Proptosis por Celulitis Orbitaria en paciente Pediátrico: reporte de un caso / Proptosis for Orbital Cellulitis in a Pediatric Patient: case report

Orbital cellulitis is an infectious disease that occurs most frequently in the pediatric age. The most common underlying factor for its development is ethmoidal sinusitis. The microorganisms associated with orbital infection are S. pneumoniae, S. aureus, H. influenzae and M. catarrhalis, whose therapeutic failure brings serious complications that include loss of vision, meningitis and intracranial infection. In the following case we want to capture the doctor's actions in this infectious pathology, the diagnoses we should rule out and antibiotic treatment. We report the case of a previously healthy 2-year-old male patient who consulted for an increase left bipalpebral volume, associated to impossibility of spontaneous opening of left eye and febrile peak of 39.4 ° C, with TAC of paranasal sinuses and orbit, where shows left medial intraorbital abscess, with preseptal compromise that determines left proptosis, deciding to start associated antibiotic therapy for orbital cellulitis with compromise preseptal. In view of the slow evolution, a study was started to rule out the associated tumor process, which is discarded, maintaining an antibiotic for 21 days with clinical improvement after these. Orbital cellulitis in the pediatric age should be diagnosed quickly and in a timely manner, since it is a medical emergency, it is a condition that requires hospitalization and management with systemic antibiotics.

Marked seasonality of Cyclospora cayetanensis infections: ten-year observation of hospital cases, Honduras.

BACKGROUND: Document seasonality occurrence and epidemiologic characteristics of Cyclospora cayetanensis infections during a 10-year period from patients consulting at the University Hospital, Honduras. METHODS: Retrospective non interventional hospital-based study analyzed laboratory results from the period 2002 to 2011 of fresh and Ziehl-Nielsen carbolfuchsin stained routine stool samples received for parasitologic examination. Sporadically a sample with numerous oocysts was allowed to sporulate in 2.5 % potassium dichromate confirming the presence of bi-cystic bi-zoic oocysts. RESULTS: A total of 35,157 fecal samples were examined during a ten-year span, of which a third (28.4 %) was stained by the Ziehl-Neelsen carbolfuchsin method diagnosing a total of 125 (1.3 %) C.cayetanensis infections. A statistically significant apparent seasonality was observed most years during May to August (range p < 0.036-0.001), with 83.3 % of 125 cases occurring in those rainy months. All C. cayetanensis cases came from urban poor neighborhoods; male/female relation was 1:1 except in 2006, when all patients were females (p = 0.05; r(2) = 22,448). Forty four point eight percent of the stool samples were diarrheic or liquid and 65.6 % infections were identified in children 10 years old or less. Enteric helminths and protozoa co-infected Cyclospora positive patients in 52 instances.: 8 % Ascaris lumbricoides, 8 % Giardia duodenalis, 23.2 % Blastocystis spp. and less frequently Entamoeba histolytica/E. dispar, Strongyloides stercoralis, and Trichuris trichiura. CONCLUSIONS: Results suggest a seasonal pattern for Cyclospora infections diagnosed in a clinical setting during the rainy months in Tegucigalpa and surrounding areas. Community studies should be conducted to support or dispute these observations.

The FAT expandability (FATe) Project: Biomarkers to determine the limit of expansion and the complications of obesity.

BACKGROUND: Obesity is an excessive accumulation of fat frequently, but not always, associated with health problems, mainly type 2 diabetes and cardiovascular disease. During a positive energy balance, as caused by excessive intake or sedentary lifestyle, subcutaneous adipose tissue expands and accumulates lipids as triglycerides. However, the amount of adipose tissue per se is unlikely to be the factor linking obesity and metabolic complications. The expandability hypothesis states that, if this positive energy balance is prolonged, a point is eventually reached where subcutaneous adipose tissue can not further expand and energy surplus no longer can be safely stored. Once the limit on storage capacity has been exceeded, the dietary lipids start spilling and accumulate ectopically in other organs (omentum, liver, muscle, pancreas) forming lipid byproducts toxic to cells. METHODS/DESIGN: FATe is a multidisciplinary clinical project aimed to fill gaps that still exist in the expandability hypothesis. Imaging techniques (CT-scan), metabolomics, and transcriptomics will be used to identify the factors that set the limit expansion of subcutaneous adipose tissue in a cohort of caucasian individuals with varying degrees of adiposity. Subsequently, a set of biomarkers that inform the individual limits of expandability will be developed using computational and mathematical modeling. A different validation cohort will be used to minimize the risk of false positive rates and increase biomarkers' predictive performance. DISCUSSION: The work proposed here will render a clinically useful screening method to predict which obese individuals will develop metabolic derangements, specially diabetes and cardiovascular disease. This study will also provide mechanistic evidence that promoting subcutaneous fat expansion might be a suitable therapy to reduce metabolic complications associated with positive energy balance characteristic of Westernized societies.

Laparoscopic biliopancreatic diversion with distal gastric preservation: technique and three-year followup.

BACKGROUND: Biliopancreatic diversion (BPD) has been used satisfactorily as one of several surgical treatments against morbid obesity in order to achieve long-term weight reduction. Our goal was to develop the BPD laparoscopically in humans in order to improve postoperative recovery and to reduce early and late complications, above all those derived from the abdominal wall, while maintaining the weight reduction results achieved. In addition, in order to reduce the laparoscopic difficulty of BPD technique and some complications associated with gastrectomy, we only carried it out in cases in which we considered it indispensable. PATIENTS AND METHODS: Since October 2000 we have performed 50 laparoscopic BPD with distal gastric preservation (39 women and 11 men). We preserve the distal stomach if the upper digestive endoscopy with biopsy does not show pathological findings. RESULTS: Two operations (within the first ten cases) were converted to open surgery. The average operating time was 177.7 minutes (range, 110-360 minutes). There were no immediate postoperative complications. There was no postoperative mortality. CONCLUSION: It has been proven that BPD can be performed satisfactorily using laparoscopy, but this technique requires a very skilled and experienced laparoscopic surgeon. Avoiding gastrectomy is a very interesting option in order to reduce technical difficulties, surgeon stress, duration of the operation, patient stress, and, probably, postoperative morbidity and mortality. Laparoscopic BPD with distal gastric preservation is a very promising bariatric procedure with potential advantages over laparoscopic BPD with gastrectomy or open BPD.

Bypass biliopancreático. Comentario / Biliopancreatic bypass. Comment

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Laparoscopic biliopancreatic diversion: technical aspects and results of our protocol.

BACKGROUND: Biliopancreatic diversion (BPD) has been an excellent operation for morbid obesity to achieve long-term weight reduction. We present our laparoscopic BPD protocol, which includes laparoscopic BPD with or without gastrectomy. METHODS: Our two interventions are: 1) BPD (Scopinaro) by laparoscopy in patients with findings on gastroscopy; 2) BPD by laparoscopy with proximal gastric division without resection in patients without findings on gastroscopy. Since October 2000, we performed 65 laparoscopic BPDs (45 women, 20 men). RESULTS: 4 cases were converted to open surgery, 3 in the first 10 cases. The average operating-time was 176 minutes (360-110). We detected 2 stenoses of the gastric anastomosis. 2 patients had to be re-operated during the immediate postoperative period because of a leak from the jejuno-ileal anastomosis and a hemoperitoneum. CONCLUSION: BPD can be performed satisfactorily by laparoscopy. Avoiding the gastrectomy is an interesting option to reduce technical difficulties, the surgeon's stress, duration of the operation, the patient's stress, and, probably, postoperative morbidity and mortality. We consider an upper digestive endoscopy to be mandatory to determine, before operating, if the patient will need a gastrectomy, depending on its results.

Retroperitoneal mucinous cystadenoma.

INTRODUCTION: Retroperitoneal mucinous cystadenomas are rare tumors. Only 25 cases have been reported in the English literature until 2002. The histogenesis is unclear, diagnosis is never made preoperatively and surgery is the only treatment. CASE REPORT: We report an additional case.

Derivación biliopancreática laparoscópica para el tratamiento de la obesidad mórbida.Aspectos técnicos y análisis de los resultadospreliminares / Laparoscopic biliopancreatic diversion for the treatment of severe obesity. Technical aspects and analysis of preliminary results

Objetivo. En el presente estudio pretendemos demostrar que la derivación biliopancreática puede ser llevada a cabo por vía laparoscópica, aunque con cierto grado de complejidad.Pacientes y método. Entre noviembre de 2000 y abril de 2003 hemos realizado una derivación biliopancreática laparoscópica a 40 pacientes afectados de obesidad mórbida, 33 mujeres y 7 varones, con una edad media de 44,8 años y un índice medio de masa corporal de 46,6 kg/m2 (rango, 39,9-61 kg/m2). En nuestra serie realizamos gastrectomía cuando existía algún factor de riesgo de enfermedad neoplásica y/o ulcerosa (positividad para Helicobacter pylori, pólipo,displasia o metaplasia). En caso contrario manteníamos el estómago distal, de forma similar al bypass gástrico. Mantuvimos el remanente gástrico distal en 29 casos y practicamos gastrectomía en 11.Resultados. El tiempo operatorio medio en los primeros 10 casos fue de 242 min (rango, 180-360 min) y 3 de ellos requirieron reconversión. En los últimos 10 pacientes el tiempo fue de 143 min (rango, 110-190 min). Entre los primeros 6 pacientes, 3 tuvieron complicaciones (fuga anastomótica, edema y estenosis de gastroyeyunostomía y un fallecimiento por broncoaspiración). En el resto de la serie hubo un caso de hemoperitoneo que no precisó intervención quirúrgica y otro de atelectasia. En el momento actual, 11 pacientes han superado los 18 meses tras la intervención, con un índice de masa corporal medio de 27,7 kg/m2 (rango, 20-31,8 kg/m2) y un porcentaje medio de sobrepeso perdido del 82,5 por ciento (rango, 61,3125 por ciento).Conclusiones. La derivación biliopancreática es factible por vía laparoscópica, pero está gravada por una dificultosa curva de apredizaje (AU)