Monitoring of glycolytic activity secondary to ischaemia in knee replacement surgery. / Monitorización de la actividad glucolítica secundaria a isquemia en cirugía sustitutiva de rodilla.

OBJECTIVES: To non-invasively assess tissue lesion secondary to ischaemia applied during knee replacement surgery. Secondary objectives: to assess whether this lesion correlates with the duration of ischaemia and whether instrumental and gender variables influence it. MATERIAL AND METHODS: Prospective cohort study. Pre and postoperative serum lactate levels have been determined as an indicator of glycolytic activity secondary to ischaemia in 88 patients. Serum lactate determination was performed by reactive strips of enzymatic-amperometric detection on capillary blood. RESULTS: Preoperative serum lactate levels (mean and SD): 2.467±1.036 mmol/L. Postoperative serum lactate levels: 3.938±2.018 mmol/L. Ischaemia time 102.98±18.25minutes. Postoperative serum lactate levels were significantly higher than preoperative lactate levels. There are no statistical differences according to the time that the ischaemia was prolonged, gender or type of instrumentation used. CONCLUSIONS: In our study, postoperative serum lactate values were significantly higher than preoperative lactate values, with no correlation to the duration of ischaemia during knee replacement surgery.

Analysis of the salivary proteome in gingivitis patients.

BACKGROUND AND OBJECTIVE: Gingivitis is a disease that is characterized by inflammation of the gingival tissue, which can progress to periodontitis and tooth loss. Although many studies have attempted to identify salivary proteins that are associated with the disease, this is the first study to use a proteomic approach to analyze and compare the proteomic profile of whole saliva from gingivitis patients and healthy controls. MATERIAL AND METHOD: To analyze the saliva proteome, two-dimensional gel electrophoresis and liquid chromatography were used, followed by mass spectrometry. RESULTS: The analyses showed that gingival inflammation was associated with increased amounts of blood proteins (serum albumin and hemoglobin), immunoglobulin peptides and keratins. In the control group, salivary cystatins, which were detected using capillary Liquid Chromatography on line to electrospray ionization Quadrupole Time-of-flight mass spectrometry, appeared to be more abundant. CONCLUSION: This approach provides novel insight into profiles of the salivary proteome during gingival inflammation, which may contribute to improvements in diagnosis.

[Pregnancy and partum in the woman with a spinal cord lesion in chronic phase]. / Embarazo y parto en la mujer con lesión medular en fase crónica.

A 34-year-old pregnant paraplegic woman with a T12 medullary lesion in chronic phase underwent cesarean delivery in the thirty-seventh week due to pelvic-cephalic disproportion. After failure of epidural anesthesia related to technical difficulties, general anesthesia was provided. A hypertensive crisis developed during surgery but was resolved within minutes after administration of hydralazine. No further complications arose. Pregnancy in a patient with medullary lesion in chronic phase is considered high risk, requiring special care due to extraordinary changes in pathophysiology caused by the lesion in addition to changes directly related to gestation. The main complications that arise are decreased respiratory volume and arterial pressure, increased incidence of thromboembolic events, anemia, urinary tract infections, premature birth, unusual progression of delivery and autonomic hyperreflexia, which is the most serious. When a hypertensive peak develops in such patients, the anesthesiologist must first rule out autonomic hyperreflexia, which has an incidence of 85% in lesions over T7 and has also been described in patients with lower lesions.

Embarazo y parto en la mujer con lesión medular en fase crónica / Pregnancy and childbirth in a woman with chronic phase medullary lesion

Gestante parapléjica de 34 años con lesión medular en T12 en fase crónica, sometida a una cesárea por desproporción pélvico-cefálica en la semana 37 de gestación.Tras fallo de la anestesia epidural por importantes dificultades técnicas, se practicó anestesia general. En el transcurso de la intervención presentó una crisis hipertensiva que se resolvió en pocos minutos tras la administración de hidralacina. La evolución posterior de la madre y del recién nacido cursaron sin incidencias.La gestación en una paciente con lesión medular en fase crónica es considerada de alto riesgo y precisa cuidados especiales debido a los extraordinarios cambios fisiopatológicos que ocurren como resultado de la lesión, a los que hay que sumar los propios del embarazo. Las principales complicaciones que presentan son: disminución de los volúmenes respiratorios y de la presión arterial, aumento de la incidencia de fenómenos tromboembólicos, anemia, infecciones del tracto urinario, parto prematuro, alteración en la progresión del parto y la hiperreflexia autónoma, que es la más grave.Ante un pico hipertensivo en estas pacientes, hay que descartar en primer lugar la hiperreflexia autónoma, que tiene una incidencia del 85 por ciento en lesiones por encima de T7 y también se ha descrito en lesiones torácicas bajas (AU)

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Local proliferation of fibroblast-like synoviocytes contributes to synovial hyperplasia. Results of proliferating cell nuclear antigen/cyclin, c-myc, and nucleolar organizer region staining.

OBJECTIVE: To test the hypothesis that local proliferation contributes significantly to the hyperplasia of rheumatoid synovium. METHODS: Immunohistologic and chemical staining was used to identify 3 markers of cell proliferation: proliferating cell nuclear antigen, c-myc proto-oncogene, and nucleolar organizer regions. Synovium from 21 patients with rheumatoid arthritis, 34 with degenerative joint disease, and 7 with joint trauma was examined. RESULTS: All 3 markers indicated substantial, active proliferation of synovial lining cells in synovium with hyperplasia. Proliferating cells showed type I procollagen immunoreactivity but were negative for CD68, a monocyte/macrophage marker. Proliferation was greater in rheumatoid arthritis than in the other conditions evaluated. CONCLUSION: In situ proliferation of fibroblast-like synoviocytes in the synovium lining contributes considerably to the increase in cell numbers in rheumatoid synovium.

Purification and characterization of protocatechuate 2,3-dioxygenase from Bacillus macerans: a new extradiol catecholic dioxygenase.

Protocatechuate 2,3-dioxygenase (2,3-PCD) from Bacillus macerans JJ1b has been purified to homogeneity for the first time. The enzyme catalyzes proximal extradiol ring cleavage of protocatechuate (PCA) with the attendant incorporation of both atoms of oxygen from O2. The holoenzyme has a mass of 143 +/- 7 kDa as determined by ultracentrifugation and other techniques. It is composed of four apparently identical subunits with M(r)s of 35,500, each containing one iron atom. Mössbauer spectroscopy of 57Fe-enriched enzyme showed that the irons are indistinguishable and are high spin (S = 2) Fe2+ in both the uncomplexed and substrate-bound enzyme. However, the quadrupole splitting, delta EQ, and isomer shift, delta, of the Mössbauer spectrum changed from delta EQ = 2.57 mm/s and delta = 1.29 mm/s to delta EQ = 2.73 mm/s and delta = 1.19 mm/s upon PCA binding to the enzyme, showing that the iron environment is altered when substrate is present. The enzyme was also found to bind variable and substoichiometric amounts of Mn2+, but this metal could be removed without loss of activity or stability. The inherently electron paramagnetic resonance (EPR)-silent Fe2+ of the enzyme reversibly bound nitric oxide to produce an EPR-active species (g = 4.11, 3.95; S = 3/2). The specific activity of the enzyme was found to be correlated with the amount of the S = 3/2 species formed, showing that activity is dependent on Fe2+. Anaerobic addition of substrates to the enzyme-nitric oxide complex significantly altered the EPR spectrum, suggesting that substrates bind to or near the iron. The enzyme was inactivated by reagents that oxidize the Fe2+, such as H2O2 and K3FE(CN)6; full activity was restored after reduction of the iron by ascorbate. Steady-state kinetic data were found to be consistent with an ordered bi-uni mechanism in which the organic substrate must add to 2,3-PCD before O2. The enzyme has the broadest substrate range of any of the well-studied catecholic dioxygenases. All substrates have vicinal hydroxyl groups on the aromatic ring except 4-NH2-3-hydroxybenzoate. This is the first substrate lacking vicinal hydroxyl groups reported for catecholic extradiol dioxygenases. 2,3-PCD is the final member of the PCA dioxygenase family to be purified. It is compared with other members of this family as well as other catecholic dioxygenases.

Microdissection demonstration of the lesion of the endocrine kidney in children.

Microdissection of nephrons of kidneys of children showing advanced ischemic tubular atrophy, and removed for control of hypertension, demonstrates marked proximal convoluted tubular atrophy, with formation of multiple small proximal tubular diverticula. These diverticula presumably contribute to the microscopic appearance of large numbers of small tubules lined by low epithelial cells with pale or clear cytoplasm, adjacent to glomeruli in the cortices of kidneys showing ischemic tubular atrophy (endocrine kidney). Segmentation of such atrophic tubules leads to formation of blind segments (microcysts), as demonstrated in this study and by Oliver. The distinctive microscopic appearance of the endocrine kidney, a not infrequent finding in kidneys of children with chronic renal insufficiency who require nephrectomy for control of hypertension, has not hitherto been emphasized in the literature on pediatric renal disease.