Peritonitis Research Papers - Academia.edu (original) (raw)

Peritonitis is caused most commonly by perforation of the hollow viscus and grave consequences of the dis-ease are attributed to the microbial infection of the perito-neal cavity. Factors predicting outcome in cases of perfo-ration... more

Peritonitis is caused most commonly by perforation of the hollow viscus and grave consequences of the dis-ease are attributed to the microbial infection of the perito-neal cavity. Factors predicting outcome in cases of perfo-ration peritonitis are well known and have been well ...

The aim of this article is to assist nurses in the assessment of abdominal pain in adults presenting to the accident and emergency (A&E) department and other acute settings. Through a structured approach to history taking and pain... more

The aim of this article is to assist nurses in the assessment of abdominal pain in adults presenting to the accident and emergency (A&E) department and other acute settings. Through a structured approach to history taking and pain assessment, nurses should be able to differentiate abdominal pain caused by acute rather than non-acute conditions. Within a contemporary, interprofessional healthcare environment, this will aid rapid and effective treatment. After reading this article you should be able to: Describe the anatomy and physiology of organs associated with abdominal pain. Identify the main causes of abdominal pain and differential diagnoses. Ask relevant questions of a patient presenting with abdominal pain. Discuss the appropriate investigations and nursing care required. Understand the principles of symptom management.

Editor: Eosinophilic peritonitis is defined as the presence of an absolute eosinophil count exceeding 30 per cubic millimeter of dialysis fluid in patients receiving mainte-nance peritoneal dialysis (PD) (1,2). In adult patients, the... more

Editor: Eosinophilic peritonitis is defined as the presence of an absolute eosinophil count exceeding 30 per cubic millimeter of dialysis fluid in patients receiving mainte-nance peritoneal dialysis (PD) (1,2). In adult patients, the incidence has been reported to range from 16% – 30% in intermittent PD to as high as 60% in continuous ambulatory PD (CAPD) (1,2). It usually occurs within the first 3 months after dialysis initiation, although it has been reported to occur even later (2). A 7-year-old boy with end-stage renal disease second-ary to focal segmental glomerulosclerosis who had been on automated PD (APD) for 3 months was admitted to our hospital for evaluation of a malfunctioning PD catheter and a history of turbid peritoneal effluent. We observed no fever, rash, or abdominal pain, and no past history of atopy or allergies. Physical examination was unre-markable. Radiography of the abdomen showed upward migration of the distal part of the catheter. Intravenous first-generat...

♦ Background: There is little information regarding the financial burden of peritonitis and the economic impact of continuous quality improvement (CQI) programs in peritoneal dialysis (PD) patients. The objectives of this study were to... more

♦ Background: There is little information regarding the financial burden of peritonitis and the economic impact of continuous quality improvement (CQI) programs in peritoneal dialysis (PD) patients. The objectives of this study were to measure the costs of peritonitis, and determine the net savings of a PD CQI program in Colombia. ♦ Methods: The Renal Therapy Services (RTS) network in Colombia, along with Coomeva EPS, provided healthcare resource utilization data for PD patients with and without peritonitis between January 2012 and December 2013. Propensity score matching and regression analysis were performed to estimate the incremental cost of peritonitis. Patient months at risk, episodes of peritonitis pre- and post-CQI, and costs of CQI were obtained. Annual net savings of the CQI program were estimated based on the number of peritonitis events prevented. ♦ Results: The incremental cost of a peritonitis episode was $250. In an 8-year period, peritonitis decreased from 1,837 epis...

The matrix metalloproteinases (MMPs) have been implicated in a number of diseases involving inflammation or cellular invasion.' GM 6001 is an inhibitor of most of these enzymes with Ki's in the low nanomolar range. Though potent in vitro,... more

The matrix metalloproteinases (MMPs) have been implicated in a number of diseases involving inflammation or cellular invasion.' GM 6001 is an inhibitor of most of these enzymes with Ki's in the low nanomolar range. Though potent in vitro, this molecule is short-lived in circulation with a half-life of a few minutes.

Background/Aims: Low protein concentration in ascitic fluid has been identified as a risk factor for spontaneous bacterial peritonitis (SBP). Until now, primary prophylaxis has not been recommended in these patients. The aim was to... more

Background/Aims: Low protein concentration in ascitic fluid has been identified as a risk factor for spontaneous bacterial peritonitis (SBP). Until now, primary prophylaxis has not been recommended in these patients. The aim was to investigate the efficacy of long-term administration of ciprofloxacin to prevent SBP.

Skip Navigation The Leading Publisher in Biotechnology. ...

Although there has been an improved management of Invasive Candidiasis in the last decade, still controversial issues remain, especially in different therapeutic critical care scenarios. We sought to identify the core clinical knowledge... more

Although there has been an improved management of Invasive Candidiasis in the last decade, still controversial issues remain, especially in different therapeutic critical care scenarios. We sought to identify the core clinical knowledge and to achieve high agreement recommendations required to care for critically ill adult patients with Invasive Candidiasis for antifungal treatment in special situations and different scenarios. Second Prospective Spanish survey reaching consensus by the Delphi technique, conducted anonymously by electronic e-mail in the first phase to 23 national multidisciplinary experts in invasive fungal infections from five national scientific societies including Intensivists, Anesthesiologists, Microbiologists, Pharmacologists and Infectious disease specialists, answering 30 questions prepared by a coordination group after a strict review of literature in the last five years. The educational objectives spanned four categories, including peritoneal candidiasis, ...

We reviewed all episodes of peritonitis associated with exit site and/or tunnel infection (n = 87; rate, 0.1/yr; 13% of all peritonitis episodes) occurring from 1979 to 1995. The exit site or tunnel infection was diagnosed at the time or... more

We reviewed all episodes of peritonitis associated with exit site and/or tunnel infection (n = 87; rate, 0.1/yr; 13% of all peritonitis episodes) occurring from 1979 to 1995. The exit site or tunnel infection was diagnosed at the time or shortly after the patient presented with peritonitis in 66% of the episodes. In the other one third the exit site

Hemorrhagic ascites in patients with cirrhosis is described as a RBC (Red Blood cell) >50,000/mm³ and leads to increased morbidity and mortality. Positive red blood cells at a level of less than 50,000/mm³ (10,000-50,000) may be... more

Hemorrhagic ascites in patients with cirrhosis is described as a RBC (Red Blood cell) >50,000/mm³ and leads to increased morbidity and mortality. Positive red blood cells at a level of less than 50,000/mm³ (10,000-50,000) may be encountered in the ascites but it is not known whether this is clinically significant or not. This study aimed to examine the outcome of hemorrhagic ascites in patients with advanced cirrhosis. Data from 329 cirrhotic patients with ascites who received paracentesis at least once due to ascites was retrospectively analyzed from the period of 2007-2013 from the Türkiye Yüksek İhtisas Hospital, Department of Gastroenterology. Patients were divided according to the number of RBC, with greater than 10,000/mm³ being described as hemorrhagic ascites, and less than 10,000 / mm³ described as the normal or control group. Patient data included: number of accepted intensive unit service stays, acute kidney injury (AKI), hepatic encephalopathy (HES), model for end-liv...

Background and Aim: Refractory ascites in liver-cirrhosis is associated with a poor prognosis. We performed a prospective study to investigate whether aggressive nutritionalsupport could improve outcomes in cirrhotic patients. Methods:... more

Background and Aim: Refractory ascites in liver-cirrhosis is associated with a poor prognosis. We performed a prospective study to investigate whether aggressive nutritionalsupport could improve outcomes in cirrhotic patients. Methods: Cirrhotic patients undergoing serial large-volume paracentesis for refractoryascites were enrolled and randomized into three groups. Group A received postparacentesis intravenous nutritional-support in addition to a balanced oral diet and a late-evening protein snack, group B received the same oral nutritional-protocol as the first group but without parenteral support, and group C (the control group) received a lowsodium or sodium-free diet. Clinical, anthropometric and laboratory nutritional parameters and biochemical tests of liver and renal function were reported for 12 months of follow-up. Results: We enrolled 120 patients, who were randomized into three groups of equal size. Patients on the nutritional-protocol showed better preservation of clinical, anthropometric and laboratory nutritional parameters that were associated with decreased deterioration of liver function compared with patients on the low-sodium or sodium-free diet (group C). Groups A and B had lower morbidity and mortality rates than the control group (C). Mortality rates were significantly better in patients who were treated with parenteralnutritional-support than for the other two groups. In patients who were on the nutritionalprotocol, there was a reduction in the requirement of taps for the treatment of refractory ascites. Conclusions: Post-paracentesis parenteral-nutritional-support with a balanced oral diet and an evening protein snack appears to be the best care protocol for patients with liver-cirrhosis that has been complicated by refractory-ascites.

Hospitalization rates are declining more rapidly for peritoneal dialysis (PD) than for hemodialysis patients. This has been postulated to be caused in part by lower peritonitis rates. However, the causes of admission have not been... more

Hospitalization rates are declining more rapidly for peritoneal dialysis (PD) than for hemodialysis patients. This has been postulated to be caused in part by lower peritonitis rates. However, the causes of admission have not been reexamined in the setting of declining rates. We prospectively examined our hospitalization rates, causes of admission, and impact of peritonitis on hospitalization in adult PD patients at a single center over a 4-year period. There were 274 admissions in 168 patient-years for a rate of 1.6 admissions and 13.0 hospital days per patient-year. Rates were greater for men (1.8 v 1.5; P ‫؍‬ 0.013), patients with diabetes (2.2 v 1.4, P F 0.001), and those with a higher peritoneal equilibration test result. Creatinine clearance and sex were independent predictors in a multivariate analysis. The most common causes for admission were cardiac disease (14.6%) and peritonitis (13.5%). Peritonitis accounted for 0.21 admissions and 2.0 hospital days per patient-year. Thirty percent of the incident patients were admitted during the first 90 days of dialysis. Admissions for dehydration and glucose abnormalities were more common in the first 90 days. Overall admission rates, as well as admission rates for peritonitis, did not change over time, although hospital days per year decreased. Those admitted for peritonitis had higher peritonitis rates, more time on PD, and were more likely to be black. Eighty-one percent of the admissions for peritonitis were caused by Staphylococcus aureus, Streptococcus spp, or gram-negative/fungal peritonitis. Patients with peritonitis caused by Staphylococcus epidermidis were less likely to be admitted than patients with peritonitis caused by other organisms. To conclude, peritonitis remains a common cause of hospitalization, despite low peritonitis rates. To decrease admissions for peritonitis, attention should be focused on preventing peritonitis caused by organisms other than S epidermidis.

Between 1969 and 1987, 68 patients with pancreatic pseudocysts were treated. The median cyst size was 10 cm (range 2–25 cm). Nine patients were managed conservatively with resolution of the pseudocyst occurring in eight patients. These... more

Between 1969 and 1987, 68 patients with pancreatic pseudocysts were treated. The median cyst size was 10 cm (range 2–25 cm). Nine patients were managed conservatively with resolution of the pseudocyst occurring in eight patients. These patients had significantly smaller (median 4 cm) cysts compared with those in both percutaneously and surgically treated patients (P<0·01). In 22 patients the pseudocysts (median 9 cm) were punctured percutaneously under ultrasound guidance and the cyst fluid was aspirated or drained through a catheter. Complete resolution occurred in 13 patients after 1–4 (mean 2·8) punctures per patient, regression occurred in six patients after 1–4 (mean 2·0) puncture procedures per patient and three were unchanged. No complications were noted, except that two patients treated percutaneously required additional surgery. Thirty-seven patients were managed surgically (median cyst size 11 cm) with external drainage (12 patients), cystgast-rostomy (17 patients), cystduodenostomy (three patients) cystjejunostomy (three patients) and pancreatic resection (two patients). Resolution of the cyst was noted in 29 patients, regression in five and three were unchanged. Five patients required additional surgery. Twelve complications were seen in ten patients (27 per cent), most frequently after external drainage. One patient died after surgical treatment. Mean hospital stay was 13 days among patients treated conservatively and 30 days in both percutaneously and surgically treated patients. Aspiration or catheter drainage of pseudocyst fluid guided by ultrasonography seems a safe and effective treatment of pancreatic pseudocysts and should be considered as initial therapy. If surgery is required cystgastrostomy is preferred.

Background: Peritonitis is considered to change peritoneal permeability and influences the long-term change in permeability during peritoneal dialysis. The objective of this study is to evaluate water transport across the peritoneum,... more

Background: Peritonitis is considered to change peritoneal permeability and influences the long-term change in permeability during peritoneal dialysis. The objective of this study is to evaluate water transport across the peritoneum, expressed as drained ultrafiltration volume, before, during, and after episodes of peritonitis. Methods: A retrospective analysis of data from a group of patients was performed in which drained ultrafiltration volume and glucose concentration in dialysis fluid were recorded for each dwell time every day during time on continuous ambulatory peritoneal dialysis treatment as a part of the clinical routine performed. Days with peritonitis and average of daily measurements 1 month before and after each peritonitis episode were evaluated separately for day and night exchanges. In all, 64 episodes of peritonitis in 30 patients were included in this study. Approximately 15,000 exchanges were recorded. Paired t-test and repeated-measures analysis of variance were performed. Results: Compared with the average for the previous month, there was a significant decrease in ultrafiltration volume for day exchanges occurring 2 days before the appearance of other clinical symptoms of peritonitis (P ‫؍‬ 0.029). For night exchanges, the decrease in ultrafiltration volume occurred 24 hours before diagnosis (P < 0.001). Ultrafiltration volume was at its minimum the day of diagnosis for both the day (P < 0.001) and night (P < 0.001) exchanges compared with average volume for the previous month. Ultrafiltration volumes remained low for 2 days after diagnosis during both the day (P ‫؍‬ 0.009) and night (P ‫؍‬ 0.017) exchanges. Relative to the previous month, glucose concentration on the day of clinical diagnosis of peritonitis did not differ significantly (P ‫؍‬ 0.328 and P ‫؍‬ 0.963 for day and night shifts, respectively). Overall, no significant changes in ultrafiltration volumes or glucose concentrations from the month before to the month after the peritonitis episode were found (P ‫؍‬ 0.99 and P ‫؍‬ 0.27 for measurements during the day, respectively). Conclusion: Osmotic forced ultrafiltration decreased during infectious peritonitis, most significantly for a long dwell time, consistent with an increase in both functional peritoneal surface area and hydraulic conductivity. This finding appeared 2 days before other clinical symptoms and remained significantly low 2 days after diagnosis. Am J Kidney Dis 43:485-491.

The objective of this study was to investigate early effects of peritoneal inflammation on the mitochondrial function in the vital organs, liver and kidney, and their relation to inflammatory and oxidative stress mediators. The study was... more

The objective of this study was to investigate early effects of peritoneal inflammation on the mitochondrial function in the vital organs, liver and kidney, and their relation to inflammatory and oxidative stress mediators. The study was performed on 14 domestic pigs. Peritoneal inflammation was induced in anesthetized pigs after a midline laparotomy by autologous feces. Fluid resuscitation maintained a MAP above 60 mmHg. Animals were sacrificed 12 h later, and tissue samples were obtained to determine mitochondrial function, mRNA levels of relevant genes [inducible NO synthase (iNOS), inducible HO (HO-1), tumor necrosis factor-alpha (TNF-alpha)], generation of reactive oxygen species (ROS), and HO-1 activity. We found impaired mitochondrial function in both liver and kidney, based on decreased state 3 respiration in the liver and increased states 2 and 4 respiration in the kidney at 12 h. This was accompanied by increased TNF-alpha protein in the blood and up-regulation of TNF-alpha mRNA in the liver. Free iron was elevated in the liver but not in the kidney. In the kidney, mitochondrial ROS production was increased. Nitric oxide levels in blood remained unchanged, corresponding to unchanged levels of iNOS mRNA expression in liver and kidney. Similarly, HO-1 mRNA and heme oxygenase (HO)-activity were unchanged. The inflammatory response in the absence of characteristic septic symptoms was not associated with morphological organ damage at this early time point. Peritoneal inflammation in pigs caused mitochondrial dysfunction in liver and kidney, preceding signs of organ damage. We did not find proof that mitochondrial dysfunction was due to increased levels of either nitric oxide (NO) or products of HO, but it was accompanied by increased levels of oxidative stress markers.

P eritonitis is a serious complication of peritoneal dialysis (PD). The mortality rate associated with PD peritonitis is estimated to be 4%, and this complication is identified as a contributing factor in 16% of peritoneal... more

P eritonitis is a serious complication of peritoneal dialysis (PD). The mortality rate associated with PD peritonitis is estimated to be 4%, and this complication is identified as a contributing factor in 16% of peritoneal dialysis-related deaths. 1 Rates of PD peritonitis have been decreasing since the early 1990s; however, the relative proportion of peritonitis episodes caused by gram-negative bacteria is increasing. 2,3 Gram-negative PD peritonitis is associated with increased rates of catheter loss, hospitalization, switch to hemodialysis, and mortality. 3-5 Although Pseudomonas aeruginosa, Escherichia coli, and Klebsiella spp. are the most common causes of gram-negative PD peritonitis, Acinetobacter spp. are also frequently isolated pathogens. 2-4 In a review of PD peritonitis from Singapore, Acinetobacter spp. was the most commonly isolated gramnegative bacteria; however, this was a single-center experience and the microbiologic trend may not be applicable to other centers. Acinetobacter baumannii is recognized as an important and increasingly drug-resistant nosocomial pathogen. 6 As a result of this species' ability to resist desiccation and disinfectants, colonize the skin, and form biofilms, A. baumannii is particularly well adapted to infect foreign material. 7 Multidrug-resistant (MDR) strains, commonly defined as resistant to at least 3 classes of antibiotics, and extensively drug-resistant (XDR) strains, defined as susceptible only to the polymyxins, have been implicated primarily in health care-associated infections and nosocomial epidemics. 7 To date, there are no published reports of successful treatment of nosocomial MDR or XDR Acinetobacter PD peritonitis. We present a case of XDR A. baumannii PD peritonitis successfully treated with a combination of intraperitoneal polymyxin B and ampicillin-sulbactam.

Abstract. In this study we investigated the long term results of intraperitoneal immunoglobulin (Ig) treatment in continuous ambulatory peritoneal dialyses (CAPD) patients with refractory or relapsing peritonitis. Sixteen CAPD patients (4... more

Abstract. In this study we investigated the long term results of intraperitoneal immunoglobulin (Ig) treatment in continuous ambulatory peritoneal dialyses (CAPD) patients with refractory or relapsing peritonitis. Sixteen CAPD patients (4 female, 12 male) with a mean age of 53 ± ...

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early... more

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

The peritoneum is a cavity which has been successfully utilized by nephrologists to perform peritoneal dialysis (PD) in patients with renal failure. The physiologic characteristic of the peritoneal cavity not only helps remove toxic... more

The peritoneum is a cavity which has been successfully utilized by nephrologists to perform peritoneal dialysis (PD) in patients with renal failure. The physiologic characteristic of the peritoneal cavity not only helps remove toxic metabolites from the body, but also provides a useful portal of entry in the body for several pharmacological agents. Several medications such as antibiotics are given via the intraperitoneal (IP) route in PD patients to treat episodes of peritonitis. More recently the IP route has been used for chemotherapy in patients with intra-abdominal malignancies, i.e. gynecological and gastrointestinal cancers and has shown very promising results. In patients with peritoneal surface malignancies, perioperative IP chemotherapy has been used with good results. The rate and amount of drug transfer in the peritoneum are dependent on several factors. Factors such as peritoneal inflammation, surface area, peritoneal blood flow, time of contact, etc, influence the drug transfer. This review discusses the usefulness of IP drug therapy and the factors influencing it, as well as strategies to increase the efficacy, and conclude that IP route is an alternate route to the more conventional drug delivery routes, and can be successfully used when the target is within the peritoneal cavity or adjacent tissue.

The anticarcinogenic and anti-inflammatory properties of curcumin have been extensively investigated, identifying prostaglandin E 2 synthase (mPGES)-1 and 5lipoxygenase (5-LO), key enzymes linking inflammation with cancer, as high... more

The anticarcinogenic and anti-inflammatory properties of curcumin have been extensively investigated, identifying prostaglandin E 2 synthase (mPGES)-1 and 5lipoxygenase (5-LO), key enzymes linking inflammation with cancer, as high affinity targets. A comparative structure− activity study revealed three modifications dissecting mPGES-1/5-LO inhibition, namely (i) truncation of the acidic, enolized dicarbonyl moiety and/or replacement by pyrazole, (ii) hydrogenation of the interaryl linker, and (iii) (dihydro)prenylation. The prenylated pyrazole analogue 11 selectively inhibited 5-LO, outperforming curcumin by a factor of up to 50, and impaired zymosan-induced mouse peritonitis along with reduced 5-LO product levels. Other pro-inflammatory targets of curcumin (i.e., mPGES-1, cyclooxygenases, 12/15-LOs, nuclear factor-κB, nuclear factorerythroid 2-related factor-2, and signal transducer and activator of transcription 3) were hardly affected by 11. The strict structural requirements for mPGES-1 and 5-LO inhibition strongly suggest that specific interactions rather than redox or membrane effects underlie the inhibition of mPGES-1 and 5-LO by curcumin.

Pathophysiology of Peptic Ulcer Disease leading to Bacterial Peritonitis

Introduction: Labia minora adhesions (LMA) are a common finding in young girls. Usually, this condition is asymptomatic and spontaneously disappears during adolescence. We report on a case revealed by infected urocolpos and peritonitis... more

Introduction: Labia minora adhesions (LMA) are a common finding in young girls. Usually, this condition is asymptomatic and spontaneously disappears during adolescence. We report on a case revealed by infected urocolpos and peritonitis and whose treatment finally required surgical reduction labioplasty. Case report: A 9-year-old girl presented with a 2-day history of abdominal pain and fever. Urinary continence had never been obtained, with diurnal leaks. Physical examination showed signs of peritoneal irritation and a subtotal vulvar obstruction due to LMA. At surgery, after LMA lysis, a large amount of cloudy urine-like fluid emptied under pressure from the vagina. Laparoscopy showed generalized peritonitis without any intraabdominal cause. The same Escherichia coli was identified in the infected urocolpos and the abdominal fluid. Postoperative course was uneventful. Because of recurrent LMA, the patient underwent several courses of local estrogen therapy. Labia minora hypertrophy with LMA developed 2 years after peritonitis, requiring surgical reduction labioplasty. We used a new technique with interposition of skin flaps. The girl is now well, without LMA or infection, 4 years after labioplasty. Conclusion: Although rare, subtotal vulvar obstruction because of LMA may lead to infected hydrocolpos and peritonitis. Recurrent LMA may necessitate surgical labioplasty.

We report a case of generic vancomycin treatment failure in a liver transplant patient with MRSA peritonitis and bacteremia, followed by a rapid sterilization of blood and peritoneal fluid after switching to the branded product. It raises... more

We report a case of generic vancomycin treatment failure in a liver transplant patient with MRSA peritonitis and bacteremia, followed by a rapid sterilization of blood and peritoneal fluid after switching to the branded product. It raises concern about therapeutic equivalence of generic vancomycin.

Nosocomial infections (NIs) now concern 5 to 15% of hospitalized patients and can lead to complications in 25 to 33% of those patients admitted to ICUs. The most common causes are pneumonia related to mechanical ventilation,... more

Nosocomial infections (NIs) now concern 5 to 15% of hospitalized patients and can lead to complications in 25 to 33% of those patients admitted to ICUs. The most common causes are pneumonia related to mechanical ventilation, intra-abdominal infections following trauma or surgery, and bacteremia derived from intravascular devices. This overview is targeted at ICU physicians to convince them that the principles of infection control in the ICU are based on simple concepts and that the application of preventive strategies should not be viewed as an administrative or constraining control of their activity but, rather, as basic measures that are easy to implement at the bedside. A detailed knowledge of the epidemiology, based on adequate surveillance methodologies, is necessary to understand the pathophysiology and the rationale of preventive strategies that have been demonstrated to be effective. The principles of general preventive measures such as the implementation of standard and isolation precautions, and the control of antibiotic use are reviewed. Specific practical measures, targeted at the practical prevention and control of ventilator-associated pneumonia, sinusitis, and bloodstream, urinary tract, and surgical site infections are detailed. Recent data strongly confirm that these strategies may only be effective over prolonged periods if they can be integrated into the behavior of all staff members who are involved in patient care. Accordingly, infection control measures are to be viewed as a priority and have to be integrated fully into the continuous process of improvement of the quality of care.

Artefactually enhanced putrefactive and autolytic changes may be misinterpreted as indicating a prolonged postmortem interval and throw doubt on the veracity of witness statements. Review of files from Forensic Science SA and the... more

Artefactually enhanced putrefactive and autolytic changes may be misinterpreted as indicating a prolonged postmortem interval and throw doubt on the veracity of witness statements. Review of files from Forensic Science SA and the literature revealed a number of external and internal factors that may be responsible for accelerating these processes. Exogenous factors included exposure to elevated environmental temperatures, both outdoors and indoors, exacerbated by increased humidity or fires. Situations indoor involved exposure to central heating, hot water, saunas and electric blankets. Deaths within motor vehicles were also characterized by enhanced decomposition. Failure to quickly or adequately refrigerate bodies may also lead to early decomposition. Endogenous factors included fever, infections, illicit and prescription drugs, obesity and insulin-dependent diabetes mellitus. When these factors or conditions are identified at autopsy less significance should, therefore, be attached to changes of decomposition as markers of time since death.

The study was carried out on 78 albino Wistar male rats (180-230 g) divided at random into 3 groups. Group 1 consisted of 58 rats with experimental acute diffusive peritonitis (ADP), 2nd group – control group with sterile 0,9% NaCl at... more

The study was carried out on 78 albino Wistar male rats (180-230 g) divided at random into 3 groups. Group 1 consisted of 58 rats with experimental acute diffusive peritonitis (ADP), 2nd group – control group with sterile 0,9% NaCl at equlibrium (n=10) and 3rd intact group (n=10). ADP was induced by intraperitoneal injection of 10% suspension of feces. We analyzed total WBC count, Wet/Dry lung indexes, data of the oxidative and antioxidative systems and endogenous intoxication indexes, light and electron microscopy. Blood samples and lung tissue were obtained in 1, 12, 24 and 48 h after ADP induction.
It has been established that after ADP induction was noticed progressive endogenous intoxication with lipid and protein peroxidation and inhibition of antioxidant protection for 24 hours with further exhaustion after the first day of experiment. The most informative and sensitive biomarker of acute lung injury is a coefficient of leukocyte lung regulation. The latter suggests enhanced leukocyte sequestration in respiratory system even on the background of leucopenia, which implies lung injury. Furthermore, lung injury has been confirmed by the analysis of morphological alterations of laboratory rats' lung tissue micro- and ultrastructure.
Key words: acute lung injury, peritonitis, endogenous intoxication, neutrophils.

1 BAB I PENDAHULUAN 1.1 Latar Belakang Gawat abdomen menggambarkan keadaan klinik akibat kegawatan di rongga perut yang biasanya timbul mendadak dengan nyeri sebagai keluhan utama. Keadaan ini memerlukan penanggulangan segera yang sering... more

1 BAB I PENDAHULUAN 1.1 Latar Belakang Gawat abdomen menggambarkan keadaan klinik akibat kegawatan di rongga perut yang biasanya timbul mendadak dengan nyeri sebagai keluhan utama. Keadaan ini memerlukan penanggulangan segera yang sering berupa tindakan bedah, misalnya padaperforasi, perdarahan intraabdomen, infeksi, obstruksi dan strangulasi jalan cerna dapat menyebabkan perforasi. Peradangan peritoneum merupakan komplikasi berbahaya yang sering terjadi akibat penyebaran infeksi dari organ-organ abdomen (misalnya apendisitis, salpingitis, perforasi ulkus gastroduodenal), ruptura saluran cerna, komplikasi post operasi, iritasi kimiawi, ataudari luka tembus abdomen. Pada keadaan normal, peritoneum resisten terhadap infeksi bakteri (secara inokulasi kecil-kecilan); kontaminasi yang terus menerus, bakteri yang virulen, resistensi yang menurun, dan adanya benda asing atau enzim pencerna aktif.

Peradangan peritoneum (membran serosa yang melapisi rongga abdomen dan menutupi visera abdomen) merupakan penyakit berbahaya yang dapat terjadi dalam bentuk akut maupun kronis. Keadaan ini biasanya terjadi akibat penyebaran infeksi dari... more

Peradangan peritoneum (membran serosa yang melapisi rongga abdomen dan menutupi visera abdomen) merupakan penyakit berbahaya yang dapat terjadi dalam bentuk akut maupun kronis. Keadaan ini biasanya terjadi akibat penyebaran infeksi dari organ abdomen (mis., apendisitis, salpingitis), perforasi saluran cerna, atau dari luka tembus abdomen. Organisme yang sering menginfeksi adalah organisme yang hidup dalam kolon (pada kasus rupture apendiks) yang mencakup Escheriela Coli atau Bacteroides, sedangkan stafilokokus dan streptokokus seringkali masuk dari luar (Price & Sylvia, 2005). Berdasarkan penelitian Tarigan pada tahun 2012, peritonitis merupakan salah satu penyebab kematian tersering pada penderita bedah dengan mortalitas sebesar 10-40%. Peritonitis difus sekunder yang merupakan 90%

Introduction Management of severe secondary peritonitis (SSP) may require intestinal resections and bowel exteriorization due to an unacceptable high risk for anastomotic dehiscence (AD). Bowel exteriorization can be achieved through loop... more

Introduction Management of severe secondary peritonitis (SSP) may require intestinal resections and bowel exteriorization due to an unacceptable high risk for anastomotic dehiscence (AD). Bowel exteriorization can be achieved through loop or ...

The lungs are one of the main essential target organs, performing detoxification functions and often being the first to respond to different polyetiological states. Particulary, in medical practice very often doctors have to meet critical... more

The lungs are one of the main essential target organs, performing detoxification functions and often being the first to respond to different polyetiological states. Particulary, in medical practice very often doctors have to meet critical conditions such as: acute diffuse peritonitis (ADP), acute intestinal obstruction (AIO), acute renal failure (ARF), hypothyroidism (HP), which require emergency surgery and intensive care, due to high mortality rates. Thus, mortality is 20–92.8% of ADP, which has a direct relationship to the number of affected organs involved in the pathological process. The mortality rate for AIO caused by various etiologies reaches 15–50%, while ARF – 15.6–62.8%, and the combination with sepsis is more than 75% with no noticeable downward trend. HP often leads to disruption of motor function of the intestinal tract and thereby promotes obstructive states.
Pulmonary haemocapillars become the first link for mediators and endotoxins. As a result, the lungs are the first organs of detoxification in the way of the factors mentioned above, whose function is decompensated. As a result, the activation of immune cells accompanied by “respiratory bursts” and the release of a large number of inflammatory mediators occurs. All this leads to increased pulmonary haemocapillars, endothelial permeability, respiratory and nonrespiratory lung function violation, and significant changes in pulmonary hemodynamics with progression of acute lung injury (ALI)

Oxidative stress directly correlates to the development and clinical course of severe acute surgical pathology, increasing its mortality, particularly in acute diffuse peritonitis (ADP), acute intestinal obstruction (AIO) with acute... more

Oxidative stress directly correlates to the development and clinical course of severe acute surgical pathology, increasing its mortality, particularly in acute diffuse peritonitis (ADP), acute intestinal obstruction (AIO) with acute pancreatitis (AP).
In the experimental study, in terms of ADP, AIO and AP marked a significant disorders in the LPO/AOP system ratio, which was reflected in the activation of lipid peroxidation and reduced antioxidant activity, and have been demonstrating the failure of endogenous metabolic and cellular defense mechanisms.

Background Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. Methods A retrospective review of complicated appendicitis managed surgically by... more

Background Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. Methods A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions. Results One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days). Conclusions The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

In experiments on 126 Wistar white male rats was determined that leukocyte sequestration is one of a major pathogenetic mechanisms of acute lung injury in acute diffuse peritonitis (ADP). We established that coefficient of the lung... more

In experiments on 126 Wistar white male rats was determined that leukocyte sequestration is one of a major
pathogenetic mechanisms of acute lung injury in acute diffuse peritonitis (ADP). We established that coefficient of
the lung leukocytes regulation proposed by us is a sensitive marker of lung injury, that was confirmed by indices of
the phagocitic activity immediately after the early stages of research. It has been established that after ADP
induction was noticed progressive endogenous intoxication with inhibition of antioxidant protection for 24 hours
with further exhaustion after the first day of experiment. The use of antioxidant Сeruloplasmin correction therapy
significantly reduces acute lung neutrophile injury.
Keywords: acute lung injury, leukocytes, peritonitis, ceruloplasmin.

Although many studies have shown beneficial effects of SDD on the incidence of respiratory tract infections, SDD did not become routine practice because mortality reduction was not demonstrated in individual trials, beneficial effects on... more

Although many studies have shown beneficial effects of SDD on the incidence of respiratory tract infections, SDD did not become routine practice because mortality reduction was not demonstrated in individual trials, beneficial effects on duration of ventilation, ICU stay or hospital stay were not demonstrated, cost-efficacy had not been demonstrated, and selection of antibiotic resistance was considered a serious side-effect.

In experiments on male white rats studied in dynamics (1, 12, 24 and 48 h) by cytochemical method metabolic and phagocytic activity of neutrophils in blood and bronchoalveolar lavage in case of acute peritonitis. Found that endogenous... more

In experiments on male white rats studied in dynamics (1, 12, 24 and 48 h) by cytochemical method metabolic and phagocytic activity of neutrophils in blood and bronchoalveolar lavage in case of acute peritonitis. Found that endogenous intoxication is accompanied by intensive activation of neutrophils during the first hour, followed by their significant inhibition.
Key words: neutrophils, acute peritonitis, lungs.

Background Colorectal anastomotic leakage is a serious complication leading to major postoperative morbidity and mortality. In the present study, we investigated the early detection of anastomotic leakage before its clinical presentation.... more

Background Colorectal anastomotic leakage is a serious complication leading to major postoperative morbidity and mortality. In the present study, we investigated the early detection of anastomotic leakage before its clinical presentation. Method Fifty-six patients with rectal cancer were included prospectively in this study. All patients underwent elective low anterior resection. Peritoneal samples were collected from the abdominal drains at the first, third, and fifth days postoperatively for bacteriological study (quantitative cultures for both aerobes and anaerobes) and cytokines (IL-6, IL-10, TNF) measurement. Patients were divided into two groups: those without symptomatic or clinical evidence of anastomotic leakage (AL; group 1) and those with clinical evidence of AL (group 2). Study variables included hospital stay, wound infection, operative time, blood loss, height of anastomosis, intraperitoneal cytokines, and microbiological study of peritoneal fluid. Result Clinically evident AL occurred in eight patients (14.3%) and diagnosed postoperatively on median day 6. Intraperitoneal bacterial colonization and cytokine levels were significantly higher in patients with clinical evidence of AL. Wound infection was significantly higher in anastomotic leakage group. The hospital stay for the patients with anastomotic leakage was significantly longer than those without AL (14±1.41 vs. 5.43±0.89 days). A significant difference among two groups was observed regarding operative time, blood loss, blood transfusion, and height of the anastomosis. Conclusion The peritoneal cytokines levels and intraperitoneal bacterial colonization might be an additional diagnostic tool that can support the decision making of surgeons for early detection of anastomotic leak in colorectal surgery.

Peritonitis adalah peradangan peritoneum, selaput serosa yang melapisi bagian dari rongga perut B. ETIOLOGI Peritonitis biasanya disebabkan oleh Penyebaran infeksi dari organ perut yang terinfeksi. Yang paling sering menyebabkan... more

Peritonitis adalah peradangan peritoneum, selaput serosa yang melapisi bagian dari rongga perut B. ETIOLOGI Peritonitis biasanya disebabkan oleh Penyebaran infeksi dari organ perut yang terinfeksi. Yang paling sering menyebabkan peritonitis adalah perforasi lambung, kandung empedu, usus buntu, asites (dimana cairan berkumpul di perut dan kemudian mengalami infeksi) Peritonitis dapat terjadi setelah suatu pembedahan. Cedera pada kantung empedu, ureter, kandung kemih, atau usus selama pembedahan dapat memindahkan bakteri ke dalam perut Trauma tembus dapat mengakibatkan peritonitis sampai dengan sepsis bila mengenai organ yang berongga intra peritoneal. Usus merupakan organ yang paling sering terkena pada luka tembus abdomen, sebab usus mengisi sebagian besar rongga abdomen Peritonitis mekonium dapat terjadi jika ada defek pada dinding usus pada masa antenatal C. PATOFISIOLOGI Peradangan peritoneum merupakan komplikasi berbahaya yang sering terjadi akibat penyebaran infeksi dari organ – organ abdomen (misalnya: apendisitis, salpingitis), rupture saluran cerna atau dari luka tembus abdomen. Organisme yang sering menginfeksi adalah organisme yang hidup dalam kolon pada kasus ruptur apendiks, sedangkan stafilokok dan streptokok sering masuk dari luar. Reaksi awal peritoneum terhadap invasi oleh bakteri adalah keluarnya eksudat fibrinosa. Abses terbentuk di antara perlekatan fibrinosa, yang menempel menjadi satu dengan permukaan sekitarnya sehingga membatasi infeksi. Perlekatan biasanya menghilang bila infeksi menghilang, tetapi dapat menetap sebagai pita – pita fibrosa, yang kelak dapat mengakibatkan obstruksi usus9. Bila bahan yang menginfeksi tersebar luas pada permukaan peritoneum atau bila infeksi menyebar, dapat timbul peritonitis umum. Dengan perkembangan peritonitis umum, aktifitas peristaltik berkurang, usus kemudian menjadi atoni dan meregang. Cairan dan elektrolit hilang ke dalam lumen usus, mengakibatkan dehidrasi, syok, gangguan sirkulasi, dan oliguria. Perlekatan dapat terbentuk antara lengkung – lengkung usus yang meregang dan dapat mengganggu pulihnya pergerakan usus dan mengakibatkan obstruksi usus. Peritonitis mekonium adalah peritonitis non bakterial yang berasal dari mekonium yang keluar melalui defek pada dinding usus ke dalam rongga peritoneum. Defek dinding usus dapat tertutup sendiri sebagai reaksi peritoneal. Bercak perkapuran dapat terjadi dalam waktu 24 jam .