Manejo quirúrgico de biopolímeros en punta nasal: reporte de caso y revisión de la literatura / Surgical Management of Biopolymers in Nasal Tip: Case Report and Literature Review

Introducción: los rellenos faciales han sido ampliamente utilizados a nivel mundial. Existen rellenos temporales, semipermanentes y permanentes. En cuanto a los rellenos permanentes, la silicona es la más utilizada y está aprobada por la agencia gubernamental de los Estados Unidos, la Administración de Alimentos y Medicamentos (FDA), en dos presentaciones para el desprendimiento de la retina. En 1997 se autorizó el uso off-label de Adatosil y Silicon 100, ambas prescritas durante la relación médico-paciente. Se han descrito múltiples eventos adversos secundarios a la inyección de silicona como relleno facial, principalmente síntomas inflamatorios, reacción a cuerpo extraño, sepsis y migración del producto, que por lo general se presentan por una aplicación inapropiada por personal sin entrenamiento. Caso clínico: se presenta el caso de un paciente masculino en la quinta década de la vida, a quien le aplicaron silicona en aceite a nivel de la punta nasal; posteriormente, presenta dermatopatía secundaria sin respuesta al manejo médico, por lo cual requiere manejo quirúrgico para el retiro del material alogénico y reconstrucción nasal secundaria. Se dan recomendaciones para el manejo quirúrgico de estos pacientes.

Introduction: Injectable facial fillers have been widely used worldwide. There are temporary, semipermanent, and permanent fillers. Regarding permanent fillers silicone is the most widely used, approved by the Food and Drug Administration (FDA) in two presentations Adatosil and Silicon 100 for retinal detachment. In 1997 the FDA allows for the off-label use prescribed within the doctor-patient relationship. There have been reported multiple adverse events, mainly inflammatory symptoms, foreign body reactions, sepsis, and product migration generally occurring by inappropriate application by untrained personnel. Case report: We present the case of a male patient in the fifth decade of life who underwent the application of silicone oil at the level of the nasal tip, and later presented secondary dermatopathy without response to medical management, which requires surgical management to remove the allogeneic material and secondary nasal reconstruction

Local Sustained Delivery of Anti-IL-17A Antibodies Limits Inflammatory Bone Loss in Murine Experimental Periodontitis.

Periodontal disease (PD) is a chronic destructive inflammatory disease of the tooth-supporting structures that leads to tooth loss at its advanced stages. Although the disease is initiated by a complex organization of oral microorganisms in the form of a plaque biofilm, it is the uncontrolled immune response to periodontal pathogens that fuels periodontal tissue destruction. IL-17A has been identified as a key cytokine in the pathogenesis of PD. Despite its well documented role in host defense against invading pathogens at oral barrier sites, IL-17A-mediated signaling can also lead to a detrimental inflammatory response, causing periodontal bone destruction. In this study, we developed a local sustained delivery system that restrains IL-17A hyperactivity in periodontal tissues by incorporating neutralizing anti-IL-17A Abs in poly(lactic-coglycolic) acid microparticles (MP). This formulation allowed for controlled release of anti-IL-17A in the periodontium of mice with ligature-induced PD. Local delivery of anti-IL-17A MP after murine PD induction inhibited alveolar bone loss and osteoclastic activity. The anti-IL-17A MP formulation also decreased expression of IL-6, an IL-17A target gene known to induce bone resorption in periodontal tissues. This study demonstrates proof of concept that local and sustained release of IL-17A Abs constitutes a promising therapeutic strategy for PD and may be applicable to other osteolytic bone diseases mediated by IL-17A-driven inflammation.

Tumores de nariz y senos paranasales en pacientes pediátricos: experiencia de un hospital pediátrico de cuarto nivel en Bogotá, Colombia, 2013-2018 / Nasal and Paranasal Sinus Tumours in the Pediatric Population: Experience from a Pediatric Hospital in Bogotá, Colombia, 2013 ­ 2018

Introducción: los tumores en la cavidad nasal y los senos paranasales son un problema serio en la población pediátrica, principalmente por la inespecificidad de los síntomas que lleva a que pasen de meses a años antes de la sospecha de una patología neoplásica, con un impacto en la calidad de vida del paciente y su entorno. Al sospechar de la presencia de un tumor nasosinusal se requiere la realización de imágenes diagnósticas como la resonancia magnética y la tomografía computarizada de los senos paranasales. Cuando se tiene un diagnóstico etiológico, siempre se debe realizar un abordaje multidisciplinario. Materiales y métodos: realizamos un estudio retrospectivo de corte transversal de la cohorte de pacientes con tumores de nariz y senos paranasales atendidos en un hospital pediátrico de cuarto nivel en Bogotá, Colombia, entre 2013-2018. Resultados: se incluyeron un total de 54 pacientes con tumores malignos y benignos de nariz y senos paranasales, la mayoría fueron hombres con un promedio de edad de ocho años. Generalmente se presentaron con síntomas nasosinusales, el principal fue obstrucción nasal en el 80 % de los pacientes. El diagnóstico mas común fue craneofaringioma en un tercio de los pacientes, seguido por angiofibroma nasofaríngeo y linfoma de Burkitt. Conclusión: es importante conocer los síntomas y características clínicas de los pacientes pediátricos con tumores nasofaríngeos. Por esta razón, se considera importante presentar la casuística y características de los tumores de nariz y senos paranasales recogida durante 5 años, en un hospital pediátrico de cuarto nivel en la ciudad de Bogotá, Colombia

Introduction: Tumors in the nasal cavity and paranasal sinuses in children is a serious problem in the pediatric population, mainly due to the non-specificity of the symptoms that leads to years or months passing before the suspicion of a neoplastic pathology. With an important impact in quality of life not only in the patient but also in its family environment. When suspecting a sinonasal tumor, diagnostic images such as magnetic resonance and computed tomography of the paranasal sinuses are required. When you have an etiological diagnosis always do a multidisciplinary approach. Methods: We conducted a cross-sectional study of the cohort of patients that had been diagnose with tumors of the nasal cavity or paranasal sinuses in a fourth level pediatric hospital in Bogota, Colombia between 2013 - 2018. Results: 54 patients were included, the majority of them were men, with an average age of eight years. They mainly presented with nasal symptoms, the main one being nasal obstruction in 80% of patients. The most common diagnosis was cranipharyngioma in one third of the patients, followed by nasopharyngeal angiofibroma and Burkitt lymphoma. Conclusion: We present this article with the objective of presenting the tumors of nose and paranasal sinuses casuistry collected during 5 years in a fourth level pediatric hospital in the city of Bogotá and the imaging characteristics for the diagnosis of these are reviewed with some clinical cases as examples.

Extracellular Vesicles Loaded miRNAs as Potential Modulators Shared Between Glioblastoma, and Parkinson's and Alzheimer's Diseases.

Glioblastoma (GBM) is the deadliest brain tumor. Its poor prognosis is due to cell heterogeneity, invasiveness, and high vascularization that impede an efficient therapeutic approach. In the past few years, several molecular links connecting GBM to neurodegenerative diseases (NDDs) were identified at preclinical and clinical level. In particular, giving the increasing critical role that epigenetic alterations play in both GBM and NDDs, we deeply analyzed the role of miRNAs, small non-coding RNAs acting epigenetic modulators in several key biological processes. Specific miRNAs, transported by extracellular vesicles (EVs), act as intercellular communication signals in both diseases. In this way, miRNA-loaded EVs modulate GBM tumorigenesis, as they spread oncogenic signaling within brain parenchyma, and control the aggregation of neurotoxic protein (Tau, Aß-amyloid peptide, and α-synuclein) in NDDs. In this review, we highlight the most promising miRNAs linking GBM and NDDs playing a significant pathogenic role in both diseases.

Galectin-3 Exerts a Pro-differentiating and Pro-myelinating Effect Within a Temporal Window Spanning Precursors and Pre-oligodendrocytes: Insights into the Mechanisms of Action.

Oligodendrocytes (OLG) are the cells resident in the CNS responsible for myelination. OLG undergo a succession of morphological and molecular changes along several maturational stages. Galectin-3 (Gal-3) is a 25- to 35-KDa protein belonging to the family of carbohydrate-binding galectins, which bind to glycoconjugates containing ß-galactosides. Gal-3 lacks a specific receptor and its binding is thus rather unspecific, as it depends on the cellular environment and the repertoire of glycomolecules at the time when Gal-3 is present. Our previous work revealed that recombinant Gal-3 (rGal-3)-treated OLG showed accelerated differentiation, evidenced by an increase in the number of mature cells to the detriment of immature ones and accelerated actin cytoskeleton dynamics. These changes were a consequence of rGal-3 influence on Akt, Erk 1/2, and ß-catenin signaling pathways. Considering this previous evidence, the aim of this study was to identify the temporal window of rGal-3 action on the OLG lineage to induce OLG maturation by using specific single pulses of rGal-3 over the different maturational stages of OLG, and to unravel its main direct targets promoting OLG differentiation by mass spectrometry analysis. Our results reveal a key temporal window spanning between OPC and pre-OLG states in which rGal-3 action promotes OLG differentiation, and identify several targets for rGal-3 binding including proteins related to the cytoskeleton, signaling pathways, metabolism and intracellular trafficking, among others. These results highlight the relevance of Gal-3 in signaling pathways regulating oligodendroglial differentiation and support a potential therapeutic role for rGal-3 in demyelinating diseases such as multiple sclerosis.

Indicaciones y resultados de la supraglotoplastia en pacientes pediátricos en la Fundación Hospital de la Misericordia en Bogotá, Colombia, una ciudad a 2 600 metros sobre el nivel del mar, del año 2017-2018 / Indications and results of supraglottoplasty in pediatric patients at Fundación Hospital de la Misericordia in Bogotá, Colombia, a city at 2,600 meters above sea level, years 2017-2018

La causa más común de estridor en población pediátrica es la laringomalacia. En trabajos publicados a nivel del mar se ha descrito una incidencia del 70% en pacientes con estridor. Materiales y Métodos: Realizamos un estudio retrospectivo de corte transversal de la cohorte de pacientes operados de supraglotoplastía en un hospital pediátrico de cuarto nivel en una ciudad localizada a 2600 mts de altitud entre el año 2017 - 2018. Resultados: Fueron intervenidos 44 pacientes, el 55% de los pacientes eran mujeres, con una mediana de edad de 11 meses (RIQ 11 días ­ 6 años), el 4,5% fueron diagnosticados con laringomalacia Tipo I, Tipo II 43%, 2,2% Tipo III y mixtas 29,5% según la clasificación de Olmey. La indicación quirúrgica se debió a falla del medro en 8 pacientes, Síndrome sibilante con riesgo inminente de falla respirato Trabajos ria en 17, episodio breve resuelto inexplicado (BRUE) de alto riesgo en 3 y apnea del sueño de predominio obstructivo 20 pacientes. De los 20 pacientes con síndrome de apnea del sueño se obtuvo el resultado del polisomnograma en 18 pacientes donde el promedio de Índice de apnea hipopnea fue de 30,5 con una desaturación de oxígeno máxima (Nadir) del 70%. Con respecto a la intervención quirúrgica se realizó supraglotoplastia tipo I en 5 pacientes, tipo II en 30, y en 9 tipo III. el 95% de los pacientes presentaban alguna comorbilidad y el 25% de los pacientes tenían diagnóstico de anomalías craneofaciales. En 9 pacientes con síndrome de apnea hipopnea del sueño se obtuvo un polisomnograma postoperatorio con un promedio de Índice de apnea hipopnea de 15 con un nadhir del 82,8%. Conclusión: Al analizar los datos obtenidos encontramos que los pacientes operados en altura por esta condición presentan una menor incidencia de resolución completa del SAHs, pero presentan mejoría de los síntomas durante el sueño, y la saturación de oxigeno mínima, independientemente del índice de apnea hipopnea residual

The most common cause of stridor in pediatric population is laryngomalacia. In papers published at sea level it has been describe an incidence of 70% in patients with stridor. We conducted a cross-sectional study of the cohort of patients that had undergo supraglotoplasty surgery in a fourth level pediatric hospital in a city located at an altitude of 2600 meter between 2017 - 2018. 44 patients were intervened, 4.5% of whom were diagnosed with type I laryngomalacia, 43% type II, 2.2% type III, 29.5% has more tan one type this according to Oley´s classification. The surgical indication was due to growing failure in 8 patient, inminent risk to respiratory failure in 17, high risk BRUE in 3 and severe sleep apnea in 20. Type I supraglotoplasty was performed in 5 patients , type II in 30 and in 9 type III. In 14 patients it was performed and additional procedure as dilatation of subglottic stenosis, amigdalectomy and tongue base resection. 95% of the patients had a comorbidity and 25% had a diagnosis of craniofacial anomalies. Conclusión: When analyzing the data obtained we found that patients operated at height for laryngomalacia, have a lower incidence of complete resolution of OSA, but show improvement of symptoms during sleep and minimal oxygen saturation, regardless of the residual hypopnea apnea index. The authors recommend pediatric otolaryngologists to take this difference into account when adressing a patient with laryngomalacia and other comorbidities.

Extracellular Galectin-3 Induces Accelerated Oligodendroglial Differentiation Through Changes in Signaling Pathways and Cytoskeleton Dynamics.

Galectin-3 (Gal-3) is a chimeric protein structurally composed of unusual tandem repeats of proline and short glycine-rich segments fused onto a carbohydrate recognition domain. Our studies have previously demonstrated that Gal-3 drives oligodendrocyte (OLG) differentiation to control myelin integrity and function. The cytoskeleton plays a key role in OLG maturation: the initial stage of OLG process extension requires dynamic actin filament assembly, while subsequent myelin wrapping coincides with the upregulation of actin disassembly proteins which are dependent on myelin basic protein (MPB) expression. In this context, the aim of the present work was to elucidate the mechanism by which recombinant Gal-3 (rGal-3) induces OLG maturation, giving special attention to the actin cytoskeleton. Our results show that rGal-3 induced early actin filament assembly accompanied by Erk signaling deactivation, which led to a decrease in the number of platelet-derived growth factor receptor α (PDGFRα)+ cells concomitantly with an increase in the number of 2',3'-cyclic-nucleotide 3'-phosphodiesterase (CNPase)+ cells at 1 day of treatment (TD1), and Akt signaling activation at TD1 and TD3. Strikingly, rGal-3 induced an accelerated shift from polymerized to depolymerized actin between TD3 and TD5, accompanied by a significant increase in MBP, gelsolin, Rac1, Rac1-GTP, and ß-catenin expression at TD5. These results were strongly supported by assays using Erk 1/2 and Akt inhibitors, indicating that both pathways are key to rGal-3-mediated effects. Erk 1/2 inhibition in control-treated cells resembled an rGal-3 like state characterized by an increase in MBP, ß-catenin, and gelsolin expression. In contrast, Akt inhibition in rGal-3-treated cells reduced MBP, ß-catenin, and gelsolin expression, indicating a blockade of rGal-3 effects. Taken together, these results indicate that rGal-3 accelerates OLG maturation by modulating signaling pathways and protein expression which lead to changes in actin cytoskeleton dynamics.

Galectin-3-Mediated Glial Crosstalk Drives Oligodendrocyte Differentiation and (Re)myelination.

Galectin-3 (Gal-3) is the only chimeric protein in the galectin family. Gal-3 structure comprises unusual tandem repeats of proline and glycine-rich short stretches bound to a carbohydrate-recognition domain (CRD). The present review summarizes Gal-3 functions in the extracellular and intracellular space, its regulation and its internalization and secretion, with a focus on the current knowledge of Gal-3 role in central nervous system (CNS) health and disease, particularly oligodendrocyte (OLG) differentiation, myelination and remyelination in experimental models of multiple sclerosis (MS). During myelination, microglia-expressed Gal-3 promotes OLG differentiation by binding glycoconjugates present only on the cell surface of OLG precursor cells (OPC). During remyelination, microglia-expressed Gal-3 favors an M2 microglial phenotype, hence fostering myelin debris phagocytosis through TREM-2b phagocytic receptor and OLG differentiation. Gal-3 is necessary for myelin integrity and function, as evidenced by myelin ultrastructural and behavioral studies from LGALS3- / - mice. Mechanistically, Gal-3 enhances actin assembly and reduces Erk 1/2 activation, leading to early OLG branching. Gal-3 later induces Akt activation and increases MBP expression, promoting gelsolin release and actin disassembly and thus regulating OLG final differentiation. Altogether, findings indicate that Gal-3 mediates the glial crosstalk driving OLG differentiation and (re)myelination and may be regarded as a target in the design of future therapies for a variety of demyelinating diseases.

Aspergillus hepatic artery thrombosis in liver transplantation.

We present the first cirrhotic patient who underwent liver transplantation (LT) and presented a hepatic artery thrombosis of the graft due to Aspergillus fumigatus, within the first month of LT. This culminated in graft loss, re-transplant with multiple biliary and infectious complications. To our knowledge, this is a case report of an early hepatic artery thrombosis due to Aspergillus fumigatus in an infection-free patient.

Seguimiento inmunológico con anticuerpos anti-HLA por tecnología Luminex™, ¿se puede prevenir el rechazo agudo celular y humoral en trasplante de intestino? / Anti-HLA antibody immunological follow up by the Luminex TM. Is it possible to prevent the acute cell and humoral immune rejection in small bowel transplant? Report of one case

Introducción. El trasplante de intestino mejora la supervivencia de pacientes con falla intestinal secundaria al síndrome de intestino corto. Estos receptores tienen gran riesgo de rechazo agudo, por lo cual, de manera protocolaria y como método de referencia, se practican biopsias intestinales. En este reporte de caso se hizo el seguimiento inmunológico de anticuerpos anti-HLA por tecnología Luminex™ (LSA) de un paciente con trasplante de intestino más biopsias por protocolo para un diagnóstico temprano, y una adecuada correlación histológica. Presentación del caso. Se trata de un paciente de 20 años de edad con síndrome de intestino corto, que ingresó a la Fundación Valle del Lili (Cali, Colombia) y requirió un trasplante aislado de intestino. El seguimiento inmunológico se hizo con tecnología Luminex™ y biopsias intestinales mensuales. Según la tamización contemplada en el protocolo previo al trasplante, el paciente tuvo anticuerpos anti-HLA (PRA de clase I y II) negativos; y a los 11 meses después del trasplante, los anticuerpos anti-HLA de clase I y II fueron positivos. Con la prueba de LSA se detectó un anticuerpo específico contra donantes (Donor Specific Antibodies, DSA) y varios anticuerpos contra otros subtipos moleculares. Se tomó una biopsia que mostró un leve rechazo celular agudo y se inició tratamiento con plasmaféresis. Hasta 21 meses después del trasplante, el paciente no ha presentado rechazos clínicos y ha tenido una adecuada evolución clínica y paraclínica Conclusión. Este es el primer trasplante de intestino en nuestro centro, en el que se hace seguimiento inmunológico con tecnología Luminex™. Consideramos que la detección con DSA es un buen marcador de rechazo agudo humoral, que permitiría una aproximación diagnóstica y una intervención oportuna

Background: Small bowel transplant improves survival of the recipients that have intestinal failure secondary to short bowel syndrome. These patients have a high risk of acute rejection; for this reason bowel biopsies are performed as protocol and is the gold standard. Immunological follow-up of anti-HLA antibodies with Luminex® technology (LSA) was carried out in a patient with intestinal transplant and biopsies were performed to achieve an early diagnosis and a suitable histological correlation. Case report: A 20-year-old patient with short bowel syndrome secondary to extensive intestinal resection due to a complicated appendicitis underwent isolated bowel transplantation. The post-transplant immunological follow-up was performed with LSA and monthly intestinal biopsies. Antibodies with mean fluorescence intensity greater than 1500 were positive. During the pre-transplant protocol, the patient was screened for anti-HLA antibodies with negative results. Eleven months post-transplant, the screening test for anti-HLA Class I and II antibodies was positive; the specificity of the LSA test detected one specific donor antibody (DSA) and several antibodies against other molecular subtypes. The biopsy result was a mild acute cellular rejection and plasmapheresis therapy was started. The patient has not presented a clinical rejection, and at 21 months post-transplantation exhibits an adequate clinical and paraclinical evolution. Conclusions: This is the first small bowel transplant where immunological follow-up is done with LSA. We believe that the detection of DSA is a marker of acute humoral rejection that allows a diagnostic approach and a timely intervention

Cirugía endoscópica endonasal para resección de tumores de base de cráneo en población pediátrica: Experiencia en el Instituto Nacional de Cancerología / Endoscopic endonasal surgery for resection of skull base tumors in the pediatric population The National Cancer Institute experience

Introducción: La cirugía endoscópica endonasal se ha convertido en una herramienta fundamental para el manejo de patologías que comprometen la base de cráneo. En casos bien seleccionados, estas técnicas permiten resecciones quirúrgicas con una menor morbilidad sin comprometer los principios oncológicos de resección. Con el desarrollo de instrumental especializado, nuevas tecnologías y la experiencia de los cirujanos, la cirugía endoscópica endonasal se usa cada vez más en cirugía de base de cráneo en niños. Objetivo: presentar una serie de casos de pacientes pediátricos con tumores de base de cráneo manejados con cirugía endoscópica endonasal. Diseño: Estudio observacional descriptivo de tipo serie de casos. Metodología: se describe la experiencia con pacientes pediátricos llevados a cirugía endoscópica endonasal para manejo de tumores de base de cráneo en el Instituto Nacional de Cancerología entre julio de 2014 y diciembre de 2016. Resultados: Fueron intervenidos 8 pacientes entre los 2 y 14 años, con una edad promedio de nueve años y un seguimiento promedio de 16 meses. En el 75% se hizo una resección total del tumor. Un paciente requirió una reintervención y un paciente fue sometido a radiocirugía post-operatoria. 1 paciente falleció a pesar de múltiples intervenciones, quimioterapia y radioterapia. Conclusión: La cirugía endoscópica endonasal para tumores de base de cráneo puede ser utilizada de forma segura en los pacientes pediátricos, es una técnica que en casos bien seleccionados pueden ofrecer excelentes resultados disminuyendo la morbilidad y complicaciones de las técnicas abiertas.

Introduction: Endoscopic endonasal approaches have become an instrumental tool in the management of skull base pathologies. In well selected cases, these techniques allow surgical resections with less morbidity without compromising oncological resection principles. As technology, instrumentation and surgeon experience have progressed, these techniques are being used more often in pediatric skull base surgery. Objective: To present a case series of pediatric patients with skull base tumors who underwent endonasal endonasal surgery. Methods: Case series of patients who underwent endoscopic endonasal surgery for pediatric skull base tumor resections at the Instituto Nacional de Cancerología (National Cancer Institute), between July 2014 and December 2016. Results: 8 patients between 2 and 14 years-old underwent endoscopic endonasal surgery. The average time of follow-up was 16 months. 75% patients had gross total resection. 1 patient requiered a second intervention and 1 patient adjuvant radiation treatment. 1 patient died despite multiple interventions, radiation and chemotherapy. Conclusion: Endoscopic endonasal approaches to the skull base can be used safely to manage skull base tumors in pediatric patients. These techniques could offer excelent outcomes in well selected patients, with potentital less morbidity and complications associated with open approaches.

Experiencia de trasplante renal de donantes y receptores mayores de 60 años en la Fundación Valle del Lili en Cali, Colombia, del año 2002 al 2016 / Kidney transplantation in donors and recipients over 60 at Fundación Valle del Lili in Cali, Colombia, from 2002 to 2016

INTRODUCCIÓN: El trasplante renal es el tratamiento de elección para los pacientes con insuficiencia renal terminal. Los pacientes mayores de sesenta años representan la población de mayor crecimiento con esta patología. Sin embargo, no se realizan los trasplantes de manera oportuna y la mayoría permanecen en diálisis con una menor sobrevida y calidad de vida. En este estudio se exponen los desenlaces de los trasplantes renales anciano-para-anciano realizados en una clínica de alta complejidad en Cali, Colombia. MATERIAL Y MÉTODOS: Estudio de cohorte, descriptivo de 31 trasplantes renales con donantes y receptores mayor de 60 años, realizados en la Fundación Valle del Lili en Cali, Colombia, desde enero del 2002 a marzo de 2016. RESULTADOS: De los 31 pacientes trasplantados renales, el 16% presentaron enfermedad cardiovascular post-trasplante, el 6,4% enfermedad cerebrovascular y el 22,6% malignidad. Se presentaron 12 (38,7%) infecciones oportunistas. Cinco pacientes (16%) presentaron disfunción crónica del injerto y tres (9,6%) pérdida del injerto. Nueve pacientes (29%) fallecieron con injerto funcionante. CONCLUSIÓN: La supervivencia de los pacientes trasplantados anciano para anciano en la Fundación Valle del Lili, es equiparable con los resultados en la literatura mundial. Las principales complicaciones asociadas a este tipo de trasplantes son malignidad, infecciones y patologías cardiovasculares. Debido a la alta complejidad y complicaciones de este tipo de trasplantes, los pacientes deben ser cuidadosamente seleccionados

INTRODUCTION: Kidney transplant is the first-line therapy for end-stage renal disease. Patients over 60 constitute a population which is increasingly affected by this disease. However, they do not receive timely transplantation and most of them stay on dialysis treatment with a reduction of their survival time and life quality. In this study we show the results of the kidney transplants between elderly patients performed at a private tertiary care hospital in Cali, Colombia. METHODS: This descriptive, cohort study includes 31 kidney transplants with donors and recipients over 60, which were carried out at Fundación Valle del Lili in Cali, Colombia, from January 2002 to March 2016. RESULTS: The average ages were 66 for recipients and 65 for donors. In most cases (90%) deceased donors were involved. The main cause of renal disease was diabetic nephropathy. CONCLUSION: The survival rate for the patients who underwent this procedure at the center mentioned above is similar to the results shown in the literature all over the world. The most common complications associated with this kind of operation are malignancy, infections and cardiovascular pathologies. Candidates for this transplantation should be carefully chosen given its complexity and related complications

Sclerosing Encapsulated Peritonitis: A devastating and infrequent disease complicating kidney transplantation, case report and literature review.

INTRODUCTION: Sclerosing Encapsulating Peritonitis (SEP) is a rare condition with an incidence of up to 3% and a mortality of up to 51% among peritoneal dialysis (PD) patients (Brown et al., Korte et al. and Kawanishi et al.). In the last ten years, the incidence of SEP in kidney transplant recipients has increased (Nakamoto, de Sousa et al. and Korte et al.). PRESENTATION OF CASE: A 31-year old male with a 15 years history of PD and later kidney retransplantation was admitted to the emergency service after experiencing several weeks of diffuse abdominal pain which had escalated to include vomiting and diarrhea during the 24h previous to admission. The patient underwent an exploratory laparotomy where severe peritoneal thickening was found, in addition to signs of chronic inflammation and blocked intestinal loops. Histopathologic findings were suggestive of sclerosing peritonitis. After two months of treatment in hospital, the patient presented an obstructed intestine, with a rigid and thickened peritoneum compromising all the intestinal loops. DISCUSSION: Despite being rare, SEP, represents a significant complication due to its high mortality and recurrence. It is insidious in its early stages and culminates in an intestinal obstruction (Fieren). Risk factors for its development in kidney transplant recipients include a history of prolonged treatment with PD and the use of calcineurin inhibitors as an immunosuppressive treatment (Korte et al.). CONCLUSION: Given the increase in the incidence of SEP in kidney transplant recipients, the clinician should be alert to the presence of this complication. A greater number of multi-centre studies are required to identify the risk factors for SEP that are inherent in renal transplant recipients.

Insuficiencia renal y trasplante post donación / Renal failure and transplant in a former donor

El trasplante renal es el tratamiento de elección para los pacientes con enfermedad renal terminal. El trasplante con donante vivo, es la mejor opción para los receptores al implicar menor morbi-mortalidad y disminución del tiempo en lista activa. A pesar que el riesgo de ser donante vivo ha sido determinado y es bajo, se debe realizar una evaluación médica a los posibles donantes para identificar factores de riesgo para desarrollar insuficiencia renal crónica. En este reporte se describe un paciente quien fue donante y 21 años después desarrolló insuficiencia renal crónica (IRC) avanzada secundaria a hipertensión arterial no tratada por lo que fue trasplantado

Kidney transplant is the first-line therapy for end-stage renal disease. Living-donor transplant is the best choice for recipients as it reduces morbidity and mortality and the time spent on the active waitlist. Although it is known that the risk of being a living donor is low, a medical evaluation must be performed in order to identify risk factors for the development of chronic kidney disease. We report a case of a patient who was a donor and 21 years later presented advanced chronic kidney disease (CKD) following untreated high blood pressure. For this reason, the patient underwent a transplant

Biliary strictures complicating liver transplantation in pediatric patients: Experience in a South American transplant center.

OBJECTIVE: To describe the experience of percutaneous transhepatic cholangiography (PTC) with biliary dilatation and drainage after pediatric liver transplantation and to determine the long-term outcome of this procedure. METHODS: Retrospective study from 2001 to 2013. Follow-up after treatment was also undertaken. A survival analysis was performed in patients in whom the procedure and eventual removal of the catheter were successful. RESULTS: In all, 196 children received liver transplants; 40 of them (20 boys and 20 girls; median age of 4 years) were treated using PTC due to biliary complications. Sixty-one PTC procedures were performed in 40 liver transplant recipients. Technically successful PTC was achieved in 87.5% of the patients. The probability of a patient not developing unfavorable outcomes 1, 5, and 10 years after treatment was 88.9%, 83.0%, and 74.1%.

Case report of cadaveric kidney transplantation with renal-portal venous drainage: A feasible way for a venous drainage in a complex generalized thrombosed vessels setting.

INTRODUCTION: One of the frequent complications suffered by patients with chronic renal failure is the lack of vascular access due to venous thrombosis. This means that the transplant surgeon must have a detailed knowledge of the intra-abdominal venous system, and other alternative surgeries, at the time of performing the renal graft implant, in order to ensure a good venous drainage. PRESENTATION OF THE CASE: This article provides a case report regarding a patient with no vascular access and with surgical difficulties at the time of the kidney transplant, in whom a renal-portal venous drainage was performed with very good outcome. DISCUSION: Renal-portal venous drainage is a way to performe kidney transplant with good outcome. In Fundación Valle del Lili we have overcome the lack of vascular access in patients that need a renal transplant by new surgical technics that improve the patients quality of life and survival. CONCLUSION: We can conclude that new surgical alternatives exist for those patients with chronic renal failure that have no vascular access. These patients are a priority for kidney transplants and the surgeon must take in to account the need for a new surgical assessment.

Galectin-1 circumvents lysolecithin-induced demyelination through the modulation of microglial polarization/phagocytosis and oligodendroglial differentiation.

Galectin-1 (Gal-1), a member of a highly conserved family of animal lectins, binds to the common disaccharide [Galß(1-4)-GlcNAc] on both N- and O-glycans decorating cell surface glycoconjugates. Current evidence supports a role for Gal-1 in the pathophysiology of multiple sclerosis (MS), one of the most prevalent chronic inflammatory diseases. Previous studies showed that Gal-1 exerts neuroprotective effects by promoting microglial deactivation in a model of autoimmune neuroinflammation and induces axonal regeneration in spinal cord injury. Seeking a model that could link demyelination, oligodendrocyte (OLG) responses and microglial activation, here we used a lysolecithin (LPC)-induced demyelination model to evaluate the ability of Gal-1 to preserve myelin without taking part in T-cell modulation. Gal-1 treatment after LPC-induced demyelination promoted a significant decrease in the demyelinated area and fostered more efficient remyelination, concomitantly with an attenuated oligodendroglial progenitor response reflecting less severe myelination damage. These results were accompanied by a decrease in the area of microglial activation with a shift toward an M2-polarized microglial phenotype and diminished astroglial activation. In vitro studies further showed that, mechanistically, Gal-1 targets activated microglia, promoting an increase in their myelin phagocytic capacity and their shift toward an M2 phenotype, and leads to oligodendroglial differentiation. Therefore, this study supports the use of Gal-1 as a potential treatment for demyelinating diseases such as MS.