Prevention of parastomal hernia with a preperitoneal polypropelene mesh.

OBJECTIVE: To show our results with the use of a polypropylene mesh at the stoma site, as prophylaxis of parastomal hernias in patients with rectal cancer when a terminal colostomy is performed. METHODS: From January 2010 until March 2014, 45 consecutive patients with rectal cancer, underwent surgical treatment with the need of a terminal colostomy. A prophylactic mesh was placed in a sublay position at the stoma site in all cases. We analyze Demographics, technical issues and effectiveness of the procedure, as well as subsequent complications. RESULTS: A prophylactic mesh was placed in 45 patients, 35 male and 10 females, mean age of 66.2 (47-88) and Body Mass Index 29.19 (20.4-40.6). A total of 7 middle rectal carcinoma, 36 low rectal carcinoma, one rectal melanoma and one squamous cell anal carcinoma were electively treated with identical protocol. Abdominoperineal resection was performed in 38 patients, and low anterior resection with terminal colostomy in 7. An open approach was elected in 39 patients and laparoscopy in 6, with 2 conversions to open surgery. Medium follow up was 22 months (2.1-53). Overall, 3 parastomal hernias (6.66%) were found, one of which was a radiological finding with no clinical significance. No complications related to the mesh or the colostomy were found. CONCLUSIONS: The use of a prophylactic polypropylene mesh placed in a sublay position at the stoma site is a safe and feasible technique. It lowers the incidence of parastomal hernias with no increased morbidity.

Activación de puntos gatillo miofasciales en deportistas sometidos a cirugía artroscópica de rodilla / Myofascial trigger points activation in sportsmen after knee arthroscopical surgery

Este estudio pretende conocer el porcentaje de activación de Puntos Gatillo Miofasciales (PGM) en una muestra de deportistas sometidos a cirugía artroscópica de rodilla y estudiar estadísticamente la importancia de los posibles factores de activación. El estudio ha sido realizado con una muestra de 27 pacientes con una edad media de 26,81 años. Se les sometió a una exploración general periódica de la rodilla y particular de la musculatura relacionada con el dolor miofascial en la zona buscando PGM. Sólo se tuvieron en cuenta los PGM activos con posterioridad a la intervención. Se procedió al análisis estadístico de los datos mediante el programa SPSS versión 11.5 para Windows. Los datos muestran un porcentaje de activación de PGM del 48,1%. Los músculos que más han activado sus PGM han sido el vasto interno, poplíteo, vasto externo, gemelo externo e isquiotibiales internos. Respecto al estudio de los factores de activación, destaca la cantidad de activaciones causadas por la isquemia quirúrgica (58,14%), aunque la posibilidad de compartir factores en las activaciones no es despreciable. El flexo de rodilla y el dolor y/o adherencias en los portales de entrada tienen importancia cuando se combinan, sobre todo con la isquemia

This study intends to find the Myofascial Trigger Point (MTP) activation rate in a sample of sportsmen after knee arthroscopical surgery and to make a statistical study of the importance of the possible factors of activation. The study has been carried out with a sample of 27 patients with an average age of 26.81 years. A general periodic exploration of the knee and an exploration of the musculature related to the miofascial pain was performed in each individually by looking for MTP. Only the MTP activated after the surgical intervention were considered. A statistical analysis of the data was done using the 11.5 SPSS programme for Windows. The data showed a percentage of 48.1% of MTPs activation. The muscles which had their MTPs more frequently activated were vastus medialis, popliteus, vastus lateralis, external gastrocnemius and internal ischiotibialis. With regard to the factors of activation, the activations caused by surgical ischemia were prominent (58.14%), although the possibility of a combination of factors in the activations is also quite possible. The knee flexum and the pain and/or adherences in the entry portals are of greater importance when they are combined, most of all with ischemia

Dolor miofascial tras la artroscopia de rodilla: estudio de la prevalencia y de los posibles factores de activación / Myofascial pain after knee arthroscopy: study of its prevalence and possible activation factors

Objetivo: Conocer la prevalencia de activación de Puntos Gatillo Miofasciales (PGM) en una muestra de pacientes sometidos a cirugía artroscópica de rodilla. Estudiar la importancia de los posibles factores de activación. Material y métodos: El estudio ha sido realizado con una muestra de 46 pacientes (28 hombres y 18 mujeres) con edades comprendidas entre los 18 y 74 años (media de 39,59 años). Se les sometió a una exploración general de la rodilla y particular de la musculatura relacionada con el dolor miofascial en la zona buscando PGM. Sólo se tuvieron en cuenta los PGM activos con posterioridad a la intervención; el dolor identificado como el previo a la cirugía no se relacionaba con PGM activados posteriormente a la misma. La exploración se repitió periódicamente hasta el momento del alta o hasta que los resultados en la búsqueda de PGM se estabilizaban durante cuatro valoraciones consecutivas. Se procedió al análisis estadístico de los datos mediante el programa SPSS versión 11.5 para Windows. Resultados: Los datos muestran una prevalencia de activación de PGM del 58,7 %. La mayoría de los pacientes tienen entre 2 y 5 PGM activos a lo largo del proceso de recuperación (77,7 %). Se han encontrado un total de 91 PGM. Los músculos que más han activado sus PGM han sido el vasto interno, poplíteo, vasto externo, gemelo interno e insquiotibiales internos. Respecto al estudio de los factores de activación, destaca la cantidad de activaciones causadas por la isquemia quirúrgica (53,87 %), aunque la existencia de factores múltiples de activación no es despreciable. De los pacientes no sometidos a isquemia quirúrgica sólo el 11,1 % tenía PGM activos. Conclusiones: La aparición de Síndrome de Dolor Miofascial tras las artroscopias de rodilla se da en el 58,7 % de los pacientes. La mayoría tienen activos entre 2 y 5 PGM a lo largo de su proceso de recuperación. En cuanto a los factores de activación, destaca la isquemia quirúrgica. El flexo de rodilla y el dolor y/o adherencias en los portales de entrada tienen más importancia cuando se combinan, sobre todo con la isquemia

Objective: To find out the prevalence of Myofascial Trigger Points (MTPs) in a sample of patients who have undergone arthroscopic knee surgery and to make a study of the possible activating factors of this activation. Materials and methods: The study has been undertaken with a sample of 46 patients (28 male and 18 female) with an age range of 18-74 years old (average age 39,95 years old). The patients' knees were given a general examination and localised examination of the muscles relationated with myofascial pain of the region searching MTPs. Only the post-operative MTPs were taken into consideration as the pain identified prior to surgery was not related to the post-operative state of the patient. The exploration was repeated periodically until the patient was discharged or in the case of the results of the MTPs search were stable during four consecutive evaluations. The statistical analysis was undertaken using the 11.5 SPSS programme version for Windows. Results: The data show a prevalence of 58,7 % of MTPs activation. The majority of patients have between 2 and 5 active MTPs over the recuperation period (77,7 %). A total of 91 MTPs have been found. The muscles, which have activated their MTPs more frequently, were vastus medialis, popliteus, vastus lateralis, internal gastrocnemius and internal ischiotibialis. With regard to the study of the activating factors, the activations caused by surgical ischemia are prominent, although the possibility of multiple activating factors in the activations is also quite possible. Of the patients who were not subjected to surgical ischemia, only 11,1 % had active MTPs.Conclusions: The appearance of the Myofascial Pain Syndrome after knee arthroscopies occurs in 58,7 % of patients. The majority have between 2 and 5 MTPs during their recuperation period. With regard to the factors of activation, the surgical ischemia is prominent. The knee flexum and the pain and/or adherences in the entry points have more importance when they are combined, above all with ischemia

Peroxisomal NADP-Dependent Isocitrate Dehydrogenase. Characterization and Activity Regulation during Natural Senescence.

The peroxisomal localization and characterization of NADP-dependent isocitrate dehydrogenase (perICDH) in young and senescent pea (Pisum sativum) leaves was studied by subcellular fractionation, kinetic analysis, immunoblotting, and immunoelectron microscopy. The subunit molecular mass for perICDH determined by immunoblotting was 46 kD. By isoelectric focusing (IEF) of the peroxisomal matrix fraction, the NADP-ICDH activity was resolved into four isoforms, perICDH-1 to perICDH-4, with isoelectric points (pIs) of 6.0, 5.6, 5.4, and 5.2, respectively. The kinetic properties of the NADP-ICDH in peroxisomes from young and senescent pea leaves were analyzed. The maximum initial velocity was the same in peroxisomes from young and senescent leaves, while the Michaelis constant value in senescent leaf peroxisomes was 11-fold lower than in young leaf peroxisomes. The protein levels of NADP-ICDH in peroxisomes were not altered during senescence. The kinetic behavior of this enzyme suggests a possible fine control of enzymatic activity by modulation of its Michaelis constant during the natural senescence of pea leaves. After embedding, electron microscopy immunogold labeling of NADP-ICDH confirmed that this enzyme was localized in the peroxisomal matrix. Peroxisomal NADP-ICDH represents an alternative dehydrogenase in these cell organelles and may be the main system for the reduction of NADP to NADPH for its re-utilization in the peroxisomal metabolism.

Proteolytic cleavage of plant proteins by peroxisomal endoproteases from senescent pea leaves

The degradation of peroxisomal and nonperoxisomal proteins by endoproteases of purified peroxisomes from senescent pea (Pisum sativum L.) leaves has been investigated. In our experimental conditions, most peroxisomal proteins were endoproteolytically degraded. This cleavage was prevented, to some extent, by incubation with 2 mM phenylmethylsulfonylfluoride, an inhibitor of serine proteinases. The peroxisomal enzymes glycolate oxidase (EC 1.1.3.1), catalase (EC 1.11.1.6) and glucose-6-phosphate dehydrogenase (EC 1.1. 1.49) were susceptible to proteolytic degradation by peroxisomal endoproteases, whereas peroxisomal manganese superoxide dismutase (EC 1.15.1.1) was not. Ribulose-1,5-bisphosphate carboxylase/oxygenase (EC 4.1.1.39) from spinach and urease (EC 3.5. 1.5) from jack bean were strongly degraded in the presence of peroxisomal matrices. These results indicate that proteases from plant peroxisomes might play an important role in the turnover of peroxisomal proteins during senescence, as well as in the turnover of proteins located in other cell compartments during advanced stages of senescence. On the other hand, our data show that peroxisomal endoproteases could potentially carry out the partial proteolysis which results in the irreversible conversion of xanthine dehydrogenase into the superoxide-generating xanthine oxidase (EC 1. 1.3.22). This suggests a possible involvement of the peroxisomal endoproteases in a regulated modification of proteins.

Role of the ascorbate-glutathione cycle of mitochondria and peroxisomes in the senescence of pea leaves

We investigated the relationship between H2O2 metabolism and the senescence process using soluble fractions, mitochondria, and peroxisomes from senescent pea (Pisum sativum L.) leaves. After 11 d of senescence the activities of Mn-superoxide dismutase, dehydroascorbate reductase (DHAR), and glutathione reductase (GR) present in the matrix, and ascorbate peroxidase (APX) and monodehydroascorbate reductase (MDHAR) activities localized in the mitochondrial membrane, were all substantially decreased in mitochondria. The mitochondrial ascorbate and dehydroascorbate pools were reduced, whereas the oxidized glutathione levels were maintained. In senescent leaves the H2O2 content in isolated mitochondria and the NADH- and succinate-dependent production of superoxide (O2.-) radicals by submitochondrial particles increased significantly. However, in peroxisomes from senescent leaves both membrane-bound APX and MDHAR activities were reduced. In the matrix the DHAR activity was enhanced and the GR activity remained unchanged. As a result of senescence, the reduced and the oxidized glutathione pools were considerably increased in peroxisomes. A large increase in the glutathione pool and DHAR activity were also found in soluble fractions of senescent pea leaves, together with a decrease in GR, APX, and MDHAR activities. The differential response to senescence of the mitochondrial and peroxisomal ascorbate-glutathione cycle suggests that mitochondria could be affected by oxidative damage earlier than peroxisomes, which may participate in the cellular oxidative mechanism of leaf senescence longer than mitochondria.