Search

Background: For a significant majority of cancers age is a major risk factor. The aim of our study was to investigate survival of older patients admitted to an intensive care unit (ICU) with underlying haematological malignancy and compare them to younger patients. Matherials and methods: A prospective observational study was carried out in Vilnius University Hospital Santaros Klinikos from2017 to 2019. Patients were categorized into two groups: younger (< 65 years) and older (≥ 65 years), depending on age on admission to ICU. Results: 114 patients were included in the study. There were 61 (53.51%) patients in the younger patient group and 53 (46.49%) patients in the older patient group. The older patient group had more chronic heart failure (34.0% vs. 11.5%), vascular disease (67.9% vs. 21.3%), poor physical performance status (39.6% vs. 13.1%) and higher APACHE II scores (23.34 vs. 20.31). Younger patients more often received intensive chemotherapy (57.4% vs. 39.6%). The proportion of patients for whom SOFA score increased over the first 48 hours in ICU also qSOFA and SOFA scores did not differ between the groups. Both groups received the same amount of organ support therapies such as vasopressors, invasive mechanical ventilation, and renal replacement therapy. We found that age did not influence survival of the patients as there was no difference in ICU, 30 days and overall mortality between the groups. Conclusion: Age group does not influence survival of critically ill oncohaematological patients, and it shouldn’t be the criteria for eligibility to the ICU. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is a serious condition that occurs in 1 of 1000-3000 pregnancies (Sultan et al. [9]). Our aim is to report a successful use of triple cannulation ECMO with anticoagulation therapy for patient, for whom pulmonary embolism occurred within 24 hours after an elective caesarean section. Our case indicates that ECMO with anticoagulative therapy could be an alternative to standard pulmonary embolism treatment, especially for patients who has high risk for bleeding complications. [Extracted from the article]

Enterobius vermicularis is one of the most common intestinal parasites found in humans. They commonly infest the terminal ileum and large intestine, and are usually considered an innocuous parasite that can be easily eradicated with proper treatment. However, extraintestinal migration of worms, although very rare, may lead to severe health disorders or even death. This article, reports the first fatal case of ectopic enterobiasis known to the authors, which developed in an adult patient with E. vermicularis infection, causing perforation of the large intestine and generalized bacterial peritonitis. Despite emergency laparotomy, the patient died from septic shock on the day after surgery. During pathological examination, worms were found not only in the large intestine, but also in the renal parenchyma; worm eggs were found deposited in the lungs as well. [ABSTRACT FROM AUTHOR]

Introduction: One of the most important requirements in treatment of acute necrotizing pancreatitis is minimized invasion., Aim: We are presenting experience in treatment of acute necrotizing pancreatitis by an original minimally invasive retroperitoneal necrosectomy technique, comparing our results to other studies, evaluating feasibility and safety, discussing advantages and disadvantages of this method., Material and Methods: We performed a retrospective analysis of 13 patients who had acute necrotizing pancreatitis with large fluid collections in retroperitoneal space and underwent retroperitoneal necrosectomy., Results: There were eight males and three females aged between 24 and 60 years, average age was 42.8 ±9.2 years. The most common cause of pancreatitis was alcohol, 10 patients (76.9%). Average time between diagnosis and performance of operation was 25.7 ±11.3 days. One patient underwent eight repeated interventions: two retroperitoneal necrosectomies; five laparotomies; ultrasound-guided drainage. One patient underwent four reinterventions: lumbotomy; revision; two lavages. Three patients had two reinterventions: one had laparotomy and tamponation; one had two repeated retroperitoneal necrosectomies; third had one repeated retroperitoneal necrosectomy and one had ultrasound-guided drainage. Three patients needed one additional retroperitoneal necrosectomy. Five patients did not required additional interventions. 61.5% of our patients did not require more than one reintervention. Postoperative stay varied from 9 to 94 days, average 50.8 ±32.6 days., Conclusions: Minimally invasive techniques should be considered as first-choice surgical option in treating patients with acute necrotizing pancreatitis. Pancreatic necrosis occupying less than 30% and with massive fluid collections in the left retroperitoneal space can be safely managed by minimally invasive retroperitoneal necrosectomy.

Context: Hypertriglyceridemia is a well known phenomenon of pregnancy occurring due to physiologic changes in sex hormone levels. Occasionally, it could lead to development of acute pancreatitis. Gestational hypertriglyceridemia-induced acute pancreatitis occurs in pregnant women usually with preexisting abnormalities of the lipid metabolism and is associated with additional diagnostic and therapeutic challenges related to hypertriglyceridemia and pregnancy., Case Report: We present a case of the hypertriglyceridemia-induced acute pancreatitis in pregnant woman with no previous history of lipid abnormality and pregnancy as the only known triggering factor for hypertriglyceridemia., Conclusions: Hypertriglyceridemia-induced acute pancreatitis is a rare complication of pregnancy; however, it should be suspected in all pregnant patients admitted for nonobsteric abdominal pain.

Background: Liver transplantation has become the treatment of choice for chronic and acute end-stage liver failure as well as for selected cases of malignancies and metabolic disorders. We report our first experience of the orthotopic liver transplantation., Material/methods: Between 2005 and 2008 16 cadaveric orthotopic liver transplantations in 16 adults (12 males, 4 females, mean age 44 years) were performed. Main indications for orthotopic liver transplantation were cholestatic liver disease (31%), viral-induced cirrhosis (25%), alcoholic liver disease (19%), hepatocellular carcinoma associated with hepatitis virus infection (13%), autoimmune cirrhosis (6%), cryptogenic acute liver failure (6%). Mean follow-up was 15 month (range: 4 days - 43 month)., Results: Intraabdominal haemorrhage was observed in 6 patients (37.5%). Vascular complications were observed in 3 patients (18.75%). Biliary complication were observed in 3 patients (18.75%). Overall 1 year patient survival was 87,5%. Four (25%) patients died during follow-up. All patients died because of sepsis and multiorgan system failure., Conclusions: Our first results showed that secret of successful liver transplantation is perfect interdisciplinary team approach, including selection of the recipient and timing of transplantation, the operative procedure itself, prevention and treatment of complications, the perioperative anaesthesiological and intensive-care management, and careful follow up after transplantation.

Objective: The objectives of this study were to determine the incidence of intra-abdominal hypertension in patients after major abdominal surgery and to evaluate the correlation of intra-abdominal pressure with fluid balance and systemic inflammatory response syndrome., Material and Methods: This is a prospective observational study. Patients, admitted to intensive care unit after major abdominal surgery, were included into the study. Intra-abdominal pressure was measured via a urinary bladder catheter twice daily. Twenty-four-hour fluid balance and systemic inflammatory response syndrome criteria met by the patients were collected daily., Results: Seventy-seven patients were included into the study. Intra-abdominal hypertension was diagnosed in about 40% of the patients in the early postoperative period. The study showed a significant positive correlation between 24-hour fluid balance and daily changes in intra-abdominal pressure. A significant association was also seen between the number of positive systemic inflammatory response syndrome criteria and intra-abdominal pressure, and intra-abdominal pressure was significantly higher in patients with systemic inflammatory response syndrome. Besides, patients with intra-abdominal hypertension on the first postoperative day had longer length of stay in the intensive care unit., Conclusions: Intra-abdominal hypertension occurs commonly in patients after major abdominal surgery, and patients with positive 24-hour fluid balance and/or systemic inflammatory response syndrome are at risk of having higher intra-abdominal hypertension.

In clinical practice, intra-abdominal pressure is usually measured indirectly via the urinary bladder using Foley catheter. This technique is minimally invasive, safe, simple and accurate. Intra-abdominal hypertension is defined as an intra-abdominal pressure above 12 mmHg. Rapid progression of intra-abdominal hypertension will lead to abdominal compartment syndrome, which is defined as an intra-abdominal pressure greater than 20 mmHg with at least one organ failure. The incidence of intra-abdominal hypertension is variable and depends on the values used to define it and on the study population. However, the mortality rate of intra-abdominal hypertension and abdominal compartment syndrome is high. Increase in intra-abdominal pressure causes significant impairment of almost all organ systems. Even slight increase in intra-abdominal pressure has negative influence on the respiratory, cardiovascular, cerebral, gastrointestinal, hepatic, and renal functions. Intra-abdominal hypertension causes visceral organ hypoperfusion, intestinal ischemia and may also lead to bacterial translocation, release of cytokines and production of free oxygen radicals. All these factors may contribute to the development of multiple organ failure in the critically ill patients. Intravascular fluid replacement and abdominal decompression are the standards of treatment for abdominal compartment syndrome.