Aseptic peritonitis in a peritoneal dialysis patient.

INTRODUCTION: Patients who have repeatedly sterile peritoneal fluid cultures despite elevated peritoneal fluid white cell count should be evaluated for disorders other than usual bacterial peritonitis. Intra-abdominal pathology was responsible for less than 6 percent of cases of peritonitis. Still, the clinical outcome is these situations are much worse than in other commoner causes. CASE REPORT: A 25-year-old male non-diabetic patient in PD started his complains with diffuse abdominal pain with spontaneous remissions and exacerbations, anorexia and vomiting with 3 days evolution. Laboratory results with persistent culture-negative peritoneal fluid results seemed compatible with the diagnosis of aseptic peritonitis. However, clinical status progression and peritoneal fluid amylase levels above 50 UI/L led to perform an abdominal ultrasound that showed a painful non-compressible tubular structure with a diameter of >6 mm at the base of the cecum. The patient was then submitted to a laparotomy with appendix removal. DISCUSSION: When assessing a patient with abdominal pain and clear or cloudy but aseptic peritoneal liquid, causes other than peritonitis should be excluded. Under antibiotic therapy, their clinical picture and evolution may be masked, delaying surgical resolution. In appendicitis, this delay may lead to perforation and consequent faecal peritonitis. All patients should be screened for peritoneal fluid amylase levels in order to differentiate bacterial peritonitis from intra-abdominal pathology. In all cases similar to the present one, an abdominal US/CAT scan should be promptly made.

Aseptic peritonitis in a peritoneal dialysis patient

Introducción: Los pacientes que presentan un cultivo bacteriano de líquido peritonealrepetidamente estéril, a pesar de un número de leucocitos elevado, deberánser excluidas otras causas y no solo la peritonitis bacteriana. La patologíaintra-abdominal es responsable por lo menos de 6% de los casos de peritonitis,ya que el cuadro clínico en estas situaciones es mucho más grave de lo que enotras etiologías más comunes. Caso clínico: Paciente de 25 años, sexo masculino, no diabético, que inicia cuadroclínico de dolor abdominal difuso con remisiones y agravamientos espontáneos,anorexia y vómitos con 3 días de evolución. Cultivos bacteriológicos persistentementenegativos sugieren el diagnóstico de peritonitis aséptica. Incluso, considerando la evoluciónclínica y los niveles de amilasa en el fluido peritoneal >50UI/L, el paciente fuesometido a ecografía abdominal, la cual mostró una estructura tubular en la base delciego, dolorosa e incomprensible, con un diámetro superior a 6 mm. Se procedió alaparotomía abdominal con extirpación del apéndice.Discusión: Considerando un paciente en diálisis peritoneal con dolor abdominal,líquido de drenaje turbio más estéril, deberán ser excluidas otras causas queno son peritonitis. Sobre un tratamiento antibiótico empírico, orientado para unaperitonitis bacteriana, la evolución clínica de patologías viscerales abdominalespodrá ser enmascarada, atrasando la resolución quirúrgica. En la apendicitis, esteatraso lleva frecuentemente a la perforación y consecuentemente a la peritonitisfecal. El hecho de controlar los niveles de amilasa en el fluido peritoneal permitediferenciar la peritonitis bacteriana de la patología visceral abdominal. Un US/TACabdominal debe ser practicado en situaciones de este tipo sin falta ni demora

Introduction: Patients who have repeatedly sterile peritoneal fluid cultures despiteelevated peritoneal fluid white cell count should be evaluated for disordersother than usual bacterial peritonitis. Intra-abdominal pathology was responsiblefor less than 6 percent of cases of peritonitis. Still, the clinical outcome is thesesituations are much worse than in other commoner causes.Case report: A 25-year-old male non-diabetic patient in PD started his complainswith diffuse abdominal pain with spontaneous remissions and exacerbations,anorexia and vomiting with 3 days evolution. Laboratory results with persistent culture-negative peritoneal fluid results seemed compatible with the diagnosis of asepticperitonitis. However, clinical status progression and peritoneal fluid amylase levelsabove 50UI/L led to perform an abdominal ultrasound that showed a painfulnon-compressible tubular structure with a diameter of > 6 mm at the base of thececum. The patient was then submitted to a laparotomy with appendix removal.Discussion: When assessing a patient with abdominal pain and clear or cloudybut aseptic peritoneal liquid, causes other than peritonitis should be excluded.Under antibiotic therapy, their clinical picture and evolution may be masked, delayingsurgical resolution. In appendicitis, this delay may lead to perforation andconsequent faecal peritonitis. All patients should be screened for peritoneal fluidamylase levels in order to differentiate bacterial peritonitis from intra-abdominalpathology. In all cases similar to the present one, an abdominal US/CAT scanshould be promptly made

Evaluation of the effect on arthropod populations by using deltamethrin to control Phloeotribus scarabaeoides Bern. (Coleoptera: Scolytidae) in olive orchards.

Field tests were made for the control of an olive insect pest, the olive bark beetle, Phloeotribus scarabaeoides (Col: Scolytidae), using the pyrethroid insecticide deltamethrin (D) and this insecticide combined with ethylene (D+E), an attractant of the olive bark beetle. The tests were run in olive orchards in the provinces of Granada and Jaén (Andalusia, southern Spain), treating several olive rows so as to create a barrier effect to control the pest attack. The main objective was to evaluate the arthropod fauna affected by these treatments. The different taxa captured have been separated in three different trophic groups: parasitoids, predators and phytophagous. A knock-down effect was found during the first dates in all the functional groups in all cases. The results showed the following trend in arthropod abundance: D+E>D>C. This trend was significant (p<0.05) for predators and phytophagous insects in both zones. The parasitoids of Prays oleae (Lep.: Plutellidae), a major olive pest, were most affected by the treatments, together with several groups of predators such as ants, cantharids, coccinellids and mirids. Data from the captures show the need to determine the optimum time for insecticide application in order to minimise its effect on beneficial insect populations.

Effect of the combined treatment of insecticides and an attractant for the control of Phloeotribus scarabaeoides, a pest of Olea europea.

Different insecticides have been tested for the control of the olive bark beetle, Phloeotribus scarabaeoides Bern. This scolytid can be managed at two points in its biological cycle: in pruned logs, where it excavates reproduction galleries, or in living trees, after emergence from the logs, where it digs feeding galleries. In mortality laboratory bioassays, the efficiency of organophosphorus insecticides has been ranked as follows: chlorpyrifos + dimethoate < formothion < methidathion. Formothion and methidathion, the two most efficient, were sprayed on olive logs together with a pyrethroid insecticide, deltamethrin, and a formulation which combined an organophosphorus (fenitrothion) and a pyrethroid (cypermethrin) insecticide. Deltamethrin inhibited the excavation of new reproduction galleries and induced a repellent effect on the olive pest. In contrast, none of the organophosphorus insecticides or the combination, fenitrothion + cypermethrin, were able to control the olive bark beetle. In olive trees, deltamethrin controlled this olive pest without showing the repellent effect observed for logs. Ethylene, a plant hormone, has been reported as an attractant for the olive bark beetle. The use of dispensers which released ethylene increased the number of P. scarabaeoides approaching the treated olive trees, thus favouring its use in a lure-and-trap control system.

Chronic haemodialysis for very old patients.

There is in the Western World a progressive ageing of the population, and consequently haemodialysis patients are also getting older. Some ethical questions have been raised as a consequence of the economic issues related to the scarcity of available resources. In this paper we review our experience in the treatment of very old chronic haemodialysis patients. Fifty patients (7.2% of our haemodialysis patients) aged over 80 years at the beginning of dialysis were included (f = 25, m = 26, age = 82.6 +/- 0.3 years). In 42% of the patients the aetiology of renal disease was unknown. In the remainder, the aetiology was: interstitial nephritis 26%, hypertensive nephrosclerosis 14%, chronic glomerulonephritis 8%, diabetes 8% and polycystic disease 2%. There was a great comorbidity: intradialytic hypotension 82%, cardiac disease 74%, gastrointestinal disease 32%, cerebrovascular disease 26%. Vascular access related problems were the main reason for hospitalization. The major cause of death was vascular (cardiac and cerebral disease). Actuarial survival was 89%, 78%, 56% and 48% at 6, 12, 24 and 36 months, respectively. We think that haemodialysis is the best available choice for treating very old chronic renal failure patients. However further studies are needed to improve the quality of life of these patients.