Colovesical fistula secondary to hernia mesh migration: an unusual incident / Fístula colovesical secundária à migração da malha para reparo de hérnia: um incidente incomum

ABSTRACT We evaluated a 27-year old male with pneumaturia and fecaluria with a past history of right inguinal hernia repair. Though, cystoscopy and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, colonoscopy revealed a mesh in the sigmoid colon making apparent the diagnosis of colovesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon with rent closure of the fistulous opening was done successfully. Our case thus, highlights the vital role of common diagnostic tool like colonoscopy in making an uncommon diagnosis.

RESUMO Avaliamos um homem de 27 anos com pneumaturia e fecalúria com antecedentes de reparo da hérnia inguinal direita. Embora a cistoscopia e a tomografia computadorizada com contraste (TCC) não tenham fornecido nenhuma evidência para obter-se um diagnóstico, curiosamente, a colonoscopia revelou uma malha no cólon sigmoide, estabelecendo o diagnóstico de fístula colovesical (FCV) secundária à migração da malha. Mais tarde, foi feita a remoção cirúrgica da malha do cólon sigmoide com fechamento da abertura fistulosa com sucesso. Nosso caso, portanto, destaca o papel vital de uma ferramenta diagnóstica comum, como a colonoscopia, para obter-se um diagnóstico incomum.

Síndrome pós-poliomielite / Post-poliomyelitis syndrome

A poliomielite é uma doença erradicada no Brasil, desde os anos 80, mas atualmente estão aparecendo novos sintomas relacionados a essa patologia, a síndrome pós-polio, que é caracterizada por uma nova desordem neurológica. Esses sintomas aparecem 30 a 40 anos após a infecção aguda da poliomielite e, como é uma patologia recente, há poucos estudos e casos diagnosticados. O objetivo deste estudo é descrever o aparecimento do caso dessa síndrome, através do relato de caso de uma paciente que realiza tratamento fisioterapêutico na clínica de Fisioterapia do Hospital Regional de Araranguá, localizado na cidade de Araranguá/SC, em agosto de 2006. Conforme a literatura, os sinais e sintomas que foram relatados pelo estudo são considerados como uma conseqüência tardia da infecção aguda da poliomielite, devido à degeneração dos brotamentos dos axônios atingidos pela poliomielite há 40 anos.

The poliomyelitis disease was eradicated in Brazil in the eighties, but now new symptoms related to this pathology are rising, like the post-polio syndrome, which is characterized by a new neurological disorder. These symptoms rise 30 to 40 years after the acute poliomyelitis infection and, as it is a recent pathology, studies and diagnosed cases are scarce. The objective of this study was to describe the onset of this syndrome, through the case of a patient attended in a Physical Therapy Clinic of a Regional Hospital of Araranguá, located in the city of Araranguá/SC, Brazil, in August 2006. According to literature, signs and symptoms reported in the study are considered as the consequence of acute poliomyelitis infection, due to degeneration of budding axons damaged by the poliomyelitis 40 years ago.

Repercussões respiratórias da ventilação por cinta abdominal pneumática em ratos normais / Respiratory repercussions of the ventilation with abdominal pneumatic belt in normal rats

A Cinta Abdominal Pneumática (CAP) é um aparelho utilizado no mercado internacional com o objetivo de melhorar a função pulmonar de pacientes com seqüelas de poliomielite, doenças neuromusculares e lesão raquiomedular. O objetivo desta pesquisa foi avaliar os parâmetros respiratórios durante o uso da CAP através de um experimento com sete ratos normais. A variação da pressão intrapleural (Ppl), o tempo inspiratório (Ti), o tempo expiratório (Te), o tempo total do ciclo (Ttot), a freqüência respiratória (FR), a relação Ti/Ttot e o produto pressão tempo (PTP) foram mensurados com um transdutor de pressão no espaço pleural dos ratos, sem e com a CAP; a fim de se verificar seus reais efeitos fisiológicos. Os resultados mostraram que a CAP determina variação significativa na pressão pleural (p = 0,0489) o que melhora os volumes pulmonares e conseqüentemente a ventilação. A FR, Ti, Te, Ttot não sofreram alterações significativas. A variação da relação Ti/Ttot e do PTP não foi significativamente diferente, o que é vantajoso, uma vez que refletem aumento do gasto energético da respiração. Observou-se também assincronia durante seu uso, funcionando como estímulo inspiratório e não como auxílio expiratório.

The Abdominal Pneumatic Belt (APB) is a device used in the international market with the objective to improve the pulmonary function of patients with polio sequels, neuromuscular disorders and injury of spinal cord. This research considered an evaluation of the respiratory parameters during the use of the APB through an experiment with seven normal rats. The variation of the pleural pressure (Ppl), the inspiratory time (Ti), the expiratory time (Te), the total time of the cycle (Ttot), the respiratory frequency (FR), the Ti/Ttot relation and the pressure-time product (PTP) had been measure, through a transducer of pressure in the pleural space, without and with such equipment; in order to analyze its real physiological effect. The results had shown that the APB determines significant variation in the pleural pressure (p = 0,0489) what probably determines better pulmonary volumes and consequently better ventilation. The FR, Ti, Te and Ttot had not suffered significant alterations. The variation of the Ti/Ttot relation and the PTP is not significant too, what it would be advantageous, because it reflects increase of energy expense of the breath. It was observed an antagonism during the use, functioning as inspiratory stimulation and not as expiratory aid.

Acute flaccid paralysis surveillance: looking beyond the global poliomyelitis eradication initiative.

In 1992 surveillance of acute flaccid paralysis (AFP) cases was introduced in Malaysia along with the establishment of a national referral laboratory at the Institute for Medical Research. The objective of this study was to determine the incidence, viral etiology and clinical picture of AFP cases below 15 years of age, reported from 2002 to 2007. Six hundred seventy-eight of 688 reported cases were confirmed as AFP by expert review. The clinical presentation of acute flaccid paralysis in these cases was diverse, the most commonly reported being Guillian-Barre syndrome (32.3%). Sixty-nine viruses were isolated in this study. They were Sabin poliovirus (25), Echovirus (22), Cocksackie B (11), EV71 (5), Cocksackie A (1), and untypable (5). Malaysia has been confirmed as free from wild polio since the surveillance was established.

Correction of genu recurvatum in poliomylitis by the ilizarov method

Mild Genu Recurvatum can cause some disability, but when quadriceps is severely weakened as in poliomyelitis, such a deformity is desirable. However severe genu recurvatum is significantly disabling. The Ilizarov apparatus was used to correct genu recurvatum in eight patients suffering from poliomyelitis using our new technique of pate liar block of the proximal tibia. In six cases, the genu recurvatum was entirely due to capsuloligamentous stretching resulting in posterior translation of the tibia whereas in two cases it was associated with osseous deformity. Preoperatively, the angle of recurvatum averaged 33.8° [23 to 42]. The average duration of external fixation was 4.8 month [3 to 7]. At the last follow-up, all patients, except one, had achieved an excellent or good radiological and functional outcome. Three patients suffered complications including, pin-track infection and Knee stiffness. Our results indicate that the Ilizarov apparatus is an effective tool for managing the deformity of Capsuloligamentous Genu recurvatum, with or without shortening

Knowledge and management of disabling conditions in South Asian histories: implications for leprosy futures.

Elimination of leprosy as a public health problem appears feasible in South Asia in the present decade through multi-drug therapy, but management of disability in cured leprosy patients will continue through the 21st century, probably with some ongoing stigma. This paper provides new perspectives on leprosy-related disabilities by reviewing the historical careers of four disabling conditions sharing some features with leprosy: lathyrism, iodine deficiency disorders (IDD), cataract and poliomyelitis. All are targeted for eradication or serious reduction using affordable surgery or preventive measures, yet they have proved unexpectedly resilient. Technical solutions alone bring only partial success. There is a need also for community-based delivery methods, individual and family self-help, and some redeployment of professional expertise.

results of U- shaped calcaneo-talar osteotomy in correction of hindfoot deformities

Thirty patients; 21 males [70%] and 9 females [30%] with an average age of 24 years old had had hindfoot deformities due to old poliomyelitis in 24 cases [80%] and neglected T.E.V in 6 cases [20%] and subjected to a calcaneotalar osteotomy. The presenting hindfoot deformities included: equinovarus in 22 cases [73.33%]; equinovalgus in 2 cases [6.66%], ealcaneus in 4 cases [13.33%] and calcaneovalgus in 2 cases [6.66%]. Associated mid and forefoot deformities included: cavovarus in 22 cases [73.3 3%]; calcaneovalgus in 2 cases [6-66%] and forefoot valgus in 2 cases [6.66%] and clawing of toes in 18 cases [60%]. Unstable ankle was present in 3 cases [10%]. Previous 42 operations had been done at an average period of 16 years before. The ostcotomy describes a roughly semicircular cut from just posterior to the talocalcanean joint, downwards in the calcaneus and upwards and forward into and through the talar head. Postoperative cast fixation was done in 3 cases [10%] and Ilizarov external fixator was used in 27 cases [90%]. Additional operations were done to corea the mid and hind foot and toe deformities and to stabilize the unstable ankle either at the first operation or at 2 and 4 weeks interval from the first operation. The average postoperative fixation was 3 months in the cast and 5 months in the fram. No major complications were happened The average follow - up period was 3 year. The mean time for osteotomy site to unite was 21/2 months. The subjective results were excellent in 18 cases [60%]; good in 9 cases [30%] and poor in 3 cases [10%]. Objectively, the results were excellent in 24 cases [80%] and good in 6 cases [20%]

Gestante portadora de cifoescoliose acentuada associada a pelve raquitica e sequela de poliomelite: apresentaçäo de um caso e revisäo da literatura / Pregnant carrier of pronounced kyphoscoliosis, associated to rachitic pelvis and sequel of polyomyelitis: report of a case and review of the literature

O presente caso diz respeito a uma paciente portadora de cifoescoliose acentuada associada a pelve raquitica e sequela de poliomelite, contraida aos 11 meses de idade e pré eclampsia leve

Isolation of poliovirus from cases of acute flaccid paralysis.

OBJECTIVE: To evaluate the frequency of isolation of polio and other viruses from fecal samples in subjects with acute flaccid paralysis in northern parts of India. SETTING: Rural and Urban Immunization Centers used for Expanded Programme on Immunization. METHODS: 219 fecal samples were collected by anal tube in 1992 from Punjab, Haryana, Himachal Pradesh and Chandigarh and processed for virus isolation. RESULTS: Of 219 fecal samples, 103 (47%) were positive for viruses in the age group of 3 mo to 5 yr. Amongst the positive samples, the predominant isolated was poliovirus type 1 (70.9%) from all the States. Non polio enteroviruses were isolated from 20.4% of fecal samples. CONCLUSION: Even though poliovirus is still the most common etiologic agent for acute flaccid paralysis in northern India, non polio enteroviruses are also emerging as important causal pathogens in this condition.

Alongamento ósseo da tíbia nas sequelas de poliomielite pelo método de Ilizarov - parte II / Lengthening of the tibia in poliomyelitis using Ilizarov technique

Os autores apresentam o estudo realizado em 19 pacientes portadores de sequelas de poliomielite submetidos ao alongamento ósseo da tíbia pelo método de Ilizarov durante o período de 1990 a 1992 no Departamento de Ortopedia e traumatologia da Escola Paulista de Medicina, Serviço do Prof. Dr. José Laredo Filho. O encurtamento mínimo encontrado foi de 2,5 cm e omáximo de 6,5 cm(média de 4,5 cm). O tempo de tratamento variou de 5 a 19 meses (média de 12 meses). Onze pacientes obtiveram a equalizaçåo dos membros (58//). Todas as complicaçÆes encontradas foram facilmente tratadas pelos meios ortopédicos convencionais. Um encurtamento residual de 0,5 cm foi encontrado em dois pacientes (10,5//); 1 cm de encurtamento foi observado em 5 pacientes (26,5//) e 1 paciente (5//) ficou com um encurtamento residual de 2 cm

Técnica de alongamento ósseo da tíbia nas sequelas de poliomielite utilizando o método "Ilizarov". Parte I / Lengthening of the tibia in poliomyelitis Ilizarov technique I

Os autores apresentam o emprego do fixador de Ilizarov com uma montagem composta de três anéis. O método foi utilizado em 19 pacientes portadores de sequelas de poliomielite para a realizaçåo do alongamento ósseo da tíbia. Analisam as vantagens da montagem proposta no alongamento da tíbia

Achalasia occurring years after acute poliomyelitis

Descrevemos o caso de uma paciente do sexo feminino de 19 anos de idade e com queixa de disfagia há 4 meses. Os exames radiológicos, endoscópico e manométrico do esôfago foram compatíveis com o diagnóstico de acalásia. Investigaçäo clínica, epidemiológica e exame sorológico foram negativos para doença de Chagas. A paciente havia tido poliomielite aos 3 anos de idade, permanecendo com atrofía muscular na perna esquerda. É possível que a acalásia do esfíncter inferior do esôfago seja conseqüente a lesöes na área do núcleo motor do nervo vago provocadas pela poliomielite. A associaçäo entre polimielite e acalásia favorece a hipótese de que acalásia seja conseqüência de doença infecciosa

Z-osteotomy in limb lengthening

Z-osteotomy is a modified technique that involves controlled distraction after subperiosteal, metaphysiocortical osteotomy in a Z- shaped manner. The technique and its advantages over other methods are described. Results of lengthening involving 29 operated bone segments [10 femura and 19 tibiae] in 23 patients are reviewed. All except one are due to limb length inequality as a complication of poliomyelitis. The desired amount of lengthening was achieved verying from 3 to 8 cm for a single bone, with a mean of 6.8 cm. The percentage increase over the initial length varied from 8 to 23% with a mean of 19%. All the lengthened segments healed without the need for bone graft and in a very short period in comparison with any other technique, especially there is no delay period and 1 cm can be gained at the first postoperative day. The complications were mentioned and no care of early or delayed bone consolidation was recorded

Inmunoprofilaxia de la poliomielitis / Inmunoprophilaxis of poliomielitis

La poliomielitis es una enfermedad viral, generalizada y aguda, que afecta al sistema nervioso central con severidad variable, y a veces se complica con parálisis. Si ocurre esto último, se trata de una parálisis fláccida, generalmente asimétrica, de diversos músculos estriados que a veces se acompaña de trastornos respiratorios y vasomotores. La poliomielitis solamente afecta al ser humano y al no haberse demostrado que en la naturaleza existen reservorios animales, se trata de una enfermedad que puede ser erradicada si se consigue inmunizar el número adecuado de sujetos como para interrumpir definitivamente la cadena de transmisión. Los subtítulos en que se divide el trabajo son: Historia, Agente, Patogenia, Diagnóstico, Inmunología, Epidemiología, Vacunas disponibles, Vacunas inactivadas, Vacuna atenuada, Reacciones diversas, Otros esquemas de inmunización, y Nuevas vacunas