1/10. Outcome following staphylococcal peritonitis.OBJECTIVE: staphylococcus spp predominate as the causative pathogen of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis.This study evaluated the difference in morbidity and mortality between peritonitis caused by S. aureus and coagulase-negative staphylococci (CoNS). DESIGN: Prospective observational study. SETTING: A single regional dialysis unit in a teaching hospital. patients: Thirty-seven patients had S. aureus peritonitis and 65 patients had CoNS peritonitis between July 1990 and November 1995. MAIN OUTCOME MEASURES: Using the first recorded episode of peritonitis, survival analysis was performed for time to (1) death, (2) removal of peritoneal dialysis catheter, and (3) change to hemodialysis. Abdominal complications were recorded for the first and subsequent episodes. RESULTS: No difference in time to death was demonstrated for the two groups (p = 0.79), although two deaths that occurred during therapy for peritonitis were attributable to S. aureus infection. In addition, 5 patients developed serious abdominal complications related to an episode of S. aureus peritonitis. patients with S. aureus peritonitis had a shorter time to both peritoneal dialysis catheter removal (p = 0.004) and change to hemodialysis (p = 0.014). The change in mode of dialysis was independent of catheter loss. CONCLUSION: This study highlights the serious nature of S. aureus peritonitis and confirms the need for effective preventive measures against infection by this pathogen.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. Toothpick injury mimicking renal colic: case report and systematic review.We describe a case of a patient with left flank pain that was caused by a perforation in the splenic flexure of the colon by a toothpick. We conducted a systematic review of the literature to examine the nature of injuries caused by ingested toothpicks. Articles were analyzed for the following outcome variables: presenting complaint, site of injury, recollection of toothpick ingestion, time to presentation, findings from imaging studies, and mortality. Most patients (70%) presented with abdominal pain. Few patients (12%) remember swallowing a toothpick. The onset of symptoms ranged from <1 day to 15 years. Toothpicks caused perforation most frequently at the duodenum and the sigmoid. In some cases, toothpicks migrated outside the gastrointestinal tract and were found in the pleura, pericardium, ureter, or bladder. Toothpicks were apparent on imaging studies in 14% of the cases. The definitive diagnosis was most commonly made at laparotomy (53%), followed by endoscopy (19%). overall mortality was 18%. Ingested toothpicks may cause significant gastrointestinal injuries, and must be treated with caution.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. Sclerosing encapsulating peritonitis: differential diagnosis to peritoneal encapsulation and abdominal cocoon--a case report.A 59 year old man presented with symptoms of partial bowel obstruction. Small bowel x-ray studies did not allow to identify the nature of the intestinal process in the upper ileum. At laparotomy small bowel encapsulation with a whitish membrane was encountered. Despite partial removal of this membrane small bowel obstruction persisted and two weeks postoperatively the patient died of peritonitis and cardiac insufficiency. autopsy findings revealed massive fibrous adhesions in the abdomen with granulomatous inflammation. The presence of foreign body giant cells and bifringent crystals were characteristic for talcum powder. The latter suggested a causal role of an appendectomy 45 years earlier. The diagnosis of sclerosing encapsulating peritonitis as established in our patient needs to be separated from peritoneal encapsulation, a congenital malformation, and abdominal cocoon, which contains histological elements of inflammation. This case report should draw attention to these entities in the differential diagnosis and surgical management of small bowel obstruction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. Intrauterine cytomegalovirus infection presenting as fetal meconium peritonitis.Recent reports have suggested that focal hyperechoic abdominal masses detected during the second trimester may represent a normal variation in fetal intestinal development that is transient in nature and not associated with pathologic conditions. The patient described here had second-trimester ultrasonic findings of fetal meconium peritonitis without ascites, polyhydramnios, or other anomalies. Subsequent ultrasound examinations at 22, 30, and 36 weeks demonstrated no change in the abdominal appearance. At birth, this preterm male infant had clinical symptoms of congenital cytomegalovirus infection confirmed by viral culture and serologic studies. retrospective studies of maternal serum obtained early in the second trimester confirmed a primary cytomegalovirus infection 4 weeks before the initial ultrasound examination. Although fetal hydrops and ascites have occasionally been associated with intrauterine cytomegalovirus infection, fetal meconium peritonitis has not been previously recognized in patients with congenital cytomegalovirus.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. Clostridial sepsis: unusual clinical presentations.We present four cases exhibiting the widely diverse nature of clinical infections due to anaerobic clostridium perfringens. These cases exemplify the need for a thorough initial physical examination, immediate Gram staining of fluid from involved tissue, and recognition of the severity of the disease in any patient who has early septic deterioration after elective or emergency surgical procedures. Management of these infections includes both high-dose parenteral penicillin therapy and aggressive initial surgical debridement of all involved tissues.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. Partial hypopituitarism following septic peritonitis with shock.A 46-year-old man had a prolonged septic peritonitis with shock that resulted from a perforated appendix at the age of 29, followed, six months later, by the gradual development of partial hypopituitarism. Radiographic studies, including a pneumoencephalogram, did not reveal any evidence of sellar or surprasellar masses. Endocrine studies revealed growth hormone and gonadotropic deficiency and possible adrenocorticotropic hormone deficiency and possible adrenocorticotropic hormone deficiency. The nature of the disease course yielded much speculation in regard to pathogenesis of the condition.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. Spontaneous peritonitis of cirrhosis due to campylobacter fetus.An unusual case of spontaneous peritonitis of cirrhosis associated with campylobacter fetus is reported. This microaerophilic gram-negative bacillus has been increasingly associated with human disease recently, particularly in patients with cirrhosis. The infection is characteristically relapsing in nature and requires protracted antimicrobial therapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Histiocytic reaction in pelvic peritoneum associated with oxidized regenerated cellulose.The authors present five cases of an unusual inflammatory reaction in pelvic peritoneal tissues associated with oxidized regenerated cellulose, a topical hemostatic agent. The findings were observed in specimens from five women who had been treated with oxidized regenerated cellulose during abdominal surgery. Histologically, the lesion was characterized by collections of large cells beneath the mesothelial surface, with small bland nuclei and abundant granular basophilic cytoplasm that stained bright red with mucicarmine. Immunohistochemical studies demonstrated that these cells stained positive for KP1 (CD68) confirming their histiocytic nature, and negative for cytokeratin and S-100 protein excluding the diagnoses of carcinoma and granular cell tumor respectively. Although unlikely, the mucicarmine positivity may be misinterpreted, leading to a erroneous diagnosis of adenocarcinoma. To avoid misdiagnosis, pathologists need to be aware of this lesion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. General peritonitis induced by rectal examination: an unusual complication of primary psoas abscess.Primary psoas abscess is a relatively rare disease with highest incidence in children and adolescents. It usually presents with fever, abdominal pain and limp. Limping tends to incriminate musculoskeletal problems below the pelvis, but movement of the hip involves the psoas muscle which is mostly retroperitoneal and intimately related to pelvic and intraperitoneal organs. Although the current tendency is to use abdominal sonography, rectal examination is still a valuable step in clinical examination, and may help to assess a pelvic mass or abscess. The following case report describes the elusive nature of psoas abscess and a rare occurrence of abscess rupture and peritonitis, immediately after rectal examination.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. color Doppler energy in prenatal diagnosis of meconium peritonitis: a case report.meconium peritonitis is an uncommon chemical peritonitis of a fetus resulting from antenatal bowel perforation. We reported a case of meconium peritonitis with pseudocystic formation diagnosed by color Doppler energy (CDE) at 34 gestational weeks. An echogenic substance inside a fetal abdominal mass was detected using ultrasound. By conventional color Doppler, there was minimal blood flow in the cystic wall or septums of the mass. Using CDE, bowel hyperperistalsis was observed in multiple small bowel loops and the region of intestinal loops into the mass was easily detected. Therefore, the angle independent nature of CDE will play a significant role in the early and accurate diagnosis of meconium peritonitis before birth.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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