RESUMO
Elemental mercury ingestion caused by folk practices is rare and usually harmless. Nevertheless, some complications related to mercury ingestion have been reported such as appendicitis related to mercury sequestration and poisoning leading to systemic toxicity. Patients usually present with nausea, vomiting, and abdominal tenderness. Mercury sequestration in the appendix depends on its anatomy and mercury physical properties, both of which may lead to appendicitis, resulting in subsequent peritonitis leading to multiple and severe surgical complications. A 26-year-old Peruvian man complaining of vomiting and abdominal pain after ingestion of elemental mercury as part of a folk practice presented to the emergency department. Physical exam was remarkable for rigid abdomen and diffuse rebound sign. A clinical diagnosis of peritonitis was made. The patient was taken to the operating room where an open appendectomy and peritoneal lavage were performed. On gross inspection, a silver foreign body within the perforated appendix was seen by the surgical team. The patient developed multiple surgical complications leading to multiple organ failure and death. Clinicians should be aware that mercury ingestion is usually benign. However, severe complications may develop. Early surgical and medical intervention should be initiated promptly to achieve better outcomes. We present the first case of peritonitis due to appendicitis related to mercury sequestration in the appendix.
RESUMO
The nervous system (NS) has a limited self-repair capability and adult neurogenesis is limited to certain regions of the brain. This generates a great interest in using stem cells to repair the NS. Previous reports have shown the differentiation of adipose tissue-derived mesenchymal stem cells (ASCs) in neuron-like cells when cultures are enriched with growth factors participating in embryonic and adult neurogenesis. Therefore, it could be thought that there exists a functional parallelism between neurogenesis and neuronal differentiation of ASCs. For this reason, the goal of this work was to study the differential gene expression of Shh and BMP genetic pathways involved in cell fate determination and proliferation. In this study we demonstrated that hASCs are endowed with active Hedgehog and BMP signaling pathways through the expression of genes of both cascades and that their expressions are downregulated after neuronal induction. This idea is in accordance with the facts that Shh and BMP signaling is involved in the maintenance of cells with stem cells properties and that proliferation decreases during the process of differentiation. Furthermore, Noggin expression was detected in induced hASCs whereas there was no expression in noninduced cells, which indicates that these cells are probably adopting a neuronal fate because noggin diverts neural stem cells from glial to neuronal fate. We also detected FM1-43 and synaptophisin staining, which is evidence of the presence of putative functional presynaptic terminals, a neuron-specific property. These results could partially contribute to the elucidation of the molecular mechanisms involved in neuronal differentiation of adult human nonneural tissues.
Assuntos
Tecido Adiposo/citologia , Proteínas Morfogenéticas Ósseas/genética , Transdiferenciação Celular/fisiologia , Regulação da Expressão Gênica/fisiologia , Proteínas Hedgehog/genética , Células-Tronco Mesenquimais/citologia , Neurônios/citologia , Tecido Adiposo/metabolismo , Adulto , Linhagem da Célula , Células Cultivadas , Endocitose/fisiologia , Feminino , Humanos , Técnicas Imunoenzimáticas , Técnicas In Vitro , Células-Tronco Mesenquimais/metabolismo , Pessoa de Meia-Idade , Neurônios/metabolismo , RNA Mensageiro/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transdução de Sinais/fisiologia , Vesículas Sinápticas/metabolismoAssuntos
Neoplasias Ósseas , Cistadenocarcinoma Seroso , Neoplasias Hepáticas , Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/patologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Ósseas/secundário , Neoplasias Ósseas/patologia , Cistadenocarcinoma Seroso/patologia , Feminino , Pessoa de Meia-IdadeAssuntos
COVID-19 , Doenças do Nervo Hipoglosso , Humanos , COVID-19/complicações , Pronação , SíndromeRESUMO
Objetivo: Realizar la recopilación de la información más relevante descrita en diversos artículos científicos acerca del vólvulo de sigmoides, e integrarla para la puesta al día del cirujano. Materiales y métodos: Se realiza una estrategia de búsqueda para el desarrollo de la revisión, haciendo uso de PubMed y Cochrane Library. Resultados: La etiología del vólvulo de sigmoides es multifactorial, siendo el sigmoide redundante un factor predisponente. La incidencia más alta se da entre los 40 a 80 años. Es más común en hombres. En casi el 100 % de pacientes, el dolor abdominal es el síntoma principal, asociado a distención abdominal y dificultad para eliminar flatos. La radiografía simple de abdomen es diagnóstica en el 57% - 90% de pacientes. La detorsión endoscópica flexible es la principal opción de tratamiento, con tasas de éxito del 33% al 91%. La cirugía de emergencia se reserva para los casos complicados. Conclusiones: El vólvulo de sigmoides, es la rotación del sigmoide alrededor de sí mismo y su mesenterio. Los síntomas principales son dolor abdominal, distensión y dificultad para eliminar flatos. Los exámenes auxiliares incluyen la radiografía simple de abdomen, la tomografía y la resonancia. La endoscopia muestra un giro espiral de la mucosa en forma de esfínter. Se debe realizar unidad clínica, radiológica, endoscópica y, a veces, quirúrgica, para su diagnóstico. La devolvulación endoscópica se sugiere como principal opción terapeutica. La cirugía de emergencia se reserva para casos complicados. Esta patología aun presenta una elevada morbimortalidad. (AU)
Objective: To compile the most relevant information described in various scientific articles about the sigmoid volvulus, and integrate it for the surgeon's update. Materials and methods: A search strategy was developed for the development of the review, using PubMed and the Cochrane Library. Results: The etiology of the sigmoid volvulus is multifactorial, being the redundant sigmoid a predisposing factor. The highest incidence occurs between 40 to 80 years. It is more common in men. In almost 100% of patients, abdominal pain is the main symptom, associated with abdominal distension and difficulty in eliminating flatus. Plain radiography of the abdomen is diagnostic in 57% - 90% of patients. Flexible endoscopic detortion is the main treatment option, with success rates of 33% to 91%. Emergency surgery is reserved for complicated cases. Conclusions: The sigmoid volvulus is the rotation of the sigmoid around itself and its mesentery. The main symptoms are abdominal pain, distension and difficulty to eliminate flatus. Auxiliary exams include plain abdominal radiography, tomography and MRI. The endoscopy shows a spiral twist of the mucosa in the form of a sphincter. A clinical, radiological, endoscopic and, sometimes, surgical unit must be performed for its diagnosis. Endoscopic devolvulation is suggested as the main therapeutic option. Emergency surgery is reserved for complicated cases. This pathology still presents a high morbidity and mortality. (AU)
Assuntos
Humanos , Masculino , Feminino , Colo Sigmoide , Volvo Intestinal , Obstrução IntestinalRESUMO
Since numerous diseases affect the central nervous system and it has limited self-repair capability, a great interest in using stem cells as an alternative cell source is generated. Previous reports have shown the differentiation of adipose-derived stem cells in neuron-like cells and it has also been proved that the expression pattern of patterning, proneural, and neural factors, such as Pax6, Mash1, Ngn2, NeuroD1, Tbr2 and Tbr1, regulates and defines adult neurogenesis. Regarding this, we hypothesize that a functional parallelism between adult neurogenesis and neuronal differentiation of human adipose-derived stem cells exists. In this study we differentiate human adipose-derived stem cells into neuron-like cells and analyze the expression pattern of different patterning, proneural, neural and neurotransmitter genes, before and after neuronal differentiation. The neuron-like cells expressed neuronal markers, patterning and proneural factors characteristics of intermediate stages of neuronal differentiation. Thus we demonstrated that it is possible to differentiate adipose-derived stem cells in vitro into immature neuron-like cells and that this process is regulated in a similar way to adult neurogenesis. This may contribute to elucidate molecular mechanisms involved in neuronal differentiation of adult human non-neural cells, in aid of the development of potential therapeutic tools for diseases of the nervous system.
Assuntos
Tecido Adiposo/citologia , Diferenciação Celular , Marcadores Genéticos , Neurônios/citologia , Transdução de Sinais , Células-Tronco/citologia , Fatores de Transcrição/metabolismo , Sequência de Bases , Western Blotting , Primers do DNA , Humanos , Imuno-Histoquímica , Reação em Cadeia da Polimerase em Tempo RealRESUMO
Since the nervous system has limited self-repair capability, a great interest in using stem cells is generated to repair it. The adipose tissue is an abundant source of stem cells and previous reports have shown the differentiation of them in neuron-like cells when cultures are enriched with growth factors involved in neurogenesis. Regarding this, it could be thought that a functional parallelism between neurogenesis and neuronal differentiation of human adipose stem cells (hASCs) exists. For this reason, we investigated the putative involvement of Notch and Wnt pathways in neuronal differentiation of hASCs through real-time PCR. We found that both Wnt and Notch signaling are present in proliferating hASCs and that both cascades are downregulated when cells are differentiated to a neuronal phenotype. These results are in concordance with previous works where it was found that both pathways are involved in the maintenance of the proliferative state of stem cells, probably through inhibition of the expression of cell-fate-specific genes. These results could support the notion that hASCs differentiation into neuron-like cells represents a regulated process analogous to what occurs during neuronal differentiation of NSCs and could partially contribute to elucidate the molecular mechanisms involved in neuronal differentiation of adult human nonneural tissues.
Assuntos
Tecido Adiposo/citologia , Diferenciação Celular/fisiologia , Neurônios/fisiologia , Receptores Notch/metabolismo , Transdução de Sinais/fisiologia , Células-Tronco/fisiologia , Proteínas Wnt/metabolismo , Adulto , Animais , Humanos , Pessoa de Meia-Idade , Neurônios/citologia , Receptores Notch/genética , Células-Tronco/citologia , Transcrição Gênica , Proteínas Wnt/genéticaRESUMO
Los hemofílicos pueden desarrollar inhibidores neutralizantes (a-VIII) y/o inhibidores lúpicos (IL). Durante 1993-1994, evaluamos 170 hemofílicos. Aquellos cuyo tiempo de tromboplastina parcial activado (TTPA) no corregía con plasma normal fueron reestudiados. En 43 pacientes (25 por ciento) se confirmó el inhibidor, realizándose a continuación: TTPA de la mezcla (1:1) luego de 1 h de incubación a 37§C; prueba con veneno de víbora Russell diluido (dRVVT), corrección (1:1) con normal y neutralización con plaquetas. El IL fue asignado en base a los resultados del dRVVT y el a-VIII al detectarse efecto neutralizante contra VIII e IL negativo. Siete (16 por ciento) pacientes presentaron a-VIII e IL (-) (A). Los 36 (84 por ciento) restantes fueron IL (+); el efecto inhibitorio potenció con la incubación en 12 (B), fue leve en 6 (C) y negativo en 18 (D). Los antecedentes de a-VIII fueron positivos en A:6/6, B:9/11, C:1/6 y D:9/17. La prevalencia de a-VIII fue bajo (4 por ciento) y alto (50 por ciento) el porcentaje de IL tiempo dependiente. Estos resultados sugieren la coexistencia de a-VIII con IL, o su desaparición. Se hace pues necesario el desarrollo de pruebas específicas que permitan identificar a-VIII en presencia de IL.
Assuntos
Humanos , Masculino , Fator VIII/imunologia , Hemofilia A , Inibidor de Coagulação do Lúpus , Fosfolipídeos , Tempo de Tromboplastina Parcial , Plasma , Tempo de ProtrombinaRESUMO
El objetivo del presente trabajo fue comparar dos métodos colorimétricos comerciales, realizados en forma manual, para la determinación de hierro sérico; uno (el método comparativo) utiliza betafenantrolina como reactivo de color y otro (el método en comparación), usa ferrozine para el mismo propósito. Se procesaron 64 sueros de diferentes pacientes, siguiendo las recomendaciones para validación de métodos dadas por el National Committee for Clinical Laboratory Standards. Las concentraciones cubrieron todo el rango de interés clínico (rango 0,63-38,31 µmol/l / 3,5-214 µg por ciento), y representaron el espectro de valores esperados en la aplicación clínica de rutina. Los métodos demostraron buena correlación (r = 0,96 p<0,0001). Se observó un buen acuerdo entre ambos obteniéndose, a partir del gráfico de Bland-Altman, en el rango de concentración de hierro útil para propósitos de diagnóstico clínico (0,63-10,74 µmol/L) una desviación relativa del 11,21 por ciento. A partir de este análisis se concluyó que las diferencias entre los dos métodos son aceptables y que ambos podrían intercambiarse, remarcándose importantes ventajas de índole práctica que tiene el método en comparación tales como utilización de menor volumen de muestra y menor tiempo de reacción