Pulmonary artery sling: a rare cause of stridor and respiratory distress

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Urgent capsule endoscopy is useful in severe obscure-overt gastrointestinal bleeding

AIM: With capsule endoscopy (CE) it is possible to examine the entire small bowel. The present study assessed the diagnostic yield of CE in severe obscure-overt gastrointestinal bleeding (OOGIB). METHODS: During a 3-year period, 15 capsule examinations (4.5% of all CE in a single institution) were carried out in 15 patients (11 men; mean age 69.9 +/- 20.1 years) with severe ongoing bleeding, defined as persistent melena and/or hematochezia, with hemodynamic instability and the need for significant red blood cell transfusion. CE was carried out after non-diagnostic standard upper and lower endoscopy. The mean time from admission until CE was 4.1 +/- 4.4 days (0-15 days). RESULTS: CE revealed active bleeding in seven patients and signs of recent bleeding in four. Etiology of bleeding was correctly diagnosed in 11 patients (73.3%) (portal hypertension enteropathy, three patients; subepithelial ulcerated lesion, two patients; angiodysplasia, two patients; jejunal ulcer with visible vessel, one patient; multiple small bowel ulcers, one patient; jejunal tumor, one patient; jejunal mucosa irregularity with adherent clot, one patient). One patient (6.7%) had active bleeding but no visible lesion. As a consequence of the capsule findings, specific therapeutic measures were undertaken in 11 patients (73.3%) with five managed conservatively, four endoscopically and two surgically. Two patients experienced bleeding recurrence. One of them, with a probable small bowel tumor, refused any other interventions. CONCLUSIONS: CE is useful in patients with severe OOGIB by providing positive findings in the majority of patients, with subsequent impact on therapeutic procedures

Allergic conjunctivitis and conjunctival provocation tests in atopic dogs.

INTRODUCTION: Canine atopic dermatitis (cAD) is a very common disease, but little is known about eye involvement. The conjunctival provocation test (CPT) is used in human to study the ocular response to allergenic stimuli and to evaluate anti-allergic therapy. To our knowledge it has not been used in dogs. OBJECTIVES: To evaluate the prevalence of ocular signs in a population of atopic dogs and relate these with clinical cAD scores; and the usefulness of CPT for dust mites in atopic dogs with itchy eyes. PROCEDURES: Sixty cAD patients were evaluated for (i) ocular signs of allergic conjunctivitis including conjunctival hyperemia, chemosis, epiphora, ocular discharge, pruritus and corneal involvement, graded 0 to 3 according to severity, and (2) cAD Extent and Severity Index (CADESI-03). Additionally, CPTs for Dermatophagoides farinae (n = 12) and Dermatophagoides pteronyssinus (n = 12) were performed in sensitized atopic dogs and 24 control dogs. RESULTS: Periocular and ocular signs of allergy were present in 60% (36/60) of cases. Conjunctival hyperemia (90%) was the most common sign. Severity of ocular signs was significantly correlated with eye pruritus (r(s)  = 0.690, P = <0.001) and skin lesions score for head region (r(s) = 0.261, P = 0.04). A highly significant difference (P < 0.001, Fisher test) was found in CPTs between the test and the control groups. CONCLUSION:  Allergic conjunctivitis signs associated with cAD seem under valuated so these patients would benefit from an ophthalmologic evaluation. Furthermore, we found CPT to be a reliable, easy to perform and safe test for the etiologic diagnosis of allergic conjunctivitis in the dog

Effect of portal hypertension in the small bowel: an endoscopic approach

BACKGROUND AND AIM: The effects of portal hypertension in the small bowel are largely unknown. The aim of the study was to prospectively assess portal hypertension manifestations in the small bowel. METHODS: We compared, by performing enteroscopy with capsule endoscopy, the endoscopic findings of 36 patients with portal hypertension, 25 cirrhotic and 11 non-cirrhotic, with 30 controls. RESULTS: Varices, defined as distended, tortuous, or saccular veins, and areas of mucosa with a reticulate pattern were significantly more frequent in patients with PTH. These two findings were detected in 26 of the 66 patients (39%), 25 from the group with PTH (69%) and one from the control group (3%) (P < 0.0001). Among the 25 patients with PTH exhibiting these patterns, 17 were cirrhotic and 8 were non-cirrhotic (P = 0.551). The presence of these endoscopic changes was not related to age, gender, presence of cirrhosis, esophageal or gastric varices, portal hypertensive gastropathy, portal hypertensive colopathy, prior esophageal endoscopic treatment, current administration of beta-blockers, or Child-Pugh Class C. More patients with these endoscopic patterns had a previous history of acute digestive bleeding (72% vs. 36%) (P = 0.05). Active bleeding was found in two patients (5.5%). CONCLUSIONS: The presence of varices or areas of mucosa with a reticulate pattern are manifestations of portal hypertension in the small bowel, found in both cirrhotic and non-cirrhotic patients. The clinical implications of these findings, as regards digestive bleeding, are uncertain, although we documented acute bleeding from the small bowel in two patients (5.5%)

Comunidade zooplanctônica de seis reservatórios no nordeste do Brasil

The aim of the present study was to investigate the zooplankton community at six reservoirs in the state of Pernambuco (Brazil). Zooplankton assemblages were identified using current literature and quantitatively analysed under a microscope and stereomicroscope. Concurrently to the sampling of zooplanktonic and phytoplanktonic communities, in situ measurements of abiotic variables, such as water temperature, dissolved oxygen and pH, were determined using field probes and transparency was determined with a Secchi disk. Total phosphorus concentrations were used for the determination of the Trophic State Index. The reservoirs were classified between eutrophic and hypertrophic, oxygenated, with pH varying from slightly acid to alkaline, high temperatures and low water transparency. A total of 27 zooplankton taxa were identified. Phytoplankton was represented by Cyanophyta, Chlorophyta, Baccilariophyta and phytoflagellates. The highest richness of species was observed for Rotifera (17), followed by Crustacea (8), Protozoa (1) and Insecta (1). Rotifers shared quantitative importance with Crustacea, which were mainly represented by juvenile forms. Jazigo Reservoir presented the highest diversity and equitability. Lowest diversity and equitability were recorded at the Poço da Cruz and Mundaú reservoirs, respectively. Dissimilarity was detected between the environments studied regarding zooplankton composition and structure.O objetivo deste trabalho foi estudar a estrutura e dinâmica do zooplâncton em seis reservatórios do Estado de Pernambuco. A comunidade zooplanctônica foi identificada com literatura atualizada e a densidade analisada sob microscópio e estereomicroscópio. Concomitantemente às coletas das comunidades zooplanctônicas e fitoplanctônicas, foram medidas in situ algumas variáveis abióticas como temperaturas da água e do ar, oxigênio dissolvido, condutividade elétrica, pH, turbidez, usando sondas de campo, transparência com disco de Secchi. As concentrações de fósforo total foram usadas para a determinação do Índice de Estado Trófico. Os reservatórios foram classificados entre eutróficos e hipertróficos, oxigenados, pH levemente ácido a alcalino, temperaturas altas e baixos valores de transparência da água. O zooplâncton esteve composto por 27 táxons. O fitoplâncton foi representado pelas Cyanophyta, Chlorophyta, Baccilariophyta e Fitoflagelados. A maior riqueza de espécies foi observada para Rotifera, (17), seguida por Crustacea (8), Protozoa (1) e Insecta (1). Rotifera compartilhou a importância quantitativa com os Crustacea, estes representados principalmente pelas formas jovens. No reservatório de Jazigo, foram obtidos os maiores valores para diversidade e equitabilidade. Os valores mais baixos foram registrados em Poço da Cruz e Mundaú, respectivamente. Foi detectada dissimilaridade entre os ambientes estudados quanto à composição e estrutura do zooplâncton

Small bowel pseudomelanosis and oral iron therapy

Small bowel pseudomelanosis is a rarely reported clinical entity characterized by brown pigmentation of small bowel mucosa. The authors describe two cases, both with iron deficiency anemia, one of an 81-year-old female patient submitted for capsule endoscopy that revealed a brown pigmentation of all small bowel mucosa and another of an 81-year-old male whose retrograde double-balloon enteroscopy revealed a diffuse brown pattern of small bowel mucosa. Ileal biopsies confirmed intense iron deposition in the macrophages of the lamina propria. Both patients were on oral iron therapy and the second one had a previous double-balloon enteroscopy, 2 years earlier, which revealed only ileal angiodysplasias. These two cases demonstrate the importance of two new endoscopic methods for diagnosis of small bowel pseudomelanosis, the rarity of such an entity and its close relation with oral iron therapy