Celioclysis in the treatment of purulent peritonitis

The advantages and contraindications associated with peritoneal drainage are discussed. Reference is made to the advantages of drainage combined with continuous coelioclysis in accordance with a personal method, using doxicycline diluted in saline passed into the peritoneal cavity via a small catheter. A personal series of 79 cases treated in this way to back up surgical management is presented. There was only one death due to septic shock.     

高氧液灌洗治疗急性继发性弥漫性腹膜炎的疗效探讨

目的探讨高氧液作为基础溶液,进行腹腔灌洗,治疗急性继发性腹膜炎疗效及作用机制。方法将成年SD大鼠随机分为3组,建立急性继发性腹膜炎模型（CLP模型）,分别进行抗生素灌洗,抗生素＋高氧液灌洗以及非灌洗3组对照。术后分别于6、12、18h抽血,测量中性粒细胞水平以及血清TNF-α,IL-6水平,以评价腹膜炎炎症反应严重程度。结果TNF-α水平在3组间差异均有统计学意义;IL-6水平在灌洗和非灌洗组间差异有统计学意义;中性粒细胞百分比在3组间差异均无统计学意义。结论高氧液作为基础溶液在急性继发性腹膜炎腹腔灌洗治疗中有一定的治疗效果。     

关节镜下清理及术后大流量短程持续灌洗治疗化脓性膝关节炎

目的 :探讨关节镜下清理及术后大流量短程持续灌洗治疗化脓性膝关节炎的新方法。方法 :作者自2 0 0 0年 10月～ 2 0 0 2年 10月采用关节镜下清理及术后持续大流量灌洗治疗化脓性膝关节炎 16例。结果 :随访 10～3 4个月 ,16例化脓性膝关节炎全部治愈无复发。随访关节功能结果优秀 13例 ,良好 2例 ,差 1例。平均治疗时间7 1d。结论 :根据化脓性膝关节炎不同病理改变时期 ,采用关节镜下清理及术后持续灌洗治疗化脓性膝关节炎损伤小 ,治疗时间短 ,恢复快 ,是一种理想的治疗方法     

腹腔镜诊治急性腹膜炎528例分析

目的:探讨为急性腹膜炎患者行腹腔镜手术的可行性。方法:回顾分析为528例急性腹膜炎患者行腹腔镜手术的临床资料。结果:8例中转开腹2,例死亡2,例放弃治疗,25例发生炎性肠梗阻,经保守治疗缓解,其余患者腹腔镜手术均获成功。结论:腹腔镜手术诊治急性腹膜炎安全可行,尤其老年人、儿童及妇科急腹症患者具有独特优势。     

A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CAPD peritonitis

Summary: Oral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg loading followed by 300 mg once daily as maintenance. of all the recruited episodes, 35 were eligible for analysis. the overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. the corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g -) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g + isolates and 33.3% of g - isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.     

Peritoneal dialysis-related peritonitis caused by gram-negative organisms: ten-years experience in a single center

ObjectivesConcerns are increasing about the clinical characteristics of gram- negative bacterial peritonitis for providing reference for clinical diagnosis, treatment and prevention.MethodsA retrospective analysis was performed examining patients who developed peritoneal dialysis-related peritonitis (PDRP) from 1 January 2009 to 31 December 2018.ResultsAmong 898 PD patients, 677 episodes of peritonitis occurred in 344 patients. Over 10 years, the proportion of gram-negative bacterial peritonitis increased from 0% to 26.15% (p = .045). E. coli was the leading cause (38.51%) of the 148 cases of gram-negative bacterial peritonitis. The increase of E. coli peritonitis between the first 5 and the last 5 years was obvious (20.45% vs. 46.15%). The antimicrobial sensitivity of gram-negative organisms to cefotaxime decreased from 71.43% to 55.84% (p = .017). In the gram-negative group, the effluent white cell count (WCC) on the first day was larger (OR: 1.374;95%CI: 1.248–1.563; p < .001), the time required for the WCC to normalize was longer (OR: 1.100;95%CI: 1.037–1.189; p = .003), and the level of C-reactive protein (CRP) was higher (OR: 1.038;95%CI: 1.026–1.042; p < .001) than those in the gram-positive group. The complete cure rate and treatment failure rate of gram-negative bacteria peritonitis were 87.8% and 12.2% respectively.ConclusionsOver 10 years, the proportion of gram-negative bacterial peritonitis increased, with E. coli epidermidis being the most common pathogen. More effluent WCC on the first day, longer time required for the WCC to normalize, and higher level of CRP are more common for gram-negative bacterial peritonitis. Prognosis of gram-negative bacterial peritonitis is worse.     

纤维支气管镜下行肺灌洗在治疗创伤性肺不张的临床应用价值

目的探究纤维支气管镜下行肺灌洗在治疗创伤性肺不张的临床应用价值。方法对照组给予常规对症支持治疗及经鼻导管吸痰治疗,观察组在对症支持治疗基础上给予纤维支气管镜下行肺灌洗治疗,观察对比两组临床疗效及术后并发症。结果观察组总有效率为95．6％,明显高于对照组的66．7％（P〈0．05）;1次经纤维支气管镜即可达到肺复张者27例（60．0％）;两组患者治疗过程中均未发生严重并发症。结论对创伤性肺不张患者行纤维支气管镜下行肺灌洗治疗,可有效解除气道堵塞,促进肺复张,改善临床预后。     

Primary anastomosis for meconium peritonitis: first choice of treatment

Purpose

Newborn surgery for meconium peritonitis (MP) is sometimes very difficult owing to severe adhesions and bleeding. The aim of this study was to reveal the benefit of primary anastomosis (PA) for MP by comparing PA with multistep operations (MO).

Patients and Methods

We retrospectively reviewed 38 patients with MP who underwent surgery in our institution from 1983 to 2009. From 1983 to 2000, we essentially used MO. After 2001, we used PA with the exception of 1 patient. We performed MO on 20 patients (group A) and PA on 18 patients (group B).

Results

Mortality was 4 in 20 in group A and 1 in 18 in group B. Three patients in group A and 2 in group B required reoperation because of complications. After 2001, 14 of 16 patients underwent PA. Of the 2 patients for whom PA could not be performed, one was postresuscitation from cardiopulmonary arrest and the other was an extremely low–birth-weight infant. The only mortality among the patients who underwent PA occurred in a very low–birth-weight infant who died from intraoperative hepatic hemorrhage.

Conclusion

PA can be performed for almost all patients with MP except for extremely low–birth-weight infants.     

腹腔镜下置管灌洗引流在重症急性胰腺炎早期治疗中的应用

目的探讨腹腔镜下置管灌洗引流(LPLD)在重症急性胰腺炎(SAP)早期治疗中应用的可行性、临床价值与技术特点。方法用LPLD的方法早期治疗21例SAP病人,对治疗结果进行回顾性分析。结果LPLD手术时间(654±276)min,术后灌洗引流时间(113±86)d,术后住院时间(325±146)d。LPLD同期完成腹腔镜胆囊切除术5例,腹腔镜经胆囊管胆总管取石1例,胆总管切开取石、T管引流术2例。1例术后4d死于多脏器功能障碍综合征(MODS),余20例治愈出院。术后随访2～22个月,发现假性胰腺囊肿1例,行内引流手术治愈。结论LPLD是SAP早期治疗中一种安全可行的方法,它用微创的方法达到开腹手术全面探查、充分灌洗引流治疗SAP的目的,值得临床推广应用。     

Detoxication properties of enterosgel in the treatment of purulent peritonitis

It was established in experiment that under the influence of enterosorpent Enterosgel, brought into abdominal cavity, the adhesions are forming, thats why the preparation usage in containers is recommended, alone or in combination with gentamycini sulfas.     

The effect of different temporary abdominal closure techniques on fascial wound healing and postoperative adhesions in experimental secondary peritonitis

Background Secondary peritonitis causes considerable mortality and morbidity. New strategies have been introduced like relaparotomy and temporary abdominal closure in the management of such persistent intra-abdominal infections. Materials and methods Rats were divided into five groups each having ten animals. After induction of peritonitis, relaparotomies were done, and the abdomen was closed by different temporary abdominal closure techniques. After performing two relaparotomies during a 48-h period, all fascias closed primarily and incisional tensile strengths, hydroxyproline contents, and adhesions were measured on the following seventh day. Results The median values of tensile strength and hydroxyproline concentrations were lowest in skin-only closure rats. Intraperitoneal adhesion scores were highest in Bogota bag closure group. Conclusion Primary, Bogota bag, and polyprolene mesh closures seem to be safe in terms of early fascial wound healing. Although it is easy to perform, skin-only closure technique has deleterious effects on fascial wound healing probably due to fascial retraction. Interestingly, Bogota bag has caused increased intraperitoneal adhesion formation.     

腹腔镜下腹腔灌洗引流治疗重症胰腺炎的疗效

目的探讨腹腔镜下腹腔灌洗引流(LPLD)治疗重症胰腺炎(SAP)的效果。方法选取2009年1月至2014年12月治疗的80例SAP患者,分为LPLD组38例和常规治疗组42例,常规治疗组给予常规对症治疗,LPLD组在常规治疗组基础上给予LPLD治疗,观察两组治疗效果。统计分析采用SPSS 19.0统计软件,两组间年龄、APACHE-Ⅱ评分、血尿淀粉酶、CRP及住院指标采用(x珋±s)表示,比较使用t检验;并发症比较使用χ~2检验。检验水准=0.05。结果 LPLD组治疗后血淀粉酶、尿淀粉酶和C反应蛋白分别为(79.8±21.2)U/L、(343.0±90.2)U/L和(38.9±14.5)U/L,均明显低于常规治疗组(P0.05);LPLD组临床症状消失的天数、自主排便时间和住院天数分别为(3.0±1.2)d、(2.1±0.9)d和(11.3±2.4)d,明显短于常规治疗组(P0.05);LPLD组并发症发生率和病死率分别为7.9%和2.6%,均明显低于常规治疗组(P0.05)。结论腹腔镜下LPLD治疗SAP有较好的效果,安全可靠,值得临床使用。     

Chylous ascites: an etiology of peritonitis in infancy

Fifty-six cases of chylous ascites in patients under the age of fifteen have been reported in the last three hundred years. A case of chylous ascites that presented with the signs and symptoms of peritonitis is reviewed. The normal anatomy and physiology of the intraabdominal lymphatic system, pathophysiology of the entity, as well as a mechanism for diagnosis, are addressed and a treatment algorithm is presented.     

Characteristics of bone metabolism markers during the healing of osteoporotic versus nonosteoporotic metaphyseal long bone fractures: a matched pair analysis

Purpose

The activity and metabolism of fracture healing can be monitored quantitatively by measuring bone turnover markers (BTMs) in serum or urine. However, in osteoporotic bone, the exact metabolism processes during the healing of metaphyseal fractures remain unknown. There is no diagnostic approach which currently allows dynamic insight into the fracture healing processes in order to monitor the progression of healing and to assist in therapeutic decision making.

Methods

Between March 2007 and February 2009, 30 patients over 50?years of age who suffered a metaphyseal fracture were included in our study. The levels of the osteoanabolic marker BAP (bone-specific alkaline phosphatase) and osteocatabolic marker β-CTX [crosslinked C-(CTX)-telopeptide-of-type-I-collagen] were monitored during the fracture healing of osteoporotic and nonosteoporotic fractures for a duration of 8?weeks.

Results

After an initial decrease of BAP in the first week, the BAP level steadily increased through the fourth week in both groups. The levels of BAP in the osteoporotic group surpassed the healthy group. β-CTX steadily increased in healthy bone up to the fourth week; in osteoporotic bone, β-CTX first increased and, thereafter, decreased from the first week onwards.

Conclusions

In this work, the first molecular biological aspects of osteoporotic fracture healing have been uncovered, helping to explain the mechanisms of delayed fracture healing in osteoporotic bone. The early decrease of reduced β-CTX as well as elevated BAP during the healing process may be the first aspects within the delayed healing of osteoporotic bone. Further studies are necessary in order to achieve more detailed insight to fracture healing and to ascertain the progression of fracture healing as being essential (criteria) for therapeutic decision making.