Paraneoplastic autoimmune autonomic ganglionopathy as the first symptom of bladder cancer: a case report and review of literature.

BACKGROUND: Autoimmune autonomic ganglionopathy is a rare, immune-mediated disorder associated with anti-ganglionic α3-subunit nicotinic acetylcholine receptor (anti-α3gAChR) antibodies, which bind to acetylcholine receptor in autonomic ganglia (parasympathetic and sympathetic) leading to autonomic failure. This disorder is mostly associated with viral infections, but it can also be associated with systemic malignancies. Here, we report the case of a paraneoplastic autonomic ganglionopathy as the first symptom of bladder cancer. METHOD: Case report. RESULTS: A 47-year-old man, without medical history of interest, stated to the emergency department for progressive blurry vision with eye and mouth dryness, constipation, and dizziness upon standing for the last 2 weeks. Orthostatic hypotension was demonstrated by a drop in 13.3 mmHg mean blood pressure (BP) from supine (100/60 mmHg) to 45° reclining sitting position (80/50 mmHg). Blood tests, chest X-ray, brain MRI, and electroneuronography were unremarkable. Electrochemical skin conductance was reduced. Serological examination was positive for anti-α3gAChR antibodies. A full-body CT scan revealed a bladder tumor, which was treated by transurethral bladder resection. The pathologic study demonstrated a low-grade non-muscle-invasive bladder urothelial carcinoma. After tumor resection, and treatment with intravenous immunoglobulins and corticoids, a gradually improvement was observed. Today, the patient remains asymptomatic. CONCLUSION: Subacute panautonomic failure can be the first symptom for systemic malignancies. This case reports a paraneoplastic autonomic ganglionopathy as the first symptom of bladder cancer. This case highlights the importance of a systemic study to rule out the presence of cancer when autoimmune autonomic ganglionopathy is present.

[V grade renal trauma in patient with union pyeloureteral stenosis not known.] / Traumatismo renal grado v en paciente con estenosis de la unión pieloureteral no conocida.

Paciente de 40 años de edad, sin alergias medicamentosas conocidas y sin antecedentesde interés, que es traído a Urgencias por dispositivo de cuidados críticos por politraumatismo tras accidente de moto...

Paciente de 40 años de edad, sin alergias medicamentosas conocidas y sin antecedentesde interés, que es traído a Urgencias por dispositivo de cuidados críticos por politraumatismo tras accidente de moto...

Traumatismo renal grado v en paciente con estenosis de la unión pieloureteral no conocida / V grade renal trauma in patient with union pyeloureteral stenosis not known

No disponible

Timeline of Intestinal Adaptation After Malabsortive Surgery: Effect of Luminal Nutrients, Biliopancreatic Secretion, and Glutamine Supplementation.

BACKGROUND: The aim of this study was to study the process of intestinal adaptation in the three limbs of the small intestine after malabsorptive bariatric surgery: the biliopancreatic limb, the alimentary limb, and the common channel. These limbs are exposed to different stimuli, namely, gastrointestinal transit and nutrients in the alimentary limb, biliopancreatic secretions in the biliopancreatic limb, and a mix of both in the common channel. We also wished to investigate the effect of glutamine supplementation on the adaptation process. METHODS: Three types of surgery were performed using a porcine model: biliopancreatic bypass (BPBP), massive (75%) short bowel resection as the positive control, and a sham operation (transection) as the negative control. We measured the height and width of intestinal villi, histidine decarboxylase (HDC) activity, and amount of HDC messenger RNA (mRNA) (standard diet or a diet supplemented with glutamine). RESULTS: An increase in HDC activity and mRNA expression was observed in the BPBP group. This increase coincided with an increase in the height and width of the intestinal villi. The increase in villus height was observed immediately after surgery and peaked at 2 weeks. Levels remained higher than those observed in sham-operated pigs for a further 4 weeks. CONCLUSIONS: The intestinal adaptation process in animals that underwent BPBP was less intense than in those that underwent massive short bowel resection and more intense than in those that underwent transection only. Supplementation with glutamine did not improve any of the parameters studied, although it did appear to accelerate the adaptive process.

Endocrine disruptors and prostate cancer. / Disruptores endocrinos y cáncer de próstata.

OBJECTIVES: Although prostate cancer is probably the most frequent cancer in men, little is known about its etiology. Clear evidence exists about variations in the incidence of prostate cancer between populations living in different countries. These variations could be explained by differences in lifestyle and a possible association with a set of substances that are able to intervene in the origin of the disease. METHODS: The reason that lifestyle may be the cause of prostate cancer is related to endocrine disruptors. These are a group of chemical substances that can mimic or alter hormone signaling. These disruptors are able to exert their effect at very low doses and act insidiously over the years, even being able to pass their effect on from one generation to the next. Cholesterol is an essential precursor in the synthesis of androgens, estrogens and other substances that are active in prostate cancer. Cholesterol is a central metabolite in lipid metabolism, the inflammatory response and other elements involved in the formation and progression of cancer. High cholesterol concentrations can give rise to the accumulation of androgens in tumor cells. Additionally, endocrine disruptors have been identified as being responsible for processes related with fertility, genital malformations and various hormonedependent cancers. Disruptors already identified include diethylstilbestrol, dichlorodiphenyltrichloroethane (DDT), polychlorinated biphenyls and dioxins. RESULTS: Though no clear direct association has yet been found in humans between most endocrine disruptors and prostate cancer, evidence suggests that an inadequate diet and contact with certain toxic agents predisposes to the disease. These disruptors are known to be especially relevant at particular times, such as during pregnancy, neonatal stages and puberty. CONCLUSIONS: The problem with these toxic agents is that their peculiarities and way of acting over time make their study difficult. Nonetheless, research must be encouraged given their importance.

Disruptores endocrinos y cáncer de próstata / Endocrine disruptors and prostate cancer

OBJETIVOS: Aunque el cáncer de próstata es, probablemente, el cáncer más frecuente en el varón, se conoce poco acerca de su etiología. Existen claras variaciones en la incidencia de cáncer de próstata entre las poblaciones de distintos países. Estas variaciones podrían explicarse por las diferencias en el estilo de vida y por una posible asociación con un conjunto de sustancias capaces de intervenir en el origen de la enfermedad. MÉTODOS: La razón por la que el estilo de vida puede ser causa del cáncer de próstata está relacionada con los disruptores endocrinos. Éstos son un grupo de sustancias químicas que pueden imitar o alterar la señalización hormonal. Dichos disruptores son capaces de ejercer su efecto a dosis muy bajas y actúan insidiosamente a lo largo de los años, incluso pudiendo trasmitir su efecto de una generación a la siguiente. El colesterol es un precursor esencial en la síntesis de andrógenos, estrógenos y otras sustancias activas en el cáncer de próstata. El colesterol es un elemento central en el metabolismo de los lípidos, la respuesta inflamatoria y otros elementos implicados en la formación y progresión del cáncer. Concentraciones altas de colesterol pueden dar lugar a la acumulación de andrógenos en las células tumorales. Además, los disruptores endocrinos han sido identificados como responsables de procesos relacionados con la fertilidad, malformaciones genitales y varios cánceres hormonodependientes. Los disruptores ya identificados incluyen dietilestilbestrol, diclorodifeniltricloroetano (DDT), bifenilos policlorados y dioxinas. RESULTADOS: Aunque aún no se ha encontrado en humanos una asociación directa y clara entre la mayoría de los disruptores endocrinos y el cáncer de próstata, la evidencia sugiere que una dieta inadecuada y el contacto con ciertos agentes tóxicos predisponen a la enfermedad. Se sabe que estos disruptores son especialmente relevantes en determinados momentos de la vida, como durante el embarazo, las etapas neonatales y la pubertad. CONCLUSIONES: El problema con estos agentes tóxicos es que sus peculiaridades y el modo de actuar en el tiempo dificultan su estudio. Sin embargo, dada su importancia, debería fomentarse su investigación

OBJECTIVES: Although prostate cancer is probably the most frequent cancer in men, little is known about its etiology. Clear evidence exists about variations in the incidence of prostate cancer between populations living in different countries. These variations could be explained by differences in lifestyle and a possible association with a set of substances that are able to intervene in the origin of the disease. METHODS: The reason that lifestyle may be the cause of prostate cancer is related to endocrine disruptors. These are a group of chemical substances that can mimic or alter hormone signaling. These disruptors are able to exert their effect at very low doses and act insidiously over the years, even being able to pass their effect on from one generation to the next. Cholesterol is an essential precursor in the synthesis of androgens, estrogens and other substances that are active in prostate cancer. Cholesterol is a central metabolite in lipid metabolism, the inflammatory response and other elements involved in the formation and progression of cancer. High cholesterol concentrations can give rise to the accumulation of androgens in tumor cells. Additionally, endocrine disruptors have been identified as being responsible for processes related with fertility, genital malformations and various hormonedependent cancers. Disruptors already identified include diethylstilbestrol, dichlorodiphenyltrichloroethane (DDT), polychlorinated biphenyls and dioxins. RESULTS: Though no clear direct association has yet been found in humans between most endocrine disruptors and prostate cancer, evidence suggests that an inadequate diet and contact with certain toxic agents predisposes to the disease. These disruptors are known to be especially relevant at particular times, such as during pregnancy, neonatal stages and puberty. CONCLUSIONS: The problem with these toxic agents is that their peculiarities and way of acting over time make their study difficult. Nonetheless, research must be encouraged given their importance