PERFURAÇÃO DUODENAL PARA O RETROPERITONEU POR PRÓTESE BILIAR

Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography (ERCP). Duodenal perforation by a biliary stent is an uncommon but hazardous complication associated with a high mortality rate. It can be either retroperitoneal, causing biloma, or intraperitoneal leading to biliary peritonitis. Duodenal perforation into the retroperitoneum presents itself as a non-specific condition. It requires an extremely high index of suspicion for its early diagnosis. A delayed diagnosis seriously aggravates the prognosis. We report a case of mortality secondary to a duodenal perforation into retroperitoneum by a biliary stent endoscopically placed with an atypical symptomatology.A migração de próteses biliares colocadas endoscopicamente é uma conhecida complicação associada à colangiopancreatografia retrógrada endoscópica. Embora rara, a perfuração duodenal por próteses biliares é uma complicação grave associada a elevada mortalidade. Esta pode ocorrer para o retroperitoneu, causando um biloma, ou intra-peritonealmente causando uma peritonite biliar. A perfuração duodenal para o retroperitoneum apresenta-se de forma inespecífica e requer um elevado índice de suspeição para o seu diagnóstico precoce, uma vez que o diagnóstico tardio agrava o prognóstico. Descrevemos um caso de mortalidade secundário a perfuração duodenal por uma prótese biliar colocada endoscopicamente, cuja forma de apresentação foi atípica

Diagnostic accuracy of C-reactive protein and procalcitonin in the early detection of infection after elective colorectal surgery - a pilot study

Publisher Copyright: © 2014 Silvestre et al.; licensee BioMed Central Ltd.Background: Colorectal surgery is associated with postoperative infectious complications in up to 40% of cases, but the diagnosis of these complications is frequently misleading, delaying its resolution. Several biomarkers have been shown to be useful in infection diagnosis.Methods: We conducted a single-centre, prospective, observational study segregating patients submitted to elective colorectal surgery with primary anastomosis, CRP and PCT were measured daily. We compared infected and non-infected patients. Results: From October 2009 to June 2011, a total of 50 patients were included. Twenty-one patients developed infection. PCT and CRP before surgery were equally low in patients with or without postoperative infectious complications. After surgery, both PCT and CRP increased markedly. CRP time-course from the day of surgery onwards was significantly different in infected and non-infected patients (P = 0.001) whereas, PCT time-course was almost parallel in both groups (P = 0.866). Multiple comparisons between infected and non-infected patients from 5 th to 9 th postoperative days (POD) were performed and CRP concentration was significantly different (P 5.0 mg/dl at the D6 was predictive of infection with a sensitivity of 85% and a specificity of 62% (positive likelihood ratio 2.2, negative likelihood ratio 0.2). Conclusions: After a major elective surgical insult both CRP and PCT serum levels increased independently of the presence of infection. Besides serum CRP time-course showed to be useful in the early detection of an infectious complication whereas PCT was unhelpful.publishersversionpublishe

The age of the Côa valley (Portugal) rock-art: validation of archaeological dating to the Palaeolithic and refutation of ‘scientific’ dating to historic or proto-historic times

The dating studies of the 'modern rock-art scientists', when critically examined, are found not to show that the Coa valley petroglyphs are of recent age, Their Upper Palaeolithic characteristics, and therefore their likely late Pleistocene age, are consistent with their archaeological context.</p