RESUMO
Primary or idiopathic retroperitoneal fibrosis, first described by Ormond in 1948, is a rare and elusive diagnosis, requiring a high level of suspicion. Patients usually present with entrapment of retroperitoneal organs, the most common being the ureters, causing hydronephrosis and acute kidney injury. Here, we present the case of a 56-year-old male presenting for recurrent and intermittent scrotal edema. Upon routine laboratory workup, he was found to have an elevated creatinine level. Imaging showed encasement of bilateral ureters. Bilateral ureteral stents were placed with relief of his obstructive uropathy, followed by normalization of creatinine. The patient later underwent laparoscopic release of retroperitoneal adhesions. Biopsies taken from the operative site showed fibroblast proliferation and elements of acute and chronic inflammation. With further workup of etiologies being negative, he was diagnosed with idiopathic retroperitoneal fibrosis.
Assuntos
Edema/etiologia , Doenças dos Genitais Masculinos/etiologia , Fibrose Retroperitoneal/diagnóstico , Escroto , Corticosteroides/uso terapêutico , Creatinina/sangue , Diagnóstico Diferencial , Edema/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/terapia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Recidiva , Fibrose Retroperitoneal/terapia , Escroto/patologia , Stents , Tomografia Computadorizada por Raios X , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/terapiaRESUMO
Following bariatric surgeries for management of morbid obesity, less nutrients are absorbed, giving rise to complications due to vitamin deficiencies with frequently dramatic consequences. Neurologic complications resulting from folate, vitamin B12, and thiamine deficiencies have been estimated to occur in up to 16% of cases and present within weeks to months following bariatric surgery. Among bariatric surgeries, Roux-en-Y gastric bypass has been the most associated with such deficiencies due to both restrictive and malabsorptive components. Complications are less seen with restrictive surgeries. We report a case of rapid Wernicke's encephalopathy due to a thiamine deficiency in a young female patient following Sleeve gastrectomy (SG).
Assuntos
Cirurgia Bariátrica/efeitos adversos , Gastrectomia/efeitos adversos , Obesidade Mórbida/cirurgia , Encefalopatia de Wernicke/etiologia , Adulto , Feminino , Humanos , Exame Neurológico , Tiamina/uso terapêutico , Deficiência de Tiamina/etiologia , Complexo Vitamínico B/uso terapêuticoAssuntos
Derivação Gástrica/efeitos adversos , Hiperêmese Gravídica/diagnóstico , Obesidade Mórbida/cirurgia , Deficiência de Tiamina/diagnóstico , Encefalopatia de Wernicke/etiologia , Anastomose em-Y de Roux/efeitos adversos , Anastomose em-Y de Roux/métodos , Dilatação e Curetagem/métodos , Feminino , Derivação Gástrica/métodos , Idade Gestacional , Humanos , Hiperêmese Gravídica/complicações , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Gravidez , Doenças Raras , Medição de Risco , Deficiência de Tiamina/complicações , Deficiência de Tiamina/tratamento farmacológico , Resultado do Tratamento , Encefalopatia de Wernicke/fisiopatologia , Encefalopatia de Wernicke/terapia , Adulto JovemRESUMO
INTRODUCTION: Streptococcus pneumoniae is an important organism in view of its prevalence and ability to cause serious infections; its resistance to antimicrobial agents is increasing worldwide. The purpose of this study was to evaluate the patterns of resistance of S. pneumoniae to penicillin, macrolides and various other antibiotics in strains isolated from Lebanese patients. METHODS: 121 strains isolated between January 2005 and January 2009 from two university hospitals in Beirut were identified and tested for MIC determination using the E-test method. The presence of erm(B) and mef(A/E) genes was investigated using PCR. RESULTS: The majority of the strains (73.5%) were isolated from respiratory tract infections, 50.4% were isolated in winter, 15.7% were invasive strains, 61.9% came from male patients, and 68.5% from adults. Out of 121 isolates, 58 were susceptible to penicillin, 61 were intermediate, and 2 were fully resistant to this antibiotic. Amoxicillin-clavunanic acid and cefpodoxime showed 100% activity on all tested isolates. In general, the MICs90 appear to fluctuate within the same range over the four years. The erm(B) gene was detected in 85.3% of the isolates, mef(A/E) in 19.5% whereas erm(A) was not detected in any of the macrolide resistant strains. DISCUSSION: The results of this study have important impact on the empirical antibiotic prescriptions; the increasing prevalence of resistance jeopardises the treatment choices posing a serious threat. Further surveillance and epidemiological serotyping are needed to monitor the local and regional resistance patterns and to track the spread route of resistance.
Assuntos
Farmacorresistência Bacteriana Múltipla , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/efeitos dos fármacos , Adulto , Antibacterianos/farmacologia , Proteínas de Bactérias/análise , Proteínas de Bactérias/genética , Criança , Feminino , Genes Bacterianos , Hospitais Universitários/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Líbano/epidemiologia , Macrolídeos/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Resistência às Penicilinas , Infecções Pneumocócicas/epidemiologia , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/microbiologia , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
Introducción: Streptococcus pneumoniae es un organismo importante en tanto la prevalencia como la capacidad de causar infecciones graves; su resistencia a los antibióticos es cada vez mayor en todo el mundo. El objetivo de este trabajo fue evaluar los modelos de resistencia de S. pneumoniae a penicilina, macrólidos y varios otros antibióticos en cepas aisladas de pacientes libaneses. Métodos: 121 cepas aisladas entre enero de 2005 y enero de 2009 en dos hospitales universitarios en Beirut se identificaron y comprobaron para la determinación de la concentración mínima inhibitoria por el método E-test. La presencia de los genes erm(B) y mef(A/E) investigó mediante PCR. Resultados: La mayoría de las cepas fueron aisladas de infecciones del tracto respiratorio (73,5%). Cincuenta con cuatro por cien fueron aislados en el invierno, 15,7% fueron cepas invasivas, 61,9% procedían de pacientes de sexo masculino, y un 68,5% de adultos. De los 121 aislamientos, 58 fueron susceptibles a la penicilina, 61 fueron intermedios, y 2 fueron completamente resistentes a este antibiótico. Amoxicilina-ácido clavulánico y cefpodoxima mostraron 100% de actividad en todos los aislamientos estudiados. En general, las CMIs90 parecen fluctuar dentro del mismo rango en los cuatro años. El gen erm(B) se detectó en el 85,3% de los aislamientos, mef(A/E) en 19,5%, mientras que erm(A) no se detectó en ninguna de las cepas resistentes a macrólidos. Discusión: Los resultados de este estudio tienen un gran impacto en la prescripción antibiótica empírica en el Líbano. Una mejor vigilancia epidemiológica acompañada de un serotipado es imprescindible para el futuro(AU)
Introduction: Streptococcus pneumoniae is an important organism in view of its prevalence and ability to cause serious infections; its resistance to antimicrobial agents is increasing worldwide. The purpose of this study was to evaluate the patterns of resistance of S. pneumoniae to penicillin, macrolides and various other antibiotics in strains isolated from Lebanese patients. Methods: 121 strains isolated between January 2005 and January 2009 from two university hospitals in Beirut were identified and tested for MIC determination using the E-test method. The presence of erm(B) and mef(A/E) genes was investigated using PCR. Results: The majority of the strains (73.5%) were isolated from respiratory tract infections, 50.4% were isolated in winter, 15.7% were invasive strains, 61.9% came from male patients, and 68.5% from adults. Out of 121 isolates, 58 were susceptible to penicillin, 61 were intermediate, and 2 were fully resistant to this antibiotic. Amoxicillin-clavunanic acid and cefpodoxime showed 100% activity on all tested isolates. In general, the MICs90 appear to fluctuate within the same range over the four years. The erm(B) gene was detected in 85.3% of the isolates, mef(A/E) in 19.5% whereas erm(A) was not detected in any of the macrolide resistant strains. Discussion: The results of this study have important impact on the empirical antibiotic prescriptions; the increasing prevalence of resistance jeopardises the treatment choices posing a serious threat. Further surveillance and epidemiological serotyping are needed to monitor the local and regional resistance patterns and to track the spread route of resistance(AU)