RESUMO
Mansonellosis is an undermapped insect-transmitted disease caused by filarial nematodes that are estimated to infect hundreds of millions of people globally. Despite their prevalence, there are many outstanding questions regarding the general biology and health impacts of the responsible parasites. Historical reports suggest that the Colombian Amazon is endemic for mansonellosis and may serve as an ideal location to pursue these questions in the backdrop of other endemic and emerging pathogens. We deployed molecular and classical diagnostic approaches to survey Mansonella prevalence among adults belonging to indigenous communities along the Amazon River and its tributaries near Leticia, Colombia. Deployment of a loop-mediated isothermal amplification (LAMP) assay on blood samples revealed an infection prevalence of â¼40% for Mansonella ozzardi . This assay identified significantly more infections than blood smear microscopy or LAMP assays performed using plasma, likely reflecting greater sensitivity and the ability to detect low microfilaremias or occult infections. Mansonella infection rates increased with age and were higher among males compared to females. Genomic analysis confirmed the presence of M. ozzardi that clusters closely with strains sequenced in neighboring countries. We successfully cryopreserved and revitalized M. ozzardi microfilariae, advancing the prospects of rearing infective larvae in controlled settings. These data suggest an underestimation of true mansonellosis prevalence, and we expect that these methods will help facilitate the study of mansonellosis in endemic and laboratory settings.
RESUMO
The inter-mountainous region of central Honduras has been experiencing abrupt urban drinking water shortages during the last decade. Land use fragmentation and rainfall deficits have rapidly reduced surface water quality and quantity in this region. Here we present a 3-yr (2018-2020) tracer study within the headwaters of the Choluteca River basin (2949 km2). We sampled rainfall (weekly N = 156; daily N = 270), drilled wells (N = 166; up to ~300 m depth), boreholes (N = 70; ~4-12 m depth), and springs (N = 128) to assess the spatiotemporal connectivity between rainfall and mean groundwater recharge elevations (MREs). Clear W-shaped incursions characterized rainfall isotopic seasonality from the dry to the wet season. Air mass back trajectory analysis revealed three primary moisture sources: 73 % (east, Caribbean Sea), 17 % (southwest, Pacific Ocean), and 10 % (north; Gulf of Mexico). Groundwater sources exhibited a strong meteoric origin with evidence of secondary evaporation evolution, characterized by low d-excess values. MREs for the drilled wells ranged from 821 to 2018 m asl with a mean value of 1570 ± 150 m asl. Seasonal isotopic variability during dry-wet transitions and the influence of rapid infiltration limited the performance of the MRE method in springs and boreholes. MREs coincided primarily with coniferous forests, pasture, and crop areas, within regions of moderate to high transmissivity. These results are intended to guide the mapping and delineation of critical recharge areas in central Honduras to enhance municipal water regulations, effective environmental protection, and long-term conservation practices.
Assuntos
Monitoramento Ambiental , Água Subterrânea , Monitoramento Ambiental/métodos , Honduras , Isótopos/análise , Isótopos de Oxigênio/análise , RiosRESUMO
Gallbladder duplication is a rare event, with an incidence at autopsy of about 1/4000, with very few documented symptomatic cases reported. Preoperative diagnosis and differentiation of this malformation are important to prevent inadvertent damage to the biliary system, a complicated postoperative course, and repeat surgery. We present a case of true gallbladder duplication found incidentally during abdominal ultrasonography (US). The diagnosis was made with US and the Y-type duplication was demonstrated with magnetic resonance cholangiopancreatography (MRCP).
Assuntos
Vesícula Biliar/anormalidades , Adulto , Vesícula Biliar/diagnóstico por imagem , Humanos , Masculino , UltrassonografiaRESUMO
OBJECTIVE: To describe a case of Hirschsprung's disease (HD) in an adult patient. BACKGROUND: HD is diagnosed in the newborn in 80 to 90% of cases. HD is rare in the adult, and usually affects an ultrashort segment of the bowel. CASE REPORT: A 49-year-old woman with a history of constipation since birth is involved. She was submitted to an abdominal laparotomy because of fecal impaction. A colostomy was performed. The diagnosis of HD affecting, the descending colon was established with manometry and histopathology. She underwent surgery, and a proctectomy and left hemicolectomy with colo-anal anastomosis was performed. CONCLUSION: Adult HD is an infrequently diagnosed entity that must be suspected in a patient with chronic, intractable constipation from infancy, evidence of megacolon, and typical manometric and histopathologic features. The short and ultrashort-segment disease are more often found in older children and adults. The differential diagnosis includes idiopathic megarectum, functional constipation, and colonic pseudo-obstruction.
Assuntos
Doença de Hirschsprung/patologia , Sulfato de Bário , Doença Crônica , Colostomia , Constipação Intestinal/etiologia , Diagnóstico Diferencial , Enema , Impacção Fecal/etiologia , Impacção Fecal/cirurgia , Feminino , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/diagnóstico por imagem , Doença de Hirschsprung/cirurgia , Humanos , Manometria , Pessoa de Meia-Idade , RadiografiaRESUMO
The results of treatment of hemorrhagic portal hypertension with selective shunts over a 21-year period in a selected patient population are reported. Patients selected for surgical treatment had good cardiopulmonary and renal function, and most also had adequate liver function (141 Child-Pugh class A, 59 class B). Among 734 patients treated surgically for bleeding portal hypertension, 221 had selective shunts (168 distal splenorenal and 53 splenocaval shunts). Global operative mortality (in the 21-year period) was 14% and 12% for Child-Pugh A patients. Operative mortality in Child-Pugh A patients in the last 5 years was only 5%. The rate of rebleeding was 6%, rate of incapacitating encephalopathy was 5%, and rate of survival was 65% at 15 years (last 5 years: 88% at 1 year and 85% at 5 years). Good quality of life was demonstrated in 80% of surviving patients. Shunt patency was 94%. Postoperative portal blood flow changes occurred in 23% of cases (8% diameter reduction, 14% thrombosis). Compared with other forms of therapy (pharmacotherapy, sclerotherapy, and transjugular intrahepatic shunting), only liver transplantation offers similar results for these patients. In countries in which liver transplantation is not routinely performed, shunting with selective shunts is the treatment of choice for patients with good liver function.
Assuntos
Hemorragia/etiologia , Hipertensão Portal/cirurgia , Derivação Esplenorrenal Cirúrgica , Angiografia , Encefalopatias/etiologia , Seguimentos , Humanos , Hipertensão Portal/complicações , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Derivação Portossistêmica Cirúrgica/efeitos adversos , Derivação Portossistêmica Cirúrgica/mortalidade , Hemorragia Pós-Operatória/etiologia , Derivação Esplenorrenal Cirúrgica/efeitos adversos , Derivação Esplenorrenal Cirúrgica/mortalidade , Taxa de Sobrevida , Grau de Desobstrução VascularRESUMO
BACKGROUND: Endocrine tumors of the pancreas arise from pancreatic and duodenal neuroendocrine cells. OBJECTIVE: To review clinical features, diagnosis and treatment of endocrine tumors of pancreas, as well as our experience at the Instituto Nacional de la Nutrición "Salvador Zubirán" (INNSZ). RESULTS: Endocrine tumors of pancreas are slow growing tumors. The most frequent tumors are insulinoma, gastrinoma and non-functioning tumors. Clinical picture of functioning tumors is determined by the action of the secreting hormone, and the diagnosis is established once high levels of the tumor secretin peptide are demonstrated. In order to localize the tumor and to search for metastasis, several imaging studies have been used. In general, image studies have demonstrated poor sensitivity in finding the primary lesion. Recently, dynamic studies have shown their ability to regionalize the peptide increase. Endoscopic and intraoperative ultrasound have shown promising results. Surgical resection is the only curative treatment, resection of hepatic metastasis can even improve survival. In the INNSZ, 38 patients with endocrine tumors of the pancreas have received initial treatment in a 32-year period. The most common neoplasia is the insulinoma, followed by non-functioning tumors and gastrinoma. Most insulinomas were benign, where as the malignancy rate of non-functioning. CONCLUSIONS: Endocrine tumors of the pancreas are rare lesions, with a variety of clinical pictures related to the hormone produced. Localizing studies are generally poor. Favorable outcome meaning cure of benign lesions or long survival despite the presence of malignancy occur in most patients.
Assuntos
Gastrinoma , Insulinoma , Neoplasias Pancreáticas , Angiografia , Diagnóstico Diferencial , Gastrinoma/diagnóstico , Gastrinoma/cirurgia , Glucagonoma/diagnóstico , Glucagonoma/cirurgia , Hepatectomia , Humanos , Insulinoma/diagnóstico , Insulinoma/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Prognóstico , Tomografia Computadorizada por Raios X , Vipoma/diagnóstico , Vipoma/cirurgia , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/cirurgiaRESUMO
OBJECTIVE: To analyze the efficacy of a combined approach using ERCP plus laparoscopic cholecystectomy in the treatment of gallstones associated to benign common bile duct obstruction. DESIGN: Prospective study. SETTING: Tertiary-care medical center. PATIENTS: From a total of 270 laparoscopic cholecystectomies performed between October 1991 and January 1994, a group of 25 patients in whom preoperative ERCP was performed to rule out bile duct obstruction was selected for analysis. RESULTS: Choledocholithiasis was documented in nine patients (36%). In eight of them, stones were retrieved by ERCP. The diagnosis of odditis was established in five patients and a papilotomy was performed. The entire bile duct was normal in 11 cases. All patients in whom the common bile duct was normal, or cleared endoscopically, underwent laparoscopic cholecystectomy uneventfully. There was one complication of papilotomy. Duodenal perforation occurred in one patient who ultimately died. CONCLUSION: The combined approach using ERCP followed by laparoscopic cholecystectomy seems to be adequate for the treatment of gallstones associated to bile duct obstruction.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/métodos , Colelitíase/cirurgia , Cálculos Biliares/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/sangue , Ampola Hepatopancreática/cirurgia , Bilirrubina/sangue , Biomarcadores/sangue , Colangite/complicações , Colangite/diagnóstico , Colangite/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Colelitíase/complicações , Duodeno/lesões , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Perfuração Intestinal/etiologia , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Esfíncter da Ampola Hepatopancreática/cirurgia , UltrassonografiaRESUMO
A 10-year experience with the devascularization operation described by Sugiura is reported here. The operation was performed electively in 100 patients in whom it was not possible to place a shunt, all of whom had different kinds of hepatopathies (63 Child's A, 32 Child's B, and 5 Child's C). In 15 patients, the procedure was done in one stage (6% operative mortality, 1 patient), and, in 51, it was performed in two stages. Eight deaths were recorded in the 63 patients of the Child's A group, with a total of 111 operations. The operative mortality rate for this group was 12% and, as related to the number of operative procedures, 7% (8 of 111 operations). Seventeen patients were not considered for a second stage. Rebleeding in the early postoperative period was 4% and at long-term 6%. Incapacitating encephalopathy was found in 2 of the 71 surviving patients (3%). Survival (as determined by Kaplan-Meier tests) was 75% (1 year), 70% (5 years), and 69.2% (10 years). Six esophageal fistulas were observed secondary to transection. The Sugiura operation is an excellent complement to the therapeutic armamentarium used to treat portal hypertension, with low rebleeding and encephalopathy rates.
Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/métodos , Criança , Junção Esofagogástrica/cirurgia , Esôfago/cirurgia , Feminino , Humanos , Hipertensão Portal/cirurgia , Hepatopatias/cirurgia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Piloro/cirurgia , Recidiva , Esplenectomia/efeitos adversos , Esplenectomia/mortalidade , Esplenectomia/estatística & dados numéricos , Estômago/irrigação sanguínea , Estômago/cirurgia , Taxa de Sobrevida , Vagotomia/efeitos adversos , Vagotomia/mortalidade , Vagotomia/estatística & dados numéricosRESUMO
The case of a patient with idiopathic portal hypertension who was subjected to a selective shunt because of variceal bleeding is reported. Large pancreatic collaterals--the pancreatic siphon--were documented 2 years after the operation with loss of portal flow. At 14 years of follow-up, the pancreatic collaterals have disappeared gradually with normalization of portal venous flow in spite of patency of the shunt.
Assuntos
Hipertensão Portal/cirurgia , Pâncreas/irrigação sanguínea , Veia Porta/fisiopatologia , Derivação Portossistêmica Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Circulação Colateral , Feminino , Seguimentos , Humanos , Pessoa de Meia-IdadeRESUMO
Six patients underwent image-guided percutaneous drainage of liver abscesses at the Instituto Nacional de la Nutricion (a tertiary care referral center in Mexico City) in a seven month period. These patients were closely followed in order to evaluate appropriate indications for percutaneous drainage as well as techniques, complications and clinical evolution. Our study group included five males and one female; their mean age was 44.4 years (28-63) and the mean hospitalization time 24.3 days (10-34). We found multiple liver abscesses in three patients, and solitary abscesses in three, two in the left lobe and one in the right lobe. Considering the largest diameter, mean abscess size was 13.7 cm. The most important clinical symptoms were: fever, abdominal pain and malaise, and the most significant laboratory abnormalities were anemia, hypoalbuminemia, leukocytosis and high alkaline phosphatase serum levels. Etiology could be determined in three cases, two were pyogenic abscesses and one amebic. Percutaneous drainage was successful in five out of our six patients (83.3%). Complications included one subcapsular hematoma, without hemodynamic consequences, and one patient with severe upper gastrointestinal tract hemorrhage who required surgery, but we could not entirely demonstrate that the bleeding episode was directly related to the percutaneous drainage.
Assuntos
Drenagem/métodos , Abscesso Hepático/terapia , Adulto , Drenagem/efeitos adversos , Feminino , Humanos , Abscesso Hepático/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , UltrassonografiaRESUMO
Patients with portal hypertension without a demonstrable cause have been reported in the literature under several different terms, such as tropical splenomegaly, phlebosclerosis, obliterative portal venopathy of the liver, hepatoportal sclerosis, noncirrhotic portal fibrosis and idiopathic portal hypertension (IPH). Such patients have been described worldwide, with a greater frequency in India and Japan. The etiology of IPH is still unknown, although some of the theories that have been proposed are: exposure to toxic substances or drugs, relationship with the hepatitis-B virus, immunologic abnormalities, systemic or intra-abdominal infections and clotting abnormalities. The main histopathologic findings are periportal fibrosis, obliteration of small portal veins and sclerosis of the interhepatic portal system. Although these abnormalities could be secondary to portal hypertension, it has been proposed that the vascular changes are the primary event that leads to portal hypertension. The site of increased resistance in IPH is found at the presinusoidal level with some component at the sinusoidal and postsinusoidal level. The main symptoms and signs in IPH are upper gastrointestinal tract bleeding secondary to esophago-gastric varices, symptoms related to anemia, and splenomegaly. The long-term prognosis for patients with IPH is better than for cirrhotic patients, with a 77% survival at ten years. Variceal bleeding is the main cause of death, and some treatment to prevent bleeding or its recurrence is warranted. Although no comparative trial has been performed in IPH patients, the surgical management could be the first choice for elective treatment in these patient without liver failure, because of the high re-bleeding rates with chronic sclerotherapy. Pharmacologic management could be considered for prophylactic treatment of these patients.
Assuntos
Hipertensão Portal , Hemodinâmica , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/etiologia , Hipertensão Portal/patologia , Hipertensão Portal/fisiopatologia , Hipertensão Portal/terapia , PrognósticoRESUMO
The Sugiura Procedure (SP) was performed in 27 patients with hemorrhagic portal hypertension secondary to extrahepatic portal vein thrombosis without associated liver disease (EPVT). There were fourteen females and 13 males. Mean age was 28 +/- 14 years. The causes of EPVT were: protein C deficiency-2 cases, antithrombin III deficiency-1 case, omphalitis history-2 cases, pancreatitis history-1 case and idiopathic-21 cases. The SP was completed with two surgical stages in 14 patients and with one operation in nine. There was one operative death. One patient developed mild postoperative encephalopathy, and two patients re-bled at long-term. Actuarial survival was 82% at five and ten years. It is concluded that the SP is a good alternative for the management of hemorrhagic portal hypertension secondary to EPVT.
Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/cirurgia , Veia Porta , Trombose/complicações , Adulto , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Hipertensão Portal/complicações , Hepatopatias/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
Benign strictures of the biliary tree present difficult problems in management. The method of transhepatic stenting constitutes an excellent and safe procedure and provides good results in this kind of surgery. It permits to fix firmly the stent, so that migration is not supposed to be possible, something frequently seen with conventional T tubes. We report on one patient with iatrogenic strictures of the biliary tree who was subjected to reconstructive surgery utilizing a transhepatic stent. On the sixth postoperative month, the patient presented migration of the stent to the Y-en-Roux intestinal loop. It was evacuated in the following hours, and the patient did not have any problem, remaining asymptomatic after that.
Assuntos
Doenças dos Ductos Biliares/cirurgia , Migração de Corpo Estranho/complicações , Doença Iatrogênica , Jejuno , Complicações Pós-Operatórias/etiologia , Adulto , Constrição Patológica/cirurgia , Feminino , HumanosRESUMO
At the beginning of the seventies, we began to perform regularly selective shunts for the treatment of portal hypertension. In a 15 year period, 177 patients (155 with liver cirrhosis) were operated with three kinds of selective shunts: 128 with a Warren shunt, 29 with an end to end renosplenic shunt and 20 with a splenocaval shunt. 167 cases were operated in an elective fashion. The 15 years global operative mortality, was 14.4%. Operative mortality of the Child A patients, was 11.6%. Survival for the Child A group was 74.6% at 1 year, 68.2% at 5 years and 64.6% at 15 years. Incapacitating encephalopathy was observed in 6.9%, rebleeding 6.2% and shunt thrombosis in 6.2%. Portal vein alterations in the postoperative period were observed: in 13.3% a reduction in diameter ocurred and in 20.5%, thrombosis was recorded. It is concluded that when feasible, the selective shunts are the treatment of choice for portal hypertension in those patients with good liver function.
Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Hipertensão Portal/complicações , Seleção de Pacientes , Derivação Portossistêmica Cirúrgica/métodos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Hiperesplenismo/epidemiologia , Hiperesplenismo/etiologia , Estimativa de Kaplan-Meier , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Veia Porta , Complicações Pós-Operatórias/epidemiologia , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Trombose/epidemiologia , Trombose/etiologia , Adulto JovemRESUMO
Ketanserin, a 5-hydroxytryptamine-2 receptor blocker, has been shown to decrease portal pressure in recent acute hemodynamic studies that have been performed both in experimental animals and portal hypertensive patients. The present study was designed to investigate the effects of chronic oral administration of ketanserin in portal hypertensive patients with cirrhosis. The mean baseline hepatic venous pressure gradient in the 13 patients with alcoholic cirrhosis who completed the study was 15.7 +/- 2.7 mmHg. It decreased significantly to 13.3 +/- 2.0 mmHg (p less than 0.001) after ketanserin was administered at a mean dose of 51 mg per day for a mean period of 32 days. This 14.6% reduction in hepatic venous pressure gradient resulted mainly from a decrease in mean wedged hepatic venous pressure (from 22.2 +/- 4.0 to 20.1 +/- 3.6 mmHg) and was accompanied by significant decreases in cardiac index (18.8%) and in mean arterial pressure (8.1%). However, changes in cardiac index or in mean arterial pressure were not predictive of modifications in the hepatic venous pressure gradient. Eight of 16 patients entered in the study developed side effects, the most significant being a reversible portosystemic encephalopathy, which occurred in three patients who had poor liver function. This study confirms evidence in favor of a role for 5-hydroxytryptamine in portal hypertension and adds a new group of agents for the chronic treatment of portal hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Hemodinâmica/efeitos dos fármacos , Hipertensão Portal/tratamento farmacológico , Ketanserina/uso terapêutico , Cirrose Hepática Alcoólica/tratamento farmacológico , Administração Oral , Adulto , Feminino , Humanos , Hipertensão Portal/fisiopatologia , Ketanserina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fatores de TempoAssuntos
Neoplasias Esofágicas/cirurgia , Estenose Esofágica/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Portal vein thrombosis has been considered idiopathic in 50% of cases reported in adults. Protein C deficiency is a recently described disorder characterized by a predisposition to develop thromboembolic disease. We report the findings in two patients with portal hypertension and bleeding varices due to portal vein thrombosis in whom a deficiency of protein C was present. Both cases were very similar, with a history of recurrent episodes of systemic thromboembolic disease, mesenteric venous thrombosis that required intestinal resection and upper gastrointestinal bleeding from gastroesophageal varices. Portal hypertension as well as portal vein thrombosis were demonstrated. The hematologic work-up revealed a deficiency of protein C. Both patients were subjected to the Sugiura procedure, and anticoagulation was instituted thereafter. At the time of surgery, a liver biopsy was performed, which was reported as "normal." Two years and 3 months, respectively, after surgery both patients are in good condition. We conclude that protein C deficiency should be investigated in all cases of portal vein thrombosis, especially in those with a history of thromboembolic disease elsewhere.
Assuntos
Veia Porta , Deficiência de Proteína C , Trombose/sangue , Adulto , Hemorragia Gastrointestinal/sangue , Hemorragia Gastrointestinal/patologia , Humanos , Hipertensão Portal/sangue , Hipertensão Portal/patologia , Masculino , Oclusão Vascular Mesentérica/sangue , Oclusão Vascular Mesentérica/patologia , Veias Mesentéricas , Pessoa de Meia-Idade , Proteína C/análise , Recidiva , Trombose/patologiaRESUMO
Forty-one of 858 patients with systemic lupus erythematosus (SLE) developed clinical deformity of their hands. This deformity was clinically and radiologically different from that found in 40 patients with classical or definite rheumatoid arthritis (RA), and tended to appear early in the course of disease. Characteristics of this arthropathy included nonerosive carpal collapse; exceptional erosion of the styloid processes; Z deformity of the thumb; nonerosive ulnar deviation and subluxation of MCP joints; parametacarpophalangeal joint hook formation; scant and asymmetric joint erosions; and swan neck deformity of the fingers. Most of these changes seemed to be due to involvement of the ligaments rather than to the destructive effect of synovitis. Patients with SLE with deforming arthropathy had a higher frequency of rheumatoid factor positivity, sicca symptoms and antibodies to native DNA, whereas they had lower incidence of facial rash and photosensitivity than did those without. Other manifestations did not differ. We propose that most patients with SLE with deforming arthropathy belong to a subset of SLE rather than representing the coexistence of SLE and RA.