Spontaneous subcapsular hepatic hematoma in pregnant patients

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum, (1/45,000-1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60-86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or foetal compromise. Nowadays the obstetric and anaesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic haemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications.

Polypeptide Pattern of Apple Tissues Affected by Calcium-related Physiopathologies

Polypeptides from the apple pulp of Smoothee Golden Delicious and White Renete apples were resolved by 1-D denaturing sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). According to the electropherograms, there were lower concentrations of 88, 74, 70.6 and 47.5-42kDa proteins in bitter pit spots. Proteins weighing 30 and 26kDa were rare in sound pulp but frequently appeared in pits and adjacent tissue. Finally, a novel 18kDa protein was found in bitter pit spots in both varieties, and also in chemically induced corky lesions either by magnesium infiltration or ammonium oxalate cortical injections. The available data suggested that the novel protein might be an inhibitor of pectinmethylesterase, a small heat stress protein (smHSP) or a product of the Ypr-10 gene family identified with ‘Mal d 1’, the main allergen of apples. To elucidate the possible smHSP nature of the 18kDa, a set of apples were heated at 40°C for 20h, developing this protein in both the oxidised tissue and in the adjacent.

[Pulmonary MALT lymphoma and paraneoplastic syndromes]

INTRODUCTION

Primary pulmonary lymphoma is a rare disease; diagnosis is often delayed because of atypical clinical presentation and slow progression.

OBSERVATION

A 42-year-old woman consulted because of haemoptysis. Chest CT-scan showed multiple nodular calcified masses. A lung biopsy led to the diagnosis of pulmonary amyloidosis with pulmonary MALT lymphoma (mucosa-associated lymphoid tissue). The patient developed two paraneoplastic syndromes: a hypertrophic osteoarthropathy and mucinosis.

CONCLUSION

Multiple nodular amyloidosis can be a mode of presentation for pulmonary lymphoma. Paraneoplastic syndromes must be systematically considered and can help in early diagnosis of the disease and its relapse.

[Paucisymptomatic presentation of an allergic bronchopulmonary aspergillosis]

Clinical atypical presentations of rare lung disease can cause a diagnostic issue. In this case report, allergic bronchopulmonary aspergillosis is not like in the traditional form of severe asthma but is revealed by a persistent cough. CT scan and biological examinations should be prescribed when there is doubt in confirming the diagnosis. Diagnostic and therapeutic management should be done early in this disease to avoid complications such as bronchiectasis.

Upper-limb muscular electrical stimulation driven by EEG-based detections of the intentions to move: a proposed intervention for patients with stroke

This study proposes an intervention for stroke patients in which electrical stimulation of muscles in the affected arm is supplied when movement intention is detected from the electroencephalographic signal. The detection relies on the combined analysis of two movement related cortical patterns: the event-related desynchronization and the bereitschaftspotential. Results with two healthy subjects and three chronic stroke patients show that reliable EEG-based estimations of the movement onsets can be generated (on average, 66.9 ± 26.4 % of the movements are detected with 0.42 ± 0.17 false activations per minute) which in turn give rise to electrical stimuli providing sensory feedback tightly associated to the movement planning (average detection latency of the onsets of the movements was 54.4 ± 287.9 ms).

[Comparison of home-based and outpatient, hospital-based, pulmonary rehabilitation in patients with chronic respiratory diseases]

INTRODUCTION

The comprehensive care and personalized pulmonary rehabilitation (PR) of patients with chronic respiratory disease is effective regardless of the place of performance. The objective of this prospective observational study was to compare two types of care in an outpatient rehabilitation center, versus a home-based PR.

METHODS

Two hundred and eighty-six patients were supported : 137 patients were included in outpatients (age : 61.2±10.8years, BMI: 28.7±7.1), 149 in home-based PR (age: 62.9±12years, BMI: 26.1±6.6). The choice between outpatient and home was a function of distance from the center and the patient's wishes. The outpatient care was done in groups of six, four times a week for 6weeks. At home she was single, once a week for 8weeks with continued physical activity independently of the other days a week depending on individual action plan. The therapeutic education programs and psycho-social support were identical in both structures. The assessment included assessment of exercise tolerance test in 6minutes stepper (TS6), anxiety and depression and quality of life.

RESULTS

There were no incidents or accidents during the PR in the two structures. The exercise intolerance was significantly higher in patients TS6 home (332.9±154.8 versus 460.2±137.9 counts, P<0.01). All the parameters studied, except for HAD score in the center, were improved significantly (P<0.001) after the course. The evolution of the different scores was not significantly different between the ambulatory versus home.

CONCLUSION

The PR of chronic respiratory unselected patients is as safe and effective at home or in outpatient center on exercise tolerance and quality of life. Home-based PR is an alternative to outpatient care as long as all activities, physical training, therapeutic education and psychosocial support, are achieved.

[Colorectal polyps: update on diagnosis]

Histological diagnosis determines the clinical behavior of colorectal polyps. Recently new types of polyps have been described and the classification has become wider and more complex. Our aim is update the current concepts in the knowledge of colorectal polyps.

[Increase of intraepithelial lymphocytes in patients with irritable bowel syndrome]

Several studies have shown increased numbers of intraepithelial lymphocytes (IEL), mast cells, enterochromaffin cells in colonic mucosa of patients with Irritable Bowel Syndrome (IBS). Many of these findings are based is based on immunohistochemistry results, which is not available in general hospitals. Our objective is to study the histological findings observed in colon biopsies from patients with IBS compared with a group without IBS, using only histochemistry. Twenty five (25) patients were included: 16 with IBS and 9 without IBS. We found increased numbers of IEL in patients with IBS (p=0,002). A group of patients with IBS (41.9%) who fulfilled histological criteria for lymphocytic colitis were excluded. There was no significant difference in mast cells, enterochromaffin cells or eosinophils.

Low serological positivity in patients with histology compatible with celiac disease in Perú

OBJECTIVE

To study the frequency of positive serology for celiac disease (CD) in patients with duodenal biopsies suggestive of this disease.

MATERIAL AND METHODS

Cross sectional study. We included patients with duodenal biopsies histologically compatible with CD and antigliadin, antiendomysial and IgA antitransglutaminase antibodies. We defined a "case" of CD if there was a positive biopsy and either antiendomisial or antitransglutaminase positive antibodies.

RESULTS

Thirty one patients were included in our study. Six were antiendomysial positive and 5 antitransglutaminase positive while the antigliadin was positive in 14 cases. Therefore, out of 31 patients only 10 had a serology compatible with CD and only one had positive both antibodies, antiendomysial and antitransglutaminase.

CONCLUSIONS

a) We have found that most of the duodenal biopsies compatible with CD are not diagnosed with positive serology; and b) we found a low correlation between serological diagnostic tests.

[Inflamatory polyps of the colon an evaluation]

AIM

We report our experience with Inflammatory Polyps of the Colon.

METHODS

Retrospective study including all polyps diagnosed at the Arias Stella Pathology Institute, Lima in the year 2008. Inflammatory polyps were diagnosed as polyp composed of reactive epithelium without dysplasia, inflamed granulation tissue.

RESULTS

We found 887 polyps of which 2.3% were inflammatory polyps. One out of three were located in the sigmoid colon, and 63% had no underlying colonic disease.

CONCLUSION

Inflammatory polyps are rare among colonic polyps and most patients have no accompanying colonic disease.

Visual Detection of Calcium by GBHA Staining in Bitter Pit-affected Apples

Bitter pit is a physiological disorder of apple fruits apparently caused by a localized calcium deficiency or imbalance in fruits associated with low levels of calcium in the flesh. A new, highly selective method using glyoxal bis(2-hydroxyanil, GBHA) was tested to reveal the presence of calcium within the fruit as a red stain. Water-soluble and insoluble calcium was analyzed by capillary electrophoresis and atomic absorption spectroscopy in pitted regions, adjacent sound areas and pulp from sound apples. Both methods, selective calcium staining and mineral analysis, showed that calcium accumulates in the pitted areas of apples affected by bitter pit. However, in mechanically inflicted wounds, the pulp of the apple was heavily stained but not the corresponding fingerprint, indicating a similar mechanism of insoluble calcium accumulation but a different distribution of soluble calcium compared to the pits.

[Immunoexpression of p53 and cyclin D1 in adenomas of the gallbladder]

INTRODUCTION

Gallbladder adenomas are infrequent neoplasms whose relation to adenocarcinoma is not well understood. It has been suggested that adenomas and adenocarcinomas follow different molecular pathways.

MATERIAL AND METHODS

This is a comparative, cross-sectional study in which we compared p53 and D1 cyclin expression in adenomas and adenocarcinomas of the gallbladder.

RESULTS

We included 12 cases in each group. Expression of p53 occurred in 83.3% of adenocarcinomas and in 16.6% of adenomas (p = 0.003). D1 cyclin was expressed in a similar number of adenomas and adenocarcinomas.

CONCLUSION

Our results support the hypothesis that p53 is an important step in the pathogenesis of adenocarcinomas but not of adenomas of the gallbladder. D1 cyclin is apparently a common pathway involved in the genesis of both tumors.

[Colon biopsy--histological characteristics in different types of chronic colitis]

In the last few years a variety of new forms of chronic colitis have been described with defined histological characteristics. It is important both for the gastroenterologists and pathologists to be acquainted with this new clinic pathological entities. The present article is a review of the anatomo-pathological characteristics of the different types of colitis.

[E-cadherin molecular expresion in the diffuse and intestinal types of gastric adenocarcinoma. A report from Lima, Peru]

OBJECTIVE

Signet ring carcinoma of the stomach is well known to be more aggressive and infiltrating than adenocarcinoma. Different studies have proposed that signet ring cell carcinoma would be more infiltrating because of the loss of E-cadherin expression, this cadherin is a class of protein cell membrane protein which plays an important role in cell-adhesion.

METHODS

We carried out a transversal comparative study, in order to measure the E-cadherin expression in 10 cases of signet ring cell and in 10 cases of adenocarcinoma, with help of immunohistochemistry.

RESULTS

We found a bigger expression of E-cadherin in adenocarcinomas (100%) than signet ring cell carcinoma (40%), this difference was significative using Fisher test (p = 0,011). The loss of E-cadherin would explain the bigger infiltrating capacity in comparison to adenocarcinoma.

[Early postoperative surgical complications of orthotopic liver transplantation in adults (II)]

Early postoperative complications after liver transplantation are classified broadly as either medical or surgical. This review covers the main aspects of the pathophysiology and clinical management of the latter group. Surgical complications of liver transplantation are an important cause of morbimortality; their early diagnosis and treatment are therefore critical issues. Such complications are usually related to surgical technique and their correction often requires a second surgical procedure. The most common early postoperative complication, and one of the most serious ones, is hepatic artery thrombosis. Venous complications are less prevalent and biliary ones predominate in the late postoperative phase.

[Early postoperative medical complications of orthotopic liver transplantation in adults (I)]

The outcome of liver transplantation in Spain has improved since our earliest experiences with this type of surgery, mainly due to breakthroughs in surgical and anesthetic techniques. Careful postoperative care of the patient also plays a key role, however, by providing the early diagnosis that allows appropriate management of complications. Together, such improvements contribute to reducing the morbidity associated with liver transplantation and to greater survival and quality of life for recipients. Early postoperative complications are diverse in nature and for convenience can be classified as either medical or surgical. This review deals with the main medical complications.

[Anesthesia for cesarean section in a patient with von Hippel-Lindau disease]

We report the case of a pregnant 38-year-old woman at full-term who had a history of von Hippel-Lindau disease with neurological symptoms. She had previously undergone surgical removal of cerebellar hemangioblastomas. A cesarean delivery performed under general anesthesia was uneventful and the outcomes were excellent for both mother and fetus. General anesthesia was chosen because patients with von Hippel-Lindau disease often have asymptomatic spinal cord and intracranial involvement. As such involvement could not be ruled out, we preferred to avoid the risks related to regional anesthesia. One of the main features of von Hippel-Lindau disease is the presence of central nervous system hemangioblastomas, which are highly vascularized, slow growing tumors that may become enlarged during pregnancy. We describe the implications of the disease for anesthesia.

[in vitro comparison of liquid antacids of commercial use]

The aim of our study was to compare the capacity of several liquid antacids to elevate the pH of a hydrochloric acid solution. An experimental model was designed to measure this capacity in different commercially available liquid antacids. Change in pH of an HCl solution was registered when each of the liquid antacids was added. We found differences between the 4 MgOH - ALOH antacids. Minimal difference was found between the 2 commercially available magaldrates.

[Cholelithiasis in patients with liver cirrhosis]

We retrospectively studied 67 cirrhotic patients hospitalized in the service of gastroenterology of Hospital Daniel A. Carrión, Callao, Perú, between June 1993 and July 1995, aimed to determine the frequency of cholelithiasis and its main clinical and epidemiological features. Twelve out of 67 cirrhotic patients (17.91%) had cholelithiasis. 24% of women and 14.3% of men were affected (p > 0.05). The mean age of women and men were 57.33 and 57.5 years old respectively (range: 41-67 years old). The frequency of cholelithiasis did not increase with age and the proportionally most affected age group was 41-50 years (33.33%). Alcoholic etiology was the most often in cirrhotic patients with cholelithiasis (41.67%). The severity of liver disease influenced in the cholelithiasis frequency (p = 0.001) and 33.33% of patients with gallstones were in grade C of Child Pugh Score. Two thirds of patients were asymptomatic. We conclude: 1. Cholelithiasis in our cirrhotic patients more prevalent than in general population (17.91% vs 0.7-5%). 2. Age did not influence in cholelithiasis prevalence in our cirrhotic patients. 3. The severity of liver disfunction influenced in highly significant way (p = 0.001) on cholelithiasis prevalence. 4. Cirrhotic patients with gallstones had mostly (66.67%) an asymptomatic course.

Low peptic ulcer and high gastric cancer prevalence in a developing country with a high prevalence of infection by Helicobacter pylori

We compared the prevalence rates of peptic ulcer (duodenal and gastric) and gastric cancer in 1,796 dyspeptic Peruvian patients with those reported in 2,883 similar patients from developed countries. The prevalence of total peptic ulcer was significantly lower, and that of gastric cancer significantly higher, in the Peruvian patients. The prevalence of gastric ulcer was lower but not significantly so. We deduced that the significantly lower prevalence of total peptic ulcer was directly related to the low prevalence rate of duodenal ulcer. We hypothesize that the reason for these differences was probably a higher prevalence of Helicobacter pylori-associated chronic atrophic gastritis with hypochlorhydria in the Peruvian patients. Hypochlorhydria decreases the predisposition to peptic ulcer (especially duodenal ulcer), and chronic atrophic gastritis may predispose an individual to gastric cancer.

[Immunological studies in hamsters (Cricetus auratus) infected with Schistosoma mansoni]

Los resultados de este trabajo muestran que el hamster (Cricetus auratus) puede ser utilizado como un modelo experimental para estudios inmunológicos en la infección por Schistosoma mansoni. Los datos obtenidos, relativos a inmunidad concomitante, producción de anticuerpo letal e inmunosupresión se asemejan a los conseguidos en otros modelos experimentales ya establecidos. Estas observaciones indican que el hámster, además de ser un hospedero satisfactorio para el mantenimiento del parásito en el laboratorio, puede ser considerado como un modelo experimental alterno cuyo crecimiento y mantenimiento son relativamente simples y además es un animal de fácil manejo.

Pulmonary dirofilariasis in a Costa Rican man

In a 33-year-old male Costa Rican who died of undetermined cause 2 hours after admission to hospital, autopsy revealed a small female Dirofilaria causing a recent hemorrhagic infarct unlike the pale coin lesion usually seen in pulmonary dirofilariasis.