Abdominal Surgery in Patients With COVID-19: Detection of SARS-CoV-2 in Abdominal and Adipose Tissues.

Multiple tissue samples were obtained during emergent abdominal surgery in 4 patients with coronavirus disease 2019 (COVID-19) to examine for tissue involvement by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first patient underwent a laparoscopic cholecystectomy for gallbladder empyema and died from severe respiratory failure. The second patient with Crohn disease underwent emergent laparotomy for a perforation in the terminal ileum and recovered. The third patient underwent an open appendectomy and recovered. The fourth patient underwent emergent laparotomy for a perforated peptic ulcer and died from sepsis. Although the SARS-CoV-2 RNA was found in the feces of 3 patients and in the duodenal wall of the patient with perforated peptic ulcer, real time reverse transcriptase polymerase chain reaction (RT-PCR) examination of abdominal fluid was negative for the virus. The RT-PCR did not detect viral RNA in the wall of small intestine, appendix, gallbladder, bile, liver, and urine. Visceral fat (omentum) and abdominal subcutaneous fat of 4 patients were also not infected with the SARS-CoV-2. Although this limited experience did not show direct involvement of abdominal fluid and omentum, assessment in large series is suggested to provide answers about the safety of abdominal surgery in patients with COVID-19.

[Effectivity of detoxification preparation reamberin in complex treatment of the patients with chronic cholecystitis combined with chronic pancreatitis on background of HCV-infection].

Effectivity of detoxic preparation reamberin at complex treatment of the patients with acuting of chronic cholecystitis combined with chronic pancreatitis on background of HCV-infection was detected. It was set that before treatment took place increase "average molecules", lipid peroxidation products--malondialdehyde and dien conjugates and increase of circulatory immune complexes in serum. Including of reamberin provided to normalization clinical-biochemical indexes.

A case of acute cholecystitis without cholestasis caused by Epstein-Barr virus in a healthy young woman.

Epstein-Barr virus (EBV) is known to be one of the causes of viral hepatitis, but its association with cholecystitis is known to be rare. Cholestasis by EBV-induced hepatitis might be a cause of acute cholecystitis in all of the recently reported cases. In contrast, we experienced the case of a 20-year-old woman who was infected with EBV and presented with acute cholecystitis without cholestasis.

Pathogenicity by parenteral injection of fowl adenovirus isolated from gizzard erosion and resistance to reinfection in adenoviral gizzard erosion in chickens.

The pathogenicity of a serotype-1 fowl adenovirus (FAV-99ZH), which causes adenoviral gizzard erosion by oral inoculation in chickens, was investigated in specific pathogen-free white leghorn chickens. In trial 1, 14 chickens were inoculated intravenously with the virus at 21 days of age and euthanatized for necropsy within 1-14 days of inoculation. Gizzard erosion was grossly observed from day 7 postinoculation (PI), and histologically, FAV-99ZH antigen-positive, basophilic intranuclear inclusion bodies were seen in the gizzard lesions from day 7 to 11 PI. Necrotizing pancreatitis, and cholecystitis and cholangitis associated with the inclusions were observed from day 3 to 14 PI (pancreatitis) and from day 5 to 9 PI (cholecystitis and cholangitis), respectively. The inclusions were also observed in the epithelial cells of the cecal tonsils from day 3 to 5 PI. The virus was recovered from samples of the lesions. It was revealed that FAV-99ZH causes not only gizzard erosion but also pancreatitis, cholecystitis, and cholangitis by intravenous inoculation in chickens. In trial 2, 10 chickens were inoculated orally with the virus twice, at 13 and 36 days of age, and euthanatized for necropsy within 4-17 days after reinfection. Macroscopically, focal gizzard lesions were observed; however, neither necrosis nor inclusions were observed by microscopy. Moreover, FAV was not recovered from the gizzard or rectum of any of the chickens at necropsy. This suggests that the gizzard lesions occurred as a result of the primary infection, and that the chickens were able to resist reinfection.

[Cytomegalovirus acalculous cholecystitis in an AIDS patient]. / Colecistitis alitiásica por citomegalovirus (CMV) en paciente con SIDA.

We report a case of acalculous cholecystitis in an AIDS patient, that appeared with insidious onset, abdominal right upper quadrant pain and fever. Cholecystectomy was performed and CMV inclusions were observed in tissue sections. CMV acalculous cholecystitis is an uncommon condition associated to the acquired immunodeficiency syndrome. It should be considered, especially when abdominal pain and fever are present in marked immunosuppressed AIDS patients. Unfortunately, a limited experience in treatment, either medical or surgical, was reported. In our case, the response to surgical procedure was successful, disappearing the abdominal pain and the fever. The patient refused both ganciclovir and foscarnet therapy.

Ureteritis and cholecystitis: two unusual manifestations of cytomegalovirus disease in renal transplant recipients.

BACKGROUND: Common clinical manifestations of cytomegalovirus (CMV) infection include flu-like symptoms with fever, diarrhea, leukopenia, and elevated liver enzymes. Diagnosis is made by detection of the virus by buffy-coat blood culture or by polymerase chain reaction (PCR) analysis. METHODS: Here we describe two renal transplant recipients who presented with unusual manifestations of CMV disease (cholecystitis and ureteritis). In both patients, no symptoms or signs of systemic CMV infection were present, and they were thought to have other common causes for cholecystitis and ureteral obstruction. RESULTS: Retrospective analysis of peripheral blood by PCR analysis was positive for CMV DNA. Histologic examination of the resected gall bladder and stenotic ureteric segment showed CMV inclusions, confirmed subsequently by in situ hybridization. Thus, we report that CMV infection may present with acute cholecystitis or ureteral obstruction without its classical clinical symptoms. CONCLUSIONS: Because CMV infection is common in transplant patients, the atypical manifestations of CMV should be considered in the differential diagnosis of posttransplant complications. Detection of CMV DNA in the peripheral blood by PCR analysis may help identify these patients.