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.     

Primary peritonitis caused by Streptococcus pneumoniae

OBJECTIVES: To examine the dilemmas for children, family, and mental health professionals posed by the presence of a delusional parent in a family, including someone with induced psychotic disorder (IPD); to identify frequently unrecognized problems; and to propose practical suggestions for professionals. METHOD: The pertinent literature on the effects of delusional parents on children, families, and professionals is reviewed. By way of 3 case vignettes, the dilemmas are identified and discussed. RESULTS: Delusional disorders are underdiagnosed, resulting in poor anticipation of their implications. Unanticipated family factors, such as "pursuit of isolation" and the related heightened risk of violence, contribute to the failure of professional interventions, which has been described as "therapeutic systems paralysis." CONCLUSIONS: These cases are complex, often requiring multisystemic involvement to reduce the risks of flight. violence, psychosis, posttraumatic stress disorder, and other psychiatric sequelae to children and other family members. The critical features of the innovative collaboration ("therapeutic consensus") required between professionals for successful therapeutic interventions with these families are described.     

Some immunologic aspects in postoperative peritonitis

The final reiterative loop of risk reduction leads to residual risk, sometimes called "tolerable risk." This is the risk with which one must live, and is typically handled through proper training, signage and personnel protective clothing. Any existing safeguards should be considered removed when performing a risk analysis. This will allow the full impact of the resulting tolerable risk (initial risk--risk reduction) to be more accurately evaluated. Trying to walk the fine line between the cost of making machine processes safe and the economics of staying competitive is not easy, and it is not the intent of the regulatory bodies to put companies out of business. However, a good rule of thumb with respect to OSHA is that if a machine process can be guarded, guard it. Otherwise the ultimate test of residual risk may be in the litigation.