Acute Abdomen Secondary to a Spontaneous Perforation of the Biliary Tract, a Rare Complication of Choledocholithiasis.

INTRODUCTION: The spontaneous perforation of the biliary tract (SPBT) is an extremely rare cause of peritonitis, which was first described by Freeland in 1982, to date only around 70 cases have been reported. Here we present a case of spontaneous perforation of the biliary tract, in a patient with choledocholithiasis, which was treated with ultrasound-guided drainage and ERCP. CASE REPORT: A 51-year-old male was admitted to the emergency room for 15-day evolution jaundice, localized pain in the right flank and hypochondrium of 3days. He had a history of cholecystectomy 15 years ago and 4 episodes of cholangitis, the last one in 2015. A magnetic resonance imaging (MRI) was performed, that showed evidence of choledocholithiasis, in addition to a possible biliary leakage. The patient was treated with ultrasound-guided drainage and ERCP successfully. DISCUSSION: Spontaneous perforation of the biliary tract is a disease entity in which wall of the extrahepatic or intrahepatic duct is perforated without any traumatic or iatrogenic injury. The clinical presentation varies from nonspecific abdominal pain to biliary peritonitis, in most of the cases forming bilomas. Universal management involves decompression of the biliary tree and repair of the leak site. CONCLUSION: The spontaneous perforation of the biliary tract is a disease that represents a diagnostic challenge. The treatment in the patients with SPBT is not well established and has to be individualized for each case, depending on the history of the patient, the site of perforation, the time of evolution, the suspicion of infection, and the patient status.

A rare case of subacute appendicitis, actinomycosis as the final pathology reports: A case report and literature review.

INTRODUCTION: Acute appendicitis is the most common indication for an emergency abdominal surgery in the world, with a lifetime incidence of around 10%. Actinomycetes are the etiology of appendicitis in only 0.02%-0.06%, having as the final pathology report a chronic inflammatory response; less than 10% of the cases are diagnosed before surgery. Here, we present the case of a subacute appendicitis secondary to actinomycosis. CASE REPORT: A 39-year-old male presented with a twelve-day evolution of intermittent abdominal pain in the right lower quadrant, treated at the beginning with ciprofloxacin and urinary analgesic. The day of the admission he referred intense abdominal pain with nausea. An open appendectomy was preformed, finding a tumor-like edematous appendix with a diameter of approximately 2.5cm. DISCUSSION: Actinomyces are part of the typical flora of the oral cavity, gastrointestinal tract and vagina. The predominant form of human disease is A. Israelii, it requires an injury to the normal mucosa to penetrate and cause disease. Abdominal actinomycosis involves the appendix and caecum in 66% of the presentations, of these, perforated appendicitis is the stimulus in 75% of the cases. A combination of antibiotic therapy and operative treatment resolves actinomycosis in 90% of cases. CONCLUSION: Abdominal actinomycosis is an uncommon disease been the common presentation a perforated appendicitis, here we present a less common presentation of it with a non-perforated appendix.

Inhibitory properties of the anti-bothropic complex from Didelphis albiventris serum on toxic and pharmacological actions of metalloproteases and myotoxins from Bothrops asper venom.

Anti-bothropic complex (ABC) was isolated from the serum of the South American opossum (Didelphis albiventris) by single-step affinity chromatography using a Sepharose-immobilized metalloprotease (BaP1) from Bothrops asper as the binding protein. Biochemical characterization of ABC showed the presence of two glycosylated subunits of 43 and 45 kDa, respectively, with an isoelectric point < 4. The two subunits were separated by ion-exchange HPLC. The N-terminal sequences of both subunits (LKAMDPTPXLWIETESP, where X is Arg-9 and Pro-9, respectively) showed a high degree of identity with other serum inhibitors isolated from different marsupials. Functional studies pointed out that ABC inhibits the hemorrhagic and proteolytic activities on fibrin, fibrinogen, and casein induced by the metalloproteases BaP1 and BaH4 isolated from B. asper venom. In addition to the anti-hemorrhagic and anti-proteolytic activities, ABC also showed anti-myotoxic, anti-lethal, and anti-edematogenic effects against myotoxic phospholipases A(2) isolated from the same venom. Moreover, it had inhibitory effects on the phospholipase A(2) activity of the crude venom as well as the isolated venom phospholipases A(2).

Distal sensory polyneuropathy in a cohort of HIV-infected children over five years of age.

BACKGROUND: Peripheral neuropathy in children with human immunodeficiency virus (HIV) infection has not been systematically studied. Objectives. To describe the symptoms and signs of peripheral neuropathy in HIV-infected children and to determine their frequency. METHODS: A cross-sectional study was conducted on a convenience sample from a cohort of children older than 5 years of age at the pediatric HIV outpatient clinic of the Federal University of Rio de Janeiro. Those patients were interviewed and examined systematically for peripheral nerve symptoms and signs. RESULTS: A total of 39 patients were clinically evaluated. Their ages ranged from 5 to 14 years, and 13 patients (34%) had symptoms and signs of peripheral nerve involvement. Distal paresthesia and/or pain plus diminished ankle jerks and/or diminished vibration sense were the most common clinical findings. Symptoms were chronic and fluctuating, and pain was, in general, not severe. Nerve conduction studies primarily revealed axonal changes. CONCLUSIONS: Peripheral neuropathy occurs in one third of HIV-infected children, and, in general, has less severe features than the distal sensory polyneuropathy described in adults. peripheral neuropathy, human immunodeficiency virus, children.

Vascularizacao das paredes intestinais subsequentes aos diversos tipos de sutura. Estudo experimental em caes. / Vascularization of the intestinal walls subsequent to the suture types. Experimental study in dogs

Em trabalho experimental os autores estudam a vascularizacao dos tecidos envolvidos em anastomoses intestinais realizadas em dois planos de sutura, variando os tipos de sutura do primeiro plano (pontos simples, pontos em U e sutura continua em guarda grega) e anastomoses em plano unico extramucoso. Os resultados encontrados levaram-nos a deduzir que os diversos tipos de sutura seromuscular nao interferem significativamente na vascularizacao das anastomoses, o mesmo nao ocorrendo em relacao a sutura em plano total. Em termos comparativos, as anastomoses em plano unico extramucoso mostraram vascularizacao significativamente melhor que as anastomoses em dois planos

Estudo experimental da vascularizacao dos tendoes planos da parede abdominal. / An experimental study of the vascularization of plain tendons of abdominal wall

Os autores estudaram, no animal de experimentacao, a vascularizacao dos tendoes planos do abdome pelo metodo de injecao de tinta nankin e diafanizacao. Verificaram que tais estruturas tem irrigacao sanguinea propria, com rede vascular presente na intimidade dos tendoes. Tais vasos sanguineos tinham origem mais frequentemente do tecido subcutaneo e, em menor numero, dos musculos adjacentes e outros tecidos. Sao feitas algumas consideracoes a respeito da aplicacao desses achados a cirurgia da parede abdominal

Estudo anatomico do aparelho extensor do polegar. / Anatomic study of the thumb extensor apparatus

Foram dissecadas macroscopicamente e sob estereomicroscopio 21 pecas anatomicas.Estabelecemos a morfologia do aparelho extensor do polegar constituido de tres porcoes: asa radial, asa ulnar e porcao central. Foi analisada a participacao funcional destas estruturas em relacao as articulacoes metacarpo-falangica e inter-falangica

[Functional architecture of the ligamentum arteriosum in adults]. / Beitrag zur kenntnis der funktionellen architektur des ligamentum arteriosum beim erwachsenen menschen

The ligamentum arteriosum was studied in eight normal adult human hearts obtained at autopsy. Four of these hearts were treated by the Zemper method and extensively dissected under a steromicroscope (from X 6 up to X 40); two were embedded in celloidin and sectioned at 100mugm; two were embedded in paraffin and sectioned one 50mugm and the other at 75 mugm. Section were stained by the axan and the resorcin-fuchsin methods. Unstained sections were examined under polarized light. The ligamentum arteriosum may be considered as a small smooth muscle, whose origin is in the arteria pulmonalis sinistra and the insertion in the arcus aortae. Therefore, the ligamentum arterisum may be considered as a myoelastic system, included in a collagenous stroma. Muscle, elastic and collagen fibers present a cross-spiral disposition. Being a myoelastic system with a collagen component, the ligamentum arteriosum cannot be considered as a simple arcus aortae support; it must play some functional role in controlling the arcus aortae curvature during the several different steps of the cardiac cycle.