Eliminação de Dioctophyme renale pela urina em canino com dioctofimatose em rim esquerdo e cavidade abdominal - Primeiro relato no Rio Grande do Sul / Elimination of Dioctophyme renale to urine in canines with dioctophymosis in the left kidney and abdominal cavity - First report in Rio Grande do Sul

Dioctophyme renale é um parasito que afeta tanto animais como humanos e tem como órgão de eleição o rim direito. Relata-se o caso clínico-cirúrgico de um paciente canino com histórico de eliminação de três exemplares de D. renale pela urina e presença de parasitos no rim esquerdo e na cavidade abdominal. No Hospital de Clínicas Veterinárias da Universidade Federal de Pelotas, foram realizados exames pré-cirúrgicos, entre eles a ultrassonografia abdominal, que identificou a localização dos nematódeos, e o exame de Doppler pulsado dos vasos intrarrenais, que demonstrou aumento nos índices resistivos nas regiões avaliadas. O paciente foi conduzido para a realização de laparotomia exploratória, sendo removidos 23 parasitos da cavidade abdominal. A presença de D. renale causa graves lesões nos rins e nos demais órgãos da cavidade abdominal, sendo essencial o diagnóstico precoce e a remoção dos nematódeos para recuperação do paciente.(AU)

Dioctophyme renale is a parasite that attacks animals as well as humans and has the right kidney as a preferred target organ. This document reports the case of a clinical-chirurgical canine patient with a history of elimination of three D. renale samples through its urine and presence of parasites at its left kidney and abdominal cavity. Pre-cirurgical exams were performed at the Veterinary Hospital of the Federal University of Pelotas. Among these exams, abdominal ultrasonography identified the nematode's location and the Pulse-Doppler of the intrarenal vessels showed an increase in the resistive indices of the evaluated areas. An Exploratory Laparotomy was conducted with the patient who had 23 parasites removed from its abdominal cavity. The presence of D. renale causes severe lesions at kidneys and other organs of the abdominal cavity, for this reason early diagnosis and nematode´s removal are essential for the patient's recovery.(AU)

A rare cervical spine abnormality associated with neurofibromatosis.

Spinal abnormalities such as kyphoscoliosis and vertebral scalloping are frequent occurrences in type 1 neurofibromatosis (NF1). We report this rare case of posterior displacement of C3 vertebral body into the spinal canal causing severe cord compression associated with neurofibromatosis in a 13-year old girl. She underwent anterior excision of C3 vertebral body, bone graft and fixation of C2- C4, with improvement of her symptoms.

Microbiology of cerebral abscess at the neurosurgical unit of the National Hospital of Sri Lanka.

OBJECTIVES: To determine the microbial pathogens responsible for cerebral abscess, ascertain the most suitable antibiotic for treatment and to determine the predisposing causes of cerebral abscess. DESIGN: Prospective study with microbiological investigation of pus aspirated from cerebral abscesses. SETTING: Neurosurgical Unit, National Hospital of Sri Lanka, Colombo. STUDY GROUP: 41 patients with cerebral abscess. PERIOD OF STUDY: 18 months (May 1997 to December 1998) RESULTS: Of the 41 samples of pus 26 (63.1%) gave a positive microbial culture. The Gram stain of the direct smear was positive in 77% of the 26 positive cultures. The most frequently occurring species were Streptococcus milleri group (35%) followed by Staphylococcus aureus (10%). Anaerobes accounted for 23% of positive cultures. All Streptococcus milleri isolates were penicillin and cefotaxime, and all anaerobic isolates except one were susceptible to sensitive to metronidazole. 75% of Gram negative bacilli isolated were sensitive to cefotaxime. All Staphylococcus aureus isolates were methicillin resistant, but sensitive to vancomycin and chloramphenicol. Common predisposing conditions were congenital heart disease (30%), trauma (25%), middle ear disease (7%), and meningitis (7%). CONCLUSIONS: Organisms of the Streptococcus milleri group were most frequently found in cerebral abscesses. The present empirical therapeutic regime adopted in the unit which consisted of cefotaxime 1 g intravenously three times daily and metronidazole 500 mg intravenously three times daily was found to be satisfactory as a majority of the organisms isolated were sensitive to these antimicrobials. In the case of methicillin resistant Staphylococcus aureus (MRSA), it is recommended that chloramphenicol be added to the current regime in management until the antibiotic sensitivity pattern is available.

Microbiological aspects of peritonitis in patients undergoing chronic peritoneal dialysis at the dialysis unit of Sri Jayawardenapura General Hospital.

BACKGROUND: Peritoneal dialysis (PD) is an established form of therapy in the management of end stage renal disease. Peritonitis is the main complication of PD. OBJECTIVES: To study the incidence and microbial aetiology of peritonitis in patients undergoing chronic PD at the dialysis unit of Sri Jayewardenapura General Hospital (SJGH); to assess the diagnostic value of the Gram's stain; and to study the relationship of the total white cell count of effluent to peritonitis. DESIGN: A prospective study over three months. SETTING: Dialysis unit of SJGH. PATIENT POPULATION: The study involved 18 patients undergoing manual intermittent peritoneal dialysis (IPD), 4 patients undergoing chronic ambulatory peritoneal dialysis (CAPD), and 1 patient undergoing nocturnal intermittent peritoneal dialysis (NIPD). MEASUREMENTS: Clinical presentation of patients with peritonitis; total and differential white blood cell counts of effluent samples; Gram stain and culture of the centrifuged deposit to determine microbial aetiology; incidence of peritonitis in different categories of dialysis. RESULTS: 32 samples were examined from patients on IPD, and 17 from patients on CAPD. In IPD most episodes were due to Gram negative organisms whereas in CAPD most episodes were due to Gram positive organisms. Sensitivity of Gram's stain in relation to culture was 32.4%. 98% of effluent samples had white blood cell counts of > 100/ml and none showed neutrophil counts of < 49%. CONCLUSIONS: The incidence of IPD associated peritonitis was 11.1 episodes per patient year, and the incidence of CAPD associated peritonitis was 14 episodes per patient year. Flavobacterium spp. were the predominant organisms in IPD associated peritonitis, whereas CAPD associated peritonitis was commonly caused by coagulase negative staphylococci. Gram's stain was not useful in the initial identification of the causative agent, but the white cell and neutrophil counts were found to be sensitive indicators of peritonitis.

The work of a diabetes clinic: an audit.

OBJECTIVE: To audit outcome and process of care at the diabetic and medical clinics. DESIGN: Prospective interventional study with each patient acting as a retrospective control. SETTING: The Sri Jayawardenepura General Hospital (SJGH) diabetic clinic. PATIENTS: 250 consecutive patients with NIDDM transferred to the diabetic clinic from the general medical clinic. INTERVENTION: Participation in a structured scheme of health care delivery which included patient education dietary advice and screening for complications. MEASUREMENTS: Fasting blood glucose, patients' knowledge score, patient satisfaction, frequency of screening. RESULTS: A Significant improvement was seen after attendance at the diabetic clinic in fasting blood glucose (8.7 SD 1.3 vs 12.5 SD 3.2 mmol/l, p < 0.05), body mass index (26.8 SD 0.6 vs 27.4 SD 0.4 kg/m2, p < 0.05), admission rates (10% vs 21%, p < 0.05), patients knowledge score (76 SD 12 vs 42 SD 16%, p < 0.05) rates of screening for retinopathy (88% vs 6%, p < 0.05) and patient satisfaction in clinical care (87% vs 13%, p < 0.05). There was no significant improvement in cholesterol levels (5.7 SD 0.1 vs 5.8 SD 0.9 mmol/l). CONCLUSIONS: The diabetes clinic is a more efficient system and a more appropriate setting to care for patients with NIDDM.

Prevalence of lipid abnormalities in Sri Lankan patients with non-insulin dependent diabetes mellitus.

OBJECTIVE: To determine the prevalence of hyperlipidaemia in Sri Lankan patients with non-insulin dependent diabetes mellitus (NIDDM) and a normal control population. DESIGN: A cross-sectional study. SETTING: Patients with NIDDM randomly selected from a diabetic clinic register and non-diabetic controls randomly selected from an electoral register. PATIENTS: 498 patients with NIDDM (197 females mean age 53.5, SD 6.2 years) and 253 non-diabetic controls (101 females, mean age 53, SD 5.5 years matched for age and sex. METHODS: Diabetes and impaired glucose tolerance (IGT) were excluded in the control group by a 75g oral glucose tolerance test. Total cholesterol, high density cholesterol and triglycerides were determined in fasting blood samples. RESULTS: The prevalence of lipid abnormalities was significantly higher in diabetic patients than in controls. The prevalence of hypercholesterolaemia was 21% vs 14% and that of hypertriglyceridaemia 16% vs 8.3%. Mean fasting blood glucose was higher (9.7 + 2.7) in hyperlipidaemic patients than in normolipidaemic diabetic patients (7.5 + 2.1) CONCLUSIONS: Hyperlipidaemias are common in Sri Lankan patients with NIDDM and screening for them should be an essential component of management of patients with diabetes mellitus.

Primeras observaciones sobre la aplicacion de la prolamina en la pancreatitis aguda necrohemorragica en el hombre. / First observations about the use of prolamine in acute necrohemorrhagic pancreatitis in the man

Continuando una serie de estudios experimentales se presentan las 2 primeras observaciones en el ser humano, de pancreatitis aguda grave tratadas mediante bloqueo intraductal pancreatico con prolamina; existian lesiones hemorragicas severas. Se efectuo ademas colecistectomia, drenaje del coledoco, duodenotomia y papiloesfinterectomia. Ambas enfermas evolucionaron bien, aunque una de ellas con una fistula pancreatica y un absceso subhepatico que curaron espontaneamente. Se evalua la posibilidad de emplear esta droga indicando la intervencion precoz. Se sugiere la posibilidad de combinar el tratamiento quirurgico con el endoscopico para la aplicacion de la droga sin necesidad de hacerlo por via transduodenopapilar

Suturas manuales y mecanicas en cirugia colonica. Estudio experimental comparativo. / Manual and mechanic sutures in colon surgery. Experimental comparative study

Con el objeto de estudiar los resultados histopatologicos comparativos en cirugia colonica utilizando suturas manuales y mecanicas fueron operados 18 perros. Se evaluaron las caracteristicas macro y microscopicas de ambas suturas, hallandose diferencias significativas en los procesos de necrosis y neoformacion

Experiencia con la operacion de Winckelhauser-von Haberer en la cirugia del sindrome de "dumping". / Experience with the Winckelhauser-Von Haberer operation in the surgery of dumping syndrome

Se presenta 4 observaciones de sindrome de "dumping" grave que requirieron cirugia correctora por fracaso del tratamiento medico. Se empleo en ellos regastrectomia con anastomosis grastroduodenal terminolateral a la manera de Winckelhauser-Von Haberer, obteniendo la curacion de los 4 pacientes

Neumoperitoneo de etiologia poco frecuente. / Pneumoperitoneum of rare frequency etiology

Se estudia el neumoperitoneo no perforativo que representa el 10% de los hallazgos de aire en la cavidad peritoneal, si se excluyen los neumoperitoneos diagnosticos y terapeuticos. La importancia de su conocimiento reside en la posibilidad de evitar operaciones inutiles, cuya ejecucion puede poner en peligro la vida de un paciente, a veces seriamente comprometida.Se presentan 4 casos clinicos, en uno de los cuales se evito la laparotomia explorador

Experiencia con mallas de materiales heterologos como elementos sustitutivos de la pared abdominal. Polipropileno y acido poliglicolico. / Experience with a mesh of heterologous materials with replacement elements of the abdominal wall. Polypropylene and polyglycolic acid

Se presentan 35 pacientes en quienes se utilizo malla de polipropileno como elemento de reemplazo de la pared abdominal.Se analizan las complicaciones inherentes a dicho elemento y su tratamiento. Se exponen las caracteristicas y cualidades de una nueva malla reabsorbible y su aplicacion en dos observaciones, una como sustitutiva de la pared abdominal y otra como elemento de refuerzo

Correlacion clinica y de los metodos de diagnostico con los hallazgos operatorios en pacientes con presuncion de hipertension biliar. / Correlation of clinics and diagnostic methods with the operative findings in patients with presumptive biliary hypertension

Se seleccionaron 162 pacientes que ingresaron con diagnostico presuntivo de sindrome de hipertension biliar de origen benigno, destacandose la discordancia hallada entre la clinica, el laboratorio y los hallazgos operatorios. Se considera la conveniencia de complementar su estudio con otros procedimientos de diagnostico entre los que merece destacarse la colangiografia retrograda, la colangiografia transparietohepatica y la ecografia

Determinacion temprana del compromiso canalicular de la pancreatitis aguda mediante la utilizacion de la colangiografia transparietohepatica con aguja ultrafina. / Early determination of canalicular involvement of the acute pancreatitis using the percutaneous transhepatic cholangiography

Se presenta una serie de 35 enfermos con diagnostico presuntivo de pancreatitis aguda, a quienes se practico una colangiografia transparietohepatica con el fin de reconocer una probable etiologia litiasica del proceso

Coledocoscopia intraoperatoria en patologia litiasica. / Intraoperative choledochoscopy in lithiasic pathology

Se presentan las primeras observaciones con la coledocoscopia intraoperatoria. Sus resultados no son aun concluyentes por la escasa experiencia acumulada, pero permite considerarla un complemento de indudable valor y promisorio futuro en el estudio intraoperatorio de la via biliar principal

Colangiografia intraoperatoria con placa de contacto. / Intraoperative cholangiography with contact plaque

Se analizan las ventajas observadas mediante la aplicacion de la colangiografia de contacto, oclusal o regional; se aconseja su incorporacion como metodo de estudio intraoperatorio del coledoco terminal, fundamentado en la mayor nitidez de sus imagenes y en la exactitud de sus rasgos anatomicos

Centellograma esofagogastrics en el diagnostico del reflujo gastroesofagico. / Gatroesophageal scintigraphy in the diagnosis of gastroesophageal reflux

En 7 casos con hernia hiatal comprobada radiologicamente se realizo centellograma esofagogastrico. Se describe la tecnica utilizada. En 6 se obtuvo evidencia centellografica de reflujo, mientras que la radiografia simple habia detectado 4. Resulta un metodo confortable para los pacientes ya que elimina el uso de la sonda nasogastrica