Chu Xiangyang. / Thesis submitted in: December 1999. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 130-148). / Abstracts in English and Chinese. / ABSTRACT --- p.i / ACKNOWLEDGMENTS --- p.v / ABBREVIATION --- p.vi / TABLE OF CONTENT --- p.viii / Chapter 1. --- Introduction / Chapter 1.1 --- General introduction --- p.1 / Chapter 1.2 --- History of laparoscopic surgery --- p.2 / Chapter 1.2.1 --- Diagnostic laparoscopy --- p.3 / Chapter 1.2.2 --- Operative laparoscopy --- p.5 / Chapter 1.2.3 --- Pediatric laparoscopy --- p.6 / Chapter 1.3 --- Pathophysiology of pneumoperitoneum --- p.8 / Chapter 1.3.1 --- Choice of gas for pneumoperitoneum --- p.9 / Chapter 1.3.2 --- C02 absorption and acid-base balance --- p.10 / Chapter 1.3.3 --- Effects of pneumoperitoneum on respiratory system --- p.16 / Chapter 1.3.4 --- Effects of pneumoperitoneum on circulatory system --- p.17 / Chapter 1.3.4.1 --- Due to hypercarbia --- p.18 / Chapter 1.3.4.2 --- Due to increased intraabdominal pressure (IAP) --- p.21 / Chapter 1.4 --- Pathophysiology of peritonitis --- p.26 / Chapter 1.4.1 --- Animal model of peritonitis --- p.26 / Chapter 1.4.2 --- Effects of peritonitis on cardiovascular system --- p.30 / Chapter 1.5 --- The purpose of this study --- p.33 / Chapter 2. --- Materials and Methods / Chapter 2.1 --- Animals and grouping --- p.34 / Chapter 2.2 --- Anaesthesia and procedures --- p.35 / Chapter 2.3 --- Pulmonary monitoring --- p.41 / Chapter 2.4 --- Hemodynamic monitoring --- p.42 / Chapter 2.4.1 --- Arterial catheter --- p.42 / Chapter 2.4.2 --- Pulmonary arterial catheter --- p.43 / Chapter 2.4.3 --- Cardiac output measurement --- p.44 / Chapter 2.5 --- Experimental design --- p.45 / Chapter 2.5.1 --- Operative intervention --- p.47 / Chapter 2.5.2 --- C02 pneumoperitoneum --- p.47 / Chapter 2.5.3 --- Data collection --- p.48 / Chapter 2.6 --- Blood gas analysis --- p.49 / Chapter 2.7 --- Oxygenation analysis --- p.50 / Chapter 2.8 --- Histological study --- p.51 / Chapter 2.9 --- Equations used for calculations --- p.54 / Chapter 2.10 --- Statistical analysis --- p.55 / Chapter 3. --- Results / Chapter 3.1 --- Baseline physiological measurements --- p.56 / Chapter 3.2 --- Acid-base balance measurements --- p.58 / Chapter 3.2.1 --- End tidal C02 tension (PetC02) --- p.58 / Chapter 3.2.2 --- Arterial partial pressure of C02 (PaC02) --- p.60 / Chapter 3.2.3 --- Arterial pH (pHa) --- p.62 / Chapter 3.2.4 --- Arterial bicarbonate (HC03a-) --- p.67 / Chapter 3.2.5 --- Arterial base excess (BEa) --- p.72 / Chapter 3.3 --- Hemodynamic measurements --- p.77 / Chapter 3.3.1 --- Mean arterial pressure (MAP) --- p.77 / Chapter 3.3.2 --- Central venous pressure (CVP) --- p.82 / Chapter 3.3.3 --- Mean pulmonary artery pressure (MPAP) --- p.84 / Chapter 3.3.4 --- Pulmonary artery wedge pressure (PAWP) --- p.86 / Chapter 3.3.5 --- Heart rate (HR) --- p.88 / Chapter 3.3.6 --- Cardiac index (CI) --- p.93 / Chapter 3.3.7 --- Stroke volume index (SVI) --- p.96 / Chapter 3.3.8 --- Systemic vascular resistance index (SVRI) --- p.98 / Chapter 3.3.9 --- Pulmonary vascular resistance index (PVRI) --- p.100 / Chapter 3.4 --- Respiratory and oxygenation measurements --- p.101 / Chapter 3.4.1 --- Peak inspiratory pressure (PIP) --- p.101 / Chapter 3.4.2 --- Arterial oxygen saturation (Sa02) --- p.105 / Chapter 3.4.3 --- Arterial oxygen content (Ca02) --- p.107 / Chapter 3.4.4 --- Oxygen delivery index (D02I) --- p.107 / Chapter 3.4.5 --- Oxygen consumption index (V02I) --- p.107 / Chapter 3.5 --- Pathology --- p.108 / Chapter 4. --- Discussion / Chapter 4.1 --- Effects on C02 homeostasis --- p.112 / Chapter 4.2 --- Effects on hemodynamics --- p.117 / Chapter 4.2 --- Effects on oxygenation --- p.123 / Chapter 4.3 --- Evaluation of the animal model --- p.124 / Chapter 5. --- Conclusion / Chapter 5.1 --- Conclusion --- p.127 / Chapter 5.2 --- Future prospective --- p.129 / BIBLIOGRAPHY --- p.130

Despite the decreasing incidence of peritoneal dialysis (PD) peritonitis over time, its occurrence is still associated with adverse outcomes. This thesis focuses on determining factors associated with PD peritonitis in order to facilitate identification of patients at risk. Using data collected in a multicentre Canadian database between 1996 and 2005, the study population comprised 4,247 incident PD patients, of whom 1,605 had at least one peritonitis episode. Variables independently associated with peritonitis included age [rate ratio (RR) 1.04 per decade increase, 95% CI 1.01-1.08], Black race (RR 1.37, 95% CI 1.00-1.88) and having transferred from hemodialysis (RR 1.24, 95% CI 1.11-1.38). There was an interaction between gender and diabetes (p=0.011), with an increased peritonitis risk only among female diabetics (RR 1.27, 95% CI 1.10-1.47). Choice of continuous ambulatory PD vs. automated PD did not influence peritonitis risk. These results contribute to our understanding of peritonitis risk among PD patients.

Despite the decreasing incidence of peritoneal dialysis (PD) peritonitis over time, its occurrence is still associated with adverse outcomes. This thesis focuses on determining factors associated with PD peritonitis in order to facilitate identification of patients at risk. Using data collected in a multicentre Canadian database between 1996 and 2005, the study population comprised 4,247 incident PD patients, of whom 1,605 had at least one peritonitis episode. Variables independently associated with peritonitis included age [rate ratio (RR) 1.04 per decade increase, 95% CI 1.01-1.08], Black race (RR 1.37, 95% CI 1.00-1.88) and having transferred from hemodialysis (RR 1.24, 95% CI 1.11-1.38). There was an interaction between gender and diabetes (p=0.011), with an increased peritonitis risk only among female diabetics (RR 1.27, 95% CI 1.10-1.47). Choice of continuous ambulatory PD vs. automated PD did not influence peritonitis risk. These results contribute to our understanding of peritonitis risk among PD patients.

In clinical findings, complications are the major cause of death in cirrhotic patients. Among all the complications, ascites is most frequent type. All cirrhotic patients with ascites could develop spontaneous bacterial peritonitis (SBP). The hospitalized prevalence of SBP was high (30%) in cirrhotic ascites patients. However, the outcome of cirrhotic SBP patients has been improved because of using the antibiotics cephalosporins. Furthermore, treatment with intravenous albumin in addition to cephalosporins reduced the incidence of renal impairment and the mortality in SBP patients in a multicentre study. However, other studies showed that administration of albumin might not work as effectively as other plasma expanders do. Moreover, administration of large volume albumin would make the medication very expensive and might have potential risk of infectious disease, since the therapeutic albumin is extracted from human plasma. Therefore, to treat patients with large volume albumin become disputable. In this study, we evaluated the effects of small volume intravenous albumin with cephalosporins treatments through monitoring patients¡¦ renal and hepatic functions and related inflammatory markers. Results showed that plasma TNF-£\, £LL-6 and ascites endotoxin, TNF-£\ and IL-6 levels were significantly reduced in patients treated with cephalosporins plus small volume albumin, but not in those treated with cephalosporins alone. Also, the combination therapy of cephalosporins and small volume albumin avoid the dramatically elevation of plasma and ascites nitric oxide, as well as the further degree of renal function impairment. The positive results of this study laid a solid foundation for a large scale investigation.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2009. / Härtill 3 uppsatser.

Zugl.: Giessen, Univ., Diss., 2005.

Universiẗat, Diss., 2005--Giessen.

Objetivo: Determinar las características clínico-epidemiológicas de la Peritonitis bacteriana espontánea (PBE) en el Hospital Nacional Arzobispo Loayza (HNAL) el 2014. Métodos: Estudio descriptivo, retrospectivo en 43 casos. Se revisaron las historias clínicas y se elaboró una hoja de datos en SPSS.21 para el análisis descriptivo con nivel de significancia p<0.05. Resultados: La edad mediana fue 59 ±14 años, el grupo etáreo más frecuente fue de 50-59 años (34.9%), sexo masculino (65.1%, p<0.05), instrucción primaria y secundaria (32.6% respectivamente) y nivel socioeconómico medio (60.5%, p<0.05). La etiología más frecuente de cirrosis hepática fue el alcohol (46.5%), se obtuvo pacientes con antecedentes de PBE previa (32.6%) y hospitalizaciones previas (76.5%). El estadío clínico por Score Child Pugh fue estadio B en el 48.8% y C en el 37.2%. El 90.7% cursaba con hipoalbuminemia, 72.1% leucocitosis, 72.1% anemia y 69.8% hiponatremia. Una mortalidad de 23.3% asociada a encefalopatía hepática (p<0.014), ascitis refractaria (p<0.035), insuficiencia renal aguda (p<0.004) y antecedentes de diabetes mellitus 2 (p<0.022). Los gérmenes con significancia para mortalidad fueron S. pneumoniae, S. aureus y Klepsiella pneumoniae (p<0.05).

Orientador: Paqual Barretti / Coorientador: Maria de Lourdes Ribeiro se Souza da Cunha / Banca: Roberto Pecoits-Filho / Banca: Nilton Lincopan / Banca: Jacqueline Costa Teixeira Caramori / Banca: Augusto Cezar Montelli / Resumo: As peritonites bacterianas se mantêm como a principal complicação do método de diálise peritoneal, sendo as espécies de Staphylococcus os agentes mais frequentes destas infecções. As infecções peritoneais devidas à espécie S. aureus apresentam pior evolução clínica, contrastando com a maior resistência antimicrobiana apresentada pelos estafilococos coagulase negativa. As características do agente, associadas às condições do hospedeiro, devem, portanto, estar relacionadas à evolução de um episódio. Assim, o objetivo deste trabalho foi avaliar a influência do perfil clonal, dos fatores de virulência e da resistência antimicrobiana de Staphylococcus, juntamente com fatores do hospedeiro, no quadro clínico e evolução de peritonites em pacientes em diálise peritoneal, ocorridas na Unidade de Diálise do Hospital das Clínicas da Faculdade de Medicina de Botucatu nos últimos 17 anos. Entre 1994 e 2011, 192 episódios, que ocorreram em 118 pacientes, foram analisados. Os dados clínicos foram obtidos dos prontuários e fichas médicas específicas. Nas amostras de Staphylococcus foram realizados testes específicos fenotípicos e/ou genotípicos, para detecção de fatores de patogenicidade e de susceptibilidade à oxacilina e vancomicina; o perfil clonal foi determinado pela técnica de pulsed-field gel electrophoresis. Modelo de regressão logística foi utilizado para avaliar a influência dos fatores clínicos e microbiológicos no desfecho das peritonites. Além de S. aureus, outras espécies de Staphylococcus foram identificadas (S. epidermidis, S. haemolyticus, S. warneri, S. hominis, S. capitis, S. cohnii, S. saprophyticus, S. lugdunensis, S. simulans e S. xylosus). As peritonites por S. aureus apresentaram maiores taxas de ocorrência hipotensão... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Bacterial peritonitis remains as the main cause of technique failure of peritoneal dialysis (PD) and Gram-positive cocci, namely Staphylococcus spp., are the main etiological agents of such infections. Peritonitis caused by Staphylococcus aureus presents poorer prognostic than infections due to coagulase negative staphylococci (CoNS), even the antimicrobial resistance is more pronounced in the last agents. Host and bacterial factors may influence, therefore, peritonitis outcome. The objective of this study was to evaluate the influence of host and bacterial factors (clonal profile, virulence and antimicrobial resistance determinants in strains of staphylococci) on peritonitis clinical findings and outcome in patients from dialysis unit of Botucatu Medical School, Brazil, from 1994 until 2011. A hundred ninety-two episodes due to Staphylococcus were assessed. Genotypic or phenotypic tests were carried out to evaluate virulence factors and antimicrobial susceptibility for oxacillin and vancomycin; clonal profile was determined by pulsed-field gel electrophoresis. Logistic regression was used for the analysis of demographic, clinical, and microbiological factors influencing peritonitis outcome. Several species besides S. aureus were identified: S. epidermidis, S. haemolyticus, S. warneri, S. hominis, S. capitis, S. cohnii, S. saprophyticus, S. lugdunensis, S. simulans, and S. xylosus. Patients with S. aureus related peritonitis presented higher hypotension rate compared to the episodes due to CoNS (p<0.05). Oxacillin resistance was more frequent among CoNS (p<0.05) strains and vancomycin resistance was not detected, neither on S. aureus nor CoNS. S. aureus strains also presented higher enzymes and virulence genes than the others species (p<0.05), except... (Complete abstract click electronic access below) / Doutor

Zugl.: Giessen, Universiẗat, Diss., 2009.