Assuntos
Cardiologia , Diagnóstico por Computador , Medicina Interna , Software , Diagnóstico Diferencial , HumanosRESUMO
In contrast to prior experience in this setting, three of four Shigella flexneri strains recently isolated from patients in Northeastern Brazil with acute inflammatory diarrhea were found to be resistant to sulfamethoxazole, trimethoprim and the combination in vitro. We performed mating studies to determine if the resistance was transferable, and then isolated and characterized plasmid DNA from the resistant Shigella isolates, other resistant Enterobacteriaceae isolated simultaneously from the stools of these individuals, and transconjugant strains. Each of the resistant Shigella strains contained a large plasmid. These plasmids were of different molecular weights ranging from 30 to 50 Mdal in size. Two of these plasmids were transferred with sulfamethoxazole-trimethoprim resistance to E. coli K-12 recipient strains. These findings of transferable resistance to sulfamethoxazole-trimethoprim associated with plasmids in Shigella and in other Enterobacteriaceae raises concerns about the potential limitations of this widely used antimicrobial combination.
Assuntos
Shigella flexneri/efeitos dos fármacos , Sulfametoxazol/farmacologia , Trimetoprima/farmacologia , DNA Bacteriano/isolamento & purificação , Diarreia/microbiologia , Combinação de Medicamentos/farmacologia , Resistência Microbiana a Medicamentos , Eletroforese em Gel de Ágar , Humanos , Técnicas In Vitro , Testes de Sensibilidade Microbiana , Plasmídeos/efeitos dos fármacos , Shigella flexneri/isolamento & purificação , Combinação Trimetoprima e SulfametoxazolRESUMO
In contrast to prior experience in northeastern Brazil, three of four Shigella flexneri strains recently isolated from patients with acute inflammatory diarrhea in this setting were found to be resistant to sulfamethoxazole-trimethoprim. The resistant strains contained large, different plasmids, two of which were transferred with sulfamethoxazole-trimethoprim resistance to Escherichia coli K-12 recipient strains.
Assuntos
Antidiarreicos/farmacologia , Shigella flexneri/efeitos dos fármacos , Sulfametoxazol/farmacologia , Trimetoprima/farmacologia , Antibacterianos/farmacologia , Brasil , DNA Bacteriano/análise , Resistência Microbiana a Medicamentos , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , PlasmídeosAssuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Colangiografia , Colecistectomia , Complicações Pós-OperatóriasRESUMO
Aborda, de maneira sucinta, as possibilidades diagnosticas do exame laparoscopico.As indicacoes, tradicionais e recentes sao analisadas no sentido de colocar o clinico a par deste metodo propedeutico endoscopico
Assuntos
Humanos , LaparoscopiaAssuntos
Humanos , Masculino , Feminino , Colelitíase , Doenças dos Ductos Biliares , Colecistectomia , Colesterol , RadiografiaRESUMO
Selective distal splenorenal shunt was successfully performed in 20 patients from October 1974 to August 1978. All of them had had gastrointestinal hemorrhage from gastroesophageal varices, diagnosed by barium swallow roentgenography or esophagogastroscopy. Only one patient underwent emergency surgery. Portal hypertension was due to hepatic schistosomiasis in 16 patients, and all underwent rectal biopsy and examination of stools to confirm the clinical diagnosis. A small group of patients had ascites, jaundice and hemorrhage. Hepatic encephalopathy has not been a problem, although the follow-up study is short.
Assuntos
Hipertensão Portal/cirurgia , Derivação Portossistêmica Cirúrgica/métodos , Veias Renais/cirurgia , Veia Esplênica/cirurgia , Adolescente , Adulto , Criança , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/etiologia , Masculino , Pessoa de Meia-Idade , Esquistossomose/complicaçõesRESUMO
Employing percutaneous transhepatic cholangiography by CHIBA method in 15 patients, it was possible to visualize biliary system in 93.3% of the cases. The radiologic diagnostic of KLATSKIN tumor was observed in 2 cases, 4 cases of carcinoma of the papila of VATER, 1 case of carcinoma of the terminal choledochus, 1 case of intrahepatic neoplasia, 1 case of stenosis secondary to choledocal, trauma, and in another it was damaged by subcapsular hepatic leakage of contrast. The complications were minor. In 5 cases the patients had biliary colic at the time of the exam. In 2 cases, signals of baeteremia occurred in the day following the exam, and in 4 cases there was a small subcapsular hepatic leakage of contrast. In one case it was encountered hematoma under the capsule of the liver, during surgery. The diagnosis was confirmed at surgery in 12 cases. We concluded that the simplicity of the technic, its low cost and its diagnostic, accuracy have made it extremely useful.
