ABSTRACT
RESUMEN Presentamos caso clínico de puérpera de cesárea de noveno día con cuadro febril en espigas, asintomática, en que se plantea desde su ingreso el diagnóstico de tromboflebitis séptica pelviana y se inicia tratamiento con antibióticos parenterales de amplio espectro y heparina de bajo peso molecular en dosis terapéuticas. La respuesta es a la mejoría al tercer día de tratamiento. Se discuten los métodos diagnósticos, el diagnóstico diferencial y el tratamiento.
ABSTRACT A case of a woman on her 9th post-operative day after childbirth by cesarean section (CS) consulting with febrile spikes, otherwise asymptomatic, is presented. The diagnosis of a septic pelvic thrombophlebitis is proposed from the admission and treated with parenteral broad-spectrum antibiotics and low-molecular-weight heparin at therapeutic doses. Patient significantly improved on her third day of treatment. The diagnostic procedures, differential diagnosis and treatment are discussed.
Subject(s)
Humans , Female , Adult , Ovary/blood supply , Thrombophlebitis/etiology , Cesarean Section/adverse effects , Sepsis/etiology , Pelvis/blood supply , Thrombophlebitis/drug therapy , Thrombophlebitis/diagnostic imaging , Heparin/therapeutic use , Tomography, X-Ray Computed , Sepsis/drug therapy , Sepsis/diagnostic imaging , Diagnosis, Differential , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic useABSTRACT
Abstract Purpose The objective of this study was to investigate the accuracy of 18F-FDG-PET in the diagnosis of multibacterial abdominal sepsis by cecum ligation and puncture (CLP) in rats. Methods Adult Wistar rats ( Rattus norvegicus ), weighing 227±35g, were allocated into a sepsis group by CLP (n=10) and sham group (n=10). 18F-FDG-PET using microPET was performed on all rats after 24 hours. Results All animals survived for postoperative 24h. The abdomen/liver ratio of the standardized uptake value (SUV) percentage was significantly higher in the sepsis group than in the sham (p=0.004). The ROC curve showed an accuracy of 18F-FDG-PET to detect abdominal sepsis of 88.9% (p=0.001), sensitivity of 90% and specificity of 88.9%. When a cut-off point of 79% of the ratio between the SUV on the abdominal region and liver was established, the sensitivity was 90%, specificity of 88.9%; positive and negative predictive values of 90.0% and 88.9%, respectively. Conclusions The diagnostic accuracy of 18F-FDG-PET in rats with abdominal sepsis was significantly high. It was also demonstrated the predictive ability of the abdomen/liver SUV ratio to diagnose abdominal sepsis. These findings may have implications for the clinical setting, locating septic foci with PETscan.
Subject(s)
Sepsis/diagnostic imaging , Radiopharmaceuticals , Fluorodeoxyglucose F18 , Positron-Emission Tomography/methods , Intraabdominal Infections/diagnostic imaging , Reference Values , Time Factors , Predictive Value of Tests , Reproducibility of Results , Rats, Wistar , Sepsis/pathology , Intraabdominal Infections/pathologyABSTRACT
Abstract Purpose: To examine a correlation of micro-PET images with photographic images of the digestive organs in abdominal sepsis model. Methods: Male Wistar rats weighing 265±18g were used. Abdominal sepsis was induced by ligature and cecal puncture. Micro-PET Images from abdominal cavity septic foci were obtained using 18-Fluoro-deoxyglucose, looking for a correlation with photographic images of abdominal cavity organs. Pearson's correlation test was used. Results: The mean standard uptake values (SUV) and lesion areas were 2.58±0.63SUVbwg/ml and 546.87±300.95mm2, respectively. There was a strong positive correlation between the two variables (r=0.863, p=0.137), which resulted in a coefficient of determination r2?0.75, meaning that 75% of SUV variation is explained by the lesion areas of digestive organs. Conclusion: Micro-PET allows high throughput assessment of lesion count and volume in pre-clinical rat model of CPL abdominal sepsis.
Subject(s)
Animals , Male , Sepsis/diagnostic imaging , Radiopharmaceuticals , Fluorodeoxyglucose F18 , Positron-Emission Tomography/methods , Intraabdominal Infections/diagnostic imaging , Time Factors , Reproducibility of Results , Rats, Wistar , Sepsis/pathology , Digestive System/pathology , Digestive System/diagnostic imaging , Disease Models, Animal , Photograph , Intraabdominal Infections/pathologyABSTRACT
Soluble suppression of tumorigenicity 2 (sST2) has emerged as a biomarker of cardiac stretch or remodeling, and has demonstrated a role in acutely decompensated heart failure. However, its role in sepsis-induced cardiac dysfunction is still unknown. We explored whether sST2 serum concentration reflects either systolic or diastolic dysfunction as measured by Doppler echocardiography. In a total of 127 patients with sepsis, correlations between sST2 and blood pressure, left ventricular (LV) ejection fraction, LV diastolic filling (ratio of early transmitral flow velocity to early diastolic mitral annulus velocity), and resting pulmonary arterial pressure were evaluated. Correlations between sST2 and other sepsis biomarkers (high-sensitivity C-reactive protein [hs-CRP] and procalcitonin) were also examined. sST2 showed a moderate correlation with mean arterial pressure (r=-0.3499) but no correlation with LV ejection fraction, diastolic filling, or resting pulmonary hypertension. It showed moderate correlations with hs-CRP and procalcitonin (r=0.2608 and r=0.3829, respectively). sST2 might have a role as a biomarker of shock or inflammation, but it cannot reflect echocardiographic findings of LV ejection fraction or diastolic filling in sepsis.