Abdominal compartment syndrome in patients with strangulated hernia.

BACKGROUND: Intestinal obstruction (IO) leads to increased intra-abdominal pressure and abdominal compartment syndrome. The purpose of this study was to investigate the characteristics of abdominal compartment syndrome in patients with IO secondary to strangulated hernia. METHODS: We studied 81 consecutive unselected patients presenting complicated hernias and IO. We measured intra-abdominal pressure using the intra-vesicular pressure method. RESULTS: Preoperative (15 min) intra-abdominal pressure was higher in patients with strangulated hernias. Postoperative (15 min) intra-abdominal pressure in both groups decreased to similar values. Intra-abdominal pressure was measured during the preoperative period in patients with strangulated hernias and during the postoperative period at 15 min (13.8 +/- 6.4 mmHg), 24 h (9.8 +/- 3.2 mmHg) and 48 h (7.4 +/- 2.4 mmHg). Abdominal compartment syndrome developed in 47% cases with strangulated hernias with a mortality of five patients. CONCLUSIONS: Serial measurements of intra-abdominal pressure evidenced the clinical severity of strangulated hernia. Intra-abdominal pressure measurement may be used as a predictor of intestinal strangulation in patients presenting acute abdominal compartment syndrome secondary to complicated hernia.

Rinolito: relato de caso e revisão de literatura / Rhinolith: a case report and literature review

Os autores relatam um caso de obstrução nasal unilateral, rinorréia purulenta e infecção crônica em um mulher de 57 anos causada por rinolito. A patologia mais freqüentemente encontrada em associação com rinolitíase é a sinusite crônica. A rinolitíase é uma concreção calcária estratificada visível ao exame radiológico. O rinolito pode ser um achado acidental em alguns pacientes. Rinolitos são raros e podem ter várias apresentações clínicas. O tratamento de escolha é remoção cirúrgica. Um alto índice de suspeição é necessário para o correto diagnóstico.

Enhanced intestinal motor response to cholecystokinin in post-Nippostrongylus brasiliensis-infected rats: modulation by CCK receptors and the vagus nerve.

The jejunal inflammation induced in rats by the nematode Nippostrongylus brasiliensis is followed by intestinal neuroimmune alterations including mast cell hyperplasia and nerve remodelling. On the other hand, cholecystokinin (CCK) plays a pivotal role in the regulation of intestinal motility. The aim of this study was to determine whether the intestinal motor response to CCK is altered 30 days after infection by N. brasiliensis. Thus, CCK-8 (50 microg kg(-1) intraperitoneally) disrupted the pattern of jejunal migrating myoelectric complexes for a longer time in postinfected rats (95.5 +/- 3.5 min) than in controls (48.1 +/- 5.1 min). This enhanced jejunal response was also found after oral administration of the potent releaser of endogenous CCK, soybean trypsin inhibitor. In contrast, no alteration of the inhibition of colonic motility by CCK administration was observed. The increased responsiveness of jejunal motility to CCK persisted after mast cell stabilisation or depletion but was prevented by atropine, devazepide and L-365260 (CCK-A and CCK-B receptor antagonists, respectively) and vagotomy. These results indicate that neuroimmune alterations after N. brasiliensis infection lead to an increased intestinal motility response to CCK that involves a cholinergic mediation, a vagal pathway and alterations in intestinal CCK-A and CCK-B receptors.

Alterations of intestinal motor responses to various stimuli after Nippostrongylus brasiliensis infection in rats: role of mast cells.

Nippostrongylus brasiliensis infection induces jejunal mastocytosis associated with enteric nerve remodelling in rats. The aim of this study was to evaluate the intestinal motility responses to meals and to neurotransmitters involved in the control of gut motility (acetylcholine (carbachol), substance P and neurokinin A) in both control and N. brasiliensis-infected rats 30 days post-infection. All rats were equipped with NiCr electrodes in the jejunum to record myoelectrical activity. The duration of disruption of the jejunal migrating myoelectrical complexes (MMC) induced by the different stimuli was determined. Meal ingestion and substance P administration disrupted the MMC pattern for similar durations in the two groups. Carbachol and neurokinin A induced a significantly longer MMC disruption in post-infected rats than in controls (125 +/- 8.3 vs. 70 +/- 6 min for carbachol 100 microg kg-1 and 51 +/- 4 vs. 40 +/- 2 for neurokinin A 50 microg kg-1). The enhanced motor response in postinfected rats was reduced by previous mast cell stabilization with ketotifen or mast cell degranulation with compound BrX 537 A. In conclusion, the increased intestinal motor reactivity to carbachol and neurokinin A in post-N. brasiliensis-infected rats depends upon intestinal mast cell hyperplasia and degranulation.

Outbreak of type A botulism and development of a botulism surveillance and antitoxin release system in Argentina.

CONTEXT: Botulism is an important public health problem in Argentina, but obtaining antitoxin rapidly has been difficult because global supplies are limited. In January 1998, a botulism outbreak occurred in Buenos Aires. OBJECTIVES: To determine the source of the outbreak, improve botulism surveillance, and establish an antitoxin supply and release system in Argentina. DESIGN, SETTING, AND PARTICIPANTS: Cohort study in January 1998 of 21 drivers of a specific bus route in urban Buenos Aires. MAIN OUTCOME MEASURE: Occurrence of botulism and implication of a particular food as the vehicle causing this outbreak. RESULTS: Nine (43%) of 21 bus drivers developed botulism, presenting with gastroenteritis, symptoms of acute cranial nerve dysfunction including ptosis, dysphagia, blurred vision, and motor weakness. One driver experienced respiratory failure. Type A toxin was detected from 3 of 9 patients' serum samples. All drivers received botulism antitoxin; there were no fatalities. Consumption of matambre (Argentine meat roll) was significantly associated with illness. Among 11 persons who ate matambre, 9 developed illness, compared with none of those who did not eat it (P<.001). The matambre had been cooked in water at 78 degrees C to 80 degrees C for 4 hours, sealed in heat-shrinked plastic wrap, and stored in refrigerators that did not cool adequately. Subsequently, a botulism surveillance and antitoxin release system was established. CONCLUSIONS: Insufficient cooking time and temperatures, storage in heat-shrinked plastic wrap, and inadequate refrigeration likely contributed to Clostridium botulinum spore survival, germination, and toxin production. A rapid-response botulism surveillance and antitoxin release system in Argentina should provide more timely distribution of antitoxin to patients and may serve as a model for other nations.

The acetabular labral tear: an arthroscopic classification.

Acetabular labral tears are well recognized in the pathology of hip disease. The patterns of such tears found in 37 patients undergoing hip arthroscopy have been analyzed. Distinct categories of labral tear were found, and may be classified in terms of etiology (traumatic, 18.9% of cases; degenerative, 48.6%; idiopathic, 27.1%; congenital, 5.4%) and morphology (radial flap, 56.8%; radial fibrillated, 21.6%; longitudinal peripheral, 16.2%; unstable, 5.4%).

[Temporal lobectomy in refractory partial epilepsy. Report of 4 cases]. / Lobectomía temporal en epilepsias parciales refractarias. Comunicación de cuatro casos.

Thirty, out of 1200 patients of North Santiago Adult Epilepsy Program, were admitted to J J Aguirre Hospital due to refractory epilepsy. Looking for candidates for functional epilepsy surgery, these patients were evaluated by neurologists, psychiatrists and psychologists and with standard EEG, video monitored EEG, CAT scan, magnetic resonance imaging and SPECT. So far, four patients with temporal partial complex epilepsy have been studied, operated (anterior temporal lobectomy and amygdalo-hippocampectomy) and followed for more than one year. Of these, two are free of seizures, one has sporadic episodes and one has an important reduction. One of these patients had a postoperative amnestic syndrome of 3 to 4 weeks duration. According to these results and those reported in the literature, the rigorous selection of patients that could be benefitted by surgery is emphasized.

Carcinoma da trompa de falopio. / Carcinoma of the fallopian tube

No presente artigo mostramos uma patologia de dificil diagnostico e rara.Sua primitividade foi comprovada histologicamente.Foram revisados sua etiologia; aspectos marco e microscopicos, clinica, diagnostico e tratamento

Endometriose de colon sigmoide. / Endometriosis of the sigmoid colon

O presente trabalho consiste na apresentacao de um caso de endometriose do colon sigmoide em que a lesao macroscopica se assemelhava a uma neoplasia maligna e que a inexistencia de outras lesoes pelvicas levou a que se optasse pela ampla resseccao intestinal. Os autores descrevem a incidencia desta patologia, sua clinica e os aspectos incomuns neste caso

Cirurgia de Burch e suas complicacoes imediatas. / Burch surgery and its immediate complications

Os autores apresentam 85 pacientes com I.U.E. operadas pela tecnica proposta por Burch. Apos descrever os criterios adotados no diagnostico da I.U.E., as indicacoes da via retropubica e os cuidados peroperatorios, apresentam suas complicacoes no pos-operatorio imediato ligadas a cirurgia adotada. As possiveis causas que contribuiram sao analisadas e medidas profilaticas sao propostas

[Current concept of chronic secretory otitis]. / Concepto actual de otitis media secretoria crónica.

Excess trust in antibiotic therapy, as well as omission in paracenthesis in treating acute otitis media, are the main factors to account for the development of a new problem in the middle ear: secretory otitis media; that is, presence of liquid, usually of mucoid type, in the tympanic cavity, which constitutes the most common cause of hearing loss in children. The eustachian tube obstruction, being an important mechanical obstructive factor in this pathologic type problem, as well as recent evidence from studies, showing that the mucosa of the middle ear, suffering repeated infections, undergoes metaplasic changes, to a glandular epithelium that maintains the presence of liquid in the cavity. Stress is placed on symptoms and signs in infants and in older children as well as on the medical and surgical therapy of this entity.

[Sinusitis in the child. Evaluation and indication for surgical treatment]. / Sinusitis en el niño. Valoración y oportunidad del tratamiento quirúrgico

Sinusitis in children is a frequent problem in pediatric otorhinolaryngology. Medical treatment is often incomplete or inadequate, creating the need for proper surgical therapy. In a 3 year period (1972-1975), at the E.N.T. Dept. of the "Hospital Infantil de México", a total of 51 patients, from 2 to 16 years age, underwent sinus surgery. The clinical diagnosis was completed with radiological and bacteriological studies. Chronic ethmoidal-maxillary and maxillary sinusitis were the most frequent types seen. Besides, considering E.N.T. sphere, other problems were present, mostly: tonsilloadenoiditis, important rhinoseptal deformity, and chronic otitis media. Also, dental caries, anemia, secondary to malnutrition and intestinal parasitosis, were additional frequent medical problems, among others. Allergic rhinosinusitis was suspected in at least 50% of them and clinically diagnosed in 15%. Bilateral nasoantral windows (antrostomy), and unilateral Caldwell-Luc procedure, were the surgical procedures most frequently performed. Adenoamygdalectomy, septorhinoplasty and mastoidectomy, were other frequent E.N.T. procedures. A total of 57% of the patients showed positive surgical findings at the time of sinus surgery; this is coincident with the work of other authors. Results of surgical and complementary medical management showed 39% of recovery rate. A high percentage of patients (31%), were lost to follow-up after initial surgery. The point of necessary conservative sinus surgery in children, is stressed in this paper.