Obesogen effects after perinatal exposure of 4,4'-sulfonyldiphenol (Bisphenol S) in C57BL/6 mice.

Bisphenol A were removed from consumer products and replaced by chemical substitutes such as Bisphenol S (BPS). Based on their structural similarity, BPS may be obesogen like Bisphenol A in mice. Our objective was to determine the impact of BPS on lipid homeostasis in C57Bl/6 mice after perinatal and chronic exposure. Pregnant mice were exposed to BPS via the drinking water (0.2; 1.5; 50µg/kg bw/d). Treatment began at gestational day 0 and continued in offspring up to 23-weeks old. Then, offspring mice were fed with a standard or high fat diet. The body weight, food consumption, fat mass and energy expenditure were measured. A lipid load test was performed to check the postprandial triglyceridemia. Plasma parameters and mRNA gene expression in adipose tissues were also analysed. BPS induced overweight in male mice offspring fed with a HFD at the two highest doses. There was no change in food intake and energy expenditure. The overweight was correlated to the fat mass, hyperinsulinemia and hyperleptinemia. The plasma triglyceride clearance was significantly increased with BPS and tyloxapol(®) (triglyceride clearance inhibitor) reversed this phenomenon. BPS induced alteration in mRNA expression of marker genes involved in adipose tissue homeostasis: hormone sensitive lipase, PPARγ, insulin receptor, SOCS3 and adiponectin. This is the first time that BPS is described as obesogenic at low doses and after perinatal and chronic exposure in male mice. BPS potentiated the obesity induced by a HFD by inducing the lipid storage linked to faster lipid plasma clearance.

Potential of mesenchymal stem cell in stabilization of abdominal aortic aneurysm sac.

BACKGROUND: In their origin, abdominal aortic aneurysms (AAAs) are related to an inflammatory reaction within the aortic wall, which can lead to weakness and degeneration of this structure. One of the most widely accepted treatment modalities for AAAs is the placement of stent grafts. Nevertheless, in some patients blood re-enters the aneurysm sac, creating so-called leaks, which constitute a renewed risk of rupture and death.This study explores the possibility of filling aneurysm sacs treated by endovascular aneurysm repair with adipose tissue-derived mesenchymal stem cells (ASCs) in a porcine model. METHODS: We developed a porcine model using 22 animals by creating an artificial AAA made with a Dacron patch. AAAs were then treated with a coated stent that isolated the aneurysm sac, after which we introduced allogeneic ASC into the sac. Animals were followed-up for up to 3 mo. The experiment consisted of the aforementioned surgical procedure performed first, followed by computed tomography and echo-Doppler imaging during the follow-up, and finally, after sacrificing the animals, histologic analysis of tissue samples from the site of cell implantation by a blinded observer and the detection of implanted cells by immunofluorescence detection of the Y chromosome. RESULTS: Our findings demonstrate the survival of ASCs over the 3 mo after implantation and histologic changes associated with this treatment. Treated animals had less acute and chronic inflammation throughout the study period, and we observed increasing fibrosis of the aneurysm sac, no accumulation of calcium, and a regeneration of elastic fibers in the artery. CONCLUSIONS: The combination of endovascular aneurysm repair and cell therapy on AAAs has promising results for the stabilization of the sac, resulting in the generation of living tissue that can secure the stent graft and even showing some signs of wall regeneration. The therapeutic value of such cell-based therapy will require further investigation.

Use of platelet-rich plasma in the healing of chronic ulcers of the lower extremity.

INTRODUCTION AND OBJECTIVES: Platelet-rich plasma (PRP) is used as an adjuvant in the treatment of chronic ulcers of the lower extremity and has shown particularly promising results in the case of neuropathic ulcers. There has been less research, however, into its use in venous and hypertensive ulcers. Our aim was to assess the safety and feasibility of using PRP in the treatment of chronic ulcers of the lower extremity and to evaluate its potential benefits in directed healing. MATERIAL AND METHODS: We prospectively selected 11 patients with nonischemic ulcers of the lower extremity that had been present for at least 6 weeks. PRP was injected subcutaneously into the perilesional tissue and applied topically in 4 sessions held at 1-week intervals. We assessed quality of life (SF-12 questionnaire), pain (visual analog scale), and the circumference of the ulcer before and after treatment. RESULTS: There was a predominance of women (8/11, 73%), and venous ulcers (7/11, 64%) were more common than hypertensive ulcers (4/11, 36%). The median age of the patients was 79 years and the median time since onset of the ulcer was 17 months (range, 6-108 months). We observed a significant reduction in pain (P<.05) and a significant improvement in the physical and mental components of the SF-12 (P<.05). The mean reduction in ulcer size was 60%, and complete healing was achieved in 5 cases. No adverse effects were observed. CONCLUSION: The local application of PRP is a valuable and practical procedure that promotes the healing of chronic ulcers of the lower extremity; it can improve patient quality of life and is particularly effective in local pain relief.

Serie de casos. Experiencia de un único centro en el tratamiento de fístulas aortoentéricas / A case series. Experience of a single centre in the treatment of aortoenteric fistulas

Objetivo: Analizar nuestra experiencia y resultados obtenidos en una patología infrecuente, compleja y grave como la fístula aortoentérica (FAE). Material y métodos: La patología aórtica previa y su tratamiento fueron: 4 síndromes de Leriche y 2 aneurismas de aorta y un aneurisma roto tratados con bypass aortobifemoral y dos endovascular aneurysms repair (EVAR). Otros datos recogidos fueron: factores de riesgo cardiovascular, patología y cirugía abdominal previa, la localización de FAE secundaria, periodo de tiempo hasta la FAE, evolución y recidivas. Nueve pacientes (7 hombres y 2 mujeres) con fístula secundaria aortoentérica tratados durante el periodo 2000-2010 se agruparon en función de la estabilidad hemodinámica: 3 hombres estables, 4 hombres y 2 mujeres inestables. Resultados: Las FAE secundarias aparecieron tras una media de tiempo de 85,8 meses (mediana: 104; rango: 5-204). Cuatro se trataron con bypass extra-anatómico, 3 inestables. Tres pacientes con reparación in situ, 2 inestables. Dos de forma endovascular, uno inestable. Hubo una muerte intra-quirófano, inestable, y durante los primeros 30 días fallecieron otros 4 pacientes, 3 inestables y uno estable. Los 4 pacientes que sobrevivieron sufrieron una recidiva de la FAE tras tres meses de media (intervalo: 2-5); solo dos se trataron, uno con endoprótesis y otro con bypass axilobifemoral. Conclusiones: La FAE secundaria es una complicación grave, rara y compleja, con una alta morbilidad y mortalidad. No existe un tratamiento estándar, aunque es fundamental el tratamiento urgente de la hemorragia, incluyendo la terapia endovascular, con o sin una nueva intervención para el tratamiento definitivo(AU()

Objective: To analyse our experience and results of a rare, complex and serious disease, aortoenteric fistula (AEF). Material and methods: Nine patients (seven males and two females) with secondary aortoenteric fistula treated during the period 2000-2010, were grouped according to hemodynamic stability: stable three males. Four males and two females were unstable. Previous aortic pathology and its treatment were: four Leriche syndrome, two aortic aneurysms and a ruptured aortic aneurysm treated by aortobifemoral bypass and two EVAR (endovascular aneurysms repair). Other data collected: cardiovascular risk factors, previous abdominal pathology and its surgery, the location of the secondary AEF, period of time until the appearance of AEF, evolution and recurrence. Results: The secondary AEF appeared after a mean time of 85.8 months (median 104, range 5-204). Four were treated with extra-anatomical bypass, and three were unstable. Three patients with in situ repair, two unstable. Two with endograft, one unstable. There was one death during surgery, unstable, and during the first 30 days, four patients died, 3 unstable, one stable. The four surviving patients had a recurrence of the AEF after a mean of three months (range, 2-5), only two were treated, one patient with endograft and one with axilobifemoral bypass. Conclusions: Secondary AEF is a serious, rare and complex complication, with high morbidity and mortality. No standard treatment exists, although the urgent treatment of bleeding is essential, including endovascular therapy, with or without a new intervention for definitive treatment(AU)

Intubación de secuencia rápida en paciente que presenta un gran cuchillo de cocina clavado en el cuello por intento autolítico / Rapid intubation in patient with a big kitchen knife nailed in the neck cause a suicide purpose

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Acute iliac artery thrombosis and pulsatile femoral and popliteal veins in the same extremity: a case report.

Systemic venous pressure is elevated in right heart failure, and this elevation may be reflected in pulsatile venous flow when there is significant tricuspid regurgitation. The presence of this systolic reversed flow in the femoral and popliteal veins may result in major difficulties for diagnosis and treatment. We report the case of a patient with signs and symptoms of acute ischemia of the right lower limb with palpable pulse in the groin and popliteal fossa. Tricuspid regurgitation was suspected by clinical examination, and Doppler ultrasonographic examination of the extremity revealed pulsatile flow in the femoral and popliteal veins while the iliac arterial axis was occluded. A preoperative angiogram revealed an underlying iliac artery thrombosis, which was successfully treated.

Aortoenteric fistula arising as a complication of endovascular treatment of abdominal aortic aneurysm.

Estimates of the incidence of aortoenteric fistula as a sequela of surgery of the aorta range 1-2%. This complication is less common in patients who have had an aortic endograft implanted for aortoiliac aneurysm. We present three cases of aortoenteric fistula complicating endovascular treatment of abdominal aortic aneurysm (3/423 patients, 0.7% in our series).

Leiomiomatosis intravenosa con extensión cardíaca. Caso clínico y revisión de la bibliografía / Intravenous leiomyomatosis with extension into the heart. A case report and review of the literature

Introducción. La leiomiomatosis intravenosa (LIV) es un tumor poco frecuente que puede crecer a través devena cava inferior hasta extenderse a las cavidades cardíacas derechas. Es un tumor originado por las células de músculoliso y normalmente se encuentra confinado al sistema venoso pélvico. Se han descrito no más de 100 casos de LIV,de los cuales, tan sólo 30 presentaban afectación cardíaca. Aunque histológicamente es benigno, la afectación de las cavidadescardíacas derechas puede producir síntomas graves como síncopes y arritmias, y en algunos casos puede llegara producir la muerte súbita. Caso clínico. Mujer de 40 años con extensión cardíaca y que no presentaba síntomas previos.La extensión del tumor se producía tanto por ambas venas ilíacas internas como por la vena ovárica izquierda, algo quetan sólo se había descrito en otros dos casos anteriormente. La escisión quirúrgica se realizó en un único tiempo quirúrgicomediante circulación extracorpórea y abordaje abdominal y torácico. Conclusión. A pesar de ser un tumor poco frecuente,el retraso en la presentación de los síntomas (incluso 20 años) puede infravalorar su incidencia. Dado el gravecuadro clínico que puede provocar, su tratamiento es en todos los casos la extirpación quirúrgica, lo que supone un importantereto para el cirujano vascular. La escasa incidencia de la LIV y el tipo de extensión del tumor en este caso clínicolo hacen realmente excepcional

Introduction. Intravenous leiomyomatosis (IVL) is a rare tumour that may spread along the inferior venacava until it reaches the cavities on the right-hand side of the heart. It is a tumour that has its origins in smooth musclecells and is normally restricted to the pelvic venous system. No more than 100 cases of IVL have been reported, of whichonly 30 presented cardiac involvement. Although histologically it is benign, the involvement of the right cavities of theheart can give rise to severe symptoms such as syncopes and arrhythmias and in some cases it can even lead to suddendeath. Case report. A 40-year-old female with extension to the heart and who had no previous symptoms. The tumourspread along both the internal iliac veins and the left ovarian vein, something which had only previously been reportedin two other cases. Surgical excision was performed in a single session of surgery by means of a heart-lung bypass andusing an abdominal and thoracic approach. Conclusions. Despite being an infrequent tumour, its incidence may beunderestimated due to the fact that its symptoms often appear very late on in the course of the disease (up to 20 years).Given the severe clinical features that it may cause, its treatment always involves surgical removal, which is animportant challenge for the vascular surgeon. The low incidence of IVL and the type of extension of the tumour in thiscase make it truly exceptional

Long-term results of femoro-femoral crossover bypass after endovascular aortouniiliac repair of abdominal aortic and aortoiliac aneurysms.

Aortouniiliac stent grafts allow the endovascular treatment of complex anatomy aortoiliac aneurysms. The main drawback is the need for femoro-femoral crossover bypass, with its complications and its patency limitations. However, some authors have shown good results of femoro-femoral crossover bypass in aneurysmal disease. In this article, initial and long-term results of our experience in femoro-femoral crossover bypass revascularization after endovascular aortouniiliac stent grafts repair of aortoiliac aneurysms is reported. Prospective collection, intention-to-treat, and retrospective analysis maintained database. Femoro-femoral crossover bypass patency assessment of all patients treated between January 1999 and September 2002, compared patients with or without associated occlusive arterial disease. Urgent indications were excluded. In total of 52 patients, with a mean age 72.6 years, 30.8% of patients were identified with associated occlusive arterial disease. Initial systemic and local, access site, complications were 7.7% and 7.7%, respectively, no early thrombosis or death is reported. Primary patency was 90.9% at 54 months, 66 months assisted primary and secondary patency were 97.7% and 100%, respectively. The 48-month survival rate was 84.2%. No significant differences between patients with or without associated occlusive arterial disease were found. Femoro-femoral crossover bypass after aortouniiliac stent grafts treatment of aortoiliac aneurysms shows excellent initial and long-term patency and low complication rate.

Combined surgical and endovascular repair of a ruptured bilateral aortoiliac aneurysm.

Aortoiliac aneurysms are frequent entities that have very important clinical implications, especially in the younger patients. We are asked not only to save lives by preventing the rupture or repairing those that are already ruptured but also to provide an acceptable quality of life in the postoperative period. Endovascular approaches certainly give us such an expectative but are not clearly indicated in our younger patients and cannot be used routinely in those aneurysms with a yuxtarrenal origin. This is the case report of a young man with a yuxtarrenal aortoiliac inflammatory aneurysm that was treated by the interposition of an aortobifemoral bypass with the addition of endovascular devices in the hypogastric vessels to preserve the pelvic blood flow; they contribute to seal the common iliac aneurysms. This approach was useful to avoid complications during a difficult iliac dissection and was permeable within 1 year of the operation. Durability must be assessed.

Aneurisma subclavio. Hallazgo casual y tratamiento endovascular / Subclavian aneurysm. A chance finding and endovascular treatment

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Pseudoaneurisma de la arteria peronea tras la embolectomía con catéter de balón / Pseudoaneurysms in the fibular artery following embolectomy with a balloon catheter

Introducción. Los pseudoaneurismas de la arteria peronea son una patología rara asociada a traumatismos de la pierna, a cirugía traumatológica o a lesiones de la pared arterial secundarias a embolectomía con balón. Pueden ser asintomáticos o, por el contrario, debutar con dolor y sensación de masa, lo que puede asociar una fístula arteriovenosa o un síndrome compartimental. El tratamiento endovascular mediante embolización representa una solución novedosa a este tipo de lesiones. Caso clínico. Mujer de 71 años que con el diagnóstico de isquemia arterial aguda en el miembro inferior derecho de probable origen cardioembólico fue intervenida de tromboembolectomía transfemoral derecha; recuperó los pulsos distales y fue dada de alta a los cinco días de la intervención. Acudió al servicio de urgencias a los 10 días del alta con clínica de dolor en la región aquílea del miembro inferior derecho y edema, y mediante eco-Doppler se diagnosticó un pseudoaneurisma de la arteria peronea derecha. Se le realizó arteriografía a través de la arteria femoral contralateral; se cateterizó selectivamente la arteria peronea, que confirmó la presencia del pseudoaneurisma, y se procedió a su embolización con coils

Introduction. Pseudoaneurysms of the fibular artery are a rare pathological condition associated with traumatic injuries to the legs, trauma surgery or lesions in the walls of the artery secondary to balloon embolectomies. They can be asymptomatic or, in contrast, they may begin with pain and the presence of a mass, which can be associated to an arteriovenous fistula or compartment syndrome. Endovascular treatment by embolisation is a novel solution to this type of lesion. Case report. We report the case of a 71-year-old female who was diagnosed as having acute arterial ischaemia in the lower right limb that probably had cardioembolic origins; the patient was submitted to a right transfemoral thromboembolectomy. Distal pulses were restored and she was discharged from hospital five days after the operation. She visited the emergency department again 10 days after discharge with symptoms of pain in the Achilles region of the right lower limb and oedema; Doppler ultrasound recording was used to reach a diagnosis of pseudoaneurysm of the right fibular artery. Arteriography was performed through the contralateral femoral artery; the fibular artery was selectively catheterised, which confirmed the presence of a pseudoaneurysm and this was then embolised using coils

Tomografía computarizada multicorte en el diagnóstico de la estenosis carotídea / Multi-slice computerised tomography in the diagnosis of carotid stenosis

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Ligadura accidental de arteria mesentérica superior como complicación de nefrectomía mediante cirugía laparoscópica / Accidental ligation of superior mesenteric artery as a complication of laparoscopic nephrectomy

Introducción. La cirugía laparoscópica en sus distintos campos de aplicación, especialmente cirugía general, urología y ginecología, a pesar de sus grandes ventajas, es también origen de complicaciones iatrógenas, entre ellas vasculares. Ocupa un lugar importante la nefrectomía por la proximidad de estructuras vasculares importantes, tales como la aorta, vena cava inferior, arterias mesentéricas superior e inferior y vasos colaterales de la arteria mesentérica superior (AMS). Las lesiones directas sobre la AMS son muy raras y apenas hay publicaciones en la literatura. Caso clínico. Paciente de 52 años diagnosticado de hipernefroma izquierdo, y se indica nefrectomía. En el transcurso de la intervención y posiblemente debido a rotación de la cámara, la AMS se confundió con la arteria renal y, por ello, de forma accidental, se ligó y seccionó, con la consiguiente isquemia intestinal; se necesitó proceder a su revascularización mediante un bypass aortomesentérico con un segmento de vena safena interna. El postoperatorio cursó sin complicaciones. Conclusiones. Se realiza una revisión de la literatura concerniente a las complicaciones de la cirugía laparoscópica y en particular las vasculares; si bien la incidencia de complicaciones en general ha disminuido a medida que la experiencia ha mejorado, no llegando en la mayoría de las estadísticas al 3%, se ponen de manifiesto lesiones tan graves, especialmente en cirugía urológica, como la sección y/o ligadura de aorta o de vena cava inferior, que ponen en peligro la vida del paciente y requieren en la mayoría de los casos conversión a cirugía abierta

Introduction. Despite the various advantages of the laparoscopic surgery and its application in several fields (preferably general surgery, gynecology and urology), it is also true that these techniques have become a source of yatrogenic vascular complications. Because of the neighboring vascular structures: aorta, inferior vena cava, superior and inferior mesenteric arteries, collateral branches of the mesenteric superior artery, etc, nephrectomy is one of the laparoscopic surgical techniques that more frequently leads to vascular complications. Injuries to the superior mesenteric artery are rare and there are very few publications on this subject. Case report. A 52 year-old man was diagnosed to have a left hypernephroma and evaluated to undergo laparoscopic nephrectomy. During the procedure and possibly because of a rotation of the camera, the superior mesenteric artery was thought to be the renal artery and thus accidentally ligated and transectioned. The subsequent intestinal ischemia had to be treated and an aorto-mesenteric bypass was performed using a long saphenous vein segment. There were no complications in the postoperative period. Conclusions. A review of the literature shows that the incidence of vascular complications during laparoscopic surgery is decreasing, not reaching 3% in almost all the publications as a consequence of the better experience in these techniques. However, some of these complications are more frequent in urologic surgery, especially ligation and transection of aorta, or inferior vena cava, that are life threatening and their repair requires in most cases the conversion to open surgery

[Ulcerative colitis associated with idiopathic thrombocytopenic purpura]. / Colitis ulcerosa asociada a púrpura trombocitopénica idiopática.

Multiple hematological anomalies have been described in association with chronic inflammatory bowel disease. Idiopathic thrombocytopenic purpura is an autoimmune disease characterized by the presence of isolated thrombopenia with a normal or increased number of megakaryocytes in bone marrow and absence of splenomegaly. Several case reports of idiopathic thrombocytopenic purpura associated with chronic inflammatory bowel disease, mostly ulcerative colitis, have been published in the literature. The pathogenic mechanism through which these entities are associated is unknown. Several treatments have been used, varying from short courses of steroids to the use of immunosuppressive agents and splenectomy, depending on the severity of the symptoms. We describe the case of a woman with ulcerative colitis and idiopathic thrombocytopenic purpura, in which the latter first presented when the patient was undergoing treatment with corticosteroids and cyclosporin, one of the therapeutic options for controlling thrombopenic purpura. Platelet deficiency persisted despite treatment with azathioprine and colectomy, also described as a possible curative treatment.

Protein and lysine content, grain yield, and other technological traits in durum wheat under Mediterranean conditions.

A major problem for durum wheat production in the Mediterranean region is yield fluctuation. This fluctuation is a result of year-to-year variation in precipitation and heat stress during grain growth, which is typical of the Mediterranean climate. Both yield stability and good quality are needed in adapted durum wheat ideotypes. Ten durum wheat cultivars differing in drought resistance were grown during 1998, under both rainfed and irrigated conditions, at three sites in southern Spain. The main traits studied were protein and lysine content, grain yield, test weight, SDS sedimentation, semolina color, and grain vitreousness. Results show a high influence of site on all traits. Only test weight (TW), SDS sedimentation, grain vitreousness, and protein per kernel appeared to be determined also by cultivar effect. Vitreousness was positively correlated with TW (r = 0.48**) and semolina color (r = 0.46**). An inverse relationship was found between grain yield and protein content. Regression of cultivar mean values of protein content and grain yield showed a negative correlation (r = -0.72***), probably due to dilution of protein by non-nitrogen compounds and reduced starch accumulation in the grain under drought conditions. Lysine content was negatively associated with protein content (r = -0.86***), indicating the difficulty of a simultaneous breeding for both characteristics.

[Malignant lymphoproliferative neoplasms and chronic hepatitis C virus infection]. / Neoplasias linfoproliferativas malignas e infección crónica por el virus del la hepatitis C.

It has been suggested that chronic hepatitis C virus (HCV) infection predisposes to the development of benign and malignant lymphoproliferative disorders. We present 2 cases of malignant lymphoproliferative neoplasias (a non-Hodgkin lymphoma [NHL] and a chronic lymphoid leukemia [CLL]) associated to chronic hepatitis C virus (HCV). The possible etiological role of HCV in the development of these tumors is discussed.

[Severe gastroesophageal lesions due to caustics: the role of nutritional support]. / Lesiones gastroesofágicas graves por cáusticos: papel del soporte nutricional.

AIM: Describe the clinical-nutritional state of patients with severe digestive lesions after the ingestion of caustic substances, as well as their nutritional support (NS). PATIENTS AND METHODS: We studied 5 patients diagnosed by means of early endoscopy, treated with artificial nutrition, 4 of whom used enteral nutrition. During the acute phase of the disease, an evaluation of the nutritional state (ENS) was done, by means of the following parameters: body mass index (BMI), creatinine/height index (CHI), visceral proteins, nitrogen content of 24 h urine, and plasma zinc level. The corrected Harris-Benedict equation was used to calculate the energy needs. RESULTS: The BMI did not experience significant changes. The CHI decreased in a large degree. The long life visceral protein did not change notably, and those of intermediate and short life increased. The losses of nitrogen were increased. We found hypozincemia in 4 of the cases. The mean Kcal provided was 2323 +/- 105. CONCLUSIONS: In the described patients, given their catabolic condition, and early ENS and NS should be done. If at all possible, the NS shall be enteral, with or without parenteral support. In our study we have found a cessation of the weight loss, a decrease of somatic protein with a short term re-filling of the visceral protein pol. The zinc levels should be monitored.

[Acalculous cholecystitis and intestinal cryptosporidiosis: frequent association in HIV patients]. / Colecistitis alitiásica y cryptosporidiasis intestinal: asociación frecuente en pacientes VIH.

Five cases of acalculous cholecystitis associated with Cryptosporidium intestinal infection in HIV infected patients are reported. Clinical, Biological and Microbiological features as well as imaging studies are described. All the patients were males. Risk factors for HIV infection included previous I.V. drug abuse (3), homosexuality (1) and unknown (1). On admission a similar history of weight loss, fever, abdominal pain, diarrhea, anorexia and asthenia, together with biological data of cholestasis, was present in all patients. Ultrasound studies showed a distended gallbladder without calculi and a thickened wall, the bile duct being dilated in four of five cases. Cryptosporidium were found in stool specimens of all patients as well as histologically in one of two patients who underwent surgery while CMV was shown in the other one. Endoscopic retrograde cholangiography was performed in four cases showing a congestive, edematous and protruded papila in three patients, being normal in the fourth with a choledocal stenosis.