RESUMEN
Harlequin ichthyosis (HI) is a rare and severe form of congenital ichthyosis. Linked to deletion and truncation mutations of a keratinocyte lipid transporter, HI is characterized by diffuse epidermal hyperkeratinization and defective desquamation. At birth, the HI phenotype is striking with thick hyperkeratotic plate-like scales with deep dermal fissures, severe ectropion and eclabium, among other findings. Over the first months of life, the hyperkeratotic covering is shed, revealing a diffusely erythematous, scaly epidermis, which persists for the remainder of the patient's life. Although HI infants have historically succumbed in the perinatal period related to their profound epidermal compromise, the prognosis of HI infants has vastly improved over the past 20 years. Here, we report a case of HI treated with acitretin, focusing on the multi-faceted management of the disease in the inpatient setting. A review of the literature of the management of HI during the perinatal period is also presented.
Asunto(s)
Acitretina/uso terapéutico , Ictiosis Lamelar/tratamiento farmacológico , Queratolíticos/uso terapéutico , Preescolar , Terapia Combinada , Ectropión/congénito , Humanos , Lactante , Recién Nacido , Modalidades de Fisioterapia , Derivación y ConsultaRESUMEN
BACKGROUND: In previous studies, it has been shown that intravenous lactate therapy can improve brain neurochemistry, adenosine triphosphate (ATP) generation and outcome after traumatic brain injury (TBI) in rats. In this study, we examined: (1) four L-lactate concentrations to determine the optimal therapeutic dose post TBI in terms of cognitive function; (2) ATP production after TBI for the L-lactate concentration found to be the optimal dose; (3) the possible production of lactic acidosis with the highest L-lactate concentration tested. METHODS: Thirty minutes following a fluid percussion injury (FPI) over the left cerebral hemisphere, the animals received an intravenous infusion of 10, 28, 100, or 280 mM L-lactate (n = 10 for each group) for 3 h at a rate of 0.65 ml/h. Shams and control injured animals received a saline infusion. At 11-15 days post injury, cognitive deficits were examined using the Morris Water Maze (MWM) test. Three groups of rats were used for ATP analysis: shams, injured + saline infusion, and injury + the optimal lactate dose as determined by the MWM (n = 4/group). Additionally, a group receiving 280 mM L-lactate (n = 5) and one receiving a saline infusion (n = 3) were monitored for arterial blood variables and blood pressures. FINDINGS: In the MWM test, only the 100 mM L-lactate-treated injured animals showed a significant reduction in cognitive deficits when compared to saline-treated injured animals (p Asunto(s)
Lesiones Encefálicas/psicología
, Trastornos del Conocimiento/tratamiento farmacológico
, Trastornos del Conocimiento/psicología
, Ácido Láctico/uso terapéutico
, Adenosina Trifosfato/metabolismo
, Animales
, Lesiones Encefálicas/metabolismo
, Corteza Cerebral/efectos de los fármacos
, Corteza Cerebral/metabolismo
, Cognición/efectos de los fármacos
, Trastornos del Conocimiento/etiología
, Infusiones Intravenosas
, Ácido Láctico/administración & dosificación
, Masculino
, Aprendizaje por Laberinto/efectos de los fármacos
, Ratas
, Ratas Sprague-Dawley
, Natación
, Heridas no Penetrantes/psicología
RESUMEN
BACKGROUND: Despite the high risk of venous thromboembolic events (VTE) in neuro-surgical patients, heparin prophylaxis has not been routinely established due to concern about bleeding complications. After initiating early low molecular weight heparin (LMWH) prophylaxis, we reviewed our patients in order to examine the viability of this practice. METHOD: Over a 3 year period, the records of patients admitted for elective neuro-surgery (ES), head injury (HI) or spontaneous intracranial haemorrhage (ICH) were analysed. Prophylaxis was performed with certoparin (3000 U anti-factor Xa s.c.) on the evening before ES and within 24 hours after surgery or admission whenever a CT did not show a progressive haematoma. Contraindications for LMWH were prothrombin time <70%, partial thrombo-plastin time >40 s, platelet count <100.000/ml, and platelet aggregation test sum <60%. The incidence of bleeding complications, VTE, and resulting morbidity/mortality was assessed. FINDINGS: 294 patients were admitted for ES, 344 for HI, and 302 for ICH. 155 of these were excluded because of contraindications. Intracranial bleeding was recorded in 1.5% (ES 1.1%, HI 3.5%, ICH 0%) and operative revision was performed in 1.1% (ES 0.7%, HI 2.8%) of patients. One case of moderate disability and no mortality occurred. The incidence of VTE and pulmonary embolism was documented in 0.2% and 0.1% of patients, with no associated mortality. No heparin induced thrombocytopenia was observed. INTERPRETATION: In neurosurgical patients, antithrombotic prophylaxis with certoparin was determined to be safe and efficacious when contraindications are carefully considered and a 12-hour time interval before and after surgery was guaranteed. This retrospective analysis should encourage a prospective trial of early LMWH prophylaxis.
Asunto(s)
Lesiones Encefálicas/cirugía , Neoplasias Encefálicas/cirugía , Derivaciones del Líquido Cefalorraquídeo , Fibrinolíticos/administración & dosificación , Heparina de Bajo-Peso-Molecular/administración & dosificación , Hemorragias Intracraneales/cirugía , Complicaciones Posoperatorias/prevención & control , Premedicación , Neoplasias de la Columna Vertebral/cirugía , Tromboembolia/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/secundario , Contraindicaciones , Evaluación de la Discapacidad , Femenino , Fibrinolíticos/efectos adversos , Hematoma Epidural Craneal/inducido químicamente , Hematoma Epidural Craneal/diagnóstico por imagen , Hematoma Epidural Craneal/cirugía , Hematoma Subdural/inducido químicamente , Hematoma Subdural/diagnóstico por imagen , Hematoma Subdural/cirugía , Heparina de Bajo-Peso-Molecular/efectos adversos , Humanos , Inyecciones Subcutáneas , Hemorragias Intracraneales/inducido químicamente , Hemorragias Intracraneales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/diagnóstico por imagen , Reoperación , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Recent studies have identified endogenous neural stem cells in adult rodent brains. The present study characterizes the early response of mitotically active cells in the brain to traumatic brain injury. Animals were subjected to lateral fluid percussion injury and sacrificed at various times after injury. To examine increases in cell proliferation animals were injected with the mitotic marker bromodeoxyuridine (BrdU) 24 h before sacrifice. Increased numbers of mitotically active cells were observed at 2 days in the subgranular zone (SGZ) and the subependymal zone (SEZ) under the injury site. To characterize the differentiation potential of these cells, animals were injected with BrdU 18 and 20 h after injury, then sacrificed at multiple time points after injury. Histologically, co-localization with betaIII-tubulin (neuronal marker) and BrdU was evident at 10 and 15 days postinjury in the SGZ. Flow cytometry analysis was used to quantitatively assess neurogenesis in the SEZ. Animals were sacrificed 1, 5, or 10 days after injury and tissue sections extracted, grown in tissue culture for 24 h, fixed, and stained for nestin and betaIII-tubulin to identify newly formed neurons. The percentage of cells expressing both markers was determined using flow cytometry analysis. There was a significant increase in newly differentiated neurons by 10 days postinjury in the SEZ. Thus, we conclude that traumatic brain injury stimulates an increase in proliferation of endogenous neural stem/progenitor cells and that a significant number of these express a neuronal marker. This response may be the brain's way of trying to heal itself after injury.