Late presentation of hepatic pseudoaneurysm after liver trauma: a case of misdiagnosed cholecystitis and successful endovascular embolization.

Hepatic artery pseudoaneurysms are a significant health concern, often incidentally discovered during computed tomography (CT) scans, as their exact incidence rate remains unknown. The most common symptoms of a pseudoaneurysm are hematemesis, abdominal pain, anemia and jaundice. A triad of right upper quadrant pain, jaundice and overt upper gastrointestinal bleeding is a classic presentation of the condition, which occurs in only a third of patients with hemobilia. Patients have a high risk of rupture, and an endovascular approach with coil embolization is recommended. A case of a 28-year-old woman with a post-traumatic hepatic pseudoaneurysm is presented in which she was initially misdiagnosed and treated for cholecystitis. After the development of jaundice, hematemesis and melena, a CT angiography confirmed diagnosis. Endovascular embolization was performed successfully, and the patient recovered without complications. This case highlights the importance of prompt diagnosis of hepatic pseudoaneurysms, as a delayed diagnosis can result in significant morbidity and mortality.

Extracellular vesicles through the blood-brain barrier: a review.

Extracellular vesicles (EVs) are particles naturally released from cells that are delimited by a lipid bilayer and are unable to replicate. How the EVs cross the Blood-Brain barrier (BBB) in a bidirectional manner between the bloodstream and brain parenchyma remains poorly understood. Most in vitro models that have evaluated this event have relied on monolayer transwell or microfluidic organ-on-a-chip techniques that do not account for the combined effect of all cellular layers that constitute the BBB at different sites of the Central Nervous System. There has not been direct transcytosis visualization through the BBB in mammals in vivo, and evidence comes from in vivo experiments in zebrafish. Literature is scarce on this topic, and techniques describing the mechanisms of EVs motion through the BBB are inconsistent. This review will focus on in vitro and in vivo methodologies used to evaluate EVs transcytosis, how EVs overcome this fundamental structure, and discuss potential methodological approaches for future analyses to clarify these issues. Understanding how EVs cross the BBB will be essential for their future use as vehicles in pharmacology and therapeutics.

Multi-tissue cytogenetic analysis for the diagnosis of mosaic Down syndrome: A case report.

Less than one percent of individuals with Down syndrome exhibit mosaicism, a biological phenomenon that describes an individual who has two or more genetically distinct cell lines. The percentage of mosaicism in different tissues can impact the presence of clinical findings and hinder cytogenetic diagnosis. We report a case of mosaicism for trisomy 21 diagnosed after multi-tissue cytogenetic analysis of peripheral blood and buccal mucosa, associated with significant intellectual disability, dysmorphic facial features, congenital heart defects, macropenis, and imperforate anus.

A novel description of a syndrome consisting of 7q21.3 deletion including DYNC1I1 with preserved DLX5/6 without ectrodactyly: a case report.

BACKGROUND: Chromosomal region 7q21.3 comprises approximately 5.2 mega base pairs that include genes DLX5/6, SHFM1, and DYNC1I1 associated with split hand/split foot malformation 1. So far, there are reports of eight families with deletion of DYNC1I1 and preserved DLX5/6 associated with ectrodactyly. From these families, only three patients did not present ectrodactyly and, unlike our patient, no other cases have been described as having craniofacial dysmorphology, mitral valve prolapse, kyphoscoliosis, inguinal herniae, or personality disorder. There is no designation described in the literature for patients with syndromic manifestations without ectrodactyly, which hinders diagnosis. CASE PRESENTATION: We report the case of a 44-year-old mestizo (combined European and Amerindian descent) man with a 3191 kilo base pairs deletion and International System for Human Cytogenetic Nomenclature array 7q21.3 (93,389,222-96,579,845)x1. Clinical manifestations included micrognathia, retrognathia, wormian bones, auditory canal stenosis, depressed nasal bridge, epicanthal fold, fullness of upper eyelid, long philtrum, low-set ears, sensorineural hearing loss, kyphoscoliosis, bilateral inguinal herniae, mild mitral valve prolapse, and paranoid personality disorder. His isolated DNA was analyzed using a CytoScan HD Microarray system. Chromosome Analysis Suite software was utilized for the microarray analysis. All copy number changes were determined using the human genome build 19 (hg19/NCBI build 37). CONCLUSIONS: Cases of deletions within chromosome 7q21.3 that include the split hand/split foot malformation 1 region represent a diagnostic challenge when not presenting ectrodactyly despite being syndromic. Due to the heterogeneity of the region, a better method to group and classify these patients is needed to facilitate their clinical diagnosis. For this purpose, we suggest that patients with 7q21.3 deletion including DYNC1I1 and preserved DLX5/6 without ectrodactyly, accompanied by craniofacial dysmorphology, personality disorder, hearing loss, musculoskeletal disorder, inguinal herniae and/or mitral valve prolapse be referred to by the eponym Ramos-Martínez syndrome.

Valoración del tono simpático en la hipertensión esencial mediante la prueba de supresión por clonidina / Evaluation of the sympathetic tone in essential hypertension by the clonidine-supression test

Evidencias recientes sugieren que el sistema nervioso simpático juega un papel importante en la patogenia y en mantenimiento de diversas formas de enfermedad hipertensiva. La prueba de supresión por clonidina permite exhibir cambios sutiles en la liberación de noradrenalina neuronal en la hipertensión esencial. Para confirmar lo anterior se seleccionaron 16 pacientes: 7 con hipertensión fronteriza (HF) (4 varones y 3 mujeres) con edad promedio de 24 años y 9 con hipertensión establecida (HE) (6 varones y 3 mujeres) con edad de 25 años. En ambos grupos, se registró la frecuencia cardiaca (FC) y la presión arterial (PA) cada 30 min y por cánula intravenosa se midieron las catecolaminas plasmásticas (CAP) y la actividad de renina plasmática (ARP) antes y después (180 y 240 min) de haber sido administrada una dosis oral de clonidina (300 mcg). Los pacientes permanecieron en clinostatismo hasta los 180 min y en ortostatismo durante 1 hora hasta los 240 min. La FC y la PA disminuyeron en los HF e HE después de la clonidina durante el clinostatismo, en comparación al período preclonidina. Las CAP también mostraron reducción a los 180 min con respecto al periodo basal. La ARP no presentó cambio a los 180 min en ambos grupos, con relación al tiempo 0. Durante el ortostatismo, la FC aumentó en los 2 grupos con respecto al período basal. La PA permaneció disminuida con relación al tiempo basal. La CAP se incrementaron con respecto al período preclonidina. La ARP mostró tendencia discreta a aumentar con relación a los 0 min en ambos grupos. Los niveles basales de CAP no son índices confiables de la participación del tono simpático en el mantenimiento de cifras elevadas de PA en la enfermedad hipertensiva. La prueba de clonidina demuestra que la actividad simpática puede ser un factor común en la patogenia de diversas variedades clínicas de hipertensión esencial y que los mecanismos involucrados en el origen y desarrollo de la enfermedad, yacen en las porciones superiores del sistema nervioso central