Human intestinal spirochetosis, histological finding associated with diarrhea with poor clinical evolution

Human intestinal spirochetosis was described by Harland and Lee in 1971, after observing colonization of the apical membrane of the intestinal mucosa by spirochetes. The clinical importance of these findings is not clear, since it is unknown whether the presence of these microorganisms is pathogenic or commensal. The clinical presentation is variable. It can be asymptomatic or manifest with abdominal pain, changes in intestinal rhythm and rectal bleeding. The prevalence of intestinal spirochaetosis is notably higher in developing countries than in developed countries, with the most likely route of transmission being fecal-oral, although sexual transmission has also been suggested as it is more prevalent in homosexual men. We present the case of a 42-year-old man, in treatment for 3 years with Tenofovir, with an HIV-positive partner, who went to the hospital for persistent diarrhea associated with eating a hamburger. (AU)

Placenta Accreta in a COVID-19 positive patient

Placenta accreta spectrum is a state of abnormal attachment of the placenta to the myometrium, resulting in hemorrhage and delayed or impossible delivery of the placenta. It`s an infrequent pathology, and this condition can be life-threatening. We present an interesting case of a 41-year-old female with COVID-19 that attends the emergency room due to scanty vaginal bleeding at 14 days postpartum. A hemostatic hysterectomy was performed, and the diagnosis of placenta accreta was made. (AU)

Racial disparities after stoma construction in colorectal surgery.

AIM: Racial disparities are under-recognized among patients undergoing colorectal surgery. The purpose of this study was to determine the complication rates and surgical outcomes stratified by race and ethnicity among patients undergoing colorectal surgery with intestinal stoma creation. METHOD: The ACS NSQIP database from 2013 to 2016 was used. Colon, rectum and small bowel cases requiring intestinal stoma creation were selected. Both African-American and other groups of minority patients were compared with Caucasian patients using a complex multivariable analysis model. Primary outcomes of interest were complication rates, mortality and extended hospital length of stay. RESULTS: The study included 38 088 admissions. After multivariable analysis, African-American patients still had a prolonged length of hospital stay and higher complication rates. Other minorities also had a prolonged length of hospital stay and higher complication rates. CONCLUSIONS: Both African-American and other groups of minority patients requiring an ostomy suffer significantly higher postoperative complication rates and a prolonged hospital length of stay, even after comorbidity adjustment. Access to care, socioeconomic status and comorbid disease management are all important factors for minority patients who undergo colorectal surgery requiring intestinal stoma construction.

Effectiveness and long-term results of laparoscopic common bile duct exploration.

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is a cost-effective, efficient, and minimally invasive method of treating choledocholithiasis. We reviewed the long-term results and efficacy of LCBDE for the common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC). METHODS: Medical charts were reviewed for all patients undergoing LCBDE at St. Vincent Hospital over 11 years (1990-2001). Demographic data, clinical features, laboratory data, radiologic and operative findings, and postoperative follow-up evaluation were analyzed. RESULTS: A total of 346 LCBDE were performed during the study period. The mean operative time was 127 +/- 3 min, and the length of hospital stay averaged 2.8 +/- 0.1 days. In 8 patients (2.3%), LCBDE was converted to an open procedure. Complications were noted in 33 patients (9.5%), including patients (2.7%) with retained stones. No postoperative mortalities were recorded. No long-term strictures or biliary complications were noted over a mean follow-up period of 43 months (follow-up data available for 96%). CONCLUSION: A policy of routine cholangiography and LCBDE for CBD stones was effective in clearing the bile duct and avoiding further hepatobiliary instrumentation. The findings show that LCBDE can be performed successfully with low morbidity and mortality.

Amnesia during cold water immersion: a case report.

This report describes a case of amnesia during a cold-water experiment. The volunteer was exposed three times in 1 day (120 min duration each time) to 20 degrees C water. During the third immersion, from min 95 to min 115, the subject experienced transient global amnesia for 20 min. The rectal temperature during this time was 35.6 degrees C. This single case demonstrates that memory loss in a young individual apparently can occur after cold-water exposure and at core temperatures above 35 degrees C.