Animals with CCl4-induced cirrhosis and food restriction have shown alterations in spermatogenic cycle that were not seen in rats without CCl4-induced cirrhosis and food restriction.

No abstract

Ventriculo-peritoneal shunt (VPS) is one of the most commonly used procedures in the treatment of hydrocephalus. Nevertheless, even being technically simple and well-known, there are several serious complications that can happen, and among them is bowel perforation. This complication is rare, especially in adults, and it usually happens within the first year after the surgical procedure. It can also be aggravated by both infections, in the central nervous system or systemic, and also by increase in the intracranial pressure, due to shunt system dysfunction. The symptoms are usually mild, what can make the diagnosis challenging, and demanding several complementary tests. Also, there are many questions about the pathophysiology and predisposing factors for this complication. Due to its low incidence, and because it is usually described through case reports and small series, there is no consensus regarding its ideal management. The treatment varies from less invasive approaches, preserving the shuntcomponents in place, until the full withdrawn of the whole system and use of wide spectrum antibiotics. We report a delayed case of bowel perforation and catheter extrusion through the anus in an adult patient, discussing the data available about this pathology.

Perioperative mortality following pancreaticoduodenectomy has improved over time and is lower than 5% in selected high-volume centers. Based on several large literature series on pancreaticoduodenectomy from high-volume centers, some defend that high annual volumes are necessary for good outcomes after pancreaticoduodenectomy. We report here the outcomes of a low annual volume pancreaticoduodenectomy series after incorporating technical expertise from a high-volume center. We included all patients who underwent pancreaticoduodenectomy performed by a single surgeon (ADC.) as treatment for periampullary malignancies from 1981 to 2005. Outcomes of this series were compared to those of 3 high-volume literature series. Additionally, outcomes for first 10 cases in the present series were compared to those of all 37 remaining cases in this series. A total of 47 pancreaticoduodenectomies were performed over a 25-year period. Overall in-hospital mortality was 2 cases (4.3%), and morbidity occurred in 23 patients (48.9%). Both mortality and morbidity were similar to those of each of the three high-volume center comparison series. Comparison of the outcomes for the first 10 to the remaining 37 cases in this series revealed that the latter 37 cases had inferior mortality (20% versus 0%; P = 0.042), less tumor-positive margins (50 versus 13.5%; P = 0.024), less use of intraoperative blood transfusions (90% versus 32.4%; P = 0.003), and tendency to a shorter length of in-hospital stay (20 versus 15.8 days; P = 0.053). Accumulation of surgical experience and incorporation of expertise from high-volume centers may enable achieving satisfactory outcomes after pancreaticoduodenectomy in low-volume settings whenever referral to a high-volume center is limited.