scholarly journals Current experience with emphysematous cholecystitis

2021 ◽  
Vol 8 (2) ◽  
pp. 463
Author(s):  
Ramiz Iqbal ◽  
Elvina Wiadji
Keyword(s):  
Mortality Rate ◽  
Open Cholecystectomy ◽  
Major Complication ◽  
Gallbladder Wall ◽  
Clinical Event ◽  
Emphysematous Cholecystitis ◽  
Open Conversion ◽  
Adverse Clinical Event ◽  
Co Morbidity ◽  
Laparoscopic Techniques

Background: Emphysematous cholecystitis (EC) is a rare variant of acute cholecystitis with a reported 15-25% mortality rate. Conventionally, EC is managed with an early open cholecystectomy. However, recent advancement in percutaneous intervention and laparoscopic techniques have influenced our management of this biliary pathology. This study reviews the management and outcomes of EC in a regional centre.Methods: Retrospective analysis of a clinical database constituting all patients diagnosed with EC at a regional Australian hospital in NSW from Jan 2010 to July 2019. Inclusion criteria: sepsis, abdominal pain and radiological evidence of gas in the gallbladder wall, lumen, and pericholecystic tissue in the absence of an abnormal connection between the gallbladder and gastrointestinal tract. We investigated patient risk factors, management and outcomes.Results: 16 patients with EC were identified. The mean age of the cohort was 73 years old. The majority of patients had co-morbidity including type 2 diabetes and ischemic heart disease (56 and 62% respectively). Laparoscopic cholecystectomies were performed in 9 patients during their index admissions and 7 patients were managed with PTC. 5 patients required ICU admission for septic shock, and all were managed with PTC drain placement. The overall mortality rate was 6%.Conclusions: Laparoscopic cholecystectomy on index admission is the treatment of choice for EC. Although more technically challenging, adverse clinical event including major complication and open conversion was avoided in our cohort while percutaneous cholecystostomy was reserved for unstable and poor surgical candidate.

scholarly journals Successful treatment of emphysematous cholecystitis by laparoscopic surgery

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Hitoshi Funahashi ◽  
Tetsuya Komori ◽  
Naoki Sumita
Keyword(s):  
Laparoscopic Surgery ◽  
Acute Cholecystitis ◽  
Rare Variant ◽  
Successful Treatment ◽  
Gold Standard ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Emphysematous Cholecystitis ◽  
Bacterial Proliferation ◽  
Calot’S Triangle

Abstract Emphysematous cholecystitis (EC) is a severe and rare variant of acute cholecystitis characterized by ischemia of the gallbladder wall with gas-forming bacterial proliferation. Open cholecystectomy is traditionally the gold standard approach to treatment due to difficulty in isolating Calot’s triangle in the setting of intense inflammation. We present a case of EC successfully and safely treated by laparoscopic surgery.

scholarly journals Emphysematous cholecystitis

2009 ◽  
Vol 22 (4) ◽  
pp. 235-236
Author(s):  
Renato Micelli Lupinacci ◽  
Najim Chafai ◽  
Emmanuel Tiret
Keyword(s):  
Open Cholecystectomy ◽  
Clinical Signs ◽  
Vascular Diseases ◽  
Gallbladder Wall ◽  
White Blood Count ◽  
Emphysematous Cholecystitis ◽  
Reactive Protein ◽  
Threatening Condition ◽  
Life Threatening ◽  
Male Patients

BACKGROUND: Emphysematous cholecystitis is life-threatening condition characterized by gas-forming infection of the gallbladder. It is mostly seems in old male patients with systemic, specially diabetes and vascular diseases. CASE REPORT: - A 30-year-old man without previous diseases was admitted because of right upper quadrant pain and nausea. On admission the patient was febrile (38.7o) with normal bilirubin levels. The white blood count was 26700/µl and reactive protein C was 470. Axial sections of single slice computed tomography imaging (section thickness 5 mm), revealed gallbladder wall enhancement after i.v. contrast, as well as dilatation of the gallbladder with intraluminal air. The patient underwent open cholecystectomy. The culture of the bile showed clostridium perfringes. The postoperative course of the patient was uneventful. CONCLUSION: This is a rare form of cholecystitis that carries a high mortality and usually present insidious clinical signs. CT is the most accurate imaging technique. Antibiotic therapy should begin quickly and include coverage of common pathogens, particularly Clostridia. Surgical intervention should take place as early as possible.

scholarly journals Early Sonographic Diagnosis of Emphysematous Cholecystitis Successfully Treated With Antibiotics

2016 ◽  
Vol 33 (1) ◽  
pp. 43-46
Author(s):  
Joseph James Tseng ◽  
R. Brooke Jeffrey
Keyword(s):  
Surgical Intervention ◽  
Early Stage ◽  
Secondary Infection ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Gallbladder Perforation ◽  
Emphysematous Cholecystitis ◽  
Pericholecystic Abscess ◽  
Emergency Surgical Intervention

Emphysematous cholecystitis (EC) is an uncommon form of acute cholecystitis, caused by secondary infection of the gallbladder wall with gas-forming organisms. The mortality rate of EC is as high as 25% due to complications such as gangrene, gallbladder perforation, pericholecystic abscess, and bile peritonitis. Traditionally, prompt emergency surgical intervention with open cholecystectomy is recommended for EC treatment. This case study of EC was diagnosed at an early stage with sonography and computed tomography and successfully treated by antibiotic treatment alone without surgery. With characteristic findings on sonography such as echogenic reflectors with posterior shadowing, EC is an important entity for sonographers to be able to identify. In the future as imaging with sonography and CT affords earlier diagnosis of EC, antibiotic therapy might be considered for some patients, but more evidence is needed to obtain the same outcome as this particular case.

IL-10 / IL-6 serum ratio as a prognosis marker of STEMI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Leboube ◽  
T Bochaton ◽  
A Paccalet ◽  
C Crola Da Silva ◽  
P Jeantet ◽  
...  
Keyword(s):  
Acute Phase ◽  
Left Ventricular ◽  
Clinical Event ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Ventricular Ejection Fraction ◽  
Adverse Clinical Event ◽  
St Elevation ◽  
Prognosis Marker ◽  
Inflammatory Effect

Abstract Introduction IL-6 and IL-10 are two major cytokines secreted at the acute phase of myocardial infarction (MI). IL-6 has a pro-inflammatory effect whereas IL-10 has anti-inflammatory effect. Objective Our objective was to assess the prognosis value of IL-6, IL-10 and IL-10/IL-6 ratio serum level at the acute phase of ST elevation MI (STEMI). Methods We prospectively enrolled 247 patients admitted for acute STEMI from 2016 to 2019. Blood samples were collected at 5 time points: admission, 4, 24, 48 hours and 1 month (H4, H24, H48, M1). IL-6 and IL-10 were assessed using ELISA. Patients underwent cardiac magnetic resonance imaging at one month for infarct size (IS) and left ventricular ejection fraction (LVEF) assessment. Clinical outcomes were prospectively recorded over 18 months. Results Patient mean age was 59±12 years. IL-6 reached a peak at H24 at 5.4 pg/mL interquartile range (IQR) [2.1–11.0] and IL-10 peaked as early as admission at 5.6 pg/mL IQR [8.7–29.3] followed by a decrease within the first month. Median IL-10/IL-6 ratio at admission was 4.2 [1.4–8.6] with a strong decrease at H24 (0.5 [0.2–1.3]). IL-6 and IL-10 levels at H24 were correlated with IS (respectively r=0.44, p<0.0001, and r=0.29, p=0.0001) and inversely correlated with LVEF (respectively r=−0.42, p<0.0001 and r=−0.26, p=0.0003). Patients with IL-10/IL-6 ratio ≥1 had smaller IS compared to patients with IL-10/IL-6 ratio <1 (respectively 9.0% IQR [2.4–15.4] of LV versus 17% IQR [8.7–29.3] of LV, p<0.0001) and they had higher LVEF (58.0% IQR [52.0–62.3] versus 49.0% IQR [41.5–56.0], p<0.0001). Patients with IL-10/IL-6 ratio <1 were more likely to have an adverse clinical event (MI, stroke, hospitalization for heart failure and all-cause death) during the first 18 months after STEMI compared to patients with IL-10/IL-6 ratio ≥1 (HR=2.7, 95% CI [1.2–5.5], p=0.04). Conclusion Serum IL-10/IL-6 >1 was associated with a poor outcome after STEMI and might be a valuable prognostic marker. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospices Civils de Lyon, Fédération Française de Cardiologie

scholarly journals Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 383
Author(s):  
Kojiro Omiya ◽  
Kazuhiro Hiramatsu ◽  
Yoshihisa Shibata ◽  
Masahide Fukaya ◽  
Masahiro Fujii ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Magnetic Resonance ◽  
Acute Cholecystitis ◽  
Signal Intensity ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Gallbladder Wall ◽  
High Signal ◽  
Mri Findings ◽  
Open Conversion ◽  
Preoperative Magnetic Resonance

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

scholarly journals DECREASING PREVALENCE OF THE ACUTE/SUBACUTE CLINICAL FORM OF PARACOCCIDIOIDOMYCOSIS IN MATO GROSSO DO SUL STATE, BRAZIL

2014 ◽  
Vol 56 (2) ◽  
pp. 121-125 ◽  
Author(s):  
Larissa Rodrigues Fabris ◽  
Úrsulla Vilella Andrade ◽  
Aline Ferreira Dos Santos ◽  
Ana Paula da Costa Marques ◽  
Sandra Maria do Valle Leone de Oliveira ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Age Distribution ◽  
Epidemiological Data ◽  
Infection Prevalence ◽  
Age Group ◽  
Clinical Form ◽  
Mato Grosso ◽  
Co Morbidity ◽  
Mato Grosso Do Sul ◽  
Overall Mortality

With the objective to evaluate the behavior of paracoccidioidomycosis in the last three decades, clinical and epidemiological data of 595 patients admitted to clinical services of the Federal University of Mato Grosso do Sul from 1980 to 2009 were investigated. Gender, age distribution, clinical form, comorbidity with tuberculosis or AIDS, and mortality were compared by decades of clinical admission. It was shown that during the three decades there was a decrease in women percentage, and the same manner occurred a reduction in participants in the age group of 20 to 39 years. Moreover, the acute/subacute forms have been diminished in the period. These fluctuations are closely related and can be simultaneously analyzed. Increased AIDS co-infection prevalence from the first to the second decade was also revealed, coinciding with the appearance of the retroviral epidemic and stabilizing during the third decade. No change in the tuberculosis co-infection rate was observed (overall = 6.9%). It reinforces the importance of this co-morbidity. The overall mortality rate remained steady at 6.7%, not varying significantly from one decade to another. The persistent mortality rate calls attention to the importance of this neglected disease.

scholarly journals Secondary Hyperparathyroidism and Hypertension: An Intriguing Couple

2020 ◽  
Vol 9 (3) ◽  
pp. 629 ◽  
Author(s):  
Mariadelina Simeoni ◽  
Alessandra F. Perna ◽  
Giorgio Fuiano
Keyword(s):  
Clinical Trials ◽  
Cardiovascular Risk ◽  
Mortality Rate ◽  
Secondary Hyperparathyroidism ◽  
Major Complication ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
High Cardiovascular Risk ◽  
High Prevalence

Secondary hyperparathyroidism (SHPTH) is a major complication in patients on maintenance hemodialysis burdened with high cardiovascular risk. Hypertension is also a high prevalence complication contributing to an increase in the mortality rate in hemodialysis patients. A possible association between SHPTH and hypertension has been widely reported in the literature and several pathogenetic mechanisms have been described. There is evidence that the decrease of plasma iPTH levels are correlated with hypertension correction in hemodialysis patients undergoing parathyroidectomy and oral calcimimetics administration. We have observed a similar behaviour also in a patient on chronic hemodialysis treated with Etelcalcetide. Even if this is an isolated observation, it could stimulate future investigation, possibly in dedicated clinical trials.

scholarly journals Clinical and Demographic Predictors of Mortality due to COVID-19 Pandemic: A Retrospective Study

2021 ◽  
Vol 11 (5) ◽  
pp. 74-81
Author(s):  
Ayushi Rajkumar Jain ◽  
Doss Prakash ◽  
Sheetal Swamy
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Early Stage ◽  
Major Complication ◽  
Respiratory Arrest ◽  
Chi Square ◽  
High Risk Factors ◽  
Demographic Predictors ◽  
Chi Square Test ◽  
The Common

The alarming statistics of COVID-19 surges up in 2021 throwing an enormous burden on the healthcare system across the world. According to WHO reports on 14th April 2021, globally 136,996,364 confirmed COVID-19 cases are reported across the continents, including 2,951,832 deaths. The state of Maharashtra reported the maximum number of cases of India including high mortality rate. This study was conducted to identify and describe the relation of different predictors (Age, gender, duration of hospital stay, presence of co morbidities) of mortality among the COVID-19 deceased patients by retrospectively analyzing the medical case records of 121 patients from a dedicated COVID hospital at Aurangabad from July 2020 to December 2020. Chi-square test was performed to assess the association between causes of death with different cluster of variables and their significance. This study helps us to identify risk factors that show association between various predictors and mortality rate in COVID-19 patients. Out of 121 deaths, 96 (79%) were male, 61 (49.6%) were in age group between 60-79 years, ARDS was one of the major complication in the deceased patients accounting 29.8% and cardio respiratory arrest was the common cause of death among the deceased patients with 85%. It was also observed that mortality rate was very higher in the initial five days of hospitalization with critical care support. Our result findings provide clinical inferences for physicians to identify high-risk factors with COVID-19 at a very early stage. Key words: COVID-19, Mortality rate, Demographic predictors, Co-morbidities, Cardio respiratory arrest.

scholarly journals A 5 Year Retrospective Analysis of Leave against Advice from the Medical Wards of a Nigerian Tertiary Hospital

2020 ◽  
pp. 351-356
Author(s):  
JE Ojobi ◽  
E Ugwu ◽  
PO Idoko ◽  
MO Ogiator ◽  
SS Gomerep ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Hospital ◽  
Third Party ◽  
Hospital Environment ◽  
Clinical Event ◽  
Health Care Administrators ◽  
Voluntary Consent ◽  
Adverse Clinical Event ◽  
Medical Wards ◽  
Attending Physician

Self discharge (SD) of hospitalized patients is an adverse clinical event often resulting from a fundamental disagreement between the patient or an interested third party and the attending physician and / or the hospital environment. This culminates in the patient’s withdrawal of their initial voluntary consent for hospitalisation and abrupt termination of in - patient medical care. Patients who left hospital admission against the advice of their doctors are both a concern and a challenge for individuals in the health industry. It negatively impacts treatment outcomes and exposes the clinician and health care administrators to the hazards of litigations. The study was aimed at determining the incidence of SD and associated factors in medical admissions. It was a retrospective descriptive hospital based study of patients who self discharged from medical wards of Federal Medical Center, Makurdi from June 2012 – May 2017. Approval was obtained from the institution’s research ethics board. Thirty one individuals (0.62% of total admission) self discharged within the study period. Financial constraints was responsible for 32.2% (10) of SD followed by proximity to social support 19.4% (6). Five patients (16.1%) elected not to disclose any reasons. The incidence reduced from 0.21% to 0.02% at the start and end of study period respectively. Though SD was relatively low in this study, the incidence could be reduced further by expanding the scope of health insurance scheme, skilful communication and negotiating patient management using patient – centred methods.

scholarly journals Acute Pulmonary Thromboembolism: A Retrospective Study in a Nigerian Private Tertiary Hospital

2021 ◽  
Vol 7 (2) ◽  
pp. 107-117
Author(s):  
JO Ogunkoya ◽  
AO Oluwole ◽  
BO Adefuye ◽  
AO Adebola-Yusuf ◽  
O Ehioghae
Keyword(s):  
Retrospective Study ◽  
Mortality Rate ◽  
Large Population ◽  
Tertiary Hospital ◽  
Pulmonary Angiography ◽  
University Teaching ◽  
Western World ◽  
High Morbidity ◽  
Co Morbidity ◽  
Few Data

Background: Pulmonary embolism (PE) is a disease associated with high morbidity and mortality in the more technically advanced western world. However, in Africa and Nigeria in particular, the burden of PE is largely poorly defined as few data are available. Objectives: To characterize the clinical profile, management and outcomes in PE patients confirmed with Computerized Tomography Pulmonary Angiography (CTPA). Methods: A retrospective study was conducted at Babcock University Teaching Hospital, Ilishan-Remo, Nigeria. The medical records of PE patients confirmed by CTPA and admitted to the intensive care unit of the hospital spanning July 2016 to June 2020 were retrieved for analysis. Results: Thirty-one patients with the age range of 26 to 93 years were included and the mean age was 55.5±18.5 years. Breathlessness was the most prevalent presenting symptom. In the majority of patients (48.4%), the risk factors were not known. However, the most common risk factor and co-morbidity was pregnancy (16.1%). The in-hospital mortality rate was 9.7%. Conclusion: The clinical characteristics of PE in this cohort were similar to those described in the literature. The high mortality rate in this study also underscores the need for large population studies in black Africans.

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