Vesicostomía cutánea: rol en la vejiga neurogénica / Cutaneous vesicostomy: in neurogenic bladder

Objetivo: En los casos de vejigas neurogénicas de alto riesgo (VNAR) se plantea la vesicostomía como una alternativa válida. El objetivo de este estudio es analizar los resultados de este procedimiento desde la creación del policlínico de mielomeningocele (MMC) en nuestro hospital. Métodos: Revisión retrospectiva de fichas clínicas e imágenes radiológicas de todos los pacientes con MMC controlados en nuestra unidad entre los años 1992-2005.Resultados: En un período de 13 años hubo 195 pacientes con MMC. De ellos 120 fueron catalogados como VNAR 69 niñas y 51 niños, sólo 20 requirieron vesicostomía. Todas fueron realizadas antes de los 4 años. Sólo 11 pacientes se han desderivado en una edad promedio de 5 años 8 meses. Cuatro pacientes están en lista de espera, 2 se cambiaron de hospital y 3 se perdieron de controles. El período de seguimiento promedio fue de 4 años. Hubo sólo 2 ostomías que se estenosaron; 1 requirió revisión quirúrgica. No hubo prolapso de las vesicostomías en esta serie. En todos los pacientes se logró estabilizar las infecciones y disminuir la hidronefrosis. No hubo pérdida de función renal en ninguno. Todos los pacientes desderivados a la fecha han requerido una ampliación vesical. Conclusiones: Podemos concluir que la vesicostomía es una buena medida que preserva la función renal, controla las infecciones urinarias a repetición y hace más fácil el manejo para los padres. Su cierre es relativamente fácil y de preferencia debe realizarse antes de la etapa escolar. Generalmente debe asociarse alguna cirugía de agrandamiento vesical.

Objective: Neurogenic bladder is a condition of difficult management. In those cases of high-risk neurogenic bladder (HRNB), vesicostomy have been rise as an alternative. The aim of this study is to evaluate the results of this practice since 1992, when the myelomeningocele (MMC) clinic was created. Methods: A retrospective case note review was carried out on all patients with diagnosis of MMC who assist our clinic between 1992-2005.Results: There were 195 patients with MMC in the 13 years period; 120 were HRNB (69 girls and 59 boys) and only 20 underwent vesicostomy. All of them were done before 4 years old. 11 were closed at a mean age of 5.8 years. Four are still in the waiting list, 2/20 moved to another hospital and 3/20had been lost from follow-up. After a mean follow-up of 4 years, there were 2 stenosis; one required surgical review. There was no prolapse in this series. All children were infection free and presented a decreased of the hydronephrosis measures. There was no lost of kidney function. The 11/11 patients who had the stoma closed required a bladder augmentation. Conclusions: Vesicostomy is a good alternative to preserve kidney function, manage urine infection and make parent supervision easier. Its closing is relatively simple and we recommend to perform it before school age. All the cases in this series required a concomitant bladder augmentation.

Entamoeba histolytica: ADP-ribosylation of secreted glyceraldehyde-3-phosphate dehydrogenase.

In addition to its classic glycolytic role, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) has been implicated in many activities unrelated to glycolysis, such as membrane fusion, binding to host proteins and signal transduction. GAPDH can be the target of several modifications that allow incorporation to membranes and possible regulation of its activity; among these modifications is mono-ADP-ribosylation. This post-translational modification is important for the regulation of many cellular processes and is the mechanism of action of several bacterial toxins. In a previous study, we observed the extracellular ADP-ribosylation of a 37-kDa ameba protein. We report here that GAPDH and cysteine synthase A are the main ADP-ribosylated proteins in Entamoeba histolytica extracellular medium, GAPDH is secreted from ameba at 37 degrees C in a time-dependent manner, and its enzymatic activity is not inhibited by ADP-ribosylation. Extracellular GAPDH from ameba may play an important role in the survival of this human pathogen or in interaction with host molecules, as occurs in other organisms.

Tratamiento endoscópico del reflujo vesicoureteral primario en sistemas únicos y dobles / Endoscopic treatment for primary vesicoureteral reflux in single and duplex system

El tratamiento endoscópico en el reflujo vésicoureteral primario es una alternativa disponible desde hace ya un tiempo. En nuestro hospital estamos usando el Deflux (copolimero de dextranomero en ácido hialurónico) desde 2002. En este trabajo revisamos la efectividad de este procedimiento en pacientes con distintos tipos y grados de reflujo. Método: Analizamos en forma prospectiva 25 pacientes, con 38 uréteres refluyentes, inyectados desde enero 2002 hasta diciembre 2005 que contaran con ecografía y uretrocistografía post operatoria. Resultados: El 86 por ciento (21) eran de sexo femenino, y su edad promedio fue de 6,1 años (2 a 14). El resultado fue exitoso en 73,6 por ciento (N=28) de los casos con una inyección, la cantidad de sustancia inyectada no fue relevante en el resultado. Se obtuvo mucho mejor resultado en los grados bajos, alcanzando 100 por ciento de resolución en los grados 1 y 2, (N=15) al igual que en los casos de uréter simple y unilateral (N=10). El peor resultado fue obtenido en los casos de uréter doble, resolviéndose sólo en 1 de 6 uréteres. El procedimiento fue siempre ambulatorio y no tuvimos complicaciones perioperatorias. Conclusiones: Nos parece que el tratamiento endoscópico con Deflux es un muy buen tratamiento para el reflujo vésicoureteral primario como alternativa tanto al tratamiento médico, como al quirúrgico, especialmente en los casos unilaterales y en sistemas únicos. Los autores recomiendan esta técnica en el moemnto de aconsejar a los padres.

Purpose: Effectivety for endoscopic treatment for primary reflux has been under discussion as a single procedure. In the last 3 years our unit have been used Deflux, (dextranomer copolymer in hialuronic acid) for this pathology. The aim of this study is to analyze the results of our experience. Material and Methods: Since 2002, a prospective protocol for VUR has been applied. We reviewed the last 25 cases treated with DefluxTM injection who had ultrasound and cistography. Results: 86% (N=21) were females and with a mean age of 6.1 years (range 2-14) the success rate with a single injection was 73.6% (N=28). The amount of deflux injected was irrelevant in the result . The results in the low grades reflux (I-II) reaching the 100% (N=15). The worse result was in the double system cases with just one successful case out of 6 injected. The procedure was in outpatient bases. There were no periprocedures complications. Conclusions: The endoscopic treatment for VUR with Deflux , is a good alternative to medical treatment especially in single ureter with low grade. Therefore the authors recommend this technique at the time of counseling parents.

The GTP-binding protein RhoA localizes to the cortical granules of Strongylocentrotus purpuratas sea urchin egg and is secreted during fertilization.

The sea urchin egg has thousands of secretory vesicles known as cortical granules. Upon fertilization, these vesicles undergo a Ca2+-dependent exocytosis. G-protein-linked mechanisms may take place during the egg activation. In somatic cells from mammals, GTP-binding proteins of the Rho family regulate a number of cellular processes, including organization of the actin cytoskeleton. We report here that a crude membrane fraction from homogenates of Strongylocentrotus purpuratus sea urchin eggs, incubated with C3 (which ADP-ribosylates specifically Rho proteins) and [32P]NAD, displayed an [32P]ADP-ribosylated protein of 25 kDa that had the following characteristics: i) identical electrophoretic mobility in SDS-PAGE gels as the [32P]ADP-ribosylated Rho from sea urchin sperm; ii) identical mobility in isoelectro focusing gels as human RhoA; iii) positive cross-reactivity by immunoblotting with an antibody against mammalian RhoA. Thus, unfertilized S. purpuratus eggs contain a mammalian RhoA-like protein. Immunocytochemical analyses indicated that RhoA was localized preferentially to the cortical granules; this was confirmed by experiments of [32P]ADP-ribosylation with C3 in isolated cortical granules. Rho was secreted and retained in the fertilization membrane after insemination or activation with A23187. It was observed that the Rho protein present in the sea urchin sperm acrosome was also secreted during the exocytotic acrosome reaction. Thus, Rho could participate in those processes related to the cortical granules, i.e., in the Ca2+-regulated exocytosis or actin reorganization that accompany the egg activation.

Purification and partial characterization of a chromate reductase from Bacillus.

A soluble NADH-dependent enzyme capable of reducing hexavalent chromium [Cr(VI)] to the trivalent form [Cr(III)] was purified from chromate-resistant Bacillus QC1-2. An enriched single protein band of 24 kDa was observed by SDS-PAGE following HPLC ion-exchange and size-exclusion procedures. In the latter step, the chromate reductase showed a molecular mass of 44 kDa, which suggested that the enzyme consists of two subunits of about 24 kDa. Purified chromate reductase displayed optimal activity at a temperature and pH of 37 degrees C and 7.0, respectively. The enzyme showed a Km of 0.35 mM for chromate and a Vmax of 50 nmol Cr(VI) reduced per minute per mg protein.

The GTP-binding protein G alpha s is present in dormant spores and expressed differentially during spore germination of the fungus Phycomyces blakesleeanus.

A DNA sequence homologous to a G alpha s DNA probe, and the corresponding G alpha s protein (stimulatory alpha-subunit of GTP-binding protein) were detected in Phycomyces blakesleeanus. The protein was demonstrated in membrane fractions of dormant spores of this fungus using three different experimental approaches. Photoaffinity-labelling experiments with [alpha-32P]GTP of the membrane fraction revealed two bands, of 56 and 32 kDa. The 56 kDa GTP-binding protein was detected by this method in all the stages of early development and growth investigated. Also, a spore protein of 56 kDa was ADP-ribosylated by cholera toxin, and a 56 kDa protein was detected by Western blotting with a specific antibody against mammalian G alpha s. These results indicate that G alpha s (56 kDa) is present in dormant spores of P. blakesleeanus. Using the ADP-ribosylation and Western blotting assays, G alpha s was detected during all stages of spore germination before the hyphae became highly branched, but it was not detected in the branched hyphae that formed 18 h after the initiation of spore germination. Therefore, G alpha s is expressed differentially during Phycomyces development.

12-O-tetradecanoyl phorbol-13-acetate interferes with germination of Phycomyces blakesleeanus sporangiospores.

The presence of protein kinase C (PKC), a key enzyme in signal transduction, has not been investigated in fungal cells. The phorbol ester TPA, an activator of PKC, may be used as an indicator of the presence and role of PKC in Phycomyces blakesleeanus spores. Activation of spore germination by acetate was prevented by 6 nM TPA. The TPA analog 4 alpha PDD, an ineffective activator of PKC, did not affect spore germination. 3 mM dbcAMP, on the other hand, reversed the inhibition of germination caused by TPA. TPA-stimulated protein kinase activity was detected in spores. The possible relationship between PKC and the increased levels of cAMP that accompany the induction of spore germination is discussed.

Stabilization of chitin synthetase and purification of chitosomes from several mycelial Mucorales.

Stability of chitin synthetase in cell-free extracts from mycelial fungi was markedly improved by the presence of sucrose in the homogenization media. Breakage of mycelium in sucrose-containing buffer yielded enzyme preparations from which chitosomal chitin synthetase could be purified by a procedure involving ammonium sulfate precipitation, gel filtration and centrifugation in sucrose density gradients. Purified chitosomes catalyzed the synthesis of chitin microfibrils in vitro upon incubation with substrate and activators. Chitosomal chitin synthetase from the filamentous form of M. rouxii was similar to the enzyme from yeast cells, except for the poorer stability and diminished sensitivity to GlcNAc activation of the former.

Colangitis aguda supurada. / Acute suppurative cholangitis

Se analizo retrospectivamente la experiencia del Hospital de Especialidades del Centro Medico La Raza con veinticuatro pacientes con colangitis obstructiva supurada aguda tratados de Abril de 1979 a Agosto de 1981. El 84% de los casos tenia etiologia benigna; embargo, la morbilidad fue de 38% y, aunque la mortalidad de toda la serie fue de 8%, en los casos con septicemia fue de 29%. Se encontro que el caracter supurativo de la colangitis no necesariamente se anuncia con un cuadro clinico tipico, que la presencia de pus en la via biliar y la diseminacion de la infeccion dependen del tiempo de evolucion y que si bien el tratamiento medico preoperatorio mejora el pronostico, cuando las condiciones clinicas del enfermo permiten instituirlo, el tratamiento definitivo es el drenaje del coledoco y no debe soslayarse mas alla del lapso indispensable para hacer el diagnostico de la enfermeda