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1.
Eur Surg Res ; 52(1-2): 63-72, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24777108

RESUMO

BACKGROUND: Protective loop ileostomies in colorectal surgery are constructed to reduce morbidity and reinterventions related to the primary operation. However, ileostomies are associated with stoma-related morbidity and postoperative complications following reversal surgery. Dutch national data show increased use of loop ileostomies in colorectal surgery for cancer justifying an adequate assessment of its morbidity. This study was undertaken to investigate morbidity associated with protective loop ileostomies in colorectal surgery. METHODS: Retrospectively, 118 consecutive patients undergoing left-sided colonic or rectal resection with protective loop ileostomy were included. Primary outcome was 30-day mortality. Secondary endpoints included total complication rate (including stoma-related morbidity), total reintervention risk, anastomotic leakage risk and total length of stay. RESULTS: No mortality was observed. Overall major complication, reintervention and anastomotic leakage risk for colorectal surgery were 20, 20 and 3.9%, respectively. Combined length of stay for stoma-related morbidity and reversal surgery was 12.7 days. The risk for stoma-related morbidity was 35%, and the risk for nonelective reversal was 12%. Closure rate (mean follow-up of 15 months) was 87% with a mean interval of 125 days. Reversal surgery was not correlated with mortality but with major complications (11%) and reintervention risk, anastomotic leakage risk (3.8%) and a mean length of stay of 9 days. CONCLUSION: Construction of loop ileostomies in left-sided colonic or rectal resection is associated with a low risk for anastomotic leakage at the expense of substantial stoma-related morbidity and morbidity related to reversal surgery. More accurate identification of colorectal cancer patients benefitting from protective loop ileostomy seems to be warranted.


Assuntos
Neoplasias do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Ileostomia/métodos , Neoplasias Retais/cirurgia , Idoso , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Feminino , Humanos , Ileostomia/efeitos adversos , Ileostomia/mortalidade , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Reoperação/efeitos adversos , Reoperação/métodos , Estudos Retrospectivos
2.
J Surg Res ; 52(3): 265-70, 1992 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-1538604

RESUMO

Multiple organ failure (MOF) can be induced by sterile intraperitoneal injection of zymosan in the rat. This results in a typical triphasic illness with maximal clinical signs at Days 2 and 12. In this model, superoxide production and lipid peroxidation closely correlate with the triphasic clinical illness. In the present experiment we studied the effect of albumin conjugated superoxide dismutase (SOD) and catalase (CAT) on lipid peroxidation and organ damage in the acute phase (Days 1 and 2). Lipid peroxidation in plasma was significantly decreased by SOD and CAT but clinical condition, mortality, and organ damage did not improve. We conclude that oxygen radical damage is not a key factor in the pathogenesis of the acute phase of multiple organ failure.


Assuntos
Catalase/farmacologia , Sequestradores de Radicais Livres , Peroxidação de Lipídeos/efeitos dos fármacos , Insuficiência de Múltiplos Órgãos/metabolismo , Superóxido Dismutase/farmacologia , Animais , Modelos Animais de Doenças , Masculino , Insuficiência de Múltiplos Órgãos/sangue , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Ratos , Ratos Endogâmicos , Zimosan
3.
Arch Surg ; 126(5): 561-5, 1991 May.
Artigo em Inglês | MEDLINE | ID: mdl-2021335

RESUMO

Gut bacteria have been incriminated as causing or contributing to generalized sepsis with multiple organ failure in severely ill patients, and selective decontamination of the gastrointestinal tract of Enterobacteriaceae has been claimed to decrease septic complications in these patients. We studied the effects of selective decontamination of the gastrointestinal tract on survival and organ function in an experimental model of sepsis with multiple organ failure. Wistar rats were inoculated intraperitoneally with zymosan and randomized into control or treatment groups (trimethoprim or streptomycin sulfate). Selective decontamination effectively prevented bacterial translocation of Enterobacteriaceae. However, only early mortality was decreased, and only so in the streptomycin-treated rats. Selective decontamination did not result in a significantly better condition of the surviving animals on day 12.


Assuntos
Sistema Digestório/microbiologia , Infecções por Enterobacteriaceae , Insuficiência de Múltiplos Órgãos/prevenção & controle , Peritonite/complicações , Trimetoprima/uso terapêutico , Animais , Enterobacteriaceae/isolamento & purificação , Enterobacteriaceae/fisiologia , Infecções por Enterobacteriaceae/prevenção & controle , Fezes/microbiologia , Linfonodos/microbiologia , Masculino , Mesentério/microbiologia , Peritonite/induzido quimicamente , Peritonite/microbiologia , Ratos , Ratos Endogâmicos , Estreptomicina/uso terapêutico , Taxa de Sobrevida , Zimosan/efeitos adversos
5.
J Surg Res ; 47(6): 471-5, 1989 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-2555632

RESUMO

Multiple organ failure (MOF) was induced by sterile intraperitoneal inoculation of zymosan in the rat. This results in a typical triphasic illness with maximal clinical signs at Days 2 and 14. In this study, granulocyte superoxide production (unstimulated and phorbol myristic acid stimulated) was studied as well as lipid peroxidation (TBAR) in plasma, liver, and lung tissue. Mainly TBAR levels in liver and lung tissue closely correlated with the triphasic clinical illness, while bacteriological data did not. It is concluded that the severe inflammatory response in this experimental model probably is the result of excessive toxic oxygen radical production. The first phase of illness may mainly be due to oxygen radical formation by activated PMN, the third phase of illness to the production of lysosomal enzymes (proteinases) from PMN, and activated macrophages as indicated by elevated N-acetylglucosaminidase levels.


Assuntos
Peróxidos Lipídicos/metabolismo , Insuficiência de Múltiplos Órgãos/fisiopatologia , Neutrófilos/fisiologia , Alanina Transaminase/sangue , Animais , Fígado/metabolismo , Fígado/patologia , Pulmão/metabolismo , Pulmão/patologia , Masculino , Tamanho do Órgão , Ratos , Ratos Endogâmicos , Superóxidos/metabolismo , Zimosan
8.
Arch Surg ; 121(8): 897-901, 1986 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-3729706

RESUMO

Multiple-organ failure is generally attributed to bacterial infection, although a correlation with positive blood cultures is not consistently found. Consequently, we studied the effects of a local nonbacterial inflammatory stimulus on distant organ functions and metabolism. Wistar rats were inoculated intraperitoneally with zymosan. Heart and ventilatory rates, oxygen consumption, and body temperature were measured. Survivors were killed at day 12 for blood analysis, weighing of organs, and microscopy. Intraperitoneal zymosan resulted in an early hyperdynamic "septic" response with a 35% mortality. After a few days, oxygen consumption decreased, serum lactate levels increased, and the function of multiple organs deteriorated, while blood cultures remained sterile. The experiment was repeated in germ-free rats with similar results but a lower mortality. We concluded that a severe inflammatory response in itself is capable of inducing multiple-organ failure with "sepsis."


Assuntos
Insuficiência de Múltiplos Órgãos/etiologia , Animais , Análise Química do Sangue , Modelos Animais de Doenças , Vida Livre de Germes , Contagem de Leucócitos , Masculino , Insuficiência de Múltiplos Órgãos/microbiologia , Insuficiência de Múltiplos Órgãos/patologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Tamanho do Órgão , Parafina , Ratos , Ratos Endogâmicos , Zimosan
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