Obstrução intestinal por Pythium insidiosum em um cão: relato de caso / Intestinal obstruction by Pythium insidiosum in a dog: case report

Relata-se um caso de pitiose intestinal em um Husky Siberiano, de um ano de idade, macho atendido em um Hospital Veterinário Escola com sinais de obstrução intestinal. Ao exame físico, notou-se massa cilíndrica na região abdominal cranial, posteriormente confirmada por meio de radiografia e ultrassonografia. Durante a laparotomia exploratória, constatou-se massa extraluminal envolvendo o jejuno e alterações na parede do órgão. Realizou-se a ressecção da porção afetada do intestino e, posteriormente, anastomose. O exame histológico do tecido evidenciou inflamação piogranulomatosa acentuada. Na coloração de prata metenamina de Grocott, hifas septadas foram observadas. O diagnóstico de infecção por Pythium insidiosum foi confirmado por meio da imunoistoquímica. Após a cirurgia, o animal restabeleceu a defecação; no 30º dia pós-cirúrgico, foi relatada ainda presença de diarreia. O tratamento com itraconazol e terbinafina foi instituído durante 60 dias. Após dois anos do procedimento cirúrgico e do tratamento com antifúngicos orais, o cão não apresentou recidiva.

A case of intestinal pythiosis in a one-year-old male Siberian Husky treated at a Veterinary School Hospital with signs of intestinal obstruction is reported. At physical examination, a cylindrical mass was palpable in the cranial abdomen, later confirmed by radiography and ultrasonography. During the exploratory laparotomy, it was evidenced an extraluminal mass involving the jejunum and alterations of the wall in the organ. After that, a resection of the affected portion of the intestine was made followed by anastomosis. The histologic examination evidenced accented pyogranulomatous inflammation. By the Grocott methenamine silver stain, branching hyphae were observed. The diagnosis of infection by Pythium insidiosum was confirmed by immunohistochemistry. The animal reestablished the defecation after the surgery; on the 30th postoperative day, it was also reported the presence of diarrhea. The treatment with itraconazol and terbinafina was instituted for 60 days. Two years after the surgical procedure and treatment with oral antifungals, the dog did not show recurrence.

[Hysteroscopic features in postmenopausal uterine bleeding]. / Quadri isteroscopici nei sanguinamenti uterini in post-menopausa.

One hundred forty three patients underwent hysteroscopy for abnormal uterine bleeding from January 1993 through December 1994. Sixty patients were postmenopausal. All but 3 of the procedures were performed on outpatient with no significant complications. Three groups could be identified on the basis of endometrial features (color, vascularity, thickness, necrotic areas): 1) negative for cancer, 2) possible or suspect (low or high risk), 3) carcinoma. Biopsy indicated cancer in one of the 16 doubtful cases, and in all (5) of the hysteroscopically diagnosed cancers. Outpatient Hysteroscopy successfully substitutes D&C (dilatation and curettage) for early diagnosis of endometrial cancer.

[Ultrasonographic and urodynamic evaluation in stress incontinence]. / Valutazione ultrasonografica ed urodinamica nell'incontinenza da sforzo.

Transvaginal sonography can show partial urinary penetration in the urethra in patients with no clinical incontinence. The Fluid Bridge Test-Pressure urodynamically demonstrates the same phenomenon. We compared these two technics in women with stress urinary incontinence (SUI). 49 patients underwent urodynamic testing and transvaginal sonography; 18 had SUI, 20 were asymptomatic postoperatively (Burch procedure) and 11 were normal controls. Urodynamics consisted of filling cystometry with saline (infusion speed: ml 70/min) using transurethral Foley catheter (n degree 14 Fr), and a profilometric-pressure Bard catheter (10 Fr); micturitional cystometry; uroflowmetry; clino- and orthostatic urethral pressure profile (UPP) (extraction speed: cm 0.5-1/sec; infusion speed: cm 1.2/min); sphincteric electromyography (EMG); FBT-P with the Bard catheter only. During extraction patients were requested to cough (stress condition). If the urethra is incompetent pressure is transmitted to the water column connected to the pressure transducer, and a "spike" is observed. A competent urethra shows little pressure variation. Ultrasound (US) equipment consisted in a General Electric (RT 3600) sonograph with an electronic transvaginal probe (7.5 MHz) inserted in a gel-lubricated condom. The probe was positioned in the vaginal vestibule in direct proximity to the urethra. Axial and coronal scannings were performed. Echo-imagings were submitted to "post-processing" on US recording equipment. Fluid penetration in the urethra was evident if iperchogenic "turbulence" was observed on playback of the dynamic sonogram on a videocassette recorder (VCR) connected to the sonograph. The SUI group shows leakage of water under stress without detrusorial activity and dynamic UPP with reduced transmission of abdominal pressure on the urethra.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute urinary obstruction in pregnancy]. / Ostruzione minzionale acuta in gravidanza.

Five cases of acute urinary obstruction during pregnancy are presented. A complete urodynamic workup, including pressure-flow studies showed high micturitional pressures with little or no flow, with at least 60% residual urine. Filling cystometry, urethral profilometry (static and dynamic), pelvic electromyography were normal. Two cases were due to uterine pelvic incarceration. One of these cases happened very early during pregnancy, because of extensive fibroids. Any cause of abnormal uterine enlargement can lead to early obstruction. Three cases were associated with paraurethral abscess (skenitis in 2 cases, urethral diverticulum in 1). Manual reduction in case of pelvic incarceration or surgical draining and antibiotic therapy in case of abscess were effective in all cases. Immediate catheterization is possible and indicated as soon as urinary obstruction is diagnosed. This prevents neuromuscular dysfunction due to excessive bladder distention. The transurethral catheter might work as a stent, and periurethral surgical drainage is probably safer with a catheter in place. Suprapubic catheterization is probably less useful in this respect. An indwelling catheter removes any urgency in treatment. Voiding difficulties can persist for some days after surgical treatment. Urodynamic testing performed in all indicated acute micturitional obstruction. Anyway, it added little to the clinical understanding of the problem, which was obvious, and the Authors feel that extensive urodynamic testing should be limited to cases presenting with a complex preexisting dysfunction or performed after treatment if symptoms do not disappear completely. All clinically doubtful cases should likewise be investigated. If periurethral abscess or incarceration are evident, simple evaluation of residual urine percentage should be sufficient in establishing the diagnosis.

[Polycythemic chorea. Description of a clinical case]. / Corea policitemica. Descrizione di un caso clinico.

The authors report a 69-year-old man affected by polycythaemia rubra vera since the age of sixty, who presented persistent left hemichorea of acute onset, occurring ten months before the exacerbation of the haematologic abnormalities. Previously he had been suffering from a transient episode of chorea concomitant with relapsing of polycythaemia. CT scan of the brain showed diffuse cortico-subcortical atrophy, whereas Doppler velocimetry of carotid arteries demonstrated a rise in cerebral blood flow resistance and a stenosis of the right carotid artery in its first tract. Pathogenetic mechanisms of chorea complicating polycythaemia vera are discussed and a multifactorial origin of the syndrome is suggested.