Cleavage and activation of LIM kinase 1 as a novel mechanism for calpain 2-mediated regulation of nuclear dynamics.

Calpain-2 (CAPN2) is a processing enzyme ubiquitously expressed in mammalian tissues whose pleiotropic functions depend on the role played by its cleaved-products. Nuclear interaction networks, crucial for a number of molecular processes, could be modified by CAPN2 activity. However, CAPN2 functions in cell nucleus are poorly understood. To unveil CAPN2 functions in this compartment, the result of CAPN2-mediated interactions in cell nuclei was studied in breast cancer cell (BCC) lines. CAPN2 abundance was found to be determinant for its nucleolar localization during interphase. Those CAPN2-dependent components of nucleolar proteome, including the actin-severing protein cofilin-1 (CFL1), were identified by proteomic approaches. CAPN2 binding, cleavage and activation of LIM Kinase-1 (LIMK1), followed by CFL1 phosphorylation was studied. Upon CAPN2-depletion, full-length LIMK1 levels increased and CFL1/LIMK1 binding was inhibited. In addition, LIMK1 accumulated at the cell periphery and perinucleolar region and, the mitosis-specific increase of CFL1 phosphorylation and localization was altered, leading to aberrant mitosis and cell multinucleation. These findings uncover a mechanism for the role of CAPN2 during mitosis, unveil the critical role of CAPN2 in the interactions among nuclear components and, identifying LIMK1 as a new CAPN2-target, provide a novel mechanism for LIMK1 activation. CFL1 is crucial for cytoskeleton remodeling and mitosis, but also for the maintenance of nuclear structure, the movement of chromosomes and the modulation of transcription frequently altered in cancer cells. Consequently, the role of CAPN2 in the nuclear compartment might be extended to other actin-associated biological and pathological processes.

Despedida al Hospital Infantil «La Fe» de Valencia / Goodbye to the Pediatric Hospital La Fe, in Valencia

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Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?

The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.

Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?

The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.

[Treatment with Ethibloc of lymphangiomas and venous angiomas]. / Tratamiento con Ethibloc de linfangiomas y angiomas venosos.

Lymphangioma and venous angioma are a group of pathological entities which have required surgical treatment since years. Extension, localization and poor delimitation of some lesions have resulted in technical difficulties and serious complications. Our group began the sclerosing therapy with an injection of fibrin adhesive and, due to the lack of response in the first patient, a program with Ethibloc as an alternative substance was developed. We present 10 cases, 4 lymphangiomas and 6 venous angiomas. In 50% of our patients one single session of sclerotherapy was made, in 25% two sessions, and in the rest 25% three. From 10 cases, 4 are still on treatment, complete remission in 5 cases, and good evolution in one case (mixed lymphangioma). As a long-term complication, we have noticed fistulization in 3 cases, and expulsion of the sclerosing agent. In our experience, percutaneous sclerosis with Ethibloc should be the first therapeutic alternative.

[Outcome of hypertrophic pyloric stenosis after pyloromyotomy]. / Evolución de la estenosis hipertrófica de píloro tras la piloromiotomía.

Twenty four patients diagnosed and operated of hypertrophic pyloric stenosis were examined by ultrasonography at diagnostic and sequential after pyloromyotomy. We measured pyloric diameter, thickness and length of the muscle and we calculated the pyloric volume. The overall configuration of the pylorus is more important than specific pyloric dimensions for diagnosis. The pyloric volume is the most discriminating criterion. Sequential sonograms at one and four months showed that all measurements fell to normal levels within four weeks, except pyloric volume.

Recurrent tracheoesophageal fistula treated with fibrin glue.

Recurrent tracheoesophageal fistula (RTF) after repair of esophageal atresia with tracheoesophageal fistula is a serious complication, with the need for a second operation. The mortality rate is high. The authors report on the eradication of RTF using fibrin glue.

[A new method for the measurement of the anatomical development of the muscle complex of the anus in children with anorectal malformations]. / Nuevo método de cuantificación del desarrollo anatómico del complejo muscular del ano en los niños con malformación anorrectal.

We present a new method for the measurement of the anorectal muscle complex. We studied 40 children with anorectal malformation (14 low and 16 high). Taking the perineal TAC with a rectal probe and quotient called "C": [formula: see text] A "C" value less than 0.31 indicates little development of the anus muscle complex. In 10/26 patients with high malformation, "C" was less than 0.31. All of these patients had fecal incontinence.

[Whole gut irrigation in pediatric patients: a comparative study]. / Irrigacion digestiva en el paciente pediatrico: estudio comparativo.

The observation of hydroelectric and pH changes, as well as the diminishing incidence of postoperative infections in pediatric patients, subjected to digestive irrigation (D.I.) before surgery, was the reason for carrying out this paper, fundamentally directed at two objectives: Firstly, to determine the hydro-ionic and clinical repercussions by means of a comparative study of the two most used irrigations solutions and secondly, to analyze the modifications that the D.I., itself and with the addition of antibiotics, is capable of producing on the fecal flora and the intestinal mucous membrane. To realize our aim, a prospective and double blinded study was designed on 124 patients irrigated with a saline solution (S-I), or with the Golytely solution (S-II). The analysis of the results showed that exist a marked predisposition to metabolic acidosis and dehydration after irrigation with S-II, compared with a tendency towards hyperhydration and alkalosis after irrigation with S-I. The effect of flushing with D.I. is capable of producing a significant lowering in the number of germs/ml found in the contents of the colon; a reduction which increases for the anaerobic group (p less than 0.001), when the antibiotics are added to the irrigation solution. Neither of the studied cases gave evidence of histomorphologic alterations in the colonic mucosa after irrigation with erythromycin and neomycin base.

[The treatment of esophageal achalasia in children by endoscopic pneumatic dilatation. A report on 4 cases]. / Tratamiento de la acalasia esofágica en niños mediante dilatación neumática endoscópica. A propósito de cuatro casos.

Four patients underwent pneumatic endoscopic dilatation of achalasia at the La Fe Children's Hospital have been studied. Endoscopic pneumatic dilatation has been performed in only one session with four dilatation maneuvers. In the absence of complications, the patients were only hospitalized for twenty-four hours. The effectiveness of endoscopic pneumatic dilatation and the safety of this method, its ease of application and possibility of repetition make it a useful method in the treatment of achalasia in children.

[Caustic burns of the stomach secondary to ingestion of acid in infants: importance of fibro-endoscopy]. / Causticaciones gástricas secundarias a la ingestión de ácido en la infancia: importancia de la fibroendoscopia.

Two cases of corrosive burns of the stomach after the ingestion of acid by children are presented. Both patients were the same sex and of a similar age (19 and 20 months). The chemical nature of the caustic substance ingested (hydrochloric acid) and the lack of initial symptoms were also similar. The clinical diagnosis however, was completely different due to the endoscopic finding of serious gastric lesions in one of the patients which were then treated accordingly. In children, the accidental ingestion of caustic acids is often accompanied by few clinical symptoms initially. This can lead to failure to diagnose correctly when symptoms are correlated with the existence and severity of digestive lesions. When a caustic substance has been ingested, in addition to symptoms, consideration of the acidity or alkalinity of the ingested product is also an important parametre in evaluating endoscopic findings.

Study of appendicitis in children treated with four different antibiotic regimens.

This is a prospective and randomized study of 100 patients with acute appendicitis who were less than 10 years old, in which four different antibiotic regimens commonly in use against gram-negative and anaerobic bacteria were compared in terms of postoperative septic complications. The antibiotics were begun immediately preoperatively and continued for five days. Ten percent of the patients developed infection complications, with 4% requiring further surgery. The best results were obtained with cefoxitin (4% of infection), metronidazole plus amikacin and latamoxef (8%), while the regimen of clindamycin plus amikacin was associated with the greatest number of complications (20%). On analyzing the main microbiologic findings of the study, we conclude that some sort of antibiotic treatment is indicated in all types of appendicitis, due to the occult presence of bacteria in the peritoneal cavity, even without clinical evidence of gangrene or perforation. Further, we emphasize the significance of Streptococcus faecalis as being responsible, along with Escherichia coli and Bacteroides fragilis, for serious postoperative complications.

[Laparoscopy in pediatrics]. / Laparoscopia en pediatría.

Laparoscopy has been performed in 68 infants and children. In 50 cases of non-palpable testis; 7 cases of liver diseases; 4 cases of abdominal trauma; 7 cases for various other indications. In our experience, laparoscopy was a considerable advantage in the diagnosis and management of a number of pediatrics disorders.

[Postoperative obstructive abdominal complications in children]. / Complicaciones obstructivas postcirugía abdominal en el niño.

In the pediatric surgical Department of the "Le Fe" Hospital, from January 1971 to December 1982 2,350 laparotomies were performed in neonates, infants and children. In 67 patients abdominal surgery was complicated by bowel obstruction for which a second laparotomy had to be performed. In 86.56%, of patients with obstruction (58 cases) this became obvious during the first three months after the previous operation. In 54 out of the 67 patients reviewed (80.59%), adhesions were the cause for obstruction and only twelve was this caused by an abscess.

[Gastric duplication. Presentation of 4 cases localized in the antropyloric region]. / Duplicación gástrica. Presentación de cuatro casos localizados en región antropilórica.

Gastric duplications are very rare, especially those located at the pyloric region. Four cases are reported with gastric duplication in patients of two days, eight months, two and a half and three and a half years old, a review is made including symtomatology, diagnostic, treatment and anatomopathological studies. In all four cases post-operative evolution was satisfactory.

[Treatment of portal hypertension in children]. / Tratamiento de la hipertensión portal en la infancia.

Esophageal transection by means of an anastomotic clip or button is a simple and useful approach to the management of haemorrhage due to esophageal varices. We have used this technique in four cases (three Prioton clips, and one autosuture) and completed the procedure with periesophageal, left gastric and fundal veins ligation. The patients have been followed up for periods ranging between five months and six years. No one has rebled. Splenoportographic controls showed good results of disconnection, and endoscopic follow up revealed variceal cure. There was no GER and in one single case we had to dilate for mild stenosis. This is a simple and effective procedure for the control of variceal haemorrhage in the short and middle ranges, and can induce cure directing portal flow through other alternative ways.