Bile duct-duodenal fistula caused by AIDS/HIV-associated tuberculosis

Allthough infrequent, digestive fistulae in HIV/AIDS patients have been reported throughout the digestive tract from the esophagus to the anus, with predominance of esophageal fistulae. AIDS/HIV-associated opportunistic infections may invade the digestive system and lead to fistula formation. Tuberculosis is the most common infection associated with these esophageal fistulae. We report here one case of bile duct-duodenal fistula in a female AIDS patient with associated abdominal Mycobacterium tuberculosis infection compromising lymphnodes of the hepatic pedicle where the fistula was found. According to the reviewed literature, this is the third case of bile duct-duodenal fistula associated with abdominal tuberculosis in AIDS patient, and the first where both the fistula and the tuberculosis infection were diagnosed at laparotomy for acute abdomen. Whether the AIDS patient with abdominal pain needs or not a laparotomy to treat an infectious disease is often a difficult matter for the surgeon to decide, as most of the times appropriate medical treatment will bring more benefit.

Clinical characteristics of women diagnosed with carcinoma who tested positive for cervical and anal high-risk human papillomavirus DNA and E6 RNA

High-risk human papillomavirus (hrHPV) is an essential cause of cervical carcinoma and is also strongly related to anal cancer development. The hrHPV E6 oncoprotein plays a major role in carcinogenesis. We aimed to evaluate the frequency of hrHPV DNA and E6 oncoprotein in the anuses of women with cervical carcinoma. We analyzed 117 women with cervical cancer and 103 controls for hrHPV and the E6 oncogene. Positive test results for a cervical carcinoma included 66.7 % with hrHPV-16 and 7.7 % with hrHPV-18. One case tested positive for both HPV variants (0.9 %). The samples from the anal canal were positive for HPV-16 in 59.8 % of the cases. Simultaneous presence of HPV in the cervix and anal canal was found in 53.8 % of the cases. Regarding expression of E6 RNA, positivity for HPV-16 in the anal canal was found in 21.2 % of the cases, positivity for HPV-16 in the cervix was found in 75.0 %, and positivity for HPV-18 in the cervix was found in 1.9 %. E6 expression in both the cervix and anal canal was found in 19.2 % of the cases. In the controls, 1 % tested positive for HPV-16 and 0 % for HPV-18. Anal samples from the controls showed a hrHPV frequency of 4.9 % (only HPV16). The presence of hrHPV in the anal canal of women with cervical cancer was detected at a high frequency. We also detected E6 RNA expression in the anal canal of women with cervical cancer, suggesting that these women are at risk for anal hrHPV infection.

Nueva especie de Cephalobium (Rhabditida, Diplogasteridae) parasito de ninfas de Gryllodes Laplatae (Orthoptera, Gryllidae) en la Argentina

Cephalobium bidentatum sp. nov., parasitizing nymphs of Gryllodes laplatae Sauss (Orthoptera, Gryllidae) from Argentina, is described and illustrated. It is distinguished from other members of the genus Cephalobium COBB, 1920, by having the buccal cavity very sclerotized with two hook-shaped teeth, vagina short and muscular, male has two spicules with hook-shaped tips, and by the distribution pattern of the postanal papillae: one pair under the anus, three pairs between the anus and the tail, and two pairs at the base of the tail appendage.

A new species of Stratiodrilus (Polychaeta, Histriobdellidae) from freshwater crayfishes of southern Brazil

A new species of polychaete, Stratiodrilus vilae, epizoic on Parastacus brasiliensis (von Martens, 1869) and P. defossus Faxon, 1898, is described from the State of Rio Grande do Sul, southern Brazil. The new species has one pair of long, anal, conical ventral lobes, one on each side of the anus, claspers in the males, and one pair of tubercles in each of the posterior locomotor appendages; and the jaw apparatus not reaching the limit between the head and the first segment.

Anfíbios Anuros da coleção Adolpho Lutz: III - Hyla claresignata Lutz & B. Lutz, 1939

Hyla claresignata Lutz & Lutz, 1939, is a large species apparently not closely allied to the other known Brazilian hylas. It is characterized by the very small tympanum; the head is short and the snout rounded; the legs are long, the hands and feet unusually large, the latter extensively webbbed. The specific name is derived from the insular, irregular, or roughly triangular, dark spots, with a light halo, found mostly in the dorso-lateral region and on the legs. It belongs to the rain-forest fauna of the Marítime Range. The adult is a bromeliad-dweller and the tadpole rhyacophilous. DESCRIPTION. Vomerine teeth in two separate, oblique, groups, behind the large choanae, parallel to the posterior half of their inner border. Tongue entire, short, very broad and hardly free behind. Snout short, rounded, with distinct canthus rostralis and gradually sloping loreal region. Eye very large and prominent, its horizontal diameter almost equal to the distance between its anterior corner and the tip of the snout. Tympanum very small, less than one third of the diameter of the eye, but distinct, partly covered by a short, heavy ridge. Lateral fingers less than one third webbed; fourth finger slightly longer than the second, just reaching the base of the disk of the third; subarticular tubercles well developed; an angular pollex rudiment, more noticeable in the males. Toes almost completely webbed, the edge of the web inserted at the base of the disk on the third and the fifth; an inner metatarsal tubercle. Skin smooth above, granular beneath, on the throat minutely so. No dermal appendage on the hell. Habit robust, head broader than long, body rather heavy, slightly narrowed in the postaxillary region. Legs long, the tibiotarsal articulation reaching beyond the tip of the snout when adpressed. Type (female): 61 mm. (Fig. 1.) DIAGNOSIS of TADPOLE (by G. Orton). "A large specialized, mountain-stream tadpole, with wide head an elongated, flattened snout, greatly enlarged lips and high tooth formula. Eyes dorsal. Spiracle sinistral, projecting, situated far back on side. Anus dextral. Tooth formula 8/12 to 9/14 in fully grown larvae. Tail with a prominent, vertical dark band across musculature and fins; a second concentration of dark pigment near tip of tail, may or may not form a similar but narrower band. Maximum known total length: 60mm.; head and body length 25mm. (Figs. 6 e 7). For further details see Lutz & Lutz, 1939 and Lutz B. & Orton G. 1946.

Sensibility of the hamster (Cricetus auratus) to the Treponema pertenue

In two experiments, 8 Hamsters inoculated with material from yaws lesions (Treponema pertenue), developed skin lesions considered specific by their clinical and histopathological aspects and by the presence of treponemae. These lesions appeared on the scrotumm, testicle, prepuce, anus, tail, muzzle, back and hinders paws (palm surface). In the internal organs no treponemae were found in direct examinations and inoculation of brain, spleen and lymph node. The incubation period was of 35 days for the testicle, 55 days for the scrotum and 107 days for peritoneal cavity inoculation. Positive sub-inoculations were obtained. The serum reactions (Qasserman's and Kahn's) were negative in all 5 tested Hamsters. Out of 4 normal females matched to infected males two developed nasal lesions resulting from direct contact. Apparently the genital lesions hindered copulation. Hamsters are very well suited for an experimental study of yaws.

Ueber das Zirkulationssystem einer Machilde (Thysanura)

Es werden Anatomie und Histologie des Zirkulations- und Bingegewebssytems der letzten Segmente und der Schwanzanhaenge einer nicht naeher bestimmten Machilide beschrieben. Es ergeben sich folgende Hauptergebnisse: a - Das Bindegewebssystem hat eine ausgedehnt Entwicklung erfahren und schliesst, abgesehen vom Respirationssystem und den Lymphzellen, alle Organe gegen die Lymphfluessigkeit des Mixocoels ab ("Diffusionsbarrieren"). Es wird der mixocoelomiale Raum dem intracoelomialen gegenueber gestellt. Dieser schliesst die Mehrzahl der Organe in sich ein und erfaehrt im aeussersten Ende des Abdomens (etwa vom Anus ab) und in den Schwanzanhaengen eine ausgedehnte Entwicklung. Abdomenende und Anhaenge werden durch eine mesodermale Quermembran gegen den mixocoelomialen Raum abgeschlossen. b - Das Zirkulationssystem besteht im hinterem Koerperteis aus dem Rueckengefaess, das sich bis zur Quermembran fortsetzt und vor dieser ein Rueckstromventil und eine Filterregion besitzt, durch die keine Lymphzellen hindurchfliessen koennen, - ferner aus einem Terminalgefaess, das in Fortsetzung des Rueckengefaesses das Terminalfilum bis zum Ende durchlaeuft; hier muendet es in den intracoelomialen Raum. Ausserdem besitzt jeder Cercus ein Gefaess, das an der Quermembran mit einer ein Ventil tragenden Oeffnung beginnt und an der Spitze des Cercus sich ebenfalls oeffnet. Es hat seitliche Eintrittsoeffnungen und Bindegewebsbaender, durch die waehrend der Pulsation des Rueckengefaesses der Querschnitt veraendert wird. Der Zirkulationsweg geht aus der Figur 4 hervor. Terminalgefaess und Cercusgefaesse haben keine Muskelelemente. Die Cercusgefaesse treten nicht mit dem Rueckengefaess in Verbindung. C - Die Lymphfluessigkeit des mixocoelomialen Raumes hat eine andere Zusammensetzung als die des Raumes hinter der Quermembran. d - Das Rueckengefaess besteht aus einer inneren Muskularis, die gegen das Gefaesslumen durch das Sarkolemm abgeschlossen ist, und aus einer bindegewebigen aeusseren "Adventitia". Die Gefaesse der Schwanzanhaenge werden ausschliesslich aus Bindegewebe gebildet. An der Basis der Schwanzanhaenge besitzt die Hypodermis umfangreiche Imaginalringe, die das imaginale Wachstum der Anhaenge ermoeglichen: Ebenso finden sich hier die "Membranoblasten", embryonale Bindegewebszellen, von denen beim Wachstum die Membranen weiter gebildet werden, und zwei grosse Lager von embryonalen Zellen mesodermalen Typs, von denen laufend Zellen auswandern, die sich als mesodermales Epithel zwischen die peritoneale Auskleidung der Anhaenge und die Hypodermis schieben. Hypodermis und Mesodermepithel durchdringen sich gegenseitig, entsprechend der Figur 24, zu einem "MIschepithel". e - Die mesodermale Komponente des Mischepithels besteht aus oktoploiden Zellen, die durch Endomitosen aus den diploiden Zellen der Embryonallager entstanden sind. Durch weitere Endomitosen und anschliessende amitose-aehnliche Kerndurchsnuerungen wird die Kernzahl der endodermalen Komponente auf ein Vielfaches vermehrt. Die basal im Mischepithel gelegenen 8-ploiden Kerne machen eine Individualisierung der Chromosome durch, doch kommt es zu keiner Endomitose, sondern zu zwei sich schnell folgenden Kernfragmentationen, durch die vier gleichwertige diploide Kerne entstehen (somatische Reduktion). Diese Kerne umgeben sich, jeder fuer sich, mit einer Portion von Cytoplasma, treten aus dem Mischepithel aus und gelangen, die peritoneale Membran durchbrechend, in den intracoelomialen Raum und werden zu Lymphzellen. Diese werden, infolge der Pulsationen des Dorsalgefaesses, durch die Gefaesse der Cerci in den mixocoelomialen Raum transportiert, wo sie gealterte Lymphzellen ersetzen. Mitotische Vermehrung von Lymphzellen des Mixocoela wurden nicht gefunden. f - Aehnliche Lymphzellen bildende Epithelien wurden bei einer Lepsmatide, der Pro-Imago einer Ephemeride, einer Ephemeridenlarve sowie bei einer isopoden Crustaceee gefunden.

Travassosnema gen. n. with the description of T. travassosi sp. n. (Dracunculoidea, Guyanemidae) parasite of Acestrorhynchus lacustris Reinhardt, 1874 (Characidae) from Três Marias Reservoir, MG, Brazil

A new genus, Travassosnema (Guyanemidae, Dracunculoidea) is proposed to include filariid worms having esophagus divided into muscular and glandular parts, with esophageal appendix near junction with intestine; anus functional; vulva anterior, well developed and functional in mature females. Travassonema travassosi sp. n., a parasite of Acestrorhynchus lacustris Reinhardt, 1874 from Três Marias Reservoir (São Francisco River) in the State of Minas Gerais, Brazil, is described. The generic and the specific names are a tribure to Brazilian parasitologist Lauro Travassos at his birth centenary.

Tratamiento de las fístulas perianales complejas con una fibrina rica en plaquetas. Estudio piloto

L'únic tractament per a la fístula perianal complexa és la cirurgia. Existeixen dos grups de tractament: les tècniques que seccionen esfínter anal que presenten una elevada eficàcia però que comporten incontinència fecal i les tècniques preservadores de l'esfínter que aconsegueixen uns resultats baixos però no alteren la continència anal. En aquest últim grup existeix una nou sellant biològic (Vivostat®) que aporta diferències amb les anteriorment comercialitzades: és un sellant autòleg i es pot afegir un gel de plaquetes que aportaria varis dels factors que afavoririen la cicatrització. Proposem un estudi per valorar l'eficàcia d'aquest sellant biològic.

Influència del factor de creixement derivat de les plaquetes en el tractament de les fístules anals de la malaltia de Crohn

El tractament de les fístules perianals de la malaltia de Crohn es basa en procediments poc invasius, amb èxit variable. L’ús de PDGF (factors de creixement derivats de les plaquetes autòlogues), és habitual en altres camps quirúrgics per millorar la curació de les ferides. No s’ha estudiat la seva aplicació en la malaltia de Crohn. Aquest és un estudi pilot combinant PDGF amb tècniques habituals. La curació va ser del 80% dels malalts i el 88’8% de trajectes fistulosos. L’ús de PDGF és una tecnologia barata, poc invasiva i senzilla, i que sembla augmentar l’èxit del tractament.

Estudio multicéntrico descriptivo de seguimiento prospectivo del tratamiento de las fístulas anales con adhesivo de fibrina

Introducció: L’ús d’adhesiu de fibrina (Tissucol®) pel tractament de la fístula anal és una tècnica senzilla, amb escàs discomfort pel pacient, realitzable en cirurgia major ambulatòria i el seu fracàs no impedeix altres tractaments. Material i mètodes: Estudi multicèntric descriptiu i prospectiu. Objectiu: Determinar l’efectivitat de Tissucol, en termes de recidiva. Resultats: 64 pacients. Seguiment 18 mesos. Fístula simple: curació 64%. Fístula complexa: curació 67%. Complicacions sèptiques: 9.4%. Conclusions: El tractament de la fístula anal amb Tissucol® ens ofereix, amb poques complicacions sèptiques (&10%), una taxa de curació de 64-67%, essent més efectiu en les fístules complexes.

Evaluación de un nuevo método de sutura para la cirugía endoscopica transluminal a través de orificios naturales en un modelo animal

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel, potentially less invasive alternative to laparoscopic surgery. However, the problems of transluminal access and closure represent significant obstacles to its successful introduction in humans. Objective: to evaluate the feasibility and safety of a novel device designed for transluminal access and closure in a survival porcine model. Subjects: Four adult female Yorkshire pigs were used in the study. Interventions: While under general anesthesia, the animals were prepared with multiple tap water enemas followed by instillation of an antibiotic suspension and povidone-iodine lavage. At a distance of 15 to 20 cm from the anus, the prototype device (LSI Solutions, Victor, NY, USA) deployed a circumscribing purse-string suture around the planned incision site and subsequently used a blade mechanism to create a 2.5-cm linear incision. The transcolonic incision was then closed by cinching and securing the purse-string suture with a titanium knot by use of a separate hand-activated suture-locking device. Main Outcome Measurements: The animals were monitored daily for signs of peritonitis and sepsis and were survived for 14 days. The peritoneal cavity was examined for peritonitis, and the colonic incision site was examined for wound dehiscence, pericolic abscess formation, and gross adhesions. Tissue samples from both incisional and random peritoneal sites were obtained for histologic examination. Results: Transcolonic incision and closure were successful in all 4 animals. The device performed in a rapid and reproducible fashion. All animals recovered without septic complications. At necropsy, there was no evidence of peritonitis, abscesses, or wound dehiscence. Salpingocolonic and colovesicular adhesions were noted in 3 of 4 animals. Histologic examination revealed microabscesses at the incision site in all animals. Conclusions: The prototype incision and closure device represents a promising solution to the problems of transluminal access for NOTES. The presence of incision-related adhesions and microabscesses signal the need for further refinement in aseptic technique. 

Neyraiella distinctus n. sp. (Oxyurida, Blattophilidae) Parasite of Nymphs of Gryllodes laplatae Sauss (Orthoptera, Gryllidae) in Argentina

Neyraiella distinctus n. sp. was found parasitizing nymphs of the cricket Gryllodes laplatae Sauss in City Bell, Argentina. This species was characterized by having the excretory pore in the posterior end of the basal bulb, vulva protruding with one lip well developed in the 1/3 end of the body, anus of the female with wings, male with a single spicule without any sculpture, gubernaculum and bursa are absent, six pairs of genital papillae arranged in two preanal pairs, one adanal pair and three postanal pairs, and the tail appendage in both sexes was short and conic.