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  • ISSN: 2373-9819
    Volume 9, Issue 3
    Case Report
    Gian Maria Pacifici*
    Enalapril maleate is a prodrug that is hydrolysed by esterase to produce enalaprilat which is a potent inhibitor of the angiotensin-converting enzyme. Enalapril maleate is administered orally, the oral bioavailability is about 60%, whereas enalaprilat is administered intravenously, and both drugs are eliminated by renal route. The initial oral dose of enalapril is 40 µg/kg once-daily in infants and in children the initial oral dose is 2.5 mg once-daily. Enalapril controls the heart disease, restores ventricle physiology, and lowers blood pressure in infants and children. Enalapril is effective for congestive heart failure, for the chronic heart failure, and reduces pulmonary resistance. The elimination half-life of enalapril is about 10 hours in infants aged < 20 days and about 3 hours in older infants and children. Enalapril interacts with felodipine, metformin, and rifampicin and the co-administration of enalapril with furosemide causes acute kidney injury. Enalapril treats severe heart failure, a dose of 0.01 mg/kg of enalapril has been recommended in preterm infants, and enalapril lowers the diastolic blood pressure. Enalapril crosses the human placenta in-vivo but a study performed with the perfusion of the placenta reveals that enalaprilat does not equilibrate between the maternal and foetal comportments and enalaprilat poorly migrates into the breast-milk. The aim of this study is the review the published data on the enalapril dosing, efficacy, safety, effects, pharmacokinetics, drug interaction and treatment in infants and children and the transfer across the human placenta and the migration into the breast-milk.
    Eduardo Crema*, Juverson Alves Terra-Júnior, Paulo Fernando Oliveira, Marisa de Carvalho Borges, Luciana Arantes Soares, and Alex Augusto Silva
    Background and aim: Choledocholithiasisis a prevalent complication in cholelithiasis and the laparoscopic treatment may be an alternative approach. Evaluate the results of the laparoscopic approach of choledocholithiasis in patients with cholelithiasis.
    Methods: A total of 290 patients with cholelithiasis associated with choledocholithiasis, including 191 women (65.86%), with a mean age of 58.4 years (21-80), were treated. A transcystic approach was used in 46 cases (15.86%) and longitudinal choledochotomy in 244 (84.14%). Conversion to open surgery was necessary in 26 cases (8.96%).
    Results: There was no case of death and the rate of early complications was 9.31% (27 cases). Thirteen patients (4.48%) had a biliary fistula demonstrated by cholangiography and all cases were treated clinically. Hyperamylasemia was detected in 11 cases (3.8%) and four patients (1.38%) had mild acute pancreatitis. All patients were treated clinically. Three cases (1.03%) developed choleperitoneum after removal of the bile duct catheter on postoperative day 21, and perforation of the posterior wall of the common bile duct was observed in one patient (0.34%). Late complications occurred in six cases (2.07%), including a residual stone in four (1.38%), which was treated by therapeutic endoscopy. Two cases (0.68%) developed bile duct stenosis; good resolution was observed in one after dilation and biliary stenting andrecurrence of stenosis occurred in the other case, which required a biliodigestive anastomosis consisting of interposition of a jejunal tube.
    Conclusions: The results showed that treatment of choledocholithiasis in a single procedure through laparoscopic bile duct clearance is safe, reproducible and associated with a low rate of complications, in addition to preserving sphincter functions of the duodenal papilla.
    Clinical Image
    Chien-Hsiang Tai and Ing-Kit Lee*
    An otherwise healthy 80-year-old female was a housewife but had habit of handling ginger. She presented to the hospital with pain, erythema, swelling, and pustules over right lower leg for 2 days (Figure A).
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