Changes in the levels of free sialic acid during ex vivo lung perfusion do not correlate with pulmonary function. Experimental model.

BACKGROUND: Ex vivo lung perfusion (EVLP) constitutes a tool with great research potential due to its advantages over in vivo and in vitro models. Despite its important contribution to lung reconditioning, this technique has the disadvantage of incurring high costs and can induce pulmonary endothelial injury through perfusion and ventilation. The pulmonary endothelium is made up of endothelial glycocalyx (EG), a coating of proteoglycans (PG) on the luminal surface. PGs are glycoproteins linked to terminal sialic acids (Sia) that can affect homeostasis with responses leading to edema formation. This study evaluated the effect of two ex vivo perfusion solutions on lung function and endothelial injury. METHODS: We divided ten landrace swine into two groups and subjected them to EVLP for 120 min: Group I (n = 5) was perfused with Steen® solution, and Group II (n = 5) was perfused with low-potassium dextran-albumin solution. Ventilatory mechanics, histology, gravimetry, and sialic acid concentrations were evaluated. RESULTS: Both groups showed changes in pulmonary vascular resistance and ventilatory mechanics (p < 0.05, Student's t-test). In addition, the lung injury severity score was better in Group I than in Group II (p < 0.05, Mann-Whitney U); and both groups exhibited a significant increase in Sia concentrations in the perfusate (p < 0.05 t-Student) and Sia immunohistochemical expression. CONCLUSIONS: Sia, as a product of EG disruption during EVLP, was found in all samples obtained in the system; however, the changes in its concentration showed no apparent correlation with lung function.

Clinical, Histological, and Profibrotic Extracellular Matrix Protein Changes in a Model of Tracheal Stenosis Induced by Cervical Tracheal Autotransplantation.

BACKGROUND: Tracheal stenosis (TS) is a complication of prolonged intubation, tracheotomy, and tracheal surgery that compromises the vascular supply. Animal models are essential for studying its pathophysiology and the effect of interventions. OBJECTIVE: To establish a TS model in rats secondary to tracheal autotransplantation with a graft submerged in bleomycin (Atx-Bleo). Additionally, to evaluate the clinical and histological changes, as well as the expression of newly formed collagen (NFC), isoforms of transforming growth factor beta (TGFß), fibronectin (FN), elastin (ELN), integrin ß1 (ITGß1), and matrix metalloproteinase 1 (MMP1) in TS. METHODS: Twenty Wistar rats were divided into three groups: group I (n = 20) control; group II (n = 10) end-to-end anastomosis of the trachea (tracheoplasty); and group III (n = 10) Atx-Bleo. The animals were evaluated clinically, tomographically, macroscopically, morphometrically, and microscopically. NFC deposition, and the expression of profibrotic and antifibrotic proteins were evaluated in tracheal scars. RESULTS: All animals survived the surgical procedure and the study period. Compared with the other study groups, the Atx-Bleo group developed TS and fibrosis, exhibited higher expression of NFC, TGFß1, TGFß2, FN, ELN, and ITGß1, and mild expression of TGFß3 and MMP1 (p < 0.005; analysis of variance, Dunnett and Tukey tests). CONCLUSION: Atx-Bleo in TS model rats produces tomographic and histological changes, and induces the upregulation of profibrotic proteins (TGFß1, TGFß2, collagen, FN, ELN, ITGß1) and downregulation of antifibrotic proteins (TGFß3, MMP1). Therefore, this model may be used to test new pharmacological treatments for reversing or preventing TS, and conduct basic studies regarding its pathophysiology.

Endothelin-Converting Enzyme 1 and Vascular Endothelial Growth Factor as Potential Biomarkers during Ex Vivo Lung Perfusion with Prolonged Hypothermic Lung-Sparing.

Lung transplantation requires optimization of donor's organ use through ex vivo lung perfusion (EVLP) to avoid primary graft dysfunction. Biomarkers can aid in organ selection by providing early evidence of suboptimal lungs during EVLP and thus avoid high-risk transplantations. However, predictive biomarkers of pulmonary graft function such as endothelin-converting enzyme (ECE-1) and vascular endothelial growth factor (VEGF) have not been described under EVLP with standard prolonged hypothermic preservation, which are relevant in situations where lung procurement is difficult or far from the transplantation site. Therefore, this study is aimed at quantifying ECE-1 and VEGF, as well as determining their association with hemodynamic, gasometric, and mechanical ventilatory parameters in a swine model of EVLP with standard prolonged hypothermic preservation. Using a protocol with either immediate (I-) or delayed (D-) initiation of EVLP, ECE-1 levels over time were found to remain constant in both study groups (p > 0.05 RM-ANOVA), while the VEGF protein was higher after prolonged preservation, but it decreased throughout EVLP (p > 0.05 RM-ANOVA). Likewise, hemodynamic, gasometric, mechanical ventilatory, and histological parameters had a tendency to better results after 12 hours of hypothermic preservation in the delayed infusion group.

Treatment with Hyaluronic Acid and Collagen-Polyvinylpyrrolidone Improves Extracellular Matrix Assembly for Scarring after Tracheal Resection.

Treatment of tracheal stenosis is occasionally performed in combination with wound healing modulators to manipulate new extracellular matrix (ECM) formation and prevent fibrosis. Hyaluronic acid (HA) and collagen-polyvinylpyrrolidone (collagen-PVP) decrease fibrosis in experimental tracheal healing. However, they have not been used clinically as their effect on ECM components, which modify tracheal scarring, has not been described. Objective. To evaluate the effect of the application of HA, collagen-PVP, a mixture of HA and collagen-PVP (HA+collagen-PVP), and mitomycin C on the expression of decorin, matrix metalloproteinase 1 (MMP1), and MMP9, as well as the type of collagen and deposits formed in the scar after resection and end-to-end anastomosis (REEA) of the cervical trachea using an experimental model. Materials and Methods. Thirty dogs underwent REEA of the cervical trachea and were treated with different wound healing modulators: group I (n = 6), control; group II (n = 6), HA; group III (n = 6), collagen-PVP; group IV (n = 6), HA+collagen-PVP; and group V (n = 6), mitomycin C. The dogs were evaluated clinically and endoscopically for 4 weeks. Subsequently, macroscopic and microscopic changes, expression of ECM proteins, and collagen deposition in tracheal scars were analysed. Results. Groups II, III, and IV showed reduced endoscopic, macroscopic, and microscopic inflammation, improved neovascularization, high decorin expression (p < 0.01, analysis of variance (ANOVA)), and moderate expression of MMP1 (p < 0.003, ANOVA) and type I and III collagen (p < 0.05, Kruskal-Wallis). Groups IV and V developed fewer collagen deposits (p < 0.001, ANOVA). Conclusion. Treatment with HA and collagen-PVP improved post-REEA healing by increasing neovascularization, stimulating the expression of decorin, and regulating the expression of MMP1, as well as type I and III collagen and their deposition.

Imagen en trauma toracoabdominal.Un diagnóstico diferencial difícil / Image in thoracoabdominal trauma. A difficult differential diagnosis

Resumen Hombre de 70 años de edad, quien ingresó en el área de urgencias con antecedente de atropellamiento. Refería dolor torácico bilateral y disnea. Al examen físico lo encontramos con vía aérea permeable, ausencia de murmullo vesicular en porción inferior de hemitórax derecho asociada con pérdida de la matidez hepática, hemodinámicamente estable, consciente, con puntaje de 15 en la escala de coma de Glasgow. Se obtuvo radiografía de tórax, la cual reveló una imagen radiolúcida por encima del hígado, por lo cual se solicitó tomografía de abdomen con contraste, la que permitió corroborar la integridad del diafragma. Este tipo de imagen radiológica puede sugerir una ruptura diafragmática traumática; sin embargo, sólo se trata de un hallazgo radiográfico.

Abstract A 70-year-old male entered the emergency department after being hit by a car. He had bilateral thoracic pain and dyspnea. On the physical examination we found him with patent airway, absence of vesicular murmur in the lower portion of the right hemithorax in association with loss of hepatic dullness, hemodinamic stability, conscious with 15 points on the Glasgow coma scale. We obtained a plain thoracic x-ray, which revealed a radiolucent image over the liver; for that reason, we obtained a contrasted CT-scan which showed diaphragmatic integrity. This image finding may suggest a traumatic diaphragmatic rupture; however, it may be only a radiological finding.

Cesárea perimortem por trauma penetrante por proyectil de arma de fuego con supervivencia fetal. Reporte de un caso / Perimortem C-Section after gunshot penetrating trauma with infant survival. Case report

Resumen Introducción: El trauma en el embarazo es un escenario complejo, y pocas publicaciones estudian los problemas secundarios a éste en el tercer trimestre, como es el caso de las indicaciones y resultados de las cesáreas de emergencia. La cesárea perimortem es un acontecimiento inusual; cuando se realiza, es el único recurso para obtener un recién nacido vivo. Si existe paro cardiorrespiratorio, la cesárea perimortem está indicada después de 4 a 5 minutos de inicio del paro en la madre. Caso: Mujer de 19 años, con antecedente de herida por proyectil de arma de fuego, que ingresó al cubículo de choque en paro y con maniobras de reanimación cardiopulmonar y embarazo de aproximadamente 36 semanas de gestación. Se realizaron 4 ciclos de reanimación sin reversión a circulación espontánea; por lo cual se decidió realizar cesárea de emergencia perimortem por un cirujano general en el área de choque. Se obtuvo un producto único vivo, y se reportó la defunción de la madre minutos después. Se trasladó el producto a la Unidad de Cuidados Intensivos Neonatales (UCIN), y 5 días después del procedimiento se reportó sin secuelas neurológicas. Conclusión: La primera razón para realizar de una cesárea perimortem es la supervivencia de la madre. Como se trata de una emergencia, no es necesario invertir tiempo en verificar la viabilidad fetal. En casos especiales, en los que debido a su patología la posibilidad de supervivenciade la madre es nula, la cesárea perimortem podrá realizarse para salvar la vida del producto. Realizar este procedimiento requiere tomar una decisión muy importante y de manera muy rápida, hay que resaltar la importancia del lugar donde se realizó, ya que era un centro de trauma, donde se cuenta con salas de choque especializadas para realizar procedimientos de emergencia con mayor rapidez, y personal capacitado sin necesidad de trasladarse a un quirófano para realizarlo, para obtener resultados satisfactorios.

Abstract Introduction: Trauma in pregnancy is a complex scenario, few publications study the issues after trauma in the 3rd trimester, including indications and outcomes in emergency C-Section. Perimorten Cesarean Section, is an unusual event, when it's performed it is the only resource for infant survival. When there is cardiac arrest, Perimortem Cesarean Section is indicated 4 to 5 minutes after cardiac arrest. Case: 19 year old female, with recent history of gunshot injury to the chest, arrives in cardiac arrest and with CPR and a 36 week pregnancy. 4 cycles of Cardiopulmonary resuscitation where performed without reversion to spontaneous circulation, then we decide to perform a Perimortem Cesarean Section by General Surgeon in the trauma room. Infant alive t is obtained, death of the mother is reported minutes later. The infant is transferred to NICU, 5 days after the procedure, it is reported without neurological sequelae. Conclusion: The first reason to perform a perimortem cesarean section is the survival of the mother, because it's an emergency, it's not necessary to lose time in verifying the infant's vitals. In special cases, in which there are few possibilities of mother survival, the perimortem cesarean section is performed for infant survival. Performing this procedure requires a very important decision making and in a quick way, it's very important to remark that this procedure was performed in a Trauma Center, which has the facilities as a trauma room, where we can do emergency procedures faster, and with the trained medical staff to do it, with no need to move to an operating room to perform it, obtaining successful outcomes.

[The masters of thoracic trauma in the Central Hospital of the Mexican Red Cross. Their story and legacy]. / Los maestros del trauma torácico en el Hospital Central de la Cruz Roja Mexicana. Su historia y legado.

The branches of medicine responsible for the care of victims of different types of injuries were born as a result of the urgent need to save lives during the wars. In Mexico, one of the first hospitals developed for the care of injured patients was the Central Hospital of the Mexican Red Cross. The aim of this article is to pay tribute to the first service for the care of patients with chest trauma, founded in 1954, its founders and those who have continued with their work: Dr. Pedro Garza Alegría, Dr. Octavio Rivas Solís Dr. Jesús Genis Becerra, etc. In 64 years of existence, there have been trained eight specialists in cardiothoracic surgery and three of them have worked in the Central Hospital of the Mexican Red Cross.

Ruptura gástrica por mecanismo de bolsa de papel por trauma cerrado de abdomen. Reporte de un caso / Gastric rupture due to paper bag mechanism because of a closed abdominal trauma. A case report

Resumen A pesar de que el trauma abdominal contuso es una entidad frecuente, su asociación con lesión gástrica es rara (aproximadamente 1.7%); sin embargo, es una posibilidad que siempre debe considerarse durante su evaluación. Además de su trascendencia como hallazgo aislado, es esencial su correlación con otras lesiones. Presentamos el siguiente caso no sólo por la escasa frecuencia con la que se observan este tipo de lesiones, sino por sus características clínicas anómalas, las cuales -salvo por el mecanismo del trauma- hicieron prácticamente imposible su sospecha.

Abstract Although closed abdominal trauma is a frequent entity, its association with gastric injury is rare (approximately a 1.7%); however, it is a possibility that should always be taken into consideration during its evaluation. In addition to its transcendence as an isolated finding, its correlation with other lesions is essential. We present the following case not only because of the low frequency with which these sort of lesions are observed, but also because of its anomalous clinical features that make any suspicion virtually impossible, except for the mechanism of the trauma.

Trichotillomania, recurrent trichobezoar and Rapunzel syndrome: case report and literature review.

BACKGROUND: Bezoar is a conglomeration of foreign material in the intestinal tract. Trichobezoar (accumulation of hair in the gastric chamber, secondary to impulsive pulling and intake) and Rapunzel syndrome (accumulation of hair in the small intestine) usually occur in children and adolescents with trichotillomania (TTM) and trichophagia history. CLINICAL CASE: We present the case of a 22-year-old female who arrived for consultation. The patient had a 10-month history of intermittent abdominal pain, gastric fullness, nausea, occasional vomiting and weight loss. In addition, she had a history of TTM, trichophagia and previous gastrotomy at 16 years of age. Laboratory tests revealed hypochromic microcytic anemia. Ultrasonographic study demonstrated intense sonic shadowing posterior to the gastric area. After performing gastrotomy, the specimen was extracted and consisted of hair that occupied the entire length of the gastric chamber and part of the small intestine. CONCLUSIONS: TTM is characterized by recurrent and impulsive pulling of one's hair for pleasure, gratification, or relief of tension. Children and women <30 years of age are the groups who most frequently suffer from this type of disorder. Hair intake sensation was a cause for presentation of the disease. Data recollection in our environment may provide information for the determination of new information regarding the presence of this condition.

Tricotilomanía, tricobezoar de repetición y síndrome de Rapunzel: informe de un caso y revisión de la literatura / Trichotillomania, recurrent trichobezoar and Rapunzel syndrome: case report and literature review

Introducción: Un bezoar es un conglomerado de material extraño en el tracto intestinal. El tricobezoar (acumulación de cabello en la cámara gástrica) y el síndrome de Rapunzel (acumulación en el intestino delgado) suelen aparecer en niños y mujeres adolescentes con antecedente de tricotilomanía y tricofagia. Caso clínico: Mujer de 22 años de edad con dolor abdominal intermitente, plenitud gástrica, náuseas, vómito ocasional y pérdida ponderal de 10 meses de evolución. Antecedentes de tricotilomanía, tricofagia y gastrotomía a los 16 años. Los exámenes de laboratorio revelaron anemia microcítica hipocrómica y el ultrasonido mostró una sombra sónica posterior en la cámara gástrica. Por gastrotomía se extrajo un conglomerado de cabello que ocupaba el estómago y parte del intestino delgado. Conclusiones: La tricotilomanía y tricofagia son más comunes en las mujeres menores de 30 años. La sensación que experimentaba la paciente al deglutir los cabellos provocaba la ingesta. La recopilación de datos puede proporcionar información acerca de los determinantes que influyen en la aparición de la enfermedad.

BACKGROUND: Bezoar is a conglomeration of foreign material in the intestinal tract. Trichobezoar (accumulation of hair in the gastric chamber, secondary to impulsive pulling and intake) and Rapunzel syndrome (accumulation of hair in the small intestine) usually occur in children and adolescents with trichotillomania (TTM) and trichophagia history. CLINICAL CASE: We present the case of a 22-year-old female who arrived for consultation. The patient had a 10-month history of intermittent abdominal pain, gastric fullness, nausea, occasional vomiting and weight loss. In addition, she had a history of TTM, trichophagia and previous gastrotomy at 16 years of age. Laboratory tests revealed hypochromic microcytic anemia. Ultrasonographic study demonstrated intense sonic shadowing posterior to the gastric area. After performing gastrotomy, the specimen was extracted and consisted of hair that occupied the entire length of the gastric chamber and part of the small intestine. CONCLUSIONS: TTM is characterized by recurrent and impulsive pulling of one's hair for pleasure, gratification, or relief of tension. Children and women <30 years of age are the groups who most frequently suffer from this type of disorder. Hair intake sensation was a cause for presentation of the disease. Data recollection in our environment may provide information for the determination of new information regarding the presence of this condition.

[Bladder injuries due to abdominal trauma in patients treated at the Central Hospital of the Mexican Red Cross]. / Lesiones de vejiga por trauma abdominal en el Hospital Central de la Cruz Roja Mexicana.

BACKGROUND: Abdominal traumas involving the urinary tract represent 10% and, of these, 25% are for bladder trauma. Type of injury depends on the mechanism of action, whether blunt or penetrating. Symptoms include hypogastric hypersensitivity and inability to urinate. The most important sign is hematuria. METHODS: This was a retrospective, observational study and descriptive analysis of patients with bladder injury, excluding iatrogenic injury. RESULTS: There were 46 cases of bladder injury comprising 35 men (76%) and 11 women (24%). Mean age was 29 years. Mechanism of injury was closed contusion (63%) and penetrating wound (37%). Diagnosis was established in 74% of cases by exploratory laparotomy and in 26% of cases by cystography. Treatment was in accordance with intra- or extraperitoneal status, and there were no reported complications. CONCLUSIONS: Patients with traumatic injuries are often young and male, in relation to patients with iatrogenic damage. Closed abdominal trauma is prevalent with penetration. Gross hematuria is the most consistent symptom. Incidence of bladder injury associated with pelvic fracture was low. Exploratory laparotomy was the primary diagnostic method, with cystography done in a limited number of patients. There were no complications.

Lesiones de vejiga por trauma abdominal en el Hospital Central de la Cruz Roja Mexicana / Bladder injuries due to abdominal trauma in patients treated at the Central Hospital of the Mexican Red Cross

Introducción: El 10 % de las lesiones traumáticas abdominales involucra la vía urinaria, de éstas 25 % corresponde a trauma vesical. El tipo de lesión depende del mecanismo de acción contuso o penetrante. Los síntomas incluyen hipersensibilidad hipogástrica e imposibilidad para la micción; el signo más importante es la hematuria. Material y métodos: Se realizó estudio retrospectivo observacional y descriptivo de los pacientes con lesión vesical atendidos de enero de 2001 a septiembre de 2007 en el Hospital Central de la Cruz Roja Mexicana de la Ciudad de México; fueron excluidos aquellos con lesiones iatrogénicas. Resultados: Se encontraron 46 casos de lesión vesical, 35 hombres (76 %) y 11 mujeres (24 %). La edad promedio fue de 29 años. El mecanismo de la lesión fue contusión cerrada en 63 % y por herida penetrante en 37 %. El diagnóstico se estableció en 26 % por cistograma retrógrado y en 74 % por laparotomía exploradora, en la cual se identificó lesión asociada de más de dos órganos. El tratamiento dependió de la condición de intra o extraperitoneal; no se informaron complicaciones. Conclusiones: Los pacientes con lesión vesical por trauma son más jóvenes en relación a los que padecen daño iatrogénico y con predominio del sexo masculino. El traumatismo cerrado de abdomen impera sobre el penetrante. La hematuria macroscópica es el síntoma más constante. La lesión vesical asociada a fractura pélvica tuvo baja incidencia. La laparotomía exploradora fue el principal método diagnóstico debido a que lesiones asociadas indicaban la realización inmediata del procedimiento.

BACKGROUND: Abdominal traumas involving the urinary tract represent 10% and, of these, 25% are for bladder trauma. Type of injury depends on the mechanism of action, whether blunt or penetrating. Symptoms include hypogastric hypersensitivity and inability to urinate. The most important sign is hematuria. METHODS: This was a retrospective, observational study and descriptive analysis of patients with bladder injury, excluding iatrogenic injury. RESULTS: There were 46 cases of bladder injury comprising 35 men (76%) and 11 women (24%). Mean age was 29 years. Mechanism of injury was closed contusion (63%) and penetrating wound (37%). Diagnosis was established in 74% of cases by exploratory laparotomy and in 26% of cases by cystography. Treatment was in accordance with intra- or extraperitoneal status, and there were no reported complications. CONCLUSIONS: Patients with traumatic injuries are often young and male, in relation to patients with iatrogenic damage. Closed abdominal trauma is prevalent with penetration. Gross hematuria is the most consistent symptom. Incidence of bladder injury associated with pelvic fracture was low. Exploratory laparotomy was the primary diagnostic method, with cystography done in a limited number of patients. There were no complications.