RESUMO
BACKGROUND: Keratinocyte life span is modulated by receptors that control proliferation and differentiation, key processes during cutaneous tissue repair. The kinin B(1) receptor (B(1)R) has been reported in normal and pathological human skin, but so far there is no information about its role in keratinocyte biology. OBJECTIVES: To determine the consequence of kinin B(1)R stimulation on tyrosine phosphorylation, a key signalling mechanism involved in keratinocyte proliferation and differentiation. METHODS: Subconfluent primary cultures of human keratinocytes were used to investigate tyrosine phosphorylation, epidermal growth factor receptor (EGFR) transactivation, cell proliferation and keratinocyte differentiation. Cell proliferation was assessed by measuring bromodeoxyuridine incorporation whereas assessment of cell differentiation was based on the expression of filaggrin, cytokeratin 10 (CK10) and involucrin. RESULTS: The major proteins phosphorylated, after B(1)R stimulation, were of molecular mass 170, 125, 89 and 70 kDa. The 170- and 125-kDa proteins were identified as EGFR and p125(FAK), respectively. Phosphorylation was greatly reduced by GF109203X and by overexposure of keratinocytes to phorbol 12-myristate 13-acetate, indicating the participation of protein kinase C. B(1)R stimulation did not increase [Ca(2+)]i, but triggered EGFR transactivation, an event that involved phosphorylation of Tyr(845), Tyr(992) and Tyr(1068) of EGFR. B(1)R stimulation did not elicit keratinocyte proliferation, but triggered cell differentiation, visualized as an increase of filaggrin, CK10 and involucrin. Blockade of EGFR tyrosine kinase by AG1478, before B(1)R stimulation, produced an additional increase in filaggrin expression. CONCLUSIONS: The kinin B(1)R may contribute to keratinocyte differentiation and migration by triggering specific tyrosine signalling pathways or by interacting with the ErbB receptor family.
Assuntos
Diferenciação Celular , Receptores ErbB/metabolismo , Queratinócitos/citologia , Cininas/metabolismo , Receptor B1 da Bradicinina/metabolismo , Receptor B2 da Bradicinina/metabolismo , Células Cultivadas/metabolismo , Proteínas Filagrinas , Humanos , Queratinócitos/metabolismo , Sistema de Sinalização das MAP Quinases/fisiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Pele/metabolismoRESUMO
The objective of this study was to determine the relation between the presence of a bullet (gunshot) after injury to the colon and the incidence of sepsis in its track and the soft tissue where it is retained. A retrospective review was carried out of the charts of consecutive patients admitted for abdominal gunshot wounds with proved colon injury during laparotomy where the bullet was either retained in the soft tissue or exited the body. The review covered a period of 4 years beginning January 1, 1990. Three groups were identified for analysis: (1) patients from whom the bullet was surgically removed, with additional cleansing and debridement of the area (n = 21); (2) patients who did not undergo surgical removal of the bullet (n = 81); and (3) patients in whom the bullet exited spontaneously and in whom only débridement of the skin was carried out (n = 83). Similar risk factors were noted among the groups (age, ATI score, colostomy rate), except for a higher incidence of shock in group 3 (p = 0.003). The incidence of sepsis in soft tissue was least in group 1. It was five and seven times greater in groups 2 and 3, respectively. After an abdominal gunshot with colon injury, the missile should be removed if feasible and the local tissue débrided. If the bullet has exited spontaneously, its internal track must be débrided and lavaged extensively.
Assuntos
Colo/lesões , Infecção dos Ferimentos , Ferimentos por Arma de Fogo/complicações , Adolescente , Adulto , Idoso , Colo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Ferimentos por Arma de Fogo/cirurgiaRESUMO
During a partial splenectomy, the resultant bleeding of the remaining spleen is difficult to control; some techniques have been described to achieve complete hemostasis. The omentum has been traditionally used to promote hemostasis on raw surfaces of solid viscus, particularly during the repair of liver injuries. We present here a technique to fix the omentum to the spleen after partial resections; emphasis is made to perform it in an atraumatic way to avoid additional damage to the splenic capsule.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Omento/cirurgia , Esplenectomia/métodos , HumanosRESUMO
OBJECTIVE: To demonstrate the applicability of nonoperative treatment to penetrating hypopharyngeal wounds. DESIGN: A prospective study. MATERIALS AND METHODS: An analysis of patients with penetrating hypopharyngeal wounds who were treated nonoperatively at the Hospital Universitario del Valle (Cali, Colombia) during 4 years (beginning January 1990) was performed. Patients older than 13 years with proven lesions produced by penetrating trauma were included. Patients with foreign-body-induced or iatrogenic lesions (orotracheal intubation, endoscopy) or immediate need for surgery (for associated lesions) were excluded. Nonoperative management consisted of nasogastric tube for feeding, suspension of oral intake, and parenteral antibiotics for 7 days. MEASUREMENTS AND MAIN RESULTS: Fourteen patients met the above criteria. Gunshot wounds (n = 11) were the most common trauma. An esophagogram/endoscopy demonstrated the lesions. The only complication in the group consisted of a cervical abscess, which presented in a patient during the first week of treatment. There were no complications such as fistula, leakage, and Horner's syndrome. CONCLUSIONS: Conservative management is a good and safe alternative when indicated in penetrating hypopharyngeal wounds.
Assuntos
Hipofaringe/lesões , Ferimentos Penetrantes/terapia , Adolescente , Adulto , Esofagoscopia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Ferimentos Penetrantes/diagnósticoRESUMO
Pelvic radiography in blunt trauma patients is routinely used in most trauma centers. The purpose of this review was to evaluate the ability of physical examination alone to detect pelvic fractures. Among patients with blunt trauma admitted to the University Hospital del Valle in Cali, Colombia, over a 3-month period, 608 adult patients, with hemodynamic stability, without spinal involvement, and with a Glasgow Coma Scale score greater than 10 were evaluated. All patients had physical examination, pelvic x-ray and adequate follow-up. Fifty-nine (9.7%) patients had pelvic fractures, with 57 of these fractures detected by physical findings. The remaining two patients had stable fractures that required no treatment. After careful analysis, we conclude that a negative physical examination following blunt trauma has a negative predictive value of 99% probability in excluding pelvic fracture, provided that the patient is not a child, is not in coma, is hemodynamically stable without evidence of blood loss, and has no spinal cord injury. A selective use of pelvic x-ray in patients with blunt trauma is a cost-effective policy.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Ossos Pélvicos/lesões , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Fraturas Ósseas/classificação , Escala de Coma de Glasgow , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Exame Físico/economia , Exame Físico/métodos , Estudos Prospectivos , Radiografia , Sensibilidade e EspecificidadeRESUMO
The study reported here evaluated the efficacy of antibiotics administered in two periods: preoperative only and additional doses postoperatively. There was no difference in developing surgical sepsis between the groups when they included antibiotics preoperatively and the severity of the trauma was minor (Abdominal Trauma Index [ATI] value < 25). Additionally, the result was the same when one of the injured organs was the colon, in contrast with past studies. One interesting point is related to the association of a Revised Trauma Index value > 20 with a colon wound: in the present study, this combination had a deleterious effect on the patients, always resulting in abdominal sepsis. Emphasis is placed on the economic benefits of the abolition of postoperative antibiotic use in patients with ATI score less than 25.
Assuntos
Traumatismos Abdominais/cirurgia , Antibacterianos/uso terapêutico , Pré-Medicação , Traumatismos Abdominais/complicações , Adulto , Feminino , Humanos , Infecções/etiologia , Masculino , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Índices de Gravidade do TraumaRESUMO
Se adelanto un trabajo de observacion clinica iniciado en 1990 en el Hospital Universitario del Valle, sobre el comportamiento y el subsiguiente tratamiento de las heridas de la hipofaringe, ocasionadas con arma de fuego y arma blanca. El proposito del estudio fue el de demostrar la conveniencia de no operar e instaurar un tratamiento conservador de tales heridas traumáticas de la hipofaringe. La investigacion incluyo 68 pacientes con lesiones traumáticas comprobadas de la orohipofaringe y el esofago cervical, de los cuales 49 (72 por ciento) fueron tratados quirurgicamente en forma obligatoria, y 19 (28 por ciento) recibieron tratamiento conservador, no quirurgico, en cuya evolucion clinica, como era obvio, hubo mucho menos morbilidad que la observada en el grupo sometido a cirugia. Mediante un completo examen clinico y paraclinico asociado a un juicioso criterio, el cirujano debe ser capaz de discemir sobre cuando no se debe operar un paciente con este tipo de lesiones cervicales.
Assuntos
Hipofaringe , Ferimentos e LesõesRESUMO
Se define el sindrome pospericardiotomia y se califica una entidad infrecuente. Se presenta 1 caso documentado de este estado patologico, diagnosticado en un hombre de 25 años de edad quien habia sufrido una herida con arma cortopunzante en el area precordial. Se discuten aspectos historicos, etiologicos, fisiopatologicos, clinicos, paraclinicos, diagnosticos, terapeuticos y anatomopatologicos del sindrome pospericardiotomia. Por ultimo, se transcriben 21 referencias bibliográficas nacionales e internacionales sobre el tema.