abdominal tuberculosis in children

PG) E 2 and PGF 2a as prototypic end-products of the Cox-1 and -2 pathway were measured in the biopsy specimens. Results: The mean PGF 2a levels were 539´2, 17´8, 194´4, 341´0 and 229´2 pg per mg liver tissue protein in groups 1±5 respectively. The respective mean PGE 2 levels were 422´6, 438´0, 272´6, 331´4 and 205 pg mg ±1 . PGF 2a values in MG were signi®cantly different from those in all other groups P < 0´001), and those in NG and MAPG were different from those in IASG and APG. On the other hand, PGE 2 levels were signi®cantly lower in NG, MAPG and APG than in IASG and MG. Liver tissue PAF was also detected in all groups except NG. Mean PAF levels in IASG, MG, APG and MAPG were 44´4, 33´2, 12´2 and 14´6 pg per mg tissue protein respectively. Conclusion: 1) PAF is an important mediator in intra- abdominal sepsis. 2) Liver PGF 2a may play a role in intra- abdominal sepsis independently from PAF. 3) Anti-PAF agent alone may help healing in peritoneal sepsis, but the main therapeutic agents are PGF 2a blocking agents. Cytokines and myeloperoxidase as markers of purulent- septic complications of acute pancreatitis A. Perejaslov and S. Chooklin Medical University, Lviv, Ukraine Background: Purulent-septic complications often determine the outcome of severe acute pancreatitis. Unfortunately, there are no useful markers that can predict the contamination of necrotic foci. Methods: Thirty-eight patients with severe pancreatitis were treated. The plasma levels of interleukin IL) 1, IL-6, IL-8 and myeloperoxidase MPO) were studied in all patients on days 1, 3, 7, 14 and 21 after the onset of acute pancreatitis. Results: Raised levels of all in¯ammatory mediators were observed in all patients on the ®rst day. A gradual decrease in cytokine and MPO levels was noted in patients with sterile necrosis and a favourable course of acute pancreatitis 17 patients). Contamination of the necrotic foci was accompanied by a rise in IL-8 140´0 pg ml ±1 or more) and MPO 11´0 nmol ml ±1 or more) levels, which preceded the clinical manifestation of purulent complications. These results were con®rmed by ultrasonographically guided aspiration. Two types of purulent-septic complications were identi®ed: local and disseminating. Local purulent-septic complications nine patients) were characterized by a moderate increase in cytokine levels and were associated with a good prognosis. The disseminating purulent-septic complications group 12 patients) was characterized by highest levels of proin¯ammatory cytokines, signi®cant multiple organ failure and a poor prognosis. Eight patients with widespread purulent-septic complications died. Conclusion: IL-8 and MPO plasma levels are valuable markers of infected necrosis in acute pancreatitis. Abdominal tuberculosis in children G. A. Tireli, H. O È zbey and T. Salman Department of Paediatric Surgery, University of Istanbul, Istanbul, Turkey Background: Abdominal tuberculosis AT) is a rare cause of abdominal infection in children. Surgical intervention is rarely indicated, other than for obtaining a specimen for histopatho- logical diagnosis or for the treatment of complications. Methods: The medical records of 13 patients who were operated on with the diagnosis of AT, between 1983 and 1999, were reviewed retrospectively. Results: The median age was 7 years range 6 months to 10 years). The clinical signs and symptoms were as follows: abdominal pain eight patients), loss of weight seven), abdominal mass six), vomiting four) and night fever four). Twelve patients were operated on, while diagnostic laparo- scopy was perfomed in one. Patients operated on with the diagnosis of acute abdomen were diagnosed immediately at laparotomy. Surgery was limited to sampling of peritoneum and/or lymph node biopsy and ascites. The reason for surgical intervention was intestinal obstruction eight), abdominal mass or ascites six), psoas abscess one) and intussusception one). In all patients the diagnosis was con®rmed by either histopatho- logical or microbiological examination. In eight patients the AT was de®ned as intestinal and mesenteric type, in three patients it was localized to the peritoneum and in two the disease was diffuse. All patients were treated with INH, rifampicin and streptomycin±pyrazinamide combination. Two patients, one with a faecal ®stula and one with malnutrition, came from another hospital. All patients survived and were treated successfully except the patient with a faecal ®stula. Conclusion: The diagnosis of AT is dif®cult before presenta- tion with complications of intra-abdominal infection. In patients with suspected AT, aggressive surgery should be avoided and surgical intervention should be limited to tissue and/or ¯uid sampling. Dexamethasone in hyperdynamic sepsis in children F. E. Martino, S. Klein, E. G. Nasatsky and G. D. Martino Servicio de Terapia Intensiva Sanatorio Reconquista, Reconquista and CaÂtedra I CirugõÂa, Facultad de Medicina Universidad Nacional del Nordeste, Corrientes, Argentina Background: A recent study analysed the usefulness of dexamethasone DX) in hyperdynamic sepsis in children. This prospective study was performed in order to con®rm or refute the conclusions obtained previously. Methods: A prospective, randomized and sequential study was performed in 38 patients of both sexes with a mean age of 10 years. Patients had at least ®ve of the following clinical features to be included in the study: hyperthermia, oliguria, tachycardia, tachypnoea, cyanosis or another sign of hypox- 956 Surgical Infection Society of Europe Abstracts British Journal of Surgery 2000, 87, 931±964 www.bjs.co.uk ã 2000 Blackwell Science Ltd

abdominal tuberculosis in children

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