scholarly journals Chylooperitoneum in the cardiovascular possurgical. Presentation of a case

2021 ◽  
Vol 6 (4) ◽  
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Cavity ◽  
Multiple Organ ◽  
Acute Renal Dysfunction ◽  
Direct Trauma ◽  
Risk Of Mortality ◽  
Rare Manifestation ◽  
Great Vessels ◽  
Intestinal Origin ◽  
Therapeutic Measures

Introduction: Chyloperitoneum is defined as the presence of lymph of thoracic or intestinal origin in the abdominal cavity. It is reported infrequently and is a rare manifestation of multiple deseases. Most of the cases are secondary and are associated with direct trauma to the peritoneal dialysis. Renal replacement therapy is necessary in up to 10% of children who undergo cardiac surgery with extracorporeal circulation, indicated in cases of water overload, acute renal dysfunction or ionic alterations. Objective: To report the case of a 15-day-old newborn, operated on for Transposition of the Great Vessels, who presented as a postoperative complication, dicharge of chylous content through the Tenckhoff, after a peritoneal dialysis regimen due to acute renal failure and fluid overload. Results: Despite the therapeutic measures taken, the patient maintains centuries-old losses of lymph, which lead to nutritional and immunological deterioration with the consequent multiple organ dysfunction and death. Conclusions: The perpetuation of lymph losses in the postoperative period of cardiovascular surgery produces a nutritional and immunological deterioration of the patient, with a high risk of mortality due to sepsis.

Insulin Resistance and Glucose Homeostasis in Peritoneal Dialysis

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 145-148 ◽  
Author(s):  
Paulo Cezar Fortes ◽  
Thyago Proença de Moraes ◽  
Jamille Godoy Mendes ◽  
Andrea E. Stinghen ◽  
Silvia Carreira Ribeiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Peritoneal Dialysis ◽  
Metabolic Disorders ◽  
Patient Survival ◽  
Metabolic Abnormalities ◽  
Dialysis Fluid ◽  
Altered Glucose ◽  
Insulin Homeostasis ◽  
Therapeutic Measures

Cardiovascular disease (CVD) is the main cause of death in peritoneal dialysis (PD) patients, a situation that can be explained by a combination of traditional and nontraditional risk factors for CVD in these patients. Glucose and insulin homeostasis are altered in chronic kidney disease (CKD) patients even in the early stages of CKD, leading to insulin resistance by various pathways. Several factors have been implicated in the pathogenesis of insulin resistance, including anemia, dyslipidemia, uremia, malnutrition, excess of parathyroid hormone, vitamin D deficiency, metabolic acidosis, and increase in plasma free fatty acids and proinflammatory cytokines. Insulin resistance and dyslipidemia are observed and increase with the progression of CKD, playing an important role in the pathogenesis of hypertension and atherosclerosis. Particularly in PD patients, exposure to glucose from dialysis fluid accentuates the foregoing metabolic abnormalities. In conclusion, insulin resistance and altered glucose metabolism are frequently observed in CKD, and although dialysis partly corrects those disturbances, the use of glucose PD solutions intensifies a series of harmful metabolic consequences. New therapeutic measures aimed at reducing metabolic disorders are urgently needed and perhaps will improve PD patient survival.

Abnormal iron status is associated with an increased risk of mortality in patients on peritoneal dialysis

2021 ◽  
Vol 31 (4) ◽  
pp. 1148-1155
Author(s):  
Dan Luo ◽  
Zhong Zhong ◽  
Yagui Qiu ◽  
Yating Wang ◽  
Hongyu Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Iron Status ◽  
Risk Of Mortality ◽  
Increased Risk

scholarly journals Variations in the aortic - common iliac bifurcation in man - a cadaveric study

2013 ◽  
Vol 02 (02) ◽  
pp. 056-060
Author(s):  
Maneesha Sharma ◽  
Tripta Sharma ◽  
Richhpal Singh
Keyword(s):  
Abdominal Aorta ◽  
Abdominal Cavity ◽  
Lumbar Vertebra ◽  
Anatomical Variations ◽  
Iliac Arteries ◽  
Medical College ◽  
Great Vessels ◽  
Exact Position ◽  
Vertebral Bodies ◽  
Common Iliac Arteries

Abstract Background and aims: The abdominal aorta usually terminates at the level of L4 vertebral body into common iliac arteries. With the present day advancements in vascular surgery and neurological surgeries involving approach to lumbar vertebral bodies, we need to know any variations from this normal course. So, the present study aimed at knowing the anatomical variations in the termination of abdominal aorta and in common iliac arteries which might prove to be of some help in some of such surgeries. Material and methods: The study was conducted on 35 adult (29 males and 6 females) embalmed cadavers obtained from anatomy departments of Govt. Medical college, Amritsar and Gian Sagar Medical college, Ramnagar, Punjab. The abdominal cavity was opened, peritoneum stripped off from aorta at its bifurcation, variations in its termination, common iliac arteries and their branches were carefully observed and recorded. Results: In 54.29% cases the level of aortic bifurcation was found opposite 4th Lumbar vertebra, in the rest it was variable between L3 and L5 vertebra. Conclusions: These variations may lead to some trouble during vertebral surgeries, making it essential to investigate and locate the exact position of great vessels before the commencement of surgery.

scholarly journals Evolution of diagnosis and surgical treatment of intra-abdominal infiltrates, abscesses of primary and postoperative origin in patients

2021 ◽  
pp. 15-29
Author(s):  
V.V. Skyba ◽  
◽  
V.F. Rybalchenko ◽  
A.V. Ivanko ◽  
R.М. Borys ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Gastric Ulcer ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Postoperative Mortality ◽  
Multiple Organ ◽  
Long Term Results ◽  
Control Group ◽  
Study Group ◽  
Perforated Gastric Ulcer

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

scholarly journals Ginkgo leaf sign on X-ray chest due to subcutaneous emphysema in a COVID-19 patient

2021 ◽  
Vol 8 (8) ◽  
pp. 1223
Author(s):  
Ashish Behera ◽  
Mohan Kumar H. ◽  
Rohit Bakshi ◽  
Arihant Sharma
Keyword(s):  
Subcutaneous Emphysema ◽  
Sudden Change ◽  
X Ray ◽  
Direct Trauma ◽  
Rare Manifestation ◽  
Subcutaneous Space ◽  
Pectoralis Muscles ◽  
Chest X Ray ◽  
Airway Access ◽  
Ginkgo Leaf

Subcutaneous emphysema (SE) is usually encountered in cases of structural lung diseases and secondary to direct trauma or iatrogenic procedures for airway access. It is mostly associated with pneumothorax. The diagnosis is made clinically by palpation of the affected area and radiology. Here we presented a case of COVID-19 pneumonia presenting with extensive subcutaneous emphysema resulting in airway compression which was a very rare manifestation of COVID-19 infection. The COVID-19 infection led to extensive alveolar damage to the lungs and the chronic cough which may have led to this complication due to sudden change of pressure differences in the chest wall cavity. The limitation of using of personal protective equipments hindered the diagnosis of this condition as auscultation and the palpatory feelings were greatly hindered. The chest X-ray shows air in subcutaneous space and the prominence of the fibres of bilateral pectoralis muscles which gives an impression of the venous system of a Ginkgo leaf, so named as Ginkgo leaf sign. 

scholarly journals Results Of Treatment Of Acute Diffuse Purulent Peritonitis Using Laparostomy

2020 ◽  
Vol 02 (11) ◽  
pp. 66-71
Author(s):  
S. A. Ruziboev ◽  
◽  
A. A. Avazov ◽  
Sh. Kh. Sattarov ◽  
A. N. Elmuradov ◽  
...  
Keyword(s):  
Bacterial Translocation ◽  
Abdominal Cavity ◽  
Multiple Organ ◽  
The Body ◽  
Abdominal Pressure ◽  
Results Of Treatment ◽  
Abdominal Hypertension ◽  
Purulent Peritonitis ◽  
Intractable Problems ◽  
Cause Of Deaths

Currently, despite significant achievements in the field of surgery, anesthesiology and resuscitation, the results of treatment of patients with advanced purulent peritonitis remain one of the most intractable problems, almost every sixth patient with acute surgical diseases and injuries of the abdominal cavity is admitted to medical institutions with peritonitis [1,3] Common peritonitis in 17-29% complicates the course of most acute surgical diseases and is the main cause of deaths in surgical hospitals [3,7]. Lethality in advanced peritonitis remains extremely high and reaches 20-39% [1,2,4,5]. In recent decades, great importance has been attached to recording intra-abdominal pressure in purulent pathology of the abdominal cavity. It was found that intra-abdominal hypertension occurs in every third patient with acute surgical pathology and negatively affects the functioning of all organs and systems of the body [1,6,8]. Pathological changes that occur with acute and excessive increase in intra-abdominal pressure (IAP) are manifestations of abdominal compartment syndrome (ACS) with disorders of the cardiovascular system; urinary disorders, disorders of perfusion of internal organs and the development of intestinal ischemia, which contributes to bacterial translocation and endogenous infection [2,7,8]. Ischemic blood flow disorders of the splanchnic zone are fraught with the development of bacterial translocation and the development of systemic inflammatory response syndrome and multiple organ failure (PON). Unsatisfactoriness with such results gave rise to a fundamentally different approach to the surgical treatment of common forms of peritonitis-the introduction of an open abdominal management method based on the ideas of I. Mikulich (1881), Jean-Louis Faure (1928), N. S. Makoch (1984) and D. Steinberg (1979).

scholarly journals A disposable, ultra-fine endoscope for non-invasive, close examination of the intraluminal surface of the peritoneal dialysis catheter and peritoneal cavity

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Masaaki Nakayama ◽  
Chieko Hamada ◽  
Keitaro Yokoyama ◽  
Yudo Tanno ◽  
Nanae Matsuo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Study ◽  
Peritoneal Cavity ◽  
Abdominal Cavity ◽  
Peritoneal Dialysis Catheter ◽  
Peritoneal Membrane ◽  
Non Invasive ◽  
Luminal Side ◽  
Stage Renal Disease ◽  
End Stage

Abstract The ability to visualize intraluminal surface of peritoneal dialysis (PD) catheter and peritoneal cavity could allow elucidation of the cases of outflow problems, and provide information on changes to the peritoneal membrane leading to encapsulating peritoneal sclerosis. A non-invasive examination that allows those monitoring in need is desirable. We have developed a disposable ultra-fine endoscope that can be inserted into the lumen of the existing PD catheter, allowing observation of the luminal side of the catheter and peritoneal cavity from the tip of the PD catheter, with minimum invasion in practice. In a pre-clinical study in pigs and a clinical study in 10 PD patients, the device provided detailed images, enabling safe, easy observation of the intraluminal side of the entire catheter, and of the morphology and status of the peritoneal surface in the abdominal cavity under dwelling PD solution. Since this device can be used repeatedly during PD therapy, clinical application of this device could contribute to improved management of clinical issues in current PD therapy, positioning PD as a safer, more reliable treatment modality for end-stage renal disease.

Outcome and Safety of Unplanned-Start Peritoneal Dialysis according to Break-In Periods: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 1-13 ◽  
Author(s):  
Yiyu Yin ◽  
Yanpei Cao ◽  
Li Yuan
Keyword(s):  
Systematic Review ◽  
Peritoneal Dialysis ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Risk Of Mortality ◽  
Catheter Obstruction ◽  
Catheter Malposition ◽  
Catheter Implantation ◽  
Unplanned Start

<b><i>Introduction:</i></b> The best timing of peritoneal dialysis (PD) initiation after catheter implantation is still controversial. It is necessary to explore whether there exists a waiting period to minimize the risk of complications. <b><i>Methods:</i></b> A systematic review and meta-analysis were searched in multiple electronic databases published from inception to February 29, 2020, to identify cohort studies for evaluating the outcome and safety of unplanned-start PD (&#x3c;14 days after catheter insertion). Risks of bias across studies were evaluated using Newcastle-Ottawa Quality Assessment Scale. <b><i>Results:</i></b> Fourteen cohort studies with a total of 2,401 patients were enrolled. We found that early-start PD was associated with higher prevalence of leaks (RR: 2.67, 95% CI, 1.55–4.61) and omental wrap (RR: 3.28, 95% CI, 1.14–9.39). Furthermore, patients of unplanned-start PD in APD group have higher risk of leaks, while those in CAPD group have a higher risk of leaks, omental wrap, and catheter malposition. In shorter break-in period (BI) group, the risk of suffering from catheter obstruction and malposition was higher for patients who started dialysis within 7 days after the surgery than for patients within 7–14 days. No significant differences were found in peritonitis (RR: 1.00; 95% CI, 0.78–1.27) and exit-site infections (RR: 1.12; 95% CI, 0.72–1.75). However, shorter BI was associated with higher risk of mortality and transition to hemodialysis (HD) while worsen early technical survival, with pooled RR of 2.14 (95% CI, 1.52–3.02), 1.42 (95% CI, 1.09–1.85) and 0.95 (95% CI, 0.92–0.99), respectively. <b><i>Conclusions:</i></b> Evidence suggests that patients receiving unplanned-start PD may have higher risks of mechanical complications, transition to HD, and even mortality rate while worsening early technical survival, which may not be associated with infectious complications. Rigorous studies are required to be performed.

Peritonitis Associated with Intra-Abdominal Pathology in Continuous Ambulatory Peritoneal Dialysis Patients

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 335-337 ◽  
Author(s):  
Antonios H. Tzamaloukas ◽  
Leo E. Obermiller ◽  
Laurence J. Gibel ◽  
Glen H. Murata ◽  
Barbara Wood ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Abdominal Cavity ◽  
Severe Infection ◽  
Exploratory Laparotomy ◽  
Enteric Pathogens ◽  
Severe Malnutrition ◽  
Diagnostic Features ◽  
Free Air ◽  
Bowel Gangrene

Features helpful in diagnosis and associated with death were evaluated In 26 episodes of peritonitis associated with intra-abdominal pathology (IAP) In continuous ambulatory peritoneal dialysis (CAPD) patients. Culture of multiple enteric pathogens, or of a single unusual enteric pathogen, from the dialysate was useful for diagnosis in 22/26 instances. Other diagnostic features (fecal material in dialysate, diarrhea containing dialysate, Increasing free air in the abdominal cavity) were infrequently found. A comparison of patients who died (n=11, 42%) and those who survived revealed that death was associated with bowel gangrene (5/6 died), recovery of bacteroides from the dialysate, more frequent and severe comorbid conditions (bacteremia, pneumonia, intra-abdominaland intracerebral bleeding, septic shock, hepatic failure), the development of severe malnutrition and thrombocytopenia during infection, and multiple surgical procedures until the diagnosis was established. Peritonitis associated with intra-abdominal pathology In CAPD patients is a severe infection with considerable diagnostic difficulty and high mortality. Early exploratory laparotomy upon suspicion of the nature of the peritonitis, usually raised by the recovery of enteric pathogens from the dialysate, may improve mortality.

Surgical Complications during Continuous Ambulatory Peritoneal Dialysis

1985 ◽  
Vol 5 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Giovanni Valenti ◽  
Donata Cresseri ◽  
Maria Luisa ◽  
Bianchi Enzo ◽  
Corghi Marc Lorenz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Surgical Complications ◽  
Abdominal Cavity ◽  
Temporary Change ◽  
Elderly Males ◽  
Group A ◽  
Main Factors ◽  
Group B ◽  
Diaphragmatic Hernias

In 30 patients (20 males and 10 females) undergoing CAPD, we observed 15 catheter-related complications -group A: leakage, dislodgement, slipping-out, protrusion of the external cuff, hemoperitonitis, and eight abdominal-cavity complications -group B: umbilical, inguinal, incisional and diaphragmatic hernias. Group A complications which occurred in 30% of the men and 80% of the women (mean age 47.2 ± 9) were easy to manage; group B complications developed mainly in elderly males (seven men and one woman, mean age 61.4 ± 5); these required temporary change of mode of dialysis in three, and permanent transfer from CAPD in two. From this review we have concluded that loss of anatomical integrity of the abdominal cavity is one of the main factors which prevents the continuation of CAPD.

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