Tratamiento quirúrgico conservador del síndrome de HELLP (ELLP) asociado a hematoma hepático subcapsular / Conservative surgical treatment of HELLP syndrome (ELLP variant) associated with a subcapsular liver hematoma

Las complicaciones hemorrágicas graves asociadas al embarazo suelen ocurrir en el tercer trimestre del mismo y se relacionan frecuentemente con situaciones de preeclampsia y síndrome HELLP. El síndrome HELLP solo incide en el 0,5-0,9% de las gestaciones, pero su elevada morbimortalidad maternofetal nos obliga a tener en cuenta su diagnóstico en sus diversas formas de presentación clínica. Aunque la gran mayoría de las alteraciones hepáticas que ocurren en el embarazo tienen relación con las escasas hepatopatías inherentes al mismo, la duda diagnóstica ocurre con cierta frecuencia. Presentamos un caso de síndrome HELLP incompleto (variante ELLP) tratado efectivamente mediante actitud quirúrgica conservadora y cuyas peculiaridades inciden en diversos aspectos de esta entidad(AU)

Severe hemorrhagic complications associated with pregnancy usually occur within the third trimester and are frequently linked to preeclampsia and HELLP syndrome. HELLP syndrome affects only 0.5-0.9% of pregnancies but, because it causes high maternal-fetal mortality, a correct diagnosis of the various forms of presentation of this syndrome is essential. Although most of the liver alterations observed during pregnancy are related to pregnancy itself, diagnostic doubts are not infrequent. We present a case of incomplete HELLP syndrome (ELLP variant) associated with a subcapsular liver hematoma, which was successfully treated with a conservative surgical approach(AU)

Erectile dysfunction and hormonal imbalance in morbidly obese male is reversed after gastric bypass surgery: a prospective randomized controlled trial.

The effects of weight loss on erectile function and hormones have not been well studied. The aim of this study was to measure the degree to which sexual function and in particular erectile function and hormonal environment change after substantial weight loss, surgically and non-surgically induced in the morbidly obese male in a prospective randomized long-term controlled trial. Furthermore, how surgery makes a difference when treating morbidly obese men was envisaged in this context. We prospectively studied 20 morbidly obese men for 24 months, divided into two groups: group A included 10 patients who underwent life style modifications (exercise and diet) for 4 months and subsequently gastric bypass, and another 10 patients in group B were kept on weekly follow-up. None of the men were taking phosphodiesterase type-5 inhibitors. All patients underwent International Index of Erectile Function (IIEF)-5 questionnaire, serum oestradiol, prolactin (PRL), luteinizing (LH) and follicle-stimulating (FSH) hormones, free and total testosterone (FT and TT) at baseline (time 0), surgery - 4 months latter baseline (time 1) and final evaluation - 24 months (time 2). From times 0 to 1, group A presented a mean body mass index (BMI) reduction of 12.6 (p < 0.0001), whereas group B, 2.1 (p > 0.05). The BMI reductions between times 0 and 2 were 24.7 (p < 0.0001) and 0.7 (p > 0.05) for groups A and B respectively. BMI average between the two groups was similar at time 0 (p = 0.2142), and different at times 1 (p = 0.0033) and 2 (p < 0.0006). Increase in IIEF-5 score (p = 0.0469), TT (p = 0.0349) and FSH levels (p = 0.0025), and reduction in PRL level (p < 0.0001) were observed in group A from times 0 to 2 and 1 to 2. There were no changes from times 0 to 1. Comparing groups A and B at time 2, IIEF-5, TT and FT increased significantly in group A (p = 0.0224, 0.0043 and 0.0149 respectively). Surgery-induced weight loss increased erectile function quality measured by IIEF-5 questionnaire, increased TT, FT and FSH and reduced PRL levels. The hormonal impact verified could justify the improvement in erectile function. Lifestyle modifications impacted BMI without hormonal or sexual impact in morbidly obese. New studies are warranted in the field to support our data.

Comunicación pancreático-pleural secundaria a pseudoquiste pancreático. Una complicación de evolución variable / No disponible

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Structural model and functional significance of pH-dependent talin-actin binding for focal adhesion remodeling.

Actin filament binding by the focal adhesion (FA)-associated protein talin stabilizes cell-substrate adhesions and is thought to be rate-limiting in cell migration. Although F-actin binding by talin is known to be pH-sensitive in vitro, with lower affinity at higher pH, the functional significance of this pH dependence is unknown. Because increased intracellular pH (pH(i)) promotes cell migration and is a hallmark of metastatic carcinomas, we asked whether it increases FA remodeling through lower-affinity talin-actin binding. Talin contains several actin binding sites, but we found that only the COOH-terminal USH-I/LWEQ module showed pH-dependent actin binding, with lower affinity and decreased maximal binding at higher pH. Molecular dynamics simulations and NMR of this module revealed a structural mechanism for pH-dependent actin binding. A cluster of titratable amino acids with upshifted pK(a) values, including His-2418, was identified at one end of the five-helix bundle distal from the actin binding site. Protonation of His-2418 induces changes in the conformation and dynamics of the remote actin binding site. Structural analyses of a mutant talin-H2418F at pH 6.0 and 8.0 suggested changes different from the WT protein, and we confirmed that actin binding by talin-H2418F was relatively pH-insensitive. In motile fibroblasts, increasing pH(i) decreased FA lifetime and increased the migratory rate. However, expression of talin-H2418F increased lifetime 2-fold and decreased the migratory rate. These data identify a molecular mechanism for pH-sensitive actin binding by talin and suggest that FA turnover is pH-dependent and in part mediated by pH-dependent affinity of talin for binding actin.

Neoplasia epitelial pseudopapilar sólido- quística de páncreas (tumor de Frantz). Estudio de dos nuevos casos / No disponible

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[Solitary hepatic carcinoid tumor in a man with prior treatment for rectal adenocarcinoma. Rapid growth without carcinoid syndrome]. / Tumor carcinoide hepático único en un paciente tratado por adenocarcinoma de recto. Crecimiento rápido sin síndrome carcinoide.

We describe a case of hepatic carcinoid tumor that was diagnosed after right hepatectomy. The tumor was initially believed to be metastases from a rectal adenocarcinoma for which surgery had been performed seven years earlier. We highlight the localization of the tumor in the liver only, its large size and rapid growth, as well as the absence of carcinoid syndrome. Diagnostic studies of function and localization are presented. The absence of neoplasia in other locations suggested that this neoplasm was probably a primary hepatic carcinoid tumor. The association of carcinoid tumors with other neoplasms is well-known. However, because of our patient's history and the absence of symptoms, the preoperative diagnosis was incorrect. The definitive diagnosis was confirmed by pathological analysis, allowing specific studies of function and localization to be performed and therapeutic and follow-up measures to be adopted. Although surgery plays a crucial role in the treatment of these tumors, it should be performed in the context of the multidisciplinary management recommended for this disease.

Helminth fauna of Falconiform and Strigiform birds of prey in Galicia, Northwest Spain.

This is a survey of the helminth fauna of 285 individuals of 14 species of birds of prey (Falconiformes and Strigiformes) from Galicia (northwest Spain), namely Buteo buteo, Accipiter nisus, A. gentilis, Milvus migrans, M. milvus, Pernis apivorus, Circus pygargus, Falco tinnunculus, F. peregrinus, F. subbuteo, Tyto alba, Strix aluco, Asio otus and Athene noctua. A total of 15 helminth species were detected, namely 8 nematodes ( Eucoleus dispar, Capillaria tenuissima, Synhimantus laticeps, Microtetrameres sp., Physaloptera alata, Procyrnea leptoptera, Hovorkonema variegatum and Porrocaecum angusticolle), 4 cestodes ( Cladotaenia globifera, Paruterina candelabraria and Mesocestoides sp.), 2 trematodes ( Neodiplostomum attenuatum and Strigea falconis), and 1 acanthocephalan ( Centrorhynchus globocaudatus). The helminth communities observed were basically similar, although there were marked differences in species richness, which was higher in falconiforms (except for A. gentilis) than in strigiforms. More specifically, species richness was highest in B. buteo (13 species), followed by A. nisus (11 species). In the falconiforms, the helminth species present generally exhibited a clear relationship with host diet. In the strigiforms, by contrast, species richness was lower than expected given the host's diet, suggesting that a different explanation is needed.

Viral phenotype, antiretroviral resistance and clinical evolution in human immunodeficiency virus-infected children.

BACKGROUND: The syncytium-inducing (SI) viral phenotype and the emergence of viral strains resistant to zidovudine have been described in persons infected with HIV, and in some cases they have been associated with poor prognosis. METHODS: HIV isolates obtained from 37 HIV-infected children were analyzed to determine whether the SI viral phenotype and the mutation on the 215 position of the reverse transcriptase (M215) could be used as markers of disease progression. We performed peripheral blood coculture mononuclear cells, and we analyzed the induction of syncytia using the MT-2 cell line. The emergence of mutations on the 215 position was determined by PCR. RESULTS: We found a statistically significant association (P < 0.05) between SI viral phenotype and (1) recurrent serious bacterial infections, (2) absolute CD4+ cell counts <2 SD, (3) progression to AIDS and (4) death. Sixty percent of the children treated with zidovudine developed 215 mutant viral strains without statistically significant association with clinical or immunologic findings. The SI viral phenotype was statistically associated with the presence of the 215 mutation (P < 0.05). CONCLUSIONS: SI viral phenotype is a marker associated with a poor clinical and immunologic progression of the disease and it may facilitate the emergence of mutant strains in children treated with zidovudine.

Comparación hemodinámica entre isoflurane y sevoflurane en el paciente quemado / Hemodynamic comparison of isoflurane and sevoflurane in the burn patient

Se estudiaron prospectivamente 27 operaciones en 13 pacientes, con una superficie corporal total quemada media de 21 por ciento (10-57). La edad promedio fue de 37 años (16-78). Se excluyeron pacientes con distress respiratorio y/o con repercusión hemodinámica que requirieran drogas vasoactivas. En todos se obtuvo un perfil hemodinámico continuo, en tiempo real y no invasivo del gasto aórtico (GAM), presión arterial media (PAM), resistencia vasculares sistémicas (RVST) e intervalo tiempo sistólicos (ITS), PePi, LVET y relación PePi/LVET. Se inició la anestesia general con sevoflurane o isoflurane en forma randomizada y, en situación estable, se cambió de agente midiendo a los 30 minutos las eventuales repercusiones hemodinámicas. Ninguna de las diferencias fueron estadísticamente significativas. Todos los valores hemodinámicos medios de ambos agentes estuvieron dentro de los rangos de normalidad para esta etapa de los quemados. Como conclusión, parece no haber diferencias hemodinámicas significativas entre ambos agentes en este tipo particular de pacientes estudiado

[Frequency of Chlamydia trachomatis in the cervix of pregnant women during prenatal examinations]. / Frecuencia de Chlamydia trachomatis en el cérvix de pacientes embarazadas en control prenatal.

From February 1993 to October 1995, 80 endocervical samples taken from 80 pregnant patients in pre-natal control were examined in private practice at the Hospital Angeles del Pedregal in Mexico City for purposes of detecting Chlamydia trachomatis by direct inmunoflorecency. Gestational ages ranged from 20 to 39 week. A positive reaction to Chlamydia trachomatis was observed in 10% (8 patients) of the participating patients. Taking into account this frequency it is suggested that this study be a part of prenatal control.

Reversible bone marrow depression by high-dose piperacillin/tazobactam.

Bone marrow toxicity, mainly neutropenia, has been described as an uncommon secondary effect of most beta-lactams, and it is usually related to large cumulative doses. Although previously described for piperacillin, no cases of marrow depression caused by piperacillin/tazobactam have been reported to date. We report a case of reversible pancytopenia, with evidence of bone marrow depression, which occurred after a 17 d course of piperacillin/tazobactam. The drug was given to an underweight 18-year-old woman, at the usual dosage of 4/0.5 g three times a day. We stress the need for reducing the recommended dosage when treating underweight adult patients, and also of monitoring haematological parameters during prolonged treatments.