Intrinsic defects explain altered proliferative responses of T lymphocytes and HVS-derived T-cell lines in gastric adenocarcinoma.

We have taken advantage of a recently described technique of transformation and immortalization of T lymphocytes using the lymphotropic Herpesvirus saimiri, to achieve long-lasting T-cell lines from gastric cancer patients and healthy volunteers. Blood samples were drawn and T lymphocytes were transformed. Once sustained growth was observed, lines were subjected to phenotypic and functional analyses, and the results compared with freshly isolated peripheral blood mononuclear cells. Cytofluorometric analysis revealed that CD3 and CD45 were found at lower proportion in primary cells from patients than from control individuals (54% vs 75%, p<0.001, 90% vs 96%, p<0.05, respectively), and in HVS-derived T-cell lines (90% vs 98%, p<0.05, 97% vs 100%, p<0.05, respectively). Proliferative analyses showed that primary isolated cells were unable to respond adequately to CD3-, CD2-, and PHA-mediated stimulation, as compared to controls. Similarly, T-cell lines from patients proliferated to a lesser extent when CD3- and CD2-mediated stimuli were considered, especially when simultaneous stimulation via CD3 and CD2 molecules was carried out (47,824 counts per minute [cpm] vs 121,478 cpm, p<0.05). Altogether these results show that the defects reported in T cells from patients with cancer are not exclusively due to tumour-derived factors, since the alterations persist in long-lasting, HVS-transformed, T-cell lines, suggesting that this model seems a suitable one to disclose them.

Growth hormone effects in intestinal adaptation after massive bowel resection in the suckling rat.

BACKGROUND: Massive small bowel resection provokes intestinal malabsorption that leads to diminished growth in the suckling rat. Growth hormone is one of the several factors that can enhance the adaptive response of the intestines in the adult rat; however, whether it also enhances postresection intestinal adaptation in the suckling rat, thus reducing the adverse effects of resection on growth, is still unclear. METHODS: Seventy-four 30-day-old suckling Wistar rats underwent 80% midgut bowel resection, laparotomy (sham operation), or no surgery. They were treated with either growth hormone or saline for 15 days and studied 15 or 45 days after surgery. Body weight was monitored and samples of bone and intestinal mucosa were obtained at the end of the study period for analysis. RESULTS: Resected rats lost body and bone weight regardless of growth hormone administration. Bowel resection provoked significant increases in the proliferation and size of the intestinal mucosa. Growth hormone significantly, but just barely, increased crypt height and mucosal mass at day 15 after surgery, but not at day 45. Lengthening of the intestines was the main effect of growth hormone. CONCLUSIONS: The relatively small adaptive response of intestines to growth hormone is insufficient to promote body growth after intestinal resection in the suckling rat. This response is lower than that in older rats and may reflect an age-related differential response to growth hormone.

Tratamiento del prolapso hemorroidal mediante mucosectomía circular endoanal (técnica de Longo) / Treatment of hemorrhoidal prolapse by endoanal circular mucosectomy (Longo's technique)

Introducción. La enfermedad hemorroidal es un proceso de gran prevalencia en la población, cuyo tratamiento quirúrgico quedó establecido hace tiempo mediante la técnica de Milligan y Morgan y sus posteriores modificaciones. No obstante, el hecho de que se generen molestias y dolor postoperatorios han motivado la propuesta de métodos alternativos, con mayor o menor éxito, pero sin duda menos idóneas que la hemorroidectomía convencional. En 1998 Longo propuso una nueva técnica, la mucosectomía circular endoanal, como tratamiento eficaz de la enfermedad hemorroidal. Objetivos. Se evalúa la dificultad de la técnica y sus resultados respecto al dolor y las complicaciones postoperatorias. Pacientes y métodos. Pacientes con hemorroides de grado III que fueron tratados mediante la técnica descrita por Longo durante el período comprendido entre abril de 1999 y julio de 2000. Se analiza la edad, el sexo, la dificultad del procedimiento, la morbilidad y la estancia hospitalaria. Siempre se prescribió la misma pauta analgésica. Al alta se le entregaba al paciente una "Encuesta de satisfacción" y un folleto donde debía anotar la intensidad y duración del dolor, así como el consumo de analgésicos. El seguimiento se realizó a los 7, 15, 30 días y 6 meses de la cirugía. El tiempo operatorio se midió con un cronómetro. Resultados. Fueron intervenidos 28 enfermos, 17 varones y 11 mujeres, con una media de edad de 36 años (rango 24-68); intervención única y completa en todos los casos; estancia media 1,2 días (rango 1-5). No hubo dificultad técnica en ningún caso. Hubo complicaciones mayores (n = 1; 3,5 por ciento) y menores (n = 12; 42,1 por ciento): la mayor, un caso de hemorragia postoperatoria debido a fallo técnico, que requirió cirugía urgente para sutura del punto sangrante bajo anestesia general y transfusión de hemoderivados; las menores: retención urinaria en las primeras 24 h (n = 9; 32,1 por ciento), hemorragia escasa durante la primera semana posterior a la cirugía (n = 5; 17,5 por ciento) y tenesmo rectal (n = 3; 10,7 por ciento). No se objetivaron dolor postoperatorio ni incontinencia temporal. El tiempo operatorio medio fue de 18,3 ñ 4,1 min. El dolor posquirúrgico fue controlado en todos los casos con la medicación prescrita, excepto en uno (el que precisó reintervención por hemorragia). Todos los pacientes tuvieron menos dolor que el esperado; ninguno precisaba medicación en la segunda revisión. El grado de satisfacción fue del 97 por ciento. La actividad laboral, controlada en 19 de los 28 enfermos, se reanudó en menos de 2 días (n = 8), en menos de 7 días (n = 9) y al mes (n = 2). Conclusiones. a) La técnica descrita por Longo es fácil de realizar y eficaz para el tratamiento de hemorroides de grado III, con una tasa baja de complicaciones, y b) se necesita un seguimiento a largo plazo de estos pacientes para evaluar resultados definitivos y detectar posibles secuelas (AU)

Metástasis esplénica de carcinoma de colon / Splenic metastases from colon carcinoma

Los tumores del bazo, tanto primitivos como metástasicos, son raros. El motivo de que el bazo sea relativamente resistente a las neoplasias es desconocido. Por su infrecuencia se presenta un caso de metástasis esplénica de adenocarcinoma de colon, que corresponde a una mujer, de 45 años de edad, operada en octubre de 1991 por presentar obstrucción intestinal por adenocarcinoma de colon (estadio D de Dukes), a la que se le practicó hemicolectomía, resección de implantes peritoneales y colostomía proximal más quimioterapia complementaria (QTC) posterior. En mayo de 1993 se le practicó histerectomía subtotal con doble anexectomía por metástasis bilaterales en ambos ovarios, más nuevos ciclos de QTC. En la TC efectuada en febrero de 1994 se observó una lesión ocupante de espacio de 2,5 cm de diámetro en el polo inferior del bazo. Se practicó esplenectomía completa. El postoperatorio transcurrió con normalidad. Fue dada de alta a la semana de la cirugía. Falleció en julio de 1996 a causa de una carcinomatosis generalizada. El diagnóstico anatomopatológico fue: "metástasis esplénica de adenocarcinoma moderadamente indiferenciado de intestino grueso". Las metástasis esplénicas pueden manifestarse por esplenomegalia dolorosa, en ocasiones asociada con derrame pleural izquierdo, o por rotura espontánea del bazo. El diagnóstico es a menudo accidental, raramente establecido por la clínica, y está basado en las imágenes obtenidas por las exploraciones adecuadas. El tratamiento es la esplenectomía completa, que debe realizarse de acuerdo con los principios de la cirugía oncológica (AU)

Rupture of splenic artery aneurysm during pregnancy and posterior evolution of gestation.

We present a case of splenic artery aneurysm rupture in a 26 weeks pregnant patient. Facing to the maternal collapse and after the ultrasonographical diagnosis of massive hemoperitoneum, the rapid intervention proved to be crucial in controlling the hemorrhage and allowed for the continuation of gestation and successful delivery.

Transperitoneal absorption of intralipid in rats: total serum fatty acids and triglyceride after absorption.

Intralipid 20% was injected percutaneously into the peritoneum of 58 female rats. The rats were divided into seven groups (with an additional control group of 35 rats). To measure transperitoneal absorption, we determined the serum fatty acid and triglyceride concentrations at 3-hr intervals for 24 hr, and found a considerable increase in all of the levels measured, with a maximum at about 6 hr. The serum triglyceride levels never rose above a mean value of 200 mg/100 ml. A second and smaller rise was seen after 15 hr, declining again to the initial values. The relative proportions of the different fatty acids changed, but not drastically.

Portoenterostomy diversion. Experimental study in antireflux technique.

Ascending cholangitis was induced in dogs by performing a biliodigestive Roux-Y anastomosis. Then two valvular antireflux mechanisms were performed on separate groups of these dogs with the aim of preventing the onset of ascending cholangitis. One was performed by a laterolateral plicature at the intestinal anastomosis and the other by invagination of the mucosa in the nonworking loop that had been anastomosed to the bile duct. All the dogs underwent analytic tests over a period of 3 months and histopathologic tests at the end of the study period. Results showed cholangitis and pericholangitis in the liver biopsy specimens of the group with no antireflux valve, to a lesser degree in the group with laterolateral plicature, and almost none in the animals with the invaginated valve.

Functional anatomy of the medial collateral ligament of the ankle joint.

The calcaneotibial and posterior talotibial ligaments slacken and the naviculotibial ligament tightens as the ankle plantarflexes; the reverse occurs in ankle extension. The naviculotibial ligament increases its length and the posterior talotibial ligament relaxes in abduction. The cutting of the posterior talotibial ligament repercutes on other parts of the medial collateral ligament. The cutting of other parts of the medial collateral ligament produces very little change on the posterior talotibial ligament. When the whole medial collateral ligament is severed, there is a lateral displacement of the talus. This may be important in the diagnosis and surgical treatment of a torn medial collateral ligament.

[Omental graft, without devascularization, in the hepatic hilum. Experimental study]. / Injerto de epiplón, sin desvascularizar, en hilio hepático. Estudio experimental.

Epiploon grafts were made into the resected hepatic hilum of dogs with the aim of creating anastomosis between the intrahepatic and epiploic lymphatic systems. Various hepatic enzymes were observed over a three month period, and then a histopathological study of the grafted area was made. This type of graft was also applied to rabbits, after tying off the common hepatic duct, and the histopathological study made fifteen days after. The results show no lymphatic anastomosis between the liver and the grafted epiploon. So we would not advise using this type of technique to drain intrahepatic cholestasis in biliary atresia, at least not as the procedure of choice.