Membrana de oxigenación extracorpórea venovenosa como puente a la reparación de una fístula bronquial traumática / Venovenous extracorporeal membrane oxygenation as a bridge to traumatic bronchial fistula closure

Las lesiones traqueobronquiales traumáticas ocurren en el 1% de los pacientes con traumatismo torácico, y la mayoría de ellos fallecen en el lugar del trauma. En este caso clínico presentamos a una paciente de 26 años de edad, ingresada en UCI debido a un traumatismo torácico cerrado causando hipoxemia y acidosis grave, decidiéndose implantar la membrana de oxigenación extracorpórea percutánea venovenosa. El uso de membrana de oxigenación extracorpórea percutánea venovenosa, iniciado con un objetivo de anticoagulación más bajo, permitió el diagnóstico y tratamiento de una fístula broncopleural en condiciones de estabilidad respiratoria y hemodinámica sin complicaciones hemorrágicas, obteniendo una asistencia rápida y adecuada para la supervivencia de la paciente

Traumatic tracheobronchial injuries occur in 1% of patients with thoracic trauma, most of them dying at the site of the trauma. In this case report, we present a 26-year-old female patient admitted to the ICU due to a blunt chest trauma causing life threatening hypoxaemia and acidosis; deciding to implant percutaneous venovenous extracorporeal membrane oxygenation. The use of percutaneous venovenous extracorporeal membrane oxygenation, implemented with a lower anticoagulation target, allowed the diagnosis and treatment of a bronchopleural fistula under conditions of respiratory and hemodynamic stability without haemorrhagic complications, obtaining a fast and adequate assistance achieving the survival of the patient

Venovenous extracorporeal membrane oxygenation as a bridge to traumatic bronchial fistula closure. / Membrana de oxigenación extracorpórea venovenosa como puente a la reparación de una fístula bronquial traumática.

Traumatic tracheobronchial injuries occur in 1% of patients with thoracic trauma, most of them dying at the site of the trauma. In this case report, we present a 26-year-old female patient admitted to the ICU due to a blunt chest trauma causing life threatening hypoxaemia and acidosis; deciding to implant percutaneous venovenous extracorporeal membrane oxygenation. The use of percutaneous venovenous extracorporeal membrane oxygenation, implemented with a lower anticoagulation target, allowed the diagnosis and treatment of a bronchopleural fistula under conditions of respiratory and hemodynamic stability without haemorrhagic complications, obtaining a fast and adequate assistance achieving the survival of the patient.

Balance hídrico y carga de cloro en las primeras 24h de ingreso en UCI y su relación con las terapias de reemplazo renal mediante un estudio multicéntrico, retrospectivo, de casos y controles emparejados por APACHE-II / Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II

Objetivo. Analizar la asociación entre el balance hídrico durante las primeras 24h de ingreso en UCI y las variables relacionadas con los valores de cloro (carga de cloro, tipo de fluido administrado, hipercloremia), con el empleo de técnicas de reemplazo renal secundarias a insuficiencia renal aguda (IRA-TRR) durante el posterior ingreso en UCI de los enfermos. Pacientes y métodos. Estudio multicéntrico de casos y controles, de base hospitalaria y ámbito nacional, llevado a cabo en 6 UCI. Los casos fueron pacientes mayores de 18 años que desarrollaron una IRA-TRR. Los controles fueron pacientes mayores de 18 años, ingresados en el mismo periodo y centro que los casos, que no desarrollaron IRA-TRR durante su ingreso en UCI. Se realizó emparejamiento por APACHE-II. Se llevó a cabo un análisis de regresión logística no condicional ajustada por edad, sexo, APACHE-II. Las variables de interés principales fueron: balance hídrico, carga de cloro administrada, e IRA-TRR. Resultados. Se han analizado las variables de 310 enfermos. Se evidenció un aumento del 10% en la posibilidad de desarrollar IRA-TRR por cada 500ml de balance hídrico positivo (OR: 1,09 [IC 95%:1,05-1,14]; p<0,001). El estudio de los valores medios de carga administrada no evidenció diferencias entre el grupo de casos y de controles (299,35±254,91 frente a 301,67±234,63; p=0,92). Conclusiones. El balance hídrico en las primeras 24h de ingreso en UCI se relaciona con el desarrollo de IRA-TRR, independientemente de la cloremia (AU)

Objective. To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients’ admission to ICU. Patients and methods. Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). Results. We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92). Conclusions. The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia (AU)

Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case-control study paired by APACHE-II. / Balance hídrico y carga de cloro en las primeras 24h de ingreso en UCI y su relación con las terapias de reemplazo renal mediante un estudio multicéntrico, retrospectivo, de casos y controles emparejados por APACHE-II.

OBJECTIVE: To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients' admission to ICU. PATIENTS AND METHODS: Multicentre case-control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). RESULTS: We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500ml of positive water balance was evident (OR: 1.09 [95% CI: 1.05 to 1.14]; P<.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; P=.92). CONCLUSIONS: The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia.

Encystment/excystment response and serotypic variation in the gastropod parasite Tetrahymena rostrata (Ciliophora, Tetrahymenidae).

Tetrahymena rostrata, which is characterized by a particular encystment-excystment cycle involving autogamy, has been recently found infecting the kidney of edible Helix aspersa snails under farming conditions. In this work, the effects of several factors on its encystment/excystment behaviour and the occurrence of different serotypes were investigated. The encystment/excystment response under starvation conditions was seriously affected by temperature. While a peak of encystment at 48 h followed by a progressive spontaneous excystment was observed at 18 and 25 °C, the encystment response was practically inhibited at 5 °C and clearly slowed down at 10 °C. At 30 °C, most of surviving ciliates remained encysted throughout the experiment, with spontaneous excystment being detected only after switching the temperature to 18 °C. Soil components also affected the encystment/excystment behaviour at 18 °C, with spontaneous excystment occurring in the presence of a sterile-filtered soil extract or mineral water but being strongly minimized with a non-filtered soil extract. Resting cysts formed in the latter extract exhibited a 3­4 times thicker and ultrastructurally more complex wall than that formed in mineral water and retained the excystment ability for about 4 weeks. Incomplete desiccation did not affect significantly the encystment response, while the mucus and kidney extracts from snails as well as a ciliate extract strongly stimulated a rapid excystment. Finally, two different serotypes infecting H. aspersa in heliciculture farms of Galicia (NW Spain) were identified, but no differences were observed between the encystment/excystment responses exhibited by two isolates belonging to each serotype.

Parasitic infections in mixed system-based heliciculture farms: dynamics and key epidemiological factors.

Heliciculture is an excellent alternative to obtain edible snails but its viability is seriously threatened by pathogens. A parasitological survey was conducted in 3 mixed system-based heliciculture farms in Galicia (NW Spain), with the species Tetrahymena rostrata, Tetrahymena limacis, Tetratrichomonas limacis, Cryptobia helicogenae, Brachylaima aspersae (metacercariae and sporocysts), Alloionema appendiculatum, Nemhelix bakeri, and Riccardoella limacum being commonly found infecting Helix aspersa aspersa (petit-gris) snails. With the exception of C. helicogenae, N. bakeri, and B. aspersae sporocysts, all species were also detected in Helix aspersa maxima (gros-gris) snails, although generally with lower parameters. Most monoxenous infections, and consequently multiple parasitism, exhibited a rising trend during the first 2 months of intensive mating, with tendencies being slowed down or even reversed during the third month as a result of accumulated mortality and a sampling-derived reduction in host density. No parasites were vertically transmitted and infections were initially acquired from invading gastropod and micromammal reservoirs during fattening. Finally, artificial hibernation reduced significantly the prevalence of most species. These results confirm the importance of parasites in heliciculture and emphasize the need to prevent the entry of wild reservoirs into the farms and to rapidly remove the carcasses of dead snails from the reproduction units and fattening pens.

Brachylaima aspersae n. sp. (Digenea: Brachylaimidae) infecting farmed snails in NW Spain: morphology, life cycle, pathology, and implications for heliciculture.

The life cycle of Brachylaima aspersae n. sp. (Trematoda: Brachylaimidae) in heliciculture farms is elucidated in light of field and experimental studies. Embryonated asymmetrical eggs (33.3 µm × 20.2 µm) are passed in the faeces of the definitive host, the domestic mouse (Mus musculus), and are ingested by its unique first intermediate host, the helicid snail Helix aspersa aspersa. After hatching, the miracidium develops into a highly branched sporocyst in the connective tissues of the digestive gland. Microcaudate cercariae emerging from this gastropod migrate up the ureter of the second intermediate host, the snails H. a. aspersa and H. a. maxima, and develop into non-encysted metacercariae in the kidney. Following predation of infected snails, the metacercariae develop into adults preferentially in the proximal portion of the duodenum of the definitive host. The strict oioxenic character for the first intermediate host, as well as the cercarial chaetotaxy (3 C(I)V+1 C(I)D, 10 C(II), 5 C(III)V, 14 C(III)L, 2 C(III)D, 16 H, 6 S(I), 6 S(II), 6 S(III), 2 A(I)L+1 A(I)V, 1 A(II)L, 3 ML, 1 P(I)L and 3 P(III)L), the distinct pars prostatica, the variable appearance of testes (rounded to irregular, with smooth or slightly to moderately lobulated margins), the size of eggs, the position of acetabulum (located somewhat posterior to the anterior third of body), and the microhabitat of the adult in the final host allow differentiation of B. aspersae from other well-known species in the genus. Massive infections with sporocysts or metacercariae of this brachylaimid may induce extensive pathological changes in the organs affected. Our results confirm that control of rodents in heliciculture farms is essential to minimize the potential health risks and morbimortality associated with this newly described species.

Coccomyxa sp. (chlorophyta: chlorococcales), a new pathogen in mussels (Mytilus galloprovincialis) of Vigo estuary (Galicia, NW Spain).

In this work, we describe the occurrence of irregular shaped green aggregations in the mantle, gill filaments, adductor muscle, visceral mass and haemolymph of wild mussels (Mytilus galloprovincialis) collected from the Vigo estuary (Galicia, NW Spain). Microscopic examination of these masses revealed that they consist of intracellular green algae which are spherical to oval in shape, 5 microm in length and 3 microm in width, without flagella and with a smooth surface. The algal cells present a small single nucleus, a mitochondrion, 1-2 parietal chloroplasts and lack pyrenoids. Reproduction is by formation of 2-4 autospores or daughter cells. Pigment analysis reveals the presence of photopigments typical of green algae in addition to alloxanthin, diadinoxanthin and diatoxanthin. These carotenoids are noted for the first time in a parasitic chlorophyte. The signs of infection, together with the morphological observations, suggest that this parasitic algae may be Coccomyxa parasitica. However, further molecular studies are required for confirmation. This is the first report of Coccomyxa algae parasitizing the species M. galloprovincialis.

Morphological and molecular characterization of renal ciliates infecting farmed snails in Spain.

Renal infections by parasitic ciliates were studied in adult snails of Helix aspersa aspersa and Helix aspersa maxima collected from 2 mixed rearing system-based heliciculture farms located in Galicia (NW Spain). The occurrence of ciliates was also examined in slugs (Deroceras reticulatum) invading the greenhouses where first growing and fattening of snails is carried out. Histological examinations revealed a severe destruction of the renal epithelium in heavily infected hosts. Three ciliate isolates, one from each host species, were obtained and grown in axenic cultures. Cultured and parasitic ciliates were characterized morphologically and morphometrically. In addition, the encystment behaviour, the occurrence of autogamy, and the sequences of the mitochondrial cytochrome-c oxidase subunit 1 (cox1) and the small subunit ribosomal RNA (SSU rRNA) genes were also studied in the 3 isolates. A polymorphic life cycle involving resting and reproductive cysts, together with the morphological and morphometrical characteristics and the confirmation that autogamy occurs within cysts, demonstrate that our ciliates belong to the species Tetrahymena rostrata (Kahl, 1926) Corliss, 1952. The 3 isolates formed a well-supported clade using both genetic markers, and were clearly separate from the strain ATCC(R) 30770, which has been identified as Tetrahymena rostrata. We argue that our Spanish isolates should be regarded as Tetrahymena rostrata, and that the ATCC isolate should be regarded as a misidentification as neither cytological nor cytogenetical support for its identity has been presented.

Virus-like particles in Urastoma cyprinae, a turbellarian parasite of Mytilus galloprovincialis.

Urastoma cyprinae is a turbellarian parasite infecting the gills of several marine bivalves. We observed the presence of virus-like particles (24 to 30 nm in diameter; icosahedral symmetry) arranged in paracrystalline arrays in the cytoplasm of subepidermal dorsal cells. These particles appear to be RNA viruses, possibly related to the Picornaviridae. This is the first report of viral particles in the parasite U. cyprinae.

Eimeria species from the European pond turtle, Emys orbicularis (Reptilia: Testudines), in Galicia (NW Spain), with description of two new species.

Parasitological examination of feces from 44 Emys orbicularis from Galicia (NW Spain) revealed the presence of 2 new eimerian species, Eimeria gallaeciaensis sp. n. and E. emydis sp. n., as well as E. mitraria (Laveran and Mesnil, 1902) Doflein, 1909. Oocysts of E. gallaeciaensis n. sp. were found in 20 of 44 (45.4%) turtles and are subspherical to lightly ovoid-ellipsoid, 19.3 x 16.0 (17-22 x 15-18) microm, shape index 1.2 (1.1-1.3), with a smooth, single-layered wall. Micropyle and polar granule are absent, but an oocyst residuum is present. Sporocysts are ellipsoid, 9.7 x 5.1 (9-10 x 5-6) microm, shape index 1.9 (1.7-2.0), each with a sporocyst residuum and a conical Stieda body usually bearing 1-4 short and thin projections. Oocysts of E. emydis n. sp. were found in the feces of 5 of 44 (11.4%) turtles and are ovoid, rarely pear-shaped, 22.6 x 17.0 (20-25 x 15.5-18) microm, shape index 1.3 (1.2-1.5), with a smooth, single-layered wall with a slight thinning at the pointed end. Micropyle and polar granule are absent, and an oocyst residuum is present. Sporocysts are ellipsoid, 11.4 x 6.0 (9-13 x 5-7) microm, shape index 1.9 (1.6-2.2), each with sporocyst residuum and a prominent Stieda body bearing 3-5 club-shaped projections. In addition to the new species described, this is the first report of E. mitraria parasitizing E. orbicularis.

Ultrastructure of the organum vasculosum laminae terminalis in the advanced teleost Chelon labrosus (Risso, 1826).

The advanced teleost Chelon labrosus shows a well-developed organum vasculosum laminae terminalis (OVLT). Together, the vascular organization and ultrastructure have many similarities with those found in mammals, though it is somewhat simpler. To date, the dense network of fenestrated capillaries in the nervous parenchyma of the OVLT observed in Chelon labrous has not been reported in other fishes, and resembles the porta system of mammals. However, the OVLT does not present intraventricular neuronal processes, as occurs in the corresponding organ of most vertebrates. Moreover, between the numerous neurons and the neuropil that surround these capillaries, terminal buttons with clear and dense-core vesicles can be appreciated. Most striking is the contact of neurons and even terminal buttons with the basal lamina of the external limiting membrane without interpose glial prolongations that separate the nervous parenchyma from the perivascular space; this represents windows in the blood brain barrier. The above characteristics and the absence of cilaited or chemorecptors structures suggest that neurohemal function of the OVLT, possibly under the control of neurotransmiters secreted by the terminal buttons dispersed throughout the whole organ.

A comparative study of the transganglionic transport of cholera toxin-horseradish peroxidase (CT-HRP) and wheat germ agglutinin-horseradish peroxidase (WGA-HRP) in the trigeminal system of the guinea pig.

A comparative study of cholera toxin (CT) and wheat germ agglutinin (WGA) conjugated with horseradish peroxidase (HRP) was made on trigeminal central projections of the lower incisor gingiva afferent neurons in the guinea pig. Considerably more CT-HRP-labeled endings were observed in the trigeminal sensory nuclear complex (TSNC) and in the cervical spinal cord (C1-C8). The substantia gelatinosa (lamina II) of both the caudal nucleus of the TSNC and C1-C2 was the only area where WGA-HRP labeled more terminals. CT-HRP-labeled fibers and endings were traced up to C7-C8, whereas with WGA-HRP were rare caudal to C5. A comparison of the two methods currently in use, i.e. the 2-step glutaraldehyde and sodium periodate, showed that the latter yields conjugates which are more sensitive as neuroanatomical tracers.

Ciliated neurons of the nucleus praeopticus magnocellularis and nucleus lateralis tuberis of an advanced teleost, Chelon labrosus (Risso, 1826).

Large groups of cilia are found on certain nucleus praeopticus magnocellularis (NPOM) and nucleus lateralis tuberis (NLT) neurons in the hypothalamus of a higher teleost, Chelon labrosus. They normally appear in an invaginated area of the perikaryon in the proximity of large numbers of synapsis buttons, and often close to unfenestrated capillaries. It is suggested that these ciliosynaptic groups act as osmoreceptors.