Efectividad de la antibioticoterapia sistémica precoz en pacientes con endoftalmitis postraumática / Effectiveness of the early systemic antibiotic therapy in patients with postraumatic endophthalmitis

Introducción: La endoftalmitis postraumática se define como una marcada inflamación de los fluidos y tejidos de las cavidades intraoculares, provocada por la invasión y replicación de microorganismos después de un traumatismo ocular a globo abierto, lo cual puede ocasionar la pérdida de la visión. Objetivo: Evaluar la efectividad de la terapia antibiótica sistémica precoz en pacientes con endoftalmitis postraumática. Métodos: Se efectuó un estudio cuasiexperimental de 72 pacientes con traumatismo ocular a globo abierto, ingresados en el Centro Oftalmológico del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero del 2017 hasta mayo del 2019. Se realizó un muestreo aleatorio simple; los pacientes se distribuyeron en 2 grupos: uno de control con 28 integrantes, a los cuales se le administró el tratamiento farmacológico habitual y otro de estudio con 44, quienes además de lo anterior recibieron terapia antibiótica sistémica. Resultados: Predominaron los pacientes masculinos, con edades entre 45 y 54 años (29,5 %); 72,7 % no mostraron antecedentes personales de interés y el trauma ocular ocurrió con más frecuencia en un ambiente rural (77,8 %). La zona 1 fue la más afectada (65,3 %); en 39,3 % de los pacientes la evolución del trauma fue menor de 6 horas, pero en el grupo que no recibió la terapéutica sistémica precoz y presentó endoftalmitis (10,7 %) este tiempo fue mayor, la reparación ocurrió tardíamente. Conclusiones: La terapia antibiótica sistémica precoz fue efectiva en la mayoría de los pacientes que recibieron este tratamiento contra la endoftalmitis postraumática.

Introduction: Postraumatic endophthalmitis is defined as a marked inflammation of the fluids and tissues of the intraocular cavities, caused by the invasion and replication of microorganisms after an ocular traumatism on open globe, that can cause loss of the vision. Objective: To evaluate the effectiveness of the early systemic antibiotic therapy in patients with postraumatic endophthalmitis. Method: A quasi-experiment study of 72 patients with ocular traumatism on open globe was carried out, they were admitted in the Ophthalmologic Center of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from January, 2017 to May, 2019. A simple random sampling was carried out; patients were distributed in 2 groups: one of control with 28 members, that received the habitual pharmacological treatment and a study group with 44 members who received systemic antibiotic therapy besides the above-mentioned. Results: Male patients prevailed, aged between 45 and 54 years (29.5 %); 72.7 % didn't show personal history of interest and the ocular trauma happened with more frequency in a rural atmosphere (77.8 %). The area 1 was the most affected (65.3 %); in 39.3 % of the patients the clínical course of trauma was less than 6 hours, but in the group that didn't receive the early systemic therapy and presented endophthalmitis (10,7 %) this time was higher, the repair happened belatedly. Conclusions: The early systemic antibiotic therapy was effective in most of the patients that received this treatment against the postraumatic endophthalmitis.

Triple Pelvic Osteotomy Fixed with Lag Screw for the Treatment of Pelvic Canal Stenosis in Five Cats.

OBJECTIVE: The aim of this study was to describe the technique and the clinical outcome of cats with obstipation as a result of pelvic canal narrowing, treated using an alternative triple pelvic osteotomy technique. METHODS: Five cats with obstipation as a result of pelvic canal narrowing due to pelvic fracture malunion or secondary hyperparathyroidism were treated by triple pelvic osteotomy. After performing the iliac osteotomy and medial partial cortical debridement (4/5 cases), the pelvic canal was widened by moving the caudal fragment of the ilium to the lateral aspect of the cranial fragment. The iliac fragments were fixed by a 2.7-mm lag screw (5/5 cases) and an additional 2 Kirschner wires 0.8 mm (1/5 cases). RESULTS: The radiographic examination immediately postoperatively and 8 weeks postoperatively showed a mean pelvic canal enlargement of 20% (range 7-38%). Minor complication occurred in one case; this resolved 15 days postoperatively without any treatment. Complications and recurrence of obstipation did not occur during the final follow-up, ranging between 5 months and 1 year in any of these cases. CLINICAL SIGNIFICANCE: The use of lag screw fixed triple pelvic osteotomy resulted in widening of the pelvic canal and led to a satisfactory outcome with no major complications. This technique is fast, requires no expensive implants and it is relatively straightforward. Further cases are required to determine the success and complication risk of the procedure.

A Prospective Evaluation of a Modified Belt-Loop Gastropexy in 100 Dogs with Gastric Dilatation-Volvulus.

Gastropexy is a surgical technique performed to prevent and decrease the recurrence rate of gastric dilatation and volvulus (GDV). The objective of this prospective, a descriptive cohort study on 100 client-owned dogs who were presented with GDV, is to describe a modified belt-loop gastropexy and determine its intraoperative complications and long-term efficacy. The transversus abdominis muscle was used to make an oblique belt-loop. A seromuscular antral fold, instead of a seromuscular antral flap, was passed through the belt-loop, and then, the passed portion of the antral fold was sutured to the dissected edge of the abdominal wall. Intraoperative complications related to gastropexy were recorded, and the incidence of GDV recurrence was determined a minimum of 1 yr postoperatively via telephone with the referring veterinarians and the owners. There were no intraoperative complications related to the modified belt-loop gastropexy technique. Based on follow-up conversations, none of the dogs presented signs of GDV recurrence during the follow-up period. Based on the results, there is strong clinical evidence that a modified belt-loop gastropexy prevents recurrence of GDV in dogs surviving an acute episode.

Feasibility and safety of day-surgery laparoscopic cholecystectomy: a single-institution 5-year experience of 1140 cases

BACKGROUNDS/AIMS: We report our experience with day-surgery laparoscopic cholecystectomy and assess its feasibility and safety. METHODS: Data was collected on all the patients who underwent day-surgery laparoscopic cholecystectomy between February 2009 and February 2014 at Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. All patients had symptomatic cholelithiasis that was proven on imaging studies with clearance of the common bile duct. The patient biographical data (age, gender, American Society of Anaesthesiology status, medical comorbidities) and surgical outcomes were then obtained. There was an evaluation of the success rate of day-surgery laparoscopic cholecystectomy, reasons for unexpected admission, and the re-admission rate. RESULTS: A total of 1,140 patients were included in this study. The success rate for day-surgery laparoscopic cholecystectomy was 96%. The reasons for unexpected hospital admission for 46 patients (4%) included persistent abdominal pain and postoperative emesis. The postoperative re-admission rate was 0.4% (5 patients). There were no major complications, and the conversion rate was 0.5% (6 patients). CONCLUSIONS: We suggest that day-surgery laparoscopic cholecystectomy is both safe and feasible in a local setting. Careful patient selection is essential in ensuring a high success rate.

Two cases of dysuria as a complication of single-session bilateral triple pelvic osteotomy.

Dysuria is a rare, but nevertheless severe postoperative complication associated with single-session bilateral triple pelvic osteotomy. Two cases are described in which contrast radiography of the lower urinary tract was used to diagnose urethral compression due to pelvic canal narrowing. Relief of the pressure on the urethra was achieved with an external fixation device, which distracted the acetabular fragments of the pelvis. In both cases the dysuria was resolved. The significance of this complication and its possible causes, especially regarding surgical technique, are discussed.

Circular external skeletal fixation stabilization of antebrachial and crural fractures in 25 dogs.

Fracture stabilization using circular external skeletal fixation was evaluated in 14 dogs with antebrachial fractures and 11 dogs with crural fractures. Most dogs were consistently weight bearing on the stabilized limb by 3 days following surgery. Although all dogs developed minor wire/pin tract inflammation and eight dogs developed major wire/pin tract inflammation, postoperative lameness was not consistently associated with wire/pin tract complications. Fractures in 23 dogs achieved radiographic union (mean +/- standard deviation [SD], 61 +/- 21 days; median, 57 days) without additional surgery; two dogs required restabilization of their fractures with linear fixators. Twenty of the 21 owners that could be contacted felt their dog had no (n=15) or only a mild (n=5) intermittent lameness at the time of final, long-term (mean +/- SD, 37 +/- 17 months; median, 42 months) assessment.

Liver transplantation in man: morphometric analysis of the parenchymal alterations following cold ischaemia and warm ischaemia/reperfusion.

Ischaemia and reperfusion phases represent critical events during liver transplantation. The purpose of this study was to describe morphological alterations of both vascular and parenchymal compartments after ischaemia and reperfusion and to evaluate the possible relationship between morphometric parameters and biochemical/clinical data. Three needle biopsies were drawn from 20 patients who underwent orthotopic liver transplantation. The first biopsy was taken before flushing with preservation solution, and the second and the third to evaluate respectively the effects of cold ischaemia and of warm ischaemia/reperfusion. Biopsies were examined by an image analyser and morphometric parameters related to the liver parenchyma were evaluated. At the second biopsy we observed a decrease of the endothelium volume fraction while the same parameter referred to the sinusoidal lumen achieved a peak value. The hepatocytes showed a lower surface parenchymal/vascular sides ratio. This parameter was reversed at the end of the reperfusion phase; furthermore the third biopsy revealed endothelial swelling and a decreased volume fraction of the sinusoidal lumen. The results quantify the damage to the sinusoidal bed which, as already known, is one of the main targets of cold ischaemia; warm ischaemia and reperfusion accentuate endothelial damage. The end of transplantation is characterised by damage chiefly to parenchymal cells. Hepatocytes show a rearrangement of their surface sides, probably related to the alterations of the sinusoidal bed. In addition, the fluctuations of morphometric parameters during ischaemia/reperfusion correlate positively with biochemical data and clinical course of the patients.

[Contusion of the liver. Importance of associated lesions in polytraumatized patients]. / Les contusions du foie. Importance des lésions associées chez les polytraumatisés.

Between January 1984 and June 1993, we treated 120 contusions of the liver in a situation of polytrauma. There were 24 patients in Stage I, 47 in Stage II, 22 in Stage III, 13 in Stage IV and 14 in Stage V according to the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma. A total of 107 patients were operated. Polytrauma related mortality was high. Besides the gravity of the liver lesion, prognosis was a function of other associated intra or extra abdominal lesions. In our series, other associated lesions were the cause fo death in 26 patients (64%) and 15 deaths (36%) were directly related to the hepatic lesion. The gravity of the Stage V lesions was related both to the state of shock of operation and the difficulties in reestablishing haemostasis. Packing decreased the effect of hypovolaemia and coagulopathy. The prognosis of supra hepatic venous lesions and hepatic resections remain disastrous. Our surgical schema has changed towards more conservative surgery and, when haemodynamic stability has been achieved, to abstention and careful monitoring. Different extra-hepatic trauma causing damage to other organs directly compromises simple hepatic lesions. The result of our series confirms the correlation between mortality and the gravity of the polytrauma as evaluated according to the Injury Severity Score proposed by Baker.

Morphology of urothelial papillary tumors.

A total of one hundred forty-seven urothelial papillary tumors (UPT) from 14 cystectomy specimens were studied, matching the morphology of these tumors as seen with a dissecting microscope with the histology. Two kinds of papillae (digitate and laminar) were identified as the elementary structures of the UPT. According to their composition, urinary papillary tumors have been classified as: digitate (mainly digitate papillae), laminar (mainly laminar papillae), laminodigitate (tumors in which neither digitate nor laminar papillae clearly prevail).

Characterization by morphometric model of liver regeneration in the rat.

A new stereological approach to the study of liver regeneration in the rat is described. The method employs a morphometric model consisting of number and size, as well as surface and volume fractions of hepatocytes, their nuclei, cytoplasm, and their relation to the sinusoidal bed. With this technique, it was found that 8 hr after partial hepatectomy, the number of nuclei increased as did the nucleus/cytoplasm ratio, suggesting an early hyperplastic phase. These data, which have not been reported in other studies, underline the importance of evaluating the complex phenomenon of liver regeneration using a stereological approach, which is more representative of all morphometric changes occurring inside and outside the hepatocyte.

Neoplastic invasion of the connective stalks in transitional cell papillary tumors (TCPT) of the bladder.

Neoplastic invasion into the connective stalks of transitional cell papillary tumors of the bladder was assessed in TUR specimens from new cases. There were 21 G1 cases, none of which showed invasion of the connective tissue stalk; this compared with definite invasion in 19 of 77 G2 cases (25%) and in 16 of 17 G3 cases (94%). During a 5 year follow-up period more of the stalk invasive cases had an unfavorable course (fatal outcome or total cystectomy) than of the stalk non-invasive cases; this was statistically significant (p less than 0.01) for the whole group of patients and for the smaller group of patients with G2 tumors (p less than 0.05).

Cytologic diagnosis of prostatic malakoplakia. Report of three cases.

Three cases of prostatic malakoplakia are reported. The cytologic findings in the smears obtained by transrectal fine needle aspiration biopsy are compared with the histologic findings obtained by simultaneously performed transrectal punch biopsy. The striking cytologic finding was the presence of large isolated histiocytes with abundant foamy cytoplasm. The concentrically laminated Michaelis-Gutmann bodies that are characteristic of malakoplakia were seen both within the histiocytes and, occasionally, in the extracellular background. The smears were further characterized by a granulomatous inflammatory reaction, consisting of large numbers of polymorphonuclear leukocytes, lymphocytes and plasma cells. These findings appear to be sufficient to make a diagnosis of this rare lesion in a prostatic aspirate. To our knowledge, this is the first description of the cytology of prostatic malakoplakia.

Growth and modeling of urothelial papillary tumors.

The development of urothelial papillary tumors (UPT) has been interpreted from some histologic patterns to suggest that intraurothelial vascularization and opening of urothelial nests that have grown in the lamina propria are basic processes for the development, growth, and modeling of UPT. These basic processes can combine in different ways to form the complex structures that compose UPT.

Bile lipid output and composition in patients fitted with external biliary drainage: activity of cicloxilic acid.

In 7 patients with external biliary drainage for total occlusion of the extrahepatic bile ducts the bile output was measured in 3-day periods, with and without cicloxilic acid treatment (240 mg daily, per os). The output increased markedly during treatment in all cases. In the 3 patients in whom the bile lipid composition was analyzed also, the bile salt and phospholipid concentrations increased while the cholesterol concentration was unchanged--with an consequent lowering of the biliary cholesterol saturation index--during treatment with cicloxilic acid.

Anaerobic and aerobic bacteria in secretions of prostate and seminal vesicles of infertile men.

A cytological and bacteriological study was made of prostatic (EPS) and vesicular (EVS) secretions from 123 infertile men who were suspected of having chronic genital tract inflammation and from 31 men with premature ejaculation (1,12,16). In the microbiological investigations samples were inoculated within 10 min on various culture media and incubated under both aerobic and anaerobic conditions. Bacterial loads of more than 10,000 colony-forming units of a single species or genus per milliliter of EPS or EVS were considered to be pathological. In the infertile subjects with proven inflammation of the seminal accessory glands, the EPS and the EVS that gave positive cultures and had bacterial loads defined as pathological contained large numbers of anaerobic or microaerophilic organisms (EPS: 51 of the 63 bacterial strains found, congruent to 81%; EVS: 19 of the 20 bacterial strains found, congruent to 95%).

High-resolution protein patterns of human expressed prostatic secretion: a new tool for the diagnosis of prostatitis.

Expressed prostatic secretions (EPS) obtained from 62 infertile and urological patients have been analyzed for their protein content by sodium dodecylsulfate electrophoresis and isoelectrofocusing. Independent cytological and bacteriological screening on the same EPS samples was carried out to detect prostatic inflammation. EPS from both urological and infertile patients without inflammation had simple and characteristic protein patterns. Important qualitative and quantitative differences in the protein composition of EPS from patients with severe dysspermia or prostatic inflammation were found. The comparison of EPS protein patterns with those of seminal plasma obtained from the same patients led to the detection of a characteristic group of low-molecular-weight bands that were not of prostatic origin.