Pneumoperitoneum in association with perforated appendicitis in a Brazilian Amazon woman. Case report.

Radiographic findings of free air in the peritoneal cavity secondary to perforation of a acutely inflamed appendix are extremely rare. It accounts for about 0-7% of all patients with pneumoperitoneum. We report on a 58-years-old Brazilian Amazon woman presenting a 1- week history of abdominal pain, tenderness and distension associated with asthenia and without passage of stool or gas. Abdominal percussion revealed a tympanic sound located on the right hypocondrium. Plain chest radiography revealed a large amount of free air beneath the right leaf of the diaphram. The patient was taken immediately to the operation room and, during surgery, a gangrenous appendix with an apex perforation was verified. Appendectomy was performed as routinely. The patient evolved with pneumonia and septic shock that responded well to intravenous antibiotics and vasoactive drugs. She was discharged to home on the twenty-first post-operative day in good clinical conditions. This case highlights that perforated acute appendicitis is rarely associated with pneumoperitoneum, but it must be considered in the differential diagnosis of patients presenting right abdominal pain and free intraperitoneal air.

Time-dependent regulation of yeast glycolysis upon nitrogen starvation depends on cell history.

In this study, the authors investigated how the glycolytic flux was regulated in time upon nitrogen starvation of cells with different growth histories. We have compared cells grown in glucose-limited chemostat cultures under respiratory conditions (low dilution rate of 0.1/h) to cells grown under respirofermentative conditions (high dilution rate of 0.35/h). The fermentative capacity was lower in cells grown under respiratory conditions than in cells grown under respirofermentative conditions, yet more resilient to prolonged nitrogen starvation. The time profiles revealed that the fermentative capacity even increased in cells grown under respiratory conditions during the first hours of nitrogen starvation. In cells grown under respirofermentative conditions the fermentative capacity decreased from the onset of nitrogen starvation. We have applied time-dependent Regulation Analysis to follow the fermentative capacity during nitrogen starvation. In both experiments, diverse categories of regulation were found. However, in the cells grown under respiratory conditions regulation was predominantly metabolic, whereas in the cells grown under respirofermentative conditions hierarchical regulation was dominant. To study the metabolic regulation, concentrations of intracellular metabolites, including allosteric regulators, were measured. The obtained results can explain some aspects of the metabolic regulation, but not all.

Thoracic high resolution computed tomography (HRCT) in asthma.

INTRODUCTION: High-resolution computed tomography (HRCT) is a widespread medical imaging method for the study of thoracic diseases. In asthma it is very useful particularly when it is difficult to achieve an effective control of disease, and in severe deterioration. AIM: It was intended to evaluate the imaging changes by HRCT in asthmatic patients and to assess the expression according to the symptoms and duration of disease. MATERIAL AND METHODS: Thirty three patients from the Outpatient Department, with asthma classified in the different clinical severity stages according to GINA, were randomly included. They were submitted to HRCT (Somaton Plus-4, Siemens). The lesions were classified in reversible (mucoid impaction, acinar pattern centrilobular nodules and lobar collapse) and irreversible (bronchiectasis, bronchial wall-thickening, sequellar line shadows and emphysema). RESULTS: The 33 asthmatic patients (20 female) had an average age of 44.76 +/- 16.98 years and a mean disease evolution time of 23.39 +/-14.83 years. 30% had mild persistent asthma, 43% moderate persistent asthma and 27% severe persistent asthma. All the patients were under inhaled corticotherapy. Only 6 patients had normal HRCT 4 with mild persistent asthma (4 to 25 years of duration of disease) and 2 with moderate persistent (10 to 48 years of duration of disease). 81.81% of the patients had changes in HRCT, being the irreversible lesions the most frequent. The most important irreversible lesions were observed in severe asthma patients with longer duration of disease. All the patients with reversible lesions had also irreversible changes. Most of the bronchiectasis were centrally located and were found in severe asthma patients. Irreversible changes were identified in 3 patients with mild asthma and a maximum of 6 years of duration of disease. DISCUSSION: HRCT findings were related with asthma severity and long lasting disease but there are some asthmatics that also present early abnormalities, even in milder forms. All the groups of asthmatic patients presented all types of imaging changes, including the irreversible ones. In asthma these changes can be the result of individual patterns of response to frequent exacerbations, leading to a persistent chronic inflammatory process that will determine airway remodelling, even in early stages of disease and/or mild asthma.

Perforation of Meckel's diverticulum by a chicken bone mimicking acute appendicitis. Case report.

Meckel's diverticulum (MD) is a congenital disorder that results from an incomplete obliteration of the vitelline duct. MD may give rise to bleeding, intestinal obstruction and inflammation; however its perforation by a foreign body is an extremely rare life-threatening complication. We report on a 52 years-old Brazilian Amazon man presenting symptoms and signs of acute abdomen with an initial suspicion of acute appendicitis. However, the right diagnosis was made only during exploratory laparotomy when the appendix was found to be normal, whereas MD was found to be inflamed and perforated by a chicken bone. The patient was treated successfully with resection of a segment of the ileum, including the perforated diverticulum, and had an uncomplicated postoperative course.