RESUMO
The aims of the present study are to compare the severity of acute diverticulitis in the first episode and in later bouts, and to determine whether there are risk factors for the presence of free perforation at the onset of diverticulitis. A single-center retrospective study was conducted of patients who developed a first episode of acute diverticulitis between January 2011 and August 2021 diagnosed by computed tomography and followed up for at least 1 year. Free perforation was considered to be present in patients with diverticulitis stage III and IV according to the Hinchey classification (modified by Wasvary). The analysis included 394 patients (224 men and 170 women) with a mean age of 58 years. Forty-eight patients (12.2%) presented free perforation at some point in the course of the disease, 43 during the first episode and 5 during subsequent bouts. The perforation subgroup showed higher rates of stoma creation and mortality (relative risks of 12.3 and 23.5, respectively). In the multivariate analysis, age (OR: 1.041 95% CI 1.016-1.067), lung disease (OR 2.154 95% CI 1.038-4.472) and immunosuppression (OR: 2.812 95% CI 1.315-6.015) were independent factors for free perforation at diverticulitis onset. Free perforation occurs more frequently during the first episode of acute diverticulitis. Older patients, immunosuppressed patients and those with respiratory disease have a greater risk of presenting freely perforated diverticulitis. Therefore, it is essential to maintain a high level of clinical suspicion in these patients to activate early focus control and thus avoid fatal outcomes.
Assuntos
Doença Diverticular do Colo , Diverticulite , Perfuração Intestinal , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico por imagem , Doença Diverticular do Colo/cirurgia , Estudos Retrospectivos , Diverticulite/complicações , Fatores de Risco , Tomografia Computadorizada por Raios X , Perfuração Intestinal/etiologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Volvo Intestinal/cirurgia , Laparotomia , Varizes/etiologia , Anormalidade Torcional/cirurgia , Diagnóstico DiferencialRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Hérnia Abdominal/cirurgia , Obesidade Mórbida/cirurgia , Cirurgia Bariátrica , Eventração Diafragmática/cirurgia , Derivação GástricaRESUMO
OBJECTIVE: To study the changes occurring in brain lipid composition after the administration of total parenteral nutrition (TPN) by comparing two lipid emulsions, one with long-chain triacylglycerols (LCT) and the other with long-chain and medium-chain triacylglycerols (MCT/LCT 50%/50%). METHODS: We used 21 young New Zealand rabbits divided into three groups of seven animals each. Two groups were subjected to TPN for 7 d, with each group receiving using one of two different lipid emulsions: Intralipid 20% (group LCT) and Lipofundin MCT/LCT 20% (group MCT/LCT). The third control group received an oral diet and underwent the same surgical procedure with the administration of intravenous saline solution. The energy administered in the TPN formulas was non-protein 100 kcal â kg(-1) â d(-1), with 40% corresponding to fats. RESULTS: There were modest increases in plasma cholesterol and triacylglycerols. In the brain tissue, there was a decrease of phosphatidylcholine in animals with TPN, which was greater in group LCT. There were no significant differences in the overall percentage distribution of brain fatty acids among the groups. CONCLUSION: The lipid emulsions administered in TPN, especially those prepared exclusively with LCT, cause changes in the brain lipid polar fractions of young rabbits.
