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Algharib A, Koning GG, van Dortmont LMC, Möller R. Sepsis in the acute phase of Charcot requiring prompt surgical treatment. Asian J Surg 2024; 47:1453-1455. [PMID: 38087693 DOI: 10.1016/j.asjsur.2023.11.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/24/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Ahmed Algharib
- Department of Vascular and Endovascular Surgery, Euregio Hospital, Nordhorn, Germany.
| | - Giel G Koning
- Department of Vascular and Endovascular Surgery, Euregio Hospital, Nordhorn, Germany
| | | | - Rüdiger Möller
- Department of Vascular and Endovascular Surgery, Euregio Hospital, Nordhorn, Germany
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Bedawi EO, Stavroulias D, Hedley E, Blyth KG, Kirk A, De Fonseka D, Edwards JG, Internullo E, Corcoran JP, Marchbank A, Panchal R, Caruana E, Kadwani O, Okiror L, Saba T, Purohit M, Mercer RM, Taberham R, Kanellakis N, Condliffe AM, Lewis LG, Addala DN, Asciak R, Banka R, George V, Hassan M, McCracken D, Sundaralingam A, Wrightson JM, Dobson M, West A, Barnes G, Harvey J, Slade M, Chester-Jones M, Dutton S, Miller RF, Maskell NA, Belcher E, Rahman NM. Early Video-assisted Thoracoscopic Surgery or Intrapleural Enzyme Therapy in Pleural Infection: A Feasibility Randomized Controlled Trial. The Third Multicenter Intrapleural Sepsis Trial-MIST-3. Am J Respir Crit Care Med 2023; 208:1305-1315. [PMID: 37820359 PMCID: PMC10765402 DOI: 10.1164/rccm.202305-0854oc] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023] Open
Abstract
Rationale: Assessing the early use of video-assisted thoracoscopic surgery (VATS) or intrapleural enzyme therapy (IET) in pleural infection requires a phase III randomized controlled trial (RCT). Objectives: To establish the feasibility of randomization in a surgery-versus-nonsurgery trial as well as the key outcome measures that are important to identify relevant patient-centered outcomes in a subsequent RCT. Methods: The MIST-3 (third Multicenter Intrapleural Sepsis Trial) was a prospective multicenter RCT involving eight U.K. centers combining on-site and off-site surgical services. The study enrolled all patients with a confirmed diagnosis of pleural infection and randomized those with ongoing pleural sepsis after an initial period (as long as 24 h) of standard care to one of three treatment arms: continued standard care, early IET, or a surgical opinion with regard to early VATS. The primary outcome was feasibility based on >50% of eligible patients being successfully randomized, >95% of randomized participants retained to discharge, and >80% of randomized participants retained to 2 weeks of follow-up. The analysis was performed per intention to treat. Measurements and Main Results: Of 97 eligible patients, 60 (62%) were randomized, with 100% retained to discharge and 84% retained to 2 weeks. Baseline demographic, clinical, and microbiological characteristics of the patients were similar across groups. Median times to intervention were 1.0 and 3.5 days in the IET and surgery groups, respectively (P = 0.02). Despite the difference in time to intervention, length of stay (from randomization to discharge) was similar in both intervention arms (7 d) compared with standard care (10 d) (P = 0.70). There were no significant intergroup differences in 2-month readmission and further intervention, although the study was not adequately powered for this outcome. Compared with VATS, IET demonstrated a larger improvement in mean EuroQol five-dimension health utility index (five-level edition) from baseline (0.35) to 2 months (0.83) (P = 0.023). One serious adverse event was reported in the VATS arm. Conclusions: This is the first multicenter RCT of early IET versus early surgery in pleural infection. Despite the logistical challenges posed by the coronavirus disease (COVID-19) pandemic, the study met its predefined feasibility criteria, demonstrated potential shortening of length of stay with early surgery, and signals toward earlier resolution of pain and a shortened recovery with IET. The study findings suggest that a definitive phase III study is feasible but highlights important considerations and significant modifications to the design that would be required to adequately assess optimal initial management in pleural infection.The trial was registered on ISRCTN (number 18,192,121).
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Affiliation(s)
- Eihab O. Bedawi
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Oxford Centre for Respiratory Medicine and
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Academic Directorate of Respiratory Medicine
| | - Dionisios Stavroulias
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Emma Hedley
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
| | - Kevin G. Blyth
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alan Kirk
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - John G. Edwards
- Department of Thoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Eveline Internullo
- Department of Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | - Adrian Marchbank
- Department of Cardiothoracic Surgery, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Rakesh Panchal
- Department of Respiratory Medicine, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Edward Caruana
- Department of Thoracic Surgery, Glenfield Hospitals, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Lawrence Okiror
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Manoj Purohit
- Department of Cardiothoracic Surgery, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Rachel M. Mercer
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Rhona Taberham
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Nikolaos Kanellakis
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Laboratory of Pleural and Lung Cancer Translational Research
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, and
| | - Alison M. Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Academic Directorate of Respiratory Medicine
| | | | - Dinesh N. Addala
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Oxford Centre for Respiratory Medicine and
| | - Rachelle Asciak
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Radhika Banka
- Department of Respiratory Medicine, PD Hinduja National Hospital, Mumbai, India
| | - Vineeth George
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Maged Hassan
- Chest Diseases Department, Alexandria University, Alexandria, Egypt
| | - David McCracken
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Anand Sundaralingam
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- Oxford Centre for Respiratory Medicine and
| | - John M. Wrightson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- Oxford Centre for Respiratory Medicine and
| | - Melissa Dobson
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
| | - Alex West
- Department of Respiratory Medicine and
| | | | - John Harvey
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, United Kingdom
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | - Mark Slade
- Department of Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom; and
| | - Mae Chester-Jones
- Oxford Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Susan Dutton
- Oxford Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert F. Miller
- Institute for Global Health, University College London, London, United Kingdom
| | - Nick A. Maskell
- Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, United Kingdom
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
| | - Elizabeth Belcher
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Najib M. Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Medicine
- National Institute for Health and Care Research Oxford Biomedical Research Centre
- Laboratory of Pleural and Lung Cancer Translational Research
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Department of Medicine, and
- Oxford Centre for Respiratory Medicine and
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Al-Afif S, Atallah O, Scheinichen D, Palmaers T, Cinibulak Z, Rollnik JD, Krauss JK. Surgical treatment of spondylodiscitis in critically ill septic patients. Acta Neurochir (Wien) 2023; 165:3601-3612. [PMID: 37587320 PMCID: PMC10739300 DOI: 10.1007/s00701-023-05748-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Surgical procedures in critically ill patients with spondylodiscitis are challenging and there are several controversies. Here, we present our experience with offering surgical intervention early in critically ill septic patients with spondylodiscitis. METHOD After we introduced a new treatment paradigm offering early but limited surgery, eight patients with spondylodiscitis complicated by severe sepsis and multiple organ failure underwent urgent surgical treatment over a 10-year period. Outcome was assessed according to the Barthel index at 12-month follow-up and at the last available follow-up (mean 89 months). RESULTS There were 7 men and 1 woman, with a mean age of 62 years. The preoperative ASA score was 5 in 2 patients, and 4 in 6 patients. Six of them presented with high-grade paresis, and in all of them, spondylodiscitis with intraspinal and/or paravertebral abscesses was evident in MR imaging studies. All patients underwent early surgery (within 24 h after admission). The median time in intensive care was 21 days. Out of the eight patients, seven survived. One year after surgery, five patients had a good outcome (Barthel index: 100 (1); 80 (3); and 70 (1)). At the last follow-up (mean 89 months), 4 patients had a good functional outcome (Barthel index between 60 and 80). CONCLUSION Early surgical treatment in critically ill patients with spondylodiscitis and sepsis may result in rapid control of infection and can provide favorable long-term outcome. A general strategy of performing only limited surgery is a valid option in such patients who have a relatively high risk for surgery.
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Affiliation(s)
- Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Dirk Scheinichen
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Thomas Palmaers
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Zafer Cinibulak
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Jens D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Affiliated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
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Kreisel SI, Sparenberg S, Sharabiany S, Hompes R, Lapid O, van der Horst CMAM, Musters GD, Tanis PJ. Gluteal Fasciocutaneous Flap Reconstruction After Salvage Surgery for Pelvic Sepsis. Dis Colon Rectum 2023; 66:1570-1577. [PMID: 36940299 DOI: 10.1097/dcr.0000000000002648] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
BACKGROUND Chronic pelvic sepsis mostly originates from complicated pelvic surgery and failed interventions. This is a challenging condition that often requires extensive salvage surgery consisting of complete debridement with source control and filling of the dead space with well-vascularized tissue. OBJECTIVE This study aimed to describe the outcomes of gluteal fasciocutaneous flaps for the treatment of secondary pelvic sepsis. DESIGN Retrospective single-center cohort study. SETTINGS Tertiary referral center. PATIENTS Patients who underwent salvage surgery for secondary pelvic sepsis between 2012 and 2020 using a gluteal flap were included in this study. MAIN OUTCOME MEASURES Percentage of complete wound healing. RESULTS In total, 27 patients were included, of whom 22 underwent index rectal resection for cancer and 21 had undergone (chemo)radiotherapy. A median of 3 (interquartile range, 1-5) surgical and 1 (interquartile range, 1-4) radiological interventions preceded salvage surgery during a median period of 62 (interquartile range, 20-124) months. Salvage surgery included partial sacrectomy in 20 patients. The gluteal flap consisted of a V-Y flap in 16 patients, superior gluteal artery perforator flap in 8 patients, and a gluteal turnover flap in 3 patients. Median hospital stay was 9 (interquartile range, 6-18) days. During a median follow-up of 18 (interquartile range, 6-34) months, wound complications occurred in 41%, with a reintervention rate of 30%. The median time to wound healing was 69 (interquartile range, 33-154) days, with a complete healing rate of 89% at the end of follow-up. LIMITATIONS Retrospective design and heterogeneous patient population. CONCLUSIONS In patients undergoing major salvage surgery for chronic pelvic sepsis, the use of gluteal fasciocutaneous flaps is a promising solution because of the high success rate, limited risks, and relatively simple technique. See Video Abstract at http://links.lww.com/DCR/C160 . RECONSTRUCCIN CON COLGAJO FASCIOCUTNEO GLTEO DESPUS DE UNA CIRUGA DE RESCATE POR SEPSIS PLVICA ANTECEDENTES:La sepsis pélvica crónica esta causada principalmente por cirugías pélvicas complicadas e intervenciones fallidas. Esta es una condición desafiante que a menudo requiere una cirugía de rescate extensa que consiste en un desbridamiento completo controlando el orígen infeccioso y rellenando el espacio muerto con tejido bien vascularizado, como por ejemplo un colgajo de tejido autólogo. La pared abdominal (colgajo de recto abdominal) o la pierna (colgajo de gracilis) se utilizan principalmente como sitios donantes para esta indicación, mientras que los colgajos glúteos pueden ser alternativas atractivas.OBJETIVO:Describir los resultados de los colgajos fasciocutáneos glúteos en el tratamiento de la sepsis pélvica secundaria.DISEÑO:Estudio de cohortes retrospectivo en un solo centro.AJUSTES:Centro de referencia terciario.PACIENTES:Todos aquellos que se sometieron a cirugía de rescate por sepsis pélvica secundaria entre 2012 y 2020 utilizando un colgajo fasciocutáneo glúteo.PRINCIPALES MEDIDAS DE RESULTADO:El porcentaje de cicatrización completa de la herida.RESULTADOS:En total, se incluyeron 27 pacientes, de los cuales 22 fueron sometidos a resección rectal por cáncer indicada y 21 pacientes que habían recibido (quimio)radioterapia. Una mediana de tres (RIC 1-5) intervenciones quirúrgicas y una (RIC 1-4) intervenciones radiológicas precedieron a la cirugía de rescate durante una mediana de 62 (RIC 20-124) meses.La cirugía de rescate incluyó una resección parcial del sacro en 20 pacientes. El colgajo fasciocutáneo glúteo consistió en la confección de un colgajo en V-Y en 16 pacientes, un colgajo incluyendo la perforante de la arteria glútea superior en 8 y un colgajo de rotación de músculo glúteo en 3 pacientes.La mediana de estancia hospitalaria fue de nueve (RIC 6-18) días. Durante una mediana de seguimiento de 18 (IQR 6-34) meses, se produjeron complicaciones de la herida en el 41%, con una tasa de reintervención del 30%.La mediana de tiempo hasta la cicatrización de la herida fue de 69 (IQR 33-154) días con una tasa de cicatrización completa del 89 % al final del seguimiento cicatricial.LIMITACIONES:Diseño retrospectivo y población heterogénea de pacientes.CONCLUSIONES:En pacientes sometidos a cirugía mayor de rescate por sepsis pélvica crónica, el uso de colgajos fasciocutáneos glúteos es una solución prometedora debido a la alta tasa de éxito, los riesgos limitados y la técnica relativamente simple. Video Resumen en http://links.lww.com/DCR/C160 . (Traducción-Dr. Xavier Delgadillo ).
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Affiliation(s)
- Saskia I Kreisel
- Department of Surgery, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, The Netherlands
| | - Sebastian Sparenberg
- Department of Surgery, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, The Netherlands
| | - Sarah Sharabiany
- Department of Surgery, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, The Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, The Netherlands
| | - Oren Lapid
- Department of Surgery, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, The Netherlands
| | - Chantal M A M van der Horst
- Department of Surgery, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gijsbert D Musters
- Department of Surgery, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Center Location University of Amsterdam, Amsterdam, The Netherlands
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Lu X, Zhou B, Hu D, Ding Y. Emergency decompression for patients with ureteral stones and SIRS: a prospective randomized clinical study. Ann Med 2023; 55:965-972. [PMID: 36883206 PMCID: PMC10795631 DOI: 10.1080/07853890.2023.2169343] [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: 09/06/2022] [Accepted: 01/11/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE Patients with ureteral calculi and systemic inflammatory response syndrome (SIRS) often require emergency drainage, and percutaneous nephrostomy (PCN) and retrograde ureteral stent insertion (RUSI) are the most commonly used methods. Our study aimed to identify the best choice (PCN or RUSI) for these patients and to examine the risk factors for progression to urosepsis after decompression. METHODS A prospective, randomized clinical study was performed at our hospital from March 2017 to March 2022. Patients with ureteral stones and SIRS were enrolled and randomized to the PCN or RUSI group. Demographic information, clinical features and examination results were collected. RESULTS Patients (n = 150) with ureteral stones and SIRS were enrolled into our study, with 78 (52%) patients in the PCN group and 72 (48%) patients in the RUSI group. Demographic information was not significantly different between the groups. The final treatment of calculi was significantly different between the two groups (p < .001). After emergency decompression, urosepsis developed in 28 patients. Patients with urosepsis had a higher procalcitonin (p = .012) and blood culture positivity rate (p < .001) and more pyogenic fluids during primary drainage (p < .001) than patients without urosepsis. CONCLUSION PCN and RUSI were effective methods of emergency decompression in patients with ureteral stone and SIRS. Patients with pyonephrosis and a higher PCT should be carefully treated to prevent the progression to urosepsis after decompression.Key messageIn this study, we evaluate the best choice (PCN or RUSI) for patients who have ureteral stones and SIRS and to examine the risk factors for progression to urosepsis after decompression. This study found that PCN and RUSI were effective methods of emergency decompression. Pyonephrosis and higher PCT were risk factors for patients to develop to urosepsis after decompression.
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Affiliation(s)
- Xiaofei Lu
- Department of Urology, Xiang Yang No. 1 Peoples Hospital Affiliated Hospital of Hubei University of Medicine, Xiangyang, China
| | - Benzheng Zhou
- Department of Urology, Xiang Yang No. 1 Peoples Hospital Affiliated Hospital of Hubei University of Medicine, Xiangyang, China
| | - Dechao Hu
- Department of Urology, Xiang Yang No. 1 Peoples Hospital Affiliated Hospital of Hubei University of Medicine, Xiangyang, China
| | - Yanting Ding
- Department of Gynaecology and Obstetrics, Xiang Yang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Maspero M, Lavryk O, Lipman J, Valente M, Kessler H, Holubar S, Steele SR, Hull T. Redo ileal pouch-anal anastomosis for early versus late sepsis-related pouch failure. Surgery 2023; 174:801-807. [PMID: 37543468 DOI: 10.1016/j.surg.2023.06.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/24/2023] [Accepted: 06/18/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Pouch failure after restorative proctocolectomy with ileal pouch-anal anastomosis occurs in 5% to 15% of cases, mostly due to septic complications. We aimed to determine if the timing of pouch failure impacted long-term outcomes for redo ileal pouch-anal anastomosis after sepsis-related complications. METHOD We retrospectively analyzed our prospectively collected institutional pouch database. Patients who underwent redo ileal pouch-anal anastomosis for septic complications between 1988 and 2020 were divided into an early (pouch failure within 6 months of stoma closure after index operation, or stoma never closed) and a late failure group (pouch failure after 6 months of stoma closure). The primary endpoint was pouch survival. RESULTS In total, 335 patients were included: 241 (72%) in the early and 94 (28%) in the late failure group. The most common indication for failure was an anastomotic leak in the early failure group (163, 68%) and fistula in the late failure group (59, 63%), P < .001. Pouch survival at 3, 5, and 10 years was 77%, 75%, and 72% for the early and 79%, 75%, and 68% for the late failure group (P = .94). The most common reason for redo pouch failure was fistula in both groups. Quality of life was similar in both groups. In multivariate analysis, the only factor associated with pouch failure was the final diagnosis of Crohn's disease. CONCLUSION Outcomes after redo ileal pouch-anal anastomosis were comparable between patients with early and late sepsis-related index pouch failure, with acceptable rates of long-term pouch survival and good quality of life.
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Affiliation(s)
- Marianna Maspero
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH. https://twitter.com/MariannaMaspero
| | - Olga Lavryk
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH. https://twitter.com/OlgaLavryk
| | - Jeremy Lipman
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Michael Valente
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Hermann Kessler
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Stefan Holubar
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH. https://twitter.com/HolubarStefan
| | - Scott R Steele
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH. https://twitter.com/ScottRSteeleMD
| | - Tracy Hull
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH.
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Eiamampai N, Ramsay EA, Soiza RL, McDonald DA, Moug SJ, Myint PK. Poor outcomes in patients with sepsis undergoing emergency laparotomy and laparoscopy are attenuated by faster time to care measures. Colorectal Dis 2023; 25:1888-1895. [PMID: 37545127 DOI: 10.1111/codi.16702] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/12/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
AIM Emergency laparotomy and laparoscopy (EmLap) are amongst the commonest surgical procedures, with high prevalence of sepsis and hence poorer outcomes. However, whether time taken to receive care influences outcomes in patients requiring antibiotics for suspected infection remains largely unexplored. The aim of this work was to determine whether (1) time to care contributes to outcome differences between patients with and without suspected infection and (2) its impact on outcomes only amongst those with suspected infection. METHOD Clinical information was retrospectively obtained from the 2017-2018 Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). Time to care referred to six temporal variables describing radiological investigation, anaesthetic triage and surgical management. Outcome measures [mortality, readmission, hospital death, postoperative destination and length of stay (LoS)] were compared using adjusted and unadjusted regression analyses to determine whether the outcome differences could be explained by faster or slower time to care. RESULTS Amongst 2243 EmLap patients [median age 65 years (interquartile range 51-75 years), 51.1% female], 892 (39.77%) received antibiotics for suspected infection. Although patients with suspected infection had faster time to care (all p ≤ 0.001) and worse outcomes compared with those who did not, outcome differences were not statistically significant when accounted for time (all p > 0.050). Amongst those who received antibiotics, faster time to care was also associated with decreased risk of postoperative intensive care unit (ICU) stay and shorter LoS (all p < 0.050). CONCLUSION Worse outcomes associated with infection in EmLap patients were attenuated by faster time to care, which additionally reduced the LoS and ICU stay risk amongst those with suspected infection.
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Affiliation(s)
- Natthaya Eiamampai
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Euan A Ramsay
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Roy L Soiza
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - David A McDonald
- Centre for Sustainable Delivery, Golden Jubilee University National Hospital, Clydebank, UK
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
| | - Susan J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
- University of Glasgow, Glasgow, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
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Rastätter M, Walter N, Bärtl S, Alt V, Rupp M. [Septic patient with gangrenous foot : A report of a surgical emergency with a foudroyant course]. Chirurgie (Heidelb) 2022; 93:1095-1098. [PMID: 35731283 PMCID: PMC9592627 DOI: 10.1007/s00104-022-01674-z] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Mario Rastätter
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Nike Walter
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Susanne Bärtl
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Markus Rupp
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
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Abstract
Thumb Carpometacarpal (CMC) total joint arthroplasty is commonly performed with increasing numbers worldwide. We present a case of Prosthetic Joint Infection (PJI) leading to severe septic shock and disseminated septic emboli 8 months following uneventful thumb CMC arthroplasty. Such extensive and life-threatening infection following thumb CMC arthroplasty has not been reported. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Tal Kalimian
- Department of Orthopedic Surgery, Assuta-Ashdod University Hospital, Ashdod, Israel, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Moti Kramer
- Department of Orthopedic Surgery, Assuta-Ashdod University Hospital, Ashdod, Israel, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Drexler
- Department of Orthopedic Surgery, Assuta-Ashdod University Hospital, Ashdod, Israel, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Uri Farkash
- Department of Orthopedic Surgery, Assuta-Ashdod University Hospital, Ashdod, Israel, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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10
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Pourlotfi A, Ahl Hulme R, Bass GA, Sjölin G, Cao Y, Matthiessen PL, Mohseni S. Statin Therapy Is Associated With Decreased 90-Day Postoperative Mortality After Colon Cancer Surgery. Dis Colon Rectum 2022; 65:559-565. [PMID: 34784312 DOI: 10.1097/dcr.0000000000001933] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There have been conflicting reports regarding a protective effect of statin therapy after colon cancer surgery. OBJECTIVE This study aimed to evaluate the association between statin therapy and the postoperative mortality following elective colon cancer surgery. DESIGN This population-based cohort study is a retrospective analysis of prospectively collected data from the Swedish Colorectal Cancer Register. SETTINGS Patient inclusion was achieved through a nationwide register. PATIENTS All adult patients undergoing elective surgery for colon cancer between January 2007 and September 2016 were included in the study. Patients who had received and collected a prescription for statins pre- and postoperatively were allocated to the statin-positive cohort. MAIN OUTCOME MEASURES The primary and secondary outcomes of interest were 90-day all-cause mortality and 90-day cause-specific mortality. RESULTS A total of 22,337 patients underwent elective surgery for colon cancer during the study period, of whom 6,494 (29%) were classified as statin users. Statin users displayed a significant survival benefit despite being older, having a higher comorbidity burden, and being less fit for surgery. Multivariate analysis illustrated significant reductions in the incidence risk for 90-day all-cause mortality (Incidence Rate Ratio = 0.12, p < 0.001) as well as 90-day cause-specific deaths due to sepsis, due to multiorgan failure, or resulting from a cardiovascular and respiratory origin. LIMITATIONS The limitations of this study include its observational retrospective design, restricting the ability to perform standardized follow-up of statin therapy. Confounding from other uncontrolled variables cannot be excluded. CONCLUSIONS Statin users had a significant postoperative benefit regarding short-term mortality following elective colon cancer surgery in the current study; however, further research is needed to ascertain whether this relationship is causal. See Video Abstract at http://links.lww.com/DCR/B738. LA TERAPIA CON ESTATINAS SE ASOCIA CON UNA DISMINUCIN DE LA MORTALIDAD POSOPERATORIA A LOS DAS DESPUS DE LA CIRUGA DE CNCER DE COLON ANTECEDENTES:Ha habido informes contradictorios con respecto al efecto protector de la terapia con estatinas después de la cirugía de cáncer de colon.OBJETIVO:Este estudio tuvo como objetivo evaluar la asociación entre la terapia con estatinas y la mortalidad postoperatoria después de la cirugía electiva por cáncer de colon.DISEÑO:Este estudio de cohorte poblacional es un análisis retrospectivo de datos recopilados prospectivamente del Registro Sueco de Cáncer Colorrectal.AJUSTES:La inclusión de pacientes se logró mediante la inclusión a través de un registro a nivel nacional.PACIENTES:Se incluyeron en el estudio todos los pacientes adultos sometidos a cirugía electiva por cáncer de colon en el período de enero de 2007 y septiembre de 2016. Los pacientes que habían recibido y recogido una receta de estatinas antes y después de la operación fueron asignados a la cohorte positiva de estatinas.PRINCIPALES MEDIDAS DE DESENLACES:Los desenlaces primarios y secundarios de interés fueron la mortalidad por cualquier causa a los 90 días y la mortalidad por causas específicas a los 90 días.RESULTADOS:Un total de 22.337 pacientes se sometieron a cirugía electiva por cáncer de colon durante el período de estudio, de los cuales 6.494 (29%) se clasificaron como usuarios de estatinas. Los usuarios de estatinas mostraron un beneficio significativo en la supervivencia a pesar de ser mayores, de tener una mayor carga de comorbilidad y de estar menos acondicionado para la cirugía. El análisis multivariado ilustró reducciones significativas en el riesgo de incidencia de mortalidad por cualquier causa a 90 días (índice de tasa de incidencia = 0,12, p < 0,001), así como muertes específicas ena 90 días debidas a sepsis, falla multiorgánica o dea enfermedades de origen cardiovascular y respiratorio.LIMITACIONES:Las limitaciones de este estudio incluyen su diseño observacional retrospectivo, que restringe la capacidad de realizar un seguimiento estandarizado de la terapia con estatinas. No se puede excluir confusión a partir de otras variables no controladas.CONCLUSIONES:Los usuarios de estatinas tuvieron un beneficio posoperatorio significativo con respecto a la mortalidad a corto plazo después de cirugía electiva por cáncer de colon en el estudio actual, sin embargo, se necesita más investigación para confirmar si eexiste una relación es causal. Consulte Video Resumen en http://links.lww.com/DCR/B738.
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Affiliation(s)
- Arvid Pourlotfi
- Department of Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Rebecka Ahl Hulme
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Gary A Bass
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Surgical Critical Care & Emergency Surgery, Penn Medicine, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Gabriel Sjölin
- Department of Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Peter L Matthiessen
- Department of Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Shahin Mohseni
- Department of Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
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11
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Revishvili AS, Olovyanny VE, Kalinin DV, Kuznetsov AV. [Mortality in acute appendicitis in Russia]. Khirurgiia (Mosk) 2022:5-14. [PMID: 36223144 DOI: 10.17116/hirurgia20221015] [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] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To analyze the causes of mortality in patients with acute appendicitis in Russia. MATERIAL AND METHODS We retrospectively studied mortality in patients with acute appendicitis in the Russian Federation in 2020. We surveyed the hospitals with mortality reported in the electronic database of annual reports to the chief surgeon of the Ministry of Health of the Russian Federation. RESULTS There were 259 deaths among 150.393 patients with acute appendicitis aged ≥18 years (in-hospital mortality 0.17%). We obtained data about 95.8% (n=248) of lethal cases including 86.3% (n=214) complicated and 13.7% (n=34) uncomplicated forms of disease. Two patients died without surgery (0.8%). Among the deceased, 58.2% (n=145) were men and 41.8% (n=103) were women. Mean patient age was 66.2 years [0.95% CI 64.2-68.1]. The main cause of death in complicated appendicitis was late presentation (after 4.9 days [0.95% CI 4.3-5.4]) that resulted peritonitis and sepsis in 71.5% (n=153) of patients. Cardiovascular diseases were noted in 23.4% (n=50) of cases. A new coronavirus infection was detected in 7.0% (n=15) of patients. However, COVID-19 as a direct cause of death was recognized in 2.8% (n=6) of cases. Other reasons accounted for 2.3% (n=5). In uncomplicated appendicitis, cardiovascular diseases were the main cause of mortality (73.5%, n=25). Peritonitis and sepsis were found in 11.8% (n=4) of cases, COVID-19 - in 5.9% (n=2). Other causes accounted for 8.8% (n=3). Diagnostic, tactical, technical problems and their combination were revealed in 54.4% of lethal outcomes. CONCLUSION Mortality from acute appendicitis in the Russian Federation is low, comparable with international data, and mainly associated with delayed treatment and complicated course of disease. However, the impact of diagnostic, tactical and technical errors on the outcome of acute appendicitis is significant.
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Affiliation(s)
- A Sh Revishvili
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - V E Olovyanny
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - D V Kalinin
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A V Kuznetsov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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12
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Cajas-Monson L, Park M, Kalra M. A 73-year-old woman with delayed intra-abdominal and systemic sepsis following complicated aortobifemoral bypass. J Vasc Surg 2021; 74:2074-2075. [PMID: 34809815 DOI: 10.1016/j.jvs.2020.12.054] [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] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/05/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Luis Cajas-Monson
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Myung Park
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minn
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
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13
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Moran B, Major E, Kufera JA, Tisherman SA, Diaz J. Pre-operative fluid resuscitation in the emergency general surgery septic patient: does it really matter? BMC Emerg Med 2021; 21:86. [PMID: 34294035 PMCID: PMC8295544 DOI: 10.1186/s12873-021-00479-3] [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] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/23/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Emergency general surgery (EGS) patients presenting with sepsis remain a challenge. The Surviving Sepsis Campaign recommends a 30 mL/kg fluid bolus in these patients, but recent studies suggest an association between large volume crystalloid resuscitation and increased mortality. The optimal amount of pre-operative fluid resuscitation prior to source control in patients with intra-abdominal sepsis is unknown. This study aims to determine if increasing volume of resuscitation prior to surgical source control is associated with worsening outcomes. METHODS We conducted an 8-year retrospective chart review of EGS patients undergoing surgery for abdominal sepsis within 24 h of admission. Patients in hemorrhagic shock and those with outside hospital index surgeries were excluded. We grouped patients by increasing pre-operative resuscitation volume in 10 ml/kg intervals up to > 70 ml/kg and later grouped them into < 30 ml/kg or ≥ 30 ml/kg. A relative risk regression model compared amounts of fluid administration. Mortality was the primary outcome measure. Secondary outcomes were time to operation, ventilator days, and length of stay (LOS). Groups were compared by quick Sequential Organ Failure Assessment (qSOFA) and SOFA scoring systems. RESULTS Of the 301 patients included, the mean age was 55, 51% were male, 257 (85%) survived to discharge. With increasing fluid per kg (< 10 to < 70 ml/kg), there was an increasing mortality per decile, 8.8% versus 31.6% (p = 0.004). Patients who received < 30 mL/kg had lower mortality (11.3 vs 21%) than those who received > 30 ml/kg (p = 0.02). These groups had median qSOFA scores (1.0 vs. 1.0, p = 0.06). There were no differences in time to operation (6.1 vs 4.9 h p = 0.11), ventilator days (1 vs 3, p = 0.08), or hospital LOS (8 vs 9 days, p = 0.57). Relative risk regression correcting for age and physiologic factors showed no significant differences in mortality between the fluid groups. CONCLUSIONS Greater pre-operative resuscitation volumes were initially associated with significantly higher mortality, despite similar organ failure scores. However, fluid volumes were not associated with mortality following adjustment for other physiologic factors in a regression model. The amount of pre-operative volume resuscitation was not associated with differences in time to operation, ventilator days, ICU or hospital LOS.
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Affiliation(s)
- Benjamin Moran
- Einstein Healthcare Network, Sidney Kimmel Medical College at Thomas Jefferson University, Einstein Medical Center, Klein Building, Suite 101, 5401 Old York Road, Philadelphia, PA 19141 USA
| | - Erin Major
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
| | - Joseph A. Kufera
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
| | - Samuel A. Tisherman
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
| | - Jose Diaz
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
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14
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Abstract
Cecal ligation and puncture (CLP) is referred to as the "gold standard" rodent model for abdominal sepsis. CLP creates a continuously leaking, polymicrobial infectious focus in the abdomen. The abdominal cavity is opened under general anesthesia and analgesia and the cecum is exposed, ligated underneath the ileocecal valve, and punctured with a needle. A small amount of feces is pressed out through the puncture and the cecum is repositioned into the abdomen, which is then closed with single button sutures and tissue glue. CLP severity can be influenced via the length of the ligated cecum as well as the needle size. Within 24 h, animals develop clinical signs of a systemic bacterial infection. Analgesia, wide range antibiotic treatment, and fluid resuscitation should be administered during the acute phase of sepsis to increase the clinical relevance of the CLP model.
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Affiliation(s)
- Susanne Drechsler
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria
| | - Marcin Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria.
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15
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Shute L, Pidutti J, Trepman E, Burnett M, Embil JM. Rectal Perforation by an Intrauterine Device Leading to Fatal Intra-Abdominal Sepsis and Necrotizing Fasciitis. J Obstet Gynaecol Can 2020; 43:760-762. [PMID: 33268310 DOI: 10.1016/j.jogc.2020.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/12/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Colorectal injury from an intrauterine device (IUD) is rare but may lead to major complications. CASE A 55-year-old woman presented to a tertiary care hospital with 4 days of generalized weakness, confusion, dysuria, and lower back pain. She provided a vague history of an unsuccessful attempt to remove an IUD 30 years prior. A computed tomography scan demonstrated an IUD in the rectal lumen, with gluteal and pelvic gas and fluid collections. Emergency surgery found necrotizing fasciitis. Despite multiple debridements, sigmoidoscopic IUD removal, and long-term intravenous antibiotics, the patient died from sepsis and multiorgan failure. CONCLUSION IUDs require proper monitoring and timely removal to prevent potential complications associated with organ perforation.
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Affiliation(s)
- Lauren Shute
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB.
| | - Joel Pidutti
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Elly Trepman
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Margaret Burnett
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - John M Embil
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB; Department of Medicine, Section of Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
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16
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Fernández LG, Matthews MR, Seal L. Intraabdominal Lavage of Hypochlorous Acid: A New Paradigm for the Septic and Open Abdomen. Wounds 2020; 32:107-114. [PMID: 32155118] [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: 06/10/2023]
Abstract
INTRODUCTION Management of the open abdomen (OA) has rapidly evolved over the last several decades due to the improved understanding of the underlying pathophysiology of patients with an OA, adoption of damage control surgery, and the use of temporary abdominal closure (TAC) techniques for this patient population. The TAC utilizing negative pressure has been successful for managing patients with an OA with improved time to closure. Recent studies have started to examine the use of TAC in conjunction with negative pressure wound therapy with instillation and dwell time (NPWTi-d) for the management of the OA. OBJECTIVE This case series illustrates the capability, safety, and clinical effectiveness of TAC/NPWTi-d with hypochlorous acid (HOCl) solution. MATERIALS AND METHODS Three successfully treated cases describe the use of NPWTi-d using HOCl solution for the management of patients with a septic OA. RESULTS This initial experience suggests instillation of HOCl through the tubing set, in conjunction with the TAC device, is safe and easy to use. This technique decreased the need for more frequent OA lavages in the operating room (OR) after the index procedure, as well as the associated concomitant risks of transporting patients who are critically ill between the SICU and OR. No acute complications related to the TAC device with HOCl were noted. CONCLUSIONS Based on the results of this study, the authors believe instillation through the TAC device may be the next evolution in the use of abdominal NPWT and programmed intermittent lavage of the peritoneal cavity represents an effective method in the care of patients with a septic OA.
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Batyrshin IM, Shlyapnikov SA, Demko AE, Ostroumova YS, Sklizkov DS, Fomin DV, Tishkov AV, Strakh LV. [Prediction and differentiated approach in the treatment of patients with secondary peritonitis and abdominal sepsis]. Khirurgiia (Mosk) 2020:27-33. [PMID: 32500686 DOI: 10.17116/hirurgia202005127] [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] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify the most important high risk criteria for predicting course of disease, as well as optimal preoperative preparation and surgical strategy in patients with secondary peritonitis. MATERIAL AND METHODS A prospective study enrolled 43 patients with diffuse secondary peritonitis. RESULTS Significant predictors were Charlson's comorbidity index (p=0.001) and SOFA score of organ dysfunction within 3 days after admission. Rapid regression of organ dysfunction (SOFA1 - p=0.0001, SOFA2 - p=0.012, SOFA3 - p=0.017) and reduced time of examination and preoperative preparation (threshold value - 520 min after admission) are predictors of favorable outcome in patients with diffuse secondary peritonitis. There was no reliable correlation between the treatment outcome and preoperative preparation (infusion volume p=0.23, duration p=0.37, absence/presence of antibacterial therapy p=0.26). Elimination or control of infection is the fundamental principle of the management of patients with diffuse secondary peritonitis.
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Affiliation(s)
- I M Batyrshin
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - S A Shlyapnikov
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - A E Demko
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - Yu S Ostroumova
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - D S Sklizkov
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - D V Fomin
- Dzhanelidze Saint Petersburg Research Institute for Emergency Care, Saint Petersburg, Russia
| | - A V Tishkov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - L V Strakh
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
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18
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Slavu I, Nitipir C, Alecu L, Tulin A, Constantinoiu S. When is Laparoscopy Avoided in the Treatment of Surgical Complications due to Crohn Disease. Chirurgia (Bucur) 2019; 114:487-493. [PMID: 31511135 DOI: 10.21614/chirurgia.114.4.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/23/2022]
Abstract
Introduction: Crohn disease (CD) has seen a steady increase in incidence over the years in Romania. Laparoscopy had a slow evolution as a feasible therapeutic option for patients with CD.
Material and Method: The study is retrospective. The period on which the data was gathered spread over 8 years (01.01.2011-01.01.2019). Data was retrieved from three Clinical Hospitals in Bucharest, Romania
Results: the preoperative diagnosis of an intestinal fistula (p = 0,02), sepsis (p = 0.01 ) or increased age should be regarded as a limitation for a laparoscopic approach in CD complications. Also in emergency settings an open approach should be the mainstay treatment (approach p = 0.000001).
Conclusion: Laparoscopy is a feasible surgical option in the treatment of surgical complication in CD. In order to increase the safety of the intervention, correct selection of patients is important.
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Høydahl Ø, Fougner RL, Stornes T. A woman in her forties with perianal sepsis. Tidsskr Nor Laegeforen 2019; 139:17-1120. [PMID: 30872832 DOI: 10.4045/tidsskr.17.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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20
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Li X, Wu X, Bai B, Yu D, Yu P, Zhao Q. [Research progress of the open abdomen in the treatment of gastrointestinal fistula with complicated intra-abdominal infection]. Zhonghua Wei Chang Wai Ke Za Zhi 2018; 21:1446-1450. [PMID: 30588599] [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: 06/09/2023]
Abstract
Gastrointestinal fistula patients may suffer from complicated intra-abdominal infection and sepsis with improper treatment, which is characterized by high mortality ranging from 20% to 60%, as well as high medical costs. Gastrointestinal fistula patients with complicated intra-abdominal infections are not often diagnosed early, and proper treatment remains an unsolved problem. Therefore it is a great challenge for surgeons to repair broken intestines under complicated intra-abdominal infection conditions and to repair ruptured intestines under conditions of severe abdominal adhesions and swelling of the intestinal wall and mesentery. After the open abdominal approach was first adopted to treat complicated intra-abdominal infection patients by Duff and Moffat in 1981, it gradually began to be used more widely. However, some investigators have reported that the open abdomen approach has not been effective in controlling controlled mortality, instead, it may even increase mortality. For this reason, the approach has only been used in large medical centers rather than having been widely popularized. In this review, the effect, timing, indications of open abdomen approach and the principles for the open abdominal wound management are summarized, and the reason for the various efficacy among different centers is also analyzed. We provide a new perspective for clinicians to manage the gastrointestinal fistula patients with complicated intra-abdominal infection.
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Affiliation(s)
- Xuzhao Li
- Department of Digestive Surgery, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The Airforce Medical University, Xi'an 710032, China
| | - Xiaoyong Wu
- Department of Digestive Surgery, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The Airforce Medical University, Xi'an 710032, China
| | - Bin Bai
- Department of Digestive Surgery, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The Airforce Medical University, Xi'an 710032, China
| | - Deliang Yu
- Department of Digestive Surgery, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The Airforce Medical University, Xi'an 710032, China
| | - Pengfei Yu
- Department of Digestive Surgery, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The Airforce Medical University, Xi'an 710032, China
| | - Qingchuan Zhao
- Department of Digestive Surgery, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The Airforce Medical University, Xi'an 710032, China, zhaoqc@fmmu. edu.cn
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Teles AR, Montgomery S, Thomas KC. Necrotizing Fasciitis Involving Spine: Unusual Medical Emergency for Spine Surgeon. World Neurosurg 2018; 121:124-126. [PMID: 30321674 DOI: 10.1016/j.wneu.2018.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/07/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a surgical diagnosis characterized by a rapidly progressive soft tissue infection, widespread tissue necrosis, and associated systemic illness. Friability of the superficial fascia, dishwater-gray exudate, and absence of pus are surgical characteristics of this diagnosis. Due to rapid progression of the infection, early recognition and aggressive surgical debridement are crucial to reduce mortality. Despite being commonly seen by general, plastic, and orthopedic surgeons, NF is an extremely rare spine surgery emergency. Our objective is to report on a case of NF involving the spine and highlight this unusual surgical emergency for the spine surgeon. CASE DESCRIPTION We present a rare case of a 61-year-old woman who presented to the emergency department in septic shock. She had a 1-week history of increasing back pain before presenting to us. Computed tomography revealed extensive soft tissue emphysema with involvement of the L3 vertebral body and spina canal. She underwent emergency surgical debridement. Despite maximal medical and surgical therapies, the patient died secondary to multisystem organ failure within 36 hours of initial presentation. CONCLUSIONS To the best of our knowledge, the literature presents only 1 previous case reported involving the spine. Necrotizing fasciitis is an unusual surgical spine surgery emergency. Spine surgeons should be aware of this diagnosis in order to provide timely aggressive surgical debridement.
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Affiliation(s)
- Alisson R Teles
- McGill Scoliosis & Spine Group, McGill University, Montreal, Quebec.
| | - Spencer Montgomery
- Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Alberta, Canada
| | - Kenneth C Thomas
- Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Alberta, Canada
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22
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Cabral L, Afreixo V, Meireles R, Vaz M, Marques M, Tourais I, Chaves C, Almeida L, Paiva JA. Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients - a retrospective observational study. BMC Anesthesiol 2018; 18:122. [PMID: 30185148 PMCID: PMC6123981 DOI: 10.1186/s12871-018-0585-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/08/2018] [Accepted: 08/24/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Early sepsis diagnosis is crucial for the correct management of burn patients, and it clearly influences outcomes. The systemic inflammatory response triggered by burns mimics sepsis presentation and complicates early sepsis diagnosis. Biomarkers were advocated to aid the diagnosis of early sepsis. Serum procalcitonin (PCT) exhibits fair accuracy and good correlation with sepsis severity, being used in diverse clinical settings. However, few studies have evaluated perioperative changes in PCT levels in burn patients. The present study evaluated PCT kinetics during the first days after burn injury and subsequent surgical interventions to assess PCT utility in distinguishing septic from non-septic inflammatory responses. METHODS This study was a retrospective observational study of all burn patients admitted to the Coimbra Burns Unit (Portugal) between January 2011 and December 2014 who presented with a total burn surface area ≥ 15% and who underwent subsequent surgery. PCT kinetics were investigated a) during the first five days after burn injury and b) preoperatively during the five days after surgery in three subsets of patients, including those with no preoperative and no postoperative sepsis (NN), no preoperative but postoperative sepsis (NS), and preoperative and postoperative sepsis (SS). A total of 145 patients met the selection criteria and were included in the analysis. RESULTS PCT levels in the first five days after burn injury were significantly higher in patients who developed at least one sepsis episode (n = 85) compared with patients who did not develop sepsis (n = 60). PCT values > 1.00 ng/mL were clearly associated with sepsis. Study participants (n = 145) underwent a total of 283 surgical interventions. Their distribution by preoperative/postoperative sepsis status was 142 (50.2%) in NN; 62 (21.9%) in NS; and 79 (27.9%) in SS. PCT values exhibited a parallel course in the three groups that peaked on the second postoperative day and returned to preoperative levels on the third day or later. The lowest PCT values were found in NN, and the highest values were observed in SS; the NS values were intermediate. CONCLUSIONS PCT kinetics coupled with a clinical examination may be helpful for sepsis diagnosis during the first days after burn injury and burn surgery.
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Affiliation(s)
- Luís Cabral
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
- Autonomous Section of Health Sciences (SACS), University of Aveiro, Aveiro, Portugal
| | - Vera Afreixo
- CIDMA-Center for Research and Development in Mathematics and Applications; iBiMED-Institute for Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Rita Meireles
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
| | - Miguel Vaz
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
| | - Margarida Marques
- Department of Anesthesiology, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Isabel Tourais
- Department of Anesthesiology, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Catarina Chaves
- Department of Clinical Pathology, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Luís Almeida
- MedinUP, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Artur Paiva
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto; Grupo de Infecção e Sépsis, Porto, Portugal
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23
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Skovsen AP, Burcharth J, Tolstrup MB, Gögenur I. [Mortality rate after acute laparotomy can be reduced]. Ugeskr Laeger 2018; 180:V09170639. [PMID: 30064620] [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: 06/08/2023]
Abstract
Acute abdomen is a common cause of admission to hospital. Emergency laparotomy is associated with a significant morbidity and mortality due to deranged physiology and surgery-induced stress. Damage control laparotomy is on the rise as an operative strategy for the septic abdomen as well as for trauma laparotomy but lacks definition in the non-trauma setting. Principles of perioperative care in elective surgery are currently applied to the emergency abdominal surgery patients and should be further studied in the future to reduce morbidity and mortality.
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24
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Kirkpatrick AW, Coccolini F, Ansaloni L, Roberts DJ, Tolonen M, McKee JL, Leppaniemi A, Faris P, Doig CJ, Catena F, Fabian T, Jenne CN, Chiara O, Kubes P, Manns B, Kluger Y, Fraga GP, Pereira BM, Diaz JJ, Sugrue M, Moore EE, Ren J, Ball CG, Coimbra R, Balogh ZJ, Abu-Zidan FM, Dixon E, Biffl W, MacLean A, Ball I, Drover J, McBeth PB, Posadas-Calleja JG, Parry NG, Di Saverio S, Ordonez CA, Xiao J, Sartelli M. Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): study protocol for a randomized controlled trial. World J Emerg Surg 2018; 13:26. [PMID: 29977328 PMCID: PMC6015449 DOI: 10.1186/s13017-018-0183-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 04/09/2018] [Accepted: 05/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. Principles of treatment include early antibiotic administration and operative source control. A further therapeutic option may be open abdomen (OA) management with active negative peritoneal pressure therapy (ANPPT) to remove inflammatory ascites and ameliorate the systemic damage from SCIAS. Although there is now a biologic rationale for such an intervention as well as non-standardized and erratic clinical utilization, this remains a novel therapy with potential side effects and clinical equipoise. Methods The Closed Or Open after Laparotomy (COOL) study will constitute a prospective randomized controlled trial that will randomly allocate eligible surgical patients intra-operatively to either formal closure of the fascia or use of the OA with application of an ANPTT dressing. Patients will be eligible if they have free uncontained intra-peritoneal contamination and physiologic derangements exemplified by septic shock OR a Predisposition-Infection-Response-Organ Dysfunction Score ≥ 3 or a World-Society-of-Emergency-Surgery-Sepsis-Severity-Score ≥ 8. The primary outcome will be 90-day survival. Secondary outcomes will be logistical, physiologic, safety, bio-mediators, microbiological, quality of life, and health-care costs. Secondary outcomes will include days free of ICU, ventilation, renal replacement therapy, and hospital at 30 days from the index laparotomy. Physiologic secondary outcomes will include changes in intensive care unit illness severity scores after laparotomy. Bio-mediator outcomes for participating centers will involve measurement of interleukin (IL)-6 and IL-10, procalcitonin, activated protein C (APC), high-mobility group box protein-1, complement factors, and mitochondrial DNA. Economic outcomes will comprise standard costing for utilization of health-care resources. Discussion Although facial closure after SCIAS is considered the current standard of care, many reports are suggesting that OA management may improve outcomes in these patients. This trial will be powered to demonstrate a mortality difference in this highly lethal and morbid condition to ensure critically ill patients are receiving the best care possible and not being harmed by inappropriate therapies based on opinion only. Trial registration ClinicalTrials.gov, NCT03163095.
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Affiliation(s)
- Andrew W. Kirkpatrick
- Department of Surgery, University of Calgary, Calgary, Alberta Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta Canada
- The Trauma Program, University of Calgary, Calgary, Alberta Canada
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- Unit of General and Emergency Surgery, Bufalini Hospital of Cesena, Cesena, Italy
| | - Derek J. Roberts
- Department of Surgery, University of Calgary, Calgary, Alberta Canada
| | - Matti Tolonen
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jessica L. McKee
- Regional Trauma Services, Foothills Medical Centre, Calgary, Alberta Canada
| | - Ari Leppaniemi
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Peter Faris
- Research Facilitation Analytics (DIMR), University of Calgary, Calgary, Alberta Canada
| | - Christopher J. Doig
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Timothy Fabian
- Surgery, University of Tennessee Health Sciences Center Memphis, Memphis, TN USA
| | - Craig N. Jenne
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta Canada
| | - Osvaldo Chiara
- General Surgery and Trauma Team Niguarda Hospital Milano, Milan, Italy
| | - Paul Kubes
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta Canada
- Department of Physiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Braden Manns
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
- Department of Medicine, University of Calgary, Calgary, Alberta Canada
- Libin Cardiovascular Institute and O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta Canada
| | | | - Gustavo P. Fraga
- Division of Trauma Surgery, University of Campinas, Campinas, SP Brazil
| | - Bruno M. Pereira
- Division of Trauma Surgery, University of Campinas, Campinas, SP Brazil
| | - Jose J. Diaz
- Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School on Medicine, Baltimore, MD USA
| | - Michael Sugrue
- Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland
| | - Ernest E. Moore
- Trauma and Critical Care Research, University of Colorado, Denver, CO USA
| | - Jianan Ren
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chad G. Ball
- General, Acute Care, and Hepatobiliary Surgery, and Regional Trauma Services, University of Calgary, Calgary, Alberta Canada
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda, CA USA
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA USA
| | - Zsolt J. Balogh
- John Hunter Hospital and Hunter New England Health District, Newcastle, NSW Australia
- Surgery and Traumatology, University of Newcastle, Newcastle, NSW Australia
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Elijah Dixon
- Department of Surgery, University of Calgary, Calgary, Alberta Canada
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
- Surgical Oncology, University of Calgary, Calgary, Alberta Canada
- City Wide Section of General Surgery, University of Calgary, Calgary, Alberta Canada
| | - Walter Biffl
- Scripps Memorial Hospital La Jolla, La Jolla, California USA
| | - Anthony MacLean
- Department of Surgery, University of Calgary, Calgary, Alberta Canada
| | - Ian Ball
- Department of Medicine, Western University, London, Ontario Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada
| | - John Drover
- Department of Critical Care Medicine, Queen’s University, Kingston, Ontario Canada
- Department of Surgery, Queen’s University, Kingston, Ontario Canada
| | - Paul B. McBeth
- Department of Surgery, University of Calgary, Calgary, Alberta Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta Canada
- The Trauma Program, University of Calgary, Calgary, Alberta Canada
| | | | - Neil G. Parry
- Department of Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario Canada
- Department of Critical Care, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario Canada
| | - Salomone Di Saverio
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Carlos A. Ordonez
- Department of Surgery, Fundación Valle del Lili and Universidad Del Valle, Cali, Colombia
| | - Jimmy Xiao
- Regional Trauma Services, Foothills Medical Centre, Calgary, Alberta Canada
| | | | - for The Closed Or Open after Laparotomy (COOL) after Source Control for Severe Complicated Intra-Abdominal Sepsis Investigators
- Department of Surgery, University of Calgary, Calgary, Alberta Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta Canada
- The Trauma Program, University of Calgary, Calgary, Alberta Canada
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
- Unit of General and Emergency Surgery, Bufalini Hospital of Cesena, Cesena, Italy
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Regional Trauma Services, Foothills Medical Centre, Calgary, Alberta Canada
- Research Facilitation Analytics (DIMR), University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
- Surgery, University of Tennessee Health Sciences Center Memphis, Memphis, TN USA
- General Surgery and Trauma Team Niguarda Hospital Milano, Milan, Italy
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta Canada
- Department of Physiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
- Department of Medicine, University of Calgary, Calgary, Alberta Canada
- Libin Cardiovascular Institute and O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- Rambam Health Care Campus, Haifa, Israel
- Division of Trauma Surgery, University of Campinas, Campinas, SP Brazil
- Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School on Medicine, Baltimore, MD USA
- Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland
- Trauma and Critical Care Research, University of Colorado, Denver, CO USA
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- General, Acute Care, and Hepatobiliary Surgery, and Regional Trauma Services, University of Calgary, Calgary, Alberta Canada
- Riverside University Health System Medical Center, Loma Linda, CA USA
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA USA
- John Hunter Hospital and Hunter New England Health District, Newcastle, NSW Australia
- Surgery and Traumatology, University of Newcastle, Newcastle, NSW Australia
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
- Surgical Oncology, University of Calgary, Calgary, Alberta Canada
- City Wide Section of General Surgery, University of Calgary, Calgary, Alberta Canada
- Scripps Memorial Hospital La Jolla, La Jolla, California USA
- Department of Medicine, Western University, London, Ontario Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada
- Department of Critical Care Medicine, Queen’s University, Kingston, Ontario Canada
- Department of Surgery, Queen’s University, Kingston, Ontario Canada
- Department of Surgery, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario Canada
- Department of Critical Care, Western University, Victoria Hospital, London Health Sciences Centre, London, Ontario Canada
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Surgery, Fundación Valle del Lili and Universidad Del Valle, Cali, Colombia
- Department of Surgery, Macerata Hospital, Macerata, Italy
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25
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Hershkovitz Y, Ashkenazi I, Shapira Z, Zmora O, Jeroukhimov I. Planned Re-Laparotomy in a Non-Trauma Setting: A Single Center Experience. Isr Med Assoc J 2018; 20:300-303. [PMID: 29761676] [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
BACKGROUND Damage control laparotomy (DCL) is the widely accepted procedure of choice in management of severely injured trauma patient. It has been implemented in non-trauma-related surgical pathology in the last decade. OBJECTIVES To evaluate our experience with planned re-laparotomy (PRL) in non-trauma patients and compare it to other reports. METHODS Charts of all patients admitted to Assaf Harofeh Medical Center who underwent PRL for non-trauma-related abdominal pathology during a 6 year period were reviewed. Data regarding demographics, vital signs, laboratory tests, indications for surgery, length of hospital stay, and mortality were obtained from medical charts. Indications for surgery, risk factors, and mortality were analyzed. RESULTS The study was comprised of 181 patients. Primary abdominal sepsis (50), postoperative sepsis (49), mesenteric event (32), and intestinal obstruction (28) were the most common indications for PRL. Mortality rate was 48.6%. Factors correlating with increased mortality were advanced age, hypotension, hypothermia, metabolic acidosis, and renal failure. Bowel resection was performed on 122 patients (67%) and primary intestinal anastomosis constructed in 46.7%. Mortality rate was lower in patients who underwent PRL with primary anastomosis compared to patients with postponed bowel anastomosis (33.3% vs. 55.4%, P = 0.018). CONCLUSIONS PRL in abdominal emergencies carries a high mortality rate. Primary anastomosis may be considered in non-trauma-related PRL.
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Affiliation(s)
- Yehuda Hershkovitz
- Department of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Ashkenazi
- Department of Surgery Hillel Yaffe Medical Center, Hadera, Israel
| | - Zahar Shapira
- Department of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Jeroukhimov
- Department of Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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26
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Cherkun OY, Sytnik DA, Kaliuzhka AS, Sheyko VD, Hryn VH. Evaluation of the effectiveness of surgical management in local purulent-septic complications of acute pancreatitis. Wiad Lek 2018; 71:1231-1234. [PMID: 30267505] [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
OBJECTIVE Introduction: In the past decades, mortality in acute pancreatitis ranges from 3% to 15 % and depends mainly on the severity of the diseases, which is characterized by the development of necrotic processes in the pancreas and systemic complications. Notwithstanding the numerous studies on severe forms of acute pancreatitis, no significant improvement of treatment outcomes of this category of patients is observed. The integrated diagnosis and treatment of this pathology, prognosis and prevention of purulentseptic complications are relevant to date. The aim: To evaluate the effectiveness of surgical management depending on the nature and incidence of local purulent-septic complications of acute pancreatitis. PATIENTS AND METHODS Materials and methods: We have analyzed the treatment outcomes of 422 patients with acute pancreatitis who were treated in the Surgical Unit at Poltava Regional Clinical Hospital in the period from 2010 to 2015. All patients were admitted to hospital following 1-7 days after infection. 315 (74.6 %) of them were diagnosed with mild acute pancreatitis; patients received conservative treatment and were discharged from the hospital within 7-10 days. Moderate and severe pancreatitis with the development of local parapancreatic complications were diagnosed in 107 patients (25, 4%) (men=67 (62.6%); women=40 (37, 4%)). Age of patients ranged from 22 to 81 years (47, 9±1.5 years). The severity of the disease was determined according to BISAP score, the presence of multiple organ failure was confirmed by the Modified Marshall Score (2012 modification) Patients were examined in compliance with the requirements of the Order of the Ministry of Health of Ukraine No 297 as of 02 April, 2010. RESULTS Review and conclusions: Moderate acute pancreatitis is characterized by localization of purulent-septic complications in 1-2 anatomical areas with fluid component mainly. Severe acute pancreatitis is characterized by the localization of purulent-septic complications in 2 or more anatomical areas with tissue component mainly. The efficacy of aspiration-and-drainage interventions depended on the proliferation of fluid accumulations in 1-2 anatomical areas and presence of fluid component mainly. Primarily, open necrsequestrotomy is the most appropriate surgery to be performed in patients with mainly tissue component in the fluid aggregations and the prevalence of local parapancreatic complications in more than two anatomic areas.
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Affiliation(s)
- Oleksiy Yu Cherkun
- Higher State Educational Establishment Of Ukraine, Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - Dmytro A Sytnik
- Higher State Educational Establishment Of Ukraine, Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - Andriy S Kaliuzhka
- Higher State Educational Establishment Of Ukraine, Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - Volodymyr D Sheyko
- Higher State Educational Establishment Of Ukraine, Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - Volodymyr H Hryn
- Higher State Educational Establishment Of Ukraine, Ukrainian Medical Stomatological Academy, Poltava, Ukraine
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27
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Vicenti G, Pesce V, Bizzoca D, Nappi V, Palmiotto F, Carrozzo M, Moretti B. Perioperative plasmatic presepsin levels in patients undergoing total hip or knee replacement: a preliminary study. J BIOL REG HOMEOS AG 2017; 31:1081-1086. [PMID: 29254318] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Presepsin (sCD14-ST) is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in the diagnosis and management of periprosthetic joint infections (PJI). The aim of this study is to define the normal perioperative plasmatic levels of presepsin in patients undergoing primary cementless total hip replacement (THR) or primary cemented total knee replacement (TKR). For this purpose, 50 patients (19 male, 31 female, mean age= 64.04±8.88) were recruited. The patients were divided into two groups: Group A patients underwent cementless THR, whereas Group B patients underwent cemented TKR. On recruitment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score (HHS) for Group A patients and Knee Society Score (KSS) for Group B patients, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS), C-reactive protein (CRP) and procalcitonin (PCT) 24 hours before arthroplasty (T0) and at 24 (T1), 48 (T2), 72 (T3) and 96 (T4) hours postoperatively. Body temperature (θ) was recorded every six hours in the time lapse T0-T4. Presepsin plasmatic concentration was comparable at baseline in both groups. After surgery, however, a significant increase of presepsin was observed in Group A, whereas in Group B no significant changes of presepsin were recorded. A comparable trend of this biomarker was found in the two groups, i.e. presepsin increased from T0 to T3, when it reached its maximum value, and its decrease started at T4. Finally, presepsin resulted more accurate than CRP in the evaluation of perioperative inflammatory response in patients undergoing THR or TKR. These data will be helpful in defining a reference interval for presepsin in patients with prosthetic joint implants, and a cut-off of this biomarker for the diagnosis of PJI.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Biomarkers/blood
- C-Reactive Protein/metabolism
- Calcitonin/blood
- Female
- Humans
- Lipopolysaccharide Receptors/blood
- Male
- Middle Aged
- Osteoarthritis, Hip/blood
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/blood
- Osteoarthritis, Knee/complications
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/surgery
- Peptide Fragments/blood
- Perioperative Period
- Preliminary Data
- Sepsis/blood
- Sepsis/complications
- Sepsis/diagnosis
- Sepsis/surgery
- Severity of Illness Index
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Affiliation(s)
- G Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - V Pesce
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - D Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - V Nappi
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - F Palmiotto
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - M Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
| | - B Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, Bari, Italy
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Smolar M, Dzian A, Hamzik J, Saniova B, Laca L. Iatrogenic perforation of hypopharynx as a cause of severe descending necrotizing mediastinitis: A case report. Neuro Endocrinol Lett 2017; 38:325-328. [PMID: 29106786] [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: 05/29/2017] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
The authors present a case report of severe descending necrotizing mediastinitis (DNM) etiologically of unrecognized traumatic endotracheal intubation with hypopharynx-esophageal junction perforation. Patient was treated inadequately for seven days in local hospital what was the cause of sepsis progression into the septic shock with multiorgan dysfunction syndrome. Patient was transferred to specialized hospital and was immediately operated in general anaesthesia - combined transcervical approach and lateral thoracotomy was used for mediastinal drainage and debridement. Combination of appropriate conventional and surgical therapy led to reversing of the unfavorable situation.
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Affiliation(s)
- Marek Smolar
- Clinic of Surgery and Transplantation Center, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital Martin, Slovakia
| | - Anton Dzian
- Clinic of Thoracic Surgery, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital Martin, Slovakia
| | - Julian Hamzik
- Clinic of Thoracic Surgery, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital Martin, Slovakia
| | - Beata Saniova
- Clinic of Anaesthesiology and Intensive Care Medicine, Comenius University in Bratislava, Jessenius Faculty of Medicine and Martin University Hospital, Martin, Slovakia
| | - Ludovit Laca
- Clinic of Surgery and Transplantation Center, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital Martin, Slovakia
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29
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Scriba MF, Laing GL, Bruce JL, Clarke DL. The absolute number of repeat operations for complex intra-abdominal sepsis is not a useful predictor of non-survival. S AFR J SURG 2017; 55:32-35. [PMID: 28876621] [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: 06/07/2023]
Abstract
BACKGROUND When multiple repeat laparotomies are required to manage intra-abdominal sepsis, questions about futility of treatment frequently arise. This study focuses specifically on patients who required two or more repeat laparotomies and describes the spectrum of disease necessitating multiple repeat laparotomies and the associated outcomes in the hope of clarifying the issue. METHOD This study was conducted over a 20-month period (December 2012 - July 2014) at Greys Hospital in Pietermaritzburg, South Africa. All surgical patients at Greys Hospital have admission, discharge and operative data prospectively entered into a computerised electronic registry, the Hybrid Medical Electronic Registry (HEMR). The ethics approval required to maintain this registry has been obtained from the Biomedical Research Ethics Committee (BCA221/13 BREC) of the University of KwaZulu-Natal and from the Research Unit of the Department of Health. Full ethical approval for this study was granted by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BE047/14). All patients aged 13 years and older who needed at least two repeat laparotomies were included in the study. This included general surgical and trauma patients. RESULTS During the study period, 72 patients required more than one repeat laparotomy and a total of 182 repeat laparotomy operations were performed on this patient cohort. Demographics showed a male predominance, with 54 (75%) being male and 18 (25%) being female patients. The average age was 39 years. General surgical patients accounted for 60% and trauma patients for 40% of the total. The majority of patients required only two repeat laparotomy (65 %), while two patients required a total of 6 repeat laparotomy each, both with an initial diagnosis of appendicitis and both these patients survived. Temporary abdominal closure (TAC) was performed in 26 (36%) of initial laparotomies, while 33 (46%) of patients had an open abdomen at the time of discharge or death. Sixty percent required intensive care or high care unit (ICU/HCU) admission and 53 patients (74%) had a total of 71 documented morbidities. Total mortality for this study was 21%, however there was no correlation between number of procedures and mortality. CONCLUSION The total number of procedures is associated with increased morbidity rates but not necessarily with increased mortality rates. This is important to consider when the issue of futility of treatment arises, as the absolute number of repeat laparotomies is a poor marker of futility and other factors must be considered.
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Affiliation(s)
- M F Scriba
- Department of Surgery, Pietermaritzburg Hospital Complex, University of KwaZulu-Natal
| | - G L Laing
- Department of Surgery, Pietermaritzburg Hospital Complex, University of KwaZulu-Natal
| | - J L Bruce
- Department of Surgery, Pietermaritzburg Hospital Complex, University of KwaZulu-Natal
| | - D L Clarke
- Department of Surgery, Pietermaritzburg Hospital Complex, University of KwaZulu-Natal
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Nerup N, Langballe KOL, Achiam MP, Svendsen LB. [Damage control surgery in patients with abdominal sepsis]. Ugeskr Laeger 2017; 179:V12160909. [PMID: 28504624] [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: 06/07/2023]
Abstract
Damage control surgery (DCS) and resuscitation has improved the survival of trauma patients with decompensated physiology. In recent years, the principles of DCS have been used in the treatment of patients with abdominal sepsis, despite the fact that only a minimum of evidence exists. The aim is to optimize the physiology prior to definitive surgery. This implies a primary decontaminating surgical procedure with temporary abdominal closure without restoration of the intestinal continuity and avoidance of stoma formation in order to reduce time in the operating theatre.
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Adam S, Sama HD, Chossegros C, Bouassalo MK, Akpoto MY, Kpemissi E. Improvised Vacuum-Assisted Closure for severe neck infection in poorly equipped conditions. J Stomatol Oral Maxillofac Surg 2017; 118:178-180. [PMID: 28391076 DOI: 10.1016/j.jormas.2017.03.008] [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] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/11/2017] [Accepted: 03/29/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Dental infections are common and are mainly due to dental caries. When left untreated, these infections can lead to severe life-threatening sepsis. CASE REPORT The authors reported a case of a severe odontogenic deep neck space infection in a 54-year-old male. The patient was a heavy smoker with incidentally discovered diabetes. He was successfully treated by surgical drainage combined with an improvised Vacuum-Assisted Closure (VAC) system. The results of surgical drainage followed by insertion of an improvised VAC system were spectacular. The abscess resolved in response to dual-agent antibiotic therapy on day 17 and blood glucose control was achieved with insulin. Full-thickness skin graft was performed to repair the necrotic zone of the neck. DISCUSSION The use of VAC can be a valuable alternative to conventional dressings and hyperbaric oxygen therapy in poorly equipped conditions. Public awareness campaigns remain the most effective form of prevention against these odontogenic infections.
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Affiliation(s)
- S Adam
- Service d'ORL et de Chirurgie Cervico-Maxillo-faciale, CHU Sylvanus Olympio, 08 BP 8146 Lomé, Togo; Service d'Odontostomatologie et de Chirurgie Maxillo-faciale, CHU Sylvanus Olympio, Lomé, Togo.
| | - H D Sama
- Service d'anesthésie réanimation, CHU Sylvanus Olympio, Lomé, Togo
| | - C Chossegros
- Stomatologie-Chirurgie Maxillo-Faciale & Orale CHU de Marseille, Hôpital de la Conception, 147 boulevard Baille, 13385 Marseille cedex 5, France
| | - M K Bouassalo
- Service d'Odontostomatologie et de Chirurgie Maxillo-faciale, CHU Sylvanus Olympio, Lomé, Togo
| | - M Y Akpoto
- Service de Chirurgie traumatologique et d'Orthopédie, CHU Sylvanus Olympio, Lomé, Togo
| | - E Kpemissi
- Service d'ORL et de Chirurgie Cervico-Maxillo-faciale, CHU Sylvanus Olympio, 08 BP 8146 Lomé, Togo
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Abstract
RATIONALE Ecthyma gangrenosum (EG) is an aggressive cutaneous disease caused by local or systemic infection with Pseudomonas aeruginosa. EG is characterized by cutaneous manifestations ranging from nodule and papule, to necrotic ulceration with surrounding erythema, especially with black eschar or central crust. EG presents with characteristic skin lesions which is important to establish diagnosis of sepsis caused by P aeruginosa, a serious condition that can be treated efficiently if diagnosed early. PATIENT CONCERNS A 3-month-old female infant was presented with characteristic skin lesions of EG and developed sepsis 3 days later. DIAGNOSES Ecthyma gangrenosum and sepsis caused by Pseudomonas aeruginosa. INTERVENTIONS Meropenem was used in combination with ceftazidime at first and excision of necrotic skin lesions was performed later. OUTCOMES Cure. LESSONS Early recognition of EG plays an important role in providing appropriate empiric antibiotic treatment at early stage of sepsis, and improves the prognosis. Surgical excision may be helpful if no improvement was achieved via antibiotic treatment.
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Affiliation(s)
| | | | | | - Hai-feng Yu
- Department of Urology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang
| | - Xu-hua Tang
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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Sartelli M, Chichom-Mefire A, Labricciosa FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, Ansaloni L, Bala M, Balogh ZJ, Beltrán MA, Ben-Ishay O, Biffl WL, Birindelli A, Cainzos MA, Catalini G, Ceresoli M, Che Jusoh A, Chiara O, Coccolini F, Coimbra R, Cortese F, Demetrashvili Z, Di Saverio S, Diaz JJ, Egiev VN, Ferrada P, Fraga GP, Ghnnam WM, Lee JG, Gomes CA, Hecker A, Herzog T, Kim JI, Inaba K, Isik A, Karamarkovic A, Kashuk J, Khokha V, Kirkpatrick AW, Kluger Y, Koike K, Kong VY, Leppaniemi A, Machain GM, Maier RV, Marwah S, McFarlane ME, Montori G, Moore EE, Negoi I, Olaoye I, Omari AH, Ordonez CA, Pereira BM, Pereira Júnior GA, Pupelis G, Reis T, Sakakhushev B, Sato N, Segovia Lohse HA, Shelat VG, Søreide K, Uhl W, Ulrych J, Van Goor H, Velmahos GC, Yuan KC, Wani I, Weber DG, Zachariah SK, Catena F. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg 2017; 12:29. [PMID: 28702076 PMCID: PMC5504840 DOI: 10.1186/s13017-017-0141-6] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [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] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/20/2017] [Indexed: 02/06/2023] Open
Abstract
Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.
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Affiliation(s)
| | - Alain Chichom-Mefire
- Department of Surgery and Obstetrics/Gynaecology, Regional Hospital, Limbe, Cameroon
| | - Francesco M. Labricciosa
- 0000 0001 1017 3210grid.7010.6Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Timothy Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
| | - Fikri M. Abu-Zidan
- 0000 0001 2193 6666grid.43519.3aDepartment of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Abdulrashid K. Adesunkanmi
- 0000 0001 2183 9444grid.10824.3fDepartment of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Luca Ansaloni
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Miklosh Bala
- 0000 0001 2221 2926grid.17788.31Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zsolt J. Balogh
- 0000 0004 0577 6676grid.414724.0Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales Australia
| | - Marcelo A. Beltrán
- Department of General Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
| | - Offir Ben-Ishay
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Walter L. Biffl
- 0000 0001 1482 1895grid.162346.4Acute Care Surgery at The Queen’s Medical Center, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, USA
| | - Arianna Birindelli
- 0000 0004 1759 7093grid.416290.8Department of Surgery, Maggiore Hospital, Bologna, Italy
| | - Miguel A. Cainzos
- 0000 0000 8816 6945grid.411048.8Department of Surgery, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | | | - Marco Ceresoli
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Asri Che Jusoh
- Department of General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia
| | - Osvaldo Chiara
- grid.416200.1Emergency Department, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Federico Coccolini
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Raul Coimbra
- 0000 0001 2107 4242grid.266100.3Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | | | - Zaza Demetrashvili
- 0000 0004 0428 8304grid.412274.6Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, T’bilisi, Georgia
| | - Salomone Di Saverio
- 0000 0004 1759 7093grid.416290.8Department of Surgery, Maggiore Hospital, Bologna, Italy
| | - Jose J. Diaz
- 0000 0001 2175 4264grid.411024.2Shock Trauma Center, University of Maryland School of Medicine, Baltimore, USA
| | - Valery N. Egiev
- 0000 0000 9559 0613grid.78028.35Department of Surgery, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Paula Ferrada
- 0000 0004 0458 8737grid.224260.0Department of Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - Gustavo P. Fraga
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Wagih M. Ghnnam
- 0000000103426662grid.10251.37Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Jae Gil Lee
- 0000 0004 0470 5454grid.15444.30Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Carlos A. Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, Brazil
| | - Andreas Hecker
- 0000 0000 8584 9230grid.411067.5Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | - Torsten Herzog
- 0000 0004 0490 981Xgrid.5570.7Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jae Il Kim
- 0000 0004 0470 5112grid.411612.1Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Kenji Inaba
- 0000 0001 2156 6853grid.42505.36Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA USA
| | - Arda Isik
- 0000 0001 1498 7262grid.412176.7Department of General Surgery, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Aleksandar Karamarkovic
- 0000 0001 2166 9385grid.7149.bClinic for Emergency Surgery, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Jeffry Kashuk
- 0000 0004 1937 0546grid.12136.37Department of Surgery, Assia Medical Group, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| | - Vladimir Khokha
- Department of Emergency Surgery, Mozyr City Hospital, Mozyr, Belarus
| | - Andrew W. Kirkpatrick
- 0000 0004 0469 2139grid.414959.4Departments of Surgery, Critical Care Medicine, and the Regional Trauma Service, Foothills Medical Centre, Calgary, Alberta Canada
| | - Yoram Kluger
- 0000 0000 9950 8111grid.413731.3Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Kaoru Koike
- 0000 0004 0372 2033grid.258799.8Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Victor Y. Kong
- 0000 0004 0576 7753grid.414386.cDepartment of Surgery, Edendale Hospital, Pietermaritzburg, Republic of South Africa
| | - Ari Leppaniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Gustavo M. Machain
- 0000 0001 2289 5077grid.412213.7II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - Ronald V. Maier
- 0000000122986657grid.34477.33Department of Surgery, University of Washington, Seattle, WA USA
| | - Sanjay Marwah
- 0000 0004 1771 1642grid.412572.7Department of Surgery, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Michael E. McFarlane
- 0000 0004 0500 5353grid.412963.bDepartment of Surgery, Radiology, University Hospital of the West Indies, Kingston, Jamaica
| | - Giulia Montori
- 0000 0004 1757 8431grid.460094.fGeneral Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Ernest E. Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Iyiade Olaoye
- 0000 0000 8878 5287grid.412975.cDepartment of Surgery, University of Ilorin, Teaching Hospital, Ilorin, Nigeria
| | - Abdelkarim H. Omari
- 0000 0004 0411 3985grid.460946.9Department of Surgery, King Abdullah University Hospital, Irbid, Jordan
| | - Carlos A. Ordonez
- 0000 0001 2295 7397grid.8271.cDepartment of Surgery and Critical Care, Universidad del Valle, Fundación Valle del Lili, Cali, Colombia
| | - Bruno M. Pereira
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | | | - Guntars Pupelis
- Department of General and Emergency Surgery, Riga East University Hospital ‘Gailezers’, Riga, Latvia
| | - Tarcisio Reis
- Emergency Post-operative Department, Otavio de Freitas Hospital and Hosvaldo Cruz Hospital, Recife, Brazil
| | - Boris Sakakhushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Norio Sato
- 0000 0001 1011 3808grid.255464.4Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Helmut A. Segovia Lohse
- 0000 0001 2289 5077grid.412213.7II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Asuncion, Paraguay
| | - Vishal G. Shelat
- grid.240988.fDepartment of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Kjetil Søreide
- 0000 0004 0627 2891grid.412835.9Department of Gastrointestinal Surgery, Stavanger University Hospital, Stravenger, Norway
- 0000 0004 1936 7443grid.7914.bDepartment of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Waldemar Uhl
- 0000 0004 0490 981Xgrid.5570.7Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Ulrych
- 0000 0000 9100 9940grid.411798.2First Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
| | - Harry Van Goor
- 0000 0004 0444 9382grid.10417.33Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - George C. Velmahos
- 0000 0004 0386 9924grid.32224.35Trauma, Emergency Surgery, and Surgical Critical Care Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | - Kuo-Ching Yuan
- 0000 0004 1756 1461grid.454210.6Trauma and Emergency Surgery Department, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Imtiaz Wani
- 0000 0001 0174 2901grid.414739.cDepartment of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Dieter G. Weber
- 0000 0004 0453 3875grid.416195.eDepartment of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Sanoop K. Zachariah
- 0000 0004 1766 361Xgrid.464618.9Department of Surgery, Mosc Medical College, Kolenchery, Cochin, India
| | - Fausto Catena
- Department of Emergency Surgery, Maggiore Hospital, Parma, Italy
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Тrybushnyi OV, Shapoval SD, Savon IL, Novak VV. [АNALYSIS OF LETHALITY IN COMPLICATED DIABETIC FOOT SYNDROME AND SEPSIS]. Klin Khir 2017:58-60. [PMID: 30272920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There were examined in dynamics 724 patients, in whom complicated diabetic foot syndrome (DFS) was diagnosed, and in 71 (9.8%) of them the disease was complicated by sepsis. The state severity in a DFS patients have depended upon duration of purulent-necrotic process on the foot, in septic patients such dependence was not revealed. All the DFS patients without sepsis were operated on. In total 36 died (lethality 5.5%), in presence of sepsis - 42 (lethality 59.1%). The cause of sepsis in the patients, suffering complicated DFS, was predominantly a wet gangrene of the lower extremities. Among those, who were not operated on, 13 (30.9%) septic patients died, of them 5 – who refused operative intervention performance - died in first hours after admittance to hospital due to irreversible injury of organs and systems.
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Boyko VV, Lykhman VN, Shevchenko AN, Merkulov AA, Osmanov RR, Ryabinskaya OS, Khanko EV. [TRANSCUTANEOUS PUNCTURE DRAINING OF THE LIQUID ACCUMULATIONS IN RETROPERITONEAL CELLULAR TISSUE IN PURULENT—SEPTIC COMPLICATIONS OF AN ACUTE PANCREATITIS]. Klin Khir 2017:7-9. [PMID: 30272929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The results of miniinvasive transcutaneous interventions for purulent—septic complications of pancreonecrosis are presented. The computeric tomography (CT) and the ultrasound investigation data where compared while choosing of transcutaneous access towards purulent focus. Peculiar attention was drawn to searching of extraperitoneal trajectory for the drain conduction way. The drains were installed, using a one—staged method with a stylet catheters, owing 10 — 12 Fr in diameter, or a two—staged one. While comparing various methods of treatment of the pancreonecrosis purulent—septic complications there was established efficacy of miniinvasive interventions, performed for pancreatogenic abscesses and relatively delimited purulent foci in retroperitoneal cellular tissue.
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Abstract
The foot comprises 3 compartments bounded by bone and fascia, each compartment containing muscle and vascular and nervous structures. Infection leading to an increase in pressures in the compartments results in rapid necrosis, a pathologic process characteristic of diabetic feet. Treatment involves fasciotomy and complete debridement of devitalized tissue with possible amputation of the involved digits. Knowledge of the anatomic structure of the foot and its compartments is therefore essential in effectively managing the diabetic foot.
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Affiliation(s)
- Dale Maharaj
- Department of General Surgery, Port-of-Spain General Hospital, University of the West Indies, Trinidad
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Cóndor JM, Rodrigues CE, Sousa Moreira RD, Canale D, Volpini RA, Shimizu MHM, Camara NOS, Noronha IDL, Andrade L. Treatment With Human Wharton's Jelly-Derived Mesenchymal Stem Cells Attenuates Sepsis-Induced Kidney Injury, Liver Injury, and Endothelial Dysfunction. Stem Cells Transl Med 2016; 5:1048-57. [PMID: 27280799 PMCID: PMC4954445 DOI: 10.5966/sctm.2015-0138] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 06/29/2015] [Accepted: 03/16/2016] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED : The pathophysiology of sepsis involves complex cytokine and inflammatory mediator networks. Downregulation of endothelial nitric oxide synthase contributes to sepsis-induced endothelial dysfunction. Human Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) are known to reduce expression of proinflammatory cytokines and markers of apoptosis. We hypothesized that treatment with WJ-MSCs would protect renal, hepatic, and endothelial function in a cecal ligation and puncture (CLP) model of sepsis in rats. Rats were randomly divided into three groups: sham-operated rats; rats submitted to CLP and left untreated; and rats submitted to CLP and intraperitoneally injected, 6 hours later, with 1 × 10(6) WJ-MSCs. The glomerular filtration rate (GFR) was measured at 6 and 24 hours after CLP or sham surgery. All other studies were conducted at 24 hours after CLP or sham surgery. By 6 hours, GFR had decreased in the CLP rats. At 24 hours, Klotho renal expression significantly decreased. Treatment with WJ-MSCs improved the GFR; improved tubular function; decreased the CD68-positive cell count; decreased the fractional interstitial area; decreased expression of nuclear factor κB and of cytokines; increased expression of eNOS, vascular endothelial growth factor, and Klotho; attenuated renal apoptosis; ameliorated hepatic function; increased glycogen deposition in the liver; and improved survival. Sepsis-induced acute kidney injury is a state of Klotho deficiency, which WJ-MSCs can attenuate. Klotho protein expression was higher in WJ-MSCs than in human adipose-derived MSCs. Because WJ-MSCs preserve renal and hepatic function, they might play a protective role in sepsis. SIGNIFICANCE Sepsis is the leading cause of death in intensive care units. Although many different treatments for sepsis have been tested, sepsis-related mortality rates remain high. It was hypothesized in this study that treatment with human Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) would protect renal, hepatic, and endothelial function in a model of sepsis in rats. Treatment with WJ-MSCs improved the glomerular filtration rate, improved tubular function, decreased expression of nuclear factor κB and of cytokines, increased expression of eNOS and of Klotho, attenuated renal apoptosis, and improved survival. Sepsis-induced acute kidney injury is a state of Klotho deficiency, which WJ-MSCs can attenuate.
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Affiliation(s)
- José M Cóndor
- Division of Nephrology, University of São Paulo, São Paulo, Brazil School of Medical Technology, National University of San Marcos, Lima, Peru
| | | | | | - Daniele Canale
- Division of Nephrology, University of São Paulo, São Paulo, Brazil
| | - Rildo A Volpini
- Division of Nephrology, University of São Paulo, São Paulo, Brazil
| | | | - Niels O S Camara
- Immunology Department, University of São Paulo, São Paulo, Brazil
| | | | - Lúcia Andrade
- Division of Nephrology, University of São Paulo, São Paulo, Brazil
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Abstract
BACKGROUND Outcome of pseudomonas enteric fever is unpredictable as multiple systemic lethal complications occur abruptly. CASE CHARACTERISTICS A 9-month-old girl with multiple ileal perforations, leukocoria, ecthyma gangrenosum, hemiplegia and a perforated ulcer in the soft palate. Blood culture suggested Pseudomonas aeruginosa infection. Operative repair of multiple ileal perforations and multidisciplinary management was provided. OUTCOME On 10th post-operative day, patient succumbed to multiple organ dysfunction syndrome. MESSAGE Early detection and management of complications of P. aeruginosa enteric disease is important.
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Affiliation(s)
- Pankaj Halder
- Department of Pediatric Surgery, Dr BC Roy, Post Graduate Institute of Pediatric Sciences (PGIPS); and *Department of Pathology, Institute of Postgraduate Medical Education and Research (IPGMR), Kolkata, West Bengal, India. Correspondence to: Dr Pankaj Halder, SarodaPalli, PanchanonTala, Baruipur, Kolkata 700 144, West Bengal, India.
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McGregor A, Bekdache K, Choi L. Idiopathic Pneumatosis Intestinalis Requiring Decompressive Laparotomy. Conn Med 2016; 80:301-304. [PMID: 27328580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are radiographic signs of questionable bowel ischemia. Pneumatosis intestinalis can be associated with possible benign conditions such as obstructive airway disease. We present a patient who demonstrated clinical signs of overt sepsis with corresponding radiological findings of PI and HPVG concering for possible small or large bowel ischemia. However at exploration, no sign of small or large bowel injury or ischemia could be detected. CASE PRESENTATION A 36-year-old male with a history of alcohol abuse presented to Danbury Hospital as a trauma alert after he slid on his motorcycle. He had a complete transection of the thoracic spinal cord which required multilevel laminectomies and a spinal fusion. He developed overt signs of sepsis with vital signs of a temperature of 38.5 degrees C (101.4 degrees F), heart rate of 141 bpm, white blood cell (WBC) count of 24.7 c/mcL, and lactic acid of 2.4 mg/dL. A CT scan of the abdomen and pelvis revealed a pneumatosis and hepatic portal venous gas. An exploratory laparotomy was performed which showed distended small bowel, but no evidence for ischemia or injury. An ABthera Open Abdomen Negative Pressure Therapy System (Kinetic Concepts, Inc., San Antonio, TX) was placed due to the fact that the abdominal wall could not be closed. A second look laparotomy revealed no injury or ischemia, and the patient's abdomen was closed primarily. CONCLUSION Pneumatosis intestinalis and hepatic portal venous gas are radiographic findings that can be associated with bowel ischemia. The clinical status of the patient should guide operative management. There is no evidence to suggest that there is an association with spinal trauma and pneumatosis intestinalis or hepatic portal venous gas.
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Smith JW, Nash N, Procter L, Benns M, Franklin GA, Miller K, Harbrecht BG, Bernard AC. Not All Abdomens Are the Same: A Comparison of Damage Control Surgery for Intra-abdominal Sepsis versus Trauma. Am Surg 2016; 82:427-432. [PMID: 27215724] [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
Damage control surgery (DCS) was developed to manage exsanguinating trauma patients, but is increasingly applied to the management of peritoneal sepsis and abdominal catastrophes. Few manuscripts compare the outcomes of these surgeries on disparate patient populations. A multi-institutional three group propensity score matched case cohort study comparing penetrating trauma (PT-DCS), blunt trauma (BT-DCS), and intraperitoneal sepsis (IPS-DCS) was performed comparing patients treated with DSC between 2008 and 2013. Propensity scoring was performed using demographic and presenting physiologic data. Four hundred and twelve patients were treated with DCS across two institutions. Propensity matching for age, gender, and initial Acute Physiology and Chronic Health Evaluation II score 80 identified 80 patients per group for comparison. Rate of primary fascial closure was lowest in the IPS-DCS group, and highest in the penetrating trauma DCS group. Intra-abdominal complication rates were highest in the IPS-DCS group. IPS-DCS had increased time to definitive closure compared with the other two groups (RR 1.8; 1.3-2.2; P < 0.03). Mortality at 90 days was highest in the IPS-DCS group and patients whose definitive closure was delayed >eight days were more than twice the risk of death at 90 days across all groups. (RR 2.15; 1.2-3.5; P < 0.002). Expected outcomes after the use of DCS for trauma and emergency general surgery are quite different. Despite this difference, prompt abdominal closure at the earliest possible opportunity afforded the best outcome in patients managed via DCS.
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Affiliation(s)
- Jason W Smith
- Hiram C. Polk Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky
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Rabindran J, Chua TC, Neale M, Samra JS. Successful Treatment of Acute Vein Graft Thrombosis Precipitated by Delayed Sepsis and Duodenocaval Fistulization. Am Surg 2016; 82:E23-E24. [PMID: 26802848] [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: 06/05/2023]
Affiliation(s)
- Joel Rabindran
- Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St Leonards, New South Wales, Australia
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Malanchuk VO, Kuhlbashna YA, Brodetskyi IS. [CHRONIC OSTHEOMYELITIS OF THE FACIAL MIDDLE ZONE WITH SPREADING ON THE BONES OF CRANIAL BASE ON BACKGROUND OF NARCOTIC DEPENDENCE]. Klin Khir 2016:54-57. [PMID: 30272875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Own experience of treatment of a narcotic dependence patients, suffering osteomyelitis of jaws, was analyzed. In those patients, who have had exposed themselves towards toxic impact of narcotic substances (even after arrest of the consumption) for a long period of time, the inflammation spreading on the bones of facial middle zone and the skull base with occurrence of a life3threatening purulent3septic, including intracerebral, complications (cerebral аbscess, meningitis, sepsis) were observed. Additional division of cerebral abscess on open and closed forms for optimization of diagnosis of іntracranial complications was proposed.
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Shapoval SD, Vorontsova LL, Tribushniy OV, Savon IL, Slobodchenko LY. [SOME PARAMETERS OF THE IMMUNE STATE OF PATIENTS WITH DIABETIC FOOT SYNDROME AND SEPSIS]. Klin Khir 2016:30-32. [PMID: 30256579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The analysis of changes in the specific immunity in patients with purulent—necrotic complications of diabetic foot syndrome (DFS) and sepsis was presented. Complicated DFS was diagnosed in 436 patients, of whom 29 (6.6%) — weighed down by sepsis. The concentration of the major classes of immunoglobulins IgA, IgM, IgG were determined by enzyme—linked immunosorbent assay (ELISA). To evaluate the immune state was determined lymphocyte subpopulations (CD4+, CD3+, CD8+, CD25+) with monoclonal antibodies to antigens use by flow cytometry. It was found that in patients with DFS indicators specific cellular immunity were in a state of suppression, which deepened at complication of sepsis. Based on the derived formula with DFS marked disorders of the immune system I degree, in sepsis — II degree. Thus, the cellular and humoral immune system in patients with both DFS and sepsis qualified as a general immune depression.
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Artiaco S, Boggio F, Colzani G, Titolo P, Zoccola K, Bianchi P, Bellomo F. Megaprostheses in the Revision of Infected Total Hip Arthroplasty. Clinical Series and Literature Review. Bull Hosp Jt Dis (2013) 2015; 73:229-232. [PMID: 26630464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE The management of severe femoral bone loss associated with hip infection is a major problem in joint replacement surgery. Femoral megaprostheses have been rarely reported in reconstructive procedure for this complex condition. The aim of the study was to evaluate clinical results observed after such uncommon reconstruction in our case series and in a similar group of patients extracted by literature review. METHODS We evaluated clinical outcomes and eradication of sepsis in five patients who underwent femoral revision with modular femoral resection stems at our institution, and we reviewed the literature about this topic. In our case series, the femoral bone loss was grade III-B in three cases and grade IV in two cases according to the Paprosky classification. One patient was operated with one-stage revision, and four patients were operated with two-stage revision. The mean age was 72 years (range: 60 to 81 years), and the mean time of follow-up was 62 months (range: 36 to 82 months). RESULTS We observed sepsis eradication in four out of five patients in our series, and clinical results were satisfactory with a mean Harris Hip Score of 74 points (range: 46 to 95 points). Cumulative results obtained considering our series and data obtained by literature review showed a mean Harris Hip Score of 75 points (range: 42 to 95 points) in patients able to walk and an overall incidence of recurrent infection in 33% of patients. Complications were observed in 8 out of 20 patients (dislocation, 6 cases; greater trochanter displacement 2 cases; and transient sciatic palsy, 1 case). CONCLUSIONS Revision with megaprostheses in case of infected total hip arthroplasty with severe femoral bone loss have a high risk of complication and should be carefully evaluated and used in selected patients when other surgical procedures are not feasible.
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Harris CR, Alwaal A, Yang G, Eisenberg ML, Breyer BN. Adult Ureterocele Presenting with Ureteral Obstruction and Urosepsis during Pregnancy. Urol J 2015; 12:2285-2286. [PMID: 26341774 PMCID: PMC4896090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/24/2015] [Accepted: 06/29/2015] [Indexed: 06/05/2023]
Affiliation(s)
| | - Amjad Alwaal
- Department of Urology, University of California, San Francisco, USA.
| | - Glen Yang
- Department of Urology, University of California, San Francisco, USA
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Kovalenko AM. [BODY SUPPORT ROLE NUTRITIONAL VICTIMS WITH BURN INJURIES IN THE STAGE SEPTICOTOXEMIA]. Klin Khir 2015:55-58. [PMID: 26521470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The analysis of the treatment results of burn victims septicotoxemia of 120 injured persons in the area of thermal lesions 40-70% of the body surface. The dynamics of the clinical course of burn disease influenced by nutritional support with solutions of amino acids (AA) Aminosol and Aminosol-neo. Patients performed enteral, parenteral and mixed food. Parenteral nutrition improves the quality and results of treatment in stage burn septicotoxemia, contributes to an earlier elimination syndrome hipermetabolizm-hiperkatabolizm and readiness wounds to the plastic skin renewal and better engraftment of transplanted grafts of skin, reducing the frequency of complications and duration of hospitalization.
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Dayama A, Sugano D, Stone ME, McNelis J. Predictive factors associated with adverse events in patients with toxic colitis: an analysis of the National Surgical Quality Improvement Project. Am J Surg 2015; 210:852-8.e1. [PMID: 26120026 DOI: 10.1016/j.amjsurg.2015.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 12/02/2014] [Revised: 03/24/2015] [Accepted: 03/30/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Toxic colitis (TC) is a potentially lethal complication of inflammatory bowel disease and infectious colitis. METHODS The National Surgical Quality Improvement Project dataset was queried to identify emergent colectomy for a primary diagnosis of TC using International Classification of Diseases, Ninth Revision codes. The study endpoints were 30-day mortality and 30-day morbidity. We performed multivariate logistic regression analyses to study factors associated with 30-day mortality. RESULTS Of the 189 TC patients, mortality for colectomy was 26.5%, 42.3% experienced pulmonary complications, 20.6% experienced sepsis complications, 17.5% experienced cardiovascular complications, 12.7% experienced renal complications, and 14.8% experienced wound complications. On multivariate analysis, independent factors associated with mortality were age 70 to 80 years (odds ratio [OR] 3.5), age greater than 80 (OR 22.2), female sex (OR 4.1), uremia blood urea nitrogen greater than 40 (OR 4.1), coagulopathy international normalized ratio greater than 2 (OR 7.7), preoperative respiratory failure (OR 2.73), and preoperative steroid use (OR 3.9). CONCLUSIONS Patients with TC are very ill. Poor outcome is associated with older age, female sex, preoperative azotemia, preoperative respiratory failure, and chronic steroid use. These factors will help acute care surgeons in preoperative risk assessment and could be an important addition to decision-making strategies.
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Affiliation(s)
- Anand Dayama
- Department of Surgery, San Joaquin General Hospital, University of California Davis, French Camp, CA.
| | - Dordaneh Sugano
- Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY 10461, USA
| | - Melvin E Stone
- Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY 10461, USA
| | - John McNelis
- Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY 10461, USA
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Maggiori L, Blanche J, Harnoy Y, Ferron M, Panis Y. Redo-surgery by transanal colonic pull-through for failed anastomosis associated with chronic pelvic sepsis or rectovaginal fistula. Int J Colorectal Dis 2015; 30:543-8. [PMID: 25586206 DOI: 10.1007/s00384-014-2119-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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] [Accepted: 12/23/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Redo-surgery with new colorectal (CRA) or coloanal (CAA) anastomosis for failed previous CRA or CAA is exposed to failure and recurrent leakage, especially in case of rectovaginal fistula (RVF) or chronic pelvic sepsis (CPS). In these two situations, transanal colonic pull-through and delayed coloanal anastomosis (DCAA) could be an alternative to avoid definitive stoma. This study aimed to assess results of such redo-surgery with DCAA for failed CRA or CAA with CPS and/or RVF. METHODS All patients who underwent DCAA for failed CRA or CAA with CPS and/or RVF were reviewed. Success was defined as a patient without any stoma at the end of follow-up. Long-term functional results were assessed using the low anterior resection syndrome (LARS) score. RESULTS 24 DCAA were performed after failed CRA or CAA with CPS (n = 15) or RVF (n = 9). Sixteen (67%) patients had a diverting stoma at the time (n = 5) or performed during DCAA (n = 11). After a mean follow-up of 29 ± 19 months, success rate was 79% (19/24): 5 patients had a permanent stoma because of recurrent sepsis (n = 2), anastomotic stricture (n = 1), or poor functional outcomes (n = 2). Functional outcomes were satisfactory (no or minor LARS) in 82% of the successful patients. CONCLUSION In case of failed CRA or CAA with CPS or RVF, DCAA was associated with a 79% success rate. It could therefore be proposed as an alternative to standard redo-CRA or CAA when the risk of recurrent sepsis and failure with subsequent definitive stoma is thought to be high.
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Affiliation(s)
- Léon Maggiori
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), 100 boulevard du Général Leclerc, 92110, Clichy, France
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Phillips MR, Khoury AL, Stephenson BJK, Edwards LJ, Charles AG, McLean SE. Outcomes of pediatric patients with abdominal sepsis requiring surgery and extracorporeal membrane oxygenation using the Extracorporeal Life Support Organization database. Am Surg 2015; 81:245-251. [PMID: 25760199 PMCID: PMC5892180] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
No study describes the use of extracorporeal membrane oxygenation (ECMO) in pediatric patients with abdominal sepsis (AS) requiring surgery. A description of outcomes in this patient population would assist clinical decision-making and provide a context for discussions with patients and families. The Extracorporeal Life Support Organization database was queried for pediatric patients (30 days to 18 years) with AS requiring surgery. Forty-five of 61 patients survived (73.8%). Reported bleeding complications (57.1 vs 48.8%), the number of pre-ECMO ventilator hours (208.1 vs 178.9), and the timing of surgery before (50 vs 66.7%) and on-ECMO (50 vs 26.7%) were similar in survivors and nonsurvivors. Decreased pre-ECMO mean pH (7.1 vs 7.3) was associated with increased mortality (odds ratio, 1.49; 95% confidence interval, 1.04 to 2.14). ECMO use for pediatric patients with AS requiring surgery is associated with increased mortality and an increased rate of bleeding complications compared with all pediatric patients receiving ECMO support. Acidemia predicts mortality and provides a potential target of examination for future studies.
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Affiliation(s)
- Michael R Phillips
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Kryvoruchko IA, Usenko OI, Andreieshchev SA. [Surgical treatment of patients for abdominal sepsis]. Klin Khir 2014:34-38. [PMID: 25417285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Results of surgical treatment of 201 patients, suffering abdominal sepsis (AS), which have occurred after operations on abdominal organs, were analyzed. Expediency of application of modern scales for the patients state severity estimation, prognostic sign-posts and dynamic of the pathological process course in every patient was substantiated. Existing systems of prognostication (APACHE II, SOFA, MODS) are applied restrictedly for diagnosis of infection in patients, what demands relaparotomy performance in presence of clinical signs of intraabdominal infection, which persists. For prognostication of the treatment result and determination of indications for relaparotomy conduction in patients, suffering severe AS and infectious-toxic shock (ITSH), the most informative is application of the Manheim's index of peritonitis together with analysis of clinico-laboratory indices for formation of groups of patients in risk, to whom reoperation is indicated. Advantages of relaparotomy "on demand" conduction were proved in comparison with "programmed" relaparotomy during the staged surgical treatment of patients, suffering severe AS and ITSH. Complex surgical treatment with substantiation of indications and choice of adequate method of intervention secures improvement of the treatment results in these severely ill patients.
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