Trombosis arterial secundaria a exostosis de tibia y peroné / Arterial thrombosis secondary to tibia and fibula exostosis

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Tumores del cuerpo carotídeo. Experiencia en 22 años y protocolo de seguimiento y despistaje familiar / Carotid body tumours. Experience over 22 years and a family screening and follow-up protocol

Introducción: Los tumores del cuerpo carotídeo son tumores raros, muy vascularizados, originados en los quimiorreceptores de la bifurcación carotídea. Se ha descrito su malignización y asociación con otros tumores endocrinos. Pueden ser familiares en el 10-50% de los casos. Objetivo: Analizar nuestros resultados en el manejo de estos tumores y presentar un protocolo de actuación y seguimiento. Material y métodos: Entre 1986 y 2008 se trataron 25 casos en 23 pacientes (2 bilaterales), con una edad media de 51 años (r 31-78), el 82,6% mujeres, un caso familiar. Como pruebas diagnósticas se realizaron ecodoppler y arteriografía en todos los pacientes, y tomografía computarizada o resonancia magnética en 12. El seguimiento postoperatorio se llevo a cabo con ecodoppler. Resultados: En todos los casos se realizó la resección completa del tumor, los 14 últimos con embolización preoperatoria. Fue necesaria la reconstrucción vascular en 6 casos. Seis pacientes tuvieron lesión neurológica, uno rotura arterial y uno neumonía postoperatoria. Según los criterios de clasificación de Shamblin, 13 casos fueron tipo I, 5 tipo II y 7 tipo III. Las complicaciones y reconstrucciones vasculares estuvieron relacionadas con tumores tipo II y III. Durante el seguimiento se detectaron 4 recidivas, 2 tumores contralaterales (bilaterales), un feocromocitoma, una trombosis del injerto y 6 éxitus (uno por malignización y metástasis). Conclusiones: La cirugía en fase precoz disminuye la morbimortalidad. El seguimiento con ecodoppler permite detectar recidivas, bilateralidad y complicaciones de la reconstrucción vascular. La posible presentación familiar, recidivas, asociación a otros tumores o metástasis ,hacen necesario el seguimiento sistematizado del paciente(AU)

Background: Carotid body tumours are rare, highly vascular, arising from the chemoreceptors of the carotid bifurcation. Their relationship with malignancy and other endocrine tumours have already been described. There can be between 10% and 50% of cases in a family. Objective: To analyse the results in the management of these tumours, and present a protocol for action and monitoring. Material and methods: Between 1986 and 2008 a total 25 cases were treated in 23 patients (2 bilateral) with a mean age of 51 years (range 31-78), with 82.6% women, 1 family case. Doppler ultrasound and angiography were performed as diagnostic tests in all patients, with computed tomography or magnetic resonance imaging in 12 cases. They were monitored annually using Doppler ultrasound. Results: According to the Shamblin classification criteria, 13 cases were type I, 5 were type II and 7 type III. A complete resection of the tumour was performed in all cases, the last 14with preoperative embolisation. Vascular reconstruction was necessary in 6 cases. Six patients had neurological injury, an arterial rupture and a postoperative pneumonia. Complications and vascular reconstruction were associated with type II and III tumours. During follow-up four recurrences were detected, two contralateral tumours, a phaeochromocytoma, a graft thrombosis and six deaths, (1 from malignancy and metastasis). Conclusions: Surgery in the early stage reduces the morbidity and mortality. Follow-up should be with Doppler ultrasound to detect recurrence, bilaterality and complications of vascular reconstruction. The possible familial presentation, recurrence, association with other tumours or metastases, requires systematic monitoring of the patient(AU)

Tratamiento de la trombosis venosa de esfuerzo en el miembro superior / Treatment of effort-induced venous thrombosis of the upper limb

IntroducciónEl correcto tratamiento de la trombosis venosa profunda (TVP) subclavia puede disminuir la secuela a largo plazo.ObjetivoAnalizar el resultado clínico a largo plazo de los pacientes tratados en nuestro servicio de trombosis venosa de esfuerzo en el miembro superior.Material y métodosEstudio retrospectivo (1986-2009). Veintinueve pacientes diagnosticados de TVP subclavia sin antecedente de marcapasos, neoplasia, accesos venosos o de hemodiálisis. Once mujeres y 18 hombres, edad media 38 años. Más de la mitad con trabajos o deportes con sobreesfuerzo de la cintura escapular. Diagnóstico: flebografía y/o ecodoppler. Tratamiento: anticoagulación: 5, fibrinólisis y anticoagulación: 9, cirugía y anticoagulación: 2, fibrinólisis, cirugía y anticoagulación: 13. La fibrinólisis (urokinasa) fue total o parcialmente efectiva en el 77% de los casos (17 de los 22 tratados con urokinasa), en 2 de ellos trombectomía adicional. Cirugía descompresiva en 15 casos: el 59% de los tratados con fibrinólisis; 4 abordajes vía transaxilar, 2 supraclavicular y 9 suprainfraclavicular. En todos los pacientes salvo en uno, resección de primera costilla asociando escalenectomía en todos. Evaluamos la secuela mediante test de calidad de vida QuickDASH y permeabilidad de la vena mediante ecodoppler.ResultadosComplicaciones precoces: una reintervención por sangrado. No complicaciones tardías. Seguimiento medio 126 meses. Siete pacientes perdidos en el seguimiento. A largo plazo, el 68% asintomáticos, de estos, el 73% sometidos a cirugía descompresiva.ConclusionesEn nuestra serie, los pacientes con TVP de esfuerzo sometidos a cirugía descompresiva, presentan un mejor resultado clínico a largo plazo que los no intervenidos(AU)

IntroductionApplying appropriate treatment for subclavian deep vein thrombosis may reduce long-term sequels.ObjectiveTo analyse the long-term clinical results of those patients treated in for upper body stress thrombosis in our Department.Materials and methodsA retrospective study (period 1986-2009) was conducted on 29 patients diagnosed with Venous Thoracic Outlet Syndrome (TOS) without pacemaker, neoplasia, previous vein access, or history of haemodialysis. The subjects included 11 women and 18 men, with a mean age of 38 years. More than half of the study subjects had jobs or took part in a sport activity involving acute stress of pectoral girdle. The diagnosis was made using Duplex Ultrasound With Venography. Treatment consisted of: anti-coagulation: 5; fibrinolysis: 9; surgery: 2; fibrinolysis+surgery: 13. Fibrinolysis was total or partially successful in 77% of cases (17 out of the 22 treated with Urokinase), two of them needing a further thrombectomy. Decompression surgery was used in 15 cases; 59% of the patients who had been treated with fibrinolysis, 4 via transaxillary approach, 2 supraclavicular and 9 supra- and infraclavicular combined. All patients but one had first rib resection, half of them had scalenectomy.ResultsEarly complications: one patient required post-intervention because of bleeding. There were no late complications. Seven patients were lost during follow up (126 months on average). In the long-term, 68% of interviewed patients remained asymptomatic, 73% of of them were subjected to decompression surgery.ConclusionsIn our series, patients who had a venous TOC decompression surgery after extrinsic compression, showed better long-term clinical results than those not operated on(AU)

Postnatal development enhances the effects of cholinergic inputs on recruitment threshold and firing rate of rat oculomotor nucleus motoneurons.

Changes in the electrophysiological and morphological characteristics of motoneurons (Mns) of the oculomotor nucleus during postnatal development have been reported, however synaptic modifications that take place concurrently with postnatal development in these Mns are yet to be elucidated. We investigated whether cholinergic inputs exert different effects on the recruitment threshold and firing rate of Mns during postnatal development. Rat oculomotor nucleus Mns were intracellularly recorded in brain slice preparations and separated in neonatal (4-7 postnatal days) and adult (20-30 postnatal days) age groups. Stimulation of the medial longitudinal fasciculus evoked a monosynaptic excitatory potential in Mns that was attenuated with atropine (1.5 µM, a muscarinic antagonist). Mns were silent at their resting membrane potential, and bath application of carbachol (10 µM, a cholinergic agonist) induced depolarization of the membrane potential and a sustained firing rate that were more pronounced in adult Mns. Pharmacological and immunohistochemical assays showed that these responses were attributable to muscarinic receptors located in the membrane of Mns. In addition, compared to control Mns, carbachol-exposed Mns exhibited a higher firing rate in response to the injection of the same amount of current, and a decrease in the current threshold required to achieve sustained firing. These latter effects were more pronounced in adult than in neonatal Mns. In conclusion, our findings suggest that cholinergic synaptic inputs are already present in neonatal Mns, and that the electrophysiological effects of such inputs on recruitment threshold and firing rate are enhanced with the postnatal development in oculomotor nucleus Mns. We propose that cholinergic input maturation could provide a greater dynamic range in adult Mns to encode the output necessary for graded muscle contraction.

Afferent and efferent connections of the mesencephalic reticular formation in goldfish.

The physiology of the mesencephalic reticular formation (MRF) in goldfish suggests its contribution to eye and body movements, but the afferent and efferent connections underlying such movements have not been determined. Therefore, we injected the bidirectional tracer biotinylated dextran amine into functionally identified MRF sites. We found retrogradely labelled neurons and anterogradely labelled boutons within nuclei of the following brain regions: (1) the telencephalon: a weak and reciprocal connectivity was confined to the central zone of area dorsalis and ventral nucleus of area ventralis; (2) the diencephalon: reciprocal connections were abundant in the ventral and dorsal thalamic nuclei; the central pretectal nucleus was also reciprocally wired with the MRF, but only boutons were present in the superficial pretectal nucleus; the preoptic and suprachiasmatic nuclei showed abundant neurons and boutons; the MRF was reciprocally connected with the preglomerular complex and the anterior tuberal nucleus; (3) the mesencephalon: neurons and boutons were abundant within deep tectal layers; reciprocal connections were also present within the torus semicircularis and the contralateral MRF; neurons were abundant within the nucleus isthmi; and (4) the rhombencephalon: the superior and middle parts of the reticular formation received strong projections from the MRF, while the projection to the inferior area was weaker; sparse neurons were present throughout the reticular formation; a reciprocal connectivity was observed with the sensory trigeminal nucleus; the medial and magnocellular nuclei of the octaval column projected to the MRF. These results support the participation of the MRF in the orienting response. The MRF could also be involved in other motor tasks triggered by visual, auditory, vestibular, or somatosensory signals.

Traumatismos vasculares de los miembros. Diagnóstico y tratamiento actual / No disponible

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Eye movements evoked by electrical microstimulation of the mesencephalic reticular formation in goldfish.

Anatomical studies in goldfish show that the tectofugal axons provide a large number of boutons within the mesencephalic reticular formation. Electrical stimulation, reversible inactivation and cell recording in the primate central mesencephalic reticular formation have suggested that it participates in the control of rapid eye movements (saccades). Moreover, the role of this tecto-recipient area in the generation of saccadic eye movements in fish is unknown. In this study we show that the electrical microstimulation of the mesencephalic reticular formation of goldfish evoked short latency saccadic eye movements in any direction (contraversive or ipsiversive, upward or downward). Movements of the eyes were usually disjunctive. Based on the location of the sites from which eye movements were evoked and the preferred saccade direction, eye movements were divided into different groups: pure vertical saccades were mainly elicited from the rostral mesencephalic reticular formation, while oblique and pure horizontal were largely evoked from middle and caudal mesencephalic reticular formation zones. The direction and amplitude of pure vertical and horizontal saccades were unaffected by initial eye position. However the amplitude, but not the direction of most oblique saccades was systematically modified by initial eye position. At the same time, the amplitude of elicited saccades did not vary in any consistent manner along either the anteroposterior, dorsoventral or mediolateral axes (i.e. there was no topographic organization of the mesencephalic reticular formation with respect to amplitude). In addition to these groups of movements, we found convergent and goal-directed saccades evoked primarily from the anterior and posterior mesencephalic reticular formation, respectively. Finally, the metric and kinetic characteristics of saccades could be manipulated by changes in the stimulation parameters. We conclude that the mesencephalic reticular formation in goldfish shares physiological functions that correspond closely with those found in mammals.

Visual orienting response in goldfish: a multidisciplinary study.

The neural basis underlying the orienting response has been thoroughly studied in frontal-eyed mammals. However, in non-mammalian species, including fish, it remains almost unknown. Therefore, we studied the contribution of the optic tectum and the mesencephalic reticular formation to the performance of the orienting response in goldfish, using behavioural, physiological, and anatomical tracer techniques. The appearance of a visual stimulus (a pellet of food) in the environment of a goldfish evoked a turn of the body to reorient the line of sight. Left-tectal lobe ablation abolished the orienting turn response towards the contralateral hemifield. Electrical microstimulation of the optic tectum suggested the presence of a motor map, which is in correspondence with the overlying visual representation, as previously reported in other vertebrates. The tracer biotin-dextran amine was injected into different functionally identified tectal zones. The results showed that rostral and caudal poles of the mesencephalic reticular formation receive outflow mainly from the rostral and caudal tectal poles, respectively. This suggests that the tectal wiring with downstream structures is site-dependent. Furthermore, the electrical activation of rostral and caudal mesencephalic reticular formation revealed a different contribution to vertical and horizontal orienting eye movements. We conclude that the basic neural system coding the orienting response appears early in phylogenesis, although some specific characteristics are selected by adaptive pressure.

Afferent connectivity to different functional zones of the optic tectum in goldfish.

This work studies the afferent connectivity to different functionally identified tectal zones in goldfish. The sources of afferents contributed to different degrees to the functionally defined zones. The dorsocentral area of the telencephalon was connected mainly with the ipsilateral anteromedial tectal zone. At diencephalic levels, neurons were found in three different regions: preoptic, thalamic, and pretectal. Preoptic structures (suprachiasmatic and preoptic nuclei) projected mainly to the anteromedial tectal zone, whereas thalamic (ventral and dorsal) and pretectal (central, superficial, and posterior commissure) nuclei projected to all divisions of the tectum. In the mesencephalon, the mesencephalic reticular formation, torus longitudinalis, torus semicircularis, and nucleus isthmi were, in the anteroposterior axis, topographically connected with the tectum. In addition, neurons in the contralateral tectum projected to the injected zones in a symmetrical point-to-point correspondence. At rhombencephalic levels, the superior reticular formation was connected to all studied tectal zones, whereas medial and inferior reticular formations were connected with medial and posterior tectal zones. The present results support a different quantitative afferent connectivity to each tectal zone, possibly based on the sensorimotor transformations that the optic tectum carries out to generate orienting responses.

Connectivity of the goldfish optic tectum with the mesencephalic and rhombencephalic reticular formation.

The optic tectum of goldfish, as in other vertebrates, plays a major role in the generation of orienting movements, including eye saccades. To perform these movements, the optic tectum sends a motor command through the mesencephalic and rhombencephalic reticular formation, to the extraocular motoneurons. Furthermore, the tectal command is adjusted by a feedback signal arising from the reticular targets. Since the features of the motor command change with respect to the tectal site, the present work was devoted to determining, quantitatively, the particular reciprocal connectivity between the reticular regions and tectal sites having different motor properties. With this aim, the bidirectional tracer, biotin dextran amine, was injected into anteromedial tectal sites, where eye movements with small horizontal and large vertical components were evoked, or into posteromedial tectal sites, where eye movements with large horizontal and small vertical components were evoked. Labeled boutons and somas were then located and counted in the reticular formation. Both were more numerous in the mesencephalon than in the rhombencephalon, and ipsilaterally than contralaterally, with respect to the injection site. Furthermore, the somas showed a tendency to be located in the area containing the most dense labeling of synaptic endings. In addition, labeled boutons were often observed in close association with retrogradely stained neurons, suggesting the presence of a tectoreticular feedback circuit. Following the injection in the anteromedial tectum, most of the boutons and labeled neurons were found in the reticular formation rostral to the oculomotor nucleus. Conversely, following the injection in the posteromedial tectum, most of the boutons and neurons were also located in the caudal mesencephalic reticular formation. Finally, boutons and neurons were found in the rhombencephalic reticular formation surrounding the abducens nucleus. They were more numerous following the injection in the posteromedial tectum. These results demonstrate characteristic patterns of reciprocal connectivity between physiologically different tectal sites and the mesencephalic and rhombencephalic reticular formation. These patterns are discussed in the framework of the neural substratum that underlies the codification of orienting movements in goldfish.

Cirugía endovascular como tratamiento de elección en el sector femoropoplíteo y distal en isquemia crónica de miembros inferiores en un servicio de angiología y cirugía vascular (1995-2001) / Endovascular surgery as first choice treatment in the femoralpopliteal and distal sector in chronic ischemia of the lower limbs in an angiology and vascular surgery service (1995-2001)

Objetivo. Analizar nuestra experiencia en el tratamiento endovascular de la isquemia crónica arteriosclerosa de miembros inferiores. Pacientes y métodos. Estudio retrospectivo: enero 1995-diciembre 2001. 46 procedimientos (43 pacientes). Edad media: 63,2ñ10,2 años. Diabetes: 34,8 per cent. Indicación: isquemia crítica, 80,4 per cent.Claudicación incapacitante: 19,6 per cent. Indicación topográfica: lesiones tipo A-B (n= 45) y tipo C (n= 1); estenosis, 54,3 per cent, y obstrucciones, 45,7 per cent. Run-off: 0-1 vasos, 39,1 per cent; 2-3 vasos, 60,9 per cent. Angioplastia aislada, 78,2 per cent, y angioplastia+stent, 21,8 per cent. Seguimiento: 0,5-66 meses (media, 19,1 meses).Calculamos la permeabilidad primaria, secundaria, salvamento de la extremidad y supervivencia actuariales en función de seis variables: sector topográfico, tipo de lesión, grado clínico, tipo de procedimiento, run-off y diabetes. Tests estadísticos: Kaplan-Meier, log-rank. Paquete estadístico SPSS. Resultados. A 30 días: permeabilidad primaria, 93,4 per cent; secundaria, 95,6 per cent; salvamento de la extremidad, 93,4 per cent. Supervivencia, 100 per cent.Tardíos: permeabilidad primaria global, 59,4 per cent (run-off: 0-1 vasos, 40,3 per cent; 2-3 vasos, 70,6 per cent; p< 0,05; el resto de variables no son significativas). Permeabilidad secundaria global, 66,6 per cent (run-off: 0-1 vasos, 48,3 per cent; 2-3 vasos, 78,6 per cent; p< 0,05). No existe ninguna relación significativa entre el resto de las variables y la permeabilidad secundaria. Conservación de la extremidad global, 74 per cent (claudicantes, 100 per cent; dolor en reposo, 85,8 per cent; lesiones tróficas, 46,9 per cent; p< 0,05. En runoff: 0-1 vasos, 19,7 per cent; 2-3 vasos, 100 per cent; p< 0,05). Supervivencia global, 80 per cent a 5,5 años. Conclusiones. Consideramos la cirugía endovascular como el tratamiento de elección en la isquemia crítica de miembros inferiores en lesiones con morfologías tipo A y B. El drenaje de salida (2-3 vasos) es el factor pronóstico más importante en nuestra serie para el éxito de esta técnica (AU)

Glucagon-like peptide-1 (GLP-1) and glucose metabolism in human myocytes.

Glucagon-like peptide-1 (GLP-1) has been shown to have insulin-like effects upon the metabolism of glucose in rat liver, muscle and fat, and on that of lipids in rat and human adipocytes. These actions seem to be exerted through specific receptors which, unlike that of the pancreas, are not - at least in liver and muscle - cAMP-associated. Here we have investigated the effect, its characteristics, and possible second messengers of GLP-1 on the glucose metabolism of human skeletal muscle, in tissue strips and primary cultured myocytes. In muscle strips, GLP-1, like insulin, stimulated glycogen synthesis, glycogen synthase a activity, and glucose oxidation and utilization, and inhibited glycogen phosphorylase a activity, all of this at physiological concentrations of the peptide. In cultured myotubes, GLP-1 exerted, from 10(-13) mol/l, a dose-related increase of the D-[U-(14)C]glucose incorporation into glycogen, with the same potency as insulin, together with an activation of glycogen synthase a; the effect of 10(-11) mol/l GLP-1 on both parameters was additive to that induced by the equimolar amount of insulin. Synthase a was still activated in cells after 2 days of exposure to GLP-1, as compared with myotubes maintained in the absence of peptide. In human muscle cells, exendin-4 and its truncated form 9-39 amide (Ex-9) are both agonists of the GLP-1 effect on glycogen synthesis and synthase a activity; but while neither GLP-1 nor exendin-4 affected the cellular cAMP content after 5-min incubation in the absence of 3-isobutyl-1-methylxantine (IBMX), an increase was detected with Ex-9. GLP-1, exendin-4, Ex-9 and insulin all induced the prompt hydrolysis of glycosylphosphatidylinositols (GPIs). This work shows a potent stimulatory effect of GLP-1 on the glucose metabolism of human skeletal muscle, and supports the long-term therapeutic value of the peptide. Further evidence for a GLP-1 receptor in this tissue, different from that of the pancreas, is also illustrated, suggesting a role for an inositolphosphoglycan (IPG) as at least one of the possible second messengers of the GLP-1 action in human muscle.

Tratamiento quirúrgico del síndrome del desfiladero torácico: nuestra experiencia (1986-2000) / Surgical treatment in the thoracic outlet syndrome: our experience (1986-2000)

Objetivo. Evaluar los resultados del tratamiento quirúrgico del síndrome del desfiladero torácico (SDT) en un servicio de angiología y cirugía vascular. Pacientes y métodos. Estudio retrospectivo. Período de estudio 1986-2000, n= 53 casos en 45 pacientes (8 bilaterales). Edad media: 32,6 años (r= 17-58). Se han incluido 29 mujeres (64 por ciento) y 16 varones (34 por ciento), diagnosticados por exploración clínica, radiología simple, pruebas neurofisiológicas, Doppler y angioRx. SDT arterial n= 43 (30 puros/13 mixtos o neurovasculares); SDT venoso n= 9 (8 TVP y 1 edema intermitente) y un caso SDT neurológico puro. Se apreciaron anomalías óseas en el 62,2 por ciento de los pacientes. Se han practicado 28 resecciones de costilla cervical/megaapófisis C7, 19 de 1.ª costilla, 3 de 1.ª costilla anómala, 1 de clavícula, 1 de músculo subclavio y 1 escalenectomía aislada. Se asoció cirugía arterial o venosa directa en 8 casos (6/2 respectivamente). Los resultados precoces y tardíos se han calculado mediante estadística descriptiva, test exacto de Fisher y Kaplan-Meier, utilizando el programa SPSS. Resultados. Precoces: mortalidad 0 por ciento, morbilidad 13 por ciento, permeabilidad acumulada 87,5 por ciento. Tardíos: seguimiento medio 36 meses (0-15 años). Permeabilidad acumulada: 85,7 por ciento. Tasa actuarial de asintomáticos: 79,2 por ciento. Tasa de asintomáticos y sintomáticos con pruebas postoperatorias normalizadas: 92,4 por ciento (a los 15 años). No se evidenció relación significativa entre sexo, edad y tipo de resección efectuada, con la persistencia de los síntomas en las tablas actuariales (p> 0,05). Se reintervinieron cuatro casos (7.5 por ciento) por recurrencia de los síntomas. Conclusiones. Nuestros resultados justifican el tratamiento quirúrgico del SDT. La selección de los pacientes es fundamental porque un porcentaje mantendrá la sintomatología pese a la normalización de los tests diagnósticos (AU)

Endarterectomía iliofemoral retrógrada transinguinal: 1986-1997 / Transinguinal retrograde iliofemoral endarterectomy: 1986-1997

Objetivos: Analizar los resultados del tratamiento de la isquemia crónica de miembros inferiores mediante la Endarterectonía iliofenoral retrógrada transinguinal (EIRT). Pacientes y métodos: Entre 1986 y 1997 hemos indicado I38 EIRT en 120 pacientes. Edad media de 66 años (r = 3890), siendo el 94,2 por ciento varones. Las indicaciones fueron la isquemia crítica de la extremidad en el 62,3 por ciento de los casos y la claudicación incapacitante de la misma en el 37,7 por ciento restantes. Obstrucción del eje iliofenoral en 74 casos (53,6 por ciento) y lesiones estenosantes significativas y difusas en los 64 restantes (46,4 por ciento). El procedimiento se realizó bajo control radiológico desde femoral común, asociando en 67 casos profundoplastia. Se describen los resultados obtenidos precoces y tardíos, así como la permeabilidad y supervivencia acumuladas mediante el análisis de tablas de vida. Resultados: Precoces: En I3 casos no se pudo completar la técnica, por lo que se realizaron 125 casos. Permeabilidad acumulada 95,5 por ciento, morbimortalidad 8 por ciento (tres amputaciones, dos éxitos por cardiopatía postoperatorios). Tardíos: Permeabilidad acumulada del 82,9 por ciento y 79,1 por ciento a los 5 y 8 años, respectivamente. Salvamento de extremidad y supervivencia actuarial a 8 años 85,9 por ciento y 88,7 por ciento. Conclusiones: La EIRT es, en nuestra experiencia, una segura y válida alternativa quirúrgica en el tratamiento de la isquemia crónica de miembros inferiores, en casos seleccionados. (AU)

Inositolphosphoglycans possibly mediate the effects of glucagon-like peptide-1(7-36)amide on rat liver and adipose tissue.

Insulin-like effects of glucagon-like peptide-1(7-36)amide (GLP-1) in rat liver, skeletal muscle and fat, and also the presence of GLP-1 receptors in these extrapancreatic tissues, have been documented. In skeletal muscle and liver, the action of GLP-1 is not associated with an activation of adenylate cyclase, and in cultured murine myocytes and hepatoma cell lines, it was found that GLP-1 provokes the generation of inositolphosphoglycan molecules (IPGs), which are considered second messengers of insulin action. In the present work, we document in isolated normal rat adipocytes and hepatocytes that GLP-1 exerts a rapid decrease of the radiolabelled glycosylphosphatidylinositols (GPIs)--precursors of IPGs--in the same manner as insulin, indicating their hydrolysis and the immediate short-lived generation of IPGs. Thus, IPGs could be mediators in the GLP-1 actions in adipose tissue and liver, as well as in skeletal muscle, through GLP-1 receptors which are, at least functionally, different from that of the pancreatic B-cell.

Preserved GLP-I effects on glycogen synthase a activity and glucose metabolism in isolated hepatocytes and skeletal muscle from diabetic rats.

To search if biological effects of GLP-I on glucose metabolism in extrapancreatic tissue are present in diabetic states, we have studied the action of GLP-I and insulin on glycogen-enzyme activity, glycogen synthesis, and glucose metabolism in isolated hepatocytes and soleus muscle from adult streptozotocin (STZ)- and neonatal STZ-treated diabetic rats. This work confirms the previously reported insulin-like effects of GLP-I on glucose metabolism in both muscle and liver tissue from normal rats (control). The present study extends those observations to the muscle and liver tissue of diabetic animals. In both muscle and liver tissue, the metabolism of D-glucose, in the absence of added peptides, was more severely affected in adult STZ (IDDM model) than in neonatal STZ (nSTZ; NIDDM model) rats, and the magnitude of hormonal effect on metabolic variables was lower in diabetic rats than in control rats, as a rule. Nevertheless, in liver and muscle tissue of diabetic rats, GLP-I was able to increase glycogen synthase activity, augment the net rate of D-[U-14C]glucose incorporation into glycogen, and increase D-[5-3H]glucose utilization, D-[U-14C]glucose oxidation, and lactate production. In conclusion, GLP-I exerts insulin-like effects on D-glucose metabolism in both muscle and liver tissue in IDDM or NIDDM animal models, and present observations reinforce the view that GLP-I may represent a most promising tool in the treatment of diabetic patients.

Exendin-4 agonist and exendin(9-39)amide antagonist of the GLP-1(7-36)amide effects in liver and muscle.

The GLP-1 structurally related peptides exendin-4 and exendin(9-39)amide were found to act, in rat liver and skeletal muscle, as agonist and antagonist, respectively, of the GLP-1(7-36)amide effects on glucose metabolism. Thus, like GLP-1(7-36)amide, exendin-4 increased glycogen synthase a activity and glucose incorporation into glycogen in both tissues and also stimulated exogenous D-glucose utilization and oxidation in muscle. These effects of GLP-1(7-36)amide and exendin-4 were inhibited by exendin(9-39)amide. Our findings provide further support to the proposed use of GLP-1, or exendin-4, as a tool in the treatment of diabetes mellitus. Thus, in addition to the well-known insulinotropic action of the peptides, they act both in liver and in muscle in a manner most suitable for restoration of glucose homeostasis, with emphasis on their positive effects upon glycogen synthesis in the two tissues and on the stimulation of exogenous glucose catabolism in muscle.

[Retroperitoneal ganglioneuroma. Report of a case]. / Ganglioneuroma retroperitoneal. A propósito de un caso.

OBJECTIVE: To report an additional case of retroperitoneal ganglioneuroma. METHODS/RESULTS: A case of retroperitoneal ganglioneuroma that had been incidentally discovered in a 27-year-old male during abdominal US evaluation is described. The diagnosis was based on the histopathological findings after US-guided biopsy. The clinical features and the findings of the complementary tests, which included radiological assessment, intravenous urography, CT and cavography are presented, as well as the pathology findings. Treatment was by complete surgical excision of the tumor. CONCLUSION: Treatment of ganglioneuroma is by surgery, since the diagnosis is generally based on the histopathological analysis of the surgical specimen. For those cases with a preoperative diagnosis, some authors advocate surgery for patients with clinical evidence of neuroblastoma or another pathology arising from this disease. Although infrequent, ganglioneuroma coexisting with neuroblastoma can occur. For this reason, complete excision of the tumor is preferred.