scholarly journals Step-up approach for acute infected necrotizing pancreatitis

2019 ◽  
Vol 41 part 2 (2) ◽  
pp. 29-34
Author(s):  
O. I. Dronov ◽  
I. O. Kovalska ◽  
A. I. Gorlach ◽  
T. V. Lubenets
Keyword(s):  
Percutaneous Drainage ◽  
Clinical Laboratory ◽  
Necrotizing Pancreatitis ◽  
Fluid Collection ◽  
Morphological Characteristics ◽  
Treatment Method ◽  
Multivariate Regression Analysis ◽  
Second Step ◽  
Percutaneous Catheter Drainage ◽  
Fluid Collections

Purpose of the study. The role of interventional methods of the treatment of acute infected necrotic pancreatitis depending on the morphological characteristics of the disease was determined. Material and methods. In present prospective cohort study, we included 96 patients with acute infected necrotizing pancreatitis. All patients were stratified according to morphologic features. Stepup approach with following steps of interventions was applied: percutaneous drainage of infected fluid collections, increasing of drainages diameter and number of it and open or minimally invasive necrosectomy. Clinical, laboratory, and instrumental monitoring were the defining indicators for the stopping of the treatment or for the passing to the next step of the treatment. Results. At the first step 7 of 96 patients with superficial focal necrosis, a necrosis index of 2 points and a category D were successfully treated. Other 89 patients were passed to the second step of treatment, of which 23 patients with superficial subtotal necrosis, necrosis index of 2 points and category E were successfully treated. Another 66 patients had undergone a third step of treatment. A multivariate regression analysis was conducted that allowed to identify predictive factors of inefficiency of using of percutaneous drainage interventions (stages I and II) as a final stage of treatment: transmural subtotal or total necrotizing pancreatitis (OR = 1,58; 95% CI 1,03–3,88; p = 0,033); Necrosis index of 4 or more points (OR = 3.19, 95% CI 1.57–8.37; p = 0,003); heterogeneous peripancreatic fluid collection (OR = 4,15, 95% CI 1,49–5.19; p = 0,001); The CT-index of severity of acute pancreatitis of 7 or more points (OR = 1,89, 95% CI: 1,03–3,43; p = 0,029). Conclusion. Step-up approach showed following results: 7,3% patients were treated at the first step, 24% – at the second step. Third step of treatment was applied in 68,7% of patients, of witch 12,5% was treated with laparoscopic necrosectomy. Predictors of ineffectiveness of ultrasound guided percutaneous drainage as the final treatment method are: necrosis index of 4 or more, heterogeneous paripancreatic fluid collections, subtotal and transmural necrotizing pancreatitis. Keywords: infected pancreatic necrosis, stepup approach, percutaneous catheter drainage, uncontrolled infection, necrosectomy.

scholarly journals Adjuvant urokinase: percutaneous drainage of post lower segment cesarean section intra-abdominal abscess

2019 ◽  
Vol 8 (5) ◽  
pp. 2125
Author(s):  
Shweta Avinash Khade ◽  
Balaji Jadhav ◽  
Preeti Meena
Keyword(s):  
Percutaneous Drainage ◽  
Ultrasound Guidance ◽  
Fluid Collection ◽  
Bleeding Complications ◽  
Abdominal Abscess ◽  
Catheter Drainage ◽  
Safe Alternative ◽  
Lower Segment Cesarean Section ◽  
Fluid Collections

The mortality in abdominal abscess is high, however the outcome has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, and site.  The single abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters.  Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage but the success rate is lower for abscesses that have septa and are multilocular. Several clinical and in vitro studies suggest urokinase may be useful in such cases. To the knowledge, however, there has been no case of post LSCS intra-abdominal abscess in which intracavitary urokinase was administered. Therefore, we report a case of post LSCS multiseptated intra-abdominal abscess occurring in a 21-year-female. Conventional percutaneous tube drainage failed, but the use of transcatheter intracavitary urokinase was successful.  Our results showed no significant change in hematologic studies and no bleeding complications. Intracavitary urokinase can be given safely during percutaneous drainage of an abscess, with no associated bleeding complications or changes in coagulation parameters.

scholarly journals Laboratory-immunological diagnostics of complicated flow of necrotic pancreatitis

2019 ◽  
Vol 41 part 2 (2) ◽  
pp. 62-65
Author(s):  
V. I. Desyateryk ◽  
V. V. Shapovalyuk ◽  
M. S. Кrykun
Keyword(s):  
High Probability ◽  
Quantitative Estimation ◽  
Necrotizing Pancreatitis ◽  
Fluid Collection ◽  
Quantitative Composition ◽  
Necrotic Pancreatitis ◽  
History Of ◽  
Complicated Course ◽  
Analysis Of Results ◽  
Fluid Collections

Purpose of the study. Justify the additional laboratory and immunological possibilities of diagnosing the complications of necrotic pancreatitis. Materials and methods. A retrospective analysis of the case history of patients with edematous and necrotic pancreatitis has been carried out, and 1060 case histories have been analyzed. By special methods, 30 patients with acute pancreatitis were examined. Laboratory and immunological studies were carried out three times: 1 research – upon admission; 2 studies – on the 7th day; 3 studies – 14 days. Results. The conducted clinical researches and analysis of results allowed working out the method of diagnostics of local complications, based on quantitative estimation of level of lymphocytes. At level of lymphocytes up to 13% is very high probability of fluid collection development; from 13% to 25% - high probability; from 25% to 37% – moderate probability; above 37% – low probability of intra- and peripancreatic fluid collections. In general, a comparison of the dynamics of Ig subclasses showed that IgG1 and IgG3 tended to gradually increase. Conclusions. Among the laboratory parameters of the complicated course of necrotic pancreatitis, the most significant is the change in lymphocytes. The distribution of individual IgG subclasses suggests that severe necrotic forms overlap with a proven increase in the quantitative composition of IgG1 and IgG3, which is a confirmation of the pro inflammatory variant of the development of SIRS and requires correction of therapeutic tactics. Key words: necrotizing pancreatitis, complicated course, diagnostics.

scholarly journals An unusual case of a persistent, infected retroperitoneal fluid collection 5 years after anterior lumbar fusion surgery: illustrative case

2021 ◽  
Vol 1 (4) ◽  
Author(s):  
Matthew T. Neal ◽  
Kara L. Curley ◽  
Alexandra E. Richards ◽  
Maziyar A. Kalani ◽  
Mark K. Lyons ◽  
...  
Keyword(s):  
Percutaneous Drainage ◽  
Unusual Case ◽  
Lumbar Fusion ◽  
Fluid Collection ◽  
Fusion Surgery ◽  
Anterior Lumbar Fusion ◽  
Persistent Symptoms ◽  
Lumbar Fusion Surgery ◽  
Continuous Drainage ◽  
Fluid Collections

BACKGROUNDAnterior lumbar fusion procedures have many benefits and continue to grow in popularity. The technique has many potential approach- and procedure-related complications. Symptomatic retroperitoneal fluid collections are uncommon but potentially serious complications after anterior lumbar procedures. Collection types include hematomas, urinomas, chyloperitoneum, cerebrospinal fluid collections, and deep infections.OBSERVATIONSThe authors present an unusual case of a patient with persistent symptoms related to a retroperitoneal collection over a 5-year period following anterior lumbar fusion surgery. To the authors’ knowledge, no similar case with such extensive symptom duration has been described. The patient had an infected encapsulated fluid collection. The collection was presumed to be a postoperative lymphocele that was secondarily infected after serial percutaneous drainage procedures.LESSONSWhen retroperitoneal collections occur after anterior retroperitoneal approaches, clinical clues, such as timing of symptoms, hypotension, acute anemia, urinary tract infection, hydronephrosis, elevated serum creatinine and blood urea nitrogen, low-pressure headaches, anorexia, or systemic signs of infection, can help narrow the differential. Retroperitoneal collections may continue to be symptomatic many years after anterior lumbar surgery. The collections may become infected after serial percutaneous drainage or prolonged continuous drainage. Encapsulated, infected fluid collections typically require surgical debridement of the capsule and its contents.

Characteristics of the course of nephritis associated with Iga-vasculitis Henoch-Schoenlein in children

2020 ◽  
Vol 24 (3) ◽  
pp. 64-71
Author(s):  
A. V. Sukalo ◽  
I. A. Kazyra
Keyword(s):  
Clinical Laboratory ◽  
Morphological Changes ◽  
Pediatric Nephrology ◽  
Morphological Characteristics ◽  
Lymphocyte Activation ◽  
Renal Tissue ◽  
Kidney Damage ◽  
Iga Vasculitis ◽  
Factors Affecting ◽  
Treatment Regimens

INTRODUCTION. Among systemic vasopathies in children, IgA vasculitis Henoch Schoenlein (HS) is the most common, according to various authors, kidney damage is noted in 25-80 % and usually determines the prognosis of the disease.THE AIM of the study was to analyze clinical, laboratory, immunological, morphological characteristics, features of the course and treatment of nephritis associated with IgA vasculitis HS in children, as well as factors affecting the prognosis.PATIENTS AND METHODS. The study included 31 patients with morphologically verified nephritis due to IgA vasculitis HS (18 – boys, 13 – girls) aged 3 to 17 years, who were monitored at the Nephrology Department of the "2nd Children's City Clinical Hospital" of the National Center for Pediatric Nephrology and Renal Replacement therapy in Minsk from 2010 to 2019 yrs.The following parameters were analyzed: the clinical variant of kidney damage, laboratory tests (including the study of BAFF, RANTES lymphocyte activation molecules, pro-inflammatory IL1β, caspase1, TNFα, growth factors VEGF, TGF), 24 hours monitoring and office blood pressure measurements, ECHO cardiography with indicescalculation, ultrasound of the carotid arteries with the thickness of intima-media complex, morphological changes in the renal tissue, as well as treatment regimens.RESULTS. The contribution of deGal-IgA1, markers of T and B lymphocytes activation, pro-inflammatory and profibrotic molecules in the development of the disease is shown. Arterial hypertension was registered in 42 % of children, signs of heart remodeling according to the calculated indices in 19,3 %. Decrease level of adiponectin, vitamin D, leptin, increase concentration of obestatin, Pro-BNP, hs-CRP, and TSAT indicator classify patients with nephritis due to IgA vasculitis HS at moderate risk for the developmentof cardio-vascular disorders, which suggests the need for timely correction.CONCLUSION. In most cases, nephritis with IgA vasculitis HS has a benign course with rare relapses and progression to the end stage of chronic kidney disease (6,5 %).

scholarly journals A Pandemic Early Warning System Decision Analysis Concept Utilizing a Distributed Network of Air Samplers via Electrostatic Air Precipitation

2021 ◽  
Vol 11 (11) ◽  
pp. 5308
Author(s):  
Joseph J. Bango ◽  
Sophia A. Agostinelli ◽  
Makayla Maroney ◽  
Michael Dziekan ◽  
Ruba Deeb ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Pathogen Detection ◽  
Clinical Laboratory ◽  
Culture Media ◽  
Morphological Characteristics ◽  
Warning System ◽  
Ambient Air ◽  
Aerosol Sampling ◽  
Distributed Network

The COVID-19 pandemic has highlighted the need for improved airborne infectious disease monitoring capability. A key challenge is to develop a technology that captures pathogens for identification from ambient air. While pathogenic species vary significantly in size and shape, for effective airborne pathogen detection the target species must be selectively captured from aerosolized droplets. Captured pathogens must then be separated from the remaining aerosolized droplet content and characterized in real-time. While improvements have been made with clinical laboratory automated sorting in culture media based on morphological characteristics of cells, this application has not extended to aerosol samples containing bacteria, viruses, spores, or prions. This manuscript presents a strategy and a model for the development of an airborne pandemic early warning system using aerosol sampling. 

scholarly journals Proactive percutaneous catheter drainage strategy during the step-up approach for (suspected) infected necrotizing pancreatitis

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e786
Author(s):  
J. van Grinsven ◽  
P. Timmerman ◽  
K.P. van Lienden ◽  
J.W. Haveman ◽  
D. Boerma ◽  
...  
Keyword(s):  
Necrotizing Pancreatitis ◽  
Percutaneous Catheter Drainage ◽  
Catheter Drainage ◽  
Percutaneous Catheter

scholarly journals Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre

2015 ◽  
Vol 30 (9) ◽  
pp. 3730-3740 ◽  
Author(s):  
Margaret G. Keane ◽  
Shun Fung Sze ◽  
Natascha Cieplik ◽  
Sam Murray ◽  
Gavin J. Johnson ◽  
...  
Keyword(s):  
Percutaneous Drainage ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
Fluid Collections

863 Peri-Implant Fluid Collection in Breast Reconstruction and Aesthetic Surgery

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Karagiannidis ◽  
E Mallidis
Keyword(s):  
Reconstructive Surgery ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Fluid Collection ◽  
Aesthetic Surgery ◽  
Large Cell ◽  
Inclusion Criteria ◽  
Electronic Data Collection ◽  
Fluid Collections ◽  
Mean Time

Abstract Introduction Peri-implant fluid more than 6 months from surgery is a known complication of breast surgery.Differential diagnosis includes infection, inflammation,implant rupture and haematoma.Other than infection raised no concern until the identification of Breast Implant Associated Anaplastic Large Cell Lymphoma(BIA-ALCL). Method Retrospective electronic data collection for women 18 years or older who met the following inclusion criteria:(a)oncoplastic and/or cosmetic reconstructive surgery with placement of implant(b)peri-implant fluid collection after 6-36 months. Results In total,17 women with implants with a mean age of 56 years were included in the study.The mean time between reconstructive surgery and the peri-implant fluid collection was 23 months.The median peri-implant fluid collection size was 143 ml.14 of the 17 peri-implant fluid collections were benign.12 of 14 had polyurethane-coated textured implants.4 of the 17 were BIA-ALCL. Conclusions The current literature suggests that late peri-implant seromas arise from friction as the implant moves within the cavity and that this friction is increased with textured rather than smooth implants.In our unit 12/14 of the benign collections appeared in reconstructions with polyurethane implants.Furthermore,BIA-ALCL should always be considered in this situation and aspirate should be sent for cytology.Is this change in polyurethane implants a new entity?

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