Whipple's disease infection surgical treatment: presentation of a rare case and literature review.

The Whipple' Disease (W.D.) is a very rare disease with an incidence of 1 per 1.000.000 inhabitants; it is a systemic infection that may mimic a wide spectrum of clinical disorders, which may have a fatal outcome and affects mainly male 40-50 years old. The infective agent is an actinomycete, Tropheryma Whipplei (T.W.) that was isolated 100 years after first description by Wipple, and identified in macrophages of mucosa of the small intestine by biopsy which is characterized by periodic acid-Schiff-positive, products of the inner membrane of his polysaccharide bacterial cell wall. The multisystemic clinical manifestations evolve rapidly towards an organic decay characterized by weight loss, malabsorption, diarrhea, polyathralgia, opthalmoplegia, neuro-psychiatric disorders and sometimes associated to endocarditis. Early antibiotic treatment with trimethoprim and sulfometathaxazole reduces the fatal evolution of the disease. The authors present a rare experience about a female subject in which the clinical gastrointestinal signs were preceded by neuro-psychiatric disorders, and evolved into obstruction and intestinal perforation which required an emergency surgery with temporary ileostomy, recanalized only after adequate medical treatment with a full dose of antibiotic and resolution of clinical disease for the high risks of fistulae for the edema and lymphadenopathy of mucosa. The diagnosis was histologically examined by intestinal biopsy performed during surgery, which showed PAS-positive histiocytes, while PRC polymerase RNA was negative, which confirms the high sensibility of PAS positive and low specificity of RNA polymerase for T.W.

Surgical management of symptomatic simple hepatic cysts.

The authors present three cases of symptomatic, large, benign, nonparasitic hepatic cysts. The diagnosis was determined by US and CT scan, the latter enabling differential diagnosis with neoplastic or hydatid cysts. All patients were treated with open hepatic resection. In 2 cases, laparoscopy was performed to enable complete diagnosis. The authors used LigaSure™ (Covidien, USA) instrument, avoiding bleeding complications and reducing surgery time. Histological examination confirmed the diagnosis of benign cysts. CT follow-up at 6 months and 1 year demonstrated the efficacy of the surgery, with no recurrences.

[Giant and bilateral adrenal myelolipoma. Case report]. / Mielolipoma surrenalico bilaterale gigante. Caso clinico.

The adrenal myelolipoma is a relatively rare benign tumour of adipose cell and bone marrow elements, non functioning and asymptomatic. Giant and bilateral adrenal myelolipoma is quite rare. The Authors report a case of bilateral adrenal myelolipoma, a giant one (> 15 cm) on the left side and a small one (> 4 cm) on the right with constant pain in a 57-year-old man, shown by computerized tomography. The hormonal blood tests were normal. Surgical excision was performed for large left symptomatic mass, by open laparotomy, and biopsy for right minor adrenal lesion. Histology confirmed diagnosis of myelolipoma for both masses. Follow-up to 6-12 months did'nt show any change of the right myelolipoma. The authors agree with the need to remove the giant adrenal myelolipoma, because the lesion > 10 cm have a high risk of cancer and hemorrhagic complication, while for small myelolipoma (< 6 cm) 6-12 months follow-up is the appropriate choice.

[Gas gangrene. Clinical considerations, prognosis and therapeutic prospects in our experience]. / La gangrène gazeuse. Considérations cliniques, pronostic et perspective thérapeutiques selon notre expérience.

The prognosis of gas gangrene is changing as the means of treatment become more accurate and are implemented earlier. The authors, in their work referring to 10 cases of gas gangrene, point out to the extreme fastness of debridement and immediate exeresis, of wide-spectrum antibiotic protection and of caloric balance, associated to a treatment using trace elements. The importance of hyperbaric oxygen therapy seems to be increasingly proven with time. Lastly, in their general experience of treatment, the authors suggest the use of a specific frequency soft laser therapy, which might speed up the process of tissue repair.