Search

Congenital toxoplasmosis (CT) is a zoonosis resulting from the fetal transmission of the obligate intracellular parasite, T. gondii, transplacentally in pregnant women usually in the first trimester of pregnancy. This research consisted in the review of indexed articles made in the Ecuador in the period between the years 2012 and 2017 with prevalence studies of the aforementioned pathology. The purpose of this collection was to determine the current situation of this disease in the Ecuadorian territory and, in addition, to recognize the risk factors involved, affected age groups, signs and symptoms, diagnosis and prevalence of the infection. Among the risk factors were the consumption of raw or undercooked meat, contact with feces of young cats and climatic conditions that stimulate the spread of oocysts, among others. Most affected ages by this disease fluctuate between 20 and 30 years. In 90% of the cases, the disease is asymptomatic or it may present adenopathies, maculo papular erythema, hepatosplenomegaly and other general signs such as fever, malaise, headache and myalgias. According to studies conducted with specific populations, it was established that the causative agent remains latent in first-trimester pregnant women from the provinces of Pichincha (71.4% of 140 pregnant women), Guayas (73% of 5683) and El Oro (16% of 250). The results of this research evidenced missing information in Ecuador, finding few and isolated studies regarding to this pathology. Therefore, it is concluded that an updated research should be conducted in order to elucidate the true epidemiological situation of congenital toxoplasmosis in Ecuador.

Dopamine is the main catecholamine found in the chick retina whereas norepinephrine is only found in trace amounts. We compared the effectiveness of dopamine and norepinephrine in promoting cyclic AMP accumulation in retinas at embryonic day 13 (E13) and from post-hatched chicken (P15). Dopamine (EC(50)=10microM) and norepinephrine (EC(50)=30microM), but not the beta(1)-adrenergic agonist isoproterenol, stimulated over seven-fold the production of cyclic AMP in E13 retina. The cyclic AMP accumulation induced by both catecholamines in embryonic tissue was entirely blocked by 2microM SCH23390, a D(1) receptor antagonist, but not by alprenolol (beta-adrenoceptor antagonist). In P15 retinas, 100microM isoproterenol stimulated five-fold the accumulation of cAMP. This effect was blocked by propanolol (10microM), but not by 2microM SCH23390. Embryonic and adult retina display beta(1) adrenergic receptor mRNA as detected by RT-PCR, but the beta(1) adrenergic receptor protein was detected only in post-hatched tissue. We conclude that norepinephrine cross-reacts with D(1) dopaminergic receptor with affinity similar to that of dopamine in the embryonic retina. In the mature retina, however, D(1) receptors become restricted to activation by dopamine. Moreover, as opposed to the embryonic tissue, norepinephrine seems to stimulate cAMP accumulation via beta(1)-like adrenergic receptors in the mature tissue.

A clinical case of Neuronal Intestinal Dysplasia (NID) is reported. This is an important pathology which is part of congenital alterations of bowel's innervation. This disease consists of two forms (A and B) which occur during different ages causing problems in intestinal motility with consequent various symptoms. Actually NID is diagnosed easier than in the past because histopathological techniques are very refined and permit to distinguish NID from cases once classified as Hirschsprung's disease. Histology can show an increase of Ach and Ldh activity in cholinergic fibers of lamina propria and of circular layer of intestinal wall. In this report a chronic status of constipation refractory to medical therapy has been treated with a total colectomy and an ileo-rectal anastomosis, resulting in a complete resolution of symptoms.

Adrenal location of a hydatic cyst is a clinical occurrence of exceptional rarity, especially in its primitive form and it could be evaluated, on the operative and autoptic comparison, not to exceed overall 0.5% of all the possible locations. Moreover, among all the cystic formations of the adrenal glands, parasitic ones are only 7%. Our observation of a case of adrenal hydatidosis, initially suspected as hepatic mass, was casually discovered by means of abdominal ultrasonography and later confirmed with the operation. This work contributes to the knowledge of this pathology, emphasizing diagnostic difficulties, and, considering the exiguous literature, helping us in supplying real indications to the surgical treatment.

Gastrinoma is a rare neoplasia producing gastrina, the hormone responsible of the clinic manifestations related to Zollinger-Ellison syndrome. The localization of gastrinoma is pancreatic or extrapancreatic (usually in Stabile and Passaro triangle). We present a case report concerning an extra-pancreatic gastrinoma not localized in this area and included in a lymph node. This is an extremely infrequent localization (2.4%). There are two different opinions about this localization. Some authors think that this is always a secondary lesion of a small primary neoplasia usually asymptomatic. Other authors think that there are primary lymph nodal gastrinomas that could be safely removed with excision of lymph node. The infrequent localisation of this case induced us to report this experience in order to contribute to the comprehension of this pathology.

The authors consider the various causes of ascites and they also develop the concept of refractory ascites. They consider the various possibilities of medical and dietary therapy whose failure constitutes the basis for a surgical approach. In the latter case it is being considered the Peritoneo Venous Shunt (PVS) that employs different types of valves. In the light of their personal experience, matured over a period of 15 years, in which 75 valves were positioned in 64 patients and precisely: 55 valves of Le Veen, 15 Hakim and 5 Denver, it is emphasized that the best results, as for as mortality and morbidity goes, were obtained through careful attention in the preoperative stage and during surgery itself with the privileged use of a Le Veen's valve. For such motives, since in a high percentage of these patients there persists a poor prognosis a year away from the onset of refractory ascites, a PVS seems proposable anyway and even though this will not alter the pathological outcome, there's a clear improvement in the quality of life without precluding any other surgical approach. Finally, the authors outline the possibilities offered by the Transjugular Intrahepatic Portosystemic Shunt (TIPS), as a new original approach for the resolution of refractory ascites.

The Authors report a case of rhabdomyosarcoma observed in a 17-year-old boy. They emphasize that this rare form has an extremely rapid evolution, and in this case was also in an unusual site and of abnormal size. The difficulty of an early diagnosis and the impossibility of radical surgery are also underlined.

The paper reports a case of carcinoma of the parathyroid associated with thyroid struma and underlines the difficulties of intraoperative diagnosis and the surgical approach which should be adopted on the basis of this finding. Often the diagnosis of the malignant nature of the neoplasia is based on the possible appearance of local or distant recurrence rather than histological examination.

We present a case report about a patient affected by an "insular" thyroid carcinoma, a poorly differentiated carcinoma, situated morphologically and biologically in an intermediate position between the well-differentiated (papillary and follicular) and the totally undifferentiated thyroid tumors. We believe that its separation from other types of thyroid cancer will lead to a more accurate estimate of its prognosis and a more aggressive therapeutic approach.

In two patients with hepatic echinococcosis, we studied the in vivo interaction between circulating immune complexes and polymorphonuclear neutrophil surface receptors according to our previously described technique and quantitated the amount of circulating immune complexes by the C1q binding assay. Both tests were positive prior to surgical removal of the cysts, to gradually become negative to weeks later, and are persistently negative at two months after complete asportation. The application of the two tests may be of value in assessing surgical radicality and consequently the prompt disappearance of circulating parasite antigens. In particular, failure of these two tests two turn negative or the occurrence of further, new positivities may suggest either uncomplete eradication of the cyst or reinfection. These immunologic techniques appear to provide a better monitoring of echinococcosis than all the other well-known immunological tests which detect specific immunoglobulins present in serum for a long time and therefore unable to indicate the persistence or the new appearance of the parasite antigens.

An aid service based on the use of helicopters for Northern Lombardy and its adjacent areas is proposed. This would be based on the Varese Hospital and on existing heliports and airports in the area, this being one of Europe's most heavily populated and industrialised regions. The question of airborne aid is discussed, together with the solutions adopted in Italy, and those proposed and partly put into effect in Italy. An examination is also made of the factors in favour of the placement proposed; geographical features, road infrastructures, distances, prevailing weather conditions, and other points. The proposal is seen as a working hypothesis available for the authorities responsible under the current legislation, and as a model for similar investigations in other areas.

The literature data and personal experience with high - and very high - risk patients show that the association of enflurane as anaesthetic and pancuronium as muscle-relaxant constitutes a positive advance in balanced general anaesthesia. Cardiocirculatory depression is not encountered; if anything, there is an improvement of homeostatic conditions. This results in increased safety, even for patients regarded as inoperable. Confirmation of the reasons for associating these two drugs has certainly been obtained. The method cannot, however, be employed indiscriminately, but, at least in theory, should be avoided in patients with serious hypertension or a myocardium that is particularly sensitive to endogenic catecholamine incretion. In hypotension, on the other hand, cases of imminent or frank shock, or situations where surgery cannot be postponed, the association is, paradoxically, a true pharmacological "support", backed up, of course, by other usual procedures. This contradiction of modern views concerning the peripheral circulation is only apparent, since the duration of anaesthesia is reduced; main aim in this period is the maintenance of sufficient circulation to the more important organs. Comparison with associations combining d-Tubocurarine, halothane and methoxyfluorane is still an open question as far as objective assessment of their usefulness is concerned. There can be no doubt, however, that the association of enflurane and pancuronium has eliminated a large sector of contraindications in the field of general anaesthesia.

Following a brief review of the literature dealing with the rarity of this disease, and the diagnostic progress made to date, the surgical techniques applicable to the various locations of the neoplasia are described. Personal experience with 8 insuloma patients is reported.

Attention is drawn to the pressing need to establish out-patient departments for anaesthesia and anaesthesiological treatment within anaesthesia, resuscitation and intensive therapy services. In addition to offering specialist services, such as anaesthesiological therapy, and such services as may be in keeping with the local situation, such departments should be engaged in research, and towards the provision of preoperative anaesthesiological management prior to admission, on behalf of patients undergoing surgery of choice, so as to cut down the overlong period of preoperative stay. An assessment is made of the economic and social benefits of such departments, particularly in the light of the experience gained from similar structures that have long been in use in other countries.