Bezoar de dinero: reporte de bezoar atípico, su manejo y una revisión de la literatura / Money Bezoar: Report of atypical bezoar, its treatment, and a literature review

Resumen Objetivos: Presentar el manejo laparoscópico en un caso de bezoar atípico y una revisión de la literatura. Materiales y métodos: Se presenta el caso de un paciente de sexo masculino de 67 años con síndrome pilórico debido a una obstrucción intestinal por cuerpo extraño. Resultados: Se encuentra como hallazgo endoscópico un bezoar atípico (bezoar de dinero) impactado en la región prepilórica sin posibilidad de resolución por este medio, por lo cual se considera el manejo laparoscópico. Discusión: Los bezoares se definen como cualquier objeto el cual tuvo una ingesta voluntaria o involuntaria, que se aloja en alguna parte del tracto gastrointestinal superior, con mayor frecuencia a nivel gástrico, y no se puede digerir por los mecanismos fisiológicos del cuerpo; además, se clasifican según su composición. Conclusiones: En pacientes con obstrucción intestinal alta debido a cuerpos extraños en los cuales el manejo endoscópico falla, el manejo quirúrgico mínimamente invasivo con cirugía laparoscópica es viable y eficaz.

Abstract Objectives: To describe the laparoscopic management of an atypical bezoar case and present a literature review. Materials and methods: This is the case of a 67-year-old male patient with pyloric stenosis due to intestinal obstruction by a foreign body. Results: The endoscopic finding was an atypical bezoar (Money bezoar) in the prepyloric region with no possible resolution by this route, so laparoscopic treatment was considered. Discussion: Bezoars are defined as any object that was voluntarily or involuntarily swollen and is obstructing some part of the upper gastrointestinal tract, usually the stomach, and cannot be digested using the physiological mechanisms of the body. They are categorized based on their composition. Conclusions: When endoscopic treatment fails to relieve upper gastrointestinal tract obstruction caused by foreign bodies, minimally invasive surgical treatment with laparoscopic surgery is a viable and efficient option.

Modelling Ebola within a community.

The 2014 Ebola epidemic was the largest on record. It evidenced the need for improved models of the spread of Ebola. In this research we focus on modelling Ebola within a small village or community. Specifically, we investigate the potential of basic Susceptible-Exposed-Infectious-Recovered (SEIR) models to describe the initial Ebola outbreak, which occurred in Meliandou, Guinea. Data from the World Health Organization is used to compare the accuracy of various models in order to select the most accurate models of transmission and disease-induced responses. Our results suggest that (i) density-dependent transmission and mortality-induced behavioural changes shaped the course of the Ebola epidemic in Meliandou, while (ii) frequency-dependent transmission, disease-induced emigration, and infection-induced behavioural changes are not consistent with the data from this epidemic.

Quasispin glass in a geometrically frustrated magnet.

The spin glass state in the spinel ZnCr(2(1-x))Ga(2x)O(4) is studied with magnetization and specific heat for x < 0.05. The freezing temperature is independent of disorder, despite a two-level-like density of states that varies linearly with x. This relationship implies the energy scale for freezing is independent of disorder, in contrast to mean field theories of spin glass. We suggest that the degrees of freedom are shielded spin vacancies, quasispins, which interact via an emergent long-range force mediated by the frustrated spin background.

Validation of a testis specific serine/threonine kinase [TSSK] family and the substrate of TSSK1 & 2, TSKS, as contraceptive targets.

A family of testis specific serine/threonine kinases, TSSK1-4 and SSTK, in addition to the substrate of TSSK1 & 2, TSKS, have been studied during the past several years in our laboratory. This paper will provide a general background on these kinases through review of pertinent literature and then will summarize data from our laboratory germane to evaluating these kinases as candidate targets for future development of small molecule kinase inhibitors that may serve to regulate male fertility. Bio-informatic and structural analyses of human TSSK1-4 and SSTK indicate that these kinases constitute a unique subfamily belonging to the AMPK branch on the human kinome tree. Expression studies showed that all five kinases and the TSKS substrate are testis abundant, if not strictly testis specific, indicating that tissue specific contraceptive targeting is possible. In situ hybridization further confirmed that mouse TSSK2, SSTK and TSKS are post-meiotic in their expression patterns, a finding that makes them possible targets of reversible contraceptive intervention by preserving spermatogonia and spermatocytes. Our laboratory detected TSSK2, TSKS and SSTK proteins in mature spermatozoa for the first time. TSKS was localized to the centrioles of human spermatozoa, while TSSK2 was observed in the sperm neck, equatorial segment and mid-piece of the sperm tail, and SSTK was localized in the equatorial segment. The interaction and binding between human TSSK2 and TSKS was confirmed by several methods: this substrate and enzyme interaction offers a particularly interesting opportunity for drug design. In vitro kinase assay showed phosphorylation of TSKS by TSSK2. The TSKS phosphopeptide, HGLSPATPIQGCSGPPGS*PEEPPR, was identified by IMAC-LC-FTMS, with serine 285 being phosphorylated (representend by asterisk). These results provide a rationale for high-throughput screening of inhibitors for TSKS phosphorylation and further studies of members of this kinase family as targets for both male contraception and intra-vaginal spermicides.

Application of proteomic methods for identification of sperm immunogenic antigens.

Although the immunogenic properties of sperm have been explored for a few decades, none of the antigens studied so far appears to be an effective target, to inhibit the fertilization process or shown the full spectrum of sperm antigenic potential. Antisperm antibodies (ASA) collected from infertile individuals and prepubertal boys with cryptorchidism together with two-dimensional (2D) electrophoresis have been employed. Immunoreactive antigens were cored from silver stained 2D gels and analyzed by mass spectrometry (MS). The obtained sequences were searched in the published protein databases. Altogether, 35 different sperm entities were identified in accessible protein databases, out of which 10 appeared to be sperm-specific. Additionally, 6 amino acid sequences indicated novel (hypothetical) proteins. Seventeen sperm entities were detected in sera samples from immune infertile males and 18 entities in ASA-positive seminal plasma (SP). Interestingly, we identified a few sperm structures, none of them sperm specific in sera samples from infertile females. Although, infertile males from whom the ASA-positive SP samples were obtained, did not have ASA in their circulation, the range of sperm antigens detected by systematic and local antibodies overlapped to a great extent (six identical entities). Sera samples from prepubertal boys allowed to show antigens, previously thought to be only present on mature sperm. Three out of four detected were sperm-specific. Using serum and SP of ASA-positive infertile adults and sera samples of prepubertal boys with testicular failure, we have extended the range of known, immunogenic sperm proteins as well as identified some novel antigens (n=6) of human sperm for further characterization.

Intubación selectiva a través del broncoscopio rígid / Selective intubation through a rigid bronchoscope

No disponible

[Neuropsychological Assessment of Children: a test battery for children between 5 and 16 years of age. A Colombian normative study]. / Evaluacion Neuropsicologica Infantil (ENI): bateria para la evaluacion de niños entre 5 y 16 años de edad. Estudio normativo colombiano.

INTRODUCTION: A neuropsychological test battery for 5 to 16 year old children has recently been developed. This battery is called Neuropsychological Assessment of Children (Evaluacion Neuropsicológica Infantil, ENI) and it includes the following sections: attention, constructional skills, memory encoding, perceptual skills, memory recall, language, metalinguistic skills, reading, writing, arithmetic, spatial skills, conceptual skills and executive functions. AIMS: Our aim was to obtain norms for the ENI in a Colombian population between 5 and 16 years of age. SUBJECTS AND METHODS: We selected 252 children (92 boys and 160 girls) in the city of Manizales (Colombia), and they were administered the ENI. In order to obtain an external validity, 21 of the participants were also given the Wechsler Intelligence Scale for Children Revised (WISC R). RESULTS: Statistically significant differences were found on most of the subtests across age groups. Differences between boys and girls appeared more specifically in tests of visuoperceptual, visual constructional, spatial and numerical skills. Some of the ENI subtests correlated with the WISC R subtests. CONCLUSIONS: It is suggested that the ENI could satisfy the existing need in the Spanish speaking world for neuropsychological tools with which to assess children and adolescents.

Lesiones traumáticas de arteria humeral proximal: 4 casos / Traumatic injuries of proximal humeral artery: 4 cases

Se presenta una serie clíniva de 4 lesiones traumáticas altas consecutivas de arteria humeral. Cada lesión fue diferente en su presentación y manejo. Un caso se resolvió con trombólisis luego de 24 h de isquemia y los otros 3 con cirugía. Dos casos terminaron en amputación, ambos infectados: uno con bypass permeable y el otro con trombosis tardía de un reimplante de extremidad. El último caso resolvió exitosamente con cirugía

Erythropoietin stimulates proliferation and interferes with differentiation of myoblasts.

Erythropoietin (Epo) is required for the production of mature red blood cells. The requirement for Epo and its receptor (EpoR) for normal heart development and the response of vascular endothelium and cells of neural origin to Epo provide evidence that the function of Epo as a growth factor or cytokine to protect cells from apoptosis extends beyond the hematopoietic lineage. We now report that the EpoR is expressed on myoblasts and can mediate a biological response of these cells to treatment with Epo. Primary murine satellite cells and myoblast C2C12 cells, both of which express endogenous EpoR, exhibit a proliferative response to Epo and a marked decrease in terminal differentiation to form myotubes. We also observed that Epo stimulation activates Jak2/Stat5 signal transduction and increases cytoplasmic calcium, which is dependent on tyrosine phosphorylation. In erythroid progenitor cells, Epo stimulates induction of transcription factor GATA-1 and EpoR; in C2C12 cells, GATA-3 and EpoR expression are induced. The decrease in differentiation of C2C12 cells is concomitant with an increase in Myf-5 and MyoD expression and inhibition of myogenin induction during differentiation, altering the pattern of expression of the MyoD family of transcription factors during muscle differentiation. These data suggest that, rather than acting in an instructive or specific mode for differentiation, Epo can stimulate proliferation of myoblasts to expand the progenitor population during differentiation and may have a potential role in muscle development or repair.

[Opinion of the primary care veterinarians of Andalusia concerning the management of their professional practice]. / Opinión de los veterinarios de atención primaria de Andalucía sobre la gestión de su ejercicio profesional.

BACKGROUND: This study describes the opinion of the veterinarians in Andalusia regarding the organization and management of their professional practice and pinpoints solutions to the problems found for the purpose of providing planning and management aspects in view of the reforms undertaken in the Andalusian Health Service Strategy Plan. METHOD: Descriptive opinion poll employing a questionnaire filled out by each individual among all of the Primary Care (PC) veterinarians in Andalusia (including those who have been currently employed who possess at least one year's experience, except substitutes). A description was provided of their personal traits, their opinion of the management-related factors involved in their professional practice. A description was also provided of the suggestions for improving the problems found to exist. RESULTS: Over 70% said they were aware of the objectives, although only the coordinators found them to be clearly motivating the practice. Their opinion was that the indicators of activity neither include any quality-related criteria nor afford the possibility of evaluating the activity they are carrying out. They believed that the contributions from other members of the multidisciplinary team improve their work and are in favor of continuing their involvement therein. They were satisfied with doing their work (the coordinators to a greater degree). They found the productivity pay to be too low and not useful as regards providing them with any incentive. They were not satisfied with the training with which they are provided and thought that what they are offered is far less than their other colleagues in the health care field. Most were of the opinion that they should remain under the authority of the Andalusian Health Service. CONCLUSIONS: This group prefers to continue working for the same organization, but improving the following management aspects: training offer, practice incentives and activity indicators.

Creatine supplementation improves intracellular Ca2+ handling and survival in mdx skeletal muscle cells.

Dystrophic skeletal muscle cells from Duchenne muscular dystrophy (DMD) patients and mdx mice exhibit elevated cytosolic Ca2+ concentrations ([Ca2+]c). Pretreatment of mdr myotubes for 6-12 days with creatine (20 mM) decreased the elevation in [Ca2+]c induced by either high extracellular Ca2+ concentrations or hypo-osmotic stress to control levels. 45Ca2+ influx measurements suggest that creatine lowered [Ca2+]c by stimulating sarcoplasmic reticulum Ca2+-ATPase. Creatine pretreatment increased levels of phosphocreatine but not ATP. Furthermore, myotube formation and survival were significantly enhanced by creatine pretreatment. Therefore, creatine supplementation may be useful for treatment of DMD.

Biphasic effects of cyclosporin A on formyl-methionyl-leucyl-phenylalanine stimulated responses in HL-60 cells differentiated into neutrophils.

The immunosuppressive drug cyclosporin A (CsA) depresses neutrophil oxidative burst which may lead to an increased susceptibility to infection in transplant patients. Using specific CsA analogues we investigated the mechanism of inhibition of the oxidative burst and evaluated short and long-term effects of CsA on dimethylsulphoxide-differentiated HL-60 neutrophils. A biphasic pattern was observed: a 4 h pre-treatment with CsA (1 microM) diminished the fMLP induced [Ca2+]c rise, reactive oxygen species (ROS) production, and beta-glucuronidase release by about 40%, whereas a 20 h pre-treatment increased these responses by about 1.5 fold. [MeVal4]CsA, which binds with high affinity to cyclophilin but inhibits the interaction of the CsA-cyclophilin complex with calcineurin, blocked the stimulation observed with CsA after a 20 h incubation but did not alter the CsA effects after a 4 h pre-treatment. PSC 833 (1 microM), a potent multi drug resistance transporter (MDR) inhibitor, diminished ROS production to the same extent as a 4 h CsA incubation but was ineffective after a 20 h pre-treatment. An involvement of MDR as a basis for CsA or PSC 833 action was ruled out based on the results of the calcein retention assay. [3H]CsA uptake showed that CsA and [MeVal4]CsA, but not CsH or PSC 833 were strongly taken up and retained by the cells. In conclusion, the reduction of the responses after 4 h appear to be due to a primary reduction of calcium signalling, while the enhanced responses after 20 h may be due to calcineurin inhibition.

Angioedema y urticaria inducidos por ejercicio: presentación de dos casos clínicos / Exercise related urticaria and angioedema: presentation of 2 clinical cases

Dos niñas (13 y 14 años respectivamente) consultaron por síncope asociado a esfuerzos, una de ellas sufría urticaria provocada por el ejercicio y el agua fría y la otra angícedema relacionado con el ejercicio. En ambas el exámen físico; electrocardiograma y ultrasonografía cardiaca eran normales. En la prueba de esfuerzo en molino rodante la primera paciente tuvo angiocedema y dificulta respiratoria alta (láringea) y la segunda urticaria. No sufrieron hipotensión o síncope, las manifestaciones desaparecieron espontáneamente. Se les recomendó abstenerse de ejercicios intensos y usar antihistáminicos orales profilácticos. La anafilaxia inducida por ejercicio fue descrita hace pocos años. La urticaria y el angioedema por esa causa son poco frecuentes. En casos severos puede ser necesario emplear epinefrina, antihistáminicos, líquidos parenterales y preservación de la vía aérea

Diagnóstico prenatal, manejo y evolución de las cardiopatías fetales / Prenatal diagnosis, management and outcome of congenital heart defects

Se presenta una experiencia con el diagnóstico prenatal, manejo y evolución de fetos con cardiopatías, realizado entre 1993, y 1996 en la Universidad Estatal de Louisiana y el Hospital de Niños de New Orleans, Estados Unidos. Se realizó 290 ecocardiografías en 244 fetos de 236 madres embarazadas, encontrándose 31 cardiopatías estructurales y 8 arritmias. Los principales diagnósticos fueron: síndrome de corazón izquierdo hipoplásico (6), canal AV completo (3) y corazón univentricular (5). Las indicaciones más frecuentes fueron diabetes gestacional e historia familiar de cardiopatía congénita. Las indicaciones con más alto rendimiento fueron: sospecha o evidencia de cardiopatía por ecografía obstétrica, anomalía extracardiaca/genopatía y arritmia fetal. El pronóstico fue pobre en aquellos defectos más graves, a pesar de la cirugía. El tratamiento médico in útero fue posible en casos de arritmias. La ecografía obstétrica (imagen de 4 cámaras) es el principal método de screening de las cardiopatías congénitas

Hair growth in neonatally undernourished rats.

Interaction between neonatal undernutrition and the increased self-grooming activity upon hair growth of several body areas was analyzed in rats of 10, 20 and 30 days of age. Light microscopic observations on methylene blue impregnated hairs showed that these perinatal influences delayed the growth of hair follicles and thickness and length of hair measurements of the head and thoracic areas. The hair growth of lateral abdominal regions was less affected. Data suggest that hair alterations are primarily related to food deprivation since hair follicle measures of all skin areas were more affected than the distal hair measurements. Moreover, the distribution of impaired hair growth on different body areas correlates well with the increased self-grooming components associated to neonatal undernourishment.

Neonatal undernutrition and self-grooming development in the rat: long-term effects.

The effect of neonatal undernutrition on six different self-grooming components was examined in male rats during the pre- and postweaning periods. Rats underfed by the maternal nipple-ligation procedure before weaning did not exhibit significant score differences in the various self-grooming measurements. In contrast, after weaning they showed a significant increment in the duration of face-washing, head-washing, fur licking and body-scratching. In all cases, the total postweaning self-grooming activity was significantly increased in the formerly underfed rats. Present data suggest that neonatal undernutrition may presumably interfere with the sequential maturational processes of central and/or peripheral mechanisms underlying some components of self-grooming behavior.

Effects of neonatal undernutrition on the electrocortical development of the association areas in the rat.

The electrocortical effects provoked by neonatal undernutrition and the environmental sensorial stimuli were studied in the cortical association areas of developing Wistar rats. When the interaction between these two factors was interfered (Experiment 1), the average frequency of the ECoG in the early starved rats was significantly increased than controls. Moreover, if these two factors were combined (Experiment 2) not significant differences in the ECoG average frequencies were observed. The data suggest that the maturation of cells underlying the ECoG in the association areas of the rat, requires not only an adequate supply of nutrients, but also the influence of sensory cues arising from the mother, littermates and the environmental surrounding.