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World Journal of Gastroenterology Apr 2020Hepatic portal venous gas (HPVG) generally indicates poor prognoses in patients with serious intestinal damage. Although surgical removal of the damaged portion is...
BACKGROUND
Hepatic portal venous gas (HPVG) generally indicates poor prognoses in patients with serious intestinal damage. Although surgical removal of the damaged portion is effective, some patients can recover with conservative treatments.
AIM
To establish an optimal treatment strategy for HPVG, we attempted to generate computed tomography (CT)-based criteria for determining surgical indication, and explored reliable prognostic factors in non-surgical cases.
METHODS
Thirty-four cases of HPVG (patients aged 34-99 years) were included. Necessity for surgery had been determined mainly by CT findings (. free-air, embolism, lack of contrast enhancement of the intestinal wall, and intestinal pneumatosis). The clinical data, including treatment outcomes, were analyzed separately for the surgical cases and non-surgical cases.
RESULTS
Laparotomy was performed in eight cases (surgical cases). Seven patients (87.5%) survived but one (12.5%) died. In each case, severe intestinal damage was confirmed during surgery, and the necrotic portion, if present, was removed. Non-occlusive mesenteric ischemia was the most common cause ( = 4). Twenty-six cases were treated conservatively (non-surgical cases). Surgical treatments had been required for twelve but were abandoned because of the patients' poor general conditions. Surprisingly, however, three (25%) of the twelve inoperable patients survived. The remaining 14 of the 26 cases were diagnosed originally as being sufficiently cured by conservative treatments, and only one patient (7%) died. Comparative analyses of the fatal ( = 10) and recovery ( = 16) cases revealed that ascites, peritoneal irritation signs, and shock were significantly more frequent in the fatal cases. The mortality was 90% if two or all of these three clinical findings were detected.
CONCLUSION
HPVG related to intestinal necrosis requires surgery, and our CT-based criteria are probably useful to determine the surgical indication. In non-surgical cases, ascites, peritoneal irritation signs and shock were closely associated with poor prognoses, and are applicable as predictors of patients' prognoses.
Topics: Adult; Aged; Aged, 80 and over; Ascites; Conservative Treatment; Embolism, Air; Female; Gases; Humans; Intestinal Mucosa; Male; Mesenteric Ischemia; Necrosis; Pneumatosis Cystoides Intestinalis; Portal Vein; Prognosis; Retrospective Studies; Risk Factors; Shock; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32327911
DOI: 10.3748/wjg.v26.i14.1628 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Feb 2023Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain...
BACKGROUND
Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain that often lead to misdiagnosis. Although the differential diagnosis may vary according to the localization and severity of the pain, and associated symptoms such as nausea-vomiting and fever, depending on the disease and site of involvement, the character of the pain is generally similar and in a continuous form. Depending on pain localization, it can mimic different clinical pictures such as acute appendicitis, acute diverticulitis, ovarian pathologies, urinary tract stones and acute cholecystitis, and patients are often diagnosed after surgical exploration. With the increased availability of computed tomography and awareness of these diseases, more patients can be diagnosed in the preoperative process and unnecessary operations can be avoided. In particular, PEA is a self-limiting local inflammatory disease and can often be managed conservatively. For all diagnoses, the surgical treatment option is local excision of the relevant epiploic appendix or omental segment, preferably laparoscopically. The most common surgical indication is diagnostic confusion and the second is persistent pain.
METHODS
The data of patients followed up and treated for a diagnosis of POT, SOT, ISON or PEA between 2006 and 2021 were recorded in a specially prepared database. The demographic characteristics of the patients, and the data regarding the diagnosis and treatment process were evaluated retrospectively and discussed in the light of the relevant literature.
RESULTS
The reason for hospitalization and treatment in 12 of the 42 patients included in the study was necrosis of a part of the omentum. Of these patients, 4 were followed up and treated with a diagnosis of POT, 3 with SOT, 5 with ISON and 30 with a diagnosis of PEA. Thirty-three of the patients were diagnosed preoperatively, and 9 intraoperatively, 22 patients were operated on, and 20 patients with PEA were treated conservatively. After surgical or medical treatment, all the patients were discharged without complications. In the comparisons between the patients, no significant difference was observed in terms of clinical and laboratory findings.
CONCLUSION
POT, SOT, ISON and PEA should be considered in the differential diagnosis of patients with acute abdominal findings. In patients with PEA diagnosed in the preoperative period, a conservative approach should be considered first. In patients with a diagnosis of POT, SOT, and ISON, a surgical or conservative approach should be evaluated according to the patient's clinical condition.
Topics: Humans; Abdomen, Acute; Retrospective Studies; Abdominal Pain; Peritoneal Diseases; Necrosis; Colitis, Ischemic; Diagnosis, Differential
PubMed: 36748764
DOI: 10.14744/tjtes.2022.28430 -
Military Medicine Nov 2023Noncompressible torso hemorrhage is the leading cause of exsanguination on the battlefield. A self-expanding, intraperitoneal deployed, thermoreversible foam has been...
INTRODUCTION
Noncompressible torso hemorrhage is the leading cause of exsanguination on the battlefield. A self-expanding, intraperitoneal deployed, thermoreversible foam has been developed that can be easily administered by a medic in austere settings to temporarily tamponade noncompressible torso hemorrhage. The purpose of this study was to assess the long-term safety and physical characteristics of using Fast Onset Abdominal Management (FOAM; Critical Innovations LLC) in swine.
MATERIALS AND METHODS
Yorkshire swine (40-60 kg) were sedated, intubated, and placed on ventilatory support. An external jugular catheter was placed for sampling of blood. Continuous heart rate, temperature, saturation of peripheral oxygen, end-tidal carbon dioxide, and peak airway pressures were monitored for a 4-hour period after intervention (i.e., FOAM agent injection or a sham introducer without agent delivery). The FOAM agent was injected to obtain an intra-abdominal pressure of 60 mmHg for at least 10 minutes. After 4 hours, the animals were removed from ventilatory support and returned to their housing for a period of 7-14 days. Group size analysis was not performed, as this was a descriptive safety study. Blood samples were obtained at baseline and at 1-hour post-intervention and then on days 1, 3, 7, and 14. Euthanasia, necropsy, and harvesting of samples for histologic analysis (from kidneys, terminal ilium, liver, pancreas, stomach, spleen, and lungs) were performed upon expiration. Histologic scoring for evidence of ischemia, necrosis, and abdominal compartment sequela was blinded and reported by semi-quantitative scale (range 0-4; 0 = no change, 1 = minimal, 2 = mild, 3 = moderate, and 4 = marked). Oregon Health & Science University's Institutional Animal Care and Use Committee, as well as the U.S. Army Animal Care and Use Review Office, approved this protocol before the initiation of experiments (respectively, protocol numbers IP00003591 and MT180006.e002).
RESULTS
Five animals met a priori inclusion criteria, and all of these survived to their scheduled endpoints. Two animals received sham injections of the FOAM agent (one euthanized on day 7 and one on day 14), and three animals received FOAM agent injections (one euthanized on day 7 and two on day 14). A transitory increase in creatinine and lactate was detected during the first day in the FOAM injected swine but resolved by day 3. No FOAM agent was observed in the peritoneal cavity upon necropsy at day 7 or 14. Histologic data revealed no clinically relevant differences in any organ system between intervention and control animals upon sacrifice at day 7 or 14.
CONCLUSIONS
This study describes the characteristics, survival, and histological analysis of using FOAM in a porcine model. In our study, FOAM reached the desired intra-abdominal pressure endpoint while not significantly altering basic hematologic parameters, except for transient elevations of creatinine and lactate on day 1. Furthermore, there was no clinical or histological relevant evidence of ischemia, necrosis, or intra-abdominal compartment syndrome. These results provide strong support for the safety of the FOAM device and will support the design of further regulatory studies in swine and humans.
Topics: Humans; Swine; Animals; Creatinine; Abdominal Injuries; Hemorrhage; Torso; Necrosis; Lactates; Ischemia
PubMed: 35820028
DOI: 10.1093/milmed/usac206 -
IDCases 2021infection is known to cause Lemierre's syndrome, not pelvic peritonitis. Herein, we report a case of pelvic peritonitis and bacteremia, without Lemierre's syndrome,...
infection is known to cause Lemierre's syndrome, not pelvic peritonitis. Herein, we report a case of pelvic peritonitis and bacteremia, without Lemierre's syndrome, mimicking intestinal necrosis. A 28-year-old woman with peritoneal irritation and shock was suspected of having intestinal necrosis due to the presence of hepatoportal venous gas and pneumatosis intestinalis. Intestinal necrosis was ruled out by emergency laparotomy. However, massive opaque ascites and inflammatory changes in the uterus and fallopian tubes were observed. and were found in ascetic fluid cultures. Moreover, was also found in blood culture. Systemic management of septic shock and antibiotic treatment improved the patient's general condition and abnormal gas on imaging. The patient had untreated bacterial vaginosis prior to admission. Pelvic peritonitis caused by is extremely rare. However, it must be recognized to avoid its rapid development into severe onset mimicking intestinal necrosis.
PubMed: 34012772
DOI: 10.1016/j.idcr.2021.e01134 -
Pleura and Peritoneum Jun 2016: Multimodal therapeutic strategies have improved the outcome of peritoneal metastases (PM). However, objective assessment of therapy response remains difficult in PM,...
: Multimodal therapeutic strategies have improved the outcome of peritoneal metastases (PM). However, objective assessment of therapy response remains difficult in PM, since radiological studies have a poor accuracy for low-volumetric disease. There is an obvious need for a histological gold standard allowing assessment of tumor response to treatment in PM. : We propose to perform peritoneal punch biopsies with a diameter of 3 to 5 mm in all four abdominal quadrants. We propose a four-tier Peritoneal Regression Grading Score (PRGS), defined as Grade 1: complete response (absence of tumor cells), Grade 2: major response (major regression features, few residual tumor cells), Grade 3: minor response (some regressive features but predominance of residual tumor cells), Grade 4: no response (tumor cells without any regressive features). Acellular mucin and infarct-like necrosis should be regarded as regression features. We recommend reporting the mean and the worst value of the regression grades obtained. When complete tumor response is suspected intraoperatively, a peritoneal cytology should be sampled. : A generic, unique score for the assessment of histological tumor response to chemotherapy in PM makes sense because of the clinical impact of histological response to therapy and because the organ of metastasis (peritoneum) is the same. By adopting PRGS, different centers will be able to use a uniform terminology and grading that will allow meaningful comparison of their results. : PRGS has now to be validated in several gastrointestinal and gynecological cancer types and may be useful both in clinical and research settings.
PubMed: 30911613
DOI: 10.1515/pp-2016-0011 -
Medical Ultrasonography May 2017Double localization of tuberculosis is a rare finding among immunocompetent patients. Intestinal tuberculosis is a rare condition and its diagnosis remains a challenge...
Double localization of tuberculosis is a rare finding among immunocompetent patients. Intestinal tuberculosis is a rare condition and its diagnosis remains a challenge to the physician. We present the case of a 21 year old male patient with intestinal tuberculosis in which the first manifestation was an acute appendicitis. Ultrasound findings were an abscessed appendicular mass. The surgical intervention found a granulomatous aspect of the peritoneum and total necrosis of the appendix. Histopathological examination confirmed the diagnosis and the pulmonary radiography detected the concomitant pulmonary tuberculosis.
Topics: Abscess; Adult; Appendicitis; Appendix; Humans; Male; Necrosis; Tuberculosis, Gastrointestinal; Ultrasonography; Young Adult
PubMed: 28845503
DOI: 10.11152/mu-1085 -
The Pan African Medical Journal 2018We conducted a retrospective study of 15 patients with complicated Meckel diverticula treated in the emergency surgery at the Aristide Le Dantec Hospital, Dakar, over a...
We conducted a retrospective study of 15 patients with complicated Meckel diverticula treated in the emergency surgery at the Aristide Le Dantec Hospital, Dakar, over a period of 13 years (January 2003-June 2016). The study included 10 men and 5 women, whose average age was 27.8 years, ranging between 1 months and 73 years. The two main circumstances of detection were occlusive syndrome and peritoneal irritation. Emergency laparotomy allowed clinicians to affirm the involvement of Meckel diverticulum in the clinical picture. In the case of occlusion, the mechanism was always a flange. Ten patients had intestinal necrosis with perforation at the time of diagnosis. All 15 patients underwent segmental resection of the intestine with elimination of the diverticulum. This resection was followed by immediate anastomosis in 12 cases. The morbidity was constituted of 2 cases of fistulas and 2 cases of postoperative peritonitis. A case of death due to septic shock was reported. Three patients had heterotopic mucosa, including gastric heterotopia, colic heterotopia and an association between colic heterotopia and gastric heterotopia in the same patient. The complications of Meckel diverticula are digestive emergencies requiring early and adapted surgical treatment. This is characterized by a non-negligible morbidity.
Topics: Adolescent; Adult; Aged; Anastomosis, Surgical; Child; Child, Preschool; Emergencies; Female; Humans; Infant; Laparotomy; Male; Meckel Diverticulum; Middle Aged; Necrosis; Peritonitis; Postoperative Complications; Retrospective Studies; Senegal; Young Adult
PubMed: 29875962
DOI: 10.11604/pamj.2018.29.81.12675 -
Arteriosclerosis, Thrombosis, and... Jun 2017Defective autophagy in macrophages leads to pathological processes that contribute to atherosclerosis, including impaired cholesterol metabolism and defective...
OBJECTIVE
Defective autophagy in macrophages leads to pathological processes that contribute to atherosclerosis, including impaired cholesterol metabolism and defective efferocytosis. Autophagy promotes the degradation of cytoplasmic components in lysosomes and plays a key role in the catabolism of stored lipids to maintain cellular homeostasis. microRNA-33 (miR-33) is a post-transcriptional regulator of genes involved in cholesterol homeostasis, yet the complete mechanisms by which miR-33 controls lipid metabolism are unknown. We investigated whether miR-33 targeting of autophagy contributes to its regulation of cholesterol homeostasis and atherogenesis.
APPROACH AND RESULTS
Using coherent anti-Stokes Raman scattering microscopy, we show that miR-33 drives lipid droplet accumulation in macrophages, suggesting decreased lipolysis. Inhibition of neutral and lysosomal hydrolysis pathways revealed that miR-33 reduced cholesterol mobilization by a lysosomal-dependent mechanism, implicating repression of autophagy. Indeed, we show that miR-33 targets key autophagy regulators and effectors in macrophages to reduce lipid droplet catabolism, an essential process to generate free cholesterol for efflux. Notably, miR-33 regulation of autophagy lies upstream of its known effects on ABCA1 (ATP-binding cassette transporter A1)-dependent cholesterol efflux, as miR-33 inhibitors fail to increase efflux upon genetic or chemical inhibition of autophagy. Furthermore, we find that miR-33 inhibits apoptotic cell clearance via an autophagy-dependent mechanism. Macrophages treated with anti-miR-33 show increased efferocytosis, lysosomal biogenesis, and degradation of apoptotic material. Finally, we show that treating atherosclerotic mice with anti-miR-33 restores defective autophagy in macrophage foam cells and plaques and promotes apoptotic cell clearance to reduce plaque necrosis.
CONCLUSIONS
Collectively, these data provide insight into the mechanisms by which miR-33 regulates cellular cholesterol homeostasis and atherosclerosis.
Topics: Animals; Atherosclerosis; Autophagy; Autophagy-Related Protein 5; Cholesterol; Gene Expression Regulation; Genetic Predisposition to Disease; Humans; Jurkat Cells; Lipid Droplets; Lysosomes; Macrophages, Peritoneal; Mice, Inbred C57BL; Mice, Knockout; MicroRNAs; Necrosis; Phenotype; Plaque, Atherosclerotic; Receptors, LDL; Signal Transduction; Transfection
PubMed: 28428217
DOI: 10.1161/ATVBAHA.116.308916 -
BMC Surgery Dec 2023It is difficult to definitively determine the degree of ischemia in the bowel in which an incarcerated groin hernia is embedded. Failure to diagnose and intervene...
BACKGROUND
It is difficult to definitively determine the degree of ischemia in the bowel in which an incarcerated groin hernia is embedded. Failure to diagnose and intervene promptly and accurately increases the rate of bowel resection and patient mortality. The aim of this study is to investigate the risk factors for incarcerated inguinal hernia complicating bowel necrosis with resection and to establish a predictive model as a reference for clinical work.
METHODS
Patients with incarcerated groin hernia who were admitted to our hospital were retrospectively analyzed. They were divided into bowel resection and non-bowel resection groups based on whether bowel resection was performed in the surgical record and postoperative pathological results. Risk factors for the development of bowel resection in incarcerated groin hernia were analyzed by univariate analysis and multivariate logistic regression, respectively. The screened independent risk factors were used to establish a prediction model, and finally, the predictive ability and accuracy of the model were validated and the clinical benefit was analyzed.
RESULTS
A total of 345 patients with incarcerated groin hernia were included, of whom 58 underwent bowel resection for bowel necrosis and 287 did not. Multifactorial logistic regression analysis identified bowel obstruction (OR, 7.285 [95% CI, 2.254-23.542], P = 0.001), peritonitis (OR, 16.786 [95% CI, 5.436-51.838], P = 0.000), duration of incarcerated groin hernia (OR, 1.009 [95% CI, 1. 001-1.018], P = 0.034), heart rate (OR, 1.109 [95% CI, 1.021-1.205], P = 0.014), and preoperative total protein (OR, 0.900 [95% CI, 0.836-0.969], P = 0.005) were independent risk factors for bowel resection in incarcerated groin hernia. The predictive value of the established prediction model was basically in agreement with the measured value with a consistency index of 0.938 (0.901-0.974) and had a good clinical benefit.
CONCLUSION
Clinical screening and management of independent risk factors for bowel resection in patients with incarcerated groin hernia should be strengthened. The predictive model developed in this study has high diagnostic efficacy for bowel resection associated with incarcerated inguinal hernia, with the aim of reducing the incidence of bowel resection and unplanned secondary surgery.
Topics: Adult; Humans; Hernia, Inguinal; Retrospective Studies; Groin; Intestines; Herniorrhaphy; Necrosis
PubMed: 38082259
DOI: 10.1186/s12893-023-02245-7 -
Evidence-based Complementary and... 2018is the traditional plant used at Korea as a herbal medicine to ameliorate inflammatory responses. Although has been traditionally used as a herbal medicine at Korea,...
is the traditional plant used at Korea as a herbal medicine to ameliorate inflammatory responses. Although has been traditionally used as a herbal medicine at Korea, no systemic research has been conducted on its anti-inflammatory activity. Therefore, the present study explored an anti-inflammatory effect and its underlying molecular mechanism using methanol extract (Cc-ME) in macrophage-mediated inflammatory responses. anti-inflammatory activity of Cc-ME was evaluated using RAW264.7 cells and peritoneal macrophages stimulated by lipopolysaccharide (LPS), pam3CSK4 (Pam3), or poly(I:C). anti-inflammatory activity of Cc-ME was investigated using acute inflammatory disease mouse models, such as LPS-induced peritonitis and HCl/EtOH-induced gastritis. The molecular mechanism of Cc-ME-mediated anti-inflammatory activity was examined by Western blot analysis and immunoprecipitation using whole cell and nuclear fraction prepared from the LPS-stimulated RAW264.7 cells and HEK293 cells. Cc-ME inhibited NO production and mRNA expression of inducible nitric oxide synthase (iNOS), cyclooxygenase (COX-2), and tumor necrosis factor-alpha (TNF-) in the RAW264.7 cells and peritoneal macrophages induced by LPS, pam3, or poly(I:C) without cytotoxicity. High-performance liquid chromatography (HPLC) analysis showed that Cc-ME contained anti-inflammatory flavonoids quercetin, luteolin, and kaempferol. Among those, the content of luteolin, which showed an inhibitory effect on NO production, was highest. Cc-ME suppressed the NF-B signaling pathway by targeting Src and interrupting molecular interactions between Src and p85, its downstream kinase. Moreover, Cc-ME ameliorated the morphological finding of peritonitis and gastritis in the mouse disease models. Therefore, these results suggest that Cc-ME exerted and anti-inflammatory activity in LPS-stimulated macrophages and mouse models of acute inflammatory diseases. This anti-inflammatory activity of Cc-ME was dominantly mediated by targeting Src in NF-B signaling pathway during macrophage-mediated inflammatory responses.
PubMed: 29725354
DOI: 10.1155/2018/3909038