Manejo de la Diverticulitis Apendicular: una patología poco común

La diverticulitis apendicular es una enfermedad poco frecuente, con una incidencia aproximada de 1%. Se define por la presencia de divertículos verdaderos o falsos en la pared del apéndice cecal. Durante la fase aguda posee una clínica indistinguible a la apendicitis, sin embargo en ocasiones presenta características clínicas particulares que la distinguen de la apendicitis aguda, tales como la presencia de dolor abdominal insidioso o intermitente y/o ausencia de sintomatología gastrointestinal (náuseas, vómitos o anorexia). En la diverticulitis apendicular las técnicas imagenológicas son de utilidad limitada al otorgar información inespecífica, por lo que el diagnóstico tiende a realizarse mediante el estudio anatomopatológico del apéndice posterior a una intervención quirúrgica en paciente con cuadro clínico compatible con apendicitis aguda. El tratamiento de elección corresponde a la apendicectomía, lo que permite evitar complicaciones futuras como por ejemplo perforación apendicular, neoplasias, entre otros. Se obtuvieron los datos de fuentes como Pubmed y Scielo. Específicamente la búsqueda de artículos originales y de revisiones sistemáticas, preferentemente menores a 15 años de publicación en revistas científicas de alto índice de impacto, con las palabras "diverticulitis apendicular", "diverticulosis" y "complicaciones diverticulares".

Appendiceal diverticulitis is a rare disease with an incidence of approximately 1%. It is defined by the presence of true or false diverticula in the wall of the cecal appendix. During the acute phase, it has symptoms that are indistinguishable from appendicitis, however, it sometimes presents particular clinical characteristics that distinguish it from acute appendicitis, such as the presence of insidious or intermittent abdominal pain and/or the absence of gastrointestinal symptoms (nausea, vomiting, or anorexia). In appendiceal diverticulitis, imaging techniques are of limited utility as they provide non-specific information, so the diagnosis tends to be made through the pathology study of the treatment after surgery in a patient with a clinical picture compatible with acute appendicitis. The treatment of choice corresponds to appendectomy, which allows avoiding future complications such as appendiceal perforation, neoplasms, among others. Data were obtained from sources such as Pubmed and Scielo, specifically searching for original articles and systematic reviews with the words "apendicular diverticulitis", "diverticulosis" and "diverticular complications". The criteria used were articles mainly under 5 years of publication in high-impact scientific journals.

Tratamientos de primera línea para pacientes estadio IV con adenocarcinoma pulmonar de mutación EGFR / First-line treatments for stage IV patients with EGFR-mutated lung adenocarcinoma

Lung cancer is one of the leading causes of death in the world. Current treatments act directly on the signal transduction pathways in cancer cells, mainly. One of the main pathways is associated with the Epidermal Growth Factor (EGFR), whose mutations leads to uncontrolled cell proliferation and a higher rate of cell invasion. Activating mutations in the EGFR gene, which includes deletions in exon 19 and the L858R mutation in exon 21, were detected in most patients with non-small cell lung cancer (NSCLC). Studies of EGFR tyrosine kinase inhibitors (EGFR-TKIs) such as Gefitinib, Erlotinib and Afatinib, compared with platinum-based treatments, showed that EGFR-TKIs produce increased disease-free survival, although only in patients whose cancers harbor activating mutations in the EGFR gene. Clinical trials also demonstrated that EGFR-TKIs are effective as first-line therapies in stage IV pulmonary adenocarcinoma. Here, the main aspects of the activation of the EGFR pathway in NSCLC will be reviewed, highlighting the importance for health professionals of correctly identifying activating mutations in the EGFR gene and acting quickly at the molecular level based on aforementioned treatments. (AU)

Meloxicam associado ou não ao tramadol no controle da dor após ovário-histerectomia videoassistida em cadelas / Meloxican with or without tramadol for control of pain undergoing laparoscopic-assisted ovariohysterectomy in bitches

O objetivo deste estudo foi avaliar a eficácia do meloxicam associado ou não ao tramadol, no controle da dor após ovário-histerectomia (OVH) laparoscópica com dois portais. Foram selecionadas 14 cadelas hígidas. Os animais foram separados de forma aleatória, em dois grupos. O grupo M (GM) recebeu meloxicam (0,2mg kg-1, s.i.d.), enquanto os animais do grupo MT (GMT) receberam a associação de meloxicam (0,2mg kg-1, s.i.d.) e tramadol (4mg kg-1, t.i.d.), ambos durante dois dias de pós-operatório. Para avaliação da dor pós-cirúrgica, foram utilizadas as escalas de Melbourne e escala visual analógica (EVA), além de mensurações de glicemia e cortisol sérico. Não houve diferença ao se avaliarem os grupos GM e GMT pela escala de Melbourne nem pela EVA. As mensurações de cortisol não atingiram valores superiores aos de referência para a espécie, enquanto os valores de glicemia não apresentaram variação significativa ao longo do tempo de avaliação nem entre grupos. Com os resultados deste estudo, foi possível concluir que a utilização de meloxicam associado ou não ao tramadol, nas doses e posologias propostas, é eficaz para controlar a dor pós-operatória de cadelas submetidas à OVH laparoscópica com dois portais.

The aim of this study was to evaluate the efficacy of meloxicam with or without tramadol for pain control after laparoscopic-assisted ovariohysterectomy (OVH) by two-portal access. Were selected 14 healthy dogs to perform video-assisted OVHs. The animals were divided randomly into two groups (GM and GMT). The GM group received meloxicam (0.2mg kg-1, s.i.d), whereas the GMT group received the combination of meloxicam (0.2mg kg-1, s.i.d) and tramadol (4mg kg-1, tid), both for two days after surgery. To evaluate the post-surgical pain Melbourne and EVA scales were used, and blood glucose and serum cortisol were measured. There was no statistical difference when evaluating GM and GMT groups and the Melbourne scale or the visual analogue scale VAS. Cortisol measurements did not reach values higher than the reference for the species, while blood glucose levels did not present significant statistical variation throughout the evaluation time or between groups. With these results, we concluded that the use of meloxicam with or without the tramadol at the doses and dosage schedules proposed, is effective to control postoperative pain in bitches that had undergone video-assisted OVH with two-portal access.

Cistopexia videoassistida em cadela com cistocele após prolapso uterino: relato de caso / Videoassisted cystopexy on a female dog with cystocele after uterine prolapse: a case report

O prolapso de vesícula urinária associado ao prolapso uterino é condição rara em cães e gatos. O tratamento preconizado para essa afecção é o reposicionamento anatômico das estruturas afetadas. No presente relato é descrito o manejo por meio de ovariossalpingo-histerectomia por celiotomia e, após dois dias, cistopexia videoassistida. Essa condição, conforme o conhecimento dos autores, não havia sido previamente descrita. A operação apresentou-se como possibilidade viável de tratamento, sem complicações pós-operatórias.(AU)

The urinary bladder prolapse associated with the uterus is a rare condition on dogs and cats. The recommended treatment is the anatomical repositioning of the affected structures by manual reduction or surgery procedure. The present report describes the management by video-assisted cystopexy two days after conventional ovariohysterectomy. This condition, according to the authors' knowledge, had not been previously described. The operation didn't showed postoperative complications, and presented itself as a viable treatment option.(AU)

Ressecção de cisto e abscesso renais por laparoscopia em um cão / Resection of renal cyst and abscess by laparoscopy in a dog

Cistos renais podem formar-se em qualquer parte do néfron e dos ductos coletores. Alguns são hereditários, originando-se durante a organogênese, e outros se desenvolvem no tecido renal normal, depois que os rins estão completamente formados. No presente relato, descreve-se a ressecção de cisto e abscesso renais, por cirurgia laparoscópica em um cão. Para o acesso, foram utilizados três portais, dois de 10mm de diâmetro e um de 5mm, dispostos na parede abdominal lateral direita e, num segundo momento, na parede abdominal lateral esquerda. Conclui-se, portanto, que a técnica laparoscópica com três portais permite a realização de ressecção de cisto e abscesso renais em cães, sem a ocorrência de recidivas em curto prazo.

Renal cysts can be formed anywhere in the nephron and collecting duct system. Some are hereditary, originated during organogenesis, and others could have origin in the normal kidney tissue, after the kidney's development. This report describes the resection of renal cysts and abscesses by laparoscopic surgery in a dog. In order to access the cavity, three portals were used; two with 10mm and another with 5mm diameter, in the right lateral abdominal wall, and in another moment, in the left lateral abdominal wall. It is concluded that the laparoscopic technique with three portals allows the resection of renal cysts and abscesses in dogs, without the occurrence of relapses in the short postoperative time.

Computation of the electronic flux density in the Born-Oppenheimer approximation.

A molecule in the electronic ground state described in the Born­Oppenheimer approximation (BOA) by the wave function ΨBO = Φ0χ0 (where Φ0 is the time-independent electronic energy eigenfunction and χ0 is a time-dependent nuclear wave packet) exhibits a nonzero nuclear flux density, whereas it always displays zero electronic flux density (EFD), because the electrons are in a stationary state. A hierarchical approach to the computation of the EFD within the context of the BOA, which utilizes only standard techniques of quantum chemistry (to obtain Φ0) and quantum dynamics (to describe the evolution of χ0 on the ground-state potential energy surface), provides a resolution of this puzzling, nonintuitive result. The procedure is applied to H2(+) oriented parallel with the z-axis and vibrating in the ground state (2)Σg(+). First, Φ0 and χ0 are combined by the coupled-channels technique to give the normally dominant z-component of the EFD. Imposition of the constraints of electronic continuity, cylindrical symmetry of Φ0 and two boundary conditions on the EFD through a scaling procedure yields an improved z-component, which is then used to compute the complementary orthogonal ρ-component. The resulting EFD agrees with its highly accurate counterpart furnished by a non-BOA treatment of the system.

Diferentes vias de administração da solução de fosfato monobásico e dibásico de sódio no preparo do cólon para colonoscopia rígida em cães / Different routes in administration of sodium phosphate monobasic and dibasic solution in bowel preparation for rigid colonoscopy in dogs

Foram comparadas duas vias de administração, oral e retal, com a solução de fosfato monobásico e dibásico de sódio (NaP), juntamente com bisacodil via oral, no preparo do cólon para colonoscopia rígida em cães, para avaliar parâmetros clínicos, qualidade do preparo e variações dos eletrólitos fósforo, cálcio, potássio (K+) sódio (Na+) e magnésio (Mg+), além da creatinina, albumina e hemograma. Todos os eletrólitos apresentaram alterações, sendo significativa a queda nos níveis de K+ e Mg+. Não houve alterações eletrocardiográficas, e a redução da microbiota bacteriana foi confirmada nos dois grupos de administração da solução. Os resultados foram similares quanto à incidência de efeitos colaterais, porém a via retal apresentou facilidade na administração, menor retenção fecal no cólon, maior rapidez para realização da colonoscopia, com menor desperdício de tempo na lavagem e na aspiração do conteúdo fecal. O preparo intestinal com bisacodil oral e solução de NaP por via retal foi mais eficaz, podendo ser recomendado em cães que serão submetidos à colonoscopia.

The efficacy of oral and rectal administration of sodium phosphate monobasic and dibasic solution (NaP) combined with bisacodil per oral, as drugs to prepare the colon for rigid colonoscopy in dogs was compa1ed. Clinical parameters; colonic cleaning, plasma concentration of calcium, potassium (K+), sodium (Na+), magnesium (Mg+), creatinine, and albumin, and complete blood count were evaluated. In both groups, all electrolytes presented alterations, with significant reduction of the levels of K+ and Mg+, but there were no electrocardiographic alterations. No difference in the reduction of bacterial population was observed between the two groups. The results were similar regarding the incidence of side effects; however, the rectal route presented less fecal retention in colon and could get patients ready for the procedure faster. The preparation of bowel with bisacodil and NaP solution by rectal route was more effective and could be recommended for colonoscopy in dogs.

Ceratoplastia com enxerto pediculado de conjuntiva fixado com adesivo de cianoacrilato em cães

O artigo não apresenta resumo.

Ceratoplastia com enxerto autógeno lamelar livre de córnea fixado com adesivo de cianoacrilato em cães

O artigo não apresenta resumo.

Reparação da traqueia cervical de cão com o músculo esterno-hioideo

O artigo não apresenta resumo.

Insuficiencia del tibial posterior y pie plano adquirido del adulto: revisión bibliográfica / Posterior tibial tendon deficiency and aquired flat foot of the adult

El autor ha hecho una revisión bibliográfica de la insuficiencia del tendón del músculo tibial posterior, una causa importante de pie plano adquirido en el adulto. Se resume la anatomía normal y patológica y la irrigación del tendón, así como la etiopatogenia de su insuficiencia, aceptando la clasificación de Johnson y Myerson. Se practica un análisis de los hallazgos que se encuentran en la anamnesis, exámen físico y estudio radiológico de estos enfermos. Se discuten los tratamientos ortopédicos y quirúrgicos preconizados por los diversos autores. En el tratamiento quirúrgico se señalan los procedimientos sobre las partes blandas, las osteotomías y las artrodesis, con sus respectivas indicaciones

Activation of cyclic AMP-dependent kinase is required but may not be sufficient to mimic cyclic AMP-dependent DNA synthesis and thyroglobulin expression in dog thyroid cells.

Thyrotropin (TSH), via a cyclic AMP (cAMP)-dependent pathway, induces cytoplasmic retractions, proliferation, and differentiation expression in dog thyroid cells. The role of cAMP-dependent protein kinase (PKA) in the induction of these events was assessed by microinjection into living cells. Microinjection of the heat-stable inhibitor of PKA (PKI) inhibited the effects of TSH, demonstrating that activation of PKA was required in this process. Overexpression of the catalytic (C) subunit of PKA brought about by microinjection of the expression plasmid pC alpha ev or of purified C subunit itself was sufficient to mimic the cAMP-dependent cytoplasmic changes and thyroperoxidase mRNA expression but not to induce DNA synthesis and thyroglobulin (Tg) expression. The cAMP-dependent morphological effect was not observed when C subunit was coinjected with the regulatory subunit (RI or RII subunit) of PKA. To mimic the cAMP-induced PKA dissociation into free C and R subunits, the C subunit was coinjected with the regulation-deficient truncated RI subunit (RIdelta1-95) or with wild-type RI or native RII subunits, followed by incubation with TSH at a concentration too low to stimulate the cAMP-dependent events by itself. Although the cAMP-dependent morphology changes were still observed, neither DNA synthesis nor Tg expression was stimulated in these cells. Taken together, these data suggest that in addition to PKA activation, another cAMP-dependent mechanism could exist and play an important role in the transduction of the cAMP signal in thyroid cells.

Calbindin localization in African giant rat kidney (Cricetomys gambianus).

Cricetomys gambianus are rodents living in savanna and follow area. They can live with restricted drinking water eating fresh food. Therefore their kidney may have some adaptive mechanisms for ion/water homeostasis compared to usual laboratory rats. In this study we have looked for calbindin, an intracellular calcium binding protein previously found in distal convoluted tubules from all mammalian species that have been studied and able to increase, in vitro, Ca2+ reabsorption. We have shown by using in situ hybridization, immunoblotting and immunohistochemistry that calbindin was expressed in three different portions of the distal nephron of the African giant rat. Calbindin was found in distal convoluted tubules, in cortical collecting tubules and in outer medullary collecting ducts. By contrast, in laboratory rat, calbindin was only found in distal convoluted tubules and undetectable in medullary collecting ducts. Thick ascending limb of Henle's loop were calbindin negative as shown by double immunolabelling using anti-uromucoid (Tamm-Horsfall protein). As previously shown in laboratory rat and rabbit, transcellular Ca2+ movement seems to be facilitated by calbindin in renal tubules segments predominantly actively transporting Ca2+, it may be suggested that in African giant rat, outer medullary collecting ducts may also actively transport Ca2+. As calretinin, another intracellular calcium binding protein highly homologous to calbindin but whose function is still conjectural has been suspected to be expressed in kidney, we have looked and not found any calretinin in both adult rat species.

Parvalbumin expression during developmental differentiation of the rat ovary.

Parvalbumin (PV) is a high-affinity Ca(2+)-binding protein which is expressed in a limited number of vertebrates tissues and restricted to a few distinct cell types. It has been shown by biochemical methods to be present in the adult rat ovary, but cellular localizations or developmental appearance have not been described until now. This study describes the presence of PV and its transcripts, analyzed by immunohistochemistry and in situ hybridization, respectively, during the postnatal development of the rat ovary: 13 developmental stages between day 1 and day 83 were examined. In ovaries 1-16 days old, neither PV mRNA nor PV was observed in any caaaaaaaaaaaaaay. By contrast, starting from day 18 postpartum, both PV mRNA and PV were detected in low amounts, simultaneously with the onset of differentiation of secondary intestitial gland cells in the ovarian interfollicular stroma. PV and its transcripts were primarily detected in conspicuous patches of interstitial gland tissue and in the differentiated thecal cells around the large follicles, and PV appeared to be fully expressed 33 days after birth. The parallel time courses of PV mRNA and PV accumulation during developmental differentiation, and the appearance of a steroid-producing cellular phenotype as well as the strict cellular colocalization of these two features, strongly suggest involvement of PV in the steroid metabolism of these cells, as earlier proposed for the Leydig cells of the testis. According to this hypothesis, we also show that suppression of gonadotrophic hormone production by hypophysectomy of adult rats totally suppresses PV production in parallel with the disappearance of the morphological features typical of steroid-producing cells in the remaining interstitial tissue of the ovary.

Expression of thyrotropin receptor (TSH-R), thyroglobulin, thyroperoxidase, and calcitonin messenger ribonucleic acids in thyroid carcinomas: evidence of TSH-R gene transcript in medullary histotype.

We studied the expression of the TSH receptor (TSH-R), thyroglobulin (Tg), thyroperoxidase (TPO), and calcitonin (CT) genes in a total of 53 tissues from 30 patients with thyroid carcinoma and from 9 patients with benign thyroid diseases. By Northern blot analysis of total RNA preparations, CT mRNA was expressed in all cases (n = 6) of medullary thyroid carcinoma (MTC). Surprisingly, 3 of them expressed the TSH-R mRNA, in association with the Tg and TPO mRNAs in 1. The presence of the TSH-R transcript in the neoplastic C-cells was confirmed in 1 MTC by in situ hybridization using a mixture of 3 oligonucleotide probes derived from dog TSH-R cDNA. With various degrees of expression, all differentiated thyroid carcinomas (20 papillary and 2 follicular) expressed TSH-R, Tg, and TPO, but not CT mRNAs. On the contrary, samples from 2 patients with anaplastic carcinoma did not express TSH-R, Tg, or TPO mRNA, but 1 of them expressed CT mRNA. All of the transcripts obtained from thyroid carcinomas (both primary and metastatic) were of the same size as the transcripts from normal or benign thyroid tissues, with the exception of 2 cases of differentiated thyroid cancer, in which TSH-R mRNA of lower mol wt (approximately 4.0 kilobases) was found in the absence of alteration in cDNA size and restriction map. The main conclusions of our study are that 1) the TSH-R gene is expressed in some MTC, which supports, at molecular level, the hypothesis of the existence of mixed follicular-medullary thyroid tumors; and 2) the expression of TSH-R, Tg, and TPO in undifferentiated thyroid cancer is lost.

Thyroperoxidase mRNA in quiescent and proliferating thyroid epithelial cells: expression and subcellular localization studied by in situ hybridization.

Using in situ hybridization procedure, we have investigated the regulation and the cellular localization of thyroperoxidase (TPO) messenger RNA accumulation as a marker of differentiation in dog thyroid epithelial cells in primary culture. The response to different mitogens (TSH acting through cAMP, EGF and TPA) has been compared. TPO mRNA accumulation was exquisitely dependent on a continuous TSH/cAMP stimulation. It was induced within 1 h in the whole cell population from a very low basal level. This effect was inhibited by the cAMP-independent mitogens EGF and TPA. By contrast, the TSH-induction of TPO mRNA accumulation was observed irrespectively of the proliferative activity of the cells, i.e. in the presence or the absence of insulin, which is required for mitogenesis. The short half-life of TPO mRNA (+/- 2 h) implies that it was continuously transcribed during TSH/cAMP-dependent cell cycling. As compared to another thyroid differentiation marker, thyroglobulin mRNA (Pohl et al., J. Cell Biol. 111, 663-672 (1990)), TPO mRNA accumulation differed by the rapidity of its control by cAMP, the pattern of its intercellular heterogeneity, and the unexpected segregation to a perinuclear region, probably the nuclear envelope that constitutes a specialized part of the endoplasmic reticulum. Despite these differences, both TPO and thyroglobulin gene transcriptions are unequivocally compatible with the cell cycle when induced by cAMP, at variance with the generally observed antagonism between growth and differentiation expression.

Calretinin in rat ovary: an in situ hybridization and immunohistochemical study.

Calretinin is a cytosolic calcium-binding protein of the calmodulin superfamily, with high homology with calbindin D28k. The only cells in which calretinin has been described so far are neurons, in the central nervous system and in retina. In the present work, we describe the expression of the calretinin gene in the interstitial cells of rat ovary. Immunohistochemistry, using a calretinin-specific antibody, allowed to detect the protein from 19 days after birth. Western blot from ovary homogenates confirmed the labelling of a 29 kDa band, the size of calretinin. In situ hybridization confirmed immunochemical data; calretinin transcripts were clearly shown in the same cell population. This represents the first description of calretinin outside the nervous system. Its function in ovary remains to be determined.

Differential regulation of thyrotropin receptor and thyroglobulin mRNA accumulation at the cellular level: an in situ hybridization study.

Regulation of TSH receptor (TSHr) mRNA accumulation has been investigated in canine thyrocytes in primary culture by in situ hybridization experiments; the effects of the mitogenic thyrotropin (TSH), epidermal growth factor (EGF), and phorbol ester TPA (12-O-tetradecanoylphorbol-13-acetate) have been compared. Apart from their mitogenic action, TSH enhances, while EGF and phorbol ester inhibit, the expression of differentiation. The TSHr gene was transcribed in almost all the cells cultured in control conditions (serum free medium supplemented with insulin). Addition of TSH slightly upregulated (twofold) the expression (mRNA) of the TSHr gene. This positive effect was maintained for 20 and 44 h of treatment. EGF and TPA reduced transiently the TSHr mRNA accumulation but did not suppress it. In these different conditions, the TSHr mRNA was homogeneously distributed within the cell population. This contrasted strongly with the effects of TSH, EGF, and TPA on the expression of the thyroglobulin gene, a prominent marker of thyroid cell differentiation: in this case, the regulation was much tighter (high range of stimulation by TSH, strong inhibition by EGF, and suppression of Tg gene expression by TPA) and displayed a great variability of the level of individual cellular response. The fact that the TSHr gene was little modulated and remained expressed regardless of the treatment may reflect the physiological role of the receptor which is the main connection of the thyrocyte to the regulation network.