Expression and regulation of insulin and the glucose transporter GLUT8 in the testes of diabetic rats.

Diabetes induces several malfunctions in male germ cells. The aim of this study was to analyze the levels and localization of the glucose transporter GLUT8 and insulin in the testes of rats induced to a diabetic status by a single dose of streptozotocin. One month after inducing diabetes, the GLUT8 immunoreactivity in diabetic rats was mainly located associated to the acrosomic system of spermatids, and at low levels in Leydig cells. Neither the immunohistochemical localization of this transporter nor its levels showed any difference when compared to control rats. Furthermore, it was observed that control rat testes expressed insulin, which was diffusely located in the cytoplasm of both Leydig cells and early elongated spermatids and concentrated in a cytoplasmic compartment in the more mature spermatids. Testicular insulin levels measured by western blot were reduced by more than half in diabetic rats, although the distribution of the hormone was unchanged. These results indicate that i) insulin is produced by testicular cells, ii) insulin is depleted by streptozotocin-induced diabetes, and iii) that insulin depletion and hyperglycemia do not regulate the expression of GLUT8 in testes. These results also suggest that testicular production of insulin could play a role in regulating spermatogenesis and/or glucose metabolism in these organs.

Lutein prevents the effect of high glucose levels on immune system cells in vivo and in vitro.

Diabetic patients present an increased susceptibility to frequent and protracted infections. The recognition of an impaired immune system has implications for the diagnosis, treatment and outcome of infections. Nuclear Factor kappa B (NF-kappaB) is a redox sensitive transcription factor involved in immune response, cell proliferation and apoptosis that has been associated to the development of diabetic complications. Herein we study the effects of high glucose on oxidative stress markers (malondialdeyde and glutathione contents) and NF-kappaB activity in U937 cells (a human promonocytic cell line). Furtheremore effects of lutein treatment in lymphocytes from diabetic rats was studied. The results show that high glucose induces oxidative stress in immune system cells, both in vitro and in vivo, as well as an increase in their NF-kappaB activity. It is also showed that lutein, a natural antioxidant without hypoglycemiant properties, is able to prevent all the alterations observed. Thus, this study confirms the role of oxidative stress in the immune system impairment described in diabetes, and allows the proposal of antioxidants for the clinical management of the diabetes-associated susceptibility to infections.

[Laparoscopic Janeway gastrostomy: an advantageous solution for self-sufficient enteral feeding]. / Gastrostomie tubulisée coelioscopique : une solution avantageuse pour une nutrition entérale autonome.

INTRODUCTION: Laparoscopic gastrostomy according to Janeway (LGJ) is an alternative to percutaneous gastrostomy techniques. METHODS: A series of 10 LGJ is reported. The laparoscopic technique involves an isoperistaltic tube of 6-7 cm of length and 10-12 mm of diameter is created by 2 applications of linear stapling and cutting device. The tube is led out, opened and fixed to the fascial and cutaneous planes and a Foley catheter is inserted. RESULTS: Mean operation time was 35 minutes. There was no complication. The LGJ was indicated in 9 patients with tumour of the pharynx and 1 patient with encephalopathy. CONCLUSION: The main drawback of the LGJ is the need of general anaesthesia. The main advantage is the creation by minimal invasive surgery of a permanent gastrostomy equipped with a removable catheter easily changeable by non specialized health professionals, and even by the patient himself.

[Liver abscesses secondary to sigmoid diverticulitis: report of four cases]. / Abcès intrahépatiques secondaires à une sigmoïdite diverticulaire: à propos de quatre cas.

INTRODUCTION: Pyogenic liver abscess often revealed by right sided abdominal pain and fever is a serious and life-threatening pathology. Biliary tract disease is the origin of the abscess in most cases but sometimes remains unidentified. A sigmoid septic source sometimes paucisymptomatic or hidden by an immunosuppressive treatment must be looked for. EXEGESIS: Here are four observations of liver abscesses, which are secondary to unknown sigmoiditis. The etiologic diagnosis was made either by abdomino-pelvic computed tomography or by enema with water-soluble products completed by a coloscopy. Each patient's liver abscesses were emptied by aspiration or catheter drainage in conjunction with antibiotics. Surgical treatment of sigmoiditis was performed either at the same time or later. CONCLUSION: Any liver abscess of unknown origin must lead to a search for unknown or disguised septic sigmoid pathology. Most of the time, injected abdomino-pelvic computed tomography makes the diagnosis possible, but enema associated with coloscopy is sometimes necessary.

[Treatment of diaphragmatic ruptures by laparoscopic approach in the lateral position]. / Traitement des ruptures de la coupole diaphragmatique par coelioscopie en décubitus latéral.

STUDY AIM: The aim of this retrospective study was to assess the feasibility of the treatment of recent diaphragmatic ruptures through laparoscopic approach in lateral position in patients with stable hemodynamic condition. PATIENTS AND METHOD: From 1994 to 1999, seven patients, 16 to 68 years old, were operated on for diaphragmatic rupture after a 6 hours to 15 days delay. Diaphragmatic rupture was located on the left side in 6 patients, on the right side in 1. Diagnosis was confirmed by CT-scan with reconstructions; there was no associated visceral injury. Patients were operated on by laparoscopic approach in lateral position, herniated viscera reintegrated by moderate pulling and diaphragmatic rupture repaired with non resorbable continuous suture. RESULTS: Stomach was the usual herniated viscera (n = 6); hemothorax was less than 300 cL; diaphragmatic rupture was 8 to 12 cm long. Duration of surgery was no more than 120 minutes. The seven patients after a two months to two years delay had normal chest X-rays. CONCLUSION: The laparoscopic approach in lateral position provides good visibility of the diaphragmatic lesions, easy reduction of herniated organs, complete thorax exploration and cleaning, and easy diaphragmatic repair. This technique is only feasible in patients with stable hemodynamic conditions and does not provide a complete abdominal exploration.

[Repair of midline incisional hernias using the Lazaro da Silva aponeuroplasty technique]. / La cure des éventrations médianes selon la technique d'autoplastie de Lazaro da Silva.

STUDY AIM: The aim of this retrospective study was to assess Lazaro da Silva's rectus sheath aponeuroplasty technique for repair of midline incisional hernias situated above the arcuate line. PATIENTS AND METHOD: Twenty-six patients underwent surgical repair of a supraumbilical (n = 19) or periumbilical (n = 7) incisional hernia. Six patients had had repeated laparotomies and two of them had recurrent incisional hernia. There were 11 obese patients (42%). Muscle diastasis ranged from 4 to 20 centimeters (mean: 9.7 cm). Three overlapping aponeurotic and peritoneal layers were used. The peritoneal sac was partially or totally incorporated in the repair. RESULTS: There was one postoperative death at day 5 from acute pancreatitis in a patient with associated cholecystectomy. Postoperative complications occurred in six patients. There were 3 abdominal wall infections. Obesity was the main factor associated with operative complications (p = 0.03). Mean follow-up was 19.1 months. There were 2 recurrences, one of them related to an abdominal wall infection. CONCLUSION: The Lazaro da Silva aponeuroplasty technique compares favourably with alternative techniques using mesh implants. It is indicated for incisional hernias less than 20 centimeters wide, situated above the arcuate line.

[Perforation and rupture of the oesophagus: treatment and prognosis]. / Perforation et rupture de l'oesophage: prise en charge et pronostic.

AIM OF THE STUDY: To analyze treatment and prognosis of perforations and ruptures of the oesophagus. MATERIAL AND METHODS: This retrospective study included 40 patients (26 men and 14 women; mean age = 59 +/- 17 years) with a perforation or a rupture of the oesophagus. Seven perforations were cervical: iatrogenic (n = 6) or following ingestion of a foreign body (n = 1). Thirty-three perforations were thoracic: iatrogenic (n = 15), spontaneous rupture (n = 14), following ingestion of foreign body (n = 3) or traumatic (n = 1). All patients with cervical perforations were operated on (suture or drainage). One patient with thoracic perforation died before surgery, 2 underwent non-operative treatment and 30 were operated on. Twenty-eight underwent an oesophageal procedure: suture (n = 13), oesophagectomy (n = 11) or double exclusion (n = 4). Two uderwent surgery without oesophageal procedure (one pleural decortication, and one ablation of a pleural foreign body). RESULTS: The overall mortality rate was 17% (7/40), 21% (3/14) after spontaneous ruptures and 19% (4/21) after iatrogenic perforations (no death for other aetiologies). The mortality rate was 14% (1/7) for cervical lesions and 18% (6/33) for thoracic ones. It was 8% (1/13) after intrathoracic suture, 18% (2/11) after oesophagectomy and 50% (2/4) after double exclusion. CONCLUSION: Iatrogenic perforation and spontaneous rupture had the same poor prognosis. Non-surgical treatment is rarely indicated. oesophagectomy is a good option in case of non suturable oesophagus or delayed operation.

Lutein and docosahexaenoic acid prevent cortex lipid peroxidation in streptozotocin-induced diabetic rat cerebral cortex.

The mechanisms underlying diabetic encephalopathy, are largely unknown. Here, we examined whether docosahexaenoic acid (DHA) and lutein could attenuate the oxidative changes of the diabetic cerebral cortex. The levels of malondialdehyde (MDA) were significantly increased and glutathione (GSH) and glutathione peroxidase activity (GPx) were decreased in diabetic rats. The number of 4-hydroxynonenal (4-HNE) positive cells was increased. Treatment with insulin, lutein or DHA and the combination of each antioxidant with insulin, significantly restored all markers concentrations mentioned above, and the increase in 4-HNE inmunofluorescence. We combined 4-HNE immunofluorescence with NeuN (Neuronal Nuclei) staining. The latter demonstrated extensive overlap with the 4-HNE staining in the cortex from diabetic rats. Our findings demonstrate a clear participation of glucose-induced oxidative stress in the diabetic encephalopathy, and that the cells suffering oxidative stress are neurons. Lowering oxidative stress through the administration of different antioxidants may be beneficial for the central nervous tissue in diabetes.

Absence of the portal bifurcation at the hilum of the liver due to intrahepatic origin of the left branch of the portal vein.

The authors report a rare anomaly of portal vascularization which was detected by CT-scan and MRI and then confirmed surgically. There was no portal bifurcation at the hilum of the liver. After giving off its right dorsal branch, the portal vein entered the right liver and divided in the parenchyma into the right ventral and left branches. The arteriobiliary distribution was normal. Only a few similar cases have been reported. The left branch of the portal vein is reported to have few variations in contrast with the right one, which has many. The venous structure of the liver varies increasingly with the distance from the left umbilical vein. During a right hepatectomy, the possibility of such a vascularization makes it necessary to ensure that the left branch of the portal vein starts upstream before dividing a portal branch entering the right liver.

Estrategias de información en una Unidad de Cuidados Intensivos polivalente / Information Strategies in a polyvalent intensive care unit

Introducción. La comprensión de la informaciónproporcionada a los familiares y allegados delos enfermos críticos ingresados en la Unidadde Cuidados Intensivos (UCI), y la transmisión,adecuada y sin contradicciones, de esta información,es un aspecto fundamental relacionado con la posible participación en las decisiones terapéuticasy con la calidad percibida respecto al proceso asistencial. Con el fin de establecer la adecuación de estos dos aspectos (comprensión y transmisión de la información) se ha realizado el presente estudio.Diseño. Estudio de opinión elaborado por elequipo médico, con la supervisión de enfermeríade una UCI polivalente.Método. Estudio cualitativo observacional.Encuesta de preguntas de respuesta abierta.Acuerdo de terminología y conceptos que debecontener la información y estimación de los distintoscontenidos de información proporcionada por los principales estamentos asistenciales (médicosy enfermeras). Elaboración, por técnica Delphi, de una hoja de transmisión de la información entre distintos facultativos, con el fin de homogeneizarel proceso informativo.Resultados. El análisis del cuestionario demuestrala gran heterogeneidad de los contenidosy formas de la información proporcionada, lo querepercute en defectos de comprensión y aparentescontradicciones, y a su vez dificulta la comprensiónde esa información y la integración de familiaresy allegados en el proceso asistencial.Se presenta el acuerdo logrado entre los distintosfacultativos encuestados para facilitar la informacióny evitar interpretaciones subjetivas porparte de los informados

Introduction. Understanding the informationprovided to families and surrogates of the criticallyill patients admitted to ICUs and its adequatecommunication without contradictions, is a fundamentaspect related with the possible participationof these persons in the treatment decisionmaking and with the quality perceived regardingthe care process. Our aim in this study is to assessthese two aspects (information and communicationof information).Design. Opinion study elaborated by the medicalteam and nursing staff of a multidisciplinary ICU.Method. Observational qualitative study performedthrough an open answers questionnaire.Search for agreement on terminology and conceptsthat should be included in the informationand estimation of the different contents of informationprovided by the main health care professionalgroups (physicians and nurses). Using theDelphi technique to elaborate an informationcommunication sheet between different staffmembers in order to homogenize the informationprocess.Results. The analysis of the questionnaire revealsthe great heterogeneity of the contents andmodes of information provided. This may cause difficulties in understanding and the integration offamilies and relatives in the care process.The agreement achieved among the differentbetween physicians to facilitate the informationand avoid subjective interpretations by the informedpeople is presented (AU)

Lutein prevents the effect of high glucose levels on immune system cells in vivo and in vitro

Diabetic patients present an increased susceptibility to frequent and protractedinfections. The recognition of an impaired immune system has implications for thediagnosis, treatment and outcome of infections. Nuclear Factor kappa B (NF-êB) isa redox sensitive transcription factor involved in immune response, cell proliferationand apoptosis that has been associated to the development of diabetic complications.Herein we study the effects of high glucose on oxidative stress markers (malondialdeydeand glutathione contents) and NF-êB activity in U937 cells (a humanpromonocytic cell line). Furtheremore effects of lutein treatment in lymphocytesfrom diabetic rats was studied. The results show that high glucose induces oxidativestress in immune system cells, both in vitro and in vivo, as well as an increase in theirNF-êB activity. It is also showed that lutein, a natural antioxidant without hypoglycemiantproperties, is able to prevent all the alterations observed. Thus, this studyconfirms the role of oxidative stress in the immune system impairment described indiabetes, and allows the proposal of antioxidants for the clinical management of thediabetes-associated susceptibility to infections (AU)

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