Vólvulo de vesícula biliar, a propósito de un caso / Gallbladder Volvulus: a case report

RESUMEN Introducción: el vólvulo de la vesícula biliar se define como la torsión del órgano sobre su mesenterio a lo largo del eje del conducto y arteria cística, es una enfermedad rara, que ocurre con mayor frecuencia en mujeres ancianas. Presentación del caso: se trata de una paciente femenina de 46 años de edad, de color de piel blanca, con antecedentes patológicos personales de úlcera duodenal, que practica hábitos tóxicos como el fumar y la ingestión de café. No se ha sometido con anterioridad a procederes quirúrgicos. Acude a cuerpo de guardia de Cirugía General del Hospital Clínico Quirúrgico Provincial Abel Santamaría Cuadrado de Pinar del Río con dolor en hipocondrio derecho, de leve intensidad y de aproximadamente 24 horas de evolución, acompañado de náuseas y dos vómitos con restos de alimentos. Se le diagnostica vólvulo de vesícula biliar, por lo cual recibe tratamiento quirúrgico. Conclusiones: el vólvulo de vesícula biliar, enfermedad infrecuente de gran similitud clínica a otras patologías de abdomen agudo, hace muy complejo su diagnóstico preoperatorio. No obstante, el advenimiento de las nuevas técnicas imagenológicas maniobradas por especialistas capacitados, junto con la correcta aplicación del método clínico epidemiológico facilitaron la capacidad diagnóstica que permitiera a los cirujanos tomar la decisión terapéutica acertada para el paciente, con resultados satisfactorios.

ABSTRACT Introduction: gallbladder volvulus is defined as the twisting of the organ over its mesentery along the axis of the duct and cystic artery; it is a rare disease, which more frequently occurs in older women. Case report: a 46 year-old, white skin color female patient, with personal pathological history of duodenal ulcer, having smoking and coffee ingestion habits, who has not previously undergone surgical procedures, she comes to the emergency room of the General Surgery Department at Abel Santamaria Cuadrado Provincial General Hospital in Pinar del Río referring pain in right hypochondriac region, of slight intensity and of approximately 24 hours of evolution; accompanied by nausea and two vomits with food remains. He is diagnosed with gallbladder volvulus, undergoing surgical treatment. Conclusions: gallbladder volvulus, an infrequent entity of great clinical similarity to other pathologies of the acute abdomen, makes a very complex pre-surgical diagnosis; nevertheless, the introduction of new imaging techniques performed by trained specialists, together with the accurate application of the clinical epidemiological method facilitated the diagnostic capacity, allowing the surgeons to take a correct and timely therapeutic decision for the patient and with satisfactory results.

An ascomycota coculture in batch bioreactor is better than polycultures for cellulase production.

Efficient hydrolysis of holocellulose depends on a proper balance between cellulase (endoglucanase, exoglucanase, ß-glucosidase) and xylanase activities. The present study aimed to induce the production of cellulases and xylanases using liquid cultures (one, two, three, and four fungal strains on the same bioreactor) of wild strains of Trichoderma harzianum, Aspergillus niger, and Fusarium oxysporum. The strains were identified by amplification and analysis of the ITS rDNA region and the obtained sequences were deposited in Genbank. Enzymes (endoglucanase, exoglucansae, ß-glucosidase, and xylanase activities) and the profile of extracellular protein isoforms (SDS-PAGE) produced by different fungal combinations (N = 14) were analyzed by Pearson's correlation matrix and principal component analysis (PCA). According to our results, induction of endoglucanase (19.02%) and ß-glucosidase (6.35%) were obtained after 4 days when A. niger and F. oxysporum were cocultured. The combination of A. niger-T. harzianum produced higher endoglucanase in a shorter time than monocultures. On the contrary, when more than two strains were cultured in the same reactor, the relationships of competition were established, trending to diminish the amount of enzymes and the extracellular protein isoforms produced. The xylanase production was sensible to stress produced by mixed cultures, decreasing their activity. This is important when the aim is to produce cellulase-free xylanase. In addition, exoglucanase activity did not change in the combinations tested.

Laccase induction by synthetic dyes in Pycnoporus sanguineus and their possible use for sugar cane bagasse delignification.

The use of synthetic dyes for laccase induction in vivo has been scarcely explored. We characterized the effect of adding different synthetic dyes to liquid cultures of Pycnoporus sanguineus on laccase production. We found that carminic acid (CA) can induce 722 % and alizarin yellow 317 % more laccase than control does, and they promoted better fungal biomass development in liquid cultures. Aniline blue and crystal violet did not show such positive effect. CA and alizarin yellow were degraded up to 95 % during P. sanguineus culturing (12 days). With this basis, CA was selected as the best inducer and used to evaluate the induction of laccase on solid-state fermentation (SSF), using sugarcane bagasse (SCB) as substrate, in an attempt to reach selective delignification. We found that laccase induction occurred in SSF, and a slight inhibition of cellulase production was observed when CA was added to the substrate; also, a transformation of SCB under SSF was followed by the 13C cross polarization magic angle spinning (CPMAS) solid-state nuclear magnetic resonance (NMR). Results showed that P. sanguineus can selectively delignify SCB, decreasing aromatic C compounds by 32.67 % in 16 days; O-alkyl C region (polysaccharides) was degraded less than 2 %; delignification values were not correlated with laccase activities. Cellulose-crystallinity index was increased by 27.24 % in absence of CA and 15.94 % when 0.01 mM of CA was added to SCB; this dye also inhibits the production of fungal biomass in SSF (measured as alkyl C gain). We conclude that CA is a good inducer of laccase in liquid media, and that P. sanguineus is a fungus with high potential for biomass delignification.

Ethanol induction of laccase depends on nitrogen conditions of Pycnoporus sanguineus

Background Ethanol has been pointed out as a laccase inducer. However, there are controversial reports about its efficiency with some fungi. In this study, we hypothesized that ethanol laccase induced in Pycnoporus sanguineus depends on nitrogen nutriment conditions. To prove this, we assessed laccase production in submerged cultures of P. sanguineus, with different nitrogen concentrations and with, or without ethanol added in a factorial designed experiment. Results In order to analyze the effects of factors on the response variables, a factorial ANOVA, and response-surface models were performed. It was found that the nitrogen source was the main factor that affected laccase production in P. sanguineus. The treatments with yeast extract (2 g/L) and ethanol (3 g/L) induced the highest laccase activity (31.01 ± 4.9 U/L), while the treatments with urea reached the lowest activity (less than 1.6 U/L). Ethanol had positive and synergic effects on laccase production, in accordance with the surface response model, as long as simple nitrogen sources (urea) were not available. Conclusions We suggest that laccase in P. sanguineus is regulated by a catabolic nitrogen repression mechanism; laccase activity is strongly inhibited by urea used as nitrogen source and it decreases when the amount of urea increases; contrarily, a synergic positive effect was observed between yeast extract and ethanol on laccase production.

Effects of treadmill running and fatigue on impact acceleration in distance running.

The effects of treadmill running on impact acceleration were examined together with the interaction between running surface and runner's fatigue state. Twenty recreational runners (11 men and 9 women) ran overground and on a treadmill (at 4.0 m/s) before and after a fatigue protocol consisting of a 30-minute run at 85% of individual maximal aerobic speed. Impact accelerations were analysed using two lightweight capacitive uniaxial accelerometers. A two-way repeated-measure analysis of variance showed that, in the pre-fatigue condition, the treadmill running decreased head and tibial peak impact accelerations and impact rates (the rate of change of acceleration), but no significant difference was observed between the two surfaces in shock attenuation. There was no significant difference in acceleration parameters between the two surfaces in the post-fatigue condition. There was a significant interaction between surface (treadmill and overground) and fatigue state (pre-fatigue and post-fatigue). In particular, fatigue when running overground decreased impact acceleration severity, but it had no such effect when running on the treadmill. The effects of treadmill running and the interaction need to be taken into account when interpreting the results of studies that use a treadmill in their experimental protocols, and when prescribing physical exercise.