RESUMEN
AIM: Vascular endothelial growth factor (VEGF) is a potent angiogenic and endothelial factor, which is abundantly found in the normal lung tissue. The objective of the study was to assess the VEGF levels in lung tissue and plasma in acute respiratory distress syndrome (ARDS) patients compared with controls who died from non-ARDS causes. METHODS: Plasma and tissue samples were prospectively collected from 20 patients with ARDS within 6 hours after intubation (VEGF in plasma and tissue samples) and on the day of extubation (plasma VEGF) or postmortem (lung tissue). We used an ELISA to measure the VEGF level in plasma. Lung specimens were obtained by bronchoscopic biopsy or by open biopsy during autopsy. All lung samples were stained for standard histopathological analysis and for immunohistochemical methods. Biomarker levels were compared between survivors (N=12), non-survivors (N=8) and controls (N=10). RESULTS: Compared with the levels in controls, in the early stages of ARDS, plasma VEGF levels rose and intrapulmonary levels fell, but during recovery, these levels went back to normal levels. CONCLUSION: The initial phase of ARDS is associated with a decrease in VEGF in the lung and an increase in the plasma. This down-regulation may represent a protective mechanism aimed at limiting endothelial permeability and may participate in the decrease in the capillary number that is observed during early ARDS. A persistent elevation of plasma VEGF over time predicts poor outcome.
Asunto(s)
Pulmón/química , Síndrome de Dificultad Respiratoria/sangre , Factor A de Crecimiento Endotelial Vascular/análisis , Adulto , Anciano , Endotelio Vascular/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Síndrome de Dificultad Respiratoria/metabolismo , Factor A de Crecimiento Endotelial Vascular/sangre , Factor A de Crecimiento Endotelial Vascular/fisiologíaRESUMEN
On the first case, in the inland literature of regulated resection based on the (supra) hepatic segmentation, the authors are widely discussing the anatomical and surgical aspects regarding the distribution in two vertical territories of the right anterior (paramedian) sector (SAD), also by the (supra) hepatic and by the portal (Hjortsjo) segmentation. In comparison with the classic, portal (Couinaud-Bismuth) segmentation, in certain fortunate situations, the vertical distribution (instead of the transversal one) of the SAD helps to preserve more hepatic parenchyma, which is such necessary for the cirrhotic or metastatic liver.
Asunto(s)
Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Neoplasias del Colon/patología , Hepatectomía/métodos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Hepatic actinomycosis is a pretty rare anatomo-clinical entity that often induces a wrong pre-operative diagnosis. By presenting a case of hepatic actinomycosis, apparently primitive and diagnosed pre-operatively as a neoplastic lesion, the authors discuss the diagnosis and treatment of this disease, mentioning that in the solid, tumoral forms, the hepatic resection is necessary. The authors consider that the post-operative addition of antibiotherapy (mega doses of penicillin) is useful for the eradication of inflammatory residual hepatic parenchyma as well as for the cicatrisation of the parietal fistulae.