Trombosis espontánea de plexo pampiniforme: Reporte de un caso y revisión de literatura

Introducción: La trombosis de plexo pampiniforme es una entidad poco conocida, solo existen 31 casos reportados a la fecha. Objetivo: Presentación de un caso de una patología poco frecuente, descripción de las publicaciones anteriores y revisión de la literatura. Reporte de caso: Paciente de 20 años, sin antecedentes, con trombosis de plexo pampiniforme derecho. Sospecha inicial de hernia inguinal derecha complicada, el diagnóstico se realizó con ecografía Doppler y recibió tratamiento con anticoagulantes. Se complementó con tomografía y estudio de trombofilias. Discusión: El estudio y manejo ha sido variable, antes prevalecía la estrategia quirúrgica. Actualmente, algunos autores recomiendan el manejo conservador y otros proponen diferenciar el tratamiento según segmento anatómico comprometido. Conclusión: Al ser una entidad poco frecuente, el tratamiento es una decisión que debe ser tomada según cada caso, ya que no existen pautas de tratamiento, pero la tendencia es cada vez mayor hacia el tratamiento conservador. El rol de la anticoagulación está por definir. Es importante realizar un adecuado diagnóstico diferencial y búsqueda de causas subyacentes.

Introduction: Pampiniform plexus thrombosis is a rare entity, with only 31 cases reported to date. Aim: Presentation of a case of a rare disease, description of previous publications and review of the literature. Case report: 20-year-old patient, with no history, with right pampiniform plexus thrombosis. Initial suspicion was complicated right inguinal hernia, diagnosis was made with Doppler ultrasound and treatment with anticoagulation. It was complemented with tomography and study of thrombophilias. Discussion: The study and management has been variable, where the surgical strategy prevailed. Currently some authors recommend conservative management and others differentiate the treatment according to the compromised anatomical segment. Conclusion: Being a rare entity, conservative treatment or surgery continues to be a decision that must be made according to each case since there are no treatment guidelines, but the trend is increasing towards conservative treatment. The role of anticoagulation remains to be defined. It is important to carry out an adequate differential diagnosis and search for underlying causes.

Disección espontánea de arteria ilíaca asociada a ejercicio y uso de ergotamina / Spontaneous dissection of iliac artery related with excercise and ergotamine. A case report

Introduction: Spontaneous dissection of the iliac artery (SDIA) is an extremely rare clinical manifestation, associated to different etiologies, and it usually shows an ischemia of the involved lower extremity. Clinical case: We report a case of a 48-year-old man, with past medical history of chronicle consumption of ergotamine, which presented left lower limb ischemia, while practicing physical exercise. An emergent contrast-enhanced computed tomography scan showed a spontaneous dissection of the common and the external left iliac artery. An endovascular therapy of the lesion was performed with self-expanding stents, achieving the reconstruction of the lesion, the recovery of the blood flow and of the lower limb ischemia. Conclusions: There are no previous descriptions of the association between ergotamine consumption, sport and this very rare pathology. Endovascular treatment represents a less invasive and, such as in our case report, successful management of the SDIA, and it should be considered among the alternative therapies.

Introducción: La disección espontánea de la arteria ilíaca es un cuadro muy poco frecuente asociado a diferentes etiologías que habitualmente se presenta como isquemia de la extremidad comprometida. Caso clínico: Se reporta el caso de un paciente masculino de 48 años con antecedente de consumo crónico de ergotamina, quien mientras practicaba deporte presenta cuadro de isquemia aguda de la extremidad inferior izquierda. Angio tomografía computada demostró disección espontánea de la arteria ilíaca común y externa izquierda. Se realizó terapia endovascular de la lesión con stents auto expandibles, logrando la reparación de la lesión, el restablecimiento del flujo y la recuperación de la isquemia de la extremidad. Discusión y conclusiones: No existen reportes previos de esta patología poco frecuente, en que se asocie en forma conjunta la práctica de deporte y el uso de ergotamina. Dentro de las alternativas terapéuticas, la reparación endovascular representa una opción menos invasiva y, como en este caso, con óptimos resultados.

Kupffer-cell activity is essential for thyroid hormone rat liver preconditioning.

We studied the role of Kupffer cell functioning in T3 liver preconditioning against ischemia-reperfusion (IR) injury using the macrophage inactivator gadolinium chloride (GdCl3) previous to T3 treatment. Male Sprague-Dawley rats given a single i.p. dose of 0.1 mg T3/kg were subjected to 1 h ischemia followed by 20 h reperfusion, in groups of animals pretreated with 10 mg GdCl3/kg i.v. 72 h before T(3) or with the respective vehicles. IR resulted in significant enhancement of serum aspartate aminotransferase (3.3-fold increase) and tumor necrosis factor-alpha (93% increase) levels, development of liver damage, and diminished nuclear factor-kappaB DNA binding over control values. These changes, which were suppressed by the T3 administration prior to IR, persisted in animals given GdCl3 before T3 treatment, under conditions of complete elimination of ED2+ Kupffer cells achieved in a time window of 72 h. It is concluded that Kupffer cell functioning is essential for T3 liver preconditioning, assessed in a warm IR injury model by hepatic macrophage inactivation.

Molecular cloning of growth hormone-releasing hormone/pituitary adenylyl cyclase-activating polypeptide in the frog Xenopus laevis: brain distribution and regulation after castration.

Pituitary adenylyl cyclase-activating peptide (PACAP) appears to regulate several neuroendocrine functions in the frog, but its messenger RNA (mRNA) structure and brain distribution are unknown. To understand the potential role of PACAP in the male frog hypothalamic-pituitary-gonadal axis, we cloned the frog Xenopus laevis PACAP mRNA and determined its distribution in the brain. We then analyzed the castration-induced alterations of mRNA expression for PACAP and its selective type I receptor (PAC1) in the hypothalamic anterior preoptic area, a region known to regulate reproductive function. The PACAP mRNA encodes a peptide precursor predicted to give rise to both GH-releasing hormone and PACAP. The deduced peptide sequence of PACAP-38 was nearly identical to that of human PACAP with one amino acid substitution. Abundant PACAP mRNA was detected in the brain, but not several other tissues, including the testis. In situ hybridization revealed strong expression of the PACAP gene in the dorsal pallium, ventral hypothalamus, and nuclei of cerebellum. PACAP mRNA signals were weak to moderate in the hypothalamic anterior preoptic area and were absent in the pituitary. Castration induced an increase in the expression of PACAP and PAC1 receptor mRNAs in the hypothalamic anterior preoptic area after 3 days. Replacement with testosterone prevented the castration-induced changes. These results provide a molecular basis for studying the physiological functions of PACAP in frog brain and suggest that PACAP may be involved in the feedback regulation of hypothalamic-pituitary-gonadal axis.

Leiomiomas de yeyuno como causa de hemorragia digestiva baja masiva: análisis de 2 casos / Jejunal leiomyomas as cause of masive low digestive hemorrhage: analysis of 2 cases

La hemorragia digestiva baja masiva sigue siendo un problema difícil de resolver, a pesar de los avances en técnicas diagnósticas. Los tumores de intestino delgado constituyen sólo el 1-3 porciento de los tumores del tracto digestivo, y las lesiones intestinales en general conforman el 5 por ciento del total de las causas de hemorragias digestivas bajas. A pesar de su baja frecuencia, estos tumores, cuando se oresentan, plantean dificultad en su diagnóstico y tratamiento. Dado lo infrecuente de su aparición y por el desafío diagnóstico y terapéutico que plantean, se presentan dos casos de leiomiomas de yeyuno que debutaron como hemorragia digestiva masiva de origen desconocido y que fueron resueltas finalmente en forma quirúrgica