RESUMEN
After the first successful laparoscopic cholecystectomy in Europe by Phillipe Mouret, the method quickly became established all over the world. In the meantime, its advantages and complications have been identified. In rare cases, major vascular injuries occur as serious and deadly complications of laparoscopic surgery. We present the case of a patient with a sizable pseudoaneurysm of the abdominal aorta that was identified 5 months after the performance of a laparoscopic cholecystectomy at another hospital. Thereafter, we review the literature in search of some methods that can be used to avoid vascular injuries.
Asunto(s)
Aneurisma Falso/etiología , Aneurisma de la Aorta Abdominal/etiología , Colecistectomía Laparoscópica/efectos adversos , Anciano , Femenino , HumanosRESUMEN
Extramedullary haemopoiesis (EH) is a compensatory process associated with chronic haemolytic anaemia. It is rare, however, for such an abnormality to cause spinal cord compression. We present two patients with known beta-thalassaemia intermedia who developed spinal cord compression due to masses of extramedullary haematopoietic tissue in the epidural space of the thoracic spine. The EH masses were diagnosed by MRI as an isointense epidural lesion on both T1- and T2-weighted images, compressing severely the spinal cord. After administration of a paramagnetic agent, an intermediate enhancement of the masses was evident. All the vertebral bodies had low to intermediate signal intensity as a result of displacement of fatty marrow by haematopoietic marrow. Expansion of thoracic ribs with bilateral paravertebral masses were characteristic. A small dose of radiotherapy was given and marked improvement in neurological symptoms was evident. An MRI examination established shrinkage of the mass and decompression of spinal cord. The role of MRI in diagnosis of EH masses is essential and radiation therapy is a very effective treatment for this rare complication.
Asunto(s)
Hematopoyesis Extramedular , Imagen por Resonancia Magnética , Compresión de la Médula Espinal/diagnóstico , Talasemia beta/diagnóstico , Adulto , Diagnóstico Diferencial , Espacio Epidural/patología , Estudios de Seguimiento , Hematopoyesis Extramedular/fisiología , Humanos , Aumento de la Imagen , Masculino , Vértebras Torácicas/patologíaRESUMEN
A 21 year old woman from Thrace with clinical and laboratory findings of mild hemolysis, was found to be homozygous for haemoglobin O Arab. Blood samples from 15 members of her family and from 42 inhabitants of her village were examined for the presence of Hb O Arab. A high incidence of this variant allele was also detected among the patient's family members as well as in other inhabitants of the village (p = 0.274 +/- 0.049). The possibility that Pomaks, a culturally unique tribe with controversial ethnic origin, may represent one of the original pools for the geographic distribution of the gene in the broader area of the Mediterranean basin is discussed.
Asunto(s)
Etnicidad/genética , Hemoglobinas Anormales/análisis , Adulto , Femenino , Grecia , Hemoglobina C/análisis , Hemoglobina Falciforme/análisis , Humanos , Masculino , LinajeRESUMEN
Extramedullary haematopoiesis is sometimes encountered in severe anaemia. Rarely, it may cause neurological symptoms, leading to spinal cord or cauda equina compression. Three patients with thalassaemia intermedia, who developed neurological complications, are described. The diagnoses were based on the clinical findings, computed tomography and magnetic resonance imaging. Small doses of radiotherapy (10-20 Gy in 5-10 fractions) relieved symptoms in all of these patients. Our experience supports the role of radiation therapy as a treatment for this complication.
Asunto(s)
Hematopoyesis Extramedular/fisiología , Compresión de la Médula Espinal/radioterapia , Talasemia beta/fisiopatología , Adulto , Cauda Equina , Estudios de Seguimiento , Hematopoyesis Extramedular/efectos de la radiación , Humanos , Imagen por Resonancia Magnética , Masculino , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/radioterapia , Dosificación Radioterapéutica , Compresión de la Médula Espinal/etiología , Tomografía Computarizada por Rayos XRESUMEN
The influence of dexamethasone and cyclophosphamide on the goat immune system was investigated. Seven goats, with a previous contact with caprine herpesvirus type 1 (CHV-1), were used. All had been vaccinated with live Mycobacterium paratuberculosis vaccine. Six goats were injected intravenously (i.v.) with dexamethasone daily for 5 days (2.5-4 mg/kg BW per day). Three also received 25 mg/kg BW of cyclophosphamide on day 0. The seventh goat was not treated. Dexamethasone alone caused depression, slight lymphopenia and fall in tuberculin reaction. Dexamethasone plus cyclophosphamide caused a severe clinical reaction, marked leukopenia (lymphopenia and polymorphopenia), fall in tuberculin reaction and significant increase in CHV-1 neutralizing antibody titres. M. paratuberculosis antibody reaction was variable and thus difficult to be assessed. CHV-1 was not isolated.
Asunto(s)
Ciclofosfamida/farmacología , Dexametasona/farmacología , Cabras/inmunología , Terapia de Inmunosupresión , Animales , Formación de Anticuerpos/efectos de los fármacos , Infecciones por Herpesviridae/inmunología , Infecciones por Herpesviridae/veterinaria , Inmunidad Celular/efectos de los fármacos , Mycobacterium avium subsp. paratuberculosis/inmunología , Paratuberculosis/inmunología , Prueba de Tuberculina/veterinariaRESUMEN
A new deficient glucose 6-phosphate dehydrogenase (G6PD) variant, G6PD Thessaloniki, which was found in the red blood cells of a 70-year-old woman who had idiopathic myelofibrosis, is described. G6PD Thessaloniki had a low Michaelis constant (Km) for G6P (20 microM), high Km for NADP (10.1 microM), normal pH optimum, reduced heat stability, decreased electrophoretic mobility (96-98% of the normal), increased 2-deoxy-G6P and decreased galactose 6-phosphate utilization. Several other enzymatic activities measured in the patient's red blood cells were normal. Studies of red blood cell survival and glucose utilization gave evidence of haemolysis caused by defective glucose utilization by the pentose phosphate pathway. The only son of the patient had normal G6PD in his red blood cells. In an attempt to investigate the origin of G6PD Thessaloniki, heat stability tests of G6PD extracted from the patient's skin have been performed.