Rupture of visceral artery aneurysm following elective spinal surgery: a case report and review.

INTRODUCTION: Visceral artery aneurysms (VAA), an uncommon disorder of splanchnic vasculature, are associated with significant morbidity and mortality. Despite largely being amenable to endovascular therapies, the initial management of symptomatic VAA typically falls under the care of general surgeons. It is thus essential to have knowledge of the diagnosis and treatment of VAA and to be cognisant of deviations from normal gastrointestinal vasculature. CASE PRESENTATION: In this paper, we describe the case of a 72-year-old male presenting with a VAA following elective spinal surgery, followed by a review of the clinical diagnosis and management of VAA. CONCLUSION: Visceral artery aneurysm must be considered as a differential diagnosis for acute abdominal pain and anaemia in the post-operative period following all major operations. Knowledge of the clinical features of VAA and indications for specific intervention are essential for all general surgeons. Furthermore, it is imperative to recognise deviations from normal vasculature of the gastrointestinal tract.

Proton pump inhibitor prescribing and costs in a large outpatient clinic.

UNLABELLED: Concerns have been raised regarding potential adverse effects and high costs of proton pump inhibitors (PPIs). Our objective was to assess issues of PPI utilization and expense in a large outpatient clinic population. METHODS: Two hundred-fifty-nine outpatient records were reviewed regarding PPI prescribing and indications during 2009. A cost analysis was performed to project cost differences if histamine-2 receptor antagonists (H2RAs) were used as an alternative to PPIs in appropriate clinical situations. RESULTS: Eighty-three (32.0%) were taking PPIs. Problem-listed gastroesophageal reflux disease (GERD) was the primary diagnosis in 69 (83.1%) of patients on PPIs. GERD was not apparent by documented history and/or endoscopy in 46.3% of problem-listed GERD patients. Symptom severity had been documented in only 36.2%. Cost analysis projected substantial savings if H2RAs had been used initially for mild to moderate symptoms. CONCLUSIONS: Outpatient PPI prescribing indications are not well documented and PPI use is probably excessive. H2RA therapy is likely underutilized.

Ureteral reconstruction with abdominal wall muscle flap: experimental study in rabbits.

The authors detail the experimental development of a technique for the reconstruction of the ureter using a tubular shape, muscle flap of the abdominal wall. the preliminary results indicate the feasibility of this surgical technique.

Conduta no tratamento do divertículo de uretra feminina / Treatment approach to female urethral diverticulum

Os divertículos de uretra feminina são incomuns e são mais freqüentes entre a terceira e a quinta décadas de vida. Geralmente é diagnosticado tardiamente. A maioria dos divertículos de uretra está relacionada à infecções recorrentes das glândulas periuretrais ou ao traumatismo uretral. . A uretrocistografia e a ressonância magnética são os métodos de imagem de maior valor no diagnóstico desta doença. O tratamento de eleição e a ressecção do divertículo.

Female urethral diverticula are uncommon and are more frequent between the third and fifth decades of life. They are usually diagnosed late. Most urethral diverticula are related to recurrent infections of the periurethral glands or urethral trauma. Cystourethrography and magnetic resonance imaging are the most valuable diagnostic methods. The treatment of choice is thte resection of the diverticulum.

[Treatment approach to female urethral diverticulum]. / Conduta no tratamento do divertículo de uretra feminina.

Female urethral diverticula are uncommon and are more frequent between the third and fifth decades of life. They are usually diagnosed late. Most urethral diverticula are related to recurrent infections of the periurethral glands or urethral trauma. Cystourethrography and magnetic resonance imaging are the most valuable diagnostic methods. The treatment of choice is thte resection of the diverticulum.

Ceftriaxona (Rocefin) no tratamento de infecçöes recorrentes do trato urinário / Ceftriaxone (Rocephin) in the treatment of recurrent urinary tract infections

Foram selecionados para um estudo aberto, comparativo e randomizado, 20 pacientes adultos portadores de infecçöes urinárias recorrentes. O primeiro grupo, composto de 10 pacientes, foi tratado com a ceftriaxona (500mg/dia). O segundo grupo utilizou gentamicina (160mg/dia). Ambos os grupos foram tratados em dose única diária, por via intramuscular, durante um período de sete dias. A Escherichia coli foi o patógeno causal em 90% dos casos do Grupo 1 e em 100% dos casos tratados com a gentamicina. No 3§ dia de tratamento, a urinocultura mostrou-se estéril em nove casos tratados com ceftriaxona (90%) e em cinco tratados com a gentamicina (50%). Durante a última avaliaçäo bacteriológica da urina, observou-se 100% de cura nos casos tratados pela ceftriaxona e manutençäo dos resultados encontrados no 3§ dia de tratamento, no grupo tratado com a gentamicina (50%)