrial fibrillation with a background of mild mitral, tricuspid and aortic valvular regurgitation. She had history of laparoscopic cholecystectomy in the past...
August 2018: Annals of Hepato-Biliary-Pancreatic Surgery
Xibing Ding, Shuqing Jin, Zhenzhen Shao, Li Xu, Zhuang Yu, Yao Tong, Zhixia Chen, Heth Turnquist, Bruce R Pitt, Timothy R Billiar, Li-Ming Zhang, Quan Li
Mechanical ventilation (MV) is frequently employed to manage respiratory failure in sepsis patients and is required for the surgical management of intra-abdominal sepsis. The impact of MV varies dramatically depending on tidal volume, with even moderate tidal volume (MTV) ventilation leading to ventilator-induced lung injury, whereas low tidal volume (LTV) ventilation protects against sepsis-induced ARDS. IL-33 is known to contribute to lung injury in sepsis and its release can be induced by mechanical stress...
September 5, 2018: Shock
Ling-Ling Zhu, Quan Zhou
Background: Sporadic studies in antimicrobial therapy have evaluated the effects of infusion rates on therapeutic and economic outcomes, and new findings may challenge the regular infusion regimen. Methods: Focusing on studies comparing the outcomes of different infusion regimens, the relevant literature was identified by searching PubMed, Web of Science, and Scopus from January 1, 2013 to March 1, 2018. Papers were finally chosen using a PRISMA flowchart. Results: Antimicrobials with the superiority of prolonged infusion to standard infusion in terms of efficacy and safety include meropenem, doripenem, imipenem, cefepime, ceftazidime, piperacillin/tazobactam, linezolid, and vancomycin...
2018: Infection and Drug Resistance
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