RESUMO
A case of primary omental torsion seen in a 26-year-old man is discussed. All signs and symptoms mimicked acute appendicitis. The patient underwent emergency laparotomy in which a normal appendix and serohemorrhagic fluid in the pelvis were observed. The pathological diagnosis was a primary torsioned omentum which was thus excised. This case helps to emphasize the importance of a routine exploration of the abdomen when serohemorrhagic fluid is found at the time of laparotomy in the absence of any pathological condition in the pelvis.
Assuntos
Apendicite/diagnóstico , Omento/patologia , Doenças Peritoneais/cirurgia , Doença Aguda , Adulto , Diagnóstico Diferencial , Humanos , Laparotomia , Masculino , Omento/cirurgia , Anormalidade TorcionalRESUMO
Although postoperative pain following laparoscopic cholecystectomy (LC) is less intense than that after open surgery, postoperative morbidity nonetheless increases with LC. The aim of this study was to investigate whether local anesthetic infiltration of trocar sites during LC decreased postoperative pain and, if so, to find the optimum timing for local anesthesia (LA). Seventy patients undergoing LC were randomized into three groups. In the first (control group, n = 25) 3 ml of 0.9% NaCl was subcutaneously infiltrated around each 5-mm trocar site, 4 ml around each 10-mm site. In the second group (n = 20), the same volume of local anesthetic was administered in the same manner prior to surgery, and in the third group (n = 25) an identical dose of local anesthetic was infiltrated at the end of surgery. A visual analog scale was given to all patients, who were asked to record their pain intensity at 1, 3, 5, 7, and 12 h postoperatively. Pethidine HCl 1 mg/kg i.m. was given to those whose pain intensities were greater than 5. The mean pain intensities were 7.6, 5.9, and 5.1 in the control, preoperative, and postoperative LA groups, respectively. In the preoperative LA group, 50% of patients and in the postoperative LA group 28% of patients required analgesics compared with 76% in the control group. The main pain intensities and analgesic requirements were significantly lower in the postoperative LA group compared with other groups. We conclude that local anesthesia during LC reduces postoperative pain and that infiltration of trocar sites following surgery offers better pain relief than local anesthetic given just before the incision.
Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Colecistectomia Laparoscópica , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Análise de Variância , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Colecistectomia Laparoscópica/métodos , Feminino , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Fatores de TempoRESUMO
A 67 year old patient with overt signs of hyperthyroidism had high serum TSH values in addition to high T3 and T4 values. Initial treatment with propyltiouracil (PTU) reduced the high serum thyroid hormone levels but TSH levels were further increased. With an augmented TSH response to TRH and negative sella tomography, diagnosis of inappropriate secretion of TSH was made. PTU was stopped and bromocriptine 10 mg daily given with perfect result in 18 weeks. The patient is euthyroid on bromocriptine therapy.
Assuntos
Bromocriptina/uso terapêutico , Hipertireoidismo/sangue , Hipertireoidismo/tratamento farmacológico , Doenças da Hipófise/tratamento farmacológico , Tireotropina/sangue , Tireotropina/metabolismo , Idoso , Feminino , Humanos , Tiroxina/sangue , Tri-Iodotironina/sangueRESUMO
Mediators responsible for renal changes in obstructive jaundice are not specified. This study is designed to study the role of endothelin-1 (ET-1) in obstructive jaundice in rats. Animals were randomly placed into five experimental groups. Group 1 (N = 3) was the sham-operated group. Group 2 (N = 8) after common bile duct (CBD) ligation, received bosentan, which is a nonselective endothelin receptor blocker, 50 mg/kg/day for seven days. Group 3 (N = 7) received 1 microg/kg/day captopril. Group 4 (N = 7) was given both drugs orally for seven days. Group 5 (N = 6) after CBD ligation, received Arabic gum as the vehicle. Blood was drawn from the infrahepatic vena cava for the determination of ET-1, bilirubin, creatinine, protein oxidation products, hyaluronic acid, and beta-N-acetyl-hexosaminase. Liver tissue samples were obtained to determine glutathione levels. ET-1, protein oxidation products, hyaluronic acid, bilirubin, and creatinine levels increased significantly in the control group when compared with sham. Bosentan effectively prevented ET-1 elevation but could not reverse creatinine or bilirubin elevation. Captopril with or without bosentan was cytoprotective but did not reverse increased creatinine levels. It is concluded that increased ET-1 in obstructive jaundice may be one of the contributing factors of renal damage.