RESUMO
A superior mesenteric artery syndrome (SMAS) was diagnosed in two young women with, respectively, a 2- and 1-year history of postprandial vomiting and epigastric pain. The patients underwent a laparoscopic duodenojejunal bypass, and resumed a normal diet on the fifth postoperative day. The patients are still symptom-free with patent anastomosis on gastrointestinal radiographic control at 24 and 6 months, respectively, following their operation. Herein we also describe the varying clinical presentation of this rare syndrome, as well as treatment options. We conclude that laparoscopic duodenojejunostomy offers a new therapeutic approach to SMAS. It is reliable and safe; the operating time is acceptable; and diet recovery and hospital stay are both short. However, these preliminary results still need to be confirmed by further observations.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodeno/cirurgia , Jejuno/cirurgia , Laparoscopia , Síndrome da Artéria Mesentérica Superior/cirurgia , Adolescente , Adulto , Feminino , Humanos , Síndrome da Artéria Mesentérica Superior/diagnósticoRESUMO
The presence of hepatic portal vein gas is the consequence of invasion by anaerobic bacteria originating from an intestinal tract lesion. Although this phenomenon is rare, it may result from several common intestinal pathologies. The prognosis, despite intensive treatment, is often very poor. The authors report a case associated with bowel necrosis resulting from intestinal band.
Assuntos
Embolia Aérea/complicações , Obstrução Intestinal/etiologia , Veia Porta , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios XRESUMO
We reviewed the records of 51 patients. In two-thirds of the cases the main symptom was icterus; one third presented with pain. The whole group underwent a retrograde choledocho-pancreatography. An abnormal papilla was found in 80% of the cases. This finding proved to be of sufficient diagnostic importance without the necessity of an associated choledocho-pancreatography for diagnostic confirmation. Although in the majority of the cases the choledochus proved to be dilated, pancreatic duct enlargment was only noted in 50%. The only treatment in the very elderly patient was endoscopic sphincterotomy. Younger patients underwent a duodeno-pancreatectomy preceded by an endoscopic sphincterotomy. The morbidity and mortality associated with endoscopic opacification of the biliary and pancreatic ducts and sphincterotomy in this setting is much higher than for all other indications in general. For this reason we propose to perform a choledocho-pancreatography only when indispensable for diagnostic purposes (nl. papilla) or when endoscopic sphincterotomy is the chosen treatment modality.
Assuntos
Adenocarcinoma/cirurgia , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Adenocarcinoma/diagnóstico , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Neoplasias do Ducto Colédoco/diagnóstico , Duodenoscopia , Endoscopia/efeitos adversos , Feminino , Humanos , Masculino , Métodos , Pessoa de Meia-IdadeRESUMO
The clinical efficacy and patient acceptability of a new solution containing mainly sodium sulfate and polyethylene glycol (solution II) compared with a balanced standard electrolyte solution (solution I) for whole gut lavage prior to colonoscopy were evaluated in 240 ambulatory and hospital patients randomly allocated to receive either of the two solutions. On the basis of the quality and rapidity of the bowel preparation and the good results obtained by clinical and biological parameters, we found that the newly designed solution was superior.
Assuntos
Colonoscopia , Polietilenoglicóis/administração & dosagem , Sulfatos/administração & dosagem , Irrigação Terapêutica/métodos , Eletrólitos/administração & dosagem , Estudos de Avaliação como Assunto , Humanos , Distribuição Aleatória , SoluçõesRESUMO
Binding of insulin to sea urchin egg plasma membrane has been studied by biochemical and immunocytochemical methods. Unfertilized and fertilized eggs as well as embryos during the first cell division have been used. 1. Competition experiments between 125I-insulin (1 nM) and an excess of native insulin (30 muM) indicate a specific hormone fixation to membrane crude extracts from unfertilized and fertilized eggs. The magnitude of "specific binding" is comparable to values recorded for mammalian cells. 2. Inhibition of insulin fixation by concanavalin A (100 mug/ml) suggests the glycoprotein composition of plasma membrane receptors. 3. An 30-min incubation of unfertilized and fertilized eggs in the presence of insulin leads to a significant increase in cyclic AMP content. 4. An immunocytochemical method demonstrates that insulin is selectively and specifically bound to the plasma membrane of eggs incubated in the presence of insulin before fixation. It can be concluded that insulin receptor sites are components of sea urchin eggs plasma membrane. Insulin binding which leads to cyclic AMP accumulation is not deeply modified by fertilization and does not include visible morphological changes in the eggs.