Análisis de nuestra experiencia en el diagnóstico y tratamiento de la hernia obturatriz en un hospital de tercer nivel / Analysis of our experience in the diagnosis and treatment of obturator hernia in a third level hospital

La patología herniaria supone un porcentaje importante de las intervenciones quirúrgicas urgentes. La hernia obturatriz es una entidad poco frecuente, presentándose generalmente como un cuadro de oclusión intestinal agudo en mujeres adultas. El objetivo del estudio es analizar la experiencia en un hospital de tercer nivel en el diagnóstico y tratamiento de la hernia obturatriz, así como detectar aquellos signos que permitan un diagnóstico precoz. La técnica de imagen de elección para su diagnóstico es la tomografía computarizada. Se trata de un estudio observacional prospectivo, en el que se incluyeron pacientes intervenidos de forma urgente por hernia obturatriz entre los años 2000 y 2016. Para el registro de la morbilidad postoperatoria se empleó la clasificación de Clavien-Dindo. Se identificaron doce pacientes con clínica de obstrucción intestinal secundaria a hernia obturatriz. Todos ellos fueron intervenidos de forma urgente, realizándose laparotomía media urgente en el 59%, laparotomía media infraumbilical en el 33% y abordaje por vía inguinal posterior en un solo paciente (8%). En ocho pacientes (67%) fue necesario realizar una resección intestinal por isquemia intestinal. La técnica quirúrgica empleada fue la reparación mediante malla de polipropileno en seis pacientes (50%), mediante tapón en dos (17%) y cierre con puntos sueltos en cuatro (33%). Cuatro de ellos presentaron complicaciones postoperatorias, registrando un único exitus secundario a perforación por sufrimiento intestinal. Es prioritario establecer un diagnóstico precoz y tratamiento quirúrgico urgente para reducir la morbimortalidad asociada a la hernia obturatriz

Hernia pathology accounts for a large percentage of urgent surgical interventions. Obturator hernia is rare, usually presenting as a picture of acute intestinal occlusion. The aim of the study is to analyze the experience in a third level hospital in the diagnosis and treatment of obturator hernia, as well as to detect those signs that allow an early diagnosis. This is a prospective observational study, which included patients operated on urgently for obturator hernia between 2000 and 2016. For the registration of postoperative morbidity, the Clavien-Dindo classification was used. We identified twelve patients with intestinal obstruction secondary to obturator hernia. All of them were operated on urgently. Urgent midline laparotomy was carried out on 59% of them, infraumbilical laparotomy on 33%, and a posterior inguinal approach was realized on only one patient (8%). In eight patients (67%) it was necessary to perform intestinal resection. Repair was performed by polypropylene mesh in six patients (50%), by plugging in two (17%) and closing with loose stitches in four patients (33%). Four of them presented postoperative complications, recording a single exitus secondary to perforation due to intestinal suffering. Obturator hernia is a rare entity that develops mostly as an occlusive condition in elderly women. The imaging technique of choice for diagnosis is computed tomography. Establishing an early diagnosis and urgent surgical treatment is a priority to reduce associated morbidity and mortality

[Analysis of our experience in the diagnosis and treatment of obturator hernia in a third level hospital]. / Análisis de nuestra experiencia en el diagnóstico y tratamiento de la hernia obturatriz en un hospital de tercer nivel.

Hernia pathology accounts for a large percentage of urgent surgical interventions. Obturator hernia is rare, usually presenting as a picture of acute intestinal occlusion. The aim of the study is to analyze the experience in a third level hospital in the diagnosis and treatment of obturator hernia, as well as to detect those signs that allow an early diagnosis. This is a prospective observational study, which included patients operated on urgently for obturator hernia between 2000 and 2016. For the registration of postoperative morbidity, the Clavien-Dindo classification was used. We identified twelve patients with intestinal obstruction secondary to obturator hernia. All of them were operated on urgently. Urgent midline laparotomy was carried out on 59% of them, infraumbilical laparotomy on 33%, and a posterior inguinal approach was realized on only one patient (8%). In eight patients (67%) it was necessary to perform intestinal resection. Repair was performed by polypropylene mesh in six patients (50%), by plugging in two (17%) and closing with loose stitches in four patients (33%). Four of them presented postoperative complications, recording a single exitus secondary to perforation due to intestinal suffering. Obturator hernia is a rare entity that develops mostly as an occlusive condition in elderly women. The imaging technique of choice for diagnosis is computed tomography. Establishing an early diagnosis and urgent surgical treatment is a priority to reduce associated morbidity and mortality.

Correction to: JNK-NQO1 axis drives TAp73-mediated tumor suppression upon oxidative and proteasomal stress.

Correction to: Cell Death Dis. 5, e1484 (2014); https://doi.org/10.1038/cddis.2014.408 ; published online 23 October 2014.

[Adult hepatoblastoma. A case report]. / Hepatoblastoma del adulto. Presentación de un caso.

Adult hepatoblastoma is a rare pathology. Its pathogeny is not well understood and prognosis is very bad. We pre-sent a case of adult hepatoblastoma treated in our centre. A 65 year-old male, without previous hepatopathy, who consulted due to right hypochondrial pain with a subacute evolution. The pathological diagnosis was adult epithelial hepatoblastoma, with free surgical margins. The patient recei-ved a second surgical intervention 5 months later due to early recurrence and died 10 months after the diagnosis due to a new massive recurrence. His definitive diagnosis is histological. Radical surgery is the only treatment that increases survival, but recurrence is frequent. There are no well-defined patterns of adjuvant chemotherapy nor is there any trans-plant experience.

Dynamics of dual-polarization VCSEL-based optical frequency combs under optical injection locking.

The present experimental work studies the dynamics of dual-polarization optical frequency combs (OFCs) based on gain switching (GS) vertical-cavity surface-emitting laser (VCSEL) diodes under optical injection locking (OIL). This study presents two main results. First, we have obtained an overall comb formed by two orthogonally polarized sub-combs with comparable span and power. The overall comb shows enhanced optical span and flatness and high coherence between its modes. The second result is that we have been able to control the polarization state of the overall comb by tuning the polarization state of the injected light by locking the same single teeth of the comb. This produces an overall comb with single polarization that is parallel or orthogonal. These are novel findings that provide for the development of efficient and compact OFCs based on GS VCSEL sources with versatile polarization dynamics.

Hepatoblastoma del adulto. Presentación de un caso / Adult hepatoblastoma. A case report

El hepatoblastoma del adulto es una patología inusual, de patogenia no bien conocida y de muy mal pronóstico. Presentamos un caso de hepatoblastoma del adulto tratado en nuestro centro. Varón de 65 años, sin hepatopatía previa, que consulta por dolor en hipocondrio derecho de evolución subaguda. El diagnóstico anatomopatológico fue hepatoblastoma epitelial del adulto, con bordes quirúrgicos libres. Fue reintervenido 5 meses después por recidiva precoz y falleció 10 meses después del diagnóstico por nueva recidiva masiva. Su diagnóstico definitivo es histológico. La cirugía radical ofrece el único tratamiento que aumente la supervivencia, pero frecuentemente recidiva. No existen pautas bien definidas de quimioterapia adyuvante, ni experiencia en trasplante (AU)

Adult hepatoblastoma is a rare pathology. Its pathogeny is not well understood and prognosis is very bad. We present a case of adult hepatoblastoma treated in our centre. A 65 year-old male, without previous hepatopathy, who consulted due to right hypochondrial pain with a subacute evolution. The pathological diagnosis was adult epithelial hepatoblastoma, with free surgical margins. The patient received a second surgical intervention 5 months later due to early recurrence and died 10 months after the diagnosis due to a new massive recurrence. His definitive diagnosis is histological. Radical surgery is the only treatment that increases survival, but recurrence is frequent. There are no well-defined patterns of adjuvant chemotherapy nor is there any transplant experience (AU)

[Epithelioid angiosarcoma of the gallbladder. Case report and review of the literature]. / Angiosarcoma epitelioide de vesícula.

Angiosarcoma of the gallbladder is an infrequent pathology but has a high morbidity and mortality. There are only 10 references in the international literature. We present a case treated in our center and we review the cases published since 1956. An 81 year-old male patient with abdominal pain, asthenia and dyspnea. Analytically anemia and leukocytosis. Exploration found a distended abdomen, right hypochondrium pain, with defense. Abdominal echography and a CT were requested with a diagnosis of acute cholecystitis and he was admitted for antibiotic treatment. The patient did not evolve favorably and was subjected to emergency surgery, which found a haemoperitoneum and a gallbladder with a tumoral appearance that could not be totally extirpated. He died 20 days after the operation. The report from pathological anatomy was compatible with epithelioid angiosarcoma of the biliary gallbladder. Gallbladder angiosarcoma is a neoplasia with a bad prognosis, whose clinical presentation can be mistaken for acute cholecystitis. Improving the prognosis of this disease involves carrying out early diagnosis and surgical treatment.

Angiosarcoma epitelioide de vesícula. Presentación de un caso y revisión bibliográfica / Epithelioid angiosarcoma of the gallbladder. Case report and review of the literature

El angiosarcoma de vesícula es una patología poco frecuente pero con una alta morbi-mortalidad del que sólo hay 10 referencias en la literatura internacional. Presentamos un caso tratado en nuestro centro y realizamos una revisión de los casos publicados desde 1956. Paciente varón de 81 años con dolor abdominal, astenia y disnea. Analíticamente anemia y leucocitosis. En la exploración destacaba un abdomen distendido, doloroso en hipocondrio derecho, con defensa. Se solicitó ecografía abdominal y un TC con diagnóstico de colecistitis aguda y se ingresó para tratamiento antibiótico. El paciente no evolucionó favorablemente y se intervino de urgencia hallando un hemoperitoneo y una vesícula de aspecto tumoral que no se pudo extirpar en su totalidad. Falleció a los 20 días de la intervención. El informe de anatomía patológica fue compatible con angiosarcoma epiteloide de vesícula biliar. El angiosarcoma de vesícula es una neoplasia de mal pronóstico, cuya presentación clínica puede confundirse con la colecistitis aguda. Conseguir mejorar el pronóstico de esta enfermedad pasa por realizar un diagnóstico y tratamiento quirúrgico precoces (AU)

Angiosarcoma of the gallbladder is an infrequent pathology but has a high morbidity and mortality. There are only 10 references in the international literature. We present a case treated in our center and we review the cases published since 1956. An 81 year-old male patient with abdominal pain, asthenia and dyspnea. Analytically anemia and leukocytosis. Exploration found a distended abdomen, right hypochondrium pain, with defense. Abdominal echography and a CT were requested with a diagnosis of acute cholecystitis and he was admitted for antibiotic treatment. The patient did not evolve favorably and was subjected to emergency surgery, which found a haemoperitoneum and a gallbladder with a tumoral appearance that could not be totally extirpated. He died 20 days after the operation. The report from pathological anatomy was compatible with epithelioid angiosarcoma of the biliary gallbladder. Gallbladder angiosarcoma is a neoplasia with a bad prognosis, whose clinical presentation can be mistaken for acute cholecystitis. Improving the prognosis of this disease involves carrying out early diagnosis and surgical treatment (AU)

JNK-NQO1 axis drives TAp73-mediated tumor suppression upon oxidative and proteasomal stress.

Hyperproliferating cancer cells produce energy mainly from aerobic glycolysis, which results in elevated ROS levels. Thus aggressive tumors often possess enhanced anti-oxidant capacity that impedes many current anti-cancer therapies. Additionally, in ROS-compromised cancer cells ubiquitin proteasome system (UPS) is often deregulated for timely removal of oxidized proteins, thus enabling cell survival. Taken that UPS maintains the turnover of factors controlling cell cycle and apoptosis--such as p53 or p73, it represents a promising target for pharmaceutical intervention. Enhancing oxidative insult in already ROS-compromised cancer cells appears as an attractive anti-tumor scenario. TAp73 is a bona fide tumor suppressor that drives the chemosensitivity of some cancers to cisplatin or γ-radiation. It is an important drug target in tumors where p53 is lost or mutated. Here we discovered a novel synergistic mechanism leading to potent p73 activation and cancer cell death by oxidative stress and inhibition of 20S proteasomes. Using a small-molecule inhibitor of 20S proteasome and ROS-inducer--withaferin A (WA), we found that WA-induced ROS activates JNK kinase and stabilizes phase II anti-oxidant response effector NF-E2-related transcription factor (NRF2). This results in activation of Nrf2 target--NQO1 (NADPH quinone oxidoreductase), and TAp73 protein stabilization. The observed effect was ablated by the ROS scavenger--NAC. Concurrently, stress-activated JNK phosphorylates TAp73 at multiple serine and threonine residues, which is crucial to ablate TAp73/MDM2 complex and to promote TAp73 transcriptional function and induction of robust apoptosis. Taken together our data demonstrate that ROS insult in combination with the inhibition of 20S proteasome and TAp73 activation endows synthetic lethality in cancer cells. Thus, our results may enable the establishment of a novel pharmacological strategy to exploit the enhanced sensitivity of tumors to elevated ROS and proteasomal stress to kill advanced tumors by pharmacological activation of TAp73 using molecules like WA.

Two combined photosensitizers: a goal for more effective photodynamic therapy of cancer.

Photodynamic therapy (PDT) is a clinically approved therapeutic modality for the treatment of diseases characterized by uncontrolled cell proliferation, mainly cancer. It involves the selective uptake of a photosensitizer (PS) by neoplastic tissue, which is able to produce reactive oxygen species upon irradiation with light, leading to tumor regression. Here a synergistic cell photoinactivation is reported based on the simultaneous administration of two PSs, zinc(II)-phthalocyanine (ZnPc) and the cationic porphyrin meso-tetrakis(4-N-methylpyridyl)porphine (TMPyP) in three cell lines (HeLa, HaCaT and MCF-7), using very low doses of PDT. We detected changes from predominant apoptosis (without cell detachment) to predominant necrosis, depending on the light dose used (2.4 and 3.6 J/cm(2), respectively). Analysis of changes in cytoskeleton components (microtubules and F-actin), FAK protein, as well as time-lapse video microscopy evidenced that HeLa cells were induced to undergo apoptosis, without losing adhesion to the substrate. Moreover, 24 h after intravenous injection into tumor-bearing mice, ZnPc and TMPyP were preferentially accumulated in the tumor area. PDT with combined treatment produced significant retardation of tumor growth. We believe that this combined and highly efficient strategy (two PSs) may provide synergistic curative rates regarding conventional photodynamic treatments (with one PS alone).

Observation of phase noise reduction in photonically synthesized sub-THz signals using a passively mode-locked laser diode and highly selective optical filtering.

A Continuous Wave (CW) sub-THz photonic synthesis setup based on a single Passively Mode-Locked Laser Diode (PMLLD) acting as a monolithic Optical Frequency Comb Generator (OFCG) and highly selective optical filtering has been implemented to evaluate the phase noise performance of the generated sub-THz signals. The analysis of the synthesized sub-THz signals up to 120 GHz gives as a result an effective reduction of the electrical linewidth when compared to direct harmonic generation that begins at 50 GHz and becomes greater as the frequency increases. The phase noise reduction offered by the setup, along with its integration potential, cost and bandwidth, make it a promising candidate to the development of an integrated and high performance low phase noise local oscillator in the sub-THz range.

Two color multichannel heterodyne interferometer set up for high spatial resolution electron density profile measurements in TJ-II.

A high spatial resolution two color [CO(2), λ=10.6 µm/Nd:YAG (Nd:YAG denotes neodymium-doped yttrium aluminum garnet), and λ=1.064 µm] expanded-beam multichannel heterodyne interferometer has been installed on the TJ-II stellarator. Careful design of the optical system has allowed complete control on the evolution of both Gaussian beams along the interferometer, as well as the evaluation and optimization of the spatial resolution to be expected in the measurements. Five CO(2) (measurement) channels and three Nd:YAG (vibration compensation) channels have been used to illuminate the plasma with a probe beam of 100 mm size. An optimum interpolation method has been applied to recover both interferometric phasefronts prior to mechanical vibration subtraction. The first results of the installed diagnostic are presented in this paper.

Experimental modulation bandwidth beyond the relaxation oscillation frequency in a monolithic twin-ridge laterally coupled diode laser based on lateral mode locking.

Monolithic twin-ridge laterally coupled diode lasers emitting at 1.3microm are presented that have a small-signal modulation bandwidth beyond the relaxation oscillation frequency of a single ridge. Spectra and spectrally resolved far fields are presented for three bias conditions: only one ridge lasing, both ridges lasing just above threshold, and both ridges lasing at biases well above threshold. In the first two cases the spectrum has single-peaked longitudinal modes, whereas the third cases shows splitting to in-phase and out-of-phase modes. The splitting frequency of the optical spectrum is measured to be 7.7 GHz. Small-signal modulation measurements reveal a strong resonance at 7.7 GHz, demonstrating an effect of lateral mode locking. As a result of this effect, the twin-ridge laser can be made to have a -3-dB bandwidth beyond that associated with its relaxation oscillation frequency.