Iberian pig early pregnancy: vascular endothelial growth factor receptor system expression in the maternofetal interface in healthy and arresting conceptuses.

In Iberian pigs, a high conceptus loss occurs during the first 30 days of gestation. Although the exact causes for these losses have not been determined to date, the importance of blood vessel development during early pregnancy has been noted. The aim of this study was to analyze the messenger RNA (mRNA) and protein expression of VEGF-rs (vascular endothelial growth factor, the VEGFR1, and the VEGFR2 receptor system) and elucidate a possible relationship with the conceptus status (healthy or arrested) on gestational Days (gd) 22 and 32. Both mRNA and protein expression for VEGF-rs molecules were consistently expressed in conceptuses and endometrium during the pregnancy period analyzed. In endometrium, a significant increase in VEGF mRNA and VEGFR2 mRNA expression in healthy sites was observed as pregnancy advances (P < 0.001 and P < 0.05, respectively), whereas VEGFR1 mRNA expression was maintained at a constant level. Interestingly, a significantly elevated VEGFR2 mRNA expression (P < 0.05) was observed on gd 22 in endometrium from arrested conceptuses. Furthermore, VEGF mRNA and VEGFR1 mRNA expression in trophoblasts from healthy conceptuses decreased as pregnancy proceeded (P < 0.001). Arrested trophoblasts on gd 32 showed higher VEGFR2 mRNA expression than healthy conceptuses (P < 0.05). Although, in endometrium attachment sites, the pattern of VEGF-rs immunostaning was not affected by conceptus status, the immunoexpression of VEGF-rs in healthy attachment sites increased slightly but consistently as gestation proceeded. In arresting trophoblasts, VEGF and VEGFR2 staining decreased from gd 22 to 32. Moreover, the number of VEGF and VEGFR1-positive capillaries in the subepithelial vascular plexus of endometrium was related to the conceptus status, showing a moderate increase in healthy sites as pregnancy advances. In conclusion, it appears that VEGF-rs is expressed and related to vascular development in Iberian pigs between gd 22 and 32. The upregulated expression of VEGF mRNA and VEGFR2 mRNA in healthy uterine sites suggests a significant role for these angiogenic factors in early pregnancy.

Gastric perforation and subarachnoid hemorrhage secondary to intragastric balloon device.

Obesity is a major health problem worldwide that leads to high morbidity and mortality rates. Medical options for obesity treatment are multiple and invasive therapy may be classified as surgical and non-surgical. Intragastric balloon device placement is an invasive non-surgical option that may benefit some obese patients. Potential complications related to intragastric balloon placement are multiple and perforations at the esophagus or stomach are the most hazardous. Prompt surgical management is mandatory upon the diagnosis of gastric perforation secondary to intragastric balloon to avoid further complications and mortality. Here we report an unusual case of patient that suffered both a subarachnoid hemorrhage as well as a gastric perforation related to intragastric balloon in which early diagnosis and prompt surgical treatment lead to a successful outcome.

Ileocolic intussusception secondary to Hodgkin's lymphoma. Report of a case.

Intussusception is a rare condition in adults and represents 1% to 5% of the total cases of intestinal obstruction. Preoperative diagnosis occurs only in a few patients and most of the cases are diagnosed during surgery. A demonstrable etiology is found in 70% to 90% of cases in adult intussusceptions, and approximately 40% of them are caused by primary or secondary malignant tumors. We report the case of a 32 year old male patient with an ileocolic intussusception secondary to Hodgkin's lymphoma, as well as the surgical treatment, and outcome.

Acute epiploic appendagitis. Report of three cases.

Primary epiploic appendagitis is a very rare condition that results from acute inflammation of an epiploic appendix. Clinical presentation is non-specific, and many times can mimic acute abdomen. When the diagnosis of epiploic appendagitis is made, conservative treatment must be initiated to avoid unnecessary surgery. We report three cases of acute epiploic appendagitis which were diagnosed by imaging and were managed conservatively with good clinical outcome.

[Laparoscopic therapy of gastric volvulus associated with hiatal hernia in the elderly patient]. / Tratamiento laparoscópico del vólvulo gástrico asociado a hernia hiatal en el paciente de edad avanzada.

Gastric volvulus is an abnormal rotation of one portion of the stomach around itself that may lead to gastric obstruction or an impairment of the vascular supply to the stomach leading to strangulation. This may present acutely or with chronic intermittent symptoms. Acute gastric volvulus is an emergency situation in which there is a closed loop obstruction and vascular compromise that requires urgent treatment. In the chronic type, unspecific abdominal pain is common. Chronic gastric volvulus must be treated to avoid complications, but there is not a standard treatment for this condition. Minimally invasion techniques, either endoscopic or laparoscopic offer the best option for treatment reducing morbidity and mortality rates. We report two cases of chronic gastric volvulus treated laparoscopically in the elderly.

Toxic megacolon secondary to Clostridium difficile colitis. Case report.

The incidence and severity of Clostridium difficile colitis has markedly increased in recent years. The spectrum of Clostridium difficile infection ranges from asymptomatic colonization to fulminant colitis requiring immediate surgery. Medical therapy failure and the presence of toxic megacolon dictate urgent surgical treatment with unfortunate high mortality rates (35% to 57%). We broach herein a case of toxic megacolon secondary to colitis due to Clostridium difficile infection in which early diagnosis and prompt surgical treatment led to a successful outcome.

Información escrita entregada por los equipos de soporte de Cuidados Paliativos a pacientes, familia y personal de atención primaria de salud en las visitas en domicilio / No disponible

Objetivo: conocer y comparar los distintos documentos que entregan los Equipos de Soporte de Cuidados Paliativos (ESCP) a los pacientes, familia y profesionales de Atención Primaria de Salud responsables del seguimiento de los pacientes incluidos en el Programa Regional de Cuidados Paliativos de Extremadura, en las visitas domiciliarias. Pretendemos averiguar si existen diferencias en las distintas áreas de salud y, de existir, si tienen relación con las características de dichas áreas y de sus ESCP. Material y método: el material de estudio son los documentos entregados por los ESCP y los datos demográficos y de recursos sanitarios de las áreas de salud de Extremadura, sin olvidar el personal de los ESCP. En cuanto a la metodología se realiza estudio estadístico descriptivo e inferencial. Resultados: cinco son los documentos entregados en domicilio: informe médico y de enfermería (lo entrega el 50% de los ESCP), hoja de tratamiento (100%), documento de presentación (75%), consejos impresos (75%) y hoja de registro de medicación subcutánea continua (12,5%). En cuanto al análisis comparativo solo encontramos diferencias estadísticamente significativas en el empleo de informe médico y de enfermería por los ESCP con menor presión asistencial (p = 0,0135). Conclusiones: existen pequeñas diferencias en el número, contenido y formato de los documentos que entregan los ESCP en domicilio. Cada ESCP ha encontrando lo que facilita la atención a los pacientes, familias y personal de Atención Primaria. Las diferencias son enriquecedoras, deben de verse como algo que respetar y de donde aprender

Objective: to know the different documents given by Palliative Care Support Teams in Extremadura’s Regional Palliative Care Program to patients, family members, and primary care professionals during home visits. We attempt to know any differences between health areas, and their relation to demographic characteristics and Palliative Care Support Teams. Material and method: the study material includes all documents given by Palliative Care Support Teams, and the demography and resources of health areas in Extremadura, including Palliative Care Support Team staff. A descriptive and comparative statistical study is made. Results: five documents are given during home visits: medical and nursing report (50%), treatment (100%), presentation document (75%), advice (75%), and registry for continuous subcutaneous medication (12.5%). Differences are statistically significant in the use of medical and nursing reports by Palliative Care Support Teams (p = 0.0135). Conclusions: differences in number, content, and format between the written documents given by Palliative Care Support Teams at home are small. The different Palliative Care Support Teams use the most appropriate written documents in their health areas. Differences are good, we must respect and learn from differences

[Left paraduodenal hernia: an unusual cause of intestinal obstruction.]. / Hernia paraduodenal izquierda:una causa inusual de obstrucción intestinal.

Paraduodenal hernias are an unusual cause of small bowel obstruction. The clinical spectrum varies from episodes of partial, intermittent,small bowel obstruction, to those of acute, complete small bowel obstruction, with the potential risk of complications such as intestinal ischemia,perforation and abdominal sepsis. Reported here in is the case of a 53 year old man with complete small bowel obstruction secondary to a left paraduodenal hernia, in whom operative treatment consisted of reduction of the hernia content, small bowel decompression and closure of the hernia ring. The operation successfully resolved the acute event and has prevented recurrences during a 4 year follow-up.

[Iron metabolism in patient infected by human immunodeficiency virus type 1]. / Metabolismo del hierro en pacientes infectados por el virus de la inmunodeficiencia humana tipo 1.

BACKGROUND: The aim of this work was to assess the major iron metabolism values in patients infected by human immunodeficiency virus (HIV), and to evaluate the correlation between these data and the immunological status of the patients as expressed by CD4 lymphocyte count. PATIENTS AND METHODS: Seventy-one patients infected by HIV (51 men and 20 women) with mean age of 29 years, plus a control group of 32 healthy subjects were studied. Haemoglobin, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, ferritin, transferrin, serum iron, total iron binding capacity and transferrin saturation index were studied in all of them. Erythrocyte sedimentation rate (ESR) and ALT were also determined in order to estimate the ferritin/ALT quotient. RESULTS: Mean haemoglobin concentration in the HIV-infected patients (133 +/- 22 g/L) was significantly lower (p < 0.05) than that of the control group (147 +/- 16 g/L), its decrease correlating in accordance with the CD4-cell count. Serum iron values in HIV infected patients (82 +/- 40 micrograms/L) are significantly lower (p < 0.02) than those of the control subjects (115 +/- 56 micrograms/ dL), decreasing in parallel with the number of CD4 lymphocytes. Serum ferritin of the HIV patients (259 +/- 250 ng/mL) is significantly higher that that of the normal group (95 +/- 73 ng/ mL), increasing with the decrease of CD4 cells. Significant correlation was found between ferritin and CD4 cells (r = 0.46, p < 0.0003) and positive correlation between ferritin and ESR (r = 0.70, p < 0.001) were found. CONCLUSIONS: As HIV infection advances, progressive anaemia is established. The study of iron metabolism in these patients shows a pattern similar to that of the anaemia of chronic diseases, with even higher serum ferritin. These changes might be due to iron sequestration in phagocytic cells induced by release of cytokines.