Visceral leishmaniasis (VL), also known as Kala-azar, is a systemic infection caused by a protozoan (Leishmania) and, in its classic form, is a serious illness associated with malnutrition, anemia, hepatosplenomegaly, infectious processes and coagulopathies. The effect of splenectomy in patients with visceral leishmaniasis is not well defined; however, it is known that the spleen is the largest reservoir of infected cells belonging to the reticulo endothelial system. Therefore, the surgical procedure is an option for the debulking of parasites, providing a cure for refractory VL and minimizing the complications of hypersplenism.Keywords: Splenectomy. Leishmaniasis. Hypersplenism. RESUMOA leishmaniose visceral (LV) ou calazar é uma infecção sistêmica causada por um protozoário (Leishmania) e na sua forma clássica é uma doença grave. Cursa com desnutrição, anemia, hepatoesplenomegalia, processos infecciosos e coagulopatias. O papel da esplenectomia em pacientes com leishmaniose visceral não é bem definido; entretanto, sabe-se que o baço é o maior reservatório de células parasitadas do sistema reticulo endotelial e o procedimento cirúrgico é, dessa forma, uma opção para debulking de parasitas, propiciando a cura da LV refratária e minimizando as complicações do hiperesplenismo.Palavras-chaves: Esplenectomia. Leishmaniose. Hiperesplenismo.Visceral leishmaniasis (VL), also known as Kala-azar, is a systemic infection caused by a protozoan of the family Trypanosomatidae, genus Leishmania, which has two forms: a flagellated form or promastigote, found in the digestive tract of the insect vector, and a nonflagellated form or amastigote, which is an obligate intracellular form that is found in the cells of the mononuclear phagocytic system of the vertebrate host. The primary vector is Lutzomyia, for which the dog is the reservoir and humans are the final host. Visceral leishmaniasis is one of the six most important endemic diseases in the world, given its incidence and high mortality rates in untreated individuals, malnourished children and HIV-positive individuals. The disease exists in all continents except Australia and Antarctica 1 . Visceral leishmaniasis has been documented in all regions of Brazil except the southern region. The disease occurs in rural and urban areas of Cities such as Rio de Janeiro/RJ, Belo Horizonte/ MG, Araçatuba/SP, and Corumbá/MS. Currently in Brazil, VL is registered in 19 of 27 states 2 . The classic symptoms consist of fever, sweating, adynamia, hepatosplenomegaly, malnutrition, cough, diarrhea, abdominal pain and distention, edema and ascites 3 . The diagnosis is based on the presence of the parasite in the bone marrow, spleen, liver, or lymph nodes. Several tests have been developed for the serologic diagnosis of VL, including molecular biology techniques 4 . Meglumine antimoniate remains the first-choice drug for treatment, and amphotericin B is the second-line drug used in cases of meglumine antimoniate resistance 5,6 . The effect of splenectomy on VL is unknown. The importance...

Bilioduodenal and biliojejunal anastomoses are effective for the treatment of biliary obstruction. The objective of this study was to compare the effects of these anastomoses on hepatobiliary excretion and enterobiliary reflux. Enterobiliary reflux and biliary excretion were evaluated respectively after oral administration of technetium ((99m)Tc) in combination with sodium phytate and intravenous infusion of (99m)Tc with diisopropyl-iminodiacetic acid. Enterobiliary reflux occurred to an equal degree in the bilioduodenal and biliojejunal groups. Maximum hepatic activity time (T(max)) and radiotracer clearance half-time (T(1/2)) were similar in both groups. However, when compared with that found for the sham-operated group, T(max), and T(1/2) were higher in the biliojejunal group (P = 0.02 and P = 0.01, respectively). Histopathological analysis showed marked reduction in ductal proliferation in both groups. These data undermine the theoretical advantages attributed to biliojejunal anastomosis and further the understanding of the pathophysiology of cholangitis that occurs even with patent anastomosis.

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Brazil. Conception, design and responsible for the surgical procedures. lll MD, Graduate Student, UFTM, Uberaba-MG, Brazil. Involved in the design, collect of data and helped to draft the manuscript. ABsTRACTPuRPOsE: To evaluate the prevalence of testicular microlithiasis among pediatric patients with inguinoscrotal affections. METHOds:Between January 2005 and January 2010, we evaluated, prospectively 1504 children ranging from 1 to 15 years with inguinoscrotal affections with a high-frequency ultrasound system, which employs a 10-MHz transducer. REsuLTs: Testicular microlithiasis was identified in 20 testes of eleven children (0.71% of 1504 patients evaluated), through an ultrasound scan. Testicular microlithiasis was found in 5 children with cryptorchidism (3.93% of 127 patients), 4 children with retractile testes (14.8% of 27 patients), 1 child with a hypotrophic testis (100% of 1 patient), and 1 child with inguinal hernia (0.07% of 1349 patients). The children with testicular microlithiasis were submitted to annual physical examinations and ultrasound evaluations.CONCLusIONs: Testicular microlithiasis was a rare condition and occurred in 0.7% of the subjects studied. The association with cryptorchidism, retractile and hypotrophic testis was significant.

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PURPOSE: To assess the effects of Roux-en-Y jejunal limb length on gastric emptying and enterogastric reflux. METHODS: Seventy male Wistar rats were submitted to antrectomy with Roux-en-Y reconstruction and then were divided into two groups of 35 animals. Group A, short limb (7.5 cm) and Group B, standard limb (15 cm). Group A and B were subdivided into five subgroups each in order to study enterogastric reflux at 30 and 60 minutes and to evaluate gastric emptying at 5, 10 and 15 minutes. In order to measure gastric emptying and enterogastric reflux, radiotracers 99m Tc-Phytate and 99m Tc-DISIDA were respectively used. RESULTS: For gastric emptying, the radiotracer concentration was lower in Group A than in Group B after five minutes. The enterogastric reflux was present, but there were no significant differences between enterogastric reflux indexes concerning both A and B Groups. CONCLUSION: A standard Roux limb, besides being unable to protect the stomach from the enterogastric reflux, may become a functional barrier for gastric emptying.

The results demonstrated that surgical biliary decompression in obstructive jaundice is followed by alterations related to hepatic ischemia- reperfusion.

Objetivo: Analisar os sinais, sintomas e os valores do hemograma inicial de crianças que tiveram posteriormente o diagnóstico definitivo, por meio do mielograma, de leucemia. Métodos: Foram avaliados prontuários de 31 indivíduos, de ambos os sexos, idade inferior a 18 anos, com diagnóstico de leucemia linfoide e mieloide no serviço de Oncologia de um hospital em uma Cidade do Estado de São Paulo. Foram avaliadas as frequências absolutas e relativas, média, desvio padrão, valores mínimos, máximos e mediana. O estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados: Considerando as variáveis dos hemogramas dos pacientes analisados, observa-se que 80,64% apresentavam anemia no momento do diagnóstico, cerca de 61,29% cursavam com leucocitose e outros 16,13% com leucopenia, já linfocitose estava presente em 67,74% das crianças. Em 25,80% dos pacientes encontrou-se bastonetes aumentados e 58,06% linfócitos atípicos, além disso, foram encontrados 54,83% de blastos nos hemogramas e 83,87% de plaquetopenia. Conclusão: O hemograma demostrou ser um instrumento complementar valioso que associado ao quadro clínico e à perspicácia do médico, pode contribuir para diagnosticar a doença em estágios iniciais, proporcionando tratamento precoce e melhora do prognóstico.