Elimination of biliary stones through the urinary tract: a complication of the laparoscopic cholecystectomy

The introduction and popularization of laparoscopic cholecystectomy has been accompanied with a considerable increase in perforation of gallbladder during this procedure (10%--32%), with the occurrence of intraperitoneal bile spillage and the consequent increase in the incidence of lost gallstones (0.2%--20%). Recently the complications associated with these stones have been documented in the literature. We report a rare complication occurring in an 81-year-old woman who underwent laparoscopic cholecystectomy and developed cutaneous fistula to the umbilicus and elimination of biliary stones through the urinary tract. During the cholecystectomy, the gall bladder was perforated, and bile and gallstones were spilled into the peritoneal cavity. Two months after the initial procedure there was exteriorization of fistula through the umbilicus, with intermittent elimination of biliary stones. After eleven months, acute urinary retention occurred due to biliary stones in the bladder, which were removed by cystoscopy. We conclude that efforts should be concentrated on avoiding the spillage of stones during the surgery, and that no rules exist for indicating a laparotomy simply to retrieve these lost gallstones.

Treatment of schistosomiasis: gathering stones together

In this paper the treatment of schistosomiasis is examined under the following headings: cercarial dermatitis, Katayama fever, schistosomiasis in the immunosuppressed host and treatment of therapeutic failures.

ClC-5 chloride channel and kidney stones: what is the link?

Nephrolithiasis is one of the most common diseases in the Western world. The disease manifests itself with intensive pain, sporadic infections, and, sometimes, renal failure. The symptoms are due to the appearance of urinary stones (calculi) which are formed mainly by calcium salts. These calcium salts precipitate in the renal papillae and/or within the collecting ducts. Inherited forms of nephrolithiasis related to chromosome X (X-linked hypercalciuric nephrolithiasis or XLN) have been recently described. Hypercalciuria, nephrocalcinosis, and male predominance are the major characteristics of these diseases. The gene responsible for the XLN forms of kidney stones was cloned and characterized as a chloride channel called ClC-5. The ClC-5 chloride channel belongs to a superfamily of voltage-gated chloride channels, whose physiological roles are not completely understood. The objective of the present review is to identify recent advances in the molecular pathology of nephrolithiasis, with emphasis on XLN. We also try to establish a link between a chloride channel like ClC-5, hypercalciuria, failure in urine acidification and protein endocytosis, which could explain the symptoms exhibited by XLN patients.

Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized, clinical trial

This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95±13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube.

Neurocryptococcosis: diagnosis by PCR method

Cryptococcus neoformans detection was optimized using PCR technique with the objective of application in the clinical laboratory diagnosis. The amplification area was ITS and 5,6S which encodes the ribosomal RNA (rRNA). A total of 72 cerebrospinal fluid (CSF) samples were used, obtained from cases with and without AIDS. The patients had cryptococcal meningitis (n = 56) and meningitis caused by other agents (n = 16). The results demonstrated that PCR test had the highest sensitivity rates, superior to culture (85.7%) and to India ink test (76.8%). PCR was found to be sensitive in detecting 1 cell/mL and highly specific since it did not amplify other fungal DNA. The comparative analysis of the methods showed that PCR is more sensitive and specific and is applicable as an important laboratorial resource for neurocryptococcosis diagnosis.

FATAL DISSEMINATED CRYPTOCOCCOSIS WITH RENAL INVOLVEMENT IN AN HIV-INFECTED PATIENT

SUMMARY Introduction: We present a fatal case of disseminated cryptococcosis in a young man whose diagnosis of HIV infection was made at the time of admission to the emergency room. Case report: The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm3 (5% lymphocytes), hemoglobin was 10g/dL, platelets were 83,000/ mm3. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF) analysis revealed 10 white blood cells/mm3 (58% neutrophils, 31% lymphocytes, 11% monocytes) and 2 red blood cells/mm3. India ink test revealed six Cryptococcus yeasts/mm3. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys. Conclusion: Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality.

Cryptococcus neoformans causing meningitis in AIDS patients

Cryptococcus neoformans causes meningitis in AIDS patients. In the São José Hospital, reference center for patients with AIDS in Fortaleza - Ceará State - Brazil, 54 samples of the cerebrospinal fluid were analyzed from January 1st through December 31st 2000. Direct examination with India ink and culture in Sabouraud's agar at 37°C were done. Of the specimens studied 5(9.25%) were positive.

Clinical and microbiological features of cryptococcal meningitis

Introduction In this study, the clinical features, underlying diseases and clinical outcomes of patients with cryptococcosis were investigated. In addition, a molecular analysis of the Cryptococcus neoformans species complex isolated from these patients was performed. Methods A prospective study of 62 cases of patients with cryptococcal infection was conducted at the Hospital de Doenças Tropicais de Goiás Dr. Anuar Auad from 2009-2010. Cryptococcal meningitis cases were diagnosed by direct examination and cerebrospinal fluid (CSF) sample culture. The profiling of these patients was assessed. The CSF samples were submitted to India ink preparation and cultured on Sabouraud dextrose agar, and C. neoformans was identified by the production of urease, a positive phenoloxidase test and assimilation of carbohydrates. C. neoformans and C. gattii isolates were distinguished by growth on L-canavanine-glycine-bromothymol blue medium, and molecular analysis was conducted via PCR fingerprinting reactions using M13 and (GACA)4 primers. Results From the 62 patients with cryptococcosis, 71 isolates of CSF were obtained; 67 (94.4%) isolates were identified as C. neoformans var. grubii/VNI, and 4 (5.6%) were identified as C. gattii/VGII. Of these patients, 53 had an HIV diagnosis. The incidence of cryptococcosis was higher among patients 20-40 years of age, with 74.2% of the cases reported in males. Cryptococcus-related mortality was noted in 48.4% of the patients, and the symptoms were altered sensorium, headache, fever and stiff neck. Conclusions The high morbidity and mortality observed among patients with cryptococcosis demonstrate the importance of obtaining information regarding the epidemiological profile and clinical course of the disease in the State of Goiás, Brazil.

Estudo do poder germinativo da semente de manga

The author studied the storage of seeds of mango trees with the aim of Keeping high its ability of germination. Seven means of storage were tried, with two temperatures: environment temperature (22 to 27 degrees Centigrade) and cold store room (5 degrees centigrade). The methods of storage tried were: 1 - The frewit kept complete. 2 - Seeds taken within the stone. 3 - Seeds taken out of the stone. 4 - Stones heated with a Fungicida (Zineb). 5 - Stones cut laterally and heated with a fungicide (Zineb). 6 - Seeds (out of sones) heated with Zineb. 7 - Stones steatified with sand. The best results were obtained for seeds kept within whole fruits, probably owing to protection provided by outer layers. The use of fungicide imposed the sanitary aspect of seeds and stones. Storage in cold store room (5 degrees Centigrade) injured the seeds and stones in all cases. Germinating power was kept high up to 70 days for complete fruits. It seems that biggers fruits were more favorable to keep high the ability of theirs seeds to germinate.

On Nesticus from Meridional South America (Araneae, Nesticidae)

Five new species of Nesticus Thorell, 1869 are described: N. potreiro, N. taim from southern Brazil; N. brignolii from southern Brazil, Argentina and Uruguay; N. calilegua from southern Brazil and Argentina and N. ramirezi, from Argentina. The male palpus and female epyginum of N. brasiliensis Brignoli, 1979 are illustrated. Described species were collected in epigean habitats, in shrubs, leaf-litter, under stones, bricks, tiles or debris.

Habitat use by a tree frog species of Scinax (Amphibia, Hylidae) at an urban forest fragment from south-eastern Brazil

We studied the pattern of habitat use by the tree frog Scinax aff. perereca. Fieldworks were performed from August 1996 to August 1997 at Parque das Mangabeiras, Belo Horizonte, State of Minas Gerais, southeastern Brazil. Calling males were observed in September, October and December 1996, February to April and June 1997. Females were found only in October 1996. Specimens were found perched on vegetation, on the ground or on stones near waterfall. At Parque das Mangabeiras, S. aff. perereca occupied nine types of substrata. The most frequently used substrata were shrubs, stones at the stream edges, and fallen trunks. The pattern of spatial occupation varied among months. Males were found calling in aggregations on the vegetation and spatial niche breadth was related to species abundance.

7ª Contribuição ao estudo dos Flebotomus (Diptera: Psychodidae): descrição dos machos de 24 novas espécies

The A. and his co-workers captured in trips in the hinterland of Brazil more tham 17.000 flebotomi from which 35 are new ones, 11 discribed by, him in previous papers. The A. found these insects in groups of species living in different habitats, some ones of them not yet known: ondoors, or outdoors attracted by light or animal baits, without Shannon’s trap, in great or small caves, in the jungle in tree’s holes, holes in stones, holes in the soil habited by animals like armadillos, pacas (Aguti paca), wild rats, cururú toad (Bufo sp.). He observed the life history of 13 species: Flebotomus longipalpis Lutz& Neiva, 1912, Flebotomus intermedius Lutz & Neiva, 1912, Flebotomus avellari Costa Lima, 1932, Flebotomus aragãoi costa Lima, 1932, Flebotomus lutzianus Costa Lima, 1932, Flebotomus limai fonseca, 1935, Flebotomus rickardi Costa Lima, 1936, Flebotomus dasipodogeton Castro, 1939, Flebotomus oswaldoi n. sp., Flebotomus villelai n. sp., Flebotomus triacanthus n. sp., Flebotomus longispinus n. sp. And flebotomus travassosi n. sp. He describes the male of 24 n. sp., explaining the differential diagnose of group or nearly allied species. He inclued F. rooti n. sp. And F. hirsutus n. sp. In the sub-genus Shannonomyia. The first one, very allied to F. davisi Root is different from it, for presenting in the dorsal side of the abdomen bristles and not scales and to have the median claspers longer than his inner appendage and F. hirsutus quite different from the others which show 3 spines on distal segment of the upper clasper and for being the only one who presents the bristles of inner appendage of median clasper longer than it. Only the females of F. amazonensis Root and f. chagasi Costa Lima, are known and then it is possible that they belong to one of the species of this sub-genus from whom only the male have been described. F. choti Floch & Abonnenc, captured also at Pará, F. triacanthus n. sp. F. trispinosus n. sp. And F. equatorialis n. sp. Are very related and to this group the A. proposes the same of Pressatia as sub-genus in honor to whom demonstrated the medical importance of the flebotomi, considering F. triacanthus as the type specie of this sub-genus. In this sub-genus the V papal joint is very long, longer than III + IV, the antennae with geniculated spines without posterior outgrowth. At the genitalia the basal segment of the upper clasper presents two types of bristles ou the inner face, arranged in tuft; the distal segment with 3 spines and 2 thin bristles something difficult to see one of them situated near the apical spine and the other on the base of tubercle where the median spine is articulated; the median clasper is unarmed and compressed; the inferior clasper is also unarmed and longer than de basal segment of the upper clasper; the pompeta is longer than the basal segment of the upper clasper. Following it is presented a key for the determination of the males of the four species of this sub-genus. F. micropygus n. sp., F. minasensis n. sp. e F. dandrophylus n. sp., f. shannoni, F. monticolus, F. pestanai, F. lanei and F. cayenensis constitute a group with many similars characters. F. micropygus is the only American species who present α smaller than β and for that reason and others is allied to. F. minuts and others related species, but presents two terminal spines on the distal segment of the upper clasper. F. micropygus and f. minasensis are quite different because they have very small genitalia, smaller than their heads. F. dendrophylus presents on the median clasper a naked area near the apex and for this and others characters is different from the others of the group. F. flaviscutellatus n. sp., F. oliverioi, F. intermedius and whithmani, are very allied but the first one can be very easily distinguished because it’s scutellum is light. Flebotomus barrettoi n. sp., F. coutinhoi n. sp., F. aragãoi, F. brasiliensis, F. lutzianus, F. texanus, F. pascalei, F. atroclavatus and F. tejeraae are very allied forming a natural group. The two last ones are not well known but the A. A. who have studied them described very long clipeus so long as the head and for that reason can be distinguished from all the others included the two new ones. F. coutinhoi is the only one who presents the apecis of the penis filaments twisted. F. barrettoi n. sp., can be distinguished from aragãoi, texamus and coutinhoi by the length of the penis filaments and from atrocavatus, tejeraae, lutzianus and brasiliensis by the arrangement of the spines of distal segment of the upper clasper. Flebotomus ubiquitalis n. sp., F. auraensis n. sp., F. affinis and F. microps e F. antunesi have many common characters. F. microps n. sp., can be distinguished from any one by the size of the eyes and the presence od well developed genae. This species and other new species are different from F. antunesi by the arrangement of the spines of the distal segment of the upper clasper of the latter. F. ubiquitalis n. sp. can be distinguished from others by the figure of the median clasper. F. auraensis n. sp. Can be distinguished from F. affinis n. sp. By the tuft hairs on the inner face of the basal segment and by arrangement of the spines of the sital segment of the upper clasper. Flebotomus brachipygus n. sp. Seemed to be F. rostrans, specie not well known, by the characters of the genitalia but can not be identified to her by the clypeus size and the palpi’s characters. Flebotomus costalimai, n. sp., f. tupynambai n. sp., and f. castroi Barreto & Coutinho, 1941, are very allied species and the A. proposes to included them the new sub-genus Castromyia, in honor to Dr. G. M. de Oliveira Castro, appointing like typespecies F. castroi with the V joint longer than III + IV; antennae with geniculated spines without posterior prolongation. Genitalia: the basal segment of the upper clasper with a tuft of hairs and the distal segment with 4 spines, one of them at the apex and near it a thin and straight bristle difficult to see; the median clasper with one spinous hair isolated...

Distribuição geográfica da fauna e flora da Baía de Guanabara

The author studied, the horizontal and vertical distribution of most common part of the flora and fauna of the bay of Guanabara at Rio de Janeiro. In this paper the eulittoral, poly, meso and oligohaline regions were localised and studied; and the first chart of its distribution was presented (fig. 2). The salinity of superficial waters was established through determinations based on 30 trips inside the buy for collecting biological materials. Some often 409 determinations which were previous reported together with the present ones served for the eleboration of a salinity map of the bay of Guanabara (fig. 1). This map of fig. 2 shows the geographic locations of the water regions. EULITTORAL WATER REGIME — Fig. 3 shows the diagram scheme of fauna and flora of this regime. Sea water salinity 34/1.000, density mean 1.027, transparent greenish waters, sea coast with moderate bursting waves. Limpid sea shore with white sand, gneiss with the big barnacle Tetraclita squamosa var. stalactifera (Lam. Pilsbry. Vertical distributions: barna¬cles layers with a green region in which are present the oyster Ostrea pa-rasitica L., the barnacles Tetraclita, Chthamalus, Balanus tintinnabulum var. tintinnabulum (L.) e var. antillensis Pilsbry in connection with several mollusca and the sea beatle Isopoda Lygia sp. Covered by water and exposed to air by the tidal ritms, there is a stratum of brown animals that is the layer of mussels Mytilus perna L., with others brown and chestnut animals : the Crustacea Pachygrapsus, the little crab Porcellana sp., the stone crab Me-nippe nodifrons Stimpson, the sea stars Echinaster brasiliensis (Mull. & Tr.), Astropecten sp. and the sea anemones Actinia sp. Underneath and never visible there is a subtidal region with green tubular algae of genus Codium and amidst its bunches the sea urchin Lycthchinus variegatus (Agass.) walks and more deeply there are numerous sand-dollars Encope emarginata (Leske). The microplancton of this regime is Ceratiumplancton. POLYHALINE WATER REGIMB — Water almost sea water, but directly influenced by continental lands, with rock salts dissolved and in suspension. Salinity: 33 to 32/1.000. This waters endure the actions of the popular nicknamed «water of the hill» (as the waters of mesohaline and oligohaline regimes), becoming suddenly reddish during several hours. That pheno¬menon returns several times in the year and come with great mortality of fishes. In these waters, according to Dr. J. G. FARIA there are species of Protozoa : Peridinea, the Glenoidinium trochoideum St., followed by its satellites which he thinks that they are able to secret toxical substances which can slaughter some species of fishes. In these «waters of the hill» was found a species of Copepoda the Charlesia darwini. In August 1946 the west shore of the Guanabara was plenty of killed fishes occupying a area of 8 feet large by 3 nautical miles of lenght. The enclosure for catching fishes in the rivers mouthes presents in these periods mass dead fishes. The phenomenon of «waters of the hill» appears with the first rains after a period of long dryness. MESOHALINE WATER REGIME — Fig. 4 shows the the diagramm scheme. Salt or brackish water from 30 to 17/1.000 salinity, sometimes until 10/1.000. Turbid waters with mud in suspension, chestnut, claveyous waters; shore dirty black mud without waving bursting; the waters are warmer and shorner than those of the polihaline regime. Mangrove shore with the mangrove trees : Rhizophora mangle L., Avicennia sp., Laguncularia sp., and the »cotton tree of sea» Hibiscus sp. Fauna: the great land crab «guaimú» Cardisoma guanhumi Latr., ashore in dry firm land. There is the real land crab Ucides cordatus (L.) in wetting mud and in neigh¬ bourhood of the burrows of the fiddler-crabs of genus Uca. On stones and in the roots of the Rhizophora inhabits the brightly colored mangrove-tree-crab («aratu» Portuguese nickname) Goniopsis cruentata (Latreille) and the sparingly the big oyster Ostrea rhizophorae Guild. Lower is the region of barnacles Balanus amphitrite var. communis Darwin and var. niveus Darwin; Balanus tintinnabulum var. tintinnabulum (L.) doesn't grow in this brackish water; lower is the region of Pelecipoda with prepollency of Venus and Cytherea shell-fishes and the Panopeus mud crab; there are the sea lettuce Ulva and the Gastreropod Cerithium. The Paguridae Clibanarius which lives in the empty shells of Gasteropod molluscs, and the sessile ascidians Tethium plicatum (Lesuer) appears in some seasons. In the bottom there is a black argillous mud where the «one landed shrimps» Alpheus sp. is hidden. OLIGOHALINE WATER REGIME — The salinity is lower than 10/1.000. average 8/1.000. There are no barnacles and no sea-beetles Isopods of genus Lygia; on the hay of the shore there are several graminea. This brackish water pervades by mouthes of rivers and penetrates until about 3 kilometers river above. While there is some salt dissolved in water, there are some mud crabs of the genus Uca, Sesarma, Metasesarma and Chasmagnatus. The presence of floating green plants coming from the rivers in the waters of a region indicated the oligohaline waters, with low salt content because when the average of NaCl increases above 8/1.000 these plants die and become rusty colored.

Patogenesis of pipe-stem fibrosis of the liver (experimental observation on murine Schistosomiasis)

Mice infected with 30 cercariae of Schistosoma mansoni developed portal and septal fibrosis due to the massive and concentrated deposition of eggs in the periportal areas which occurred following the 16th week after infection. The lesion resembled pipe-stem fibrosis seen in human hepatosplenic schistosomiasis in the following characters: portal fibrosis interconnecting portal spaces as well as portal spaces and central canals; portal inflammation; periovular granulomas; vascular obstruction and telangiectasia. The liver parenchyma maintained its normal architecture. Vascular injection techniques with Indian ink and vinylite revealed that the portal system developed numerous dilated collateral venules coming from the large and medium-sized portal branches, about 10 weeks after schistosome infection. The lodging of schistosome eggs into these collaterals resulted in granulomatous inflammation and fibrosis along all the portal tracts, thus forming the pipe-stem lesion. Although not readily demonstrable grossly, the pipe-stem fibrosis of murine schistosomiasis has many similarities with the human lesion and can be considered to have the same basic pathogenesis.

Repair of schistosomal intestinal vascular lesions after curative treatment

The process of repairing intestinal vascular lesions induced by schistosomiasis in mice was studied before and after curative chemotherapy, by means of histopathology coupled with injections of the mesenteric veins with India ink or plastic, in this case followed by corrosion in strong acid. The granulomas were avascular, mainly formed while within blood vessels, and were associated with distortion of the intestinal vasculature in their proximity, represented by tortuosities, focal dilatation, narrowing, and anastomosis of the mucosal and submucosal veins. Two to four months after cure of schistosomiasis involuting granulomas were seen to be slowly vascularized, a process going from the periphery toward the center of the granulomas. No intravascular granulomas were seen four months after treatment. The previously distorted mucosal and submucosal veins gradually regained their normal appearance, only a slight tortuosity remaining.