Esofagotomía y cierre primario por cuerpo extraño en esófago superior / Esophagotomy and primary closure due to foreign body in the upper esophagus

RESUMEN Los cuerpos extraños en el esófago son un problema frecuente en urgencias, debido la mayoría de las veces a ingestión accidental. Presentamos el caso de una paciente femenina de 50 años, sin antecedentes patológicos, que consulta por presentar la ingesta de prótesis dental mientras almorzaba, con posterior disfagia, odinofagia y dolor cervical. Se le realizan radiografías y tomografía computarizada (TC) donde se evidencia imagen radiopaca en esófago cervical. Se interconsulta con el Servicio de Gastroenterología, dada la imposibilidad de extracción de la prótesis por vía endoscópica. Se realiza luego cervicotomía lateral izquierda de emergencia, con esofagotomía, extracción del cuerpo extraño y cierre primario del esófago. La obstrucción del esófago por cuerpos extraños puede ocasionar muchas complicaciones. La consecuente demora en el tratamiento puede llevar a un marcado aumento de la mortalidad. Por eso, en este caso, se prioriza la cirugía ante un riesgo elevado de perforación y hemorragia.

ABSTRACT Esophageal foreign bodies are a common problem in the emergency department, usually due to accidental ingestion. We report the case of a 50-year-old otherwise healthy female patient who sought medical care due to dysphagia, odynophagia and cervical pain after swallowing a partial denture while having lunch. The patient underwent X-rays and a computed tomography (CT) scan which showed a radiopaque image in the upper esophagus. After a failed attempt to remove the denture through endoscopy, surgery was decided via a left lateral emergency cervicotomy with esophagotomy, foreign body removal and primary closure of the esophagus. Esophageal obstruction due to foreign bodies may cause many complications. Treatment delays may result in increased mortality. Thus, in this case we prioritized surgery due to high risk of perforation and bleeding.

Ibero-American Endometriosis Patient Phenome: Demographics, Obstetric-Gynecologic Traits, and Symptomatology.

Background: An international collaborative study was conducted to determine the demographic and clinical profiles of Hispanic/Latinx endometriosis patients from Latin America and Spain using the Minimal Clinical Questionnaire developed by the World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonization Project (EPHect). Methods: This is a cross-sectional study to collect self-reported data on demographics, lifestyle, and endometriosis symptoms of Hispanic/Latinx endometriosis patients from April 2019 to February 2020. The EPHect Minimal Clinical Questionnaire (EPQ-M) was translated into Spanish. Comprehension and length of the translated survey were assessed by Spanish-speaking women. An electronic link was distributed via social media of endometriosis patient associations from 11 Latin American countries and Spain. Descriptive statistics (frequency, means and SD, percentages, and proportions) and correlations were conducted using SPSSv26. Results: The questionnaire was completed by 1,378 participants from 23 countries; 94.6% had self-reported diagnosis of endometriosis. Diagnostic delay was 6.6 years. Most participants had higher education, private health insurance, and were employed. The most common symptoms were back/leg pain (85.4%) and fatigue (80.7%). The mean number of children was 1.5; 34.4% had miscarriages; the mean length of infertility was 3.7 years; 47.2% reported pregnancy complications. The most common hormone treatment was oral contraceptives (47.0%). The most common comorbidities were migraines (24.1%), polycystic ovary syndrome (PCOS) (22.2%), and irritable bowel syndrome (21.1%). Most participants (97.0%) experienced pelvic pain during menses; for 78.7%, pain was severe; 86.4% reported dyspareunia. The mean age of dysmenorrhea onset was 16.2 years (SD ± 6.1). Hormone treatments were underutilized, while impact was substantial. Pain catastrophizing scores were significantly correlated with pain intensity (p < 0.001). Conclusion: This is the first comprehensive effort to generate a clinical-demographic profile of Hispanic/Latinx endometriosis patients. Differences in clinical presentation compared to other cohorts included higher prevalence and severity of dysmenorrhea and dyspareunia and high levels of pain catastrophizing. Though future studies are needed to dissect the impact of race and ethnicity on pain and impact, this profile is the first step to facilitate the recognition of risk factors and diagnostic features and promote improved clinical management of this patient population. The EPHect questionnaire is an efficient tool to capture data to allow comparisons across ethnicities and geographic regions and tackle disparities in endometriosis research.

Polipectomías difíciles por residentes: ¿Es posible? / Difficult polypectomies by residents: Is it possible?

Antecedentes: La polipectomía endoscópica (PE) es una herramienta habitual en el campo de la coloproctología. La misma ofrece un desafío al residente más aún cuando son pólipos difíciles (mayores de 20 mm). La bibliografía es escasa y no concluyente en lo que respecta a la curva de aprendizaje de este procedimiento. Objetivos: analizar la eficacia y complicaciones de la (PE) en pólipos difíciles de colon realizadas por médicos residentes en coloproctología, comparando sus resultados con los de la bibliografía internacional. Pacientes y métodos: Durante el periodo 1 de junio de 2009 al 31 de mayo del 2010 se efectúa el análisis retrospec­tivo de las polipectomías endoscópicas difíciles realizadas por un médico residente de su último año de formación bajo supervisión de un tutor. Se evalúan las siguientes variables: el tamaño, patología y complicaciones. Resultados: Se realizaron 1303 colonoscopias. Se encontraron 34 pólipos mayores a 20 mm en 34 pacientes, realizando pe en 24 casos de los cuales el residente pudo realizar el 95,8%. La edad media fue de 63 años. 15 del sexo masculino y 9 femeninos. El tamaño promedio fue 28 mm. El tiempo medio fue de 47 minutos. Displasia leve fue reportada en el 66,4%, grave en 29.4 %, cáncer invasor en 4,2 %. Complicaciones: un paciente presento un sangrado que se resuelve endoscópicamente colocando clips. No se registraron perforaciones ni síndromes post polipectomias. Conclusiones: Con una técnica adecuada y una selección cuidadosa de los casos, las polipectomías endoscópicas de pólipos de gran tamaño pueden ser realizadas con seguridad y eficacia por residentes con una adecuada curva de entrenamiento.

Background: the endoscopic polypectomy (EP) is a widespread practice in the coloproctology field. It is usually seen as a challenge by the resident, and it is seen even more challenging when operating on difficult polyps (bigger than 20 mm). The available literature is Iittle and it is not conclusive regarding the learning curve of this procedure. Objectives: analyse the efficiency and complications of the EP practiced on difficult polyps performed by residents specialized in coloproctology, and compare the outcome with the international literature available. Patients and Techniques: the retrospective analysis ­from 1st of June 2009 to 31 st of May 2010- of the EP practiced on difficult polyps done by a senior resident supervised by his mentor; considering the following indicators: size, pathology and complications of the polyp. Results: 1303 colonoscopies performed. 34 polyps bigger than 20 mm were found in 34 patients: EP was practiced on 24 cases of which the resident was able to accomplish the 95.8%. The median age of patients was 63 years old. 15 of which were males and 9 females. The average size of the polyp resulted in 28 mm. The median time of the practice was 47 minutes. The 66.4% of the cases indicated moderate dysplasia, the 29.4% acute dysplasia and the rest 4.2% invader cancer. Complications: a patient bleeding. No perforations nor post polypectomies syndroms were observed. Conclusions: With an appropiate technique and a carefuI case selection, the endoscopic polypectomies of big size polyps can be efficiently performed by residents with an adequate training curve.

OVO transcription factors function antagonistically in the Drosophila female germline.

OVO controls germline and epidermis differentiation in flies and mice. In the Drosophila germline, alternative OVO-B and OVO-A isoforms have a common DNA-binding domain, but different N-termini. We show that these isoforms are transcription factors with opposite regulatory activities. Using yeast one-hybrid assays, we identified a strong activation domain within a common region and a counteracting repression domain within the OVO-A-specific region. In flies, OVO-B positively regulated the ovarian tumor promoter, while OVO-A was a negative regulator of the ovarian tumor and ovo promoters. OVO-B isoforms supplied ovo(+) function in the female germline and epidermis, while OVO-A isoforms had dominant-negative activity in both tissues. Moreover, elevated expression of OVO-A resulted in maternal-effect lethality while the absence of OVO-A resulted in maternal-effect sterility. Our data indicate that tight regulation of antagonistic OVO-B and OVO-A isoforms is critical for germline formation and differentiation.

Sec24 proteins and sorting at the endoplasmic reticulum.

COPII proteins are necessary to generate secretory vesicles at the endoplasmic reticulum. In yeast, the Sec24p protein is the only COPII component in which two close orthologues have been identified. By using gene knock-out in yeast, we found that the absence of one of these Sec24 orthologues resulted in a selective secretion defect for a subset of proteins released into the medium. Data base searches revealed the existence of an entire family of Sec24-related proteins in humans, worms, flies, and plants. We identified and cloned two new human cDNAs encoding proteins homologous to yeast Sec24p, in addition to two human cDNAs already present within the data bases. The entire Sec24 family identified to date is characterized by clusters of highly conserved residues within the 2/3 carboxyl-terminal domain of all the proteins and a divergent amino terminus domain. Human (h) Sec24 orthologues co-immunoprecipitate with hSec23Ap and migrate as a complex by size exclusion chromatography. Immunofluorescence microscopy confirmed that these proteins co-localize with hSec23p and hSec13p. Together, our data suggest that in addition to its role in the shaping up of the vesicle, the Sec23-24p complex may be implicated in cargo selection and concentration.

In vitro bypass replication of the cisplatin-d(GpG) lesion by calf thymus DNA polymerase beta and human immunodeficiency virus type I reverse transcriptase is highly mutagenic.

Eukaryotic DNA polymerase beta and the reverse transcriptases are the most inaccurate of the known DNA polymerases. We report here mutagenic replication in vitro past intrastrand N(7)G-N(7)G chelates of the cis-diamminedichloroplatinum(II), the major DNA adduct of the antitumor agent cisplatin by calf thymus DNA polymerase beta and human immunodeficiency virus type I reverse transcriptase (42% and 26% mutations, respectively). The most frequent modifications generated by both enzymes were one-base frameshift deletions. Only one mutational hot spot opposite the platinated guanines was observed with human immunodeficiency virus type I reverse transcriptase, while two hot spots were generated by DNA polymerase beta, one at the base situated 5' to the lesion and the other situated 4-6 nucleotides 5' to the adduct. An unusual mutagenic event, tandem replication of a 12-base pair sequence, was observed with DNA polymerase beta. The mutational spectra of the two DNA polymerases suggest that template slippage occurred with higher frequency in the presence of the more distributive DNA polymerase beta.

DANA elements: a family of composite, tRNA-derived short interspersed DNA elements associated with mutational activities in zebrafish (Danio rerio).

DNA is the first SINE isolated from zebrafish (Danio rerio) exhibiting all the hallmarks of these tRNA-derived elements. DANA is unique in its clearly defined substructure of distinct cassettes. In contrast to generic SINE elements, DANA appears to have been assembled by insertions of short sequences into a progenitor, tRNA-derived element. Once associated with each other, these subunits were amplified as a new transposable element with such a remarkable success that DANA-related sequences comprise approximately 10% of the modern zebrafish genome. At least some of the sequences comprised by the full-length element were capable of movement, forming a new group of mobile, composite transposons, one of which caused an insertional mutation in the zebrafish no tail gene. Being present only in the genus Danio, and estimated to be as old as the genus itself, DANA may have played a role in Danio speciation by massive amplification and genome-wide dispersion. There are extensive DNA polymorphisms between zebrafish populations and strains detected by PCR amplification using primers specific to DANA, suggesting that the DANA element will be useful as a molecular tool for genetic and phylogenetic analyses.