797 resultados para Ileal-pouch anastomosis


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A new species of South American planorbid snail, Biomphalaria occidentalis, is described. It is indistinguishable from B. tenagophila (Orbigny, 1835), by the characteristics of the shell and of most organs of the genital system. In B. tenagophila there is a pouch on the ventral wall of the vagina (Fig. 4A, vp), absent in B. occidentalis (Fig. 3A), and on the ventral wall of the vagina (Fig. 4A, vp), absent in B. occidentalis (Fig. 3A), and the prepuce is much wider than the penial sheath, its width increasing distalward (Fig. 4, ps,pp), whereas in B. occidentalis the prepuce is wider than the penial sheath but keeps about the same width all along (Fig.3, ps, pp). The two species are biologically separate by absolute reproductive isolation. The geographical distribution of B. occidentalis is shown in Fig. 14. So far it has been found in the Brazilian states of Acre, Amazonas (?), Mato Grosso, Mato Grosso do Sul and Paraná, and in Paraguay. Its type-locality is Campo Grande, state of Mato Grosso do sul, where it was collected from several biotopes related to affluents of the Aquiduana river, chiefly Córrego Prosa and Córrego Ceroula. Specimens were deposited in the following malacological collections: Instituto Oswaldo Cruz, Rio de Janeiro; Academy of Natural Sciences, Philadelphia; Museum of Zoology, University of Michigan; and British Museum (Natural History).

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A new species of South American lymnaeid snail, Lymnaea rupestris, is described. So far it has been found only in its type-locality, Nova TeuTõnia, a village in the municipality of Seara (27° 07' S, 52° 17' W), state of Santa Catarina, Brazil. It is distinguishable, by characteristics of the shell and internal organs, from the other two lymnaeid species known to occur in the area, Lymnaea columella and L. viatrix. Its shell has 4 markedly shouldered whorls, deep suture, ovoid or rounded aperture occupying about half the length of the shell, and reaches about 6 mm in length in adults; in columella and viatrix the shell has 4-5 rounded whorls, shallow suture, and reaches over 10 mm in adults; the aperture is ovoid, occupying about half the length of the shell in viatrix, about two thirds in columella. Anatomically it is readily separated from L. columella by the shape of the ureter, straight in rupestris, with a double flexure in columella. Comparison with L. viatrix shows the following main differences: distalmost portion of the oviduct with a low, caplike lateral swelling in rupestris, with a well-developed pouch in viatrix; uterus bent abruptly caudalward in rupestris, only slightly curved rightward in viatrix; basal half of the spermathecal duct hidden by the prostate in rupestris, wholly visible or nearly so in viatrix; spermiduct sinuous and uniformly wide in rupestris, straight and gradually narrowing in viatrix; prostate more than half as long and nearly as wide as the nidamental gland, and with a slit-like lumen in cross-section in rupestris, less than half as long as and much narrower than the nidamental gland, and with an inward fold in cross-section in viatrix; penial sheath about as long and as wide as the prepuce in rupesris, shorter and narrower than the prepuce in viatrix. An important ecological characteristic of L. rupestris is its habitat on wet rocks most often outside bodies of water, although in close proximity to them. Specimens were deposited in the following malacological collections: Instituto OswaldoCruz, Rio de Janeiro; Academy of Natural Sciences, Philadelphia; Museum of Zoology, University of Michigan; and British Museum (Natural History).

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A description of the species Lymnaea diaphana King, 1830 is presented, on the basis of material collected at its type-locality, San Gregorio, on the north coast of the Strait of Magellan, in the Chilean province of Magallanes. It may be identified by the following characters taken together: adult shell over 10 mm in length, whorls inflated, regularly convex, separated by a well-marked suture, aperture ovate occupying about half the shell length; renal organ forming an approximately right angle with the ureter; pouch of the oviduct well noticeable high on the right ventral surface and on the right side of the nidamental gland; uterus bent to the right into an approximately right angle; body of the spermatheca projected into the pulmonary cavity and adhered to the pericardium and to the roof of the pulmonary cavity; spermiduct highly sinuous, folding dorsalward between the left half of the oviduct and the left shoulder of the nidamental gland, and then winding on ventralward to reach the prostate on the middle line; prostate voluminous, convex on the left, pushed in on the right, with a deep dorsal furrow corresponding to a fold which projects into the prostatic lumen and is more developed at the fore half of the organ; apical end of the penial sheath with about six minute protuberances corresponding to inner chambers; prepuce from about as long about twice as long as the penial sheath, with some variation beyond those limits; lateral teeth of the radula basically tricuspid, with a usually simple ectocone which may show a bifid or trifid point. A diagnosis between lymnaea diaphana and three other lymnaeids which also occur in South America and were previously studied by the author - L. columella, L. viatrix and L. rupestris - is presented.

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A new subspecies of planorbid snail, biomphalaria tenagophila guaibensis, is described. It has been found along the coastal belt of the Brazilian state of rio grande do Sul and the middle part of Uruguay, from Porto Alegre to Mercedes. It differs from the nominate subspecies, Biomphalaria tenagophila tenagophila, in the appearance of the penial complex (prepuce longer and proportionally slenderer in B. t. guaibensis, shorter and proportionally stouter in b. t. tenagophila), in the ratio between the lengths of the penial sheath and the prepuce, in the ratio between the lengths of the uterine complex and the penial complex, and in a coefficient of difference of 2.44 for the ratio between the penis sheath and prepuce and of 2.02 for the ratio between the uterine complex and penial complex. The shell and the other organs of the genital system are similar in both subspecies. B. t. guaibensis is very similar to Biomphalaria occidentalis Paraense, 1981, but is readily separated from it by the presence of a vaginal pouch, which is lacking in the latter, besides showing highly significant difference in the penis sheath: prepuce and uterine complex: penial complex ratios. Crossbreeding experiments which lend additional support to the recognition of B. t. guaibensis as a subspecies will be reported elsewhere.

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Background: In 1989, we introduced a 1-stage procedure with orthotopic colonic transplants for esophageal stenosis. A pitfall of this procedure is frequent reflux and/or stasis in the transplants from the cologastric anastomosis. Since 1993, we have used a new antireflux wrap (ARW) using an anterior wrap technique similar to the Dor procedure but fixed to the right crus of the diaphragm.Purpose: The purpose of the study was to evaluate ARWs.Method: From 1993 to 2008, the records of 67 patients with an ARW were compared with 27 without ARW (either operated on before 1993 or ARW was not appropriate) after colonic transplant for caustic esophageal stenosis. Both groups otherwise underwent the same surgical procedure. Postoperative esophagograms done on postoperative day 10 were reviewed for the presence of gastrocolonic reflux and stasis in the transplant.Results: The reflux rate on the initial esophagogram was reduced from 48.1% to 7.5% using ARW. The incidence of reflux on later esophagograms was 40.0% with no ARW and 21.4% with ARW. The 25% long-term rate of stasis in the colonic transplant was not increased with ARW.Conclusions: A loose ARW in patients with colonic esophageal replacements reduces gastrocolic reflux without increasing the rate of stasis. In the long term, children adapt better to stasis than to reflux and are thus protected from occult inflammation.

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OBJECTIVE. The purpose of this study was to evaluate the prevalence of mesenteric venous thrombosis (MVT) in the Swiss Inflammatory Bowel Disease Cohort Study and to correlate MVT with clinical outcome. MATERIALS AND METHODS. Abdominal portal phase CT was used to examine patients with inflammatory bowel disease (IBD). Two experienced abdominal radiologists retrospectively analyzed the images, focusing on the superior and inferior mesenteric vein branches and looking for signs of acute or chronic thrombosis. The location of abnormalities was registered. The presence of MVT was correlated with IBD-related radiologic signs and complications. RESULTS. The cases of 160 patients with IBD (89 women, 71 men; Crohn disease [CD], 121 patients; ulcerative colitis [UC], 39 patients; median age at diagnosis, 27 years for patients with CD, 32 years for patients with UC) were analyzed. MVT was detected in 43 patients with IBD (26.8%). One of these patients had acute MVT; 38, chronic MVT; and four, both. The prevalence of MVT did not differ between CD (35/121 [28.9%]) and UC (8/39 [20.5%]) (p = 0.303). The location of thrombosis was different between CD and UC (CD, jejunal or ileal veins only [p = 0.005]; UC, rectocolic veins only [p = 0.001]). Almost all (41/43) cases of thrombosis were peripheral. MVT in CD patients was more frequently associated with bowel wall thickening (p = 0.013), mesenteric fat hypertrophy (p = 0.005), ascites (p = 0.002), and mesenteric lymph node enlargement (p = 0.036) and was associated with higher rate of bowel stenosis (p < 0.001) and more intestinal IBD-related surgery (p = 0.016) in the outcome. Statistical analyses for patients with UC were not relevant because of the limited population (n = 8). CONCLUSION. MVT is frequently found in patients with IBD. Among patients with CD, MVT is associated with bowel stenosis and CD-related intestinal surgery.

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Purpose: In extreme situations, such as hyperacute rejection of heart transplant or major bleeding per-operating complications, an urgent heart explantation might be the only means of survival. The aim of this experimental study was to improve the surgical technique and the hemodynamics of an Extracorporeal Membrane Oxygenation (ECMO) support through a peripheral vascular access in an acardia model. Methods: An ECMO support was established in 7 bovine experiments (59±6.1 kg) by the transjugular insertion to the caval axis of a self-expanded cannula, with return through a carotid artery. After baseline measurements of pump flow and arterial and central venous pressure, ventricular fibrillation was induced (B), the great arteries were clamped, the heart was excised and right and left atria remnants, containing the pulmonary veins, were sutured together leaving an atrial septal defect (ASD) over the cannula in the caval axis. Measurements were taken with the pulmonary artery (PA) clamped (C) and anastomosed with the caval axis (D). Regular arterial and central venous blood gases tests were performed. The ANOVA test for repeated measures was used to test the null hypothesis and a Bonferroni t method for assessing the significance in the between groups pairwise comparison of mean pump flow. Results: Initial pump flow (A) was 4.3±0.6 L/min dropping to 2.8±0.7 L/min (P B-A= 0.003) 10 minutes after induction of ventricular fibrillation (B). After cardiectomy, with the pulmonary artery clamped (C) it augmented not significantly to 3.5±0.8 L/min (P C-B= 0.33, P C-A= 0.029). Finally, PA anastomosis to the caval axis was followed by an almost to baseline pump flow augmentation (4.1±0.7 L/min, P D-B= 0.009, P D-C= 0.006, P D-A= 0.597), permitting a full ECMO support in acardia by a peripheral vascular access. Conclusions: ECMO support in acardia is feasible, providing new opportunities in situations where heart must urgently be explanted, as in hyperacute rejection of heart transplant. Adequate drainage of pulmonary circulation is pivotal in order to avoid pulmonary congestion and loss of volume from the normal right to left shunt of bronchial vessels. Furthermore, the PA anastomosis to the caval axis not only improves pump flow but it also permits an ECMO support by a peripheral vascular access and the closure of the chest.

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This paper deals with the morpholgy of Pomacea lineata (Spix, 1827) collected at its type locality. The shell is globose, moderately heavy, horn-colored with brown spiral bands; apex subelevated; 4 - 5 rounded whorls increasing in diameter rather rapidly, separated by deep suture. Aperture large and ovoid; outer lip sharp; umbilicus narrow and deep; operculum concentric, corneous. Ratios: shell width/shell length = 0.74 - 0.83 (mean 0.78); spire length/shell length = 0.10 - 0.18 (mean 0.13); aperture length/shell length = 0.70 - 0.77 (mean 0.73). The animal is longisiphonate. Renal organ brownish with marked invagination at its right edge. Ureter elongated with its long axis transverse to the main axis of the kidney. The radula is taenioglossate (2.1.1.1.2) and has on average 35 transverse rows of teeth. The form and arrangement of the radula teeth are nearly the same as in other Ampullariidae. The testis is cream-colored and lies in the first three whorls of the spire. Spermiduct uniformly narrow, running to the base of the spire. Seminal vesicle whitish, slightly pressed dorsoventrally. Prostate cylindric and thick, similar in color to the testis. Penis whiplike, with a closed circular spermiduct. Penis pouch ovoid completely envelping the penis. Penis sheath elongated, broad prosimally, tapering distally. Its inner surface shows a longitudinal channel along its proximal half and two glands, one on the middle and the other apical. Ovary composed of branched whitish tubules situated on the surface of the digestive gland. Oviduct slender running along the columellar axis toward the base of the spire. Seminal receptalble tubiform, thick-walled and rounded proximally. Albumen gland large, pink, enclosing the receptacle and the spiral capsule gland. Vestigial male copulatory apparatus (penis and its sheath) present in all females examined.

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The validity of Biomphalaria kuhniana (Clessin, 1883) is confirmed through morphological study of specimens from Surinam (type locality) and the area of Tucurui (Tocantins river, state of Pará, Brazil) in comparison with B. straminea (Dunker, 1848), and throught crossing experiments which revealed complete reproductive isolation between the two species. The full-grown shell of kuhniana is smaller (about 7.5 mm) than that of straminea (11 mm to 16.5 mm). Anatomically they differ in the degree of corrugation of the vaginal wall (little developed in kuhniana, conspicuous in straminea), number and shape of prostatic diverticula (kuhniana 4 to 9, shorter and less branched; straminea 9 to 18, longer and more branched),number of muscle layers at the middle of the penis (two in kuhniana, three in straminea), distal segment of the spermiduct usually straight or slightly wavy in kuhniana, more or less curly in straminea. Differences between B. kuhniana and B. intermedia (paraense & Deslandes, 1962) are less marked. The latter has a shell up to about 12 mm in diameter, 7 to 15 prostatic diverticula, two muscle layers at the middle of the penis, and a vaginal wall with a combination of a more or less developed corrugation (or sometimes a mere swelling) on the left of the spermathecal duct and a rudimentary pouch on the right of the duct. A Biomphalaria straminea complex is proposed to include that species as well as B. kuhniana and B. intermedia.

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A description of Pomacea sordida (Swainson, 1823) collected in Caxias and Nova Iguaçu, state of Rio de Janeiro, is presented. The shell is globose, heavy, whith greenish or horn-colored periostracum and dark spinal bands; apex subelevated, 4-5 moderately shoudered whorls, increasing rather rapidly and separated by deep suture. Aperture large, moderately round, yellowish or violaceous; lip thick and sometimes dark brown; umbilicus large and deep; operculum corneous and heavy, entirely closing the aperture. Ratios: shell width/shell length = 0.81-0.91 (mean 0.86); aperture length/shell length = 0.66-0.75 (mean 0.70). Testis, spermiduct and penis pouch as in Pomacea lineata (Spix, 1827). Seminal vesicle whitish and bean-shaped. Prostate cylindric and narrow, cream in coloar as the testis. Penis whiplike whith a closed circular spermiduct. Penial sheath elongated and tapered, with its distal tip turned to the right; outer basal gland situated on the left; inner median gland rounded; apical gland elongated and wrinkled. Ovary composed of branched whitish tubules lying superficially on the digestive gland; oviduct and seminal receptacle as in P. lineata; albumen gland yellowish - orange. Vestigial male copulatory apparatus (penis and its sheath) present in all females examined.

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A description of Biomphalaria obstructa (Morelet, 1849), based on specimens collected at its type locality - isla del carmen, state of Campeche, Mexico - is presented. The Shell is small, 13 mm in diameter, 3.5 mm in width and with 5.75 whorls in the largest specimen, thin, moderately lustrous and translucent, horn-colored. Whorls increasing regularly (neither slowly nor rapidly) in diameter, rounded on the periphery side, bluntly angular on the left. Suture well-marked, deeper on the left. Right side widely concave, with first whorl deeply situated and partly hidden by the next. Left side shallower than right one, largely flattened, with first whorl plaintly visible. Aperture roundly heart-shaped, usually in the same plane as the body whorl but somewhat deflected to the left (less frequently to the right) in some specimens. Peristome sharp, seldom blunt; a distinct callus on the parietal wall. A number of young shells develop one set (seldom more) of apertural lamellae which tend to be resorbed as the shell grows. Absence of renal ridge. Ovotestis with about 70 mostly unbrached diverticula. Seminal vesicle beset with well-developed knoblike to fingerlike diverticula. Vaginal pouch more or less developed. Spermatheca club-shaped when empty, egg-shaped when full, and with intermediate forms between those extremes. Spermathecal body usually somewhat longer than the duct. Prostate with 7 to 20 (mean 12.06 ± 2.51) usually short diverticula which give off plumpish branches spreading out in a fan shape and overlapping to some extent their immediate neighbors. Foremost prostatic diverticulum nearly always partially or completely inserted between the spermathecal body and the uterine wall. Penial sheath consistently narrower and shorter than the prepuce. Muscular coat of the penis consisting of an inner longitudinal and an outer circular layers. Ratios between organ lengths: caudal to cephalic parts of female duct = 0.55 to 1.37 (mean 0.85 +- 0.17); cephalic parte of female duct to penial complex = 1.36 to 2.81 ((mean 1.90 +- 0.33); penial sheath to prepuce = 042 to 0.96 (mean 0.67 +- 0.13). Comparison with Morelet’s type specimens of Planorbis orbiculus and P. retusus points to the identity of those nominal species with B. obstructa.

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The pharmacological activities of a water extract (WE) of Ageratum conyzoides L, a plant populary known for its analgesic and anti-inflamatory properties, were studied in vivo and in vitro preparations. Oral administration (p.o.) of the water extract (WE, 0.1 to 5 g/Kg) to rats and mice induced quietness and reduced the spontaneous motility. the sleeping time induced by sodium pentobarbital (50 mg/Kg, i.p.) in mice was not altered by previous treatment with We (2 g/Kg, p.o.). The same treatment did not influence the paw edema induced by carrageenan or dextran, nor did it reduce the chronic paw edema induced by complete Freund's adjuvant or formaldehyde in rats. The tail flick response in immersion test and writhings induced by 0.8%acetic acid in mice were not altered by WE either. In isolated guinea-pig ilea WE (0.4 to 4 mg/ml) did not alter the EC50 values of histamine or acetylcholine, but reduced the maximal response to the agonists by 20 to 50%. We (0.01 to 10 mg/ml) produced tonic contractions of the ileal smooth muscle proportional to the doses, reaching a maximum of 75% relatively to the maximum obtained with histamine. Those contractions were blocked by diphenhydramine (10 nM) and reduced by 32% in presence of atropine (10 nM). The results indicated that oral treatment of rodents with A. conyzoides L neither reduced the inflammatory edema nor did it decrease the reaction to pain stimuli. In vitro the extract presented an unexpected histamine-like activity characteristic of a partial agonist. The results did not confirm the popular medicinal indications of the plant.

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OBJECTIVE: The purpose of this study was to evaluate the prevalence of mesenteric venous thrombosis (MVT) in the Swiss Inflammatory Bowel Disease Cohort Study and to correlate MVT with clinical outcome. MATERIALS AND METHODS: Abdominal portal phase CT was used to examine patients with inflammatory bowel disease (IBD). Two experienced abdominal radiologists retrospectively analyzed the images, focusing on the superior and inferior mesenteric vein branches and looking for signs of acute or chronic thrombosis. The location of abnormalities was registered. The presence of MVT was correlated with IBD-related radiologic signs and complications. RESULTS: The cases of 160 patients with IBD (89 women, 71 men; Crohn disease [CD], 121 patients; ulcerative colitis [UC], 39 patients; median age at diagnosis, 27 years for patients with CD, 32 years for patients with UC) were analyzed. MVT was detected in 43 patients with IBD (26.8%). One of these patients had acute MVT; 38, chronic MVT; and four, both. The prevalence of MVT did not differ between CD (35/121 [28.9%]) and UC (8/39 [20.5%]) (p = 0.303). The location of thrombosis was different between CD and UC (CD, jejunal or ileal veins only [p = 0.005]; UC, rectocolic veins only [p = 0.001]). Almost all (41/43) cases of thrombosis were peripheral. MVT in CD patients was more frequently associated with bowel wall thickening (p = 0.013), mesenteric fat hypertrophy (p = 0.005), ascites (p = 0.002), and mesenteric lymph node enlargement (p = 0.036) and was associated with higher rate of bowel stenosis (p < 0.001) and more intestinal IBD-related surgery (p = 0.016) in the outcome. Statistical analyses for patients with UC were not relevant because of the limited population (n = 8). CONCLUSION: MVT is frequently found in patients with IBD. Among patients with CD, MVT is associated with bowel stenosis and CD-related intestinal surgery.

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BACKGROUND: For over 50 years, radiocephalic wrist arteriovenous fistulae (RCAVF) have been the primary and best vascular access for haemodialysis. Nevertheless, early failure due to thrombosis or non-maturation is a major complication resulting in their abandonment. This prospective study was designed to investigate the predictive value of intra-operative blood flow on early failure of primary RCAVF before the first effective dialysis. METHODS: We enrolled patients undergoing creation of primary RCAVF for haemodialysis based on the pre-operative ultrasound vascular mapping discussed in a multidisciplinary approach. Intra-operative blood flow measurement was systematically performed once the anastomosis had been completed using a transit-time ultrasonic flowmeter. During the follow-up, blood flow was estimated by colour flow ultrasound at various intervals. Any events related to the RCAVF were recorded. RESULTS: Autogenous RCAVFs (n = 58) in 58 patients were constructed and followed up for an average of 30 days. Thrombosis and non-maturation occurred in eight (14%) and four (7%) patients, respectively. The intra-operative blood flow in functioning RCAVFs was significantly higher compared to non-functioning RCAVFs (230 vs 98 mL/min; P = 0.007), as well as 1 week (753 vs 228 mL/min; P = 0.0008) and 4 weeks (915 vs 245 mL/min, P < 0.0001) later. Blood flow volume measurements with a cut-off value of 120 mL/min had a sensitivity of 67%, specificity of 75% and positive predictive value of 91%. CONCLUSIONS: Blood flow <120 mL has a good predictive value for early failure in RCAVF. During the procedure, this cut-off value may be used to select appropriately which RCAVF should be investigated in the operation theatre in order to correct in real time any abnormality.

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The genus Vampirolepis Spasskij, 1954 is re-defined on the basis of the original description and the first detailed redescription by Andreiko et al. (1969). A restricted definitions is proposed, the main features being the arrangement of testicles on a straight line snd numerous hooks of fraternoid shape. Other important characters are the strobila with numerous proglottids, the cirrus pouch of moderate size and the cirrus, smooth or armed with minute spines. Formerly included Hymenolepidid cestodes with reduced strobila, particularly long cirrus pouch and different arrangement of gonads do not belong to Vampirolepis. Members of Vampirolepis in the restricted sense show a cosmopolitan repartition and parasitize only bats. The author does not accept the synonymy of Rodentolepis Spasskiji, 1954 with Vampirolepis. A tentative list of the species belonging to the genus is proposed.