Diagnóstico, manejo y tratamiento de pacientes con peritonitis secundaria en una unidad de cirugía general / Diagnosis, management and treatment of patients with secondary peritonitis in a general surgery unit

La peritonitis es una inflamación aguda o crónica del peritoneo que generalmente tiene un origen infeccioso. Existen varios tipos, siendo la de tipo secundario la más frecuente. El término peritonitis secundaria se define como la inflamación localizada o generalizada de la membrana peritoneal causada por infección polimicrobiana posterior a la ruptura traumática o espontánea de una víscera o secundaria a la dehiscencia de anastomosis intestinales. Esta entidad se caracteriza por la presencia de pus en la cavidad peritoneal o de líquido; que, en el estudio microscópico directo, contiene leucocitos y bacterias. El tratamiento de esta patología constituye una urgencia y puede ser de tipo clínico y/o quirúrgico. El objetivo del manejo operatorio se basa en identificar y eliminar la causa de la infección, recoger muestras microbiológicas, realizar una limpieza peritoneal y prevenir la recidiva. El tratamiento clínico se ocupa de las consecuencias de la infección mediante la reanimación perioperatoria y el tratamiento antibiótico1. A pesar de los avances en diagnóstico, procedimientos quirúrgicos, terapia antimicrobiana y cuidados intensivos, la mortalidad asociada con la peritonitis secundaria grave es aún muy alta. El pronóstico y el manejo oportuno representan la clave para mejorar la sobrevida y reducir la mortalidad asociada a infecciones intraabdominales extensas2. Es importante establecer lineamientos en cuanto al diagnóstico, manejo antibiótico y pautas de tratamiento quirúrgico para disminuir la morbilidad y mortalidad asociada a esta enfermedad. Palabras clave: Peritonitis; Peritoneo; Cavidad Abdominal/cirugía; Cavidad Peritoneal; Líquido Ascítico/patología; Procedimientos Quirúrgicos Operativos.

Peritonitis is an acute or chronic inflammation of the peritoneum that generally has an infectious origin. There are several types, with secondary peritonitis being the most frequent. The term secondary peritonitis is defined as localized or generalized inflammation of the peritoneal membrane caused by polymicrobial infection following traumatic or spontaneous rupture of a viscus or secondary to dehiscence of intestinal anastomoses. This entity is characterized by the presence of pus in the peritoneal cavity or fluid which, on direct microscopic examination, contains leukocytes and bacteria. The treatment of this pathology constitutes an emergency and can be clinical and/or surgical. The aim of operative management is based on identifying and eliminating the cause of the infection, collecting microbiological samples, performing peritoneal cleansing and preventing recurrence. Clinical management deals with the consequences of the infection by perioperative resuscitation and antibiotic treatment1 . Despite advances in diagnosis, surgical procedures, antimicrobial therapy and intensive care, mortality associated with severe secondary peritonitis is still very high. Prognosis and timely management represent the key to improving survival and reducing mortality associated with extensive intra-abdominal infections2. It is important to establish guidelines for diagnosis, antibiotic management and surgical treatment guidelines to reduce the morbidity and mortality associated with this disease.

Splanchnic vein thrombosis as a manifestation of latent myeloproliferative neoplasm associated with sticky platelet syndrome / Trombosis esplácnica como presentación de neoplasia mieloproliferativa latente asociada con síndrome de plaqueta pegajosa

Abstract Vein thrombosis of unusual sites such as the splanchnic region continues to be not only a diagnostic but also a therapeutic challenge for the clinician due to its manifestation and associated pathologies. Latent JAK2 (Janus kinase 2) positive myeloproliferative neoplasm associated with sticky platelet syndrome is unusual. We present a clinical case of a 38-year-old female patient who presented with sudden onset abdominal pain of a possible vascular origin. Splanchnic thrombosis was diagnosed in latent myeloproliferative neoplasm by identifying the JAK2V617F mutation and sticky platelet syndrome via platelet aggregometry. Off-label anticoagulation with rivaroxaban 20 mg/day was administered. During her outpatient follow-up, she did not suffer any new thrombotic episodes.

Resumen La trombosis venosa de sitios inusuales como la esplácnica continúa siendo un reto no solo diagnóstico sino también terapéutico para el clínico debido a su forma de presentación y las patologías asociadas. La neoplasia mieloproliferativa latente JAK2 (cinasa de Janus 2) positiva asociada con síndrome de plaqueta pegajosa es inusual. Se presenta un caso clínico de una paciente de 38 años de edad que debutó con dolor abdominal de inicio súbito que sugirió un posible origen vascular. Se diagnosticó trombosis esplácnica en relación con neoplasia mieloproliferativa latente por la identificación de la mutación de la JAK2V617F y síndrome de plaqueta pegajosa mediante agregometría plaquetaria. Se administró de manera off-label anticoagulación con rivaroxabán 20 mg/día. Durante su seguimiento ambulatorio no ha presentado nuevos episodios trombóticos.

Evaluation of chemical silage on egg quality parameters in ISA Brown line laying hens (Gallus gallus domesticus) / Evaluación del ensilado químico sobre los parámetros de calidad del huevo en gallinas ponedoras de la línea ISA Brown (Gallus gallus domesticus)

ABSTRACT In this study we evaluated the inclusion of chemical silage from red tilapia viscera (Oreochromis sp.) in diets for ISA Brown line laying hens (Gallus gallus domesticus) and its influence on nutritional parameters and egg quality. A total of 56 16-week-old laying hens were randomly divided into two groups (one per diet), which in turn were subdivided into 7 groups, each with 4 birds. Eggs were collected during the first 13 weeks of laying. During this period the egg quality parameters were evaluated until week 11; the bromatological characterization of the egg was carried out in the 2nd and 4th week of laying. The results indicated that the inclusion of chemical silage in 17,18% dry matter does not result in statistically significant differences in egg quality parameters or in their bromatological composition, with respect to the control. This led to the conclusion that chemical silage can be used as an alternative to protein inputs such as fish meal and soybean cake in the diet of laying hens, without modifying the quality of the final product.

RESUMEN En este trabajo se evaluó la inclusion de ensilado químico de vísceras de tilapia roja (Oreochromis sp.) en dietas para gallinas ponedoras (Gallus gallus domesticus) de la raza Isa-Brown, y su influencia sobre parámetros nutricionales y la calidad del huevo. Se utilizó un total de 56 gallinas ponedoras de 16 semanas de edad divididas al azar en dos grupos (uno por dieta), los cuales a su vez se subdividieron en 7 grupos de 4 aves cada uno. Se les recolectó huevos durante las primeras 13 semanas de postura. Durante este periodo se realizó la evaluación de los parámetros de calidad del huevo hasta la semana 11. La caracterización bromatológica del huevo se realizo en las semanas 2 y 4, luego de haber sido puestos. Los resultados indicaron que la inclusion de ensilado químico en un 17,18% materia seca, no genera diferencias estadísticamente significativas (p < 0,05) en los parámetros de calidad del huevo ni en su composición bromatológica, con respecto al control. Esto permitió concluir que el ensilado químico puede ser usado como alternativa a insumos proteicos como harina de pescado y torta de soya en la alimentación de gallinas ponedoras, sin modificar la calidad del producto final.

A comprehensive morphometric study of visceral and subcutaneous adipose tissue depots in mice, hamsters and rats / Un estudio morfométrico completo de los depósitos de tejido adiposo visceral y subcutáneo en ratones, hámsters y ratas

SUMMARY: Adipose tissue morphology of different fat tissue depots can be described using the number of adipocytes and cell surface of adipocytes. This study deals with characteristics and morphometric analysis of white and brown adipose tissue depots in healthy adult laboratory mice, hamsters and rats of both sexes. The number of unilocular adipocytes in white adipose tissue differs from one adipose tissue depot to another, with the largest number of adipocytes in mice and a similar number in hamsters and rats. The smallest surface area and the largest percentage of small unilocular adipocytes were found in mice. White adipose tissue in hamsters and rats was predominantly made out of a larger percentage of medium-sized adipocytes and a smaller percentage of small and medium-sized adipocytes. Uncoupling protein 1 positive multilocular adipocytes were found in classic brown adipose tissue depots with larger percentages in mice (93.20 %) and hamsters (91.30 %), while rats had a smaller percentage (78.10 %). In white and brown adipose tissue, significant differences between species and both sexes within the same species were found, indicating the influence of sexual dimorphism. The presented morphometric results could serve as a basis for further studies concerning experimental animal models of metabolic disorders and obesity.

RESUMEN: La morfología del tejido adiposo de diferentes depósitos de tejido graso se puede describir utilizando el número de adipocitos y la superficie celular de los adipocitos. Este estudio analiza las características y el análisis morfométrico de los depósitos de tejido adiposo blanco y marrón en ratones, hamsters y ratas de laboratorio, adultos sanos de ambos sexos. El número de adipocitos uniloculares en el tejido adiposo blanco difiere de un depósito de tejido adiposo a otro, con el mayor número de adipocitos en ratones y un número similar en hámsteres y ratas. La superficie más pequeña y el mayor porcentaje de adipocitos uniloculares pequeños se encontraron en ratones. El tejido adiposo blanco en hámsteres y ratas estaba compuesto predominantemente por un mayor porcentaje de adipocitos de tamaño mediano y un porcentaje menor de adipocitos de tamaño pequeño y mediano. Los adipocitos multiloculares positivos para la proteína desacopladora 1 se encontraron en depósitos de tejido adiposo marrón clásico con mayores porcentajes en ratones (93,20 %) y hámsters (91,30 %), mientras que las ratas tenían un porcentaje menor (78,10 %). En el tejido adiposo blanco y pardo se encontraron diferencias significativas entre especies y entre ambos sexos dentro de una misma especie, lo que indica la influencia del dimorfismo sexual. Los resultados morfométricos presentados podrían servir como base para futuros estudios sobre modelos animales experimentales de trastornos metabólicos y obesidad.

Carangoides bartholomaei (Cuvier, 1833) stomach: a source of aspartic proteases for industrial and biotechnological applications / Estômago de Carangoides bartholomaei (Cuvier, 1833): uma fonte de proteases aspárticas para aplicações industriais e biotecnológicas

The viscera and other residues from fish processing are commonly discarded by the fishing industry. These by products can be a source of digestive enzymes with industrial and biotechnological potential. In this study, we aimed at the extraction, characterization, and application of acidic proteases from the stomach of Carangoides bartholomaei (Cuvier, 1833). A crude extract from the stomachs was obtained and submitted to a partial purification process by salting-out, which obtained a Purified Extract (PE) with a specific proteolytic activity of 54.0 U·mg-¹. A purification of 1.9 fold and a yield of 41% were obtained. The PE presents two isoforms of acidic proteases and a maximum proteolytic activity at 45 °C and pH 2.0. The PE acidic proteolytic activity was stable in the pH range of 1.5 to 7.0 and temperature from 25 °C to 50 °C. Purified Extract kept 35% of its proteolytic activity at the presence of NaCl 15% (m/v) but was totally inhibited by pepstatin A. Purified Extract aspartic proteases presented high activity in the presence of heavy metals such as Cd2+, Hg2+, Pb2+, Al3+, and Cu2+. The utilization of PE as an enzymatic addictive in the collagen extraction from Nile tilapia scales has doubled the process yield. The results indicate the potential of these aspartic proteases for industrial and biotechnological applications.

As vísceras e outros resíduos do processamento de peixes são geralmente descartados pela indústria pesqueira. Esses resíduos podem ser uma fonte de enzimas digestivas com potencial industrial e biotecnológico. Neste estudo, objetivamos a extração, caracterização e aplicação de proteases aspárticas do estômago de Carangoides bartholomaei (Cuvier, 1833). Um extrato bruto do estômago foi obtido e submetido a um processo de purificação parcial, que obteve um Extrato Purificado (EP) com uma atividade proteolítica específica de 54,0 U·mg-¹. Foi obtida uma purificação de 1,9 vezes e um rendimento de 41%. O EP apresenta duas isoformas de proteases ácidas e atividade proteolítica máxima a 45 °C e pH 2,0. A atividade proteolítica do EP foi estável na faixa de pH de 1,5 a 7,0 e temperatura de 25 °C a 50 °C. O EP manteve 35% de sua atividade proteolítica na presença de NaCl a 15% (m/v), mas foi totalmente inibida pela pepstatina A. As proteases ácidas do EP apresentaram alta atividade na presença de metais pesados como o Cd2+, Hg2+, Pb2+, Al3+ e Cu2+. A utilização de EP como aditivo enzimático na extração de colágeno a partir de escamas de tilápia do Nilo dobrou o rendimento do processo. Os resultados indicam um potencial dessas proteases para aplicações industriais e biotecnológicas.

Obtención y evaluación de concentrado proteico hidrolizado de residuos animales como alternativa de alimentación en Piaractus brachypomus (Cuvier 1818) / Obtaining and evaluating hydrolyzed protein concentrate from animal waste as a feeding alternative in Piaractus brachypomus (Cuvier 1818)

RESUMEN En la industria acuícola, se vienen desarrollando acciones encaminadas a buscar fuentes proteicas alternativas palatables y de alto valor biológico para reemplazar las fuentes convencionales. Debido al potencial nutricional de los subproductos animales, se han adoptado tecnologías para su uso, como las técnicas de bioconversión por hidrólisis enzimática. En consecuencia, el objetivo de este estudio fue obtener y evaluar un concentrado de proteína hidrolizada de residuos animales (CPHRA) como alternativa en dietas para Piaractus brachypomus. Las vísceras de los subproductos avícolas se evaluaron utilizando ácido fórmico y vísceras de trucha al 20% para promover la hidrólisis enzimática a un pH más bajo (pH 3,66). El producto resultante se utilizó en la formulación de dietas para determinar coeficiente de digestibilidad aparente (CDA) de energía y nutrientes, utilizando una dieta control () y tres dietas con inclusión de 10%, 20% y 30% de CPHRA (T1, T2 y T3). Se alimentaron por triplicado ciento veinte juveniles de híbridos de cachama blanca con un peso promedio de 145 ± 3,0 g. La CPHRA presentó alto contenido proteico y se evidenciaron diferencias significativas (p < 0,05) para los CDA de materia seca, proteína bruta, grasa bruta, energía bruta y absorción de cenizas, calcio y fósforo. Los CDA de nutrientes y energía estaban por encima del 80%. En consecuencia, el concentrado de proteína hidrolizada de los desechos de aves de corral tiene un gran potencial como alternativa proteica y energética de alto valor nutricional en la alimentación de los peces.

ABSTRACT The aquaculture industry aims to find new strategies to replace fishmeal in formulated diet-sources with high attraction and palatability and high biological value to replace conventional sources. Due to the nutritional potential of animal by-products, technologies have been adopted for their use, such as bioconversion techniques by enzymatic hydrolysis. Consequently, the objective of this study was obtaining and evaluating a hydrolyzed protein concentrate of animal waste (CPHRA, by its Spanish acronym) in diets for Piaractus brachypomus. Viscera from poultry by-products was evaluated by using formic acid and a 20% trout viscera to promote the catalyst at lower pH (3,66). The resulting product was used in feed formulation to determine the Apparent Digestibility Coefficient (ADC) of energy and nutrients, using a control diet (T0) and three diets with 10%, 20%, and 30% CPHRA (T1, T2 y T3). One hundred and twenty juveniles of hybrids of cachama blanca with an average weight of 145 ± 3,0 g were fed in triplicate groups. The CPHRA presented high protein content and significant differences (p < 0,05) were evidenced for the ADCs of dry matter, crude protein, crude fat, crude energy, and ash absorption, calcium and phosphorus. The ADCs for nutrients and energy were above 80%. Accordingly, the hydrolyzed protein concentrate from poultry waste has great potential as a protein and energy alternative of high nutritional value in fish feeding.

Anafilaxia a alfa-gal: um relato de caso paraibano / Alpha-gal anaphylaxis: a case report from Paraíba, Brazil

O presente relato apresenta um caso de anafilaxia tardia ao carboidrato alfa-gal em um adolescente da cidade de Belém, na Paraíba, Brasil. O paciente desenvolveu reação tardia à ingesta de carne e vísceras de animais. Ele mora em fazenda e tem contato próximo com animais potencialmente contaminados por carrapatos. Essa causa de reação alérgica é nova, e estudos começaram a atribuí-la a casos antes ditos idiopáticos. A anafilaxia é uma reação potencialmente fatal, que deve ser prontamente diagnosticada e tratada. Sendo assim, a descoberta de seu fator desencadeante é um dos principais itens que direcionam o tratamento. No Brasil, nenhum caso de anafilaxia por alfa-gal foi antes descrito na literatura local.

This report presents a case of late anaphylaxis to alpha-gal carbohydrate in a teenager living in the city of Belém, Paraíba, Brazil. The patient developed a late reaction to eating meat and offal of animals; he lives on a farm and has close contact with animals potentially contaminated by ticks. This cause of allergic reaction is new, and studies have started to attribute it to cases previously said to be idiopathic. Anaphylaxis is a potentially fatal reaction that must be promptly diagnosed and treated. Thus, the discovery of its triggering factor is one of the main items that guide treatment. In Brazil, no case of alpha-gal anaphylaxis had been described in the local literature.

Mobilização visceral em adultos com dor lombar inespecífica / Visceral mobilization in adults with unspecified lumbar pain

Objetivo: analisar a efetividade da mobilização visceral na melhora dos sintomas de dor lombar inespecífica. Método: participaram do estudo indivíduos de ambos os sexos, que apresentavam sintomas dor lombar. A qualidade de vida foi avaliada pela versão brasileira do Questionário de Qualidade de Vida - SF 36 e a intensidade da dor por uma escala visual analógica. Para todos participantes foi utilizado um protocolo de técnicas de mobilização visceral. Quanto à análise estatística, as variáveis foram avaliadas por meio do teste não paramétrico de Wilcoxon e os valores de significância equivalentes a 5%. Resultados: participaram do estudo sete indivíduos, sendo quatro participantes com idade entre 40 a 50 anos (58%) e três entre 51 a 60 anos (42%) anos, sendo um do sexo masculino e seis do sexo feminino. Em ambos os aspectos avaliados, intensidade da dor e qualidade de vida, indicam diferenças entre as distribuições dos dados antes e após o tratamento pelas técnicas de mobilização visceral. Do mesmo modo, algumas variáveis estão dentro do nível de significância estabelecido, indicando que houve diferença entre as distribuições dos dados antes e após a aplicação do tratamento. Conclusão: constatou-se melhora significativa em relação aos sintomas de lombalgia na amostra estudada, na incapacidade específica e intensidade da dor, aspectos físicos, dor e estado geral de saúde. (AU)

Objective: to analyze the effectiveness of visceral mobilization in improving the symptoms of nonspecific low back pain. Method: individuals of both sexes, who had low back pain symptoms, participated in the study. Quality of life was assessed using the Brazilian version of the Quality of Life Questionnaire - SF 36 and pain intensity using a visual analog scale. For all participants, a protocol of visceral mobilization techniques was used. As for the statistical analysis, the variables were evaluated using the Wilcoxon non-parametric test and the significance values equivalent to 5%. Results: seven individuals participated in the study, four participants aged between 40 and 50 years old (58%) and three between 51 and 60 years old (42%) years old, one male and six female. In both aspects evaluated, pain intensity and quality of life, indicate differences between data distributions before and after treatment by visceral mobilization techniques. Likewise, some variables are within the level of significance established, indicating that there was a difference between the data distributions before and after the treatment application. Conclusion: there was a significant improvement in relation to low back pain symptoms in the sample studied, in specific disability and pain intensity, physical aspects, pain and general health status.(AU)

Comiso de vísceras por fascioliasis y equinococosis quística en bovinos, ovinos y caprinos faenados en Apurímac, Perú / Viscera seizure due to fascioliasis and cystic echinococcosis in cattle, sheep and goats slaughtered in Apurimac, Peru

Objetivo. Determinar el porcentaje de fascioliasis y equinococosis quística; también, el impacto del comiso de vísceras en rumiantes faenados en el matadero municipal de Abancay, Perú. Materiales y métodos. El estudio fue básico, transversal y analítico. Se incluyeron todos los rumiantes faenados en el matadero, de septiembre a diciembre de 2012. Se determinó el peso vivo de los rumiantes, además del peso de sus vísceras sanas e infectadas. Se estimó la pérdida económica por la incautación de vísceras. El análisis de los datos se realizó con el programa Excel Windows 2010 y el paquete estadístico MINITAB versión 17. Se utilizó la prueba de Chi-cuadrado para determinar diferencias entre proporciones y la prueba t de igualdad de medias, utilizando un nivel de confianza del 95%. Resultados. El porcentaje de infección por fascioliasis fue 79.6% (IC 95% = 77.7-81.6) en bovinos, 53.2% (IC 95% = 48.9-57.4) en ovejas y 21% (IC 95% = 16.1-25.8) en cabras. El porcentaje de infección por equinococosis quística fue 5,4% (IC 95% = 4.3-6.6) en bovinos, 16.7% (IC 95% = 13.5-19.7) en ovejas y 12.4% (IC 95% = 8.4-16.3) en cabras. La pérdida económica en la temporada de estudio fue de USD 16.507,46. Conclusiones. La presencia de duela hepática afecta el peso de los hígados en bovinos y ovinos. El quiste hidatídico afecta el peso del hígado en todos los rumiantes estudiados y afecta el peso de los pulmones en ovejas y cabras. La mayor pérdida económica se debió al comiso de hígados debido a la fascioliasis.

Topography and syntopy of abdominopelvic viscera of the giant anteater (Myrmecophage tridactyla - Linnaeus, 1758) / Topografia e sintopia das vísceras abdominopélvicas do tamanduá-bandeira (Myrmecophage tridactyla - Linnaeus, 1758)

In view of the scarcity of data about the topography and syntopy of abdominopelvic viscera of the giant anteater (Myrmecophage tridactyla - Linnaeus, 1758), the present study aimed to elucidate these characteristics and to compare them with the other animal species, especially the domestic ones. Three specimens, two males and one female, were donated by the Environmental Military Police of Franca to the Anatomy Veterinary Laboratory of the University of Franca, after death by road killings. The animals were fixed and maintained in aqueous 10% formaldehyde solution, followed by conventional dissection of the abdominopelvic cavities for subsequent direct inspection and topographic description of the viscera, aiming at comparative analyzes with other species, whose positioning and particularities are already established in the literature. It was observed that most of the viscera of these cavities have similar location and syntopy to domestic animals, except for the kidneys and testicles. In view of the established methodology and the results obtained, it is accepted that more specimens of anteater, both genera, should be evaluated and registered scientifically to confirm the data of the current research and anatomical preconization of the abdominopelvic cavity, inasmuch anatomical individual variation are possible between animals of the same species.(AU)

Diante da escassez de dados sobre a topografia e a sintopia das vísceras abdominopélvicas do tamanduá-bandeira (Myrmecophage tridactyla - Linnaeus, 1758), o presente estudo teve como objetivo elucidar essas características e compará-las com as demais espécies animais, mormente as domésticas. Utilizaram-se três espécimes, dois machos e uma fêmea, provenientes de doação da Polícia Militar Ambiental de Franca ao Laboratório de Anatomia Veterinária da Universidade de Franca, após óbitos por atropelamentos. Os animais foram fixados e mantidos em solução aquosa de formaldeído a 10%, seguidos de dissecação convencional das cavidades abdominopélvicas para posterior inspeção direta e descrição topográfica das vísceras, visando a análises comparativas com outras espécies, cujo posicionamento e cujas particularidades já são bem estabelecidos na literatura. Observou-se que a maioria das vísceras dessas cavidades possuem localização e sintopia similares aos animais domésticos, exceto os rins e os testículos. Diante da metodologia estabelecida e dos resultados obtidos, admite-se que mais espécimes de tamanduás-bandeiras, de ambos os gêneros, devam ser avaliados e registrados cientificamente, visando à confirmação dos dados da atual pesquisa e à preconização anatômica da cavidade abdominopélvica, visto que variações anatômicas individuais são passíveis entre animais da mesma espécie.(AU)

Abscesos residuales en apendicitis aguda: comparación entre abordaje laparotómico vs. laparoscópico / Residual abscesses in acute appendicitis: comparison between laparotomy vs. laparoscopic / Abcessos residuais na apendicite aguda: comparação entre laparotômico vs. laparoscópico

La apendicitis aguda es la urgencia quirúrgica más frecuente con una incidencia de 1.17 pacientes/1,000 habitantes. Con el advenimiento de la laparoscopía, un nuevo enfoque mini invasivo surgió para el tratamiento de la apendicitis aguda. Se han demostrado algunas ventajas de este abordaje como menor dolor posoperatorio, incisiones más pequeñas, estadías hospitalarias más cortas y un rápido reintegro a las actividades diarias y laborales, con menor frecuencia de infecciones a nivel de la herida operatoria. Sin embargo, se ha asociado también con un aumento en la frecuencia de abscesos residuales intra-abdominales. En este trabajo analizamos de manera retrospectiva a todos los pacientes operados en el Hospital Maciel de Montevideo, a los que se les realizó una apendicectomía entre el 1° de Junio de 2013 y el 30 de junio de 2016, tanto por vía laparoscópica como laparotómica. Esto correspondió a un total de 426 pacientes. 235 (55%) eran hombres y 191 (45%) mujeres. La media de edad fue de 32,6 en un rango desde los 15 años hasta los 96 años de edad. 128 pacientes presentaban apendicitis edematosas (30%), 157 apendicitis flemonosa (36,9%) 76 pacientes apendicitis gangrenosas (17,8%) 37 pacientes absceso o plastrón (8,7%) y peritonitis en 28 pacientes (6,6%). Con respecto al abordaje, 287 se realizaron por vía laparoscópica (67,4%) y 139 se abordaron por vía laparotómica (32,6%). Los abscesos residuales representan el 3,28% del total, no habiendo diferencias significativas entre los diferentes abordajes. La gran mayoría de estos abscesos residuales pueden tratarse con antibioticoterapia exclusivamente. La tasa de conversión fue del 8,7%. No se observaron lesiones de víscera hueca con el abordaje laparoscópico en esta serie.

Acute appendicitis is the most frequent surgical emergency with an incidence of 17 patients/1,000 inhabitants. With the advent of laparoscopy, a new mini-invasive approach emerged for the treatment of acute appendicitis. Some advantages of this approach have been demonstrated, such as less postoperative pain, smaller incisions, shorter hospital stays and a rapid reintegration to daily and work activities, with a lower frequency of infections at the level of the operative wound. However, it has also been associated with an increase in the frequency of intra-abdominal residual abscesses. In this paper, we retrospectively analyzed all patients operated on at the Maciel Hospital in Montevideo, who underwent an appendectomy between June 1, 2013 and June 30, 2016, both laparoscopically and laparotomically. Of these 235 (55%) were men and 191 (45%) women. The average age was 32.6 in a range from 15 years to 96 years of age. 128 patients presented edematous appendicitis (30%), 157 phlegmonous appendicitis (36.9%), 76 patients gangrenous appendicitis (17.8%), 37 patients presented abscess or plastron (8.7%), and peritonitis had developed in 28 patients (6.6%). Regarding the approach, 287 were performed laparoscopically (67.4%) and 139 were approached via laparotomy (32.6%). The residual abscesses rate represents 3.28% of the series, with no significant differences in incidence between the two different approaches. The vast majority of these residual abscesses can be treated with antibiotic therapy alone. The conversion rate was 8.7%. No intestinal lesions were observed with the laparoscopic approach in this series.

A apendicite aguda é a emergência cirúrgica mais freqüente, com uma incidência de 17 pacientes/1.000 habitantes. Com o advento da laparoscopia, uma nova abordagem mini-invasiva surgiu para o tratamento da apendicite aguda. Isto têm demonstrado algumas vantagens, como menor dor pós-operatória, incisões menores, menor hospitalização e restabelecimento mais rápido as atividades diárias e ao trabalho, assim como infecções menos freqüentes ao nível da ferida cirúrgica. No entanto, também foi associado a um aumento na freqüência de abscessos residuais intra-abdominais. Foram analisados retrospectivamente todos os pacientes operados no Hospital Maciel de Montevidéu, submetidos a uma apendicectomia desde o dia 01 de Junho de 2013 a 30 de Junho de 2016, tanto por abordagem laparoscópica como laparotomica. Destes, 235 (55%) eram homens e 191 (45%) mulheres. A idade média foi de 32,6 com intervalo de 15 anos a 96 anos de idade. 128 pacientes apresentaram apendicite edematosa (30%), 157 apendicite flemonosa (36,9%) 76 pacientes apendicite gangrenosa (17,8%) 37 pacientes abscesso ou plastrão (8,7%) e peritonite em 28 pacientes (6,6% ) Quanto à abordagem, foram realizadas 287 apendicectomias por via laparoscópica (67,4%) e 139 foram abordadas por laparotomia (32,6%). Os abscessos residuais representam 3,28% do total, não havendo diferenças significativas entre as diferentes abordagens. A grande maioria desses abscessos residuais pode ser tratada apenas com antibioticoterapia. A taxa de conversão foi de 8,7% Nenhuma lesão visceral foi observada com a abordagem laparoscópica nesta série.

Principais condenações de vísceras bovinas observadas durante a inspeção post mortem em um abatedouro-frigorífico no município de Januária, norte de Minas Gerais / Main condemnation of bovine viscera observed during post mortem inspection in an industrial slaughterhouse in the municipality of Januária, north of Minas Gerais

Objetivou-se analisar as principais causas e a distribuição das condenações de vísceras bovinas em um abatedouro-frigorífico recém-inaugurado no município de Januária/MG. Foram abatidos 4.619 bovinos, dos quais 864 (18,70%) tiveram as vísceras condenadas. O pulmão foi o órgão que apresentou o maior índice de condenações com 63,43%, seguido dos rins (16,20%), fígado (13,07%), coração (4,87%), baço (2,08%), língua (0,23%) e cabeça (0,12%). As causas mais frequentes de condenações por órgão foram: aspiração de conteúdo ruminal (44,52%), cistos (48,57%), abscessos (75,23%), contaminação (100%) e cisticercose calcificada (100%). Os resultados revelam falhas durante o processo de abate, necessitando de melhoria na capacitação dos funcionários a fim de minimizar os prejuízos causados pelas condenações.

Causas e prejuízos econômicos por condenação visceral de bovinos em um matadouro frigorífico sob inspeção oficial no município de Corumbá, MS, Brasil / Origin and economic losses decured of bovine visceral condemnation in a slaughterhouse under official inspection in Corumbá, MS, Brazil

O objetivo do estudo foi mensurar as principais causas de condenações viscerais e seus prejuízos econômicos em um matadouro frigorífico localizado na cidade de Corumbá - MS. Foi realizada a quantificação do número de cabeças e órgãos condenados, identificação das principais lesões e estimativa dos prejuízos econômicos causados pelas mesmas. Foram abatidos 21.097 animais, dos quais 13.215 vísceras foram condenadas. Os órgãos com maiores índices de condenações foram os pulmões (47,73%), seguido dos rins (30,2%) e fígados (12,24%). As lesões de maior incidência de condenações foram enfisema pulmonar (27,63%), nefrite (17,43) e aspiração ruminal (13,43%). As condenações levaram a um prejuízo de R$ 73.484,19 em um ano. O fígado foi o órgão responsável por mais da metade das perdas econômicas (56,59%).

Treatment of aortic dissecting aneurysm involving visceral arteries with multi-layer bare stents

SUMMARY OBJECTIVE: Aortic dissecting aneurysms involving visceral arteries are difficult for clinical treatment. This study aimed to explore the clinical efficacy and safety of multi-layer bare stents technique in the treatment of aortic dissecting aneurysms involving visceral arteries. METHOD: The clinical data of 16 patients of aortic dissecting aneurysm involving visceral artery treated with multi-layer bare stents technique from March 2013 to March 2017 in Tianjin Medical University General Hospital were retrospectively analyzed. To explore the clinical efficacy, the number of stents applied, postoperative aortic dissecting thrombosis and postoperative cumulative branch arterial patency of the16 patients. RESULTS: The operations of the 16 patients were successfully completed without peri-operative death cases. The 16 patients were implanted with 39 bare stents with an average of 2.44 per person. There were 2 cases with 1 stent, 8 cases with 2 stents and 7 cases with 3 stents. One month after the operation, CTA showed complete thrombosis in the arterial dissection in 4 cases (25.0%), partial thrombosis in 12 cases (75.0%); CTA showed that celiac artery, left and right renal arteries, and superior mesenteric artery were all unobstructed. There were 4 cases (25.0%) of dissecting artery with reduced diameter, 12 patients (75.0%) without changes in the diameter, and no diameter expanding cases. CONCLUSION: The treatment for aortic dissecting aneurysm involving the visceral arteries using multi-layer bare stents technique is safe and reliable with a higher patency rate of postoperative accumulated branch arteries.

RESUMO Objetivo: Aneurismas dissecantes da aorta envolvendo artérias viscerais são de difícil tratamento clínico. O objetivo deste estudo foi explorar a eficácia e segurança clínica da técnica de stents multicamadas não farmacológicos para o tratamento de aneurismas dissecantes da aorta envolvendo artérias viscerais. Métodos: Foi feito um estudo retrospectivo usando os dados de 16 pacientes com aneurisma dissecante da aorta envolvendo artérias viscerais e tratados com stents multicamadas não farmacológicos de março de 2013 a março de 2017, do Hospital da Escola de Medicina da Universidade de Tianjin. Foram analisados nos 167 pacientes: a eficácia clínica, o número de stents aplicados, trombose dissecante da aorta no pós-operatório e patência cumulativa pós-operatória do ramo arterial. Resultados: As operações dos 16 pacientes foram concluídas com sucesso sem nenhum óbito perioperatório. Os 16 pacientes receberam 39 stents não farmacológicos, com uma média de 2,44 por indivíduo. Houve 2 casos com 1 stent, 8 com 2 stents, e 7 com 3. Um mês após a operação, a ATC mostrou trombose completa da dissecção arterial em 4 casos (25,0%) e trombose parcial em 12 casos (75%). Também mostrou que a artéria celíaca, as artérias renais direita e esquerda e a artéria mesentérica superior estavam todas desobstruídas. Houve 4 casos (25,0%) de artéria dissecante com diâmetro reduzido, 12 (75,0%) pacientes sem alteração no diâmetro, e nenhum caso de aumento de diâmetro. Conclusão: O tratamento para aneurisma dissecante da aorta envolvendo artérias viscerais com a técnica de stents não farmacológicos multicamadas é seguro e confiável, com uma taxa mais alta de patência de ramos arteriais acumulados no pós-operatório.

Comparative study of four different types of intraperitoneal mesh prostheses in rats

Abstract Purpose: To compare four types of mesh regarding visceral adhesions, inflammatory response and incorporation. Methods: Sixty Wistar rats were divided into four groups, with different meshes implanted intraperitoneally: polytetrafluoroethylene (ePTFE group); polypropylene with polydioxanone and oxidized cellulose (PCD); polypropylene (PM) and polypropylene with silicone (PMS). The variables analyzed were: area covered by adhesions, incorporation of the mesh and inflammatory reaction (evaluated histologically and by COX2 immunochemistry). Results: The PMS group had the lowest adhesion area (63.1%) and grade 1 adhesions. The ePTFE and PM groups presented almost the total area of their surface covered by adherences (99.8% and 97.7% respectively) The group ePTFE had the highest percentage of area without incorporation (42%; p <0.001) with no difference between the other meshes. The PMS group had the best incorporation rate. And the histological analysis revealed that the inflammation scores were significantly different. Conclusions: The PM mesh had higher density of adherences, larger area of adherences, adherences to organs and percentage of incorporation. ePTFE had the higher area of adherences and lower incorporation. The PMS mesh performed best in the inflammation score, had a higher incorporation and lower area of adherences, and it was considered the best type of mesh.

Klebsiella Pneumoniae Visceral Organ Abscesses - Clinical Characteristics

INTRODUCTION@#In recent years, () has emerged as the predominant cause of pyogenic liver abscess in Asia. - as the causative microorganism in other visceral organ abscesses-is less described. In this study, we seeked to describe the clinical characteristics of visceral organ abscesses in our institution and evaluated the prescription practices of physicians with regard to antibiotic therapy.@*MATERIALS AND METHODS@#A retrospective analysis of patients with culture positive (blood or abscess aspirate) visceral organ abscesses from May 2014 to April 2016 requiring hospitalisation in Changi General Hospital was conducted.@*RESULTS@#A total of 140 adult patients with visceral organ abscesses were identified. The commonest site of involvement was the liver (77.9%), followed by genitourinary tract (20.7%). Diabetic patients were more likely to have liver abscesses, genitourinary abscesses, abscesses in 2 or more organs, genitourinary disease with abscess formation outside of the genitourinary tract, and endovascular infection. Patients with extended spectrum beta-lactamase producing , were more likely to have an obstructive lesion related to the site of the abscess. Overall mortality rate was 7.1%. Amongst survivors, the mean total duration of parenteral antimicrobial therapy was 2.5 weeks before switching to oral antimicrobial agents.@*CONCLUSION@#Genitourinary tract is the commonest extra-hepatic site for visceral organ abscess in infections. Parenteral to oral switch of antimicrobial agents appears to be a safe and effective treatment option.

Topographical anatomy of the greater omentum and transverse mesocolon: a study using human fetuses / 대한해부학회지

CD57 (Leu-7, HNK-1) immunoreactivity seen in thin arteries in the human fetal lung / 대한해부학회지

CD57 (synonyms: Leu-7, HNK-1) is a well-known marker of nerve elements including the conductive system of the heart, as well as natural killer cells. In lung specimens from 12 human fetuses at 10–34 weeks of gestation, we have found incidentally that segmental, subsegmental, and more peripheral arteries strongly expressed CD57. Capillaries near developing alveoli were often or sometimes positive. The CD57-positive tissue elements within intrapulmonary arteries seemed to be the endothelium, internal elastic lamina, and smooth muscle layer, which corresponded to tissue positive for a DAKO antibody reactive with smooth muscle actin we used. However, the lobar artery and pulmonary arterial trunk as well as bronchial arteries were negative. Likewise, arteries in and along any abdominal viscera, as well as the heart, thymus, and thyroid, did not express CD57. Thus, the lung-specific CD57 reactivity was not connected with either of an endodermal- or a branchial arch-origin. CD57 antigen is a sugar chain characterized by a sulfated glucuronic acid residue that is likely to exist in some glycosphingolipids. Therefore, a chemical affinity or an interaction might exist between CD57-positive arterioles and glycosphingolipids originating from alveoli, resulting in acceleration of capillary budding to make contact with the alveolar wall. CD57 might therefore be a functional marker of the developing air-blood interface that characterizes the fetal lung at the canalicular stage.

Experiencia en loxoscelismo cutáneo y cutáneo visceral de manejo hospitalario: clínica, evolución y propuesta terapéutica / Experience in visceral cutaneous and cutaneous loxoscelism of hospital management: clinical, evolution and therapeutic proposal

Resumen Introducción: El loxoscelismo es una patología frecuente en nuestro medio con un amplio espectro de presentaciones y diagnósticos diferenciales, con complicaciones potencialmente graves, e incluso con riesgo de muerte. A la fecha no existe un tratamiento estándar para estos pacientes. Objetivo: Describir las manifestaciones clínicas, principales complicaciones, manejo terapéutico y evolución de pacientes internados por loxoscelismo en un hospital terciario en Chile. Pacientes y Método: Se analizaron todos los pacientes consultantes e internados por loxoscelismo en el Hospital Clínico de la Pontificia Universidad Católica de Chile entre los años 2014 y 2017, evaluados en interconsulta por Dermatología. Revisión de los registros clínicos incluyendo semiología, imágenes, informes de laboratorio y tratamientos efectuados. Resultados: Se registraron 17 casos de loxoscelismo de manejo hospitalario, cuya presentación responde al patrón epidemiológico nacional. La mayoría de los casos fue manejada con antimicrobianos, corticosteroides sistémicos, antihistamínicos y dapsona. De ellos, 11,8% correspondieron a loxoscelismo cutáneo visceral, manejados exitosamente con medidas de soporte, corticosteroides sistémicos y antihistamínicos. El 59% presentó resolución de las lesiones al mes de tratamiento, con cicatriz residual leve o hiperpigmentación postinflamatoria, sin mortalidad en nuestra serie. Discusión: La mayoría de los casos de loxoscelismo cutáneo presentó excelente respuesta y rápida resolución del cuadro tras el tratamiento asociado de corticosteroides sistémicos, antimicrobianos y dapsona, sugiriendo que el uso de estas terapias podría detener la progresión de la necrosis cutánea y prevenir las complicaciones asociadas al loxoscelismo.

Background: Loxoscelism is a common pathology in our environment with a broad spectrum of differential diagnoses and presentations, with potentially serious complications, even to the point of death. To date, there is no standard treatment for these patients. Aim: To describe the clinical manifestations, main complications, therapeutic management, and evolution of loxoscelism in an inpatient setting from a tertiary hospital in Chile. Methods: All patients consulting and hospitalized in the hospital of the Pontificia Universidad Católica de Chile with diagnosis of loxoscelism between 2014 to 2017 and evaluated by dermatologist were included. Review of clinical files, including symptoms, images, laboratory parameters and treatment. Results: We evaluated seventeen inpatient with loxoscelism, whose presentation responds to the national epidemiological pattern. Most cases were managed with antibiotics, systemic corticosteroids, antihistamines, and dapsone. From these, 11.8% corresponded to viscerocutaneous loxoscelism, successfully managed with supportive measures, systemic corticosteroids and antihistamines. Fifty-nine percent healed their cutaneous lesions after one month of treatment, with slight residual scarring or post inflammatory hyperpigmentation, without associated mortality in our series. Discussion: Most cases of cutaneous loxoscelism presented excellent response and rapid resolution of the disease after combined therapy with systemic corticosteroids, antibiotics and dapsone, suggesting that the use of these therapies could stop the progression of cutaneous necrosis and prevent complications associated with loxoscelism.

Laparoscopic Cholecystectomy in Two Patients with Situs Inversus Totalis: A Case Report

Situs inversus totalis (SIT) is a rare condition in which the viscera are transposed in a mirror image reversal. We report two cases of laparoscopic cholecystectomy (LC) performed for SIT patients. A 63-year old male patient with SIT was diagnosed with symptomatic gallstones. We performed LC by 3-port method. The patient was discharged uneventfully on postoperative day 2. A 57-year old female patient with SIT underwent LC for acute cholecystitis. Due to severe inflammation an assistant was needed. The patient was discharged uneventfully on postoperative day 3. Over 80 cases of LCs in SIT patients have been reported so far and LC has become the standard treatment. The current report confirms the safety of laparoscopy in such cases. Laparoscopic cholecystectomy can be performed safely in SIT patients if care is taken. Surgeons need to be careful of reversed anatomy and unaccustomed working hand.