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PubMed2004

Albumin infusion for low serum albumin in preterm newborn infants.

BACKGROUND: Intravenous albumin infusion to treat hypoalbuminaemia is used in intensive care nurseries. Hypoalbuminaemia occurs in a number of clinical situations including prematurity, the acutely unwell infant, respiratory distress syndrome (RDS), chronic lung disease (CLD), necrotising enterocolitis (NEC), intracranial haemorrhage, hydrops fetalis and oedema. Fluid overload is a potential side effect of albumin administration. Albumin is a blood product and therefore carries the potential risk of infection and adverse reactions. Albumin is also a scarce and expensive resource. OBJECTIVES: The primary objective was to assess whether albumin infusions, in preterm neonates with low serum albumin, reduces mortality and morbidity. A secondary objective was to assess whether albumin infusion is associated with significant side effects. SEARCH STRATEGY: Searches were made of MEDLINE from 1966 to April 2004, CINAHL from 1982 to April 2004 and the current Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library issue 1, 2004). Previous reviews (including cross references) and abstracts were also searched. SELECTION CRITERIA: All randomised controlled trials in which individual patients were allocated to albumin infusion versus control were included. Cross-over studies were excluded. Quasi randomised trials were excluded. Participants were preterm infants who had hypoalbuminaemia. Types of interventions included albumin infusion versus placebo (e.g. crystalloid) or no treatment. DATA COLLECTION AND ANALYSIS: The reviewers worked independently to search for trials for inclusion and to assess methodological quality. Studies were assessed using the following key criteria: blinding of randomisation, blinding of intervention, completeness of follow up and blinding of outcome measurement. MAIN RESULTS: Only two small studies were found for inclusion in this review and only one reported clinically relevant outcomes - it found no significant differences for our primary outcome measure of death (RR 1.5 [95% confidence interval 0.3 - 7.43]) or secondary outcome measures of intraventricular haemorrhage, patent ductus arteriosus, necrotising enterocolitis, bronchopulmonary dysplasia, duration of mechanical ventilation and duration of oxygen therapy. REVIEWERS' CONCLUSIONS: There is a lack of evidence from randomised trials to determine whether the routine use of albumin infusion, in preterm neonates with low serum albumin, reduces mortality or morbidity, and no evidence to assess whether albumin infusion is associated with significant side effects. There is a need for good quality, double-blind randomised controlled trials to assess the safety and efficacy of albumin infusions in preterm neonates with low serum albumin.

Albumins↗
PubMed1985

Typhlitis in adults.

Although described initially in children, typhlitis is an important clinical condition that may also occur in adults with hematologic malignancy or, less commonly, aplastic anemia. We describe 6 adult patients with typhlitis and review the salient features of this condition. In typhlitis, a necrotizing process of multifactorial origin involves the right colon alone or the right colon and other areas of the intestine as well. Secondary colonization of mucosal ulcers by colonic flora commonly leads to septicemia and pyrexia. Typhlitis may be associated with a variety of clinical and radiographic findings. However, a high index of suspicion and certain constellations of clinical and radiographic findings may lead to an accurate presumptive diagnosis of typhlitis, followed by the institution of appropriate therapy. Notwithstanding, the short-term prognosis for typhlitis remains poor.

Adolescent↗
PubMed1991

Cyclic neutropenia--unusual cause of acute abdomen. Report of a case.

Cyclic neutropenia, a rare blood disorder, may be complicated by spontaneous necrosis of the cecum and ascending colon. We describe one such case, where a staged surgical approach achieved a successful outcome. The importance of recognition of this disorder is stressed, since this allows both performance of appropriate surgery and consultation with hematologic colleagues.

Abdomen, Acute↗
PubMed1986

Typhlitis: selective surgical management.

Typhlitis is a neutropenic enterocolitis of varying severity. Its incidence is increasing, particularly in patients with acute myelogenous leukemia undergoing high dose cytosine arabinoside chemotherapy. The onset is heralded by prodromal fever, watery or bloody diarrhea, abdominal distension, and nausea during the phase of severe neutropenia. The symptoms may then localize to the right lower quadrant with an associated increase in systemic toxicity. The diagnosis can be confirmed in these and other less specific cases by serial reexamination and abdominal radiographs, ultrasonography, computerized tomograms, or radionucleotide scans. The mainstay of management is complete bowel rest with nasogastric suction and total parenteral nutrition. Broad-spectrum combination antibiotics are essential, as is the avoidance of laxatives or antidiarrheal agents. Granulocyte support may be helpful. Patients with a history of nonspecific gastrointestinal complaints or of true typhlitis, successfully managed nonoperatively, should have prophylactic bowel rest and total parenteral nutrition instituted at the beginning of further chemotherapy. Patients with ongoing severe systemic sepsis who do not respond to chemotherapy and those with overt perforation, obstruction, massive hemorrhage, or abscess formation require surgical intervention. All necrotic material must be resected, usually by a right hemicolectomy, ileostomy, and mucous fistula. Divided ileostomy for less severe cases may be useful. Failure to remove the necrotic focus in these severely immunocompromised patients is fatal. With adequate recognition of typhlitis and its precipitating factors, the incidence of complications can be reduced through prevention and timely surgical intervention. Although typhlitis developed in a quarter of our acute myeloblastic leukemia patients, use of this combined approach was successful in all cases.

Adolescent↗
PubMedDate not supplied

Ischaemic colitis (necrotizing colitis, pseudomembranous colitis) in acute schistosomiasis mansoni: report of two cases.

Two cases of ischaemic necrosis of the sigmoid colon (necrotizing colitis) are reported in 2 brothers aged 7 and 4 years, diagnosed within a 10 d interval. The children had bathed in streams suspected to be contaminated by Schistosoma mansoni about 50-60 d before the onset of acute disease. Both patients had been previously exposed to schistosome-infected streams without showing signs or symptoms of infection. Before admission, S. mansoni eggs had not been found in the stool. Both patients presented with an apparently identical, relatively symptomatic clinical course with rapid evolution to an acute abdomen. Laparotomy disclosed, in both patients, extensive necrosis (ischaemic necrotizing colitis of schistosomal aetiology) of about 20 cm in the first child and 8 cm in the second, extending from part of the descending colon to the sigmoid. The patients were successfully operated upon (hemicolectomy plus colostomy). The histopathological findings were similar in both patients. Ischaemic necrosis with complete destruction of the mucosa and part of the submucosa was detected in the first case; in the necrotic areas a few eggs of S. mansoni were seen, with no granulomatous reaction, but surrounded by cell shadows, pycnotic nuclei and amorphous material. Necrosis extended to the muscular layer and serosa, in which schistosome granulomas in the necrotic-exudative phase were seen, as well as diffuse granulocytic exudate and fibrin. Sections of tissue from both patients contained numerous eggs and granulomas all in the same exudative phase in regional lymph nodes and near the thrombotic vessels. After surgery, the 2 patients progressed similarly. About 10 d after hospital discharge, the patients received anti-schistosomal treatment with oxamniquine. No further sign of infection was detected at subsequent recall visits.

Acute Disease↗
PubMed1988

The acute abdomen in the immunocompromised host.

Immunocompromised hosts are a heterogeneous group, including patients receiving transplants, those receiving chemotherapy for malignant disease, and those receiving steroids for autoimmune disease, as well as patients with AIDS. Each group has specific abdominal conditions, and the clinician must be familiar with the specific causes of the acute abdomen within each subset. The causes of the acute abdomen in immunocompromised patients may be divided into two broad categories: (1) those disorders that are closely associated with the immunocompromised state and (2) those processes that can occur in any patient regardless of the immune status. Physicians at every level of specialization must become familiar with the unusual complications that occur in this population and with the ways in which the underlying disease and its therapy can modify the clinical presentation and management of common abdominal conditions. This article outlines broad principles of common clinical findings and surgical therapy in these patients.

Abdomen, Acute↗
PubMed2000

Enterocolic (lymphocytic) phlebitis: a rare cause of intestinal ischemic necrosis: a series of six patients and review of the literature.

Vasculitis of the gastrointestinal tract is known to occur as part of a systemic process but also may be present in a localized form involving only the digestive tract. We report the clinical and pathologic findings of six patients with intestinal ischemia and necrosis resulting from localized phlebitis associated with fresh and/or organized thrombosis of intramural mesenteric veins. None of the patients showed clinical or laboratory evidence of systemic vasculitis. In all cases the arteries were not involved in the inflammatory process. Follow up ranged between 2 and 15 years without recurrence necessitating reoperation. This form of intestinal phlebitis is described in the literature under different terms but lymphocytic phlebitis, granulomatous phlebitis, necrotizing phlebitis, and myointimal venous hyperplasia are probably morphologic variants of the same entity. We propose to unify the nomenclature and to use for this unusual clinicopathologic entity only the generic term of enterocolic (lymphocytic) phlebitis.

Abdomen, Acute↗
PubMed1975

[Frequency of detecting bacteria of the genera Citrobacter and Hafnia in different contingents of examined adults].

A study of the incidence of bacteria of the Citrobacter and Hafnia genus in adults permitted to establish a greater occurrence of the mentioned microbes in the patients with various acute intestinal diseases in comparison with the healthy ones. Bacteria of the Citrobacter and Hafnia genus were revealed in the patients with acute intestinal diseases of obscure etiology, which often were diagnosed as gastroenteritis, enteritis, etc. Bacteria of the Citrobacter and Hafnia genus were revealed in the dysentery patients. Results of studies carried out among various healthy groups of the population indicated no significant differences in respect to the carrier state of the Citrobacter and Hafnia bacteria both within each of the groups of the persons examined and between them. Further studies directed to the investigation of the etiological role of bacteria of the Citrobacter and Hafnia genus in the pathology of enteric disturbances are necessary.

Acute Disease↗
PubMed1990

[Acute appendicitis in patients with Yersinia infection].

The article is the result of the joint work of a surgeon and a specialist in infectious diseases and is based on the results of treatment of 307 patients with the abdominal form of Yersinia infection Acute appendicitis was diagnosed in 73 (23.8%) of them. The abdominal form of Yersinia infection is encountered frequently among children. The authors analyse the clinical picture of acute appendicitis in patients with Yersinia infection, the time between the onset of the disease and the patient's call for the doctor, the dependence of the histologic findings in the examined removed vermiform processes on the duration of the disease, and the results of surgery. The difficulties in making the diagnosis of acute appendicitis in patients with yersinosis and concomitant mesadenitis and terminal ileitis are discussed. It is concluded that laparoscopy is advisable in doubtful clinical signs of acute appendicitis in patients with Yersinia infection due to the high frequency of destructive forms (77.9%). The average duration of in-patient treatment of persons with acute appendicitis and Yersinia infection was 4.8 days. The positive results of treatment are attributed to timely prescription of specific antibacterial therapy--the prescription of chloramphenicol from the moment that the diagnosis of yersinosis was established.

Acute Disease↗