[Gastric volvulus, an infrequent cause of acute abdominal pain]. / Vólvulo gástrico, causa infrecuente de dolor abdominal agudo.

Gastric volvulus (GV) is characterized by the abnormal rotation of a portion of the stomach around a horizontal or vertical axis that can cause obstruction, vascular disorder and even strangulation, and may evolve into necrosis or even perforation. It can be classified according to its aetiology into primary or secondary GV, according to its anatomy into axial organ or into axial mesenteric GV, and according to its presentation into chronic or acute GV. Both types of volvulus require treatment; however, in spite of the classic treatment being open surgery, there is no standard treatment, nor is there consensus on the alternative of choice at present. Minimally invasion techniques, whether endoscopic or laparoscopic, should be considered in patients of advanced age or high surgical risk, where what is sought is a reduction in perioperative morbidity and mortality.

Hemorragia digestiva baja grave en joven de 25 años / Severe lower gastrointestinal bleeding in a 25-year-old patient

La hemorragia digestiva baja se define como la que tiene su origen por debajo del ligamento de Treitz. La etiología de la misma varía dependiendo de la edad de los pacientes. Excluida la patología anorrectal benigna, en niños y jóvenes las causas más habituales son el divertículo de Meckel, los pólipos juveniles y la enfermedad inflamatoria intestinal. El divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal, estando presente en el 2% de la población general. La mayoría de los divertículos de Meckel son asintomáticos y se diagnostican de forma incidental. Aproximadamente, el riesgo de presentar complicaciones es del 4-6%, siendo la hemorragia una de ellas. Presentamos el caso de un paciente de 25 años, que acudió a nuestro servicio con un cuadro de molestias abdominales inespecíficas y rectorregia. Tras estudio endoscópico completo, el diagnóstico de divertículo de Meckel se realizó intraoperatoriamente. Se realizó resección ileal incluyendo el divertículo, con evolución posterior satisfactoria(AU)

Lower gastrointestinal bleeding refers to blood loss originating from a site distal to the ligament of Treitz. The aetiology varies depending on the age of patients. Excluding benign anorectal pathology in children and young people, Meckel’s diverticulum, juvenile polyps and inflammatory bowel disease are the main causes. Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, being present in about 2% of the general population. Most Meckel’s diverticulum are asymptomatic and are diagnosed incidentally. The risk of complications is 4-6%, with bleeding as one of them(AU)

[Severe lower gastrointestinal bleeding in a 25-year-old patient]. / Hemorragia digestiva baja grave en joven de 25 años.

Lower gastrointestinal bleeding refers to blood loss originating from a site distal to the ligament of Treitz. The aetiology varies depending on the age of patients. Excluding benign anorectal pathology in children and young people, Meckel's diverticulum, juvenile polyps and inflammatory bowel disease are the main causes. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, being present in about 2% of the general population. Most Meckel's diverticulum are asymptomatic and are diagnosed incidentally. The risk of complications is 4-6%, with bleeding as one of them.

Diagnostic yield and reliability of endoscopic ultrasonography in patients with idiopathic acute pancreatitis.

OBJECTIVES: To evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with idiopathic acute pancreatitis (IAP), find factors predictive of a positive EUS finding in these patients and investigate whether these etiological findings are maintained during follow-up. MATERIAL AND METHODS: We performed EUS in patients with IAP between July 2004 and August 2007. We recorded epidemiological data, the number and severity of previous bouts of pancreatitis and gallbladder status. RESULTS: A total of 44 patients were included in the study. EUS was normal in seven patients (16%). In the remaining 37 patients (84%) we found cholelithiasis (n = 3), microlithiasis (n = 20), chronic pancreatitis (n = 14), pancreas divisum (n = 3), pancreatic mass (n = 1), apudoma (n = 1), cystic tumor of the pancreas (n = 2) and choledocholithiasis (n = 2). Positive EUS findings were not influenced by sex, severity of pancreatitis or recurrent disease. Patients aged < 65 years (age > or < 65 years: 73.9% versus 95.2%; P = 0.097) and patients with gallbladder in situ (cholecystectomy versus non-cholecystectomy: 63.6% versus 90.9%; P = 0.054) showed a tendency to have positive EUS findings. Mean follow-up was 28.95 +/- 10.86 months (range 12-64 months; median 28 months). During follow-up the etiological diagnosis was changed in two patients, lowering the diagnostic yield to 79%. CONCLUSIONS: EUS identified the cause of IAP in 79% of patients. Patients with gallbladder in situ and patients aged < 65 years showed a tendency to have positive EUS findings. The majority of the diagnoses provided by EUS are maintained during follow-up and seem to be reliable.

Hepatotoxicidad por iopromida / No disponible

No disponible

Distribution of the CD45R antigen in the maturation of lymphoid and myeloid series: the CD45R negative phenotype is a constant finding in T CD4 positive lymphoproliferative disorders.

We have compared the expression of the common leucocyte antigen (CD45) and the restricted leucocyte antigen (CD45R) on normal haematopoietic cells, cell lines, and a total number of 136 cases of myeloid and lymphoid proliferative syndromes. CD45, the conventional leucocyte antigen, presents a generalized distribution along the lymphoid and myeloid maturation pathway with the exception of some myelomas and pre-B leukaemias. In contrast, the expression of the CD45R determinant is more limited. Although it is found in the majority of the differentiation stages of B cells and monocytes, it is present only in the early stages of myeloid differentiation. On T cells it is expressed on mature thymocytes and in the majority of CD8+ lymphocytes and a subset of CD4+ cells on peripheral blood. Finally, our results also indicated that CD4+ T lymphoproliferative syndromes are derived from the CD4+ CD45R- subset (20/20 cases).

A monoclonal antibody, GR7A4, reacting with the T10 antigen.

The monoclonal antibody GR7A4 was produced against a human lymphoblastic leukemia (ALL-B). Biochemical characterization of GR7A4 was carried out with Raji cells in SDS-PAGE studies. GR7A4 precipitated a 43 kd molecule. The tissue distribution and molecular weight were similar to the T10 antigen. Modulation and capping of GR7A4 antigen reduced its binding ability to cells with either GR7A4 or OKT10. However, the cell surface distribution pattern observed was somewhat different from other similar monoclonal antibodies. Thus GR7A4 reacted greatly with pre-B-cell lines, Burkitt cell lines, EBV cell lines and activated PHA, ConA and PWM lymphocytes, however reactivity with leukemic cells was very limited. The kinetics of appearance of GR7A4 antigen on PWM blasts show that this molecule seems to represent an intermediate stage in lymphocytic activation. The differences in comparison with other similar MAbs are discussed and correlated with the peculiar discontinous pattern of appearance of this antigen.

Characterization of monoclonal antibodies directed against HLA class II molecules.

Four MAbs recognizing HLA class II antigens were produced by immunization with human leukemic cells, and were characterized through immunoprecipitation and cell distribution studies. They were tested against a panel of normal and leukemic cells, Epstein-Barr virus (EBV)-transformed homozygous typing cells (HTC)s, deletion mutant cell lines, and 11 other cell lines. The immunochemical studies revealed the presence of two bands of 34 and 28 kD, corresponding to the alpha- and beta-subunits of HLA class II antigens, respectively. The cell distribution studies led to the conclusion that GRB1, GRB2, and GRB3 MAbs recognize the HLA-DR monomorphic antigens, and that the GRB4 MAb seems to recognize basically the DR molecules but shows also a cross-reaction to DP molecules.