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RESUMEN Introducción: el vólvulo de la vesícula biliar se define como la torsión del órgano sobre su mesenterio a lo largo del eje del conducto y arteria cística, es una enfermedad rara, que ocurre con mayor frecuencia en mujeres ancianas. Presentación del caso: se trata de una paciente femenina de 46 años de edad, de color de piel blanca, con antecedentes patológicos personales de úlcera duodenal, que practica hábitos tóxicos como el fumar y la ingestión de café. No se ha sometido con anterioridad a procederes quirúrgicos. Acude a cuerpo de guardia de Cirugía General del Hospital Clínico Quirúrgico Provincial Abel Santamaría Cuadrado de Pinar del Río con dolor en hipocondrio derecho, de leve intensidad y de aproximadamente 24 horas de evolución, acompañado de náuseas y dos vómitos con restos de alimentos. Se le diagnostica vólvulo de vesícula biliar, por lo cual recibe tratamiento quirúrgico. Conclusiones: el vólvulo de vesícula biliar, enfermedad infrecuente de gran similitud clínica a otras patologías de abdomen agudo, hace muy complejo su diagnóstico preoperatorio. No obstante, el advenimiento de las nuevas técnicas imagenológicas maniobradas por especialistas capacitados, junto con la correcta aplicación del método clínico epidemiológico facilitaron la capacidad diagnóstica que permitiera a los cirujanos tomar la decisión terapéutica acertada para el paciente, con resultados satisfactorios.
ABSTRACT Introduction: gallbladder volvulus is defined as the twisting of the organ over its mesentery along the axis of the duct and cystic artery; it is a rare disease, which more frequently occurs in older women. Case report: a 46 year-old, white skin color female patient, with personal pathological history of duodenal ulcer, having smoking and coffee ingestion habits, who has not previously undergone surgical procedures, she comes to the emergency room of the General Surgery Department at Abel Santamaria Cuadrado Provincial General Hospital in Pinar del Río referring pain in right hypochondriac region, of slight intensity and of approximately 24 hours of evolution; accompanied by nausea and two vomits with food remains. He is diagnosed with gallbladder volvulus, undergoing surgical treatment. Conclusions: gallbladder volvulus, an infrequent entity of great clinical similarity to other pathologies of the acute abdomen, makes a very complex pre-surgical diagnosis; nevertheless, the introduction of new imaging techniques performed by trained specialists, together with the accurate application of the clinical epidemiological method facilitated the diagnostic capacity, allowing the surgeons to take a correct and timely therapeutic decision for the patient and with satisfactory results.
RESUMO
Background Ethanol has been pointed out as a laccase inducer. However, there are controversial reports about its efficiency with some fungi. In this study, we hypothesized that ethanol laccase induced in Pycnoporus sanguineus depends on nitrogen nutriment conditions. To prove this, we assessed laccase production in submerged cultures of P. sanguineus, with different nitrogen concentrations and with, or without ethanol added in a factorial designed experiment. Results In order to analyze the effects of factors on the response variables, a factorial ANOVA, and response-surface models were performed. It was found that the nitrogen source was the main factor that affected laccase production in P. sanguineus. The treatments with yeast extract (2 g/L) and ethanol (3 g/L) induced the highest laccase activity (31.01 ± 4.9 U/L), while the treatments with urea reached the lowest activity (less than 1.6 U/L). Ethanol had positive and synergic effects on laccase production, in accordance with the surface response model, as long as simple nitrogen sources (urea) were not available. Conclusions We suggest that laccase in P. sanguineus is regulated by a catabolic nitrogen repression mechanism; laccase activity is strongly inhibited by urea used as nitrogen source and it decreases when the amount of urea increases; contrarily, a synergic positive effect was observed between yeast extract and ethanol on laccase production.