- 作者列表："Kaestner S","Fraij A","Fass J","Deinsberger W
BACKGROUND:Patients with ventriculoperitoneal shunt (VPS) often present to emergency departments with acute abdomen. It is challenging to distinguish between the abdominal problems caused by a VPS and acute surgical abdomen having another cause because VPS infections occasionally cause peritonitis. The frequencies and clinical features of acute abdomen caused by VPS infection are unknown. METHODS:This was a retrospective analysis of all patients with a VPS who presented with acute abdomen to emergency department for a 10-year period. Clinical data, diagnostic workflow, and subsequent treatment were assessed using patient medical records. RESULTS:In total, 1679 patients presented with acute abdomen; of these, 24 (1.4%) had a VPS at the time of presentation. Of the 24 patients, 12 had an acute surgical abdomen related to gastrointestinal sources with subsequent therapy. In the remaining 12 patients (50%), peritonitis was caused by a VPS infection; seven of these had erroneous abdominal surgeries because of misdiagnosis. Patients with shunt infections as a source of peritonitis underwent shunt surgeries within the past 10 wk (mean, 58 d). Patients with an acute surgical abdomen with gastrointestinal sources had their most recent shunt surgery at a mean of 4.7 y before presentation to the emergency department. CONCLUSIONS:Acute abdomen and peritonitis are challenging in the presence of a VPS. Shunt infections frequently mimic acute surgical abdomen and may lead to misdiagnosis, unnecessary diagnostic procedures, unnecessary surgery, and delay in receiving the appropriate treatment. Shunt surgery in recent patient history is suggestive of VPS infection, and a shunt tap should be performed to confirm the diagnosis.
背景: 脑室腹腔分流术 (VPS) 患者常出现急腹症。区分由VPS引起的腹部问题和具有另一原因的急性外科腹部是具有挑战性的，因为VPS感染偶尔引起腹膜炎。由VPS感染引起的急腹症的频率和临床特征是未知的。 方法: 回顾性分析10年间因急腹症到急诊科就诊的所有VPS患者。使用患者医疗记录评估临床数据，诊断工作流程和后续治疗。 结果: 共有1679例患者出现急腹症; 其中24例 (1.4%) 在出现急腹症时有VPS。在24名患者中，12名患者患有与胃肠来源相关的急腹症，随后接受治疗。在其余12例患者 (50%) 中，腹膜炎是由VPS感染引起的; 其中7例由于误诊而进行了错误的腹部手术。分流感染作为腹膜炎来源的患者在过去10周 (平均58 d) 内接受分流手术。有胃肠来源的急腹症患者在急诊就诊前进行了最近一次平均4.7岁的分流手术。 结论: 急腹症和腹膜炎在VPS的存在下具有挑战性。分流感染通常模仿急腹症，并可能导致误诊、不必要的诊断程序、不必要的手术和延迟接受适当的治疗。在最近的患者病史中，分流手术提示VPS感染，应进行分流tap以确定诊断。
METHODS:BACKGROUND:The most common sites of malignant mesothelioma are the pleura and peritoneum, but little is known about the incidence, prognosis, or treatment of patients with disease in both cavities. Previous series suggest that multimodality treatment improves overall survival for pleural or peritoneal disease, but studies typically exclude patients with disease in both cavities. Despite limitations, this investigation is the only study to broadly examine outcomes for patients with malignant mesothelioma in both the pleural and peritoneal cavities. METHODS:This study retrospectively examined 50 patients with both pleural and peritoneal mesothelioma treated with the intent to prolong survival. The primary end point was overall survival from the initial operative intervention. RESULTS:The median overall survival was 33.9 months from the initial intervention. Female gender and intraperitoneal dwell chemotherapy were independent predictors of overall survival. Within 1 year after the initial diagnosis, second-cavity disease was diagnosed in 52% of the patients. The median time to the second-cavity diagnosis for those with a diagnosis 1 year after the initial diagnosis was 30 months. CONCLUSIONS:Well-selected patients with both pleural and peritoneal mesothelioma have a survival benefit over palliative treatment that is comparable with that seen in single-cavity disease. The presence of disease in both cavities is not a contraindication to multimodality treatment aimed at prolonging survival, whether the disease is diagnosed synchronously or metachronously. Patients with an initial diagnosis of single cavity disease are at the highest risk for identification of second-cavity disease within the first year after diagnosis.
METHODS:INTRODUCTION:Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is an accepted treatment for peritoneal mesothelioma. In this study, we evaluated QOL after HIPEC for peritoneal mesothelioma. METHODS:This was a prospective study performed after HIPEC for peritoneal mesothelioma between 2002 and 2015. Patients completed QOL surveys, including the Short Form-36 (SF-36), Functional Assessment of Cancer Therapy + Colon (FACT-C), Brief Pain Inventory (BPI), and Center for Epidemiologic Studies Depression Scale (CES-D) preoperatively and at 3, 6, 12, and 24 months postoperatively. RESULTS:Overall, 46 patients underwent HIPEC for peritoneal mesothelioma and completed QOL surveys. Mean age was 52.8 ± 13.8 years and 52% were male. Good preoperative functional status was 70%. Median survival was 3.4 years, and 1, 3, and 5-year survivals were 77.4, 55.2, and 36.5%, respectively. CES-D score decreased at 3 months postoperatively, but increased at 24 months (p = 0.014); SF-36 physical functioning scale decreased at 3 months but returned to baseline at 12 months (p = 0.0045); and the general health scale decreased at 3 months, then improved by 6 months (p = 0.0034). Emotional well-being (p = 0.0051), role limitations due to emotional problems (p = 0.0006), social functioning (p = 0.0022), BPI (p = 0.025), least pain (p = 0.045), and worst pain (p < 0.0001) improved. FACT-C physical well-being decreased at 3 months but returned to baseline at 6 months (p = 0.020), and total FACT-C score improved at 6 months (p = 0.052). CONCLUSION:QOL returned to baseline or improved from baseline between 3 months and 1 year following surgery. Despite the risks associated with this operation, patients may tolerate HIPEC well and have good overall QOL postoperatively.
METHODS:BACKGROUND:Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be associated with decreases in quality of life (QOL). Bowel-related QOL (BR-QOL) after CRS-HIPEC has not been previously studied. The objectives of the current study were to examine the effect of different types of bowel resection during CRS-HIPEC on overall QOL and BR-QOL. METHODS:A prospective cohort study was performed. QOL data were collected using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR-29 questionnaires at 3, 6, and 12 months after CRS-HIPEC. Patients were divided into groups that underwent no bowel resection, non-low anterior resection (LAR) bowel resection, LAR, and LAR with stoma. Primary outcomes were global QOL and BR-QOL. RESULTS:Overall, 158 patients were included in this study. Bowel resections were performed in 77% of patients, with 31% undergoing LAR. Global QOL was not significantly different between groups. LAR patients (with and without stoma) had significantly worse BR-QOL, embarrassment, and altered body image, with LAR + stoma patients having the largest impairments in these domains. Trends toward higher levels of impotence and anxiety were also seen in LAR patients. Although global QOL improved over time, impairments in BR-QOL and sexual and social function did not significantly improve over time. CONCLUSIONS:Although global QOL after CRS-HIPEC was not affected by the type of bowel resection, the use of LAR and ostomies was associated with clinically meaningful and persistent impairments in BR-QOL and related functional domains. Generic QOL questionnaires may not adequately capture these domains; however, targeted questionnaires in these patients may help improve QOL after CRS-HIPEC.