Amebic peritonitis

Fifteen cases with generalized amebic peritonitis have been described. Early surgical intervention combined with intensive resuscitation and specific chemotherapy has given good results. Mortality associated with colonic perforation may be reduced by performing staged procedures. Chances of survival may be improved through early diagnosis by suspecting an amebic cause in cases of generalized peritonitis in endemic areas.     

Amebic liver abscess of unusual presentation

A 35-year-old male who had travelled extensively in the tropics presented with severe anorexia and vomiting associated with fever of 39-40 degrees C during a 4-day period. The clinical findings were entirely negative. In 1973, he had been given metronidazole for amebic dysentery, since when recurrent attacks of diarrhea and abdominal pain had been treated with iodoquinoleines. Stool examination was negative for amebae. Liver scan revealed a suspect "expansive process" in the right lobe. The presumptive diagnosis of amebic abscess was made and metronidazole therapy was started. In less than 24 h the patient became afebrile. The abscess was confirmed by a further liver scan. The definitive diagnosis of amebiasis was established 16 days later when the immunofluorescence level, which had been previously negative, became positive 1/480. This case demonstrates the dangers of the indiscriminate use of iodoquinoleines in patients who have travelled in tropical countries. The amebic liver abscess may be silent locally while causing systemic manifestations such as fever. Early treatment of hepatic amebiasis is recommended even with a presumptive diagnosis. Serological tests during the development of an amebic abscess may be negative and should be repeated after several days of therapy.     

Barium peritonitis

One-thousand single live-born infants were examined and 111 were found to have low birthweight (2500 g or less). Assessment of maturity was made by using physical and neurological criteria without knowledge of when the last menstrual period occurred. The incidence of prematurity among all single live births was 4.5% by physical and 4.9% by neurological criteria and among low birthweight babies it was 40.6% and 44.2% respectively. Both the criteria were found to be equally reliable but physical signs are recommended for routine clinical use because of their simplicity.     

Amebic liver abscess: changing trends over 20 years

The metabolism of [2,3-13C]succinic acid dimethyl ester ([2,3-13C]-SAD) 10 mmol/L was examined in hepatocytes from overnight-fasted normal rats, 3-day starved rats, and overnight-fasted hereditarily diabetic Goto-Kakizaki (GK) rats. The amount of 13C-labeled succinate, fumarate, malate, lactate, alanine, and aspartate released by the hepatocytes was much higher in fasted normal rats than in starved or diabetic animals. Although the integrated areas of the 13C2 and 13C3 signals assigned to double-labeled malate, lactate, or alanine were not significantly different, the amount of single-labeled malate, lactate, alanine, and aspartate was higher in C3- versus C2-labeled isotopomers. The release of 13C-labeled glucose by the hepatocytes was lower in fasted versus starved or diabetic rats. Virtually all hexose molecules double-labeled in the C1-C2-C3 and/or C6-C5-C4 moieties corresponded to the [1,2-13C] and/or [5,6-13C] isotopomers. However, in the case of the single-labeled species, 13C-labeling of C1 (or C6) exceeded that of C2 (or C5). Both the single- and double-labeled molecules enriched with 13C in the C1-C2-C3 moiety were less abundant than those labeled in the C6-C5-C4 moiety, with such asymmetry being most marked in overnight-fasted normal rats, less pronounced in diabetic animals, and virtually absent in starved rats. These findings document that SAD is efficiently metabolized in hepatocytes, with its use as a gluconeogenic precursor being influenced by the nutritional and hormonal status of the animals. The present experiments also reinforce the view that asymmetrical labeling of glucose by 13C-labeled precursors is modulated by the relative contribution of exogenous and endogenous nutrients to the production of triose phosphates incorporated into the hexose.     

Spontaneous bacterial peritonitis

BACKGROUND: Since the beginning of the eighties systematic investigations broadened our knowledge about the clinical picture of spontaneous bacterial peritonitis very much. Important insights into epidemiology, pathogenesis, symptomatology, diagnosis and therapy of this disease, which is a frequent complication in patients with cirrhosis of the liver and ascites, could be gained. Actual research work primarily deals with questions of therapy and prophylaxis. AIM: Aim of this review is a comprehensive presentation of the different aspects of this disease on the basis of the present literature. CONCLUSIONS: As on the one side the clinical symptoms may be very little and on the other side the prognosis is very bad, it is extremely important to take this entity into the differential considerations to make an early diagnosis and to start an adequate therapy early.     

Amebic liver abscess: ultrasound and clinical follow-up of 20 patients

The objective of this study was to investigate the feasibility of developing a system whereby measurements taken on bulk tank milk samples could be used to monitor the level of subclinical mastitis in dairy herds. The variables that were examined were the logarithmically transformed total somatic cell counts and percentages of cell volume in channel 8 (volumes from 89.2 to 178.3 microm(3)), the presence or absence of Streptococcus agalactiae and various husbandry/management factors including herdsize and the use of teat dips. Each of the use of actual monthly and rolling average bulk tank cell count determinations was investigated. It was found that the inclusion of all variables resulted in a correct classification of approximately 85% of herds and that no improvement was achieved by the use of rolling as opposed to actual monthly values. The inclusion of various husbandry/management practices improved the percentage correct classification to some extent over that achieved by the sole use of total somatic cell counts and percentages of cell volume in channel 8 when the herds were grouped on the basis of quarter infection rate (<10%, >10%) but not in the case of the cow infection rate categories (<20%, >20%). The use of both total cell counts and percentages of cell volume in channel 8 did not improve the overall predictive value over that achieved by the sole use of percentage of cell volume in channel 8 in the case of the quarter infection rate groupings but did to some extent in the case of the cow infection rate groupings. When the classification functions were applied prospectively and considering combinations of the two cell count determinations only, it was found that they were able to correctly classify, on the basis of the quarter infection rate groupings, approximately 75% of the study herds. It is concluded that the system described herein has limited application as a basis for selecting problem herds.     

Amebic meningoencephalitis caused by Balamuthia mandrillaris: case report and review

Balamuthia mandrillaris, formerly referred to as a leptomyxid ameba, is a free-living ameba that has recently been identified as a cause of meningoencephalitis. Previously, only two genera, Naegleria and Acanthamoeba, were recognized as causes of central nervous system (CNS) infections in humans. In contrast to Naegleria, Balamuthia causes a subacute-to-chronic infection of the CNS. Distinct from Acanthamoeba, which appears to favor the immunocompromised host, Balamuthia is capable of infecting both healthy and immunosuppressed hosts. Retrospective analyses as well as an accumulation of newly identified cases have demonstrated that this ameba is an increasingly important pathogen to recognize. We report the isolation, histopathologic features, and confirmation by indirect immunofluorescence of B. mandrillaris in a case of fatal amebic meningoencephalitis.     

Spontaneous pneumoperitoneum without peritonitis

We report one case of spontaneum pneumoperitoneum without peritonitis in a male newborn was admitted in Infantil Robert Reid Cabral Hospital. Many radiological studies were carried out. Its treatment was conservative. The child had excellent evolution. We recommend this treatment for all the patient who has the same features.     

Sclerosing peritonitis after practolol administration

We have recently managed two patients with sclerosing peritonitis who had undergone a course of practolol but had ceased taking it some months prior to presentation. Publication of these cases will help to assess the extent of this complication and will increase awareness amongst surgeons who may be called upon to treat such cases.     

Therapy of spontaneous bacterial peritonitis

The outcome of untreated spontaneous bacterial peritonitis (SBP) is fatal. In the onset of SBP clinical manifestations may be subtle, therefore every patient with hepatogenic ascites has to be examined for SBP at admission. If polynuclear cell count in ascitic fluid exceeds 250/microliter, antibiotic therapy has to begin immediately, until irreversible complications develop. Aerobic gram-negative bacilli of the normal intestinal flora are responsible for most cases of SBP, followed by gram-positive organisms and anaerobes. Antibiotic agents with extended spectrum, such as third-generation cephalosporins are considered the drugs of choice for SBP. In severe cases combination with metronidazole is recommended. As soon as repeated paracenteses show polynuclear cells beyond 250/microliter, the antibiotic therapy can be stopped. Selective decontamination of the gut with norfloxacin is effective to prevent SBP in high-risk patients. Trimethoprim-sulfamethoxazole is superior due to its activity even against gram-positive organisms. Overall prognosis of patients with SBP, however, is determined mainly to complications specific for cirrhosis, e.g. variceal bleeding, coma etc.     

Combined treatment of generalized acute peritonitis

The results of examination and treatment of 166 patients were studied. The patients were divided into 3 groups: in the 1st (80 patients) acute generalized peritonitis was treated according to the conventional surgical canons, in the 2nd (54 patients) interchangeable plasmapheresis was added to the conventional treatment, in the 3d (32 patients) the whole complex of treatment was used--the routine method together with extracorporeal detoxication and staged sanatations of the abdominal cavity. Including plasmapheresis and staged sanatations in complex of treatment of acute generalized peritonitis intensifies the effect of treatment. The intervals between the staged sanatations and sessions of plasmapheresis depend on the stage and course of peritonitis. In the conventional method of treatment of acute generalized peritonitis according to the authors' observations the mortality rate made up 39%, when plasmapheresis was included it lowered to 30%, and when combined treatment was used mortality rate dropped to 22%. The data of this study demonstrates the potential and efficacy of combined treatment of acute generalized peritonitis with the use of interchangeable plasmapheresis and staged sanatations of the abdominal cavity.     

Peritoneal mesothelioma in recurrent familial peritonitis

A 39-year-old man had a 2-year history of fatigue, weight loss, drug-resistant ascites, and decreased intestinal motility. During adolescence he began to suffer frequent episodes of acute benign peritonitis that spontaneously subsided at age 35. The fact that his younger brother was taking colchicine for the same symptoms led us to diagnose familial Mediterranean fever (FMF). The medical workup revealed uniform thickening of the intestinal wall with no signs of amyloidosis. Exploratory laparotomy revealed diffuse peritoneal mesothelioma that proved to be unresponsive to chemotherapy. There was no history of asbestos exposure. It is probable that the chronic peritoneal inflammation was responsible for the development of this tumor, although in almost all cases of FMF this phenomenon causes only limited peritoneal fibrosis or, less commonly, encapsulating peritonitis. A computerized search of the literature indicates that this is the second report of peritoneal mesothelioma associated with FMF.     

Spontaneous bacterial peritonitis in liver failure

Cirrhosis of the liver results from a variety of mechanisms that cause progressive hepatic injury. It is the sixth leading cause of death in all patients between the ages of 35 and 55. This study attempts to correlate the morbidity and mortality of spontaneous bacterial peritonitis in liver failure patients to numerous etiologic and clinical variables. A retrospective review of 26 patients with spontaneous bacterial peritonitis associated with chronic liver disease was performed in a university hospital. Demographics (age and gender), clinical variables (etiology of liver failure, Child's classification, prior history of ascites, fever, abdominal pain, encephalopathy, and upper gastrointestinal hemorrhage), and laboratory variables (ascitic polymorphonuclearcyte count and cultures, serum albumin, bilirubin, creatinine, and prothrombin time) were studied. All of the patients had Child's C liver disease. Mortality rate was 46 per cent. Alcohol (46%) and hepatitis (30%) were the most common etiologies. Escherichia coli and Klebsiella pneumoniae were the most common culture isolates. All of the infections were monomicrobial. The only significant predictor of mortality (P < 0.05) in this study was the peritoneal fluid polymorphonuclear (PMN) cell count. PMN count >1000 PMN/mm3 was associated with a mortality of 88 per cent. Few patients with spontaneous bacterial peritonitis are ultimately transplanted.