Functional renal failure and haemorrhagic gastritis associated with endotoxaemia in cirrhosis

Forty-three patients with cirrhosis and ascites, 21 with normal renal function, 10 with a progressive functional renal failure (FRF), and 12 with a steady FRF, were investigated for the presence of endotoxaemia by the Limulus lysate test. Endotoxaemia was found in nine patients with FRF and in none of the 21 with normal renal function (P less than 0-01). A positive Limulus test was almost exclusively associated with a progressive FRF (eight of 10 patients) and all but one of them died. Renal function improved as endotoxaemia disappeared in the survivor. Endotoxaemia was also associated with haemorrhage due to acute erosions of the gastric mucosa, being present in six of the seven patients who had this complication. Intravascular coagulation was not found in any patient. The Limulus test was positive in the ascitic fluid in 18 of 21 patients tested, although only two of them had peritonitis. These results suggest that endotoxaemia may play a critical role in the development of progressive renal failure and haemorrhagic gastritis in cirrhosis, and emphasise the potential risk of procedures involving reinfusion of ascitic fluid

Descontaminação prévia de materiais médico-cirúrgicos: estudo da eficácia de desinfetantes químicos e água e sabão Descontaminación prévia de los instrumentos médico-quirúrgicos: estudio de la eficacia de desinfectantes químicos y agua y jabón Previous descontamination of the medical surgical materials: study of the efficiency of chemical disinfectants and water and soap

Estudo experimental, visando a comparar a eficácia da descontaminação prévia de materiais médico-cirúrgicos pelo uso de desinfetantes químicos e pela utilização de água, sabão e ação mecânica, e verificar a interferência da matéria orgânica nesse procedimento. Utilizaram-se como carreadores pinças cirúrgicas contaminadas com Staphylococcus aureus ATCC-6538, Salmonella cholerae suis ATCC-10708 e Pseudomonas aeruginosa ATCC-15442, em presença e ausência de matéria orgânica (soro fetal bovino a 10%). Empregaram-se cinco tratamentos: glutaraldeído 2%, hipoclorito de sódio 1%, peróxido de hidrogênio 6%, álcool 70% e, água, sabão e ação mecânica; com oito repetições, em um total de 480 observações. Nas condições testadas, os desinfetantes foram eficazes na descontaminação prévia de materiais médico-cirúrgicos e pouco inativados pela matéria orgânica. A limpeza mecânica com água e sabão apresentou redução dos microrganismos a níveis considerados adequados para descontaminação prévia.<br>Estudio experimental, dirigido a comparar la eficacia de la descontaminación previa de instrumentos médico-quirúrgicos por el uso de desinfectantes químicos y de agua, jabón y acción mecánica, y vereificar la interferencia de la materia orgánica en ese procedimento. Se utilizaron como vehículos, pinzas quirúrgicas contaminadas con Staphylococcus aureus ATCC-6538, Salomella choleras suis ATCC-10708 y Pseydomonas aeruginosa ATCC-15423, en presencia y ausencia de materia orgánica (suero fetal bovino, 10%). Se emplearon cinco tratamientos: glutaraldeído 2%, hipoclorito de sodio 1%, peróxido de hidrógeno 6%, alcohol 70% y agua, jabón y acción mecánica; con ocho repeticiones, en un total de 480 observaciones. En las condiciones probadas, los desinfectantes fueron eficaces en la descontaminación previa de instrumentos médico-quirúrgicos y poco inactivados por la materia orgánica. La limpieza mecánica con agua y jabón, presentó redución de microorganismos a niveles considerados adecuados para descontaminación previa.<br>In this experimental study we compared the previous descontamination efficacy of the medical surgical materials by the use of chemical disinfectants and the mechanical cleaning with water and soap, as well as verified the organic material interference in these procedures. To carry out this study, we used surgical pincers under contamination with: Staphylococcus aureus ATCC-6538, Salmonella cholerae suis ATCC-10708, and Pseudomonas aeruginosa ATCC-15442 in presence and absence of organic matter (fetal bovine serum). The following treatments: glutaraldehyde 2%, sodium hypochlorite 1%, hydrogen peroxide 6%, alcohol 70% and the mechanical cleaning with water and soap were compared with eight repetitions in a total of 480 observations. In the described conditions, the disinfectants had a good efficacy in the previous descontamination of the medical surgical materials and a less inativation by the organic material. The mechanical cleaning with water and soap showed a reduction of the microrganism to safe levels, considered adequate for previous descontamination