RESUMO
We report a case of a baby with Down Syndrome and history of a corrective surgery for a duodenum stenosis, which was subjected to a parenteral nutrition with central venous catheter. A two-dimensional color Doppler echocardiographic examination revealed a voluminous oval-shaped mobile inhomogeneous mass adhering to the tricuspid valve. The intraoperative pathology showed that it was a large fungal vegetation. The probable source of Candida Albicans was an infected intravenous catheter. We wish to remark the role of echocardiography in the diagnosis and choice of timing of surgery.
Assuntos
Candidíase/diagnóstico por imagem , Candidíase/etiologia , Síndrome de Down/complicações , Ecocardiografia Doppler em Cores , Micetoma/diagnóstico por imagem , Micetoma/etiologia , Candidíase/microbiologia , Candidíase/cirurgia , Procedimentos Cirúrgicos Cardíacos , Cateterismo Venoso Central/efeitos adversos , Obstrução Duodenal/microbiologia , Obstrução Duodenal/terapia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Micetoma/microbiologia , Micetoma/cirurgia , Nutrição Parenteral/instrumentação , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
Small intestinal obstruction due to Strongyloides stercoralis is rare and has not been reported in an immunocompetent patient. We describe a 70-year-old immunocompetent man presenting with duodenal obstruction secondary to severe S. stercoralis infestation, as documented on duodenal biopsy. He was treated with ivermectin, with which he recovered remarkably.
Assuntos
Obstrução Duodenal/microbiologia , Strongyloides stercoralis , Estrongiloidíase/diagnóstico , Idoso , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Obstrução Duodenal/tratamento farmacológico , Humanos , Masculino , Estrongiloidíase/tratamento farmacológicoRESUMO
In this study, 41 randomly chosen patients aged 15 to 35 years (mean 22 years) were carefully examined. As primary operations there were 13 membrane excisions, five duodenoduodenostomies, 22 duodenojejunostomies, and one gastrojejunostomy. Twenty-eight patients were symptom-free, ten admitted some discomfort, three had major pains, including one with a history of duodenal ulcer. Reoperation for adhesion ileus had been performed in six patients, in the early postoperative phase in one instance. At late follow-up barium meals (N = 41) showed completely normal findings in two cases only, hiatal hernia in two, gastritis in three, duodenogastric reflux in 12, slight dilation of the duodenum with good emptying and no reflux in 16, a huge duodenal sac in nine, diminished peristalsis in eight, delayed emptying in five, slight luminal narrowing in three, duodenal diverticuli in nine, bezoars in two, and a polyp in the duodenum of one patient. Ultrasound (N = 35) revealed a gallbladder septum in one patient and a dilated common bile duct in another; in one subject the gallbladder was not visualized satisfactorily. Isotope biligraphy (N = 15) showed biliary reflux to the stomach in 12 cases. Endoscopy (N = 20) findings were: esophagitis (1), hiatal hernia (2), gastric mucosa in the lower esophagus (2), biliary reflux (9), gastritis (7), gastric polyps (2), dilated duodenum of variable degree (19), diminished peristalsis (4), marked retention (2), abnormal papilla (3), diverticuli (4), and a persistent membrane (1). Histology showed superficial gastritis in three patients. E coli was cultured from the duodenal juice in five patients and Candida found in two.(ABSTRACT TRUNCATED AT 250 WORDS)