Although endoscopic ultrasound(EUS)-guided drainage has become the standard procedure for pancreatic pseudocysts in recent years and is generally regarded as a safe and effective method,there have been few reports of ...Although endoscopic ultrasound(EUS)-guided drainage has become the standard procedure for pancreatic pseudocysts in recent years and is generally regarded as a safe and effective method,there have been few reports of EUS-guided drainage of postoperative intra-abdominal abscesses.Here we report our experience with 4 cases of postoperative intraabdominal abscesses for which EUS-guided drainage was performed between May 2011 and May 2014.Distal pancreatectomy had been performed in 3 cases,whereas low anterior resection for rectal cancer was performed in the remaining case.All patients underwent transgastric naso-cystic drainage,which resulted in clinical improvement without complications,even when performed within 4 wk after surgery.On average,the naso-cystic drain was removed 10 d after placement,with no abscess recurrence.Based on these findings,we believe that EUS-guided drainage of postoperative intraabdominal abscesses is a safe and effective method,although further large-scale investigations are required to confirm our findings.展开更多
Although rare, infection with Streptococcus anginosus has a known predilection for abscess formation. We report here a case of a 20 year-old, otherwise healthy female patient noted to have developed abdominal and pelv...Although rare, infection with Streptococcus anginosus has a known predilection for abscess formation. We report here a case of a 20 year-old, otherwise healthy female patient noted to have developed abdominal and pelvic abscesses secondary to Streptococcus anginosus infection. Although the inciting focus of the pathogen remains unclear in our patient, this case report emphasizes the importance of rapid identification of the organism and highlights the approach to therapeutic options in the management of such cases.展开更多
Intra-abdominal abscess and an intractable abdominal wall sinus forty years after splenectomy is rare, which has not been described previously in the surgical literature. We report the management of a patient who had ...Intra-abdominal abscess and an intractable abdominal wall sinus forty years after splenectomy is rare, which has not been described previously in the surgical literature. We report the management of a patient who had presented with an intractable sinus on his left hypochondrium forty years after having undergone splenectomy and cholecystectomy, which persisted for more than two years despite repeated surgery and courses of antibiotics and compromised quality of life significantly from pain. A sinogram and computerised tomographic scan followed by exploration and laying open of the sinus delivered multiple silk sutures used for ligation of splenic pedicle, led to complete resolution of the sinus. It is important to avoid using non-absorbable silk sutures during splenectomy when splenectomy is undertaken in a contaminated field. Appropriate imaging and exploration is mandatory for its resolution.展开更多
Purpose: Catheter drainage of intra-abdominal abscesses has shown to be effective in reducing sepsis and mortality. We sought to determine whether or not tissue plasminogen activator (tPA), a fibrinolytic, is safe and...Purpose: Catheter drainage of intra-abdominal abscesses has shown to be effective in reducing sepsis and mortality. We sought to determine whether or not tissue plasminogen activator (tPA), a fibrinolytic, is safe and facilitates resolution when used as an adjunct during drainage of intra-abdo-minal abscesses. Methods: A single-blinded, prospective, multi-center, randomized control trial was performed on patients presenting with image confirmed abscesses;the first group (n = 24) received catheter-directed tPA of their abscess and the second group (n = 23) had their abscess drained without tPA instillation. Variables examined included patient age, gender, location of the abscess, pre-drainage volumes and size of catheters inserted. Baseline variables were compared between tPA and non-tPA groups using a chi-square test for discrete variables and a Wilcoxon rank sum test for continuous variables and for the outcome of drainage volume. Results: Technical success of the drainage procedures was 100% for both groups. The tPA group had higher volume of drainage over the first three days (median for total after 3 days: without tPA: 300 mL vs. with tPA: 322 mL, p = 0.42). At days 4 to 7 the tPA group had significant greater drainage volume than did the non-tPA patient group, 150 mL vs. 110 mL (p = 0.046). The number of days to resume diet was also assessed in the 20 patients where this datum was available, 11 tPA and 9 non-tPA with no difference between groups. No adverse events, such as localized or systemic bleeding were encountered. Conclusion: Instillation of tPA into catheter directed intra-abdominal abscesses was safe, easy to perform and was associated with significantly improved drainage of abscesses from days 4 -7.展开更多
BACKGROUND Colorectal cancer(CRC)has one of the highest morbidity and mortality rates among digestive tract tumors.Intra-abdominal infection(IAI)is a common postoperative complication that affects the clinical outcome...BACKGROUND Colorectal cancer(CRC)has one of the highest morbidity and mortality rates among digestive tract tumors.Intra-abdominal infection(IAI)is a common postoperative complication that affects the clinical outcomes of patients with CRC and hinders their rehabilitation process.However,the factors influencing abdominal infection after CRC surgery remain unclear;further,prediction models are rarely used to analyze preoperative laboratory indicators and postoperative complications.AIM To explore the predictive value of preoperative blood markers for IAI after radical resection of CRC.METHODS The data of 80 patients who underwent radical resection of CRC in the Anorectal Surgery Department of Suzhou Hospital affiliated with Anhui Medical University were analyzed.These patients were categorized into IAI(n=15)and non-IAI groups(n=65)based on whether IAI occurred.Influencing factors were compared;general data and laboratory indices of both groups were identified.The relationship between the indicators was assessed.Further,a nomogram prediction model was developed and evaluated;its utility and clinical applic-ability were assessed.RESULTS The risk factors for IAI after radical resection of CRC were neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and carcinoembryonic antigen(CEA)levels.NLR was correlated with PLR and SII(r=0.604,0.925,and 0.305,respectively),while PLR was correlated with SII(r=0.787).The nomogram prediction model demonstrated an area under the curve of 0.968[95%confidence interval(CI):0.948-0.988]in the training set(n=60)and 0.926(95%CI:0.906-0.980)in the validation set(n=20).The average absolute errors of the calibration curves for the training and validation sets were 0.032 and 0.048,respectively,indicating a good model fit.The decision curve analysis curves demonstrated high net income above the 5%threshold,indicating the clinical practicality of the model.CONCLUSION The nomogram model constructed using NLR,PLR,SII,and CEA levels had good accuracy and reliability in predicting IAI after radical resection of CRC,potentially aiding clinical treatment decision-making.展开更多
BACKGROUND Pancreatic trauma(PT)is rare among traumatic injuries and has a low incidence,but it can still lead to severe infectious complications,resulting in a high mortality rate.Acute pancreatitis(AP)is a common co...BACKGROUND Pancreatic trauma(PT)is rare among traumatic injuries and has a low incidence,but it can still lead to severe infectious complications,resulting in a high mortality rate.Acute pancreatitis(AP)is a common complication after PT,and when combined with organ dysfunction and sepsis,it will result in a poorer prognosis.CASE SUMMARY We report a 25-year-old patient with multiple organ injuries,including the pancreas,due to abdominal trauma,who developed necrotising pancreatitis secondary to emergency caesarean section,combined with intra-abdominal infection(IAI).The patient underwent performed percutaneous drainage,pancreatic necrotic tissue debridement,and abdominal infection foci debridement on the patient.CONCLUSION We report a case of severe AP and IAI secondary to trauma.This patient was managed by a combination of conservative treatment such as antibiotic therapy and fluid support with surgery,and a better outcome was obtained.展开更多
We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting...We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.展开更多
Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of r...Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of rupture is linked to the volume of the malformation, its cortical location and venous drainage. In literature, few cases of rupture have been reported in cases of meningitis, but none are associated with a brain abscess. Objective: To report a case of an intraparenchymal hemorrhage due to rupture of an arteriovenous malformation with an associated brain abscess. Observation: The authors report the case of a 2-year-old child, admitted for impaired state of consciousness associated with a right hemiparesis and seizures in a febrile context. Clinical evaluation revealed a Blantyre score of 3, fever at 40˚C, divergent strabismus of the right eye, a right pyramidal syndrome and meningeal irritative syndrome. Cerebral CT scan revealed a left fronto-parietal intra-parenchymal hematoma and a right occipital ring-enhanced lesion, suggesting a brain abscess. An MRI suggested a probable rupture of an arteriovenous malformation resulting in the intra-parenchymal hematoma. Management consisted of craniotomy to evacuate the intra-parenchymal hematoma, antibiotic therapy with vancomycin and ceftriaxone at meningeal doses. Histopathological analysis of the intraoperative sample revealed an arteriovenous malformation. The postoperative course was marked by regression of hyperthermia, persistence of spasticity, irritability and clonic movement of the right lower limb. These were managed with baclofen, phenobarbital, and ergotherapy. We observed a regression of spasticity and improved motor skills in the right limbs. At 6 months follow-up, child could interact with his social environment despite aphasia, regression of spasticity and right hemiparesis. Conclusion: Rupture of arteriovenous malformations can be enhanced by neuro-meningeal infections and particularly brain abscesses. Cerebrovascular complications of these conditions mostly have unfavorable outcomes and neurological sequelae.展开更多
This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incid...This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.展开更多
BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate th...BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.展开更多
BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in d...BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.展开更多
BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complicati...BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment.This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body,focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.CASE SUMMARY A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia.Initial evaluation revealed hemodynamic stability and a tender,non-mucosal lesion in the anterior left rectal region.Imaging studies,including colonoscopy,magnetic resonance imaging,and endosonography,identified an erythematous,exophytic lesion and a perirectal abscess containing a foreign body.Surgical inter-vention revealed necrotic tissue and purulent material,along with two solid foreign body fragments(bone or plant matter).Postoperative follow-up showed the patient in good condition,and pathology confirmed the fragments as mature bone.CONCLUSION This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.展开更多
BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to...BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.展开更多
Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deteriora...Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.展开更多
AIM: To systematically review evidence on pathophysiology of intra-abdominal pressure(IAP) in acute pancreatitis(AP) with its clinical correlates. METHODS: Systematic review of available evidence in English literature...AIM: To systematically review evidence on pathophysiology of intra-abdominal pressure(IAP) in acute pancreatitis(AP) with its clinical correlates. METHODS: Systematic review of available evidence in English literature with relevant medical subject heading terms on Pub Med, Medline and Scopus with further search from open access sources on internet as suggested by articles retrieved. RESULTS: Intra-abdominal hypertension(IAH) is increasingly gaining recognition as a point of specific intervention with potential to alter disease outcome and improve mortality in AP. IAH can be expected in at least 17% of patients presenting with diagnosis of AP to a typical tertiary care hospital(prevalence increasing to 50% in those with severe disease). Abdominal compartment syndrome can be expected in at least 15% patients with severe disease. Recent guidelines on management of AP do not acknowledge utility of surveillance for IAP other than those by Japanese Society of Hepato-BiliaryPancreatic Surgery. We further outline pathophysiologic mechanisms of IAH; understanding of which advances our knowledge and helps to coherently align common observed variations in management related conundrums(such as fluid therapy, nutrition and antibiotic prophylaxis) with potential to further individualize treatment in AP. CONCLUSION: We suggest that IAP be given its due place in future practice guidelines and that recommendations be formed with help of a broader panel with inclusion of clinicians experienced in management of IAH.展开更多
AIM: To evaluate the impact of postoperative infectious complications on hepatocellular carcinoma following curative hepatectomy.METHODS:We performed a retrospective analysis of200 hepatocellular carcinoma patients wh...AIM: To evaluate the impact of postoperative infectious complications on hepatocellular carcinoma following curative hepatectomy.METHODS:We performed a retrospective analysis of200 hepatocellular carcinoma patients who underwent hepatectomy at our institution between September2003 and June 2011.The patients’demographics,clinicopathological characteristics and postoperative infectious complications were analyzed.The ClavienDindo classification was adopted to assess the severity of complications.The dynamic change in the neutrophilto-lymphocyte ratio,defined as the absolute neutrophil count divided by the absolute lymphocyte count,after surgery was also investigated.The observation endpoints for this study were recurrence-free survival and overall survival of the patients.Statistical analysis of the survival curves was performed using the KaplanMeier method and the log-rank test.The prognosticvalue of each variable for predicting prognosis was assessed via multivariate Cox proportional hazards regression analysis.The cutoff score for each variable was selected based on receiver operating characteristic curve analysis.All statistical tests were two-sided,and significance was set at P<0.05.RESULTS:The median age of the patients was 49years,and the majority of patients were male(86%)and had been infected with hepatitis B virus(86%).The 30-d postoperative infectious complication rate was34.0%(n=68).Kaplan-Meier survival analysis revealed that postoperative infection was significantly correlated with tumor recurrence(P<0.001).The postoperative intra-abdominal infection group exhibited a worse prognosis than the non-intra-abdominal infection group(P<0.001).A significantly increased incidence of postoperative intra-abdominal infection was observed in the patients with hepatic cirrhosis(P=0.028),concomitant splenectomy(P=0.007)or vascular invasion(P=0.026).The patients who had an elevated postoperative neutrophil-to-lymphocyte ratio change(>1.643)clearly exhibited poorer recurrence-free survival than those who did not(P=0.009),although no significant correlation was observed between overall survival and the change in the postoperative neutrophilto-lymphocyte ratio.Based on multivariate analysis,hepatitis B surface antigen positivity,Child-TurcottePugh class B,an elevated postoperative neutrophilto-lymphocyte ratio change and intra-abdominal infection were significant predictors of poor recurrencefree survival.Hepatic cirrhosis,the maximal tumor diameter and intra-abdominal infection were significant predictors of overall survival.CONCLUSION:Postoperative intra-abdominal infection adversely affected oncologic outcomes,and the change in postoperative neutrophil-to-lymphocyte ratio was a good indicator of tumor recurrence in hepatocellular carcinoma patients after curative hepatectomy.展开更多
Background:Intra-abdominal hypertension(IAH) is a disease with high morbidity and mortality among critically ill patients.The study's objectives were to explore the prevalence of IAH and physicians' awareness ...Background:Intra-abdominal hypertension(IAH) is a disease with high morbidity and mortality among critically ill patients.The study's objectives were to explore the prevalence of IAH and physicians' awareness of the 2013 World Society of Abdominal Compartment Syndrome(WSACS) guidelines in Chinese intensive care units(ICUs).Methods:A cross-sectional study of four ICUs in Southwestern China was conducted from June 17 to August 2,2014.Adult patients admitted to the ICU for more than 24 h,with bladder catheter but without obvious intravesical pressure(IVP) measurement contraindications,were recruited.Intensivists with more than 5 years of ICU working experience were also recruited.Epidemiological information,potential IAH risk factors,IVP measurements and questionnaire results were recorded.Results:Forty-one patients were selected.Fifteen(36.59%) had IVP?12mm Hg.SOFA(Sequential Organ Failure Assessment) hepatic and neurological sub-scores were utilized as independent predictors for IAH via logistic backward analysis.Thirty-seven intensivists participated in the survey(response rate:80.43%).The average score of each center was less than 35 points.All physicians believed the IAH prevalence in their departments was no more than 20.00%.A significant negative correlation was observed between the intensivists' awareness of the 2013 WSACS guidelines and the IAH prevalence in each center(r=-0.975,P=0.025).Conclusion:The prevalence and independent predictors of IAH among the surveyed population are similar to the reports in the literature.Intensivists generally have a low awareness of the 2013 WSACS guidelines.A systematic guideline training program is vital for improving the efficiency of the diagnosis and treatment of IAH.展开更多
Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecess...Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial use.Two sets of guidelines for the management of intra-abdominal infections were recently published.In 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA) created guidelines for the diagnosis and management of complicated IAIs.The new SIS-IDSA guidelines replace those previously published in 2002 and 2003.The World Society of Emergency Surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug methodology.These guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.展开更多
BACKGROUND: Severe acute pancreatitis (SAP) is a serious disease with many complications, high mortality and poor prognosis. It is characterized by rapid deterioration and poses one of the most difficult challenges in...BACKGROUND: Severe acute pancreatitis (SAP) is a serious disease with many complications, high mortality and poor prognosis. It is characterized by rapid deterioration and poses one of the most difficult challenges in clinical practice. Previous investigations suggest that SAP is one of the main causes of intra-abdominal pressure (IAP) increase. The aim of this study was to evaluate the utility of IAP-monitoring in predicting the severity and prognosis of SAP. METHODS: Eighty-nine patients with SAP who had been treated from February 2001 to December 2005 were studied. Since bladder pressure accurately reflects IAP, we measured it instead of IAP. Bladder pressure was measured at the time of admission and every 12 hours in the course of the disease, 9 consecutive times in all. The APACHE II scores of all patients were obtained within 24 hours after admission. According to a maximum bladder pressure <10 cmH(2)O, all patients were divided into two groups, mildly-elevated and severely-elevated. Mortality and mean APACHE II scores in the two groups were calculated. In addition, the mean bladder pressure and APACHE II scores in survivors were compared with those in deaths. RESULTS: Sixty-eight of the 89 patients were in the severely-elevated group. Mortality and mean APACHE II scores in this group were much higher than those in the mildly-elevated group (mortality, 39.71% vs. 9.52%; mean APACHE II score, 23.15 +/- 7.42 vs. 15.95 +/- 5.35, P<0.01). The mean bladder pressures and APACHE II scores in deaths were significantly greater than those in survivors (mean bladder pressure, 14.1 +/- 3.8 vs. 9.2 +/- 2.3 cmH(2)O, P<0.01; mean APACHE II score, 27.83 +/- 4.87 vs. 18.37 +/- 6.74, P<0.01). CONCLUSION: It is suggested that IAP may be used as a marker of the severity and prognosis of SAP.展开更多
Background: To investigate the effect of intra-abdominal volume increment(IAVI) on intra-abdominal hypertension(IAH) in the kidneys.Methods: Eight minipigs were successfully established as IAH models and were randomly...Background: To investigate the effect of intra-abdominal volume increment(IAVI) on intra-abdominal hypertension(IAH) in the kidneys.Methods: Eight minipigs were successfully established as IAH models and were randomly divided into two groups: the IAVI group and the sham-operated group. The intravesical pressure, inferior vena cava pressure and urine volume were measured before shock, 2 h after IAH, and 22 h after surgery, respectively. The following indices were measured: serum creatinine, urea nitrogen, renal cortical thickness, ratio of abdominal anteroposterior diameter/transverse diameter, renal thickness, diameter of the renal sinus and the wet/dry ratio of renal tissues.Results: The intravesical pressure(IVP) of the 8 minipig IAH models was calculated to be 21.16±4.63 mmHg. There was a significant increase in the abdominal anteroposterior diameter/transverse diameter ratio. The minipigs in the IAVI group survived during the observational period, whereas 2 minipigs died at 18 h and 20 h in the sham-operated group. Twenty-two hours after surgery, the animals in the IAVI group displayed increased urinary volume(UV) and decreased Cr and Ur and remarkable decreases of VP and IVCP. After IAH, the renal cortical thickness and the renal thickness increased significantly. The renal wet/dry ratio in the sham-operated group was higher than that in the IAVI group.Conclusion: IAVI helps to control renal dysfunction after IAH, which may be related to lowering the intra-abdominal pressure, thus alleviating renal edema and blood stasis.展开更多
文摘Although endoscopic ultrasound(EUS)-guided drainage has become the standard procedure for pancreatic pseudocysts in recent years and is generally regarded as a safe and effective method,there have been few reports of EUS-guided drainage of postoperative intra-abdominal abscesses.Here we report our experience with 4 cases of postoperative intraabdominal abscesses for which EUS-guided drainage was performed between May 2011 and May 2014.Distal pancreatectomy had been performed in 3 cases,whereas low anterior resection for rectal cancer was performed in the remaining case.All patients underwent transgastric naso-cystic drainage,which resulted in clinical improvement without complications,even when performed within 4 wk after surgery.On average,the naso-cystic drain was removed 10 d after placement,with no abscess recurrence.Based on these findings,we believe that EUS-guided drainage of postoperative intraabdominal abscesses is a safe and effective method,although further large-scale investigations are required to confirm our findings.
文摘Although rare, infection with Streptococcus anginosus has a known predilection for abscess formation. We report here a case of a 20 year-old, otherwise healthy female patient noted to have developed abdominal and pelvic abscesses secondary to Streptococcus anginosus infection. Although the inciting focus of the pathogen remains unclear in our patient, this case report emphasizes the importance of rapid identification of the organism and highlights the approach to therapeutic options in the management of such cases.
文摘Intra-abdominal abscess and an intractable abdominal wall sinus forty years after splenectomy is rare, which has not been described previously in the surgical literature. We report the management of a patient who had presented with an intractable sinus on his left hypochondrium forty years after having undergone splenectomy and cholecystectomy, which persisted for more than two years despite repeated surgery and courses of antibiotics and compromised quality of life significantly from pain. A sinogram and computerised tomographic scan followed by exploration and laying open of the sinus delivered multiple silk sutures used for ligation of splenic pedicle, led to complete resolution of the sinus. It is important to avoid using non-absorbable silk sutures during splenectomy when splenectomy is undertaken in a contaminated field. Appropriate imaging and exploration is mandatory for its resolution.
文摘Purpose: Catheter drainage of intra-abdominal abscesses has shown to be effective in reducing sepsis and mortality. We sought to determine whether or not tissue plasminogen activator (tPA), a fibrinolytic, is safe and facilitates resolution when used as an adjunct during drainage of intra-abdo-minal abscesses. Methods: A single-blinded, prospective, multi-center, randomized control trial was performed on patients presenting with image confirmed abscesses;the first group (n = 24) received catheter-directed tPA of their abscess and the second group (n = 23) had their abscess drained without tPA instillation. Variables examined included patient age, gender, location of the abscess, pre-drainage volumes and size of catheters inserted. Baseline variables were compared between tPA and non-tPA groups using a chi-square test for discrete variables and a Wilcoxon rank sum test for continuous variables and for the outcome of drainage volume. Results: Technical success of the drainage procedures was 100% for both groups. The tPA group had higher volume of drainage over the first three days (median for total after 3 days: without tPA: 300 mL vs. with tPA: 322 mL, p = 0.42). At days 4 to 7 the tPA group had significant greater drainage volume than did the non-tPA patient group, 150 mL vs. 110 mL (p = 0.046). The number of days to resume diet was also assessed in the 20 patients where this datum was available, 11 tPA and 9 non-tPA with no difference between groups. No adverse events, such as localized or systemic bleeding were encountered. Conclusion: Instillation of tPA into catheter directed intra-abdominal abscesses was safe, easy to perform and was associated with significantly improved drainage of abscesses from days 4 -7.
基金Supported by Suzhou Health Scientific Research Project,No.SZWJ2022a001.
文摘BACKGROUND Colorectal cancer(CRC)has one of the highest morbidity and mortality rates among digestive tract tumors.Intra-abdominal infection(IAI)is a common postoperative complication that affects the clinical outcomes of patients with CRC and hinders their rehabilitation process.However,the factors influencing abdominal infection after CRC surgery remain unclear;further,prediction models are rarely used to analyze preoperative laboratory indicators and postoperative complications.AIM To explore the predictive value of preoperative blood markers for IAI after radical resection of CRC.METHODS The data of 80 patients who underwent radical resection of CRC in the Anorectal Surgery Department of Suzhou Hospital affiliated with Anhui Medical University were analyzed.These patients were categorized into IAI(n=15)and non-IAI groups(n=65)based on whether IAI occurred.Influencing factors were compared;general data and laboratory indices of both groups were identified.The relationship between the indicators was assessed.Further,a nomogram prediction model was developed and evaluated;its utility and clinical applic-ability were assessed.RESULTS The risk factors for IAI after radical resection of CRC were neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and carcinoembryonic antigen(CEA)levels.NLR was correlated with PLR and SII(r=0.604,0.925,and 0.305,respectively),while PLR was correlated with SII(r=0.787).The nomogram prediction model demonstrated an area under the curve of 0.968[95%confidence interval(CI):0.948-0.988]in the training set(n=60)and 0.926(95%CI:0.906-0.980)in the validation set(n=20).The average absolute errors of the calibration curves for the training and validation sets were 0.032 and 0.048,respectively,indicating a good model fit.The decision curve analysis curves demonstrated high net income above the 5%threshold,indicating the clinical practicality of the model.CONCLUSION The nomogram model constructed using NLR,PLR,SII,and CEA levels had good accuracy and reliability in predicting IAI after radical resection of CRC,potentially aiding clinical treatment decision-making.
基金Supported by China Medical and Health Development Foundation,Young and Middle-aged Doctors Excellent Talent,Pei Ying Program,No.BJ2023YCPYJH003Tianjin Nankai Hospital integrated Traditional Chinese and Western Medicine Prevention and Treatment Key Technology and Program Optimization 2022 Key Project,No.NKYY-IIT-2022-009-2+3 种基金Tianjin Key Areas of Traditional Chinese Medicine Science and Technology Project,No.2022005Tianjin Natural Science Foundation Key ProjectTianjin Administration of Traditional Chinese Medicine Fund of Traditional Chinese and Western Medicine Integrated Research Project,No.2021006Tianjin 131 Innovative Talent Team,Innovation Team for Diagnosis and Treatment of Acute Abdomen Related to Biliary and Pancreatic Diseases,No.201938.
文摘BACKGROUND Pancreatic trauma(PT)is rare among traumatic injuries and has a low incidence,but it can still lead to severe infectious complications,resulting in a high mortality rate.Acute pancreatitis(AP)is a common complication after PT,and when combined with organ dysfunction and sepsis,it will result in a poorer prognosis.CASE SUMMARY We report a 25-year-old patient with multiple organ injuries,including the pancreas,due to abdominal trauma,who developed necrotising pancreatitis secondary to emergency caesarean section,combined with intra-abdominal infection(IAI).The patient underwent performed percutaneous drainage,pancreatic necrotic tissue debridement,and abdominal infection foci debridement on the patient.CONCLUSION We report a case of severe AP and IAI secondary to trauma.This patient was managed by a combination of conservative treatment such as antibiotic therapy and fluid support with surgery,and a better outcome was obtained.
文摘We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.
文摘Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of rupture is linked to the volume of the malformation, its cortical location and venous drainage. In literature, few cases of rupture have been reported in cases of meningitis, but none are associated with a brain abscess. Objective: To report a case of an intraparenchymal hemorrhage due to rupture of an arteriovenous malformation with an associated brain abscess. Observation: The authors report the case of a 2-year-old child, admitted for impaired state of consciousness associated with a right hemiparesis and seizures in a febrile context. Clinical evaluation revealed a Blantyre score of 3, fever at 40˚C, divergent strabismus of the right eye, a right pyramidal syndrome and meningeal irritative syndrome. Cerebral CT scan revealed a left fronto-parietal intra-parenchymal hematoma and a right occipital ring-enhanced lesion, suggesting a brain abscess. An MRI suggested a probable rupture of an arteriovenous malformation resulting in the intra-parenchymal hematoma. Management consisted of craniotomy to evacuate the intra-parenchymal hematoma, antibiotic therapy with vancomycin and ceftriaxone at meningeal doses. Histopathological analysis of the intraoperative sample revealed an arteriovenous malformation. The postoperative course was marked by regression of hyperthermia, persistence of spasticity, irritability and clonic movement of the right lower limb. These were managed with baclofen, phenobarbital, and ergotherapy. We observed a regression of spasticity and improved motor skills in the right limbs. At 6 months follow-up, child could interact with his social environment despite aphasia, regression of spasticity and right hemiparesis. Conclusion: Rupture of arteriovenous malformations can be enhanced by neuro-meningeal infections and particularly brain abscesses. Cerebrovascular complications of these conditions mostly have unfavorable outcomes and neurological sequelae.
文摘This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.
文摘BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.
基金Supported by Suqian Science and Technology Project Contract,No.S201910。
文摘BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.
文摘BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment.This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body,focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.CASE SUMMARY A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia.Initial evaluation revealed hemodynamic stability and a tender,non-mucosal lesion in the anterior left rectal region.Imaging studies,including colonoscopy,magnetic resonance imaging,and endosonography,identified an erythematous,exophytic lesion and a perirectal abscess containing a foreign body.Surgical inter-vention revealed necrotic tissue and purulent material,along with two solid foreign body fragments(bone or plant matter).Postoperative follow-up showed the patient in good condition,and pathology confirmed the fragments as mature bone.CONCLUSION This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.
文摘BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.
文摘Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.
文摘AIM: To systematically review evidence on pathophysiology of intra-abdominal pressure(IAP) in acute pancreatitis(AP) with its clinical correlates. METHODS: Systematic review of available evidence in English literature with relevant medical subject heading terms on Pub Med, Medline and Scopus with further search from open access sources on internet as suggested by articles retrieved. RESULTS: Intra-abdominal hypertension(IAH) is increasingly gaining recognition as a point of specific intervention with potential to alter disease outcome and improve mortality in AP. IAH can be expected in at least 17% of patients presenting with diagnosis of AP to a typical tertiary care hospital(prevalence increasing to 50% in those with severe disease). Abdominal compartment syndrome can be expected in at least 15% patients with severe disease. Recent guidelines on management of AP do not acknowledge utility of surveillance for IAP other than those by Japanese Society of Hepato-BiliaryPancreatic Surgery. We further outline pathophysiologic mechanisms of IAH; understanding of which advances our knowledge and helps to coherently align common observed variations in management related conundrums(such as fluid therapy, nutrition and antibiotic prophylaxis) with potential to further individualize treatment in AP. CONCLUSION: We suggest that IAP be given its due place in future practice guidelines and that recommendations be formed with help of a broader panel with inclusion of clinicians experienced in management of IAH.
基金Supported by National Natural Science Foundation of China,No.81372374 and No.81000959the Combination Project of Production,Education and Research from Guangdong Province and Ministry of Education,No.2012B091100460Science and Technology Planning Project of Guangdong Province,No.2009B030801007
文摘AIM: To evaluate the impact of postoperative infectious complications on hepatocellular carcinoma following curative hepatectomy.METHODS:We performed a retrospective analysis of200 hepatocellular carcinoma patients who underwent hepatectomy at our institution between September2003 and June 2011.The patients’demographics,clinicopathological characteristics and postoperative infectious complications were analyzed.The ClavienDindo classification was adopted to assess the severity of complications.The dynamic change in the neutrophilto-lymphocyte ratio,defined as the absolute neutrophil count divided by the absolute lymphocyte count,after surgery was also investigated.The observation endpoints for this study were recurrence-free survival and overall survival of the patients.Statistical analysis of the survival curves was performed using the KaplanMeier method and the log-rank test.The prognosticvalue of each variable for predicting prognosis was assessed via multivariate Cox proportional hazards regression analysis.The cutoff score for each variable was selected based on receiver operating characteristic curve analysis.All statistical tests were two-sided,and significance was set at P<0.05.RESULTS:The median age of the patients was 49years,and the majority of patients were male(86%)and had been infected with hepatitis B virus(86%).The 30-d postoperative infectious complication rate was34.0%(n=68).Kaplan-Meier survival analysis revealed that postoperative infection was significantly correlated with tumor recurrence(P<0.001).The postoperative intra-abdominal infection group exhibited a worse prognosis than the non-intra-abdominal infection group(P<0.001).A significantly increased incidence of postoperative intra-abdominal infection was observed in the patients with hepatic cirrhosis(P=0.028),concomitant splenectomy(P=0.007)or vascular invasion(P=0.026).The patients who had an elevated postoperative neutrophil-to-lymphocyte ratio change(>1.643)clearly exhibited poorer recurrence-free survival than those who did not(P=0.009),although no significant correlation was observed between overall survival and the change in the postoperative neutrophilto-lymphocyte ratio.Based on multivariate analysis,hepatitis B surface antigen positivity,Child-TurcottePugh class B,an elevated postoperative neutrophilto-lymphocyte ratio change and intra-abdominal infection were significant predictors of poor recurrencefree survival.Hepatic cirrhosis,the maximal tumor diameter and intra-abdominal infection were significant predictors of overall survival.CONCLUSION:Postoperative intra-abdominal infection adversely affected oncologic outcomes,and the change in postoperative neutrophil-to-lymphocyte ratio was a good indicator of tumor recurrence in hepatocellular carcinoma patients after curative hepatectomy.
基金supported by the grants from Program of China"Research of New Technology for Trauma Care and Integrated Demonstration"(2012BAI11B01)
文摘Background:Intra-abdominal hypertension(IAH) is a disease with high morbidity and mortality among critically ill patients.The study's objectives were to explore the prevalence of IAH and physicians' awareness of the 2013 World Society of Abdominal Compartment Syndrome(WSACS) guidelines in Chinese intensive care units(ICUs).Methods:A cross-sectional study of four ICUs in Southwestern China was conducted from June 17 to August 2,2014.Adult patients admitted to the ICU for more than 24 h,with bladder catheter but without obvious intravesical pressure(IVP) measurement contraindications,were recruited.Intensivists with more than 5 years of ICU working experience were also recruited.Epidemiological information,potential IAH risk factors,IVP measurements and questionnaire results were recorded.Results:Forty-one patients were selected.Fifteen(36.59%) had IVP?12mm Hg.SOFA(Sequential Organ Failure Assessment) hepatic and neurological sub-scores were utilized as independent predictors for IAH via logistic backward analysis.Thirty-seven intensivists participated in the survey(response rate:80.43%).The average score of each center was less than 35 points.All physicians believed the IAH prevalence in their departments was no more than 20.00%.A significant negative correlation was observed between the intensivists' awareness of the 2013 WSACS guidelines and the IAH prevalence in each center(r=-0.975,P=0.025).Conclusion:The prevalence and independent predictors of IAH among the surveyed population are similar to the reports in the literature.Intensivists generally have a low awareness of the 2013 WSACS guidelines.A systematic guideline training program is vital for improving the efficiency of the diagnosis and treatment of IAH.
文摘Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial use.Two sets of guidelines for the management of intra-abdominal infections were recently published.In 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA) created guidelines for the diagnosis and management of complicated IAIs.The new SIS-IDSA guidelines replace those previously published in 2002 and 2003.The World Society of Emergency Surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug methodology.These guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.
文摘BACKGROUND: Severe acute pancreatitis (SAP) is a serious disease with many complications, high mortality and poor prognosis. It is characterized by rapid deterioration and poses one of the most difficult challenges in clinical practice. Previous investigations suggest that SAP is one of the main causes of intra-abdominal pressure (IAP) increase. The aim of this study was to evaluate the utility of IAP-monitoring in predicting the severity and prognosis of SAP. METHODS: Eighty-nine patients with SAP who had been treated from February 2001 to December 2005 were studied. Since bladder pressure accurately reflects IAP, we measured it instead of IAP. Bladder pressure was measured at the time of admission and every 12 hours in the course of the disease, 9 consecutive times in all. The APACHE II scores of all patients were obtained within 24 hours after admission. According to a maximum bladder pressure <10 cmH(2)O, all patients were divided into two groups, mildly-elevated and severely-elevated. Mortality and mean APACHE II scores in the two groups were calculated. In addition, the mean bladder pressure and APACHE II scores in survivors were compared with those in deaths. RESULTS: Sixty-eight of the 89 patients were in the severely-elevated group. Mortality and mean APACHE II scores in this group were much higher than those in the mildly-elevated group (mortality, 39.71% vs. 9.52%; mean APACHE II score, 23.15 +/- 7.42 vs. 15.95 +/- 5.35, P<0.01). The mean bladder pressures and APACHE II scores in deaths were significantly greater than those in survivors (mean bladder pressure, 14.1 +/- 3.8 vs. 9.2 +/- 2.3 cmH(2)O, P<0.01; mean APACHE II score, 27.83 +/- 4.87 vs. 18.37 +/- 6.74, P<0.01). CONCLUSION: It is suggested that IAP may be used as a marker of the severity and prognosis of SAP.
基金support,in part,from the "Twelfth FiveYear Plan" Scientific and Technological Supporting Program of China (2012BAI11B00)Chongqing integrated demonstration project "Trauma Emergency Treatment and Rehabilitation Technology Platform"(cstc2013jcsfC10001)
文摘Background: To investigate the effect of intra-abdominal volume increment(IAVI) on intra-abdominal hypertension(IAH) in the kidneys.Methods: Eight minipigs were successfully established as IAH models and were randomly divided into two groups: the IAVI group and the sham-operated group. The intravesical pressure, inferior vena cava pressure and urine volume were measured before shock, 2 h after IAH, and 22 h after surgery, respectively. The following indices were measured: serum creatinine, urea nitrogen, renal cortical thickness, ratio of abdominal anteroposterior diameter/transverse diameter, renal thickness, diameter of the renal sinus and the wet/dry ratio of renal tissues.Results: The intravesical pressure(IVP) of the 8 minipig IAH models was calculated to be 21.16±4.63 mmHg. There was a significant increase in the abdominal anteroposterior diameter/transverse diameter ratio. The minipigs in the IAVI group survived during the observational period, whereas 2 minipigs died at 18 h and 20 h in the sham-operated group. Twenty-two hours after surgery, the animals in the IAVI group displayed increased urinary volume(UV) and decreased Cr and Ur and remarkable decreases of VP and IVCP. After IAH, the renal cortical thickness and the renal thickness increased significantly. The renal wet/dry ratio in the sham-operated group was higher than that in the IAVI group.Conclusion: IAVI helps to control renal dysfunction after IAH, which may be related to lowering the intra-abdominal pressure, thus alleviating renal edema and blood stasis.
