[Esplenectomía laparoscópica, una opción eficaz en un hospital de segundo nivel]. / Laparoscopic splenectomy, an efficient option in a second level hospital.

INTRODUCTION: Laparoscopic splenectomy was reserved for selected cases, however and because of the improvement in surgical technique and laparoscopic instruments, nowadays, there are few contraindications. METHOD: Retrospective and observational study of patients surgically treated of laparoscopic splenectomy secondary to hematologic diseases in a period span of 6 years. We analyzed demographic, preoperative, transoperative and postoperative variables. RESULTS: We studied eight patients, 62.5% were men with a mean age of 47.5 years. The most frequent hematologic diagnosis was idiopathic thrombocytopenic purpura (50%). The approach was laparoscopic in 100%. Median surgical time was 129.87 min and median transoperative bleeding was 396.25 cc. Median length of resected spleen was 15 cm. Median time for oral feeding was 20.62 h and total hospital stay was 4 days. There was only one reported complication. CONCLUSION: Laparoscopic splenectomy represents a safe and feasible option with rapid recovery and few complications.

INTRODUCCIÓN: La esplenectomía laparoscópica era reservada para pacientes sin esplenomegalia y enfermedades benignas; sin embargo, debido a la mejoría en la técnica y en los instrumentos de laparoscopía, actualmente las contraindicaciones son pocas. MÉTODO: Estudio retrospectivo y observacional de pacientes sometidos a esplenectomía laparoscópica por enfermedades hematológicas refractarias durante 6 años. Se analizaron variables demográficas, preoperatorias, transoperatorias y posoperatorias. RESULTADOS: Se estudiaron ocho pacientes, de los cuales el 62.5% eran hombres y la edad promedio era de 47.5 años. El diagnóstico hematológico más común fue púrpura trombocitopénica idiopática (50%). El abordaje fue laparoscópico en el 100% de los casos. El tiempo quirúrgico fue 129.87 minutos. El sangrado transoperatorio fue de 396.25 ml. El tamaño de los bazos resecados fue de 15 cm. El tiempo para el inicio de la vía oral fue de 20.62 horas y la estancia intrahospitalaria fue de 4 días. Se reportó una complicación. CONCLUSIÓN: La esplenectomía laparoscópica es un procedimiento seguro y factible, con recuperación rápida y menos complicaciones.

Role of SdiA on Biofilm Formation by Atypical Enteropathogenic Escherichia coli.

Atypical enteropathogenic Escherichia coli are capable to form biofilm on biotic and abiotic surfaces, regardless of the adherence pattern displayed. Several E. coli mechanisms are regulated by Quorum sensing (QS), including virulence factors and biofilm formation. Quorum sensing is a signaling system that confers bacteria with the ability to respond to chemical molecules known as autoinducers. Suppressor of division inhibitor (SdiA) is a QS receptor present in atypical enteropathogenic E.coli (aEPEC) that detects acyl homoserine lactone (AHL) type autoinducers. However, these bacteria do not encode an AHL synthase, but they are capable of sensing AHL molecules produced by other species, establishing an inter-species bacterial communication. In this study, we performed experiments to evaluate pellicle, ring-like structure and biofilm formation on wild type, sdiA mutants and complemented strains. We also evaluated the transcription of genes involved in different stages of biofilm formation, such as bcsA, csgA, csgD, fliC and fimA. The sdiA mutants were capable of forming thicker biofilm structures and showed increased motility when compared to wild type and complemented strains. Moreover, they also showed denser pellicles and ring-like structures. Quantitative real-time PCR (qRT-PCR) analysis demonstrated increased csgA, csgD and fliC transcription on mutant strains. Biofilm formation, as well as csgD, csgA and fimA transcription decreased on wild type strains by the addition of AHL. These results indicate that SdiA participates on the regulation of these phenotypes in aEPEC and that AHL addition enhances the repressor effect of this receptor on the transcription of biofilm and motility related genes.