The pattern of fall of serum bilirubin after operative relief of obstructive jaundice. A preliminary report / Perfiles de caída de la bilirrubina sérica luego de corrección quirúrgica de la ictericia obstructiva

This is the beginning of a prospective study on patients who have obstructive jaundice to see how the serum bilirubin falls after operative relief of the obstruction. Seven of such patients have been studied; four had carcinoma of the head of the pancreas while the other three had choledocholithiasis. The patients with carcinoma had relief of the jaundice through a biliary -enteric anastomosis and those with common bile duct stones had choledochotomy with stone extraction which was completed with insertion of a T-tube. Serial bilirubin estimations were then performed post-operatively to chart the pattern and rate of descent of this in each patient. Our observations suggest that the pattern of fall of serum bilirubin after successful decompression of the extra-hepatic biliary tree exhibit a distinct pattern regardless of the surgical procedure performed for the relief of the obstruction.

El presente artículo es el reporte preliminar de un estudio prospectivo de pacientes con ictericia obstructiva, que evalúa la disminución progresiva en los niveles séricos de bilirrubina luego de la corrección quirúrgica de la obstrucción. El estudio incluye 7 pacientes, 4 de ellos con carcinoma en la cabeza del páncreas y los 3 restantes cursaron con coledocolitiasis. Los pacientes con carcinoma fueron sometidos a una anastomosis bilio -entérica con el fin de corregir la ictericia, mientras que los pacientes con cálculos en el conducto biliar fueron sometidos a coledocotomía, extracción de los cálculos biliares e inserción de un tubo en T. Posteriormente, se realizaron numerosas cuantificaciones de los niveles de bilirrubina en suero, para determinar el patrón y la taza de descenso de dichos niveles en cada paciente. Los resultados muestran el patrón de caída de los niveles séricos de bilirrubina luego de la desobstrucción exitosa de las vías biliares extrahepáticas. Tres pacientes mostraron un patrón aberrante a pesar del correcto procedimiento quirúrgico.

Pyoderma gangrenosum and ulcerative colitis in the tropics / Pioderma gangrenoso e colite ulcerativa nos trópicos

Pyoderma gangrenosum is a rare inflammatory skin condition, characterized by progressive and recurrent skin ulceration. There may be rapidly enlarging, painful ulcers with undermined edges and a necrotic, hemorrhagic base. Disorders classically associated with pyoderma gangrenosum include rheumatoid arthritis, inflammatory bowel disease, paraproteinemia and myeloproliferative disorders. There have been some reports of the occurrence of pyoderma gangrenosum in Africa, and in Nigeria, but only one specifically reported pyoderma gangrenosum in association with ulcerative colitis. We report on a 45-year-old man who presented with pyoderma gangrenosum associated with ulcerative colitis; the second report in Nigeria. The skin lesions were managed with daily honey wound dressings. Oral dapsone and prednisolone were started. The frequency of the bloody diarrhea decreased, and was completely resolved by the second week after admission. The ulcers also showed accelerated healing. The goal of therapy is directed towards the associated systemic disorder, if present.

Pioderma gangrenoso é uma rara forma de inflamação dermatológica, caracterizada por ulceração progressiva e recorrente da pele. Pode ocorrer rápida formação de úlceras dolorosas expansivas, com bordas solapadas e base necrótica e hemorrágica. Condições classicamente associadas com pioderma gangrenoso incluem artrite reumatóide, doença inflamatória intestinal, paraproteinemia e doenças mieloproliferativas. Existem alguns relatos da ocorrência de pioderma gangrenoso na África e na Nigéria, mas apenas um relato específico da associação de pioderma gangrenoso e colite ulcerativa. Os autores relatam o caso de um homem de 45 anos que apresentou pioderma gangrenoso associado a colite ulcerativa, sendo este o segundo relato na Nigéria. As lesões de pele foram tratadas com curativos diários de mel. Foram utilizadas dapsona e prednisona via oral. A freqüência de diarréia sanguinolenta diminuiu e se resolveu completamente até a segunda semana após a admissão. As úlceras também mostraram rápida cicatrização. A meta do tratamento deve abordar também a doença sistêmica associada, quando presente.