Síndrome de Boerhaave secundario a vólvulo gástrico / Boerhaave’s syndrome secondary to gastric volvulus

El síndrome de Boerhaave es una ruptura espontánea del esófago, causada por un aumento de presión intraluminal que se produce en el contexto de una presión negativa intratorácica. Tiene un alto índice de morbimortalidad (14-40%), por lo que precisa un diagnóstico y tratamiento precoces. Debería incluirse en el diagnóstico diferencial del dolor epigástrico en un paciente que ha presentado vómitos. Las hernias de hiato paraesofágicas pueden complicarse con una volvulación gástrica. Esta, a su vez, puede producir necrosis tanto esofágica como gástrica que requiere un manejo quirúrgico precoz. Presentamos el caso de un paciente de 83 años que presentó una volvulación gástrica como complicación de una hernia de hiato, con vómitos asociados que desencadenaron un síndrome de Boerhaave. Se trata del segundo caso publicado en la literatura (AU)

Boerhaave’s syndrome is a spontaneous rupture of the oesophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality (14-40%), which is why it requires early diagnosis and treatment. When a patient presents vomiting, the differential diagnosis should include epigastric pain. Para-esophageal hiatal hernias can be complicated by gastric volvulus. In its turn, this can produce both oesophageal and gastric necrosis requiring early surgical treatment. We describe the case of an 83-year-old patient who presented gastric volvulus with complications from a hiatal hernia with associated vomiting, which triggered Boerhaave’s syndrome. This is the second case published in the literatura (AU)

[Boerhaave's syndrome secondary to gastric volvulus]. / Síndrome de Boerhaave secundario a vólvulo gástrico.

Boerhaave's syndrome is a spontaneous rupture of the oesophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality (14-40%), which is why it requires early diagnosis and treatment. When a patient presents vomiting, the differential diagnosis should include epigastric pain. Para-esophageal hiatal hernias can be complicated by gastric volvulus. In its turn, this can produce both oesophageal and gastric necrosis requiring early surgical treatment. We describe the case of an 83-year-old patient who presented gastric volvulus with complications from a hiatal hernia with associated vomiting, which triggered Boerhaave´s syndrome. This is the second case published in the literature. Key words. Boerhaave´s syndrome. Gastric volvulus. Surgical treatment.

Physician satisfaction with hospital clinical laboratory services in Aden Governorate, Yemen, 2009.

To evaluate the level of physicians' satisfaction with hospital clinical laboratory services and related factors in Aden Governorate, we carried out this cross-sectional study during September 2008-September 2009. Satisfaction with laboratory services of 3 public and 3 private hospitals was assessed. The overall physician satisfaction was 3.30 out of 5.00. The highest mean score (3.40) was observed for phlebotomy services, while the lowest mean score (1.95) was for esoteric test turnaround time. The most important laboratory service category forthe physicians was quality and reliability of the results (54.4%). An association was observed between physician satisfaction and institution type in 11 categories, with lower satisfaction for public compared to private institutions for all services. No statistically significant association was observed between physician satisfaction and experience in the field. Lower satisfaction was observed among those with more than 20 years experience. Our findings may help to improve the quality of clinical laboratory services.

Overweight/obesity and hypertension in schoolchildren aged 6-16 years, Aden Governorate, Yemen, 2009.

Hypertension and obesity in children are increasing concerns worldwide. A cross-sectional study of hypertension in relation to overweight/obesity was conducted in 2009 among schoolchildren aged 6-16 years in Aden, Yemen. Using multistage stratified random sampling 1885 children were classified into wasted, normal weight, overweight and obese according to body mass index. The prevalence of wasting was 10.1%, normal weight 69.2%, overweight 12.7% and obesity 8.0%. The rate of high blood pressure (World Health Organization criteria) was 8.2% for prehypertension and 2.4% for hypertension and was significantly related to the presence of overweight or obesity. Child's body mass index combined with age was a predictor for systolic and diastolic blood pressure. The study provides further evidence that overweight/obesity is associated with hypertension in these schoolchildren.

Overweight/obesity and hypertension in schoolchildren aged 6-16 years, Aden governorate, Yemen, 2009

Hypertension and obesity in children are increasing concerns worldwide. A cross-sectional study of hypertension in relation to overweight/obesity was conducted in 2009 among schoolchildren aged 6-16 years in Aden, Yemen. Using multistage stratified random sampling 1885 children were classified into wasted, normal weight, overweight and obese according to body mass index. The prevalence of wasting was 10.1%, normal weight 69.2%, overweight 12.7% and obesity 8.0%. The rate of high blood pressure [World Health Organization criteria] was 8.2% for prehypertension and 2.4% for hypertension and was significantly related to the presence of overweight or obesity. Child's body mass index combined with age was a predictor for systolic and diastolic blood pressure. The study provides further evidence that overweight/obesity is associated with hypertension in these schoolchildren

Prosthetic valve endocarditis

Prosthetic valve infective endocarditis represents a defined pathological entity which follows an epidemiological and nosological pattern in accordance to an arbitrary classification. Chronologically it is divided into the entities of early and late prosthetic valve endocarditis, each with its own unique characteristics. The clinical features, complications and diagnosis do not vary much from native valve endocarditis. There are clear and precise indications to aid in the diagnosis and treatment of this entity which differ from native valve endocarditis

Bone marrow stromal cell defects and 1 alpha,25-dihydroxyvitamin D3 deficiency underlying human myeloid leukemias.

Primary myelodysplasia (MDP) and acute and chronic myelogenous leukemias (AML, CML) are considered disorders of clonal stem cell division. Several constitutive gene defects that contribute to the development of abnormal cell behavior have been identified in the hematopoietic cells. The role of bone marrow stroma cells in leukemogenesis, however, has not been established. We studied the organization of the bone marrow (BM) microenvironment to see if it was impaired during the initiation and progression of these malignancies. The buffy coat, hematon, and plasma fractions were separated from BM aspirates taken from healthy donors and diseased subjects at distinct clinical stages. The structural integrity of the BM microenvironment was evaluated analyzing the morphogenetic unit, the hematon. The hematon is a multicellular complex that includes fibroblasts, adipocytes, endothelial cells, resident macrophages, hematopoietic cobblestone area-forming cells (CAFC), high-proliferative potential colony-forming cells (HPP-CFC), granulocyte-macrophage colony-forming unit (GM-CFU), burst-forming unit erythroid (BFU-E), and terminally differentiated cells in normal BM. Hematon complexes were present in most BM aspirates from healthy donors (46H+/55). But they were absent from most of the patients with MDP (21H+/62) and AML (5H+/24) in the first perceptible phase, and from those with CML throughout the disease (5H+/55). Hematon complexes were present in the BM aspirate in 22/36 AML patients at clinical remission after chemotherapy or differentiation therapy. The hematon fraction isolated from normal BM, contained 25 times more 25-hydroxyvitamin D3 and about 500-fold more 1alpha,25-dihydroxyvitamin D3 than the BM plasma. The concentration of 1alpha,25-dihydroxyvitamin D3 was low or undetectable in the BM plasma of some, but not all, patients with MDP (18/35) or AML (9/24). Thus, in the BM microenvironment, the metabolism of low-density lipids and lipophylic hormones are severely impaired prior to initiation or during the accelerated expansion of leukemia cells. The lack of organized stromal network and the decreased level of some lipophylic hormones, acting probably as morphogens, may contribute to the onset and progression of human myeloid leukemias.

The hematon, a morphogenetic functional complex in mammalian bone marrow, involves erythroblastic islands and granulocytic cobblestones.

The development of pluripotential hematopoietic stem cells (PHSC) requires the continuous support provided by the bone tissue and bone marrow (BM) stromal cells. The basic rule of spatial and temporal organization of the distinct stromal cells and differentiating hematopoietic cells in the course of development, regenerative morphogenesis, or under homeostasis is still poorly understood. We have identified a cohort of preformed, multicellular aggregates in human BM aspirates that we have called hematons. This study shows that homologous hematon complexes can be isolated from the femoral BM shaft of normal mice. Cytologic analysis showed that both human and mouse hematons contained finely arborized endothelial cells, fibroblasts, preadipocytes, lipid-laden cells, and resident macrophages. This stromal cell web was tightly packed with hematopoietic cells comprising primitive cells with marrow-repopulating ability (MRA); day-8 and -12 colony-forming unit-spleen (CFU-S8 and -S12) in the mouse hematon; and high proliferative potential colony-forming cell (HPP-CFC), burst-forming unit-erythroid (BFU-E), granulocyte-macrophage-CFU (GM-CFU), as well as differentiated postmitotic cell populations in both human and mouse hematons. A cohort of single hematons produced a large, but variable, number of myeloid and erythroid cells, as well as megakaryocytes, in organotypic microculture, indicating the heterogenous growth potential of individual hematons. Each hematon developed into a complex, adherent colony in long-term liquid culture, which involves erythroblastic islands and granulocytic cobblestones. The hematons, isolated from 5-fluorouracil (5-FU)-treated mice, contained more HPP-CFC, BFU-E, and GM-CFU populations than the buffy coat (BC) fraction and produced significantly more CFU than normal hematons in organotypic microcultures. The present results provide further support for our hypothesis that the hematon is a tissue-specific complex structure that plays a critical roles in the maintenance of homeostasis and in the regenerative morphogenesis of mammalian BM.

Phase I trial of Perrimustine, a new cysteamine (2-chloroethyl) nitrosourea: an intrapatient escalation scheme.

The recently synthesized nitrosourea, N-[N'-chloro-2-ethyl-N'-nitrosocarbamoyl]-S-methyl cysteamine sulfoxide (Perrimustine), is water soluble and has a high alkylating activity, similar to that of the widely used nitrsoureas BCNU and CCNU, and a low carbamoylating activity. Preclinical studies with a broad spectrum of murine tumors indicate that this new compound may be clinically useful. The maximally efficient dose range (MEDR) in L1210 bearing mice was 45 mg/m2 (subcurative dose) to 67 mg/m2 (subtoxic dose). The present phase I trial used an intrapatient escalation schedule, so that each patient entering the study received a potentially active dose. The first dose injected was 1:100 of the MEDR suboptimal dose to check for anaphylactic sensitivity. Patients were then given increasing doses at increasing time intervals until toxicity was observed. The highest dose was given on day 150-230. The main toxic effect was myelosuppression [five out of the 24 patients evaluated: one grade 4 thrombocytopenia, two grade 3 thrombocytopenia; anemia and leucopenia were milder (grade 1 to 2 on OMS scale)]. Of the 19 patients evaluated for clinical response, one showed response after the 45 mg/m2 dose (disappearance of the cerebral metastasis with persistence of hepatic localizations in a patient with melanoma) and the disease was stabilized in two cases (a pleural mesothelioma and a renal carcinoma with lung metastases) after 26 and 37 weeks, with total cumulative doses per m2 of 232 and 196 mg, respectively.

Phase I trial of cystemustine, a new cysteamine (2-chloroethyl) nitrosourea: an intrapatient escalation scheme.

A trial of cystemustine, a cysteamine nitrosourea, was carried out on 34 patients with advanced malignancies at increasing dosage of the drug over a period of up to 190 days in seven or eight cycles. A partial response to treatment was obtained in three patients. A degree of haematological toxicity developed in a number of the patients.