[Strongyloidiasis in nephrologic patients]. / Strongiloidosi: la cenerentola delle parassitosi. due casi emblematici in pazienti nefrologici.

Strongyloides stercoralis is a nematode causing strongyloidiasis, more frequent in immigrants and in travelers coming from tropical and subtropical areas. Infection is usually asymptomatic, frequently associated with eosinophilia. Immunocompromised patients are at high risk of developing hyperinfection syndrome (HI) or dissemination (SD), life threatening complications. Diagnosis of strongyloidiasis is firstly based on larvae isolation in stool samples; specific therapy involves the use of ivermectin as first choice and albendazole as second choice. We describe two cases of strongyloidiasis. The first one is a disseminated strongyloidiasis occurred in an Ecuadorian male on corticosteroid therapy for nephrotic syndrome due to focal segmental glomerulosclerosis, successfully treated with ivermectin; the second one involves another Ecuadorian male affected by acute kidney failure and nephrotic syndrome in IgA nephropathy with a diagnosis of chronic strongyloidiasis performed before starting the immunosuppressive treatment. The timing of treatment with ivermectin has allowed the complete eradication of the parasite before starting steroid and mycophenolate mofetil therapy, preventing the occurrence of a disseminated infection. Epidemiological data show us how strongyloidiasis is rising at our latitude because of increased number of migrants and travelers coming from endemic areas. So we must always exclude asymptomatic strongyloidiasis before prescribing a steroid or immunosuppressive therapy, in order to avoid developement of disseminated and often fatal disease.

An Internet-based survey of risk factors for surgical gastric dilatation-volvulus in dogs.

OBJECTIVE: To evaluate risk factors for gastric dilatation-volvulus (GDV) in a large number of privately owned dogs across a wide geographic area. DESIGN: Internet-based, cross-sectional study. ANIMALS: 2,551 privately owned dogs. PROCEDURES: A questionnaire addressed dog-specific, management, environmental, and personality-associated risk factors for GDV in dogs. Respondents were recruited through the posting of the electronic link to the questionnaire on websites for dog owners; the information was also disseminated at meetings of dog owners and via newsletters, e-mail lists for dog owners and breeders, owner-oriented dog publications, and e-mails forwarded by participants. Descriptive statistics and logistic regression analysis were performed. RESULTS: Factors significantly associated with an increased risk of GDV were being fed dry kibble, anxiety, residence in the United Kingdom, being born in the 1990s, being a family pet, and spending at least 5 hours a day with the owner. Factors associated with a decreased risk of GDV were playing with other dogs and running the fence after meals, fish and egg dietary supplements, and spending equal time indoors and outdoors. A significant interaction between sex and neuter status was observed, with sexually intact females having the highest risk for GDV. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs with a high risk of GDV, regular moderate daily and postprandial activity appeared to be beneficial. Feeding only commercial dry dog food may not be the best choice for dogs at risk; however, supplements with fish or eggs may reduced this risk. The effect of neuter status on GDV risk requires further characterization.

Video-assisted thoracoscopy in thoracic injury: early or delayed indication?

The aim of this study was to evaluate the diagnostic role and therapeutic effectiveness of videothoracoscopy in chest trauma. Between 1st January 1993 and 30th September 2003, 112 traumatized patients underwent a videothoracoscopy. The origin of trauma was different: 60 road accidents, 42 accidental falls, 7 knife wounds and 3 firearm wounds. Seventy-six patients presented hemothorax, 21 hemopneumothorax, 10 suspected diaphragmatic injury and 5 pericardium effusion. All patients were hemodynamically stable and conscious. In suspected diaphragmatic rupture patients, videothoracoscopy confirmed the presence of 4 lesions with diameter from 7 to 10cm. The etiopathogenetic causes in the other clinical patterns were: 20 lung lacerations, 17 apical adhesion lacerations, 11 diaphragmatic lesions, 16 wall bleedings and 38 vessel lesions. Ninety patients (80.3%) were treated with video assisted thoracic surgery. The remaining procedures were : 17 drainage tube insertions, 4 thoracotomies and 1 laparotomy. Videothoracoscopy made the use of the primary intention drainage tube obsolete in stable traumatized patients with hemothorax or hemopneumothorax. It is a safe technique that allows the diagnostic and surgical management of the lesions.

Giant bullous emphysema resection by VATS. Analysis of laser and stapler techniques.

OBJECTIVE: Advances in video-assisted thoracic surgical (VATS) technique led the authors to reconsider the treatment and thoracoscopic management of patients with giant bullous emphysema (GBE). METHODS: From January 1993 to December 2001 we treated 40 patients with unilateral GBE: 24 males and 16 females, mean age 51+/-1 years. Thirty patients presented respiratory insufficiency, seven patients a spontaneous pneumothorax and three patients a bullae infection. Excision was performed by using Nd:YAG laser in five patients (12.5%) and stapling device in 35 patients (87.5%). Among the last 35, in 20 patients a partial pleurectomy stripping up to the 5th intercostal space was associated. In 15 patients this technique was modified through the systematic application of polytetrafluoroethylene (PTFE) to reinforce stitches. RESULTS: We experienced one conversion to open thoracotomy owing to haemorrhaging, in one patient who underwent a partial pleurectomy stripping. In the stapler resection patients, with PTFE application, the mean duration of air leaks, for type 1 bullae of Wakabayashi was 2.2+/-1.8 days and, for type 4, 5.9+/-1.4 days; the mean length of hospital stay was 6.1+/-0.5 days. CONCLUSIONS: The resection in VATS of giant bullous emphysema by stapling device associated to reinforcement in PTFE reduces duration of air leaks and hospitalisation and improves pulmonary function.