L'orientation du patient souffrant d'un syndrome douloureux abdominal aigu a domicile [Hospitalisation criteria for the acute abdominal pain patient seen at home or in an ambulatory setting].

Dealing at patient's home with an acute abdominal pain may be particularly challenging for the primary care physician. In such a clinical situation, the part of laboratory and radiological investigations is increasing in the diagnostic process. The decision to keep the patient at home based on a clinical evaluation alone may represent a great medical responsibility for the physician. Emergency departments (ED) are of course in charge of investigating such patients with a wide panel of investigation techniques. But these structures are chronically overcrowded resulting frequently in long and difficult periods of waiting. Based on a literature review, a description of useful clinical symptoms and signs is summarized and should help the decision process for the orientation of the patient.

Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients.

OBJECTIVE: To evaluate the efficacy and safety of intravenous fluconazole for the prevention of intra-abdominal Candida infections in high-risk surgical patients. DESIGN: Randomized, prospective, double-blind, placebo-controlled study. SETTING: Two university-affiliated hospitals in Switzerland. PATIENTS: Forty-nine surgical patients with recurrent gastrointestinal perforations or anastomotic leakages. INTERVENTIONS: Prophylaxis with intravenous fluconazole (400 mg per day) or placebo continued until resolution of the underlying surgical condition. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated daily, and specimens for culture were obtained three times per week during prophylaxis. The primary study end points were the frequency of and the time to intra-abdominal Candida infections. Secondary end points were the frequency of candidiasis (intra-abdominal and extra-abdominal) and the emergence or persistence of Candida colonization. Among patients who were not colonized at study entry, Candida was isolated from surveillance cultures during prophylaxis in 15% of the patients in the fluconazole group and in 62% of the patients in the placebo group (relative risk, 0.25; 95% confidence interval, 0.07 to 0.96; p = .04). Candida peritonitis occurred in one of 23 patients (4%) who received fluconazole and in seven of 20 patients (35%) who received placebo (relative risk, 0.12; 95% confidence interval, 0.02 to 0.93; p = .02). In addition, one catheter-related Candida albicans sepsis occurred in a fluconazole-treated patient. Thus, overall, candidiasis developed in two fluconazole patients and seven placebo patients (relative risk, 0.25; 95% confidence interval, 0.06 to 1.06; p = .06). C. albicans accounted for 87% of the Candida species isolated before or during prophylaxis, and all C. albicans strains were susceptible to fluconazole. Fluconazole was well tolerated, and adverse events occurred at similar frequencies in both treatment groups. CONCLUSIONS: Fluconazole prophylaxis prevents colonization and invasive intra-abdominal Candida infections in high-risk surgical patients.

Tegumentar glands associated to foveae in the second metasomal tergum of Panurgillus Moure (Apoidea, Andrenidae, Panurginae)

Panurginae have a pair of cuticular depressions in the second metasomal tergum, recognized as lateral foveae of the T2. These structures have been used as systematic and taxonomic characters, although their functions are yet unknown. We aimed a morphological analysis at lateral foveae of three species of Panurgillus Moure, 1998: P. vagabundus (Cockerell, 1918), P. reticulatus Schlindwein & Moure, 1998 e P. flavitarsis Schlindwein & Moure, 1998. The study of the external morphology showed that the lateral foveae of the T2 are evident among females, but in males they are undistinguishable or absent. The surface of the foveae is micropunctuated in all species. The histological analysis has shown that the region of the lateral foveae of the T2, of female and male of the three species, presented tegumentar specializations. The inner part showed an evident secretory epithelium recognized as Class I gland. The height of this secretory epithelium was not uniform, although the cellular features are similar independent of sex. We have not found any previous information regarding the presence of glands related to abdominal foveae in Panurginae species.

Morphological study of the thorax of the five nymphal instars of Triatoma arthurneivai Lent & Martins (Hemiptera, Reduviidae, Triatominae)

Scanning electron microscope (SEM) was done in order to study dorsal, ventral and lateral sides of 1st, 2nd, 3rd, 4th and 5th nymphal instars of Triatoma arthurneivai. The five nymphal instar can be recognized based on different pronotum, mesonotum and metanotum shapes and characteristics. In the 1st instar collar, hairless areas and tubercles are absent. The 2 nd instar presents collar, hairless areas and tubercles. In the 3rd instar occurs the development of wing pads. In the 4 th instar the four wing pads are expanded, but do not reach the abdomen and in the 5th instar the anterior wing pads almost overlap the posterior ones. At the ventral side, two metasternal glands openings (1+1) were found in all five nymphal instars. Brindley's gland evaporation areas (1+1) are located at the mesopleuron, as well as an evaporation area is located at the propleuron in all nymphal instars (1+1).

Surface swimming behavior of the curculionid Ochetina uniformis Pascoe (Erirhininae, Stenopelmini) and Ludovix fasciatus (Gyllenhal) (Curculioninae, Erodiscini)

The swimming behavior exhibited by specimens of L. fasciatus and O. uniformis was analyzed frame-by-frame with video observation recorded with a digital camera, attached to a stereomicroscope. Adults of O. uniformis, an aquatic insect, swim with all three pairs of legs. During the process of swimming the majority of the abdomen and rostrum remain submerged, part of the fore and hind tibiae remain above the surface, while the mid tibiae remain submerged. The mesothoracic legs, during the power-stroke stage, provide the greatest thrust while the metathoracic legs provide the least forward propulsion. The prothoracic legs, extended forward, help to direct the swimming. The semi-aquatic specie L. fasciatus shows the same swimming style as O. uniformis, that is, with movement of all the three pairs of legs; the mesothoracic legs are responsible for the main propulsion. The insect body remains on the water surface during the process of swimming, while the legs remain submerged. Both species complete a swimming cycle in 0.33 and 0.32 seconds, respectively, with an average speed of 1.38 cm/s and a maximum and minimum swimming duration time of 11.15 and 5.05 minutes, respectively, for L. fasciatus. The swimming behavior exhibited by O. uniformis and L. fasciatus corresponds to the style known as a breast strokelike maneuver. This is the first record of this kind of swimming for both species here observed and increases to seven the number of genera of Curculionidae exhibiting this behavior.

Atelosteogenesis Type 2

Disease characteristics. Clinical features of atelosteogenesis type 2 (AO2) include rhizomelic limb shortening with normal-sized skull, hitchhiker thumbs, small chest, protuberant abdomen, cleft palate, and distinctive facial features (midface hypoplasia, depressed nasal bridge, epicanthus, micrognathia). Other typical findings are ulnar deviation of the fingers, gap between the first and second toes, and clubfoot. AO2 is lethal at birth or shortly thereafter because of pulmonary hypoplasia and tracheobronchomalacia. Diagnosis/testing. The diagnosis of AO2 rests on a combination of clinical, radiologic, and histopathologic features. SLC26A2 (DTDST) is the only gene currently known to be associated with AO2. The diagnosis can be confirmed by molecular genetic testing of SLC26A2, which is clinically available. Management. Treatment of manifestations: palliative care for liveborns. Genetic counseling. AO2 is inherited in an autosomal recessive manner. At conception, each sib of a proband with AO2 has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Once an at-risk sib is known to be unaffected, the risk of his/her being a carrier is 2/3. Prenatal diagnosis for pregnancies at 25% risk is possible. Carrier testing for at-risk relatives and prenatal testing for pregnancies at increased risk are possible if both disease-causing alleles in the family are known and the carrier status of the parents has been confirmed. Ultrasound examination early in pregnancy is a reasonable complement or alternative to molecular genetic prenatal diagnosis.

A new species of Buenoa Kirkaldy (Hemiptera, Heteroptera, Notonectidae) from Rio de Janeiro, Brazil

Members of Buenoa are restricted to the Western Hemisphere, with the greatest diversity of species in South America. There are about 50 described species and approximately 20 of them have been reported from Brazil. Buenoa pseudomutabilis Barbosa, Ribeiro and Nessimian, sp. nov. is described here from Maricá, Rio de Janeiro State. This species resembles B. mutabilis Truxal, 1953 because males have a stridulatory area on inner surface of forefemur, forefemur narrowed at apex, with length more than three times its width at apex, and rostral prong longer than third rostral segment. Males of B. pseudomutabilis sp. nov. can be readily recognized by the presence of 21 to 25 teeth in the stridulatory comb of foretibia, whereas in B. mutabilis the stridulatory comb of foretibia consists of approximately 33 to 38 teeth. Males of B. pseudomutabilis sp. nov. bear one nodule on each ventral laterotergite 1 of abdomen. A key to male species of Buenoa occurring in Rio de Janeiro State, including the new species, is provided.

In situ introducer sheath dilatation for complex aortic access.

Aortic access problems due to diseased or small peripheral vessels are a major issue in endovascular aneurysm repair (EVAR). In the emergency setting, like aortic rupture after blunt trauma, or in patients with a hostile abdomen, a more proximal access to the aorta is not a pleasant perspective. We developed in situ introducer sheath dilatation as a bail-out technique for patients with difficult aortic access under various circumstances including EVAR, intra-aortic balloon pump insertion and cannulation for perfusion. The method described allows to increase the access vessel diameter by 50% (from 6 to 9 mm) or the luminal circumference from 18 to 27 F. We have used this technique in five patients without complication, very much in contrast to the traditionally practiced 'forced device insertion'.

Fetal dose reduction in head and neck radiotherapy of a pregnant woman.

BACKGROUND AND PURPOSE: A pregnant woman was referred for post-operative radiotherapy of a malignant schwannoma in the head and neck region. A best-treatment plan was devised in order to minimize the fetal dose. MATERIAL AND METHODS: The fetal dose resulting from radiological examinations was determined according to international protocols, that resulting from radiotherapy was calculated according to Recommendation 36 of the American Association of Physicists in Medicine (AAPM) Task Group. Pre-treatment dosimetry was performed with an anthropomorphic phantom. Several alternative treatment plans were evaluated. The use of a multileaf collimator (MLC) and a virtual wedge (VW) was compared to cerrobend blocks (CB) and physical wedge (PW). In-vivo dosimetry was performed using a vaginal probe containing thermoluminescent dosimeters (TLD). RESULTS: The total fetal dose resulting from diagnostic and radiotherapy procedures was estimated to be 36 mGy. The technique based on MLC and VW was elected for patient treatment. Measurements for this configuration resulted in afetal dose reduction of 82%. The shielding of the patient's abdomen further reduced the fetal dose by 42%. CONCLUSION: The use of VW and MLC for the treatment of a pregnant woman is highly recommended. Each case should be individually studied with pre-treatment and in-vivo dosimetry.

Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis--the role of routine abdominal drainage.

Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis. This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay. Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p < 0.0001). No benefits were observed for prophylactic drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.

A new species of Giovanella Bonatto (Diptera, Calliphoridae, Mesembrinellinae) from Colombia

A new species of Giovanella Bonatto (Diptera, Calliphoridae, Mesembrinellinae) from Colombia. The Mesembrinellinae are exclusively Neotropical, with 33 nominal species distributed in nine genera. Only the genera Mesembrinella, Eumesembrinella, Huascaromusca and Laneella had until now been recorded in Colombia. In this work we present a new species of Giovanella Bonatto, 2005, genus with only one species, G. bolivar Bonatto, differing from the new species G. carvalhoi sp. nov., in the characters: legs entirely dark chestnut; thorax with dorsocentrals setae 1:2; abdomen with T5 with discal bristles poorly differentiated; T6 symmetric and paraphallus not extended and with denticules. Giovanella carvalhoi sp. nov. is from Cordillera Oriental, from the Departments of Caquetá (Amazonian foothills) and Santander, Colombia, collected between 22002400 m., and associated with decomposing organic matter. A key for the identification of males and females of the two species of Giovanella, illustrations of the genitalia and photographs of male and female of new species are also presented.

External morphology of the adult of Dynamine postverta (Cramer) (Lepidoptera, Nymphalidae, Biblidinae) and patterns of morphological similarity among species from eight tribes of Nymphalidae

External morphology of the adult of Dynamine postverta (Cramer) (Lepidoptera, Nymphalidae, Biblidinae) and patterns of morphological similarity among species from eight tribes of Nymphalidae. The external structure of the integument of Dynamine postverta postverta (Cramer, 1779) is based on detailed morphological drawings and scanning electron microscopy. The data are compared with other species belonging to eight tribes of Nymphalidae, to assist future studies on the taxonomy and systematics of Neotropical Biblidinae.

Estudio prospectivo de sintomatología visual positiva en fase aguda de ictus: incidencia y características.

Desconocemos los mecanismos fisiopatológicos subyacentes a la aparición de alucinaciones/alucinosis visual en pacientes con ictus, su incidencia, características y valor predictivo topográfico o pronóstico. En este trabajo estudiamos prospectivamente 78 pacientes con ictus isquémico/hemorrágico agudo y ausencia de enfermedad neurodegenerativa/psiquiátrica basal o clínica alucinatoria previa, administrándoles cuestionario estandarizado sobre alucinaciones/alucinosis visual y realizándoles prueba de neuroimagen. Un subgrupo de pacientes también cuenta con EEG y evaluación neuropsicológica. La incidencia de alucinaciones/alucinosis fue del 16,7%, siendo la mayoría imágenes complejas, con presentación precoz y curso autolimitado. Se asoció con lesiones occipitales, defecto campimétrico inicial, y alteraciones del sueño entre otras variables.

Aspectos biológico - pesqueros del Camaroncito Rojo Pleuroncodes monodon (M Edwards, 1837) en el litoral peruano

Se analizaron algunos parámetros poblacionales de 11 583 ejemplares del Pleuroncodes monodon (CRUSTACEA: ANOMURA: GALAYHEIDAE) distribuidos en 5 860 (52%) ejemplares machos y 5723 (48%) ejemplares hembras, las muestras se obtuvieron de los lances de comprobación de los cruceros de evaluación tanto para recursos pelágicos y demersales ejecutados por el Instituto del Mar del Perú (IMARPE) entre febrero y noviembre del 2001, la zona de estudio estuvo comprendida entre Puerto Pizarro (03°29,1’ S; 80°23,0’ W) hasta Los Palos (18°20,18’ S; 70°22,5’ W). La presencia del Pleuroncodes monodon respecto a su distribución batimétrica abarcó entre 1,5 y 300 m. De profundidad. La distribución total de tallas fluctuó entre 6,0 y 42,4 mm de longitud cefalotoráxica (Lc) y entre 6,0 y 41,1 mm de Lc para machos y hembras respectivamente. Por estaciones la estructura por tallas fue variable denotándose dos marcados grupos de talla, predominando un primer grupo los denominados ”juveniles” de (de 6 hasta 20 mm de Lc), sin embargo aquellos ejemplares con longitud cefalotoráxica menor a los 13 mm se registraron mayormente en las estaciones de verano y primavera, mientras un segundo grupo perteneciente a los de talla intermedia denominados “adultos jóvenes” registrados en todas las estaciones. Su distribución horizontal fue mayormente costera; aunque su presencia fue hasta más de las 50 millas náuticas (mn) de la costa; sin embargo los mayores registros de este recurso fue dentro de las 25 mn de la costa, en cuanto a los ejemplares “juveniles” su presencia fue marcada dentro de las 10 mn de la costa. La composición sexual de la población muestreada varió durante el periodo de estudio obteniéndose una razón promedio de 1,02 (machos/hembras). Además se encontraron hembras con huevos en todo el periodo de estudio, sin embargo los altos porcentajes de hembras ovígeras se registraron entre las estaciones de invierno (70%) y primavera (68%) del total. La talla de madurez sexual en las hembras fue de 18,8 mm Lc, mientras que el primer desove en 17,4 mm de Lc. Al registrarse hembras ovígeras en todo el año, existe un periodo anual de postura (liberación de los huevos eclosionados), detectándose éste en la estacón de primavera. La relación longitud cefalotoráxica vs Fecundidad, está determinada por la ecuación: NHT 0,1899 Lc2,9883 Además se analizaron los siguientes parámetros: largo cefalotoráxico, peso total, peso del abdomen, características de los huevos. Complementándose tales evaluaciones con determinaciones de áreas de distribución y concentración, así como la relación de los factores: abióticos (temperaturas, salinidad y oxígeno) y bióticos en relación a predadores y competidores dentro de la cadena trófica.