RESUMEN
Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient.
Asunto(s)
Hiponatremia/diagnóstico , Hiponatremia/terapia , Algoritmos , Enfermedad Crítica , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: Ewing's family of tumors (EFT) comprises a broad spectrum of tumors composed of primitive committed cells with neuroectodermal capacity. The degree of neural differentiation within EFT, as measured with morphological features and expression of neural markers, delimits two members: Ewing's sarcoma (ES) and peripheral primitive neuroectodermal tumor (pPNET). Molecules such as c-kit and its ligand (Stem cell factor, SCF), CD95 (FAS), CD95L (FASL), IGF-IR, protect EFT cells from apoptosis, whereas c-erb-B2, erythropoietin (EPO) and its receptor (EPO-R) participate in the maturation of primitive committed neuroectodermal cells and in the normal embryonal brain development. The aim of the present study was to analyse the expression of these molecules in paraffin-embedded material from a series of EFT. MATERIALS AND METHODS: Forty-five cases of EFT (23 typical ES, 4 atypical and 18 pPNET) were analysed following the immunohistochemical LSAB method, with antigen retrieval heating using an autoclave, citrate buffer pH 6.0 and the following primary antibodies: FAS (APO-CD 95), FAS-L, c-kit, SCF, IGF-IR and c-erbB2. The expression was evaluated independently by three of the authors and the final score (0 to 3+) was based on the intensity and percentage of positively stained cells. In a second cooperative analysis, tissues from 30 cases of EFT (15 typical, 3 atypical and 12 PNET) were immunostained with EPO and EPO-R. RESULTS: High expression of c-kit/SCF (2+, 3+) was detected in 28/45 cases of EFT (62.2%), whereas FAS-FAS-L and IGF-IR were observed in 16/45 (37.7%) and 9/45 (20%), respectively. Regarding the neuroectodermal pathway, membranous and cytoplasmic expression of c-erb-B2 was observed in 9/45 (20%) EFT, regardless of the morphological and immunohistochemical expression of conventional neural markers. High expression of EPO and EPO-R was observed in 20/30 EFT (66.6%). CONCLUSION: C-kit/SCF and EPO/EPO-R seem to participate in the pathway of anti-apoptotic and proliferative advantage, while c-erb-B2 does not play an important role in the neuroectodermal differentiation pathway in EFT cells.
Asunto(s)
Biomarcadores de Tumor/biosíntesis , Neoplasias Óseas/metabolismo , Sarcoma de Ewing/metabolismo , Neoplasias Óseas/patología , Proteína Ligando Fas/biosíntesis , Humanos , Inmunofenotipificación , Proteínas Proto-Oncogénicas c-kit/biosíntesis , Receptor ErbB-2/biosíntesis , Receptor IGF Tipo 1/biosíntesis , Sarcoma de Ewing/patología , Receptor fas/biosíntesisRESUMEN
We describe the development of sandwich enzyme-linked immunosorbent assays designed to measure native and glycated apolipoprotein B containing particles in plasma. The assays utilize monoclonal antibodies anti native or glycated apo B-LDL for coating and a polyclonal anti apoB-LDL-peroxidase conjugate as the detecting antibody. The method is specific, sensitive and precise. The intra assay coefficient of variation for the plasma native and glycated apolipoprotein B-containing particles was determine to be 7.8% and 7.5%, respectively. The method described can provide specific and reproducible determinations of apoB and glycated-apoB containing particles in plasma; it will be of great interest in the evaluation of atherosclerotic risk in dyslipoproteinemic states in diabetic and non-diabetic subjects.
Asunto(s)
Apolipoproteínas B/sangre , Ensayo de Inmunoadsorción Enzimática/métodos , Anticuerpos Monoclonales , Glicosilación , Humanos , Reproducibilidad de los ResultadosRESUMEN
We report a patient suffering from mitral insufficiency after isolated rupture a papillary muscle as a result of a car accident with blunt chest trauma. The diagnosis is often difficult due to related multiple lesions which vary the clinical picture. Physical exploration, electrocardiogram, enzymatic and nuclear scan lack adequate sensitivity and specificity. Echocardiography appears to be the most reliable noninvasive diagnostic method now available.
Asunto(s)
Rotura Cardíaca/complicaciones , Insuficiencia de la Válvula Mitral/etiología , Músculos Papilares/lesiones , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicaciones , Adulto , Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Rotura Cardíaca/diagnóstico por imagen , Humanos , Masculino , Insuficiencia de la Válvula Mitral/diagnóstico por imagenRESUMEN
La hiponatremia es el trastorno electrolítico más prevalente en las Unidades de Cuidados Intensivos. Se asocia a un aumento de la morbilidad, mortalidad y estancia hospitalaria. La mayoría de los estudios publicados hasta el momento son observacionales, retrospectivos y no incluyen pacientes críticos, lo que dificulta la extracción de conclusiones sólidas. Además, debido a la escasa evidencia científica de calidad, incluso las recomendaciones realizadas por distintas sociedades científicas recientemente publicadas difieren en aspectos importantes como son el diagnóstico o el tratamiento de la hiponatremia. Los mecanismos etiopatogénicos en los pacientes críticos suelen ser complejos. Sin embargo, hay que profundizar en ellos para llegar al diagnóstico más probable y a la pauta de tratamiento más adecuada. Todo ello, ha motivado la realización de esta revisión práctica sobre aspectos útiles en el abordaje de la hiponatremia en las Unidades de Cuidados intensivos, con el objetivo de homogeneizar el manejo de esta entidad y disponer de un algoritmo diagnóstico a nivel nacional
Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient