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Filipović A, Mašulović D, Bulatović D, Zakošek M, Igić A, Filipović T. Emphysematous Pancreatitis as a Life-Threatening Condition: A Case Report and Review of the Literature. Medicina (Kaunas) 2024; 60:406. [PMID: 38541132 PMCID: PMC10972193 DOI: 10.3390/medicina60030406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/09/2024]
Abstract
Emphysematous pancreatitis represents the presence of gas within or around the pancreas on the ground of necrotizing pancreatitis due to superinfection with gas-forming bacteria. This entity is diagnosed on clinical grounds and on the basis of radiologic findings. Computed tomography is the preferred imaging modality used to detect this life-threating condition. The management of emphysematous pancreatitis consists of conservative measures, image-guided percutaneous catheter drainage or endoscopic therapy, and surgical intervention, which is delayed as long as possible and undertaken only in patients who continue to deteriorate despite conservative management. Due to its high mortality rate, early and prompt recognition and treatment of emphysematous pancreatitis are crucial and require individualized treatment with the involvement of a multidisciplinary team. Here, we present a case of emphysematous pancreatitis as an unusual occurrence and discuss disease features and treatment options in order to facilitate diagnostics and therapy.
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Affiliation(s)
- Aleksandar Filipović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.F.); (D.M.); (M.Z.)
- Center for Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (D.B.); (A.I.)
| | - Dragan Mašulović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.F.); (D.M.); (M.Z.)
- Center for Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (D.B.); (A.I.)
| | - Dušan Bulatović
- Center for Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (D.B.); (A.I.)
| | - Miloš Zakošek
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.F.); (D.M.); (M.Z.)
- Center for Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (D.B.); (A.I.)
| | - Aleksa Igić
- Center for Radiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (D.B.); (A.I.)
| | - Tamara Filipović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.F.); (D.M.); (M.Z.)
- Institute for Rehabilitation, 11000 Belgrade, Serbia
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Fukunaga S, Naito Y, Hoshino Y, Oba M, Kawanishi M, Yoshikane K, Egawa M, Ito T, Tanabe K. Indications for Percutaneous Drainage in Patients with Huang Class 3B Emphysematous Pyelonephritis: A Case Report and Literature Review. Intern Med 2023; 62:2871-2876. [PMID: 36792198 PMCID: PMC10602843 DOI: 10.2169/internalmedicine.0694-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023] Open
Abstract
Emphysematous pyelonephritis (EPN) is a severe urinary tract infection common in patients with diabetes. Nephrectomy is recommended when the Huang classification is ≥3B. We herein report a case in which nephrectomy was avoided using antimicrobial agents and percutaneous drainage (PCD). A 59-year-old man was diagnosed with EPN (Huang classification 3B). The causative bacteria were Escherichia coli. Despite high-risk factors, EPN was cured with kidney preservation and PCD because the emphysema and abscess were not extensive. Thus, PCD should be considered in patients with Huang Class 3B EPN and high-risk factors if emphysema and abscess are not extensive.
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Affiliation(s)
| | - Yumi Naito
- Division of Nephrology, Shimane University Hospital, Japan
| | - Yuki Hoshino
- Division of Nephrology, Shimane University Hospital, Japan
| | - Masafumi Oba
- Division of Nephrology, Shimane University Hospital, Japan
| | | | | | - Masahiro Egawa
- Division of Nephrology, Shimane University Hospital, Japan
| | - Takafumi Ito
- Division of Nephrology, Shimane University Hospital, Japan
| | - Kazuaki Tanabe
- Department of Internal Medicine IV, Faculty of Medicine, Shimane University, Japan
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Pan N, Wang S, Miao Z. Emphysematous hepatitis with successful treatments: A rare case report. Medicine (Baltimore) 2023; 102:e32530. [PMID: 36705361 PMCID: PMC9875965 DOI: 10.1097/md.0000000000032530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE Emphysematous hepatitis (EH) is a rare and fulminant gas-forming liver infection. Only 3 patients were successfully treated. Diabetes mellitus and a history of digestive system cancer may predispose individuals to EH. Computed tomography (CT) findings support the diagnosis of EH and monitor progress. PATIENT CONCERNS A 48-year-old man with diabetes presented with nausea, vomiting (gastric contents) and diarrhea. Laboratory test results revealed elevated levels of inflammatory indicators and abnormal liver function. CT showed a large-scale air collection with some remaining parenchymal debris in the left lobe of the liver. Remarkably, no fluid was observed inside the lesion. DIAGNOSE The abdominal CT features and laboratory examination results rationalized the diagnosis of EH. INTERVENTIONS AND OUTCOMES The patient finally recovered from this severe disease through a series of effective treatments, including strict glucose control, sensitive antibiotic therapy, and subsequent percutaneous drainage. LESSONS EH generally deteriorates rapidly and eventually leads to death. This case will raise awareness of the rare and severe disease, strengthen diagnostic capacities, and provide advice to treat it.
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Affiliation(s)
- Nannan Pan
- Department of Radiology, Tianjin Medical University Baodi Clinical College: Tianjin Baodi Hospital, Tianjin, China
| | - Shuo Wang
- Department of Orthopaedic Surgery, Tianjin Medical University Baodi Clinical College: Tianjin Baodi Hospital, Tianjin, China
| | - Zhenwei Miao
- Department of Radiology, Tianjin Medical University Baodi Clinical College: Tianjin Baodi Hospital, Tianjin, China
- * Correspondence: Zhenwei Miao, Tianjin Medical University Baodi Clinical College: Tianjin Baodi Hospital, No.8 Guangchuan Road, Baodi, Tianjin 301800, China (e-mail: )
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Tan TJ, Parmar K, Mukherjee A, Sonawane P, Badrakumar C. Emphysematous cystitis: an incidental finding with varying outcomes. Ann R Coll Surg Engl 2023; 105:87-90. [PMID: 35638917 PMCID: PMC9773271 DOI: 10.1308/rcsann.2022.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/24/2022] Open
Abstract
Emphysematous cystitis (EC) is a rare severe urinary tract infection characterised by pockets of air in and around the urinary bladder wall caused by gas-forming organisms. Common predisposing factors are chronic infection, immunosuppression, diabetes and neurogenic bladder. The presentation may vary from mild illness to severe life-threatening cystitis. We report two cases of incidental detection of EC diagnosed on imaging for the evaluation of unrelated symptoms. Although asymptomatic, this lethal disease still warrants prompt recognition and treatment with broad-spectrum antibiotics and urinary bladder drainage to prevent severe morbidity and mortality.
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Affiliation(s)
- T J Tan
- South Tees Hospitals NHS Foundation Trust, UK
| | - K Parmar
- South Tees Hospitals NHS Foundation Trust, UK
| | - A Mukherjee
- South Tees Hospitals NHS Foundation Trust, UK
| | - P Sonawane
- South Tees Hospitals NHS Foundation Trust, UK
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Sánchez-Hernández CDR, Farías-Cuevas KP. [Emphysematous gastritis. Report of a case in the elderly]. Rev Med Inst Mex Seguro Soc 2022; 60:236-241. [PMID: 35759695 PMCID: PMC10396023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/14/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Emphysematous gastritis is an uncommon pathology but with high mortality, its clinical presentation is insidious, the tomography image is distinguished by a pattern of linear bubbles with thickening of the gastric wall. BACKGROUND This is a 78-year-old male, previously healthy, functional, who was admitted for pertrochanteric fracture of the left hip, who during hospitalization presented hyperactive delirium, abdominal distention with decreased perstalsis in addition to arterial hypotension, an abdominal tomography with evidence of gastric dilation and multiple air bubbles in the wall. He is managed with a broad spectrum antibiotic, fluid therapy and parenteral nutrition, with a favorable response. CONCLUSIONS Advanced age does not in itself lead to a worse disease prognosis, the evidence supports that early diagnosis and early therapeutic intervention are the measures that have proven to be more effective in reducing mortality in patients with emphysematous gastritis.
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Affiliation(s)
| | - Karla Paulina Farías-Cuevas
- Instituto Mexicano del Seguro Social, Hospital General de Zona con Medicina Familiar No. 16, Servicio de Geriatría. Torreón, Coahuila, México
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Arrambide-Herrera JG, Robles-Torres JI, Ocaña-Munguía MA, Romero-Mata R, Gutiérrez-González A, Gómez-Guerra LS. Predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis: 5-year experience in a tertiary care hospital. Actas Urol Esp 2022; 46:98-105. [PMID: 35120854 DOI: 10.1016/j.acuroe.2021.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Emphysematous pyelonephritis is a life-threatening infection of the kidney and surrounding tissues associated with a high mortality rate. The aim of this study was to determine predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis, and to propose a therapeutic algorithm based on current literature and our experience. METHODS A retrospective study was done including patients with emphysematous pyelonephritis in a single center in the north of Mexico from 2011 to 2016. Demographic, clinical, microbiological and biochemical parameters, therapeutic management, and outcomes were assessed. Factors associated with admission to intensive care unit and mortality were determined. Comparison was assessed using X2 test for categorical variables, and T-test for numerical variables. Univariate and multivariate logistic regression analyses were performed. Statistical significance was set at P < .05. RESULTS A total of 63 patients were included, of which 55 (87.3%) were females, with a mean age of 55.5 ± 12.2 years. The most common comorbidities were diabetes and hypertension. Escherichia coli was the most common isolated microorganism (51.7%) and extended-spectrum beta-lactamase-producing agents were reported in 31.7%. Conservative therapy was provided to 38.7%, double J stent 42.9%, open/percutaneous drainage 12.7%, and nephrectomy 25.3%. Overall mortality and intensive care admission were 20.6% and 36.5%, respectively. In the multivariate analysis, hemodynamic instability (P = .005), qSOFA ≥ 2 (P = .003), hypoalbuminemia (P = .02), and early nephrectomy (P = .002) were associated with intensive care admission. Huang scale 4 (P = .006) and early nephrectomy (P = .001) were associated to mortality. CONCLUSIONS Emphysematous pyelonephritis is a life-threatening disease and evidence of management is based in small case series due to the low incidence of this condition. Hemodynamic instability, hypoalbuminemia, qSOFA ≥ 2, Huang scale ≥3, and early nephrectomy are associated with poor prognosis.
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Affiliation(s)
- J G Arrambide-Herrera
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - J I Robles-Torres
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - M A Ocaña-Munguía
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - R Romero-Mata
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - A Gutiérrez-González
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - L S Gómez-Guerra
- Department of Urology, Universidad Autónoma de Nuevo León, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico.
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Desai R, Batura D. A systematic review and meta-analysis of risk factors and treatment choices in emphysematous pyelonephritis. Int Urol Nephrol 2022; 54:717-736. [PMID: 35103928 DOI: 10.1007/s11255-022-03131-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/25/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Emphysematous pyelonephritis (EPN) is an acute, severe necrotising infection of the kidney. There has been a shift from early nephrectomy to conservative methods. We conducted a meta-analysis to assess the impact of risk factors and treatment choices on outcomes in EPN. METHODS We conducted a database search of all studies in English, reporting more than 12 patients of EPN from 1980 to 2020. We compiled the demographics, clinical presentations, risk factors, critical diagnostic results, treatment modalities and outcomes, including mortality. RESULTS We identified 37 observational studies, 32 retrospective and 5 prospective. The studies reported on 1146 patients, of which 790(68.9%) were female, and 946 (82.5%) were diabetic. In addition, 184 (16.1%) patients had stones, and 235 (20.5%) had obstructive uropathy. Fever and flank pain were the most frequent symptoms. The most common clinical features were pyuria, fever, flank tenderness, and tachycardia. E. coli, Klebsiella pneumoniae and Proteus were the most frequent organisms isolated. X-ray KUB and ultrasound were used as initial diagnostic modalities, but CT scan was the usual diagnostic and confirmatory investigation. Confusion, shock, thrombocytopenia, sepsis, emergency nephrectomy and hyponatremia were significantly associated with mortality. In particular, confusion and hyponatremia were associated with a sevenfold increase in mortality risk. There was no evidence that diabetes, stones, obstructive uropathy, AKI or proteinuria was associated with higher mortality. Nevertheless, 143 of the total 1146 patients died (12.5%). While 26% of the patients who had upfront emergency nephrectomy died, only 9.7% and 10% of patients with medical management and medical management plus minimally invasive treatments died. However, patients that failed medical and minimally invasive treatments and needed salvage emergency nephrectomy had a mortality of upwards of 27%. CONCLUSION The risk factors for mortality in emphysematous pyelonephritis are shock, thrombocytopenia, confusion, hyponatremia and emergency nephrectomy. Conservative and minimally invasive treatment should be the initial management strategy for emphysematous pyelonephritis as they carry lesser mortality risks. The presence of risk factors may help predict the subset of patients who need aggressive treatment and minimally invasive treatment modalities or early nephrectomy.
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Affiliation(s)
- Rajeev Desai
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Deepak Batura
- Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
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8
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Yu SC, Xu ZH, Zhang C, Zhu SB, Ding GQ, Li GH. [Diagnosis and treatment for emphysematous pyelonephritis: analysis of 14 cases from a single centre]. Zhonghua Wai Ke Za Zhi 2022; 60:159-163. [PMID: 35012276 DOI: 10.3760/cma.j.cn112139-20210509-00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To examine the modalities of treatment and clinical outcomes of emphysematous pyelonephritis (EPN), in order to improve the survival rate of EPN patients. Methods: Totally 14 patients diagnosed as EPN between October 2011 and November 2020 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this article. Data collection including patient demographics, clinical manifestations, management and clinical outcomes were conducted by retrospective charts review, after receiving the institutional review board's approval. There were 11 females and 3 males with a median age of 59 years (range: 52 to 73 years). The lesions were located on the left side in 10 patients and right side in 4 patients. All the 14 patients suffered from fever, and present with severe sepsis or septic shock. The median time from symptom onset to admission to hospital was 3 days(range: 2 to 5 days). All cases had diabetes mellitus. Escherichia coli was the most common organism been cultured (11 cases), while Klebsiella pneumonia was the second (3 cases). CT scan showed bubbly or located gas in the renal parenchyma in 5 cases and presence of steaky or mottled gas in the renal parenchyma in 9 cases. All patients had been admitted to ICU for anti-septic shock therapy. Three patients had undergone percutaneous catheter drainage along with broad-spectrum antibiotics therapy while 3 patients had immediate nephrectomy, the other 8 cases had a combination of an initial percutaneous catheter drainage and second stage nephrectomy. Results: In this case series, 3 patients were died from EPN while the other 11 were survived. The median ICU stay time was 6 days (range: 3 to 11 days). Of the 3 patients died from EPN, 2 had undergone percutaneous catheter drainage along and 1 had received immediate nephrectomy. Among the 11 patients who were survived, only 1 had received percutaneous catheter drainage while the other 10 received nephrectomy (8 patients had staged nephrectomy). Follow-up was performed 6 months after discharge. Of the 11 surviving patients, 2 were lost to follow-up, and the remaining 9 patients had an creatine level of (118.4±29.4) μmol/L (range: 89 to 176 μmol/L). Conclusions: For patients coupled with diabetes who were initially diagnosed as acute pyelonephritis, the possibility of EPN should be considered when the disease progressed rapidly especially septic shock occurred. On the basis of empirical broad-spectrum antibiotics therapy and standardized anti-septic shock treatment, a combination of an initial percutaneous catheter drainage and second stage nephrectomy could be efficacious.
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Affiliation(s)
- S C Yu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Z H Xu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - C Zhang
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - S B Zhu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - G Q Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - G H Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
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Magallanes-Gamboa JO, Notario-Barba V, Herrero Domingo A, Marcos-Sánchez F. [Emphysematous cystitis and emphysematous pyelonephritis]. Rev Esp Geriatr Gerontol 2021; 56:364-367. [PMID: 34315613 DOI: 10.1016/j.regg.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 06/06/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022]
Abstract
Emphysematous cystitis and emphysematous pyelonephritis are rare entities, difficult to diagnose and with high morbidity and mortality. The non-specificity of the medical history and the little usefulness of laboratory tests contribute to diagnostic delay, which increases the possibility of therapeutic failure. We present 2 cases, one of cystitis and another of emphysematous pyelonephritis, who attended the emergency room due to severe urinary sepsis. Despite severity of the symptoms, conservative management was performed with bladder drainage and antibiotic treatment, without interventions or surgeries, presenting a favorable evolution and resolution of the infectious process. Each case must be individualized to offer the best possible therapeutic alternative.
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Affiliation(s)
| | - Verónica Notario-Barba
- Servicio de Urgencias, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
| | - Almudena Herrero Domingo
- Servicio de Medicina Interna, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, España
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Affiliation(s)
- David da Silva Dias
- Medical Oncology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
| | - Catarina Jorge
- Internal Medicine Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Maria Pilar Perez
- Polivalent Intensive Care Unit, Centro Hospitalar Universitário do Algarve, Faro, Portugal
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Protoshchak VV, Sivakov AA, Babkin PA, Karandashov VK, Gorbynov AE, Lazutkin MV, Alentyev SA. [Emphysematous pyelonephritis: case of successful conservative treatment]. Urologiia 2020:118-121. [PMID: 33377689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Emphysematous pyelonephritis is rare form of pyelonephritis, which has mortality of nearly 80%. Conservative treatment can be successful in less than 30% of cases. Currently, in the guidelines there is no standard approach to conservative and surgical treatment of this entity. The clinical observation of successful conservative treatment of a patient with emphysematous pyelonephritis, associated with decompensated diabetes mellitus, from the diagnosis to recovery without performing nephrectomy in order to preserve kidney function, is described in the article.
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Affiliation(s)
- V V Protoshchak
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - A A Sivakov
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - P A Babkin
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - V K Karandashov
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - A E Gorbynov
- Department and Clinic of Urology of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - M V Lazutkin
- Department and Clinic of General Surgery of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - S A Alentyev
- Department and Clinic of General Surgery of FGBVOU VO S. M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
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Makar M, Park T, Orosz E, Law C, Patel AV. A case of emphysematous gastritis related to cocaine use treated successfully with conservative management. J Gastrointestin Liver Dis 2020; 29:467-468. [PMID: 32830820 DOI: 10.15403/jgld-2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Michael Makar
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Taeyang Park
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Evan Orosz
- Department of Gastroenterology, Rutgers Robert Wood; Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Cindy Law
- Department of Gastroenterology, Rutgers Robert Wood; Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Anish Vinit Patel
- Department of Gastroenterology, Rutgers Robert Wood; Johnson Medical School, New Brunswick, New Jersey, USA.
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Jang YO, Lee SH, Choi JJ, Kim DH, Choi JM, Kang MJ, Oh YM, Park YJ, Shin Y, Lee SW. Fecal microbial transplantation and a high fiber diet attenuates emphysema development by suppressing inflammation and apoptosis. Exp Mol Med 2020; 52:1128-1139. [PMID: 32681029 PMCID: PMC8080776 DOI: 10.1038/s12276-020-0469-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/24/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Recent work has suggested a microbial dysbiosis association between the lung and gut in respiratory diseases. Here, we demonstrated that gut microbiome modulation attenuated emphysema development. To modulate the gut microbiome, fecal microbiota transplantation (FMT) and diet modification were adopted in mice exposed to smoking and poly I:C for the emphysema model. We analyzed the severity of emphysema by the mean linear intercept (MLI) and apoptosis by the fluorescent TUNEL assay. Microbiome analysis was also performed in feces and fecal extracellular vesicles (EVs). The MLI was significantly increased with smoking exposure. FMT or a high-fiber diet (HFD) attenuated the increase. Weight loss, combined with smoking exposure, was not noted in mice with FMT. HFD significantly decreased macrophages and lymphocytes in bronchoalveolar lavage fluid. Furthermore, IL-6 and IFN-γ were decreased in the bronchoalveolar lavage fluid and serum. The TUNEL score was significantly lower in mice with FMT or HFD, suggesting decreased cell apoptosis. In the microbiome analysis, Bacteroidaceae and Lachnospiraceae, which are alleged to metabolize fiber into short-chain fatty acids (SCFAs), increased at the family level with FMT and HFD. FMT and HFD attenuated emphysema development via local and systemic inhibition of inflammation and changes in gut microbiota composition, which could provide a new paradigm in COPD treatment.
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Affiliation(s)
- Yoon Ok Jang
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Se Hee Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, 13496, Republic of Korea
| | - Jong Jin Choi
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Do-Hyun Kim
- Department of Life Science, College of Natural Sciences, Research Institute for Natural Sciences, Research Institute for Convergence of Basic Sciences, Hanyang University, Seoul, 04763, Republic of Korea
| | - Je-Min Choi
- Department of Life Science, College of Natural Sciences, Research Institute for Natural Sciences, Research Institute for Convergence of Basic Sciences, Hanyang University, Seoul, 04763, Republic of Korea
| | - Min-Jong Kang
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, 06520-8057, Connecticut, USA
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Young-Jun Park
- Environmental Disease Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, 34141, Republic of Korea
| | - Yong Shin
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
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Affiliation(s)
- Colin Andrew Hinkamp
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Neil Keshvani
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Abstract
The present manuscript reports two extremely rare cases of coexisting emphysematous gastritis with gastric mucormycosis. The cases were managed successfully, considering the high mortality associated with both conditions independently. The aim of the manuscript is to elucidate the importance of prompt diagnosis, early surgical intervention for source control and concomitant application of antifungal therapy for a favourable outcome.
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Affiliation(s)
- Digvijoy Sharma
- Surgical Gastroenterology, Kasturba Medical College, Manipal, Karnataka, India
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16
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Iwamuro M, Tanaka T, Yamauchi N, Nakashima Y, Wada T, Hiraoka S, Kawahara Y, Okada H. Cytomegalovirus Colitis Followed by Colonic Pseudolipomatosis and Gastric Emphysema in a Post-resuscitation Patient. Intern Med 2020; 59:519-525. [PMID: 31645533 PMCID: PMC7056364 DOI: 10.2169/internalmedicine.3633-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 64-year-old Japanese man suffered cardiopulmonary arrest, which may have resulted from sepsis and/or hyperosmolar hyperglycemic non-ketonic coma, and was admitted after successful resuscitation. He had watery diarrhea on day 18 and was diagnosed with cytomegalovirus enterocolitis. In addition, computed tomography performed on day 27 and colonoscopy revealed gastric emphysema and intestinal pseudolipomatosis, respectively. This report is the first to describe a patient with cytomegalovirus enterocolitis and subsequent gastric emphysema and pseudolipomatosis. Gastrointestinal cytomegalovirus infection may underlie gastric emphysema and intestinal pseudolipomatosis, particularly in patients with relative or obvious immune dysfunction.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Nao Yamauchi
- Center for Graduate Medical Education, Okayama University Hospital, Japan
| | - Yuri Nakashima
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Takahira Wada
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Yoshiro Kawahara
- Department of Practical Gastrointestinal Endoscopy, Okayama University Hospital, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Yasuhara H, Naito H, Kosaki Y, Yamakawa Y, Iida A, Yumoto T, Yamamoto H, Yamada T, Tsukahara K, Osako T, Mandai Y, Nakao A. Emphysematous cystitis successfully treated with hyperbaric oxygen therapy: case report. Undersea Hyperb Med 2018; 45:701-703. [PMID: 31158940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Emphysematous cystitis is an uncommon acute infection of the underlying bladder musculature and mucosa, caused by gas-producing organisms. Here we describe an 87-year-old woman with diabetes mellitus and emphysematous cystitis who was successfully treated with hyperbaric oxygen (HBO2) therapy. Her predisposition of diabetes and infection with gas-producing bacteria was considered to precede the development of emphysematous cystitis. Computed tomography revealed gas accumulation in the bladder wall and lumen. Antibiotics and HBO2 therapy were administered. HBO2 therapy may be beneficial due to the improvement in oxygenation of the tissues affected by the disease. HBO2 is a useful adjunct therapy for the management of severe emphysematous cystitis.
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Affiliation(s)
- Hirotaka Yasuhara
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinori Kosaki
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuaki Yamakawa
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsuyoshi Iida
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirotsugu Yamamoto
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Taihei Yamada
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Tsukahara
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takaaki Osako
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Mandai
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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18
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Cohen NS, Collins JN. Gastric Pneumatosis: Fatal or Benign? Am Surg 2018; 84:e485-e486. [PMID: 30747660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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19
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Evans R, Brutsche M, Busca R, Deslee G, de Soyza A, Fellrath JM, Franzen D, Hartman J, Mealing S, Morton T, Munavvar M, Sculpher M, Shah P, Slebos DJ, Durand-Zaleski I. Quantifying patient centered outcomes associated with the use of bilateral endobronchial coil treatment in patients with severe emphysema. Curr Med Res Opin 2018; 34:1927-1932. [PMID: 29625529 DOI: 10.1080/03007995.2018.1462784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the impact of endobronchial coils on health-related quality-of-life (HRQoL). This paper utilizes trial data to identify the predictors of HRQoL in patients with severe emphysema, and subsequently estimates the impact of a new treatment on HRQoL (measured by utilities). These utility estimates are used to generate indicative long-term QALY estimates for a range of clinically plausible scenarios as a precursor to cost-effectiveness analyses. METHODS Patient level HRQoL data from RENEW and the National Emphysema Treatment Trial (NETT) were combined and mapped to generic EuroQol 5-dimension health utility questionnaire (EQ-5D) values using a published algorithm. Multilevel statistical models were developed using treatment, time, response, and baseline characteristics (EQ-5D, age, gender, FEV1, lung RV) to predict EQ-5D over time. Lifetime QALY estimates were generated using published survival data from NETT (assuming no impact of treatment on mortality) and four clinically plausible response profiles. Each response profile was combined with assumptions around treatment impact (constant or time varying). RESULTS After controlling for baseline characteristics, both treatment and response had a statistically significant impact (p < .001) on utility (+0.101 and +0.061, respectively). When combined with selected baseline characteristics and time, Coils and Standard of Care (SoC) generated more QALYs than SoC alone in all scenarios, with incremental lifetime benefit ranging from 0.29-0.55 QALYs. CONCLUSIONS Coils and SoC resulted in statistically significant improvements in HRQoL compared to SoC alone in patients with severe emphysema.
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Affiliation(s)
| | | | | | - Gaetan Deslee
- d University Hospital, INSERM UMRS 903 , Reims , France
| | | | | | | | - Jorine Hartman
- h University Medical Center , Groningen , The Netherlands
| | - Stuart Mealing
- i York Health Economics Consortium , North Yorkshire , UK
| | - Tim Morton
- j Decision Resources Group Bicester , Oxfordshire , UK
| | | | | | - Pallav Shah
- m Royal Brompton & Harefield NHS Foundation Trust , and Imperial College , London , UK
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20
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Wang Q, Sun M, Ma C, Lv H, Lu P, Wang Q, Liu G, Hu Z, Gao Y. Emphysematous pyelonephritis and cystitis in a patient with uremia and anuria: A case report and literature review. Medicine (Baltimore) 2018; 97:e11272. [PMID: 30407278 PMCID: PMC6250534 DOI: 10.1097/md.0000000000011272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) or cystitis (EC) is a severe infection of the urinary tract with high mortality. EPN is uncommon among the patients of end stage of renal failure (ESRD) CASE PRESENTATION:: A 38-year-old male with uremia and anuria who was on hemodialysis was found to have gas formation in the bilateral pelvis, ureters, and urinary bladder by CT scan. The diagnosis was emphysematous pyelonephritis and cystitis. And Foley catheter was placed and bladder irrigation was performed. Escherichia coli infection was identified in urine culture and antibiotic was prescribed accordingly. Gas disappeared completely and the patient recovered uneventfully. CONCLUSION This is the first case report of asymptomatic EPN and EC in uremic patient, and conservative management was optimistic in this condition. More attention should be paid to EPN and EC happening to ESRD patients.
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Affiliation(s)
- Qiang Wang
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Meifeng Sun
- Department of Rehabilitation, Affiliated Hospital of Qingdao University, PR China
| | - Chengjun Ma
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Hailin Lv
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Peng Lu
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Qi Wang
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Guangyi Liu
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Zhao Hu
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
| | - Yanxia Gao
- Department of Nephrology, Qilu Hospital of Shandong University (Qingdao)
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Abdel Malek M, Smissaert van de Haere T, Loffeld R. [Air configurations in the pelvis]. Ned Tijdschr Geneeskd 2018; 162:D2535. [PMID: 30212014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 74-year-old man presented to the Emergency Department after a fall from a ladder. Plain radiographic screening of the lumbar spine revealed an unanticipated curvilinear, oval-shaped air configuration in the pelvis. Computed tomography of the lumbar spine showed air within the bladder wall and lumen. Urine cultures were positive for Escherichia coli. The patient was discharged after bladder drainage and empiric antibiotic treatment.
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Affiliation(s)
- Michel Abdel Malek
- Zaans Medisch Centrum, afd. Interne Geneeskunde, Zaandam
- Contact: M. Abdel Malek
| | | | - Ruud Loffeld
- Zaans Medisch Centrum, afd. Interne Geneeskunde, Zaandam
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22
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Harsch IA, Langer K, Abramowski C, Konturek PC. Emphysematous pyelonephritis - a rare complication of diabetes mellitus. Wiad Lek 2018; 71:917-921. [PMID: 30099435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Emphysematous pyelonephritis is a rare form of acute necrotizing pyelonephritis. It is a gas-producing, necrotizing infection involving the renal parenchyma and surrounding tissues. It is associated with high mortality and morbidity. In the majority of cases, patients with long-standing diabetes and poor glycemic control are affected. We report the case of a 67 yr old female who survived severe sepsis due to emphysematous pyelonephritis. Potential therapeutic strategies in the aftermath from a diabetologist's point of view are discussed.
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Affiliation(s)
- Igor Alexander Harsch
- Thuringia Clinic Saalfeld "Georgius Agricola", Department Of Internal Medicine Ii, Division Of Endocrinology And Metabolism, Teaching Hospital Of The University Of Jena, Saalfeld/Saale, Germany
| | - Kai Langer
- Thuringia Clinic Saalfeld "Georgius Agricola", Department Of Urology, Teaching Hospital Of The University Of Jena Saalfeld/Saale, Germany
| | - Christiane Abramowski
- Thuringia Clinic Saalfeld "Georgius Agricola", Department Of Pathology Saalfeld/Saale, Germany
| | - Peter Christopher Konturek
- Thuringia Clinic Saalfeld "Georgius Agricola" , Department Of Internal Medicine Ii, Division Of Gastroenterology, Teaching Hospital Of The University Of Jena, Saalfeld/Saale, Germany
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Tana C, Silingardi M, Giamberardino MA, Cipollone F, Meschi T, Schiavone C. Emphysematous pancreatitis associated with penetrating duodenal ulcer. World J Gastroenterol 2017; 23:8666-8670. [PMID: 29358874 PMCID: PMC5752726 DOI: 10.3748/wjg.v23.i48.8666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
In the “proton pump inhibitors era”, a penetrating peptic ulcer (PPU) represents an exceptional cause of abdominal pain, and was more frequently observed in the past where there was not an effective antacid treatment. Ulcer-induced pancreatitis is very rare, too, and manifests with persistent, intense pain radiating to the back. A mild to severe pancreatitis with peripancreatic fluid collection can be observed at imaging. However, only a few cases of association between PPU and emphysematous pancreatitis (EP) have been published in the literature. EP is a rare but potentially fatal form of acute necrotizing pancreatitis in which gas grows in and outside the pancreas, and typically involves the whole parenchyma in diabetic individuals.
Here we report an extremely rare case of a duodenal ulcer penetrating the pancreas and complicated with EP. Unlike the classic form of EP, which involves the whole parenchyma and has a poor prognosis, we found that the emphysematous involvement of the pancreas by PPU has a benign course if a conservative therapy is promptly established. Gas is confined to the site of penetration, usually the pancreatic head, and ulcers most often involve the duodenum.
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Affiliation(s)
- Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma 43126, Italy
| | - Mauro Silingardi
- Internal Medicine Unit, Maggiore Hospital of Bologna, Bologna 40133, Italy
| | - Maria Adele Giamberardino
- Ce.S.I.-Met, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
- Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
| | - Francesco Cipollone
- Ce.S.I.-Met, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
- Geriatrics Clinic, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
- Regional Center for the Study of Atherosclerosis, Hypertension and Dyslipidemia, “SS Annunziata” Hospital - ASL Chieti, Chieti 66100, Italy
| | - Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma 43126, Italy
| | - Cosima Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, “G. D’Annunzio” University of Chieti, Chieti 66100, Italy
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Rountree KM, Lopez PP. Emphysematous Gastritis, a Spectrum of Disease: A Four-Case Report. Am Surg 2017; 83:e285-e287. [PMID: 28822362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Rizzi M, Airoldi A, Cristiano A, Frassanito F, Macaluso C, Vanni S, Legnani D. Oxygen therapy in COPD patients with isolated nocturnal hypoxemia; comparison of quality of life and sleep between bronchitis and emphysema phenotype: A prospective observational study. Eur J Intern Med 2016; 34:78-84. [PMID: 27614376 DOI: 10.1016/j.ejim.2016.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND COPD is a heterogeneous disease composed by two main phenotypes: bronchitis (COPDb) and emphysema (COPDe) with different clinical presentation, physiology, imaging, response to therapy and decline in lung function. The aim of this study is to evaluate whether nocturnal hypoxemic COPDb and COPDe have a different behaviour during sleep and the effect of nocturnal oxygen supplementation (nO2LT). MATERIALS AND METHODS 75 COPDb and 120 COPDe were enrolled. All patients performed polysomnography, Pittsburgh and Maugeri Foundation Respiratory Failure questionnaire, and pulmonary function before and after six months of nO2LT. RESULTS At baseline, compared to COPDb, COPDe have decreased sleep efficiency (SE) (67.5±6% vs. 76.9±3% p<0.05) and higher arousals (A/I) (18.1±3 event/h vs. 8.7±1 event/h p<0.05). Oxygen desaturation index (ODI) was increased during REM (7.1±1 event/h vs. 2.3±0.5 event/h p<0.05). nO2LT in COPDe improves SE (77±4% vs. 67.5±6% p<0.05) and decreases A/I (9±5 event/h vs. 18.1±3 event/h p<0.05). ODI during REM (3.5±2 event/h vs. 7.1±1 p<0.05) decreases and quality of life (QoL) improves (MFR-28 total 56±22 vs 45±20 p<0.05), due to an improvement in cognitive abilities (45±30 vs 33±31 p<0.05) and daily activities (61±29 vs 53±21 p>0.05). In COPDb nO2LT reduces ST90 (15±6% vs. 43±8% p<0.05) less than in COPDe (15±6% vs. 8±4% p<0.05); improves A/I (10±2 event/h vs. 8.7±1 p<0.05) and there is no evidence of an improvement in QoL. CONCLUSIONS Six months of nO2LT improve quality of life in COPDe, not in COPDb. We found a difference in sleep quality between COPDe and COPDb.
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Affiliation(s)
- Maurizio Rizzi
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Andrea Airoldi
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Andrea Cristiano
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | | | - Claudio Macaluso
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Silvia Vanni
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Delfino Legnani
- Pulmonary Department, "Luigi Sacco" University Hospital, Milan, Italy.
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26
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Affiliation(s)
- Zhenqing Brett Wu
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary, New York, NY, USA
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27
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Affiliation(s)
- Deng-Wei Chou
- Department of Critical Care Medicine, Tainan Municipal Hospital, Tainan, Taiwan, ROC.
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan, ROC.
| | | | - Shu-Chen Han
- Department of Radiology, Tainan Municipal Hospital, Tainan, Taiwan, ROC.
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29
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Torres-Mercado LO, García-Padilla MÁ, Serrano-Brambila E, Maldonado-Alcaraz E, López-Sámano VA, Montoya-Martínez G, Moreno-Palacios J. [Prognostic factors of morbimortality in patients with emphysematous pyelonephritis]. Rev Med Inst Mex Seguro Soc 2016; 54 Suppl 2:S156-S161. [PMID: 27561019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN. METHODS It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome. RESULTS 73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p <0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p <0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p < 0.001) were factors significantly associated with adverse outcome. CONCLUSION Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.
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Affiliation(s)
- León Octavio Torres-Mercado
- Servicio de Urología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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30
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Garde H, Useros E, Hernando A, Chávez C, Paños E, Quijano P, Martínez M, Alpuente C, Brinquis MÁ, García-Murga JC. [Emphysematous cystitis: Report of 2 cases with different outcomes]. ARCH ESP UROL 2015; 68:627-632. [PMID: 26331400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To report two cases of emphysematous cystitis, a rare, potentially serious disease. METHODS Analysis of two different cases treated in our center and review of the existing literature. RESULTS One patient underwent emergency surgery (radical cystectomy) due to the advanced stage of the disease. The second patient, whose was in an initial stage, benefited from a new treatment, consisting of hyperbaric oxygen and wide spectrum antibiotics. CONCLUSIONS Early diagnosis is the cornerstone of the conservative management of the disease. Hyperbaric oxygen therapy may be beneficial due to the improvement in oxygenation of the tissues affected by the disease.
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Affiliation(s)
- Héctor Garde
- Service of Urology. Hospital Central de la Defensa "Gómez Ulla". Madrid. Spain
| | - Eduardo Useros
- Service of Urology. Hospital Central de la Defensa "Gómez Ulla". Madrid. Spain
| | - Alberto Hernando
- Service of Urology. Hospital Central de la Defensa "Gómez Ulla". Madrid. Spain
| | - César Chávez
- Service of Urology. Hospital Central de la Defensa "Gómez Ulla". Madrid. Spain
| | - Eva Paños
- Service of Urology. Hospital Central de la Defensa "Gómez Ulla". Madrid. Spain
| | - Pablo Quijano
- Service of Urology. Hospital Central de la Defensa "Gómez Ulla". Madrid. Spain
| | - Mar Martínez
- Service of Urology. Hospital Central de la Defensa "Gómez Ulla". Madrid. Spain
| | - Carlos Alpuente
- Service of Urology. Hospital Central de la Defensa "Gómez Ulla". Madrid. Spain
| | - Miguel Ángel Brinquis
- Service of Subaquatic Medicine and Hyperbaric Chamber. Hospital Central de la Defensa "Gómez Ulla". Madrid. Spain
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31
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Ali SN, Ahmed N, Naushad A, Naushad M. Emphysematous pyelonephritis: a review of six cases. J Ayub Med Coll Abbottabad 2014; 26:591-597. [PMID: 25672195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Emphysematous pyelonephritis is a severe life threatening necrotising infection of the renal parenchyma. The infection most commonly occurs in the diabetic population, often associated with the organism E. coli Emphysematous pyelonephritis differs from standard pyelonephritis by the bacterial liberation and accumulation of gas in the surrounding tissues. The condition is rarely encountered in clinical practice and since the first description by Kelly et al in 1898, approximately 200 cases have been reported in the literature. METHODS The case series examines our experience with six diagnosed cases of emphysematous pyelonephritis over a one year period. RESULTS All patients were female, the mean age of presentation being 53 years. Of the six patients, five were diabetics with hypertension, the one exception being a non-diabetic patient who had undergone renal exploration in the past. Computed tomography confirmed the diagnosis in all patients except one which was confirmed during renal exploration. Urine culture was positive for E. coli in two patients. CONCLUSION Emphysematous pyelonephritis which used to be a rare disease is now being more readily diagnosed. The cases were diagnosed at a late stage making its conservative management not feasible
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Affiliation(s)
- T Takada
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, 1-16-4 Iso, Urasoe, Okinawa 901-2132, Japan
| | - A Kuriyama
- Department of General Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
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Beaudoin EL, Chee A, Stather DR. Interventional pulmonology: an update for internal medicine physicians. Minerva Med 2014; 105:197-209. [PMID: 24988085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Interventional pulmonology is a subspecialty that uses advanced diagnostic and therapeutic procedures to care for patients with benign and malignant diseases of the lung, airways and pleura. There has been a rapid proliferation of new pulmonary procedural technologies over the last decade. Common diagnostic applications include endobronchial ultrasound, guided bronchoscopy and a number of pleural disease interventions. Endobronchial ultrasound is performed with a specially design flexible bronchoscope and allows safe and accurate sampling of intrathoracic structures through the airway wall under direct visualization. Guided bronchoscopy methods are granting significant improvement in the diagnostic yield of flexible bronchoscopy. Virtual bronchoscopy, radial probe endobronchial ultrasound and electromagnetic navigational bronchoscopy are examples of these methods. Interventional pulmonologists can also be trained to perform ultrasound guided thoracentesis, closed-needle pleural biopsy and medical thoracoscopy to help in the diagnosis of different pleural pathologies. Therapeutic applications can be used to efficiently bring symptomatic relief of benign and malignant central airway obstruction by using a myriad of flexible and rigid bronchoscopy techniques. Airway stenting and ablative techniques such as laser, electrocautery, cryosurgery and microdebrider techniques are example of resources that can be used by interventional pulmonologists for therapeutic purposes. A number of effective therapies for the management of malignant pleural disease have been studied in recent years, including chemical pleurodesis and tunnelled pleural catheters, greatly adding to our understanding of which therapy to use in which patient. In addition, flexible bronchoscopy approaches to more common disease, such as asthma and chronic obstructive pulmonary disease are currently available or are being developed. This update aims to provide the internal medicine physician with a brief overview of some of the common clinical procedures performed by interventional pulmonary specialists and the current indications and evidence for their use.
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Affiliation(s)
- E L Beaudoin
- Department of Medicine, University of Calgary Calgary, Alberta, Canada -
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Kashiura M, Sugiyama K, Akashi A, Hamabe Y. Emphysematous pyelonephritis. Intern Med 2014; 53:2557. [PMID: 25366025 DOI: 10.2169/internalmedicine.53.2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Masahiro Kashiura
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Japan
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Rajković Z, Papes D, Altarac S, Arslani N. Differential diagnosis and clinical relevance of pneumobilia or portal vein gas on abdominal x-ray. Acta Clin Croat 2013; 52:369-373. [PMID: 24558770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
The purpose of the article is to present the differential diagnostic criteria between pneumobilia (air in the biliary system) and portal vein gas on abdominal x-ray. Differential diagnosis is essential because of its influence on patient management. Two patients are presented, one with pneumobilia and the other with portal vein gas on abdominal x-ray, with review of the relevant literature. Pneumobilia is often iatrogenic and even in cases of cholecystitis it is never a sole indication for emergency surgery. Patients with pneumobilia on abdominal x-ray can always be investigated further. On the other hand, the presence of air in portal vein is in most cases a sign of acute mesenteric ischemia. In adults with abdominal pain indicating intestinal ischemia (pain that is 'out of proportion' to clinical abdominal examination findings), it is an indication for emergency exploratory laparotomy. It is vital to act early when intestinal ischemia is suspected.
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Affiliation(s)
- Zoran Rajković
- Department of Surgery, Zabok General Hospital, Zabok, Croatia
| | - Dino Papes
- Department of Surgery, Zabok General Hospital, Zabok, Croatia
| | - Silvio Altarac
- Department of Surgery, Zabok General Hospital, Zabok, Croatia
| | - Nuhi Arslani
- Department of Surgery, Maribor University Clinical Center, Maribor, Slovenia
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Abstract
An 86-year-old woman with type 2 diabetes was admitted with increasing lethargy and hyperglycaemia. On examination she was noted to have a tender and tympanic bladder. CT revealed a distended bladder with gas locules in the bladder wall. She was diagnosed with hyperglycaemic hyperosmolar non-ketosis precipitated by emphysematous cystitis. After systemic antibiotics and bladder drainage via a urethral catheter, her symptoms readily improved. Radiographic appearances of the bladder were normal one week after instigating treatment. Emphysematous cystitis is characterized by gas within the bladder wall. Although rare it is increasingly more recognized with the advent of modern imaging. The mainstay of treatment is antibiotics and bladder drainage. Rarely surgical debridement and even cystectomy is required.
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Cortés-González JR, Ortiz-Lara GE, Salinas M, Hernández-Galván F, Gómez-Guerra LS. Computed tomography scan in supine and prone positions: an alternative method to detect intramural gas in emphysematous cystitis and to evaluate efficacy after adjuvant continuous intravesical irrigation treatment. Scand J Infect Dis 2013; 45:292-296. [PMID: 23148785 DOI: 10.3109/00365548.2012.737018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the efficacy of continuous intravesical irrigation with saline plus amikacin as adjuvant therapy and to evaluate the computed tomography (CT) scan in supine and prone positions (CystoCT scan) as an alternative diagnostic and evaluation method of intramural gas in emphysematous cystitis (EC) before and after treatment. METHODS Consecutive patients with a diagnosis of EC who were hospitalized between March 2006 and January 2011 were investigated. The diagnosis was made by CystoCT scan. Treatment consisted of intravenous antibiotics, control of concomitant diseases, and placement of a 3-way urinary catheter for continuous irrigation of 500 mg of amikacin diluted in 1 l of saline given on days 0, 3, and 7. Treatment was considered successful when there was an absence of gas in the bladder wall, the urine culture was negative, there was clinical improvement, and there was an absence of toxicity. RESULTS Eleven patients were hospitalized with a diagnosis of EC during the study period. Four were excluded from the study, 2 due to the lack of confirmation of the diagnosis with the CystoCT scan. Treatment was successful in all patients; for 6 (86%) this was achieved in 3 days and for 1 (14%) in 7 days. No toxicity was reported. CONCLUSIONS Continuous intravesical irrigation with saline plus amikacin as adjuvant treatment of EC is an inexpensive, effective, and safe tool that might help conventional treatment and provide a rapid recovery. The CystoCT scan is an alternative method to diagnose and evaluate intramural gas in EC patients. These findings should be challenged in a randomized, multi-centre, placebo-controlled clinical trial.
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Affiliation(s)
- Jeff R Cortés-González
- Urology Service, Dr. José E. González University Hospital, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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Peters K, Akin F, Dillemans B. Relapsing emphysematous gastritis: a case report. Acta Chir Belg 2013; 113:146-148. [PMID: 23741935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- K Peters
- 'Faculty of Medicine, University of Ghent, Belgium.
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Vega-Cabrera C, Costero-Fernández O, Rivas-Becerra B, Menéndez-González D, Selgas-Gutiérrez R. Emphysematous cystitis. Nefrologia 2013; 33:149-150. [PMID: 23364649 DOI: 10.3265/nefrologia.pre2012.sep.11626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 06/01/2023] Open
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Abstract
The case of a 66-year-old woman with untreated diabetes mellitus who was admitted to our hospital with a fever, hypotension and an altered mental status is herein reported. Computed tomography revealed bilateral emphysematous pyelonephritis along with a splenic abscess. Blood and urine cultures grew Escherichia coli. Treatment with systemic antibiotics combined with the insertion of percutaneous and renoureteral catheters was successful. The patient was discharged and completed treatment without developing any subsequent complications.
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Affiliation(s)
- Hiroshi Morioka
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan
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Hagiya H, Kuroe Y, Nojima H, Otani S, Sugiyama J, Naito H, Kawanishi S, Hagioka S, Morimoto N. Emphysematous liver abscesses complicated by septic pulmonary emboli in patients with diabetes: two cases. Intern Med 2013; 52:141-5. [PMID: 23291690 DOI: 10.2169/internalmedicine.52.8737] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
An emphysematous liver abscess is a fatal condition that often occurs in patients with uncontrolled diabetes mellitus. I herein describe two cases of Klebsiella pneumoniae-induced emphysematous liver abscesses complicated by septic pulmonary emboli in patients with poorly controlled diabetes mellitus. Both patients showed hemoglobin A1c levels of more than 10% and did not present with any abdominal symptoms on admission. However, they were diagnosed and successfully treated with percutaneous transhepatic abscess drainage and antibiotics. This fatal disease should be taken into consideration in patients with uncontrolled diabetes mellitus who suffer from prolonged fevers and uncharacteristic general malaise.
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Affiliation(s)
- Hideharu Hagiya
- Emergency Unit and Critical Care Center, Tsuyama Central Hospital, Japan.
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Cherif M, Kerkeni W, Bouzouita A, Selmi MS, Derouiche A, Ben Slama MR, Chebil M. [Emphysematous pyelonephritis. Epidemiological, clinical, biological, bacteriological, radiological, therapeutic and prognostic features. Retrospective study of 30 cases]. Tunis Med 2012; 90:725-729. [PMID: 23096514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Emphysematous pyelonephritis is an uncommon, necrotizing bacterial infection of the kidney. It is a severe, life threatening affection. AIMS To study the epidemiological, clinical, biological, bacteriological and radiological features of this affection, and to describe its therapeutic management and prognostic characteristics. METHODS We conducted a retrospective study including 30 patients who were treated for an emphysematous pyelonephritis, in Charles Nicolle hospital department of urology, from 1987 to 2009. RESULTS Emphysematous pyelonephritis generally affects adults. It is especially favored by diabetes and urinary tract obstruction. Escherichia coli is the main causative agent. Uroscan is the key of diagnosis. It is both medical and surgical emergency; the treatment combines intensive care with appropriate antibiotics and often drainage. Nephrectomy may be necessary from the outset, or after drainage failure. Prognosis is poor, with a high mortality rate (23 %), in our series. CONCLUSION Management of emphysematous pyelonephritis poses real problems. This affection is still threatening, despite of advances in intensive care.
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Affiliation(s)
- Mohamed Cherif
- Service d'urologie, Hopital Charles Nicolle de Tunis, Tunisie
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Fujii T, Sutoh T, Morita H, Katoh T, Yajima R, Yamaguchi S, Tsutsumi S, Asao T, Kuwano H. Emphysematous cystitis after surgery for rectal cancer. Am Surg 2012; 78:E441-E442. [PMID: 22964194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Takaaki Fujii
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan.
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Affiliation(s)
- Seung-Kwan Lim
- Department of Infectious Disease, Ajou University School of Medicine, Suwon, Korea
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Affiliation(s)
- Dana Ahnood
- St George's University of London, Cranmer Terrace, London
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Srinivasan S, Teh HS, Clarke MJ. Clinics in diagnostic imaging (138). Emphysematous pyelitis. Singapore Med J 2012; 53:214-218. [PMID: 22434298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present the case of a 49-year-old woman with poorly controlled diabetes mellitus of ten years' duration. She presented to the emergency department with nonspecific left lower abdominal pain. Ultrasonography showed mild left renal hydronephrosis, but the cause was not demonstrated. Computed tomography (CT) showed a swollen left kidney with a mildly dilated collecting system containing gas and dense fluid, confirming the diagnosis of emphysematous pyelitis. Management consisted of emergency antegrade nephrostomy drainage and parenteral antibiotics. Subsequently, the patient made a good recovery and was well when discharged home after two weeks. Gas-forming infections of the genitourinary tract carry high mortality and morbidity, and usually occur in patients with poorly controlled diabetes mellitus. Escherichia coli is the most common microorganism. This case emphasises the importance of CT in making an early diagnosis of emphysematous pyelitis, which allows prompt treatment and improves prognosis.
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Affiliation(s)
- S Srinivasan
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768228.
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Parra-Riffo H, Lemus-Peñaloza J, Maira P. Emphysematous cystitis resolved with medical treatment. A case report and literature review. Nefrologia 2012; 32:127. [PMID: 22294018 DOI: 10.3265/nefrologia.pre2011.oct.11209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2011] [Indexed: 05/31/2023] Open
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Affiliation(s)
- Chi-Feng Hsu
- Department of Emergency Medicine, Buddhist Tzu Chi General Hospital, Taiwan
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Dubey IB, Agrawal V, Jain BK. Five patients with emphysematous pyelonephritis. Iran J Kidney Dis 2011; 5:204-206. [PMID: 21525582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 12/25/2010] [Indexed: 05/30/2023]
Abstract
Emphysematous pyelonephritis is an acute necrotizing infection of the renal parenchyma, resulting in presence of gas within either in the collecting system or perinephric space. We herein report our experience with 5 cases of emphysematous pyelonephritis in 2 men and 3 women managed by broad spectrum antibiotics, supportive measures including hemodialysis (2 patients), ureteral stenting (2 patients), surgical drainage of perinephric collection (1 patient), and control of diabetes mellitus (4 patients). Four patients were discharged after a mean hospital stay of 18 days. A nondiabetic male patient with a nonobstructed kidney died on the second postoperative day due to persistent septicemia despite nephrectomy. Emphysematous pyelonephritis is a potentially fatal disease requiring careful and prompt diagnosis and individualized rational therapy. Ureteropelvic stenting should be used for drainage of pent-up collections as a lifesaving measure through relieving the obstruction. Perinephric fluid collection should be drained either percutaneously or surgically.
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