The clinical aspects of peritonitis developing after cystectomy

Background. Surgical morbidities of radical cystectomy, which are, as a rule, complicated intraabdominal infections, appear to be the main causes of repeated surgeries and fatal outcomes. The elimination of the infection Indus and an-timicrobic therapy are the currently accepted standard of treatment for postoperative peritonitis in cancer urology, as well as in general surgery hospital.Objective: defining the most reasonable option of surgical aid for peritonitis developing after cystectomy.Materials and methods. In the time period from 2000 through 2014, 58 cancer patients with postoperative peritonitis developing after cystectomy received indoor treatment at N.N. Alexandrov Republican Research and Practical Center for Oncology and Medical Radiology. Their mean age was 64.9 years, the range 44-90 years, 53 (91.4 %) of them being male. Primary urinary bladder cancer was present in 51 (87.9 %) patients. Peritoneal infection was microbiologically verified in 57 (98.3 %) patients. Each case of fatal outcome was associated with ineffective treatment of peritonitis. Depending on the intraoperative findings (presence or absence of a hollow organ defect) and the surgical approach undertaken (obstructive resection or operation maintaining the continuity of the intestinal and/or urinary tract), the patients were stratified into three groups: group 1 (n = 28), group 2 (n = 20) and group 3 (n = 10). There were no significant differences in the basic parameters specifying peritoneal infection severity between the patients of groups 1 and 2 vs group 3 (p >0.05).Results. Overall mortality amounted to 25.9 %, 15 patients died. Among the 28 (48.3 %) patients (group 1) who underwent obstructive elimination of the peritonitis focus by means of urointestinal reservoir ablation, resection of small or large intestine with ileo- or colostomy, 6 patients died, mortality 21.4 %. In the 10 (17.2 %) patients (group 3) who succeeded in preserving the urinary conduit or continuity of the bowels by anastomosis defect closure, resection of enteroentero-anastomosis or urointestinal reservoir with repeated anastomosing or defect closure, mortality was higher (60 %) (p = 0.045); 6 patients died.Conclusion. The most effective option of surgical treatment of postoperative peritonitis developing after cystectomy is obstructive reoperation on the bowels and urinary tracts: compared with the intervention consisting in preserving the urinary conduit and/or continuity of the intestinal tract, this type of surgery caused a 2.8-fold lower mortality.

Synergistic Activity of Colistin Combined With Auranofin Against Colistin-Resistant Gram-Negative Bacteria

Colistin-resistant (Col-R) bacteria are steadily increasing, and are extremely difficult to treat. New drugs or therapies are urgently needed to treat infections caused by these pathogens. Combination therapy with colistin and other old drugs, is an important way to restore the activity of colistin. This study aimed to investigate the activity of colistin in combination with the anti-rheumatic drug auranofin against Col-R Gram-negative bacteria. The results of checkerboard analysis demonstrated that auranofin synergized with colistin against Col-R Gram-negative bacteria. Time-kill assays showed significant synergistic antimicrobial activity of colistin combined with auranofin. Electron microscopy revealed that the combination resulted in more cellular structural alterations compared to each drug alone. Auranofin enhanced the therapeutic effectiveness of colistin in mouse peritoneal infection models. These results suggested that the combination of colistin and auranofin might be a potential alternative for the treatment of Col-R Gram-negative bacterial infections.

Ultrasound guided percutaneous biopsy of omentum: a safest technique to detect the causes of omental thickening

Background: The objective of our study was to determine the diagnostic value and safety of ultrasound guided percutaneous biopsy of omental thickening.Methods: We prospectively analyzed 60 patients who underwent USG-guided omental biopsies in our institute from January 2016 to December 2016.Results: Total 60 patients were included in our study. There were 40 (66.7%) female and 20 (33.3%) male patients. There were total 36 (60%) malignant cases, 20 (33.3%) chronic inflammation suggestive of TB while 4 (6.7%) were chronic peritoneal infection. Out of 36 malignant cases, majority 24 (66.7%) had ovarian cancer, 8 (22.2%) had endometrium cancer and 4 (11.1%) had large bowel cancer. Repeat biopsies were performed only in 4 (6.7%) cases.Conclusions: Ultrasound-guided percutaneous biopsy of omentum is less expensive, safe and effective method with a high diagnostic accuracy.

Experience with Ventriculoatrial Shunt

Cerebrospinal fluid (CSF) diversion through shunting, either internal or external, is the standard of care for hydrocephalic patients. Although Ventriculoperitoneal (VP) shunt is always the first choice, right atrium for Ventriculoatrial (VA) shunt is considered a suitable and convenient option for drainage of excess CSF in patients with history of abdominal surgeries, peritoneal infection or shunt obstruction.1 Here we are reporting our experience with a patient who underwent VA shunt insertion because of a previous malfunctioning VP shunt. A thorough review of the literature revealed that, although reported worldwide, there is an apparent deficiency of similar reports from Arabian Gulf region. Through this case report, we aim to shed light on this internal CSF diversion method, which could be considered in centers lacking advanced care facilities for procedures like Endoscopic 3rd Ventriculostomy (ETV).

First reported case of peritoneal dialysis infection with lactobacillus gasseri: when the body’s friend turns against its host

Summary We report a case of lactobacillus gasseri peritonitis in a patient treated by peritoneal dialysis. Streptococcus anginus and lactobacillus gasseri bacteria are commensal organisms of human oral, small intestinal, colic and vaginal mucous membranes. An infection with streptococcus anginosus during peritoneal dialysis, one responsible for an intra-abdominal abscess, has already been described, this type of streptococcus being widely associated with abscess formation. In contrast, no case of peritoneal infection with lactobacillus gasseri has ever been described. This bacterium is native to the mucous membranes, and colonizes the digestive tract of infants during childbirth, as they pass through the vaginal canal. It has local adaptation capacities, namely tolerance to acid pH, adhesion to the mucous membrane and resistance to bile salts. It is recognized as having an antimicrobial and probiotic function due to its production of bacteriocin, its local immunomodulatory role, its attenuation of the development of helicobacter pylori, its positive effect on the balance of the vaginal flora and its improvement of infectious diarrhea. This usually makes it an ally that contributes to our systemic balance but its irruption in the peritoneum has made it a pathogenic bacterium. The treatment of this peritoneal infection required a classic duration of treatment of organisms of digestive origin, i.e. 3 weeks

Does Helium Pneumoperitoneum Reduce the Hyperinflammatory Response in Septic Animals during Laparoscopy?

Background/Aim. An exacerbated reaction to peritoneal infection and attendant surgical procedures is characterized by an intense hyperinflammatory state, the magnitude of which is proportional to the severity of tissue injury. Laparoscopy generates lower levels of tissue damage compared with open surgery and should induce less pronounced immune responses. The aim of this study was to determine whether laparoscopy assisted by helium rather than carbon dioxide pneumoperitoneum would induce an attenuated inflammatory state in septic animals. Materials and Methods. Thirty-two Wistar rats were divided randomly into four equal groups, two of which were submitted to carbon dioxide or helium pneumoperitoneum-assisted laparoscopic cecal ligation and puncture (CLP) induced sepsis and subsequent abdominal lavage. Two control groups were submitted to identical laparoscopic procedures with carbon dioxide or helium as insufflator gas but without CLP. After 24 hours, serum levels of tumor necrosis factor alpha (TNF-α), interleukins 1 and 6 (IL-1 and IL-6, respectively), and cortisol were determined. Results. Mean concentrations of I L-1 and IL-6 in the groups of septic animals submitted to laparoscopy with carbon dioxide or helium pneumoperitoneum were not significantly different but were significantly higher than those of their respective non-CLP controls. In contrast, the levels of TNF-α and cortisol in the two groups of septic animals were similar but were not significantly different from those of their respective non-CLP controls. Conclusions. Laparoscopy with helium insufflation was similar to carbon dioxide in relation to the inflammatory response since levels of the proinflammatory TNF-α, IL-1, and IL-6 and of the anti-inflammatory cortisol were comparable for both gases.

Antimicrobial resistance in chronic liver disease

High levels of antimicrobial drug resistance deleteriously affecting the outcome of treatment with antibacterial agents are causing increasing concern worldwide. This is particularly worrying in patients with cirrhosis with a depressed immune system and heightened susceptibility to infection. Antibiotics have to be started early before results of microbiological culture are available. Current guidelines for the empirical choice of antibiotics in this situation are not very helpful, and embracing antimicrobial stewardship including rapid de-escalation of therapy are not sufficiently emphasised. Multi-drug resistant organism rates to quinolone drugs of up to 40% are recorded in patients with spontaneous bacterial peritonitis on prophylactic antibiotics, leading to a break-through recurrence of intra-peritoneal infection. Also considered in this review is the value of rifaximin-α, non-selective beta-blockers, and concerns around proton pump inhibitor drug use. Fecal microbial transplantation and other gut-targeting therapies in lessening gut bacterial translocation are a promising approach, and new molecular techniques for determining bacterial sensitivity will allow more specific targeted therapy.