Síndrome de Wünderlich / Wünderlich syndrome

Introducción: El Síndrome de Wünderlich o hemorragia retroperitoneal espontánea es una entidad poco frecuente, su etiología obedece a múltiples causas. Su forma aguda se caracteriza por dolor y tumor lumbar con signos de hemorragia interna (tríada de Lenk). La presentación suele ser brusca, con elevada morbi-mortalidad. Su tratamiento es quirúrgico en la mayoría de los casos.Objetivo: Presentar dos casos de hemorragia retroperitoneal espontánea.Materia y Método: Análisis de historias clínicas.Caso Nº1: masculino, 47 años, con dolor cólico y distensión abdominal de 48 hs. de evolución, con tumoración en fosa ilíaca izquierda (FII) y flanco izquierdo. Se descompensa hemodinámicamente, cirugía de urgencia, nefrectomía y suprarrenalectomía izquierda. Egreso hospitalario al 10º día. Anatomía Patológica: panarteritis nodosa con compromiso necrotizante de una rama de la arteria renal con dilatación aneurismática y ruptura con hematoma retroperitoneal.Caso Nº 2: femenino, 72 años, ingresa con dolor y tumoración en fosa ilíaca de varios días de evolución, con equimosis. Cirugía electiva al 6º día de internación, diagnóstico intraoperatorio de hematoma retroperitoneal espontáneo: drenaje. Egreso hospitalario al 7º día. Anatomía Patológica: hematoma organizado.Conclusión: El síndrome de Wünderlich es una patología de muy baja frecuencia, se encuentra asociado a procesos tumorales renales y autoinmunes. La TAC es el método de elección para su diagnóstico. El diagnóstico precoz disminuye su alta mortalidad.

Human osteoblast-like cell proliferation induced by calcitonin-related peptides involves PKC activity.

The calcitonin peptides [calcitonin (CT), calcitonin gene-related peptide (CGRP), amylin] share many biological actions, including activity on bone cells. In the present study, CT (10(-11) to 10(-9) M) stimulated [(3)H]thymidine incorporation in primary cultures of human osteoblasts (hOB), as already demonstrated for CGRP and amylin. RT-PCR analysis showed that the calcitonin receptor and the calcitonin receptor-like receptor are both expressed in hOB. In these cells, CT (10(-10) M) and amylin (10(-9) M), in contrast to CGRP (10(-8) M), did not increase cAMP production. All three peptides stimulated protein kinase C (PKC) activity. To evaluate PKC involvement in hOB proliferation, cells were incubated with phorbol 12,13-dibutyrate, a stimulator of PKC activity; cell proliferation was increased in a dose-dependent manner (EC(50) = 3.4 x 10(-8) M). Staurosporine (10(-9) M), a PKC inhibitor, blocked phorbol 12,13-dibutyrate-induced PKC activity and cell proliferation. Inhibition of PKC by staurosporine also counteracted the stimulatory effect of CT, CGRP, and amylin on hOB proliferation. From these data, it is deduced that the activation of PKC is important for hOB proliferation and that it is involved in the anabolic effect of CT peptides on bone.

New bileaflet bioprosthesis: early and mid term results.

A new bovine pericardial bioprosthesis (AMB bioprosthesis) with a bileaflet geometry was designed and developed, with the aim of achieving uniform stress distribution within the prosthesis. The ultimate goal was to limit tissue degeneration to a minimum by attaining optimum fluid dynamics, thereby obtaining an extended clinical durability. The two-leaflet, dome-shaped geometry with a central hinge allowed a very low profile, low ventricular projection in the mitral position, large effective orifice area and low gradients. The design of the thin Delrin stent and the centrally crossing bridge was developed using finite element analysis. Pre-clinical laboratory investigations showed very low trans-valvular gradients and no mechanical or tissue failure after 400 million cycle accelerated wear test. The final model of the prosthesis was manufactured by Baxter-Edwards CVS Division and tested in sheep with good results for up to five months. A limited clinical trial was started in January 1990 and stopped one year later encompassing 12 aortic and six mitral implants. The patients were followed clinically and by echocardiography three, six and 12 months, and four years after surgery. Mean gradients were 4 mmHg in the mitral and 10 mmHg in the aortic position with only minimum regurgitation and no tissue failure. We conclude that early and mid term results with this new pericardial bioprosthesis appear to be favorable and intend to closely monitor further outcome within the limited patient population.