Effects of chronic inhibition of Testosterone metabolism on cardiac remodeling after ischemia/reperfusion-induced myocardial damage in gonadectomized rats.

The effects of testosterone on cardiovascular homeostasis are still not well understood. The objective of this work was to evaluate the effects of testosterone in the absence or presence of inhibition of Aromatase (4-hydroxyandrostenedione) and/or 5α reductase (Finasteride) enzymatic activities on the myocardial remodeling 30 days after ischemia/reperfusion (I/R) injury in gonadectomized rats. Results showed that testosterone administration to ORX rats resulted in decreased myocardial damaged area, inflammatory infiltrates and reduced MMP-3 and 13 expressions. Interestingly, Finasteride administration resulted in a greater decrease in scar tissue, inflammatory infiltrates, along with a significant decrease in MMP-3 and 13 expressions. In contrast, 4-hydroxyandrostenedione administrations increased all parameters. Our results suggest that testosterone does not have a direct effect since simultaneous inhibition of aromatase and 5α-reductase did not induce significant changes in I/R induced myocardial injury.

[Esophageal perforation]. / Perforación esofágica.

OBJECTIVE: We describe our experience in the management of esophageal perforation. MATERIAL AND METHODS: Retrolective study of the esophageal perforation patients, managed from January 1999 to December 2003. Analyzed variables were age, sex, aetiology, time of diagnosis and treatment, as well as ancillary methods employed, mode of treatment and morbidity and mortality. RESULTS: We found 13 patients: eight males (61.54%) and five females (38.46%), with an average age of 36.07 years with standard deviation of 19.77. Penetrating trauma was the leading cause in six cases, continued by iatrogenic perforation in four, Boerhaave's syndrome in one, foreign body in one, and blunt abdominal trauma in one. The principal symptom was pain in 84.61% of the cases. The esophagogram confirmed diagnosis in six cases (46.15%). The diagnosis was accomplished early in eight patients (61.54%) and late in five patients (38.46%). Nonsurgical treatment was carried out in two cases (15.38%) and surgical in 11 patients (84.62%). The average hospital stay was 22.45 days. Mortality in general was 15.38%, 0% for those with an early diagnosis and management and 40% for those delayed. CONCLUSIONS: An early diagnosis of esophageal perforation with the appropriate management (surgical or nonsurgical) will considerably diminish patient morbidity and mortality. A treatment choice could not be defined for the early or late diagnosis, but if surgical treatment is undertaken, adequate drainage for the perforation should be instituted as one of its principles.

[Gallstone ileus]. / Ileo biliar.

OBJECTIVE: To determine the frequency of gallstone ileus as a cholelithiasis complication and likely cause of intestinal obstruction, as well as the factors that can influence morbidity and mortality of these patients in our hospital. MATERIAL AND METHODS: The files of patients undergoing cholecystectomy, as well as of those patients surgically treated for intestinal obstruction between January 2001 and December 2003, were reviewed. We analyzed the files of patients with gallstone ileus for the following characteristics: age, sex, time of evolution, signs and symptoms, diagnosis, APACHE II, concomitant diseases, mode of treatment, obstruction/fistula site and morbidity and mortality. RESULTS: A total of 1054 patients for cholelithiasis and 189 for intestinal obstruction were treated surgically. Of these, there were seven cases of gallstone ileus: six females (85.7%) and one male (14.3%). Average age was 62.85 years (range: 39 to 89 years). Average time of evolution was 4.85 days until the surgical intervention. Preoperative diagnosis ws carried out in five of seven cases (71.42%). APACHE II for severity was present in all patients >60 years old; 71.42% of the cases presented some associated chronic illness. Surgical procedure was enterolithotomy without dismantlement of the fistula in five of seven cases and in two of seven cases surgery was carried out in a single stage. Obstruction occurred in ileum (four of seven cases), jejunum (two of seven cases), and one in the duodenum; the fistula occurred in duodenum in five cases and two cases in the stomach. Morbidity and general mortality were, respectively, 28.57% and 14.28%. CONCLUSIONS: We found a frequency of 0.66% of gallstone ileus as a complication of cholelithiasis (7/1054 cases) and 3.70% as a case of intestinal obstruction (7/189 cases), increasing to 12% in patients >60 years. The factors that elevated the morbidity and mortality were a delay in seeking medical care, patients > 60 years, associated chronic illnesses and an APACHE II for severity.