Recombinant Subunit Vaccine Candidate against the Bovine Viral Diarrhea Virus.

Multivalent live-attenuated or inactivated vaccines are often used to control the bovine viral diarrhea disease (BVD). Still, they retain inherent disadvantages and do not provide the expected protection. This study developed a new vaccine prototype, including the external segment of the E2 viral protein from five different subgenotypes selected after a massive screening. The E2 proteins of every subgenotype (1aE2, 1bE2, 1cE2, 1dE2, and 1eE2) were produced in mammalian cells and purified by IMAC. An equimolar mixture of E2 proteins formulated in an oil-in-water adjuvant made up the vaccine candidate, inducing a high humoral response at 50, 100, and 150 µg doses in sheep. A similar immune response was observed in bovines at 50 µg. The cellular response showed a significant increase in the transcript levels of relevant Th1 cytokines, while those corresponding to the Th2 cytokine IL-4 and the negative control were similar. High levels of neutralizing antibodies against the subgenotype BVDV1a demonstrated the effectiveness of our vaccine candidate, similar to that observed in the sera of animals vaccinated with the commercial vaccine. These results suggest that our vaccine prototype could become an effective recombinant vaccine against the BVD.

Chronic Cardiac Herniation: A Peculiar Diagnosis.

The presented case describes a 56-year-old male with adult-onset Still's disease, exhibiting polyserositis in 2019, who underwent pleurectomy and pericardiectomy. Despite treatment with tocilizumab and methylprednisolone, the patient developed deep vein thrombosis and pulmonary embolism in 2022, managed with apixaban. A contrast-enhanced chest tomography revealed no recurrent thromboembolic events. Over a year, the patient experienced progressive dyspnea, correlating with signs of constriction on transthoracic echocardiogram. Cardiac magnetic resonance imaging confirmed cardiac herniation, prompting pericardiectomy. Surgery led to complete resolution of anatomical alterations without heart failure or new abnormalities, although exertional dyspnea persists post-discharge. The pathophysiology of cardiac herniation involves complex mechanisms influenced by congenital or acquired factors, resulting in abnormal heart protrusion. Medical literature highlights varied presentations, with acute cases typically post-thoracic surgeries, while late-onset cases are less common. Imaging modalities like computed tomography (CT) and cardiac magnetic resonance (CMR) aid diagnosis, emphasizing interdisciplinary collaboration. Despite challenges posed by its rarity, timely diagnosis and treatment are crucial for favourable outcomes, demonstrating the importance of considering this entity in clinical practice.

Self-expanding Metal Stents in Malignant Obstruction of the Esophagus: A 25-Year Multicentric Study

Background: Self-expanding metal prostheses improve dysphagia in patients with incurable esophageal cancer (EC). New stents have been introduced, and chemoradiotherapy has been implemented for EC, changing patients' risk profiles. It is unknown whether this has affected palliation with stents. Patients and methods: Retrospective study in three centers in Medellín-Colombia; patients undergoing placement of palliative esophageal prostheses for malignant dysphagia (1997-2022). Major and minor complications after implantation, the influence of oncological therapies, and survival were evaluated for 1997-2009 (n = 289) and 2010-2022 (n = 318). Results: 607 patients underwent esophageal prostheses; 296 (48.8%) became complicated. It was higher in the second period (52.5% vs. 48.1%), as were major complications (20.8% vs. 14.2%, p = 0.033), with no differences in minor complications (33.9% vs 31.8%, p = 0.765). Also, 190 (31.3%) patients presented with recurrent dysphagia, stable in both periods. Migration increased over time (from 13.1% to 18.2%, p = 0.09). The most common minor adverse event was pain, increasing over time (from 24.9% to 33.95%, p < 0.01), and associated factors were chemoradiotherapy, absence of fistula, and squamous cell carcinoma. Acid reflux decreased in the second group (p = 0.038). Twelve percent of patients required another intervention for feeding. Survival was not impacted by time and use of stents. Conclusions: Stents are an alternative in non-surgical malignant dysphagia, although recurrent dysphagia has not decreased over time. Minor stent-related complications are increasing in association with the implementation of chemoradiotherapy.

Antecedentes: Las prótesis metálicas autoexpandibles mejoran la disfagia en pacientes con cáncer esofágico (CE) incurable. En las últimas décadas se han introducido nuevos tipos de stents y se ha implementado la quimiorradioterapia para el CE, generando cambios en los perfiles de riesgo de los pacientes. Se desconoce si estos cambios han afectado la paliación con stents. Pacientes y métodos: Estudio retrospectivo en tres centros de Medellín-Colombia; pacientes sometidos a colocación de prótesis esofágicas paliativas para disfagia maligna (1997-2022). Se evaluaron en dos períodos: 1997-2009 (n = 289) y 2010-2022 (n = 318), complicaciones mayores y menores después del implante, la influencia de las terapias oncológicas y la sobrevida. Resultados: Se evaluaron 607 pacientes sometidos a prótesis esofágicas. 296 (48,8%) se complicaron, y fue mayor en el segundo periodo (52,5% frente a 48,1%), al igual que las complicaciones mayores (20,8% frente a 14,2%, p = 0,033), sin diferencias en complicaciones menores (33,9% frente a 31,8%, p = 0,765). 190 (31,3%) pacientes presentaron disfagia recurrente, estable en ambos períodos. La migración aumentó con el tiempo (de 13,1% a 18,2%, p = 0,09). El evento adverso menor más frecuente fue dolor, que aumentó con el tiempo (de 24,9% a 33,95%, p < 0,01), y los factores asociados fueron quimiorradioterapia, ausencia de fístula y carcinoma de células escamosas. El reflujo ácido disminuyó en el segundo grupo (p = 0,038). El 12% de pacientes requirieron otra intervención para alimentarse. No se impactó la sobrevida con el tiempo y uso de stents. Conclusiones: Los stents son una alternativa en la disfagia maligna no quirúrgica, aunque la disfagia recurrente no ha disminuido con el tiempo. Las complicaciones menores relacionadas con el stent van en aumento, asociadas a la implementación de la quimiorradioterapia.

[Post-colonoscopy colorectal cancer: Evaluation of a cohort in its clinical and colonoscopic characteristics, survival and its causes according to the World Endoscopy Organization]. / Cáncer colorrectal post-colonoscopia: Evaluación de una cohorte en sus características clínicas, colonoscópicas, sobrevida y sus causas según la Organización Mundial de Endoscopia.

Post-colonoscopy colorectal cancer (PCCRC) is a tumor that appears after a normal colonoscopy before the established time for the endoscopic follow up. Its origin reflects the quality of the colonoscopy and the different tumoral biologics between the CRC and the CRCPC. Our aim is to describe the characteristics of the PCCRC in our region, to identify risk factors, to discriminate the potential causes according to the World Endoscopý Organization (WEO) and to determine its impact in the patient's survival. We studied patients with colorectal cancer (CRC) attended at the gastro-oncology clinic of two institutions of Medellin-Colombia, between January 2012 and December 2021 that had been submitted to a colonoscopy between 6-36 months before the colonoscopy in which the CRC was diagnosed. 919 patients during 10 years for CRC, 68 cases of PCCRC (6.9%); It was more frequent in older patients (74 vs. 66 years; p=0.03), with background of adenomatous polyps (36.8% vs. 20.1%; p=0.01) and in right colon (57.4% vs. 40.6%; p=0.006), with a tendency in patients with diverticulosis (41.2% vs. 31.3%; p=0.05) and diabetes (25% vs. 14%; p=0.06); less survival at 5 and 10 years (58% and 55.2% vs. 67% and 63%; p < 0.001). According to the WEO, the PCCRC presents in 61.3% because of abnormal findings omitted in inadequate colonoscopies, 29% in a suitable colonoscopy and 9.7% incomplete resections of adenomas. In conclusion, the rate of PCCRC was 6.9% with more propension in older patients, a background of polyp resection, and proximal colon. According to the WEO, the abnormal findings omitted more frequently were related with inadequate colonoscopies. The patients with PCCRC had less survival.

Cáncer colorrectal post-colonoscopia: Evaluación de una cohorte en sus características clínicas, colonoscópicas, sobrevida y sus causas según la Organización Mundial de Endoscopia

Cáncer colorrectal post-colonoscopia (CCRP) es el tumor que aparece posterior a una colonoscopia normal antes de cumplirse el tiempo establecido para seguimiento endoscópico. Origen multifactorial, refleja la calidad de la colonoscopia y las diferentes biologías tumorales entre los cánceres colorrectales detectados (CCRD) y el CCRP. Nuestro objetivo es describir las características del CCRP en nuestro medio, identificar factores de riesgo, discriminar sus causas según la Organización Mundial de Endoscopia (OME) y determinar el efecto en la sobrevida del paciente. El estudio se realizó en pacientes con cáncer-colorrectal (CCR) atendidos en consulta de gastro-oncología de dos instituciones en Medellín-Colombia, entre enero de 2012 y diciembre de 2021 que se habían sometido a una colonoscopia en los 6 a 36 meses anteriores a la colonoscopia en la que se diagnosticó el CCR. 919 pacientes durante 10 años por CCR, 68 casos de CCRP (6,9%), se encontró que se presenta con más frecuencia en pacientes mayores (74 vs. 66 años; p=0,03), con antecedentes de pólipos adenomatosos (36,8% vs. 20,1%; p=0,01) y en colon derecho (57,4% vs. 40,6%; p=0,006), con una tendencia en pacientes con diverticulosis (41,2% vs. 31,3%; p=0,05) y diabetes (25% vs. 14%; p=0,06); menor sobrevida a 5 y 10 años (58%-55,2% vs. 67%-63%; p<0,001). Según la OME, los CCRP se presentaron en 61,3% por lesiones omitidas en colonoscopias inadecuadas, 29% colonoscopias adecuadas y 9,7% resecciones incompletas de adenomas. En conclusión, la tasa de CCRP fue de 6,9%, con mayor propensión en pacientes de mayores, antecedente de resección de pólipos, y en colon derecho. Acorde a la OME, las lesiones omitidas más frecuentemente se relacionaron con colonoscopias inadecuadas. Los pacientes con CCRP tienen menor sobrevida.

Post-colonoscopy colorectal cancer (PCCRC) is a tumor that appears after a normal colonoscopy before the established time for the endoscopic follow up. Its origin reflects the quality of the colonoscopy and the different tumoral biologics between the CRC and the CRCPC. Our aim is to describe the characteristics of the PCCRC in our region, to identify risk factors, to discriminate the potential causes according to the World Endoscopý Organization (WEO) and to determine its impact in the patient's survival. We studied patients with colorectal cancer (CRC) attended at the gastro-oncology clinic of two institutions of Medellin-Colombia, between January 2012 and December 2021 that had been submitted to a colonoscopy between 6-36 months before the colonoscopy in which the CRC was diagnosed. 919 patients during 10 years for CRC, 68 cases of PCCRC (6.9%); It was more frequent in older patients (74 vs. 66 years; p=0.03), with background of adenomatous polyps (36.8% vs. 20.1%; p=0.01) and in right colon (57.4% vs. 40.6%; p=0.006), with a tendency in patients with diverticulosis (41.2% vs. 31.3%; p=0.05) and diabetes (25% vs. 14%; p=0.06); less survival at 5 and 10 years (58% and 55.2% vs. 67% and 63%; p<0.001). According to the WEO, the PCCRC presents in 61.3% because of abnormal findings omitted in inadequate colonoscopies, 29% in a suitable colonoscopy and 9.7% incomplete resections of adenomas. In conclusion, the rate of PCCRC was 6.9% with more propension in older patients, a background of polyp resection, and proximal colon. According to the WEO, the abnormal findings omitted more frequently were related with inadequate colonoscopies. The patients with PCCRC had less survival.

Emergent Endovascular Repair of a Ruptured Ascending Aorta Pseudoaneurysm With Thoracic Aortic Stent Graft.

Pseudoaneurysm of the ascending aorta is a rare complication of cardiac surgery due to tissue degeneration at the site of graft anastomosis, aortotomy, or extracorporeal circulation cannulation. We describe the case of a patient who developed an ascending aorta pseudoaneurysm after coronary artery bypass graft surgery, which initially required percutaneous closure with an atrial septal defect occlusion device. However, three years later the patient presented again with active external bleeding secondary to pseudoaneurysm enlargement and rupture, which was emergently repaired by percutaneous endovascular repair with a thoracic aortic stent graft. At one-year follow-up the patient is in good conditions and asymptomatic.

Sarcopenia and myosteatosis are accompanied by distinct biological profiles in patients with pancreatic and periampullary adenocarcinomas.

INTRODUCTION: Pancreatic and periampullary adenocarcinomas are associated with abnormal body composition visible on CT scans, including low muscle mass (sarcopenia) and low muscle radiodensity due to fat infiltration in muscle (myosteatosis). The biological and clinical correlates to these features are poorly understood. METHODS: Clinical characteristics and outcomes were studied in 123 patients who underwent pancreaticoduodenectomy for pancreatic or non-pancreatic periampullary adenocarcinoma and who had available preoperative CT scans. In a subgroup of patients with pancreatic cancer (n = 29), rectus abdominus muscle mRNA expression was determined by cDNA microarray and in another subgroup (n = 29) 1H-NMR spectroscopy and gas chromatography-mass spectrometry were used to characterize the serum metabolome. RESULTS: Muscle mass and radiodensity were not significantly correlated. Distinct groups were identified: sarcopenia (40.7%), myosteatosis (25.2%), both (11.4%). Fat distribution differed in these groups; sarcopenia associated with lower subcutaneous adipose tissue (P<0.0001) and myosteatosis associated with greater visceral adipose tissue (P<0.0001). Sarcopenia, myosteatosis and their combined presence associated with shorter survival, Log Rank P = 0.005, P = 0.06, and P = 0.002, respectively. In muscle, transcriptomic analysis suggested increased inflammation and decreased growth in sarcopenia and disrupted oxidative phosphorylation and lipid accumulation in myosteatosis. In the circulating metabolome, metabolites consistent with muscle catabolism associated with sarcopenia. Metabolites consistent with disordered carbohydrate metabolism were identified in both sarcopenia and myosteatosis. DISCUSSION: Muscle phenotypes differ clinically and biologically. Because these muscle phenotypes are linked to poor survival, it will be imperative to delineate their pathophysiologic mechanisms, including whether they are driven by variable tumor biology or host response.

Fyn inhibition rescues established memory and synapse loss in Alzheimer mice.

OBJECTIVE: Currently no effective disease-modifying agents exist for the treatment of Alzheimer disease (AD). The Fyn tyrosine kinase is implicated in AD pathology triggered by amyloid-ß oligomers (Aßo) and propagated by Tau. Thus, Fyn inhibition may prevent or delay disease progression. Here, we sought to repurpose the Src family kinase inhibitor oncology compound, AZD0530, for AD. METHODS: The pharmacokinetics and distribution of AZD0530 were evaluated in mice. Inhibition of Aßo signaling to Fyn, Pyk2, and Glu receptors by AZD0530 was tested by brain slice assays. After AZD0530 or vehicle treatment of wild-type and AD transgenic mice, memory was assessed by Morris water maze and novel object recognition. For these cohorts, amyloid precursor protein (APP) metabolism, synaptic markers (SV2 and PSD-95), and targets of Fyn (Pyk2 and Tau) were studied by immunohistochemistry and by immunoblotting. RESULTS: AZD0530 potently inhibits Fyn and prevents both Aßo-induced Fyn signaling and downstream phosphorylation of the AD risk gene product Pyk2, and of NR2B Glu receptors in brain slices. After 4 weeks of treatment, AZD0530 dosing of APP/PS1 transgenic mice fully rescues spatial memory deficits and synaptic depletion, without altering APP or Aß metabolism. AZD0530 treatment also reduces microglial activation in APP/PS1 mice, and rescues Tau phosphorylation and deposition abnormalities in APP/PS1/Tau transgenic mice. There is no evidence of AZD0530 chronic toxicity. INTERPRETATION: Targeting Fyn can reverse memory deficits found in AD mouse models, and rescue synapse density loss characteristic of the disease. Thus, AZD0530 is a promising candidate to test as a potential therapy for AD.

Thoracoscopic management of an esophageal lung, report of a case / El manejo toracoscópico de un pulmón esofágico, el informe del caso

Esophageal lung is a rare broncopulmonary foregut malformation, in which the main stem bronchus arises from the esophagus. Since the description by Keely et al. in 1960, less than 25 cases have been reported. We present a case of a 4-month-old female, who was referred to our institution after 2 months of management for respiratory recurrent infections. Contrast studies were performed during the evaluation and a right broncography was identified in the esophagogram. Bronchoscopy was performed confirming the atresic right bronchus. Complementary imaging and cardiology evaluation confirmed the absence of major vascular anomalies, especially a pulmonary artery sling that has been described in relation with this entity. Due to the hypoplastic lung in the absence of major vascular anomalies, thoracoscopic pneumonectomy was deemed possible. Procedure was performed with four ports and 3 mm equipment was used. Special attention was made identifying and dissecting the vascular structures first, and then the arising esophageal bronchus was dissected. The hypoplastic lung was extracted trough a small incision inferior to the axilla.We consider that due to the hypoplastic lung and vessels, the thoracoscopic approach is safe and feasible for the management of the esophageal lung and even for de esophageal bronchus in the absence of major vascular anomalies.

El pulmón esofágico es una malformación broncopulmonar rara del intestino anterior, en la que el bronquio principal del tallo surge del esófago. Desde la descripción de Keely et al. en 1960, se informaron menos de 25 casos. Presentamos el caso de una mujer de 4 meses de edad, que fue remitida a nuestra institución después de 2 meses de tratamiento por infecciones respiratorias recurrentes. Se realizaron estudios de contraste durante la evaluación y se identificó una broncografía derecha en el esofagograma. Se realizó broncoscopia confirmando el bronquio derecho atresico. La evaluación complementaria de imágenes y cardiología confirmó la ausencia de anomalías vasculares mayores, especialmente una honda de la arteria pulmonar que se ha descrito en relación con esta entidad. Debido al pulmón hipoplásico en ausencia de anomalías vasculares mayores, se consideró posible la neumonectomía toracoscópica. El procedimiento se realizó con cuatro puertos y se utilizó un equipo de 3 mm. Se prestó especial atención a la identificación y disección de las estructuras vasculares primero, y luego se disecó el bronquio esofágico resultante. El pulmón hipoplásico se extrajo a través de una pequeña incisión inferior a la axila. Consideramos que, debido al pulmón y los vasos hipoplásicos, el abordaje toracoscópico es seguro y factible para el manejo del pulmón esofágico e incluso para el bronquio esofágico en ausencia de mayor anomalías vasculares

Traumatic abdominal wall hernia from handlebar injury, laparoscopic repair - Report of two cases / Hernia traumática de la pared abdominal por lesión del manubrio, reparación laparoscópica - Informe de dos casos

Although rare, traumatic abdominal wall hernia associated with handlebar injury is a well-described entity in the pediatric population with about 40 cases and only one laparoscopic repair reported in children. We present two cases of male patients, 9 and 13 years old, who were assessed in our emergency room for blunt abdominal trauma associated with handlebar injury. The patients showed signs of handlebar trauma in the abdominal wall: one presented with a painful mass, and the other with intermittent pain in the area of trauma with no palpable mass. Neither of the patients were hemodynamically unstable or showed any peritoneal signs. Ultrasound and CT scans were performed in both patients to identify abdominal wall hernias containing bowel content in the absence of other injuries. Laparoscopic repair was performed uneventfully in both patients with interrupted non-absorbable multifilament suture with 2 and 3 ports respectively. Oral intake was initiated one day after surgery and both patients were discharged the following day. In the follow-up visit, the patients were asymptomatic and no signs of abdominal wall hernias were found. Laparoscopic repair of blunt traumatic abdominal wall hernias is safe and technically possible in children and should be considered as the standard initial approach in the stable patient.

Aunque rara, la hernia traumática de la pared abdominal asociada a una lesión en el manubrio es una entidad bien descrita en la población pediátrica, con aproximadamente 40 casos y solo se informó una reparación laparoscópica en niños. Presentamos dos casos de pacientes varones, de 9 y 13 años de edad, que fueron evaluados en nuestra sala de emergencias por un traumatismo abdominal cerrado asociado con una lesión en el manubrio. Los pacientes mostraron signos de traumatismo del manubrio en la pared abdominal: uno presentó una masa dolorosa y el otro con dolor intermitente en el área de trauma sin masa palpable. Ninguno de los pacientes presentaba inestabilidad hemodinámica ni signos peritoneales. Se realizaron ecografías y tomografías computarizadas en ambos pacientes para identificar las hernias de la pared abdominal que contenían contenido intestinal en ausencia de otras lesiones. La reparación laparoscópica se realizó sin incidentes en ambos pacientes con sutura discontinua no reabsorbible interrumpida con 2 y 3 puertos respectivamente. La ingesta oral se inició un día después de la cirugía y ambos pacientes fueron dados de alta al día siguiente. En la visita de seguimiento, los pacientes estaban asintomáticos y no se encontraron signos de hernias de la pared abdominal. La reparación laparoscópica de las hernias de pared abdominal traumáticas romas es segura y técnicamente posible en los niños y debe considerarse como el abordaje inicial estándar en el paciente estable.

Hidrogeniones metabólicos y su correlación con el lactato sérico en pacientes críticamente enfermos / Metabolic hydrogen ions and their correlation with serum lactate in critically ill patients

La acidosis metabólica con lactato elevado es uno de los trastornos más frecuentes en pacientes críticos. El lactato es un marcador importante pero no está ampliamente disponible en las unidades de cuidados intensivos y su costo es un limitante de su uso. La valoración de la diferencia en la concentración de iones metabólicos a través del Delta Hidrogenión (DH) puede indicar alteraciones del tipo acidosis metabólica. Objetivo Determinar si los valores de DH se correlacionan con los de lactato sérico en pacientes críticamente enfermos. Diseño Estudio transversal de correlación. Lugar y sujetos Pacientes mayores de 18 años y críticamente enfermos, ingresados en la Unidad de Cuidados Intensivos (UCI) del Hospital General de las Fuerzas Armadas HG-1 de la ciudad de Quito. Mediciones principales Muestras sanguíneas para análisis gasométrico y de lactato sérico al momento de ingreso a UCI. Cálculo del DH por la diferencia entre hidrogeniones totales y respiratorios. Resultados De 77 pacientes (35 de sexo femenino; edad media 66.2 ± 18.6 años) en 53 (68.8%) se halló un DH elevado (≥5 mmol/L). El DH se correlacionó con el exceso de base (r= -0.956; p<0.001) y de forma moderada con el lactato sérico (r= 0.523; p<0.001). Los valores elevados de DH se relacionaron mejor (R2= 0.277) que los normales (R2= 0.035) con las cifras de lactato. Conclusión El DH podría ser usado como un complemento al acercamiento diagnóstico habitual de la condición ácido-base en pacientes críticamente enfermos con trastornos metabólicos, pero no es posible recomendar su uso como sustituto de la cuantifcación de lactato sérico.

Metabolic acid-base disorder with lactic acidosis is one of the most common problems in critically ill patients. Lactate measurement is not widely available in the intensive care units and the cost affects its use. The measurement of the difference in the concentration of metabolic ions through the Delta hydrogen ion (DH) could indicate alterations such as metabolic acidosis. Objective To determine the correlation between DH and serum lactate in critically ill patients. Design Cross-sectional correlational study. Subjects and setting Patients over 18 years old and critically ill hospitalized in the Intensive Care Unit (ICU) of the General Hospital of the Armed Forces HG-1 in the city of Quito. Main measurements Samples for arterial blood gas analysis and serum lactate were taken upon admission to ICU. DH was calculated by the difference between total and respiratory hydrogen ion. Results From 77 patients (35 female, mean age 66.2 ± 18.6 years) a number of 53 (68.8%) had a high DH (≥5 mmol/L). DH was correlated with base excess (r= -0.956; p<0.001) and only moderately with serum lactate (r= 0.523; p<0.001). Higher values of DH were better correlated (R2= 0.277) than normal values (R2= 0.035) with lactate levels. Conclusion DH could be used as an adjunct to standard diagnostic approach to acid-base status in critically ill patients with metabolic disorders, but we can´t recommend its use as a substitute for the quantifcation of serum lactate.

Cardiomiopatía de Tako-tsubo: reporte de dos casos / Tako-tsubo cardiomyopathy: report of two cases

Se presentan dos casos de mujeres postmenopáusicas que consultan al servicio de urgencias presentando su primer episodio de dolor torácico desencadenado después de una situación de estrés emocional; sus EKG mostraban cambios compatibles con eventos coronarios agudos y sus niveles de Troponina T fueron francamente positivos. Al ser llevadas a coronariografía, se encontró coronarias sanas y ventriculografía con fracción de eyección disminuida. Los ecocardiogramas iniciales mostraron alteración de la contractilidad segmentaria principalmente de los segmentos apicales con confirmación de la disfunción sistólica; los de control mostraron reversión de estos hallazgos, con mejoría de la fracción de eyección; uno de los casos presentó recurrencia. El diagnóstico final de ambas pacientes fue cardiomiopatía de Tako-tsubo.

Edema pulmonar refractario secundario a estenosis valvular aórtica severa - valvuloplastia aórtica como terapia puente a cirugía / Refractory pulmonary edema secondary to severe aortic valvular stenosis - aortic valvuloplasty as bridge therapy to surgery

La estenosis valvular aórtica es una entidad progresiva, que cuando es severa y produce síntomas, tiene un pronóstico sombrío que afecta de forma adversa la sobrevida. En estos casos el tratamiento de elección es la cirugía de cambio valvular, la cual, bajo determinadas circunstancias clínicas, puede ser de muy alto riesgo, y obliga así a considerar alternativas de manejo menos agresivas que permitan solucionar el problema. Se muestra el caso de un hombre de 65 años, con estenosis valvular aórtica severa, quien desarrolló edema pulmonar refractario al manejo médico, que se resolvió mediante valvuloplastia aórtica, como terapia puente a cirugía.

Aortic valve stenosis is a progressive disease; when it is severe and symptomatic has a bleak prognosis that affects adversely the patient survival. In these cases, the treatment of choice is valve replacement surgery that under certain circumstances can bear a huge risk that forces the physician to consider less aggressive management alternatives to solve the problem. The case of a 65 years old male with severe aortic valve stenosis is reported. He developed pulmonary edema refractory to medical treatment that was solved by aortic valvuloplasty as bridge therapy to surgery.

[Diminished apoptosis in nasal mucosa of patients with persistent allergic rhinitis]. / Disminución de la apoptosis en la mucosa nasal de pacientes con rinitis alérgica persistente.

OBJECTIVE: To assess apoptosis frequency in the nasal mucosa of patients with perennial allergic rhinitis. PATIENTS AND METHODS: Eleven patients and five healthy subjects accepted to participate, from 10 to 16 years old. None of them had evidence of acute infectious disease, tobacco exposure or use of corticosteroids, antileukotrienes, antihistamines or immunotherapy. After a clinical evaluation and a skin prick testing, a nasal symptoms questionnaire was applied and a nasal washing was performed. Two hundred cells were examined (Giemsa and eosin yellowish) and apoptosis was identified by immunohistochemistry (Active-Caspase-3) (p20L18, sc-1225. Santa Cruz Biothecnology, Inc. Santa Cruz). RESULTS: The most common allergen was Dermatophagoides sp in 10 patients (91%). The total score of the nasal symptom questionnaire was 3 to 8 (median 6) in patients and 1 to 4 (median 2) in healthy subjects (p < 0.05, Mann Whitney U test). Frequency of eosinophils was 11 to 80% in patients and 0 to 1% in healthy subjects (p < 0.05, Z for proportions). Apoptosis was less frequent in patients (0 to 5, median 2) than in healthy subjects (4 to 16, median 8) (p < 0.01, Mann Whitney U test). CONCLUSIONS: Perennial allergic rhinitis may be associated with decreased apoptosis in the nasal mucosa.

Opacidades en vidrio esmerilado con TC de alta resolución: su utilidad en los diagnósticos diferenciales / Ground-glass opacity at high resolution CT: an approach

Propósito. Evaluar la distribución anatómica de las opacidades en vidrio esmerilado y las alteraciones estructurales parenquimatosas asociadas, correlacionándolas con las diferentes etiologías. Material y método. Se estudiaron retrospectivamente 38 pacientes, 22 hombres y 16 mujeres, entre 20 y 88 años, (promedio 54,6), mediante TCAR, haciendo cortes de 2 mm cada 10 mm de incremento de camilla, con inyección de contraste iodado en 11 pacientes. El diagnóstico definitivo se efectuó por estudio del esputo, lavado bronquioloalveolar, biopsia transbronquial y a cielo abierto. Resultados. El análisis obtenido se basó en la distribución anatómica de las opacidades en vidrio esmerilado y en las alteraciones estructurales parenquimatosas pulmonares. Distribución centrolobular: se relacionó con la afectación temparna del espacio aéreo con infección (21 casos), sangre (4 casos), en neumonitis por hipersensibilidad (1 caso) y en neumonitis intersticial descamativa (1 caso). Distribución panlobular: se observó en proteinosis alveolar (1 caso), toxicidad por drogas (1 caso), sarcoidosis (1 caso) y neumonía por pneumocystis carinii (1 caso), silicoproteinosis (1 caso). Distribución periférica: fibrosis pulmonar (1 caso) y bronquiolitis obliterante (1 caso). Las alteraciones estructurales asociadas fueron: bronquiectasis (10 casos), quistes (3 casos), bandas lineales densas subpleurales, engrosamiento de septos intersticiales (4 casos), engrosamiento peribroncovascular o nodulillar con microquistes concomitantes (1 caso) y enfisema (18 casos). Conclusión. La tomografía computada de alta resolución ha sido una herramienta diagnóstica útil en la investigación del patrón en vidrio esmerilado, así como en las alteraciones estructurales parenquimatosas concomitantes, habiendo logrado aproximarnos al diagnóstico etiológico en la mayoría de los casos, dentro del contexto clínico y orientar al médico de cabecera en la conducta terapéutica en los restantes