A deceptive case of emphysematous cholecystitis complicated with retroperitoneal gangrene and emphysematous pancreatitis : clinical and computed tomography features

Purpose: Emphysematous cholecystitis (EC) is an uncommon, severe variant of acute cholecystitis caused by gasforming bacteria - most often Clostridium perfringens and Escherichia coli. We present a deceptive case of EC associated with retroperitoneal gas gangrene and emphysematous pancreatitis. Case report: An 86-year-old, overweight woman was admitted to the emergency department with non-specific abdominal symptoms. Admission laboratory tests showed elevated diastase levels indicating acute pancreatitis. Computed tomography (CT) demonstrated a substantial amount of gas in the retroperitoneum and peritoneal cavity, which raised a suspicion of duodenal perforation. Primary diagnosis was not confirmed during emergency laparotomy, which revealed a gangrenous gallbladder adjacent to the duodenum and surrounded by purulent fluid. The final diagnosis established after laparotomy and rereading of CT scans was that of emphysematous cholecystitis associated with gangrenous pancreatitis and retroperitoneal gangrene. After surgery, the patient was transferred to the intensive care unit in septic shock. Shortly after, the second laparotomy was undertaken on suspicion of internal bleeding. During surgery, the patient experienced cardiac arrest and died despite immediate resuscitation. Conclusions: Emphysematous cholecystitis may be associated with a spread of infection both to the peritoneal cavity and retroperitoneum and result in a substantial amount of gas in those anatomic compartments. The knowledge of this rare complication may be helpful in establishing a correct diagnosis

The knowledge concerning kidney transplantation in the group of patients on the waiting list

Wstęp. Przeszczepianie nerki stanowi standardową metodę leczenia nerkozastępczego, dającą długoletnie przeżycie biorców. Ma na to wpływ postępowanie okołooperacyjne, ale również wiedza i doświadczenia jakie posiada potencjalny biorca.Cel pracy. Celem pracy była ocena wiedzy na temat przeszczepiania nerki u pacjentów oczekujących na transplantację.Materiał i metody. Badania przeprowadzono w 14 ośrodkach dializ województwa mazowieckiego w oparciu o kwestionariusz ankiety. Grupę badaną stanowiło 74 hemodializowanych pacjentów zgłoszonych do Krajowej Listy Oczekujących. Dwadzieścia cztery procent stanowiły osoby po przeszczepieniu, zgłoszone po raz drugi lub trzeci.Wyniki. Dziewięćdziesiąt procent ankietowanych podało jako dawcę narządu osobę zmarłą. O przeszczepieniu wyprzedzającym słyszało 32%, 73% znało lokalizację przeszczepu, 36% podało jako średni czas przeżycia graftu 10 lat. Osiemdziesiąt sześć procent wiedziało, że transplantacja jest poważnym zabiegiem z możliwością powikłań. Większość o tej metodzie leczenia dowiedziała się od lekarza. Pięćdziesiąt trzy procent badanych miało wiedzę na temat leczenia immunosupresyjnego, 50% wiedziało o potrzebie regularnej kontroli pooperacyjnej. Połowa ankietowanych rozumie potrzebę zmiany stylu życia.Wnioski. Wiedza ankietowanych na temat kwalifikacji, pochodzenia organów, przebiegu leczenia i możliwych powikłaniach jest ogólna i niewystarczająca. Wiedza na temat leczenia immunosupresyjnego, wizyt kontrolnych i stylu życia jest niedostateczna. Wdrożenie programów edukacyjnych dla tej grupy chorych wpłynie na zwiększenie wiedzy i poprawę wyników leczenia.Problemy Pielęgniarstwa 2014; 22 (4): 420–425Introduction. Kidney transplantation (KTx) is the best treatment of end stage renal failure, assuring long patient survival. Its outcome is affected not only by surgical technique, but also by the information on the topic and personal experience of recipients, as factors influencing patients behavior after KTx.Aim. The goal of this work was to assess the knowledge of the patients on the waiting list, on the matter of KTx.Material and methods. The information was gathered in 14 dialysis centers in Mazowieckie district, with the use of questionnaire. 74 hemodialysed patients were included to the study. Twenty-four percent of them were submitted for the second transplantation. Results. Ninety percent of patients announced that organ for KTx is harvested from the deceased donor. Thirty-two percent had knowledge of possible preemptive transplantation, 73% knew the localization of the kidney graft after the operation. Thirty-six percent informed of 10 years mean time of graft survival. Eighty six percent were aware that KTx is a large operation and may concern treatment complications. The majority of respondents received their knowledge from physicians. Fifty three percent had some knowledge concerning immunosupression, 50% is aware of the need of systematic medical control. About 50% knows and introduces changes in lifestyle.Conclusions. The knowledge of qualification process, organ origin, treatment and possible complications is general and insufficient. The awareness of immunosuppressive therapy, posttransplant control and changes in everyday life is insufficient. Introduction of educational program for those patients would improve knowledge as well as transplantation results.Nursing Topics 2014; 22 (4): 420–42

First Report of Echinococcus ortleppi in Human Cases of Cystic Echinococcosis in Poland

Cystic echinococcosis is considered as an emerging zoonosis that can develop asymptomatically for years, clinically nonpathognomic. The disease is of public health importance due to often late, difficult diagnostics, uncertain results of treatment, the need to remove hydatid cysts surgically in advanced cases, and poor prognosis in untreated patients. Six Polish female patients with diagnosed cystic echinococcosis (CE) were examined. DNA extracted from the liver and lung samples served for amplification of mitochondrial nad1 gene fragment. Sequence alignments of 5 isolates showed identity with the pig strain, Echinococcus canadensis G7. One case was in 100% identical with Echinococcus ortleppi G5, the cattle strain. These data demonstrate first report of E. ortleppi, regarded as extinct species, causing human cystic echinococcosis in Poland, where the most frequent causative agent of human CE is E. canadensis

Adiponectin/resistin interplay in serum and in adipose tissue of obese and normal-weight individuals

Abstract Background The interplay between adiponectin and resistin, the two adipokines of opposite effects, may determine the metabolic profile of obese individuals and development of obesity-related complications. The current study was conducted to assess how adiponectin/resistin interplay in sera and adipose tissues may influence the metabolic profile of obese and normal-weight subjects. Methods Concentrations of adiponectin and resistin were measured on protein level by immunoassay in visceral and subcutaneous adipose tissues from 50 obese (body mass index > 40 kg/m2) and 28 normal-weight (body mass index 20–24.9 kg/m2) individuals. Simultaneously expression of ADIPOQ and RETN (encoding adiponectin and resistin, respectively) was assessed on mRNA level by real-time PCR. Results ADIPOQ mRNA (P = 0.0001) and adiponectin protein (P = 0.0013) levels were lower, while RETN mRNA (P = 0.0338) and resistin (P < 0.0001)—higher in subcutaneous adipose tissues of obese subjects. ADIPOQ and RETN mRNA levels did not correlate with protein concentrations in the investigated adipose tissues. In obesity adiponectin serum concentrations correlated positively with ADIPOQ mRNA in subcutaneous adipose tissue (P = 0.005) and negatively with protein levels in visceral adipose tissue (P = 0.001). Obesity was associated with higher adiponectin–resistin index value in sera (P < 0.0001) and decreased in subcutaneous adipose tissue (P < 0.001), but only adiponectin–resistin index measured in sera was significantly higher in obese with the metabolic syndrome (P = 0.04). Conclusions Obesity affects synthesis of adiponectin and resistin mainly in subcutaneous adipose tissue. The adiponectin–resistin index assessed in the adipose tissues has a different prognostic value compared to the adiponectin–resistin index in serum and does not reflect a metabolic risk in obese individuals

Interleukins 6 and 15 Levels Are Higher in Subcutaneous Adipose Tissue, but Obesity Is Associated with Their Increased Content in Visceral Fat Depots

Excess adiposity is associated with chronic inflammation, which takes part in the development of obesity-related complications. The aim of this study was to establish whether subcutaneous (SAT) or visceral (VAT) adipose tissue plays a major role in synthesis of pro-inflammatory cytokines. Concentrations of interleukins (IL): 1β, 6, 8 and 15 were measured at the protein level by an ELISA-based method and on the mRNA level by real-time PCR in VAT and SAT samples obtained from 49 obese (BMI &gt; 40 kg/m2) and 16 normal-weight (BMI 20–24.9 kg/m2) controls. IL-6 and IL-15 protein concentrations were higher in SAT than in VAT for both obese (p = 0.003 and p &lt; 0.0001, respectively) and control individuals (p = 0.004 and p = 0.001, respectively), while for IL-1β this was observed only in obese subjects (p = 0.047). What characterized obese individuals was the higher expression of IL-6 and IL-15 at the protein level in VAT compared to normal-weight controls (p = 0.047 and p = 0.016, respectively). Additionally, obese individuals with metabolic syndrome had higher IL-1β levels in VAT than did obese individuals without this syndrome (p = 0.003). In conclusion, concentrations of some pro-inflammatory cytokines were higher in SAT than in VAT, but it was the increased pro-inflammatory activity of VAT that was associated with obesity and metabolic syndrome

NGS Reveals Molecular Pathways Affected by Obesity and Weight Loss-Related Changes in miRNA Levels in Adipose Tissue

Both obesity and weight loss may cause molecular changes in adipose tissue. This study aimed to characterize changes in adipose tissue miRNome in order to identify molecular pathways affected by obesity and weight changes. Next generation sequencing (NGS) was applied to identify microRNAs (miRNAs) differentially expressed in 47 samples of visceral (VAT) and subcutaneous (SAT) adipose tissues from normal-weight (N), obese (O) and obese after surgery-induced weight loss (PO) individuals. Subsequently miRNA expression was validated by real-time PCR in 197 adipose tissues and bioinformatics analysis performed to identify molecular pathways affected by obesity-related changes in miRNA expression. NGS identified 344 miRNAs expressed in adipose tissues with ≥5 reads per million. Using &gt;2 and &lt;−2 fold change as cut-offs we showed that the expression of 54 miRNAs differed significantly between VAT-O and SAT-O. Equally, between SAT-O and SAT-N, the expression of 20 miRNAs differed significantly, between SAT-PO and SAT-N the expression of 79 miRNAs differed significantly, and between SAT-PO and SAT-O, the expression of 61 miRNAs differed significantly. Ontological analyses disclosed several molecular pathways regulated by these miRNAs in adipose tissue. NGS-based miRNome analysis characterized changes of the miRNA profile of adipose tissue, which are associated with changes of weight possibly responsible for a differential regulation of molecular pathways in adipose tissue when the individual is obese and after the individual has lost weight

Epigenetic Regulation of Estrogen Receptor Genes&rsquo; Expressions in Adipose Tissue in the Course of Obesity

Estrogen affects adipose tissue function. Therefore, this study aimed at assessing changes in the transcriptional activity of estrogen receptor (ER) &alpha; and &beta; genes (ESR1 and ESR2, respectively) in the adipose tissues of obese individuals before and after weight loss and verifying whether epigenetic mechanisms were involved in this phenomenon. ESR1 and ESR2 mRNA and miRNA levels were evaluated using real-time PCR in visceral (VAT) and subcutaneous adipose tissue (SAT) of 78 obese (BMI &gt; 40 kg/m2) and 31 normal-weight (BMI = 20&ndash;24.9 kg/m2) individuals and in 19 SAT samples from post-bariatric patients. ESR1 and ESR2 methylation status was studied using the methylation-sensitive digestion/real-time PCR method. Obesity was associated with a decrease in mRNA levels of both ERs in SAT (p &lt; 0.0001) and ESR2 in VAT (p = 0.0001), while weight loss increased ESR transcription (p &lt; 0.0001). Methylation levels of ESR1 and ESR2 promoters were unaffected. However, ESR1 mRNA in the AT of obese subjects correlated negatively with the expression of hsa-miR-18a-5p (rs = &minus;0.444), hsa-miR-18b-5p (rs = &minus;0.329), hsa-miR-22-3p (rs = &minus;0.413), hsa-miR-100-5p (rs = &minus;0.371), and hsa-miR-143-5p (rs = &minus;0.289), while the expression of ESR2 in VAT correlated negatively with hsa-miR-576-5p (rs = &minus;0.353) and in SAT with hsa-miR-495-3p (rs = &minus;0.308). In conclusion, obesity-associated downregulation of ER mRNA levels in adipose tissue may result from miRNA interference