RESUMEN
INTRODUCTION: Granulocyte and monocyte adsorptive apheresis (GMA) removes neutrophils and monocytes from peripheral blood, preventing their incorporation into the inflamed tissue also influencing cytokine balance. Published therapeutic efficacy in ulcerative colitis (UC) is more consistent than in Crohn's disease (CD). We assessed clinical efficacy of GMA in UC and CD 4 weeks after last induction session, at 3 and 12 months, sustained remission and corticosteroid-free remission. PATIENTS AND METHOD: Retrospective observational study of UC and CD patients treated with GMA. Partial Disease Activity Index-DAIp in UC and Harvey-Bradshaw Index-HBI in CD assessed efficacy of Adacolumn® with induction and optional maintenance sessions. RESULTS: We treated 87 patients (CD-25, UC-62), 87.3% corticosteroid-dependent (CSD), 42.5% refractory/intolerant to immunomodulators. In UC, remission and response were 32.2% and 19.3% after induction, 35.5% and 6.5% at 12 weeks and 29% and 6.5% at 52 weeks. In CD, remission rates were 60%, 52% and 40% respectively. In corticosteroid-dependent and refractory or intolerant to INM patients (UC-41, CD-14), 68.3% of UC achieved remission or response after induction, 51.2% at 12 weeks and 46.3% at 52 weeks, and 62.3%, 64.3% and 42.9% in CD. Maintained remission was achieved by 66.6% in CD and 53.1% in UC. Up to 74.5% of patients required corticosteroids at some timepoint. Corticosteroid-free response/remission was 17.7% in UC and 24% in CD. CONCLUSIONS: GMA is a good therapeutic tool for both in UC and CD patients. In corticosteroid-dependent and refractory or intolerant to INM patients it avoids biological therapy or surgery in up to 40% of them in one year.
RESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Adulto , Duodeno/diagnóstico por imagen , Duodeno/patología , Mucosa Gástrica/patología , Endoscopía del Sistema DigestivoRESUMEN
We present the case of a 30-year-old female patient with Gilbert's syndrome and gastrointestinal intolerance to proton pump inhibitors (PPI) with longstanding epigastric pain. Laboratory tests were unremarkable, except for a slight elevation of indirect bilirubin due to Gilbert's syndrome. An upper gastrointestinal tract endoscopy showed a diffuse and homogeneous micropolypoid mucosal pattern that involved the entire duodenal bulb. Histopathology analysis revealed gastric heterotopic mucosa with foveolar epithelium and fundic glands. A diagnosis of diffuse duodenal gastric heterotopia was determined. Anti-H2 blockers were prescribed with a significant clinical improvement.
Asunto(s)
Duodeno , Tracto Gastrointestinal Superior , Adulto , Duodeno/diagnóstico por imagen , Endoscopía Gastrointestinal , Femenino , Mucosa Gástrica , Humanos , Inhibidores de la Bomba de Protones/uso terapéuticoRESUMEN
The aim of this paper is to give a practical overview, showing how recent available digital technology can be combined to build a laboratory capable to produce 3D (and reproduce in 3D) anatomical models for research, teaching and museum exhibitions on topics related to anatomy, morphology in natural sciences, biology and medicine. We present workflows in our Virtual Morphology Lab that can be used for research, training (museum, academic), and external service. We first review different surface scanning equipment and post-processing techniques that are useful for scanning in museum collections and provide technical recommendations for hard- and software as well as storing media on the web. This section is followed by an overview of available software packages for rigorous and effective 3D measurements of landmarks and sliding semi-landmarks, providing extensive supplementary information with guiding manuals for self-teaching in these cutting-edge but complicated research methods. We review briefly most recent work on virtual GM and describe ways for representing results in form of 3D images and 3D prints (outputs). The last part is dedicated to a summary of our experience in 3D-printing using FDM technology of differently sized printers and thermoplastic materials. Finally, we discuss the above-described workflows and its potential applications in research (paleo, biomedical), teaching and museums pedagogics.
Asunto(s)
Imagenología Tridimensional/métodos , Modelos Anatómicos , Paleontología/métodos , Impresión Tridimensional , Animales , Huesos/diagnóstico por imagen , Fósiles/diagnóstico por imagen , Hominidae , Humanos , Flujo de TrabajoRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Adulto , Endometriosis/diagnóstico , Abdomen/patología , Cicatriz/patología , Enfermedad de Crohn/complicaciones , Cesárea , Complicaciones PosoperatoriasRESUMEN
Class III peroxidases are glycoproteins with a major role in cell wall maturation such as lignin formation. Peroxidases are usually present in a high number of isoenzymes, which complicates to assign specific functions to individual peroxidase isoenzymes. Arabidopsis genome encodes for 73 peroxidases, among which AtPrx72 has been shown to participate in lignification. Here, we report by using knock out peroxidase mutants how the disruption of AtPrx72 causes thinner secondary walls in interfascicular fibres but not in the xylem of the stem. This effect is also age-dependent, and AtPrx72 function seems to be particularly important when lignification prevails over elongation processes. Finally, the suppression AtPrx72 leads to the down-regulation of lignin biosynthesis pathway, as well as genes and transcription factors involved in secondary wall thickening.
Asunto(s)
Proteínas de Arabidopsis/genética , Arabidopsis/genética , Regulación de la Expresión Génica de las Plantas , Lignina/genética , Peroxidasas/genética , Arabidopsis/metabolismo , Proteínas de Arabidopsis/metabolismo , Pared Celular/metabolismo , Técnicas de Inactivación de Genes , Lignina/biosíntesis , Peroxidasas/metabolismo , Tallos de la Planta/genética , Tallos de la Planta/metabolismo , Metabolismo SecundarioRESUMEN
Catharanthus roseus is a medicinal plant belonging to the family Apocynaceae which produces terpenoid indole alkaloids (TIAs) of high medicinal importance. Indeed, a number of activities like antidiabetic, bactericide and antihypertensive are linked to C. roseus. Nevertheless, the high added value of this plant is based on its enormous pharmaceutical interest, producing more than 130 TIAs, some of which exhibit strong pharmacological activities. The most striking biological activity investigated has been the antitumour effect of dimeric alkaloids such as anhydrovinblastine, vinblastine and vincristine which are already in pre-, clinical or in use. The great pharmacological importance of these indole alkaloids, contrasts with the small amounts of them found in this plant, making their extraction a very expensive process. To overcome this problem, researches have looked for alternative sources and strategies to produce them in higher amounts. In this sense, intensive research on the biosynthesis of TIAs and the regulation of their pathways has been developed with the aim to increase by biotechnological approaches, the production of these high added value compounds. This review is focused on the different strategies which improve TIA production, and in the analysis of the beneficial effects that these compounds exert on human health.
Asunto(s)
Catharanthus/química , Extractos Vegetales/química , Alcaloides de Triptamina Secologanina/metabolismo , Alcaloides de Triptamina Secologanina/farmacología , Antibacterianos/metabolismo , Antibacterianos/farmacología , Antineoplásicos/metabolismo , Antineoplásicos/farmacología , Antioxidantes/metabolismo , Antioxidantes/farmacología , Antivirales/metabolismo , Antivirales/farmacología , China , Humanos , Hipoglucemiantes/metabolismo , Hipoglucemiantes/farmacología , Extractos Vegetales/farmacología , Brotes de la Planta/química , Plantas Medicinales/químicaRESUMEN
Lignins result from the oxidative polymerization of three hydroxycinnamyl (p-coumaryl, coniferyl and sinapyl) alcohols in a reaction mediated by peroxidases (EC 1.11.1.7) and laccases (EC 1.10.3.2), yielding H, G and S units, respectively. Although both acidic and basic peroxidases can oxidize p-coumaryl and coniferyl alcohol, only basic peroxidases are able to oxidize sinapyl alcohol. The AtPrx52 from Arabidopsis is a basic peroxidase that has been reported to be highly homologous to the basic peroxidase of Zinnia elegans, the only peroxidase which has been unequivocally linked to lignin formation. Here, we show how the suppression of AtPrx52 causes a change in lignin composition, mainly at the level of stem interfascicular fibers. Quantification of lignins in two different atprx52 knock-out mutants revealed a decrease of lignin amount compared with wild type. The S/G ratio, obtained by both nitrobenzene oxidation and thioacidolysis, indicated a decrease in S units in the atprx52 mutants. As deduced from Wiesner and mainly Mäule staining, this reduction in S unit content appears to be restricted to the interfascicular fibers. Moreover, quantitative polymerase chain reaction analysis in atprx52 plants showed a general downregulation of genes involved in lignin biosynthetic pathway, as well as genes related to secondary cell wall. On the other hand, other routes from phenylpropanoid metabolism were induced. Taken together, our results indicate that AtPrx52 is involved in the synthesis of S units in interfascicular fibers at late stages of the lignification process.
Asunto(s)
Proteínas de Arabidopsis/metabolismo , Arabidopsis/metabolismo , Lignina/metabolismo , Peroxidasas/metabolismo , Tallos de la Planta/metabolismo , Xilema/metabolismo , Arabidopsis/genética , Proteínas de Arabidopsis/genética , Pared Celular/genética , Pared Celular/metabolismo , Perfilación de la Expresión Génica , Regulación Enzimológica de la Expresión Génica , Regulación de la Expresión Génica de las Plantas , Técnicas de Inactivación de Genes , Lignina/ultraestructura , Microscopía Electrónica de Transmisión , Mutación , Peroxidasas/genética , Tallos de la Planta/genética , Tallos de la Planta/ultraestructura , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Xilema/genéticaRESUMEN
Syringyl lignins result from the oxidative polymerization of sinapyl alcohol in a reaction mediated by syringyl (basic) peroxidases. Several peroxidases have been identified in the genome of Arabidopsis thaliana as close homologues to ZePrx, the best characterized basic peroxidase so far, but none of these has been directly involved in lignification. We have used a knock-out mutant of AtPrx4, the closest homologue to ZePrx, to study the involvement of this basic peroxidase in the physiology of the plant under both long- and short-day light conditions. Our results suggest that AtPrx4 is involved in cell wall lignification, especially in syringyl monomer formation. The disruption of AtPrx4 causes a decrease in syringyl units proportion, but only when light conditions are optimal. Moreover, the effect of AtPrx4 disruption is age-dependent, and it is only significant when the elongation process of the stem has ceased and lignification becomes active. In conclusion, AtPrx4 emerges as a basic peroxidase regulated by day length with an important role in lignification.
Asunto(s)
Proteínas de Arabidopsis/metabolismo , Arabidopsis/enzimología , Regulación de la Expresión Génica de las Plantas , Lignina/metabolismo , Peroxidasa/metabolismo , Peroxidasas/metabolismo , Arabidopsis/genética , Proteínas de Arabidopsis/genética , Pared Celular/metabolismo , Oxidación-Reducción , Peroxidasa/genética , Peroxidasas/genética , Tallos de la Planta/enzimología , Tallos de la Planta/genéticaRESUMEN
Zinnia elegans constitutes one of the most useful model systems for studying xylem differentiation, which simultaneously involves secondary cell wall synthesis, cell wall lignification, and programmed cell death. Likewise, the in vitro culture system of Z. elegans has been the best characterized as the differentiation of mesophyll cells into tracheary elements allows study of the biochemistry and physiology of xylogenesis free from the complexity that heterogeneous plant tissues impose. Moreover, Z. elegans has emerged as an excellent plant model to study the involvement of peroxidases in cell wall lignification. This is due to the simplicity and duality of the lignification pattern shown by the stems and hypocotyls, and to the basic nature of the peroxidase isoenzyme. This protein is expressed not only in hypocotyls and stems but also in mesophyll cells transdifferentiating into tracheary elements. Therefore, not only does this peroxidase fulfil all the catalytic requirements to be involved in lignification overcoming all restrictions imposed by the polymerization step, but also its expression is inherent in lignification. In fact, its basic nature is not exceptional since basic peroxidases are differentially expressed during lignification in other model systems, showing unusual and unique biochemical properties such as oxidation of syringyl moieties. This review focuses on the experiments which led to a better understanding of the lignification process in Zinnia, starting with the basic knowledge about the lignin pattern in this plant, how lignification takes place, and how a sole basic peroxidase with unusual catalytic properties is involved and regulated by hormones, H2O2, and nitric oxide.
Asunto(s)
Asteraceae/enzimología , Asteraceae/genética , Pared Celular/metabolismo , Regulación de la Expresión Génica de las Plantas , Lignina/metabolismo , Peroxidasas/genética , Arabidopsis/citología , Arabidopsis/enzimología , Arabidopsis/genética , Asteraceae/citología , Diferenciación Celular , Peróxido de Hidrógeno/metabolismo , Óxido Nítrico/metabolismo , Peroxidasas/metabolismo , Reguladores del Crecimiento de las Plantas/metabolismoRESUMEN
Lignins result from the oxidative polymerization of three hydroxycinnamyl (p-coumaryl, coniferyl, and sinapyl) alcohols in a reaction mediated by peroxidases. The most important of these is the cationic peroxidase from Zinnia elegans (ZePrx), an enzyme considered to be responsible for the last step of lignification in this plant. Bibliographical evidence indicates that the arabidopsis peroxidase 72 (AtPrx72), which is homolog to ZePrx, could have an important role in lignification. For this reason, we performed a bioinformatic, histochemical, photosynthetic, and phenotypical and lignin composition analysis of an arabidopsis knock-out mutant of AtPrx72 with the aim of characterizing the effects that occurred due to the absence of expression of this peroxidase from the aspects of plant physiology such as vascular development, lignification, and photosynthesis. In silico analyses indicated a high homology between AtPrx72 and ZePrx, cell wall localization and probably optimal levels of translation of AtPrx72. The histochemical study revealed a low content in syringyl units and a decrease in the amount of lignin in the atprx72 mutant plants compared to WT. The atprx72 mutant plants grew more slowly than WT plants, with both smaller rosette and principal stem, and with fewer branches and siliques than the WT plants. Lastly, chlorophyll a fluorescence revealed a significant decrease in ΦPSII and q L in atprx72 mutant plants that could be related to changes in carbon partitioning and/or utilization of redox equivalents in arabidopsis metabolism. The results suggest an important role of AtPrx72 in lignin biosynthesis. In addition, knock-out plants were able to respond and adapt to an insufficiency of lignification.
Asunto(s)
Proteínas de Arabidopsis/metabolismo , Arabidopsis/enzimología , Biología Computacional , Lignina/biosíntesis , Peroxidasa/metabolismo , Peroxidasas/metabolismo , Secuencia de Aminoácidos , Proteínas de Arabidopsis/química , Proteínas de Arabidopsis/genética , Asteraceae/enzimología , Pared Celular/metabolismo , Clorofila/metabolismo , Clorofila A , Fluorescencia , Modelos Moleculares , Anotación de Secuencia Molecular , Datos de Secuencia Molecular , Mutación/genética , Peroxidasa/química , Peroxidasas/genética , Fenotipo , Tallos de la Planta/anatomía & histología , Estructura Secundaria de Proteína , Alineación de Secuencia , Espectroscopía Infrarroja por Transformada de Fourier , Xilema/citología , Xilema/metabolismoRESUMEN
CONTEXT: Catharanthus roseus (L.) G. Don (Apocynaceae) is a medicinal plant that produces more than 130 alkaloids, with special attention given to the production of the anti-hypertensive monomeric indole alkaloids, serpentine and ajmalicine, and the antitumor dimeric alkaloids, vinblastine and vincristine. OBJECTIVE: This study evaluated the cytotoxic activity of the indole alkaloid-enriched bioactive extract obtained from suspension cultured-cells of C. roseus elicited with methyl jasmonate (MJ) and cyclodextrins (CDs) in three cell lines: JURKAT E.6 human lymphocytic leukemia, THP-1 human monocytic leukemia and BL 1395 non-tumor human B-cell line. MATERIALS AND METHODS: An indole alkaloid-enriched bioactive extract was obtained from C. roseus cell cultures elicited with MJ and CDs. The indole alkaloids were identified using an HPLC-diode array system coupled to a time-of-flight mass spectrometer using electrospray ionization (ESI) source. The cytotoxic assays were made using the colorimetric assay 2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-S-[(phenylamino)carbonyl]-2 tetrazolium hydroxide (XTT). RESULTS: Four indole alkaloids were identified (catharanthine, ajmalicine, tabersonine and lochnericine) but only catharanthine and ajmalicine were quantified. The concentration of the indole alkaloid-enriched bioactive extract that inhibited cell growth by 50% was 211 and 210 ng/mL for the JURKAT E.6 and THP-1 cell lines, respectively. DISCUSSION AND CONCLUSION: The results confirm that the powerful antitumor activity of this indole alkaloid-enriched bioactive extract is not due to the effect of a single compound but depends on the synergistic action of the four compounds identified.
Asunto(s)
Antineoplásicos Fitogénicos/farmacología , Catharanthus/metabolismo , Alcaloides Indólicos/farmacología , Extractos Vegetales/farmacología , Hojas de la Planta/metabolismo , Acetatos/farmacología , Antineoplásicos Fitogénicos/biosíntesis , Antineoplásicos Fitogénicos/química , Antineoplásicos Fitogénicos/aislamiento & purificación , Catharanthus/química , Catharanthus/citología , Catharanthus/efectos de los fármacos , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Cromatografía Líquida de Alta Presión , Ciclodextrinas/farmacología , Ciclopentanos/farmacología , Descubrimiento de Drogas , Humanos , Alcaloides Indólicos/química , Alcaloides Indólicos/metabolismo , Concentración 50 Inhibidora , Oxilipinas/farmacología , Extractos Vegetales/química , Extractos Vegetales/aislamiento & purificación , Hojas de la Planta/citología , Hojas de la Planta/efectos de los fármacos , Quinolinas/química , Quinolinas/metabolismo , Quinolinas/farmacología , Alcaloides de Triptamina Secologanina/química , Alcaloides de Triptamina Secologanina/metabolismo , Alcaloides de Triptamina Secologanina/farmacología , Espectrometría de Masa por Ionización de Electrospray , Alcaloides de la Vinca/química , Alcaloides de la Vinca/metabolismo , Alcaloides de la Vinca/farmacologíaRESUMEN
Suspension-cultured cells of Vitis vinifera cv Monastrell were used to investigate the effects of methyljasmonate, ethylene and salicylic acid separately or in combination with cyclodextrins on both trans-resveratrol production and the induction of defense responses. The results showed that the addition of methyljasmonate or ethylene to suspension-cultured cells jointly treated with cyclodextrins and salicylic acid provoked a decrease of trans-resveratrol levels suggesting that salicylic acid has a negative and antagonistic effect with methyljasmonate or ethylene on trans-resveratrol production. Likewise, the exogenous application of these compounds induced the accumulation of pathogenesis-related proteins. Analysis of the extracellular proteome showed the presence of amino acid sequences homologous to an specific ß-1,3-glucanase, class III peroxidases and a ß-1,4-mannanase, which suggests that these signal molecules could play a role in mediating defense-related gene product expression in V. vinifera cv Monastrell. Apart from these inducible proteins, other proteins were found in both the control and elicited cell cultures of V. vinifera. These included class IV chitinase, polygalacturonase inhibitor protein and reticuline oxidase-like protein, suggesting that their expression is constitutive being involved in the modification of the cell wall architecture during cell culture growth and in the prevention of pathogen attack.
Asunto(s)
Antiinfecciosos/farmacología , Resistencia a la Enfermedad/efectos de los fármacos , Enfermedades de las Plantas/inmunología , Proteínas de Plantas/metabolismo , Estilbenos/metabolismo , Vitis/inmunología , Vitis/metabolismo , Acetatos/farmacología , Células Cultivadas , Ciclodextrinas/farmacología , Ciclopentanos/farmacología , Etilenos/farmacología , Regulación de la Expresión Génica de las Plantas/efectos de los fármacos , Genes de Plantas , Oxilipinas/farmacología , Reguladores del Crecimiento de las Plantas/farmacología , Resveratrol , Ácido Salicílico/farmacología , Transducción de Señal , Vitis/citología , Vitis/efectos de los fármacos , Vitis/genéticaRESUMEN
The use of cyclic oligosaccharides like cyclodextrins (CDs), alone or combined with methyl jasmonate (MJ), as elicitors has proved very effective in stimulating the production of trans-resveratrol (trans-R) in Vitis vinifera suspension-cultured cells (SCC). Since elicitors can be used to increase trans-R production, understanding the molecular mechanisms involved would improve the management of grapevine cells as factories of this compound. The results obtained in this study provide evidence for a role of Ca(2+) in mediating elicitor-induced trans-R production in grapevine SCC. The Ca(2+) elevation was promoted by an uptake of Ca(2+) from the extracellular medium, and by Ca(2+) mobilization from intracellular organelles. Moreover, protein phosphorylation/dephosphorylation events seem to be involved in the signal transduction pathways triggered by CDs separately or in combination with MJ since trans-R production is dependent on both, the phosphorylation status of several proteins through mitogen-activated kinase pathway and the activity of tyrosine phosphatases. Our results also suggest that H(2)O(2) and NO participated in the production of trans-R triggered by both elicitors in grapevine SCC. Finally, a fast alkalinization of the extracellular medium is induced in the presence of CDs and/or MJ.
Asunto(s)
Acetatos/farmacología , Señalización del Calcio/efectos de los fármacos , Ciclodextrinas/farmacología , Ciclopentanos/farmacología , Sistema de Señalización de MAP Quinasas/efectos de los fármacos , Oxilipinas/farmacología , Células Vegetales/metabolismo , Reguladores del Crecimiento de las Plantas/farmacología , Vitis/metabolismo , Señalización del Calcio/fisiología , Quinasas MAP Reguladas por Señal Extracelular/metabolismo , Peróxido de Hidrógeno/metabolismo , Sistema de Señalización de MAP Quinasas/fisiología , Óxido Nítrico/metabolismo , Proteínas de Plantas/metabolismo , Vitis/citologíaRESUMEN
trans-Resveratrol (trans-R) has been reported to be a potential cancer chemopreventive agent. Although its cytotoxic activity against different cancer cell lines has been tested, its effect on human acute leukemia cell lines has scarcely been investigated, and only a few in vitro studies were performed using human breast epithelial cell lines. Due to its potential value for human health, demand for trans-R has rapidly increased, and new biotechnological strategies to obtain it from natural edible sources have been developed. Thus, grapevine cell cultures represent a reliable system of trans-R production since they biosynthesize trans-R constitutively or in response to elicitation. In addition, there are no studies deepen on the inhibitory effect of trans-R, produced by elicited grapevine cell cultures, on growth of human tumor cell lines. In this work, the effect of trans-R extracted from the culture medium, after elicitation of grapevine cell cultures, was tested on two human acute lymphocytic and monocytic leukemia cell lines, and one human breast cancer cell line. The effect of trans-R on cell proliferation was not only dose- and time-dependent but also cell type-dependent, as seen from the different degrees of susceptibility of cancer cell lines tested. As regards the effect of trans-R on cell cycle distribution, low trans-R concentrations increased cells in the S phase whereas a high trans-R concentration increased G0/G1 phase in all cell lines. Perturbation of the cell cycle at low trans-R concentrations did not correlate with the induction of cell death, whereas a high trans-R concentration, cell proliferation decreased as a result of increasing apoptosis in the three cell lines. In leukemia cells, trans-R up-regulated the expression of caspase-3 while trans-R-induced apoptosis in breast cells occur through a caspase-3-independent mechanism mediated by a down-regulation of Bcl-2.
Asunto(s)
Antineoplásicos Fitogénicos/farmacología , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Estilbenos/farmacología , Vitis/química , Antineoplásicos Fitogénicos/aislamiento & purificación , Apoptosis/efectos de los fármacos , Caspasa 3/metabolismo , Técnicas de Cultivo de Célula , Ciclo Celular/efectos de los fármacos , Muerte Celular/efectos de los fármacos , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Cromatografía Líquida de Alta Presión , Ciclodextrinas/farmacología , Relación Dosis-Respuesta a Droga , Regulación hacia Abajo/efectos de los fármacos , Femenino , Genes bcl-2/efectos de los fármacos , Humanos , Resveratrol , Espectrometría de Masa por Ionización de Electrospray , Estilbenos/aislamiento & purificación , Factores de Tiempo , Regulación hacia Arriba/efectos de los fármacos , Vitis/efectos de los fármacosAsunto(s)
Agranulocitosis/inducido químicamente , Anticuerpos Monoclonales/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/inmunología , Fármacos Gastrointestinales/efectos adversos , Adulto , Enfermedad de Crohn/patología , Femenino , Humanos , Infliximab , Tomografía Computarizada por Rayos X , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
Primary Esophageal Melanoma (PEM) is an extremely rare neoplasm, with less than 270 cases described. Although clinical presentation is similar to any other esophageal neoplasm, MEP's behavior is more aggressive and fatal in most cases. We report two new cases of MEP diagnosed through endoscopy and anatomical-pathological analysis of collected biopsies. Both samples were positive for HMB-45 and S100, so the presence of primary melanoma in other location was ruled out. The form of presentation as left miosis with no eyelid ptosis or enophthalmos should be highlighted in the first case, which was described by this early manifestation. Unfortunately, the neoplasm could not be excised when diagnosed because the thoracic artery was found to be affected through echoendoscopy. In the second case, in spite of the fact that the neoplastic extension was only local, and neoplasm was subject to transhiatal esophagectomy, the patient had multiple post-surgical complications and died nineteen days after the surgical procedure. Furthermore, bibliographic review is applied to diagnosis, treatment options, and prognosis of this exceptional neoplasm.