[Acute appendicitis in newborn infants].
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Acute Disease↗
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Yersinia enterocolitica infection in a patient with sickle cell disease after exposure to chitterlings.
PURPOSE: We describe certain clinical, epidemiologic, and host-susceptibility features of Yersinia enterocolitica infection in the context of a patient with underlying risk factors. PATIENTS AND METHODS: A 10-year-old black girl with sickle cell disease receiving chelation therapy for iron overload resulting from chronic transfusion therapy was admitted with acute abdominal pain and fever. RESULTS: Upon hospital admission, differential diagnoses included enterocolitis, appendicitis, and vasoocclusive crisis. On the 6th hospital day, the patient's stool culture became positive for Y. enterocolitica. Household exposure to raw pork intestines (chitterlings) was the presumed source of the infection. Deferoxamine therapy was withheld, and antibiotic therapy was administered with subsequent clinical improvement. CONCLUSIONS: Y. enterocolitica infection should be considered as a cause of abdominal pain mimicking appendicitis in patients with underlying risk factors (including certain sickle cell patients). History of exposure to raw or undercooked pork products and appropriate cultures should be obtained. Deferoxamine therapy should be withheld in iron-overloaded patients presenting with such symptoms because deferoxamine and iron overload constitute independent risk factors for Yersinia infection. Such patients should be advised to avoid potential exposures to this pathogen.
Anemia, Sickle Cell↗
Inadequate pouch emptying following Martin's pull-through procedure for intestinal aganglionosis.
Diarrhea is an expected problem following Martin's operation. Its cause is obvious. With medical management, the phase of intolerance to enteral feeding can be bridged. Adaptation is usually reached within 3-6 mo of surgery. This is confirmed by our experience with five patients treated in this manner. In two further patients, episodic bouts of diarrhea continued to mar their recovery. It was then appreciated that this was related to pouch content stasis. The nonoperative management of this complication proved unsuccessful. A death at 20 mo post-pull-through due to "enterocolitis" and an operation 13 mo post-pull-through to repair an acute pouch perforation followed. Attention is drawn to this complication. The following points aimed at preventing stasis, which in our series has been the most difficult problem to treat, are made: a low anal anastomosis--0.5 cm above dentate line; limit pouch size; and use normally innervated bowel. With the use of these changes, early postoperative diarrhea may be difficult to control. For this reason it is proposed that parenteral feeding be used routinely in the immediate postoperative period, and, as rapid fluid loss is better tolerated, surgery be deferred until the patient is 8 mo or more of age.
Colon↗
Necrotizing enterocolitis in full-term newborns.
During a 17-month period, 19 full-term newborn infants were hospitalized for necrotizing enterocolitis (NEC). 10 of these infants had no apparent risk factors. Only 7 suffered acute fetal distress. 16 of the 19 infants were born in the same hospital. Toxicological and bacteriological investigations of possible cause revealed no specific agent. Virological analysis of 8 stool samples revealed the presence of corona virus in 5 of the 8.
Bacteroides↗
[Clostridium difficile bacteremia].
BACKGROUND: Extra-digestive manifestations of Clostridium difficile infection are very uncommon. Exceptional cases of C. difficile bacteremia or severe sepsis have been described in intensive care patients, demonstrating the capacity of this agent to generate generalized infection. CASE REPORT: C. difficile bacteremia occurred in a 66-year-old immunodepressed patient treated for acute myeloblastic leukemia. Bacteremia was associated with a abscess of the anal margin. Outcome was favorable after treatment with metronidosole. DISCUSSION: Clostridium difficile is generally selected by prior antibiotic treatment. It is the principal agent of nosocomial diarrhea. In immunodepressed patients, systemic dissemination is a rare but possible development.
Aged↗
Effective peritoneal dialysis in an infant with extensive resection of the small intestine.
Acute renal failure and pulmonary edema developed in a 1-month-old baby with necrotizing enterocolitis and hypovolemic shock. Following resection of 93% of her small intestine and mesentery, peritoneal dialysis was started; it was terminated 96 h later with complete recovery of renal and pulmonary functions. Two weeks later, while on total parenteral nutrition, the infant developed fulminant septicemia and died. Postmortem examination showed normal kidneys. Surface measurement of the abdominal wall and viscera revealed that the actual peritoneal surface area of the patient was 671 cm2, only 44% of her calculated normal peritoneal surface area. We conclude that effective peritoneal dialysis is feasible in infants with acute renal failure even after marked reduction of the peritoneal surface area.
Edema↗
[Risk factors related to mortality in newborns with stage III necrosing enterocolitis].
BACKGROUND: The aim of this study was to identify risk factors associated to mortality in newborn stage III necrotizing enterocolitis (NEC III). SETTING: Neonatal Intensive Care Unit (NICU) at the Hospital de Pediatría CMN Siglo XXI IMSS; Mexico City. METHODS: Twenty one clinical records were analyzed. A case-control study was realized from patients admitted in the NICU from January to November 1997. RESULTS: Two cases were excluded. The 19 that remained had 52% mortality. They were ten cases and nine controls. They were no significant differences between both groups in gestational age, birth weight, breast or formula feeding, neither X-rays nor whíte blood cells and platelet counts showed differences, except in band-count increase. Anterior abdominal wall celullitis and gut perforation, both had significative differences (p = 0.01); also shock and acute renal failure had an odds ratio of 11.2 and 72, respectively. CONCLUSIONS: The NEC mortality in this study is similar to previous communications; nevertheless, the gestational age of these patients is greater than the literature reports. The most significant risk factors found in this paper in relationship to mortality were shock and acute renal failure; both had a high odds ratio.
Acute Kidney Injury↗
Combined Sarcocystis and gram-positive bacterial infections. A possible cause of segmental enterocolitis in Thailand.
Between 1981 and 1990, 22 intestinal specimens surgically resected due to segmental enterocolitis were collected and examined. Grossly, the specimens were classified into 3 groups 1) Acute inflammation with hemorrhage and necrosis 2) Constrictive lesion 3) False diverticulum with perforation. Mostly, there was unisegmental involvement, distributed in jejunum, ileum and ileocolon. Microscopically, small parasitic structures, interpreted to be unconventional excystation stage of Sarcocystis hominis, (Railliet and Lucet, 1891) Dubey 1976, were present on the luminal border and within the crypt-lining epithelial cells. At the ulcerated area, tissue invasion by Gram-positive bacteria were always seen and considered as second pathogen. Source of the parasite was likely from cyst-containing beef available in markets, (Bos indicus and Bubalus bubalis) along with consumption of undercooked beef. Antismooth muscle antibody, IgG class, with the titer ranging from 1:16-1:256 were detected in 45 per cent of the patients. This is considered as autoimmunity against intestinal smooth muscle damaged previously from subclinical inflammatory condition. Present information suggests a long-standing existence of Sarcocystis in the patients' intestine, associated with Gram-positive bacterial infection, as the mechanism producing segmental enterocolitis found in the Central region.
Adolescent↗
Clostridium difficile toxin A perturbs cytoskeletal structure and tight junction permeability of cultured human intestinal epithelial monolayers.
Toxin A of Clostridium difficile causes severe inflammatory enterocolitis in man and animals that appears to be mediated in part by acute inflammatory cells that migrate into the toxin A-exposed mucosa. To determine the direct effects of toxin A on intestinal epithelial permeability and structure in the absence of other modulating factors, we used cultured monolayers of a human intestinal epithelial cell line (T84). A toxin A concentration of 7 x 10(-1) micrograms/ml (3 x 10(-9) M) nearly abolished monolayer transepithelial resistance within 6-8 h. This marked permeability defect occurred while the monolayers were still confluent. Dual sodium-mannitol flux studies localized the permeability defect to the intercellular tight junction. Cytotoxicity assays and morphological evaluation using Nomarski optics and electron microscopy failed to demonstrate any evidence of cell damage at the time the maximum resistance response was observed. Fluorescent staining for F actin, however, revealed a marked decrease in fluorescent intensity in toxin-treated monolayers versus controls. These data show that toxin A can directly affect the barrier function of this model intestinal epithelium and initially does so by selectively enhancing tight junction permeability. Furthermore, cytoskeletal structure is markedly altered over the same time course, although the integrity of individual cells is maintained. Because the cytoskeleton of intestinal epithelial cells is known to be capable of regulating tight junction permeability, we speculate that the above effects of toxin A on epithelial barrier function result from alterations of the cytoskeleton.
Animals↗
[Diagnosis of liver abscess].
The diagnosis of hepatic abscesses in outpatients is accurate in hardly half of the cases. The rest of them are commonly taken for: acute cholecystitis, cholecystopancreatitis, pancreatitis, peritonitis, phlebitis of the splenic veins, intestinal obstruction, chronic enterocolitis, pneumonia, pleurisy. Misdiagnosis is usually attributed to the absence of pathognomonic symptoms and atypical course of a hepatic abscess. With right chest and hypochondrium pains of unknown origin and elevation of body temperature, diagnostic efforts should be directed to recognition of a hepatic abscess.
Adult↗
[Behcet's disease--clinical picture and treatment].
Behcet's disease is a systemic inflammatory disease of unknown etiology which usually occurs as a trait of symptoms: aphatous stomatitis, genital ulcerations and eye disease. Characteristic manifestations are frequent: erythema nodosum, arthralgias, arthritis, myalgias, phlebothrombosis and nervous system disorders as well as disorders of other organs and systems. Behcet's disease was discovered in 1937 for the first time by dermatovenerologist Hulusi Behcet (1889 - 1948) after whom it was named Behcet's disease or Behcet's syndrome. At the beginning of the disease the diagnosis is uncertain because of different schedule of certain manifestations and a long period up to the full clinical picture manifestation. As it is well known, the main changes occur at the buccal mucosa in a form of a recidivant aphthous and herpetiformis lesions. Genital ulcerations are present in 64 to 87% of patients. Changes which occur on eyes may be present in 28 - 80% of patients and may dominate the clinical picture. The skin is affected in about 50% of patients. Manifestations on joints occur at major joints of the lower limbs. Sometimes gastrointestinal manifestations occur as enterocolitis and ulcerous colitis. Nervous system lesions have poor prognosis. The treatment involves: acute exacerbations with multisystemic manifestations by utilization of non-steroid anti-inflammatory drugs and immunosuppressive preparations. Corticosteroids are used in severe cases.
Behcet Syndrome↗
[Surgical results of coronary artery bypass grafting in patients older than 75 years].
We studied 19 patients, all older than 75 years of age, who had isolated coronary artery bypass grafting (CABG) from January 1990 to December 1996. Clinical characteristics, hospital mortality and long-term survival were compared between this elderly group (> or = 75 years) and a younger group (60-74 years) in which 130 consecutive patients underwent the same procedure during the same period. There were no differences of coronary risk factors, renal function, respiratory function and ejection fraction between the two groups. The incidences of left main trunk stenosis (> or = 50%) and three-vessel-disease were more common in the elderly group, but the difference between the groups was not statistically significant. Preoperative use of an intra-aortic balloon pump was more frequent in the elderly group (p < 0.01). The hospital mortality rate of 31.6% for the elderly group was significantly higher than that of 5.4% for the younger group (p < 0.01). However, of particular note is that the 30-day hospital mortality was half (15.8%) and that three of six (50%) hospital deaths occurred between 35 and 148 days. These patients died from acute respiratory failure subsequent to aspiration pneumonia, ruptured dissecting aortic aneurysm, and ischemic enterocolitis. This difference between the 30-day hospital mortality rate (15.8%) and hospital mortality rate (31.6%) emphasizes the influence that postoperative complications can have on subsequent outcome. Of 136 hospital survivors (123 in the younger group and 13 in the elderly), 98% have been followed for a mean of 32 months. The 4-year survival was 60 +/- 22% for hospital survivors of the elderly group. It compares favorably with that for the younger group (85 +/- 5%), and with previously reported data. We conclude that despite a significantly increased hospital mortality, good long-term survival can be realized after CABG, even in patients older than 75 years.
Age Factors↗
A mouse model for S. typhimurium-induced enterocolitis.
Salmonella typhimurium has emerged as a model pathogen that manipulates host cells in a complex fashion, thus causing disease. In humans, S. typhimurium causes acute intestinal inflammation. Intriguingly, type III secreted virulence proteins have a central role in this process. At the cellular level, the functions of these factors are well characterized; at present, animal models are required for elucidating how these factors trigger inflammatory disease in vivo. Calf infection models have been employed successfully and, recently, a mouse model was identified: in streptomycin-pretreated mice, S. typhimurium causes acute colitis. This mouse model provides a new avenue for research into acute intestinal inflammation because it enables the manipulation and dissection of both the bacterial and host contributions to the disease in unsurpassed detail.
Animals↗
Volvulus of the cecum associated with acute suppurative appendicitis.
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Appendicitis↗
[Acute mesenteric vascular occlusions].
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Embolism↗
[Acute necrotizing enteropathy of the newborn].
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Enterocolitis, Pseudomembranous↗
[A case of acute pancreatitis in an infant].
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Enterocolitis, Pseudomembranous↗
Necrotizing enterocolitis presenting in the Emergency Department: case report and review of differential considerations for vomiting in the neonate.
Historically, most of the acute complications of prematurity have occurred in the neonatal intensive care unit, not in the Emergency Department (ED). It is becoming increasingly common, however, for premature infants to be discharged from the hospital before they have reached a postconceptual age of 40 weeks. Such infants remain at relatively increased risk for a variety of complications of prematurity and may present to the ED in their first month of life. To highlight its symptomatology and review its management, we present the case of an infant presenting back to the ED with coffee ground emesis and fulminant necrotizing enterocolitis.
Emergency Service, Hospital↗