RESUMEN
Dimethyl fumarate (DMF, Tecfidera) is an oral drug utilized to treat relapsing-remitting multiple sclerosis (MS). DMF treatment reduces disease activity in MS. Gastrointestinal discomfort is a common adverse effect of the treatment with DMF. This study aimed to investigate the effect of DMF administration in the gut draining lymph nodes cells of C57BL6/J female mice with experimental autoimmune encephalomyelitis (EAE), an animal model of MS. We have demonstrated that the treatment with DMF (7.5 mg/kg) significantly reduces the severity of EAE. This reduction of the severity is accompanied by the increase of both proinflammatory and anti-inflammatory mechanisms at the beginning of the treatment. As the treatment progressed, we observed an increasing number of regulatory Foxp3 negative CD4 T cells (Tr1), and anti-inflammatory cytokines such as IL-27, as well as the reduction of PGE2 level in the mesenteric lymph nodes of mice with EAE. We provide evidence that DMF induces a gradual anti-inflammatory response in the gut draining lymph nodes, which might contribute to the reduction of both intestinal discomfort and the inflammatory response of EAE. These findings indicate that the gut is the first microenvironment of action of DMF, which may contribute to its effects of reducing disease severity in MS patients.
Asunto(s)
Dimetilfumarato , Encefalomielitis Autoinmune Experimental , Ganglios Linfáticos , Ratones Endogámicos C57BL , Linfocitos T Reguladores , Animales , Dimetilfumarato/farmacología , Dimetilfumarato/uso terapéutico , Encefalomielitis Autoinmune Experimental/tratamiento farmacológico , Encefalomielitis Autoinmune Experimental/inmunología , Ganglios Linfáticos/inmunología , Ganglios Linfáticos/efectos de los fármacos , Ratones , Femenino , Linfocitos T Reguladores/inmunología , Linfocitos T Reguladores/efectos de los fármacos , Mesenterio , Citocinas/metabolismo , Inmunosupresores/farmacología , Inmunosupresores/uso terapéutico , Modelos Animales de EnfermedadRESUMEN
BACKGROUND: Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site. METHODS: This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization. RESULTS: None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien-Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%. CONCLUSION: The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC.
Asunto(s)
Cistectomía , Mesenterio , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Robotizados , Derivación Urinaria , Humanos , Cistectomía/métodos , Femenino , Masculino , Procedimientos Quirúrgicos Robotizados/métodos , Derivación Urinaria/métodos , Persona de Mediana Edad , Anciano , Complicaciones Posoperatorias/prevención & control , Mesenterio/cirugía , Neoplasias de la Vejiga Urinaria/cirugía , Tratamientos Conservadores del Órgano/métodos , Resultado del Tratamiento , Complicaciones Intraoperatorias/prevención & control , Estudios Retrospectivos , Reproducibilidad de los Resultados , Estudios de CohortesRESUMEN
Introducción. La hidatidosis o equinococosis es una zoonosis parasitaria que se adquiere al ingerir huevos de cestodos del género Echinococcus. El diagnóstico clínico raramente se hace en sitios no endémicos. La mayoría de los pacientes se encuentran asintomáticos y los hallazgos incidentales en los estudios de imágenes o en procedimientos quirúrgicos permiten la sospecha diagnóstica. Caso clínico. Paciente masculino de 70 años, residente en área rural del municipio de Puerto Libertador, departamento de Córdoba, Colombia, quien consultó por masa abdominal en epigastrio y mesogastrio, parcialmente móvil e indolora. Resultados. En cirugía se identificaron lesiones quísticas mesentérica y hepática. Después de la cirugía y mediante estudios de inmunohistoquímica, se confirmó el diagnóstico de quiste hidatídico. El paciente tuvo una evolución satisfactoria. Conclusión. La hidatidosis quística mesentérica y hepática sintomática es una enfermedad rara en sitios no endémicos, donde la cirugía constituye un pilar fundamental en el diagnóstico y tratamiento, sumado al manejo médico farmacológico.
Introduction. Hydatidosis or echinococcosis is a parasitic zoonosis that is acquired by ingesting eggs of cestodes of the genus Echinococcus. Clinical diagnosis is rarely made in non-endemic sites. Most patients are asymptomatic and incidental findings on imaging studies or surgical procedures allow for diagnostic suspicion. Clinical case. A 70-year-old male patient, resident in a rural area of the municipality of Puerto Libertador, department of Córdoba, Colombia, who consulted for an abdominal mass in the epigastrium and mesogastrium, partially mobile and painless. Results. In surgery, mesenteric and hepatic cystic lesions were identified. After surgery and through immunohistochemistry studies, the diagnosis of hydatid cyst was confirmed. The patient had a satisfactory evolution. Conclusion. Symptomatic mesenteric and hepatic cystic hydatidosis is a rare disease in non-endemic sites, where surgery constitutes a fundamental pillar in the diagnosis and treatment in addition to pharmacological medical management.
Asunto(s)
Humanos , Zoonosis , Equinococosis Hepática , Equinococosis , Laparotomía , MesenterioRESUMEN
Introducción. Los teratomas son neoplasias que surgen a partir de células germinales pluripotenciales y derivan de dos o más capas de células. Se clasifican en tumores maduros, que contienen tejidos bien diferenciados, o inmaduros, que contienen estructuras inmaduras y embrionarias. Su localización más frecuente son las gónadas; la ubicación mesentérica es infrecuente y se han descrito aproximadamente 40 casos en la literatura mundial. Dentro del abordaje diagnóstico y terapéutico, se emplea la tomografía computarizada y la resonancia magnética nuclear para caracterizar la lesión, evaluar la extensión intraabdominal y la relación con otras estructuras. El diagnóstico debe confirmarse mediante el examen histopatológico. Caso clínico. Paciente femenina de 56 años, con antecedente de carcinoma ductal infiltrante de mama izquierda en remisión, en estudios de seguimiento con hallazgo incidental en tomografía de abdomen de lesión abdominopélvica dependiente del mesenterio, contornos lisos y nivel grasa-líquido. Estudios de extensión con marcadores tumorales negativos. Resultados. Por la alta sospecha clínica e imagenológica de teratoma, fue llevada a resección quirúrgica de la lesión. El examen histopatológico confirmó el diagnóstico de teratoma quístico maduro del mesenterio. Conclusión. El teratoma mesentérico es una entidad clínica rara, que debe ser considerado como uno de los diagnósticos diferenciales de una masa abdominal con efecto compresivo. El diagnóstico se basa principalmente en el examen clínico y los hallazgos imagenológicos. La escisión quirúrgica temprana es el pilar del tratamiento; el abordaje laparoscópico o abierto depende de las características clínicas y la experiencia del cirujano.
Background. Teratomas are neoplasms that arise from pluripotent germ cells, derived from two or more layers of germ cells. They are classified as mature tumors (cystic or solid), which contain well-differentiated tissues, or as immature tumors, which contain immature and embryonic structures. Its most frequent location is the female and male gonads; the mesenteric location is rare and approximately 40 cases have been described in the world literature. Within the diagnostic and therapeutic approach, computed tomography and magnetic resonance imaging are used to characterize the lesion, assess intra-abdominal extension and the relationship with other structures. The diagnosis must be confirmed by histopathological examination. Clinical case. A 56-year-old female patient with a history of infiltrating ductal carcinoma of the left breast in remission. In follow-up studies, incidental abdominal tomography finding of an abdominopelvic lesion dependent on the mesentery at the level of the mesogastrium, smooth contours with fat-liquid level. Extension studies with negative tumor markers. Results. Due to high clinical and imaging suspicion of teratoma, the patient was taken to resection of the lesion. Histopathological examination confirmed the diagnosis of mature cystic teratoma of the mesentery. Conclusion. Mesenteric teratoma is a rare clinical entity and is considered one of the differential diagnoses of an abdominal mass with a compressive effect. Diagnosis is mainly based on clinical examination and imaging findings. Early surgical excision is the mainstay of treatment; laparoscopic or open approach depends on the clinical characteristics and the experience of the surgeon.
Asunto(s)
Humanos , Teratoma , Neoplasias Abdominales , Patología , Células Germinales Embrionarias , MesenterioRESUMEN
Las duplicaciones intestinales constituyen malformaciones quísticas o tubulares, que pueden aparecer en proximidad en todo el tubo digestivo. El abordaje videoasistido transumbilical combina las ventajas conocidas de la cirugía mínima invasiva convencional con el ahorro de tiempo y costo de material de la cirugía abierta. Se reporta el caso de pre- escolar masculino de 4 años de edad quien presentó varios episodios de dolor abdominal difuso acompañado de vómitos e hiporexia de 4 meses de evolución. Los estudios de imagen revelaron lesión de ocupación de espacio quística en hemiabdomen inferior derecho. Se realizó laparoscopia diagnóstica más resección transumbilical de lesión sacular del borde mesentérico del íleon, a 60 cm de la válvula ileocecal, así como anastomosis ileoileal termino-terminal. El paciente egresó al quinto día post-operatorio en óptimas condiciones. La biopsia reportó duplicación intestinal tipo tubular no comunicante. Concluimos que este abordaje es factible y ventajoso en el paciente pediátrico(AU)
Intestinal duplications are cystic or tubular malformations, which can appear in proximity to the entire digestive tract. The transumbilical video-assisted approach combines the known advantages of conventional minimally invasive surgery with the savings in time and material cost of open surgery. The case of a 4-year-old male preschooler who presented several episodes of diffuse abdominal pain accompanied by vomiting and hyporexia of 4 months of evolution is reported. Imaging studies revealed cystic space-occupying lesion in the lower right abdomen. Diagnostic laparoscopy plus transumbilical resection of a saccular lesion located on the mesenteric edge of the ileum, nearly 60 cm from the ileocecal valve, and a two layer end-to-end ileo-ileal anastomosis was performed. The patient was discharged on the fifth postoperative day in optimal conditions. The biopsy reported noncommunicating tubular type intestinal duplication. We conclude that this approach is feasible and advantageous in the pediatric patient(AU)
Asunto(s)
Humanos , Masculino , Preescolar , Procedimientos Quirúrgicos Mínimamente Invasivos , Cirugía Asistida por Video , Tracto Gastrointestinal/anomalías , Mesenterio , Anomalías Congénitas , Vómitos , Laparoscopía , ÍleonAsunto(s)
Neoplasias de la Mama , Drenaje , Humanos , Femenino , Drenaje/métodos , Técnicas de Sutura , Mastectomía , Mesenterio/cirugía , Neoplasias de la Mama/cirugíaRESUMEN
El hemangiolinfangioma es un tipo muy raro de malformación del sistema vascular, caracterizado histológicamente por la presencia de vasos venosos y linfáticos dilatados quísticamente, cuyas células endoteliales de revestimiento son positivas para marcadores de inmunohistoquímica como CD31, CD34 y D2-40. El compromiso extenso retroperitoneal y del tracto gastrointestinal es infrecuente. Se presenta el caso de una paciente femenina de 24 años con antecedente de dolor pélvico crónico, con exacerbación de síntomas. El diagnóstico imagenológico mostró una masa retroperitoneal multiquística. Se hizo hemicolectomía derecha y resección de la masa, encontrándose que dicha lesión estaba íntimamente adherida al mesenterio con compromiso extenso del tracto gastrointestinal, y cuyo estudio histopatológico reveló un hemangiolinfangioma, con mejoría clínica posterior a la resección quirúrgica. Aportamos a la literatura mundial, la caracterización de los hallazgos clínicos, imagenológicos e histopatológicos de este tipo de malformaciones
Hemangiolymphangioma is a very rare type of malformation of the vascular system, characterized histologically by the presence of cystically dilated venous and lymphatic vessels, whose lining endothelial cells are positive for immunohistochemical markers such as CD31, CD34 and D2-40. Extensive retroperitoneal and gastrointestinal tract involvement is uncommon. We present the case of a 24-yearold female patient with a history of chronic pelvic pain with exacerbation of symptoms. The imaging diagnosis revealed a multicystic retroperitoneal mass. A right hemicolectomy and resection of the mass was performed, finding that the lesion was intimately adherent to the mesentery with extensive involvement of the gastrointestinal tract, and whose histopathological study revealed a hemangiolymphangioma, with clinical improvement after surgical resection. We contribute to the world literature with the characterization of the clinical, imaging and histopathological findings of this type of malformations
Asunto(s)
Humanos , Femenino , Adulto Joven , Neoplasias Peritoneales/diagnóstico , Hemangioma/diagnóstico , Linfangioma/diagnóstico , Mesenterio/patología , Neoplasias Peritoneales/cirugía , Neoplasias Peritoneales/patología , Células Endoteliales/patología , Malformaciones Vasculares/diagnóstico , Malformaciones Vasculares/patología , Hemangioma/cirugía , Hemangioma/patología , Linfangioma/cirugía , Linfangioma/patologíaRESUMEN
Introducción. Los quistes mesentéricos son tumores poco frecuentes y usualmente benignos, que se diagnostican principalmente en la edad pediátrica, de manera incidental.Caso clínico. Se presenta el caso de una paciente de cuatro años de edad, con dificultad para acceso a servicio de salud por localización de su vivienda, quien cursa con un cuadro clínico de dos años de evolución de distensión abdominal progresiva, interpretada y manejada como ascitis. Se realizó una tomografía de abdomen en la que se documentó una lesión quística gigante, por lo que fue llevada a resección por laparotomía, con confirmación histopatológica de un quiste mesentérico. Discusión. Los quistes mesentéricos pueden tener cualquier localización en el mesenterio del tracto gastrointestinal. Su principal etiología es la proliferación anormal y benigna de tejido linfático mesentérico. Las manifestaciones clínicas van desde la ausencia de síntomas hasta el abdomen agudo. Dentro de los síntomas abdominales no agudos se encuentran masa abdominal indolora, dolor abdominal, distensión abdominal y signos clínicos que simulan ascitis. La resección completa del quiste mesentérico es considerada el tratamiento de elección; el abordaje laparoscópico o abierto dependerá de las características clínicas de cada paciente y la experiencia del cirujano tratante. Conclusión. Es importante que los cirujanos conozcan las principales características y el manejo de esta entidad, que una vez presente, puede simular un síndrome ascítico.
Introduction. Mesenteric cysts are rare and usually benign tumors, which are diagnosed incidentally, mainly in children.Clinical case. We present the case of a 4-year-old patient, with difficulty accessing health services due to the location of her home, who has a 2-year history of progressive abdominal distension, interpreted and managed as ascites. An abdominal tomography was performed in which a giant cystic lesion was documented. She underwent resection by laparotomy, with histopathological confirmation of a mesenteric cyst. Discussion. Mesenteric cysts can have any location in the mesentery of the gastrointestinal tract. Its main etiology is the abnormal and benign proliferation of mesenteric lymphatic tissue. Clinical manifestations range from the absence of symptoms to an acute abdomen. Non-acute abdominal symptoms include a painless abdominal mass, abdominal pain, abdominal distension, and clinical signs that mimic ascites. Complete resection of the mesenteric cyst is considered the treatment of choice; laparoscopic or open approach will depend on the clinical characteristics of each patient and the experience of the treating surgeon. Conclusion. It is important for surgeons to know the main characteristics and management of this entity, which once present, can mimic an ascites syndrome
Asunto(s)
Humanos , Ascitis , Quiste Mesentérico , Epiplón , Diagnóstico Diferencial , Neoplasias Abdominales , MesenterioRESUMEN
Cystic lymphatic malformation (CLM) is a rare and benign entity caused by alterations in the embryological development of lymphatic structures. Its typical location is in the head and neck, although it has also been described at the abdominal level. It may not be evident in the first stages of life and its first manifestation may be a complication such as abdominal distension, hemorrhage, or sepsis, which may put the patient's life at risk. Surgical treatment is increasingly discussed, and less invasive techniques are proposed. OBJECTIVE: To describe an uncommon presentation of CLM, radiographic findings, complications, differential diagnosis, and both invasive and more conservative treatments. CLINICAL CASE: Newborn female infant consulted for fever and irritability, without specific signs on physical examination, with suspicion of sepsis. Ultrasonography showed a complex septate mass with cysts of different sizes encompassing the mesenteric vessels, supravesical location. In its most ante rior aspect, it presented a greater echogenicity that corresponded to the superinfected component. Magnetic resonance imaging identified a multitabulated cystic tumor corresponding to a complica ted mesenteric lymphangioma with signs of infection. Due to its size, which compressed the vena cava and the associated signs of complication, complete resection was decided with good subsequent evolution. CONCLUSION: The treatment of CLM in pediatric age is increasingly individualized and can vary from surgical resection to less invasive approaches that could reduce acute intraoperative or postoperative complications and mortality. In our case, the infection acted as sclerotherapy, mana ging to delimit the CLM and helping to improve the prognosis.
Asunto(s)
Linfangioma Quístico , Anomalías Linfáticas , Sepsis Neonatal , Niño , Citrobacter freundii , Femenino , Humanos , Lactante , Recién Nacido , Linfangioma Quístico/diagnóstico por imagen , Linfangioma Quístico/cirugía , Anomalías Linfáticas/patología , Mesenterio/patología , Sepsis Neonatal/patologíaAsunto(s)
Hernia Abdominal , Obstrucción Intestinal , Vólvulo Intestinal , Hernia , Humanos , Hernia Interna , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/cirugía , MesenterioRESUMEN
Blunt abdominal trauma occurs in 20% of polytraumatized patients, of which approximately 5% may have mesenteric lesions. We present a case of a woman suffering from a blunt abdominal trauma, who underwent computed tomography with evidence of hematoma on the right flank, which was controlled by angioembolization of the superior mesenteric artery. Treatment of mesenteric lesions will be determined according to the hemodynamic status of the patient, since in view of stability, a choice can be made between open surgery and embolization, but in case of instability, laparotomy is recommended.
El trauma abdominal cerrado se presenta en el 20% de los pacientes politraumatizados, de los cuales aproximadamente el 5% pueden llegar a tener lesiones mesentéricas. Presentamos el caso de una mujer que sufre un traumatismo abdominal cerrado a la cual se le realizó tomografía computarizada con evidencia de un hematoma en el flanco derecho, que se logra controlar por angioembolización de la arteria mesentérica superior. El tratamiento de las lesiones mesentéricas se determinará según el estado hemodinámico del paciente, pues ante la estabilidad se puede escoger entre cirugía abierta y embolización, pero en caso de inestabilidad se recomienda la laparotomía.
Asunto(s)
Traumatismos Abdominales , Embolización Terapéutica , Heridas no Penetrantes , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/terapia , Femenino , Humanos , Mesenterio/diagnóstico por imagen , Mesenterio/lesiones , Estudios Retrospectivos , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/terapiaRESUMEN
Described for the first time in themedical literature in 1978 by Parks and Nicholls, total proctocolectomy with ileal-pouch anal anastomosis (IPAA) is nowadays the procedure of choice for patients with ulcerative colitis inwhom themedical therapy has, a selected group of patients with Crohń s disease, and for patients with familial adenomatous polyposis. Despite the advances in medical treatment regarding inflammatory bowel disease, up to 30% of patients still require surgery, and restorative proctocolectomy and IPAA are the mainstay of the surgical treatment. It is considered a demanding and technically-challenging procedure, with the main challenge being the performance of a tension-free IPAA; the main reason for failure of the tension-free anastomosis is a shortened mesentery. With particular attention to detail, sufficient length can be achieved to enable a safe anastomosis in most patients. Herein, we describe the available techniques to lengthen the mesentery of the ileal pouch to perform an easyto- reach tension-free anastomosis. (AU)
Asunto(s)
Proctocolectomía Restauradora/métodos , Mesenterio/cirugíaRESUMEN
Nowadays, the mesentery as a new organ was discovered. Mesenteric events may play an important role in the pathophysiology of several diseases. The aim of our study was investigate the synergic effects of ultrasound (US) and laser therapies on mesentery in obese-hyperglycemic rats. The 25 male Wistar rats were randomized into five groups. Obese nondiabetic (OND) group: obese rats without diabetes and no treatment conditions; SHAM group: obese-hyperglycemic rats treated with placebo; US group: obese-hyperglycemic rats treated with US; LASER group: obese-hyperglycemic rats treated with laser and; US+LASER group: obese-hyperglycemic rats treated with US plus laser. An animal model of type 2 diabetes based on a hyperlipidemic diet combined with a low dose of streptozotocin was used in this study. Body mass and biochemical measurements were performed. GOT and GPT level showed a significant reduction in the treated groups than SHAM. The total cholesterol, triglycerides and very low-density lipoprotein (VLDL) levels showed significantly lower values for the US+LASER group. There was also reduced risk of cardiovascular diseases evidenced by Castelli index in the treated groups than SHAM. This study showed that the US and laser treatment on mesentery resulted to an improvement in biochemical measurements of the obese-hyperglycemic rats, especially the total cholesterol, triglycerides and VLDL levels.
Asunto(s)
Diabetes Mellitus Tipo 2 , Terapia por Láser , Animales , Glucemia , Masculino , Mesenterio/diagnóstico por imagen , Obesidad/terapia , Ratas , Ratas Wistar , TriglicéridosRESUMEN
In most of the world Toxoplasma gondii is comprised of archetypal types (types I, II and III); however, South America displays several non-archetypal strains. This study used an experimental mouse model to characterize the immune response and parasite kinetics following infection with different parasite genotypes. An oral inoculation of 50 oocysts per mouse from T. gondii M4 type II (archetypal, avirulent), BrI or BrIII (non-archetypal, virulent and intermediate virulent, respectively) for groups (G)2, G3 and G4, respectively was used. The levels of mRNA expression of cytokines, immune compounds, cell surface markers and receptor adapters [interferon gamma (IFNγ), interleukin (IL)-12, CD8, CD4, CD25, CXCR3 and MyD88] were quantified by SYBR green reverse transcription-quantitative polymerase chain reaction. Lesions were characterized by histology and detection by immunohistochemistry established distribution of parasites. Infection in G2 mice was mild and characterized by an early MyD88-dependent pathway. In G3, there were high levels of expression of pro-inflammatory cytokines IFNγ and IL-12 in the mice showing severe clinical symptoms at 811 days post infection (dpi), combined with the upregulation of CD25, abundant tachyzoites and tissue lesions in livers, lungs and intestines. Significant longer expression of IFNγ and IL-12 genes, with other Th1-balanced immune responses, such as increased levels of CXCR3 and MyD88 in G4, resulted in survival of mice and chronic toxoplasmosis, with the occurrence of tissue cysts in brain and lungs, at 14 and 21 dpi. Different immune responses and kinetics of gene expression appear to be elicited by the different strains and non-archetypal parasites demonstrated higher virulence.
Asunto(s)
Toxoplasma/fisiología , Toxoplasmosis Animal/parasitología , Animales , Antígenos CD/metabolismo , Gatos , Citocinas/metabolismo , ADN Complementario/biosíntesis , ADN Protozoario/aislamiento & purificación , Femenino , Genotipo , Inmunohistoquímica , Ganglios Linfáticos/parasitología , Ganglios Linfáticos/patología , Mesenterio , Ratones , Factor 88 de Diferenciación Mieloide/metabolismo , ARN Protozoario/genética , ARN Protozoario/aislamiento & purificación , Distribución Aleatoria , Reacción en Cadena en Tiempo Real de la Polimerasa , Receptores CXCR3/metabolismo , Bazo/parasitología , Bazo/patología , Toxoplasma/clasificación , Toxoplasma/genética , Toxoplasma/inmunología , Toxoplasmosis Animal/inmunología , Toxoplasmosis Animal/patologíaRESUMEN
A 47-year-old female presented with a lengthy history of dyspeptic symptoms, weight loss, and occasional diarrhea. A computed tomography (CT) scan showed several mesenteric nodular lesions, with peripheral calcifications, inversion of the fold pattern of the small intestine loops and an atrophic spleen.
Asunto(s)
Enfermedad Celíaca , Enfermedades Linfáticas , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/diagnóstico por imagen , Femenino , Humanos , Ganglios Linfáticos , Mesenterio/diagnóstico por imagen , Persona de Mediana Edad , SíndromeRESUMEN
Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of the inflammatory myofibroblastic tumor. It has an aggressive clinical course and a high rate of recurrence. EIMS primarily affects children and young adults. Hereby, we report this entity in a 4-month-old infant who presented with an abdominal mass. Imaging studies revealed a large hypodense mesentery-based lesion involving the right half and mid-region of the abdomen. The mass with an attached segment of the small bowel was excised in toto. Grossly, a large encapsulated tumor was identified arising from the mesentery of the small bowel. The histological examination showed a tumor consisting of epithelioid to spindle cells loosely arranged in a myxoid background with numerous blood vessels and lymphoplasmacytic inflammatory infiltrate. On immunohistochemistry, the tumor cells showed positivity for ALK1 (nuclear), desmin, SMA, CD68, and focal positivity for CD30. A final diagnosis of EIMS of the small intestine was rendered. To the best of our knowledge, this case is the youngest reported case in literature.
Asunto(s)
Humanos , Femenino , Lactante , Sarcoma , Neoplasias Intestinales/patología , Inmunohistoquímica , Células Epitelioides/patología , Quinasa de Linfoma Anaplásico , Intestino Delgado , MesenterioRESUMEN
Petersen's space hernia is the most frequent location of internal hernia after a laparoscopic gastric bypass. The diagnosis or a high suspicion of internal herniation are indications for urgent surgery. We present the case of a patient who required an exploratory laparoscopy. He had a computed tomography compatible with internal herniation. We found a Petersen's space hernia and a jejunojenustomy defect. We reduced the protruded loops and we closed both mesenteric defects. The closure of mesenteric defects in primary surgery is a controversial matter. Overall, it is recommended to close them.
Las hernias del espacio de Petersen son la localización más frecuente de las hernias internas tras un bypass gástrico laparoscópico. Su diagnóstico, e incluso su sospecha, son indicación de cirugía urgente. Presentamos el caso de un paciente que requirió una laparotomía exploradora en la que se halló una hernia del espacio de Petersen tras presentar en la tomografía computarizada el signo del «remolino¼. Se realizó la reducción de las asas intestinales herniadas junto al cierre del defecto mesentérico de dicho espacio. El cierre de los defectos mesentéricos en la cirugía primaria continúa generando controversia, pero como norma general se recomienda su cierre.
Asunto(s)
Derivación Gástrica , Hernia Abdominal , Laparoscopía , Obesidad Mórbida , Hernia , Humanos , Hernia Interna , Masculino , Mesenterio , Obesidad Mórbida/cirugía , Estudios RetrospectivosRESUMEN
Internal hernias are defined by the protrusion of an abdominal organ through a peritoneal or mesenteric aperture. They are responsable for up to 5.8% of all small bowel obstructions (SBOs). Pericecal hernia is a highly unusual variation. We present a case of a 17-year-old Asian male turned to the emergency department due to abrupt abdominal pain and peritonitis. An emergent laparotomy revealed a small bowel herniation through the avascular space of Treves with small bowel necrosis. A pericecal hernia is an extremely unusual clinical entity; however, it should be considered in the differential diagnosis of SBO.
ANTECEDENTES: La hernia interna se define como la protrusión de un órgano abdominal a través de un orificio peritoneal o mesentérico. Las hernias son causa de hasta el 5% de las obstrucciones de intestino delgado. La hernia pericecal es un subtipo extremadamente infrecuente. Presentamos el caso de un varón asiático de 17 años que acudió a nuestro centro por un cuadro de abdomen agudo con dolor y peritonitis. Durante la laparotomía se evidenció la herniación del intestino delgado a través del espacio avascular de Treves, con necrosis del mismo. La hernia pericecal es un subtipo extremadamente raro, pero que debemos plantearnos en el diagnóstico diferencial del síndrome de obstrucción intestinal.
Asunto(s)
Hernia Abdominal , Obstrucción Intestinal , Adolescente , Adulto , Hernia/complicaciones , Hernia/diagnóstico por imagen , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico por imagen , Humanos , Hernia Interna , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado/diagnóstico por imagen , Masculino , MesenterioRESUMEN
Here, we tested the hypothesis that TNAP (tissue nonspecific alkaline phosphatase) modulates vascular responsiveness to norepinephrine. In the isolated, Tyrode's-perfused rat mesentery, 50 µmol/L of L-p-bromotetramisole (L-p-BT; selective TNAP inhibitor, Ki=56 µmol/L) significantly reduced TNAP activity and caused a significant 9.0-fold rightward-shift in the norepinephrine concentration versus vasoconstriction relationship. At 100 µmol/L, L-p-BT further reduced mesenteric TNAP activity and caused an additional significant right-shift of the norepinephrine concentration versus vasoconstriction relationship. A higher concentration (200 µmol/L) of L-p-BT had no further effect on either mesenteric TNAP activity or norepinephrine-induced vasoconstriction. L-p-BT did not alter vascular responses to vasopressin, thus ruling-out nonspecific suppression of vascular reactivity. Since in the rat mesenteric vasculature α1-adrenoceptors mediate norepinephrine-induced vasoconstriction, these finding indicate that TNAP inhibition selectively interferes with α1-adrenoceptor signaling. Additional experiments showed that the effects of TNAP inhibition on norepinephrine-induced vasoconstriction were not mediated by accumulation of pyrophosphate or ATP (TNAP substrates) nor by reduced adenosine levels (TNAP product). TNAP inhibition significantly reduced the Hillslope of the norepinephrine concentration versus vasoconstriction relationship from 1.8±0.2 (consistent with positive cooperativity of α1-adrenoceptor signaling) to 1.0±0.1 (no cooperativity). Selective activation of A1-adenosine receptors, which are known to participate in coincident signaling with α1-adrenoceptors, reversed the suppressive effects of L-p-BT on norepinephrine-induced vasoconstriction. In vivo, L-p-BT administration achieved plasma levels of ≈60 µmol/L and inhibited mesenteric vascular responses to exogenous norepinephrine and sympathetic nerve stimulation. TNAP modulates vascular responses to norepinephrine likely by affecting positive cooperativity of α1-adrenoceptor signaling via a mechanism involving A1 receptor signaling.