Prognostic factors of esophageal perforation and rupture leading to mortality: a retrospective study

Background Esophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning factors affecting mortality are limited. This report presents the prognostic factors of mortality in EPR based on experience in the management of such patients. Methods For this retrospective analysis, 79 patients diagnosed as having EPR between 2006 and 2016 and managed at Gyeongsang National University Hospital were examined. The management method was determined in accordance with the location and size of the EPR, laboratory findings, and radiological findings. Thirty-nine patients were treated with surgery; and 40, with nonsurgical management. Results The most common cause of EPR was foreign body (fish bone or meat bone), followed by vomiting, iatrogenic causes, and trauma. Thirty-nine patients underwent primary repair of EPR, of whom 4 patients died. Forty patients underwent nonsurgical management, of whom 3 patients died. The remaining patients were discharged. Mortality correlated with the size of the EPR (> 25 mm) and the segmented neutrophil count percentage (> 86.5%) in the white blood cell test and differential. Conclusions The mortality risk was increased when the EPR size and the segmented neutrophil count percentage in the white blood cell test and differential was high. Delayed diagnosis, which was considered an important predictive factor in previous investigations, was not statistically significant in this study. Trial registration: Not applicable.

Prognostic Factors of Esophageal Perforation and Rupture Leading to Mortality: A Retrospective Study

BackgroundEsophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning factors affecting mortality are limited. This report presents the prognostic factors of mortality in EPR based on experience in the management of such patients.MethodsFor this retrospective analysis, 79 patients diagnosed as having EPR between 2006 and 2016 and managed at Gyeongsang National University Hospital were examined. The management method was determined in accordance with the location and size of the EPR, laboratory findings, and radiological findings. Thirty-nine patients were treated with surgery; and 40, with nonsurgical management.ResultsThe most common cause of EPR was foreign body (fish bone or meat bone), followed by vomiting, iatrogenic causes, and trauma. Thirty-nine patients underwent primary repair of EPR, of whom 4 patients died. Forty patients underwent nonsurgical management, of whom 3 patients died. The remaining patients were discharged. Mortality correlated with the size of the EPR (>25 mm) and the segmented neutrophil count percentage (>86.5%) in the white blood cell test and differential.ConclusionsThe mortality risk was increased when the EPR size and the segmented neutrophil count percentage in the white blood cell test and differential was high. Delayed diagnosis, which was considered an important predictive factor in previous investigations, was not statistically significant in this study.Trial registrationNot Applicable

Haematological findings in 158 cows with acute toxic mastitis with a focus on the leukogram

Background In cows with acute toxic mastitis (ATM), the leukogram aids in the assessment of the severity of disease. The goal of our study was to compare the leukogram of 158 cows with ATM (cases) and 168 clinically healthy cows (controls). We hypothesised that the leukograms of surviving and non-surviving cows differ and that there are variables of the leukogram with sufficient prognostic potential to be used in the decision to treat or not to treat a cow with ATM. The cows were examined clinically and underwent haematological and biochemical examination of blood and bacteriological culture of milk samples. Results All cows with ATM had a poor appetite or anorexia, and 34 cows (21.5%) were recumbent. A single quarter was affected in 119 cows (75.3%), two quarters in 37 cows (23.4%) and three quarters in two cows (1.3%). Bacteriological culture showed Gram-negative pathogens in 100 cows (63.3%), Gram-positive in 15 (9.5%) and yeast in 4 (2.5%). The median total leukocyte count of cases was 4300 cells/µL (interquartile range = 2300–8200/µL), which was significantly lower than 8000 cells/µL (6525–9300/µL) in controls. Except for band neutrophils and metamyelocytes, the counts of all components of the leukogram were lower in cases compared with controls. Significantly more cows with ATM had leukopenia (60.1 vs. 4.1%) or leukocytosis (10.1 vs. 3.0%) than controls. Diseased cows had significantly lower segmented neutrophil counts than controls (860 vs. 2598 cells/µL), and 69.5 and 17.3%, respectively, had counts below the reference interval. Cases had increased band (77.3%) and metamyelocyte (25.0%) counts compared with controls (0.6 and 0%, respectively). In diseased cows, eosinopenia occurred in 66.4% (controls, 1.8%), monocytopenia in 40.6% (4.2%) and lymphopenia in 60.2% (1.8%). Twenty-one diseased cows (16.4%) had a regenerative and 57 (44.5%) had a degenerative left shift. The median neutrophil-to-lymphocyte ratio was 0.97 in diseased cows and 0.63 in controls. Toxic changes in neutrophils including cytoplasmic basophilia and vacuolisation were seen in 101 (91.8%) of 110 blood smears of diseased cows. The leukogram of the surviving and non-surviving cows did not differ significantly, and the hypothesis was rejected. Conclusions ATM results in severe changes in the leukogram particularly leukopenia, lymphopenia, and degenerative left shift. The hypothesis that the leukograms of surviving and non-surviving cows differ was rejected. The leukogram has not sufficient prognostic potential to be used in the decision to treat or not to treat a cow with ATM.

Factors Associated with Failure of Pneumatic Reduction in Children with Ileocolic Intussusception

Intussusception is one of the most common causes of intestinal obstruction in children. Pneumatic reduction is the treatment of choice and has a high success rate. The most common cause of pneumatic reduction failure is the presence of a pathological leading point. We aimed to identify other factors that can lead to pneumatic reduction failure in children with ileocolic intussusception. This was a retrospective study conducted in two centers. Data were collected from January 2013 to December 2014. A total of 156 patients were diagnosed with intussusception and underwent pneumatic reduction, with the exception of one patient with peritonitis. We included patients with ileocolic-type intussusception without apparent pathological leading points. Logistic regression analysis of clinical parameters was performed to identify factors associated with pneumatic reduction failure. Of 156 patients diagnosed with intussusception in both hospitals, 145 were enrolled in the study. The overall efficacy of pneumatic reduction was 85.7%, and surgical reduction was performed in 21 patients. Univariate analysis showed that a high segmented neutrophil count, low hemoglobin level, high body temperature, and higher weight percentile were associated with pneumatic reduction failure. Multivariate analysis showed that a high segmented neutrophil count, low hemoglobin level, and higher weight percentile were significantly associated with pneumatic reduction failure. Pneumatic reduction is safe and effective as a first-line treatment for pediatric intussusception. However, a high segmented neutrophil count, low hemoglobin level, and higher weight percentile are associated with the failure of this treatment.

Haematological findings in 158 dairy cows with toxic mastitis with a focus on the leukogram

Background: Acute toxic mastitis is characterised by typical clinical findings and changes in the leukogram. The goal of our study was to compare the leukogram of 158 cows with toxic mastitis and 168 clinically healthy cows. The cows were examined clinically and underwent haematological and biochemical examination of blood and bacteriological culture of milk samples. Results: All cows with toxic mastitis were ill and had a poor appetite or anorexia, and 34 cows (21.5%) were recumbent. A single quarter was affected in 119 cows (75.3%), two quarters in 37 cows (23.4%) and three quarters in two cows (1.3%). Bacteriological culture showed gram-negative pathogens in 100 cows (63.3%), gram-positive in 15 (9.5%) and yeast in 4 (2.5%). The median total leukocyte count of ill cows was 4,300 cells/µl, which was significantly lower than 8,000 cells/µl in controls. With the exception of band neutrophils and metamyelocytes, the counts of all components of the leukogram were lower in ill cows compared with controls. Significantly more cows with toxic mastitis had leukopenia (60.1 vs. 4.1%) or leukocytosis (10.1 vs. 3.0%) than controls. Ill cows had significantly lower segmented neutrophil counts than controls (860 vs. 2,598 cells/µl), and 69.5 and 17.3%, respectively, had counts below the reference interval. Ill cows had increased band (77.3%) and metamyelocyte (25.0%) counts compared with control cows (0.6 and 0%, respectively). In ill cows, eosinopenia occurred in 66.4% (controls, 1.8%), monocytopenia in 40.6% (controls, 4.2%) and lymphopenia in 60.2% (controls, 1.8%). Twenty-one ill cows (16.4%) had a regenerative and 57 (44.5%) had a degenerative left shift. The median neutrophil-to-lymphocyte ratio was 0.97 in ill cows and 0.63 in controls. Toxic changes in neutrophils including cytoplasmic basophilia and vacuolisation were seen in 101 (91.8%) of 110 blood smears of ill cows.Conclusions: Acute toxic mastitis results in severe changes in the leukogram particularly leukopenia, lymphopenia and degenerative left shift. The leukogram has significant diagnostic value and may aid in the modification of treatment when needed.

PERCENTAGE OF SEGMENTED NEUTROPHIL IN INVAGINATION PATIENTS IN H. ADAM MALIK MEDAN HOSPITAL

INTRODUCTION: Invagination cases are cases of pediatric surgical emergencies that are very often encountered, where the most frequent complications are necrosis and perforation.For the digestive system which plays the most role as the immune system is neutrophils. Segmented neutrophils are full capacity active cells containing cytoplasmic granulomas and chromatin-rich hollow cell nuclei. Segmented neutrophils are associated with the body's defense against infection and inflammatory processes and are the first cells present when an infection occurs.The purpose of this study is to assess the percentage of segmented neutrophil in invaginated patients at.H.Adam Malik Medan Hospital. METHOD: This research is a descriptive design study, which was carried out in the Division of Pediatric Surgery, Department of Surgery H. Adam Malik Medan Hospital, by collecting samples from invagination patients' medical records starting from January 2016 to December 2018 that met the inclusion and exclusion criteria. Data processing is performed using statistical software SPSS programs in the form of tables or diagrams. RESULTS: There were 23 study samples with a mean sample age ≤ 1 year, and the majority were male with 15 patients (65.21%).In this study,the average percentage of segmented neutrophil in patients with invagination in H.Adam Malik Medan Hospital is 62.93%. Segmented neutrophils ≥70% had a lower proportion of 9 patients (39.13%) compared to segmented neutrophils <70% of 14 patients (60.87%). CONCLUSION: The mean percentage of segmented neutrophil in patients with invagination at the H. Adam Malik Medan Hospital is 62.93%.

Incorporation of dynamic segmented neutrophil-to-monocyte ratio with leukocyte count for sepsis risk stratification

The association between sepsis and segmented neutrophil-to-monocyte (SeMo) ratio is unclear. We postulated that an increase in dynamic SeMo ratio measurement can be applied in risk stratification. This retrospective study included 727 consecutive sepsis patients in medical intensive care units (ICUs), including a subpopulation of 153 patients. According to the leukocyte (white blood cell, WBC) count on day 3 (normal range, between 4,000/µL and 12,000/µL) and delta SeMo (value of SeMo ratio on day 3 minus value of SeMo ratio on day 1; normal delta SeMo, <7), patients were grouped into 3 (delta SeMo & WBC tool). The survival lines separated significantly with hazard ratios of 1.854 (1.342–2.560) for the delta SeMo or WBC abnormal group and 2.860 (1.849–4.439) for the delta SeMo and WBC abnormal group compared to the delta SeMo and WBC normal group. Delta SeMo & WBC tool and delta sequential organ failure assessment (SOFA) tool performed better than the other tools (delta SeMo, delta WBC, day 3 WBC, and day 1 WBC). Severity in delta SeMo & WBC tool and delta SeMo tool reflected the immune dysfunction score, cytokine expression, and human leukocyte antigen D-related monocyte expression on day 1 and day 3. There was correspondence between delta SOFA and delta WBC and between delta SeMo and delta cytokine expression. Incorporation of dynamic SeMo ratio with WBC count provides risk stratification for sepsis patients admitted in the ICU.