Apendicitis aguda en una gestante lúpica / Acute appendicitis in pregnant lupus

El lupus eritematoso sistémico es una enfermedad autoinmune que se caracteriza por un proceso inflamatorio crónico y el aumento de la producción de autoanticuerpos como mecanismos patogénicos. Se presenta con mayor frecuencia en pacientes femeninas y en edad fértil. La gestación en pacientes con esta enfermedad se considera como una condición de extrema precaución, ya que existe influencia de la gestación en la actividad clínica del lupus y del lupus en la evolución de la gestación. Las complicaciones quirúrgicas, como es el caso de una apendicitis aguda, aportan mayor riesgo al binomio madre-feto. El objetivo del presente trabajo es comunicar la experiencia de tratamiento de una paciente de 31 años de edad, con diagnóstico de lupus eritematoso sistémico y a quien a las 35,6 semanas de gestación se le presentó un cuadro de apendicitis aguda que no solo provocó la actividad de la enfermedad, sino que causó la interrupción de la gestación. La paciente y el recién nacido presentaron una evolución favorable sin complicaciones posteriores.

Systemic lupus erythematosus is an autoimmune disease that includes the presence of a chronic inflammatory process and increased production of autoantibodies as etiopathogenic mechanisms. As a disease, it occurs more frequently in female patients and those of childbearing age. Pregnancy in patients with this disease is considered an element of extreme caution since there is an influence of pregnancy on the clinical activity of lupus and lupus on the evolution of pregnancy. The presence of surgical complications, as is the case of acute appendicitis, brings greater risk to the mother-fetus binomial. The objective of this report is to communicate the treatment experience of a 31-year-old patient, diagnosed with systemic lupus erythematosus and who at 35.6 weeks of gestation presented acute appendicitis that not only causes disease activity, but it generates the need to interrupt the pregnancy. The patient and the newborn had a favorable evolution, with no subsequent complications.

Pharmacological Studies on the Role of 5-HT1 A Receptors in Male Sexual Behavior of Wildtype and Serotonin Transporter Knockout Rats.

Brain serotonin (5-HT) neurotransmission plays an important role in male sexual behavior and it is well established that activating 5-HT1 A receptors in rats facilitate ejaculatory behavior. However, the relative contribution of 5-HT1 A somatodendritic autoreceptors and heteroreceptors in this pro-sexual behavior is unclear. Moreover, it is unclear whether the contribution of somatodendritic 5-HT1 A autoreceptors and postsynaptic 5-HT1 A heteroreceptors alter when extracellular 5-HT levels are chronically increased. Serotonin transporter knockout (SERT-/-) rats exhibit enhanced extracellular 5-HT levels and desensitized 5-HT1 A receptors. These rats model neurochemical changes underlying chronic SSRI-induced sexual dysfunction. We want to determine the role of presynaptic versus postsynaptic 5-HT1 A receptors in the pro-sexual effects of 5-HT1 A receptor agonists in SERT+/+ and in SERT-/- rats. Therefore, acute effects of the biased 5-HT1 A receptor agonists F-13714, a preferential 5-HT1 A autoreceptor agonist, or F-15599, a preferential 5-HT1 A heteroreceptor agonist, and S15535 a mixed 5-HT1 A autoreceptor agonist/heteroreceptor antagonist, on male sexual behavior were assessed. A clear and stable genotype effect was found after training where SERT+/+ performed sexual behavior at a higher level than SERT-/- rats. Both F-15599 and F-13714 induced pro-sexual activity in SERT+/+ and SERT-/- animals. Compared to SERT+/+, the F13714-dose-response curve in SERT-/- rats was shifted to the right. SERT+/+ and SERT-/- rats responded similar to F15599. Within both SERT+/+ and SERT-/- rats the potency of F-13714 was much stronger compared to F-15599. S15535 had no effect on sexual behavior in either genotype. In SERT+/+ and SERT-/- rats that were selected on comparable low sexual activity (SERT+/+ 3 or less ejaculations and SERT-/- 5 or less ejaculations in 10 weeks) S15535 also did not influence sexual behavior. The two biased compounds with differential effects on 5-HT1 A auto- and hetero-receptors, exerted pro-sexual activity in both SERT+/+ and SERT-/- rats. Applying these specific pharmacological tools has not solved whether pre- or post-synaptic 5-HT1 A receptors are involved in pro-sexual activity. Moreover, the inactivity of S15535 in male sexual behavior in either genotype was unexpected. The question is whether the in vivo pharmacological profile of the different 5-HT1 A receptor ligands used, is sufficient to differentiate pre- and/or post-synaptic 5-HT1 A receptor contributions in male rat sexual behavior.

Incidencia de hidronefrosis transitoria en reimplante vesicouretral abierto con técnica de Lich Gregoir en niños con reflujo vesicoureteral / Incidence of Transient Hydroneprosis in Open Vesicouretral Reimplant with Lich Gregoir Technique in Children with Vesicoureteral Reflux

Introducción y Objetivo La técnica de Lich Gregoir es actualmente la de elección para la corrección del reflujo vesicoureteral (RVU) de alto grado, con complicaciones como la obstrucción ureteral. La literatura reporta tasas del 6% al 28% de hidronefrosis transitoria, las cuales, en su gran mayoría, corresponden a un hallazgo temporal sin repercusión clínica. El objetivo de este trabajo es establecer la incidencia de hidronefrosis transitoria y la asociación con factores de riesgo. Materiales y Metodos Realizamos una cohorte descriptiva retrospectiva, analizando 119 unidades ureterales reimplantadas mediante técnica de Lich Gregoir (LG) en menores de 18 años, entre Septiembre del 2009 y abril del 2017. Se excluyeron pacientes con megauréter primario, RVU secundario y cirugía previa para corrección de RVU. El análisis estadístico se realizó con Stata 13.0 Resultados Evaluamos 85 pacientes, 34 de ellos reimplantados de manera bilateral, para un total de 119 unidades ureterales. El promedio de edad fue de 4,4 años y el 68% fueron mujeres. El RVU grado IV fue el más prevalente con el 42%. Las ecografías renales prequirúrgicas fueron normales en el 63% de los casos y el 14,2% presentó hidronefrosis transitoria con resolución a los 3 meses. No se reportaron casos de obstrucción ureteral. El grado de reflujo prequirúrgico no se asoció con hidronefrosis transitoria (p = 0,64) así como tampoco la lateralidad (p = 0,06). Conclusión El reimplante vesicoureteral abierto con técnica de Lich Gregoir en nuestra institución, reporta tasas de hidronefrosis transitoria comparables a la literatura mundial. No se identificaron factores de asociación para hidronefrosis transitoria, diferentes a la técnica quirúrgica perse.

Introduction and Objective Lich Gregoir technique is currently the choice for correction of vesicoureteral reflux (VUR), with complications such as ureteral obstruction. Literature reports rates from 6% to 28% of transient hydronephrosis, from which, most correspond to a temporary finding without clinical repercussion. This study aims to establish the incidence of transient hydronephrosis and the association with risk factors. Material and Methods In a descriptive retrospective cohort, we analyzed 119 ureteral units reimplanted with Lich Gregoir, under 18 years old, between September 2009 and April 2017. We have excluded patients with primary megaureter, VUR secondary and previous surgery for VUR correction. Statistical analysis was performed with Stata 13.0. Results We have evaluated 85 patients, 34 bilaterally reimplanted, totaling 119 ureteral units. Mean age was 4.4 years and 68% were women. VUR grade IV was the most prevalent with 42%. Pre-surgical renal ultrasounds were normal in 63% of the cases, and 14.2% had transient hydronephrosis with resolution at 3 months. No case of ureteral obstruction was reported. Pre-surgical reflux grade was not associated with transient hydronephrosis (p = 0.64) as well as neither laterality (p = 0.06). Conclusion Open Vesicoureteral reimplantaion with Lich Gregoir technique in our institution reports transient hydronephrosis rates similar to the literature. We have not found association factors with transient hydronephrosis, except for the surgical technique perse.