ABSTRACT
Echinococcosis (hydatid disease) is a zoonosis caused by the larval stage of Echinococcus granulosus (or Taenia echinococcus). The adult form of the parasite lives in the gut of the dog, while the intermediate hosts, where the tapeworm develops to larval stage are cats, cattle, pigs and humans(considered to be accidental intermediate hosts). The parasite has a worldwide distribution, but the endemic areas are Canada and Alaska, Australia, New Zealand, South America and the Mediterranean region. Hydatid cyst can grow many years before the symptoms and clinical signs appear. The liver and the lungs are the most affected organs, but primary location of the hydatid disease in the axilla is extremely rare. In our country we did not find any records of axillary hydatid disease, while the literature contains only 12 cases of axillary location. We present the case of a woman, 60 years old, with a primary axillary location of hydatid cyst, who underwent a total cystectomy.
Subject(s)
Axilla/pathology , Axilla/surgery , Echinococcosis/diagnosis , Echinococcosis/surgery , Echinococcus granulosus/isolation & purification , Animals , Axilla/parasitology , Echinococcosis/parasitology , Female , Humans , Middle Aged , Treatment OutcomeABSTRACT
AIM: To evaluate the immunoinflammatory markers that shape the evolution of acute peritonitis and to assess their utility in specifying the development of septic shock from peritonitis. MATERIAL AND METHOD: We conducted a prospective study on a sample of 100 patients with acute peritonitis, hospitalized during 2001-2005 and immunologically monitored. We realized 2000 dosages of immunoinflammatory markers for 15 days by 1200 simple radial immunodiffusion tests (IDRS), the Mancini-Carbonara method for C reactive protein, complement component C3, immunoglobulins and 836 ELISA tests to evaluate cytokines. Results were reported to a witness group. RESULTS: C reactive protein (CRP) values were significantly elevated in patients with peritonitis (12-310 ng%) vs. witness group (1.5-8 ng%). Postoperative, elevated values were maintained at the patients who will develop serious complications and were correlated with multiple organic dysfunction in deceased patients. Determination of circulating immune complexes have shown elevated values in patients with peritonitis. Dosage of pro/antiinflammatory cytokines may be specific to the severity of inflammatory response to infection. The level of procalcitonin was increased in patients with sepsis and severe inflammatory reactions and become an important prognostic tool. CONCLUSIONS: The study of biological markers in microbial aggression highlights the role of cytokines as messengers and important mediators of immunoinflammatory response. PCT test can be introduced in the daily tracking protocol for septic patients.
Subject(s)
Bacterial Infections/immunology , C-Reactive Protein/metabolism , Calcitonin/blood , Cytokines/blood , Peritonitis/immunology , Peritonitis/microbiology , Protein Precursors/blood , Shock, Septic/immunology , Acute Disease , Bacterial Infections/diagnosis , Biomarkers/blood , Calcitonin Gene-Related Peptide , Case-Control Studies , Humans , Peritonitis/complications , Peritonitis/diagnosis , Predictive Value of Tests , Prospective Studies , Sampling Studies , Severity of Illness Index , Shock, Septic/blood , Shock, Septic/diagnosis , Shock, Septic/microbiologyABSTRACT
AIM: diagnostic improvement in complicated acute appendicitis (AA) by implementing the new sepsis concepts and modern imaging procedures; optimization of treatment with decreasing postoperation morbidity and mortality and improving the cost-efficiency indicator. 1495 cases of AA admitted between 2000 and 2004 have been assessed retrospectively and among them 306 (20.46%) had complications. On admission 80.43% patients were diagnosed with AA, 17.50% with acute abdominal syndrome and 2.07% with chronic appendicitis. On discharge there were 1158 (77.45%) cases of inflammatory AA and 306 (20.46%) cases of complicated AA (perforation, gangrene, peritonitis, plastron abscess). TREATMENT: 98.26% of patients under-went operation and 1.73% did not. SURGICAL PROCEDURES: standard appendicectomy in 1407 (95.77%) cases; laparoscopic appendicectomy in 30 (2.04%) cases; extraperitoneal approach in 15 (1.02%) cases; associated with surgical interventions on other organs in 75 (5.10%) cases. POST-OPERATORY MORBIDITY:128 (41.08%) cases out of 306; septic parietal complications in 102 (33.33%) cases; intraperitoneal complications in 26 (8.49%) cases. POST-OPERATORY MORTALITY: 6 deaths in patients aged over 68. AVERAGE LENGTH OF STAY IN HOSPITAL: 4 days for uncomplicated AA and 14.6 days for complicated ones. Perioperative septic complications are the result of evolution of late diagnosed disease, unjustified postponing of operation, surgical technique, patient health condition.
