Resultados de la aplicación de un protocolo de alta ambulatorización en patología hemorroidal en un hospital general desde el punto de vista del paciente / Results of a high ambulatory rate protocol on the treatment of hemorrhoidal pathology from the patient point of view

El tratamiento quirúrgico de las hemorroides ha sido asociado a un periodo postoperatorio doloroso e incómodo que, clásicamente, se ha asociado a una hospitalización prolongada con el único objetivo de controlar el dolor. Actualmente, la técnica más utilizada es hemorroidectomía de Milligan-Morgan clásica, a pesar de que la tasa de ambulatorización de la patología hemorroidal va en aumento, lo que se puede traducir en un mejor control de los síntomas postoperatorios más modificaciones en la técnica quirúrgica. Nuestro centro es una joven institución con gran vocación professional y apoyo a la cirugía ambulatoria. En este contexto se ha puesto en marcha un nuevo protocolo para la ambulatorización de los procedimientos proctológicos. En este campo, la patología hemorroidal es un gran reto. Presentamos los resultados de la aplicación de este protocolo, centrándonos en el punto de vista del paciente (AU)

The surgical treatment of hemorrhoids is been associated with a postoperative painful and uncomfortable time, that classically associated a prolong hospitalization with the only objective of pain control1 . Today the classic Milligan-Morgan resection remains as the most frequent technique2 , despite this the ambulatory rate keep increasing on time, what can be indirectly explained by a better pain control plus recent technique modifications3 . Our centre is a young institution with a great professional vocation and institutional support on the “day-case” or major ambulatory surgery. In this context we initiate a protocol trying to do almost all the proctology surgery on a ambulatory or day-case way, in this onset the hemorrhoidal pathology is a great challenge. We present the data of this protocol, focusing in the patient point of view of the whole experience (AU)

Survival of Oospores of Phytophthora capsici in Soil.

This study assessed survival of Phytophthora capsici oospores in soil in Illinois. Soils differing in texture and other characteristics were collected from four Illinois Counties (Champaign, Gallatin, Madison, and Tazewell), equilibrated to -0.3 MPa, and infested with oospores of P. capsici at a density of 5 × 103 oospores/g of dry soil. Samples (25 g) of the infested soil were placed in 15-µm mesh polyester bags, which were sealed and placed at 2-, 10-, and 25-cm depths in 15.3-cm-diameter PVC tubes containing the same field soil as the infested bags. Tubes were buried vertically in the ground at the University of Illinois Vegetable Research Farm in Champaign in October 2004. Soil samples were assayed for recovery and germination of oospores 1 day and 3, 6, 12, 24, 30, 36, and 48 months after incorporation of oospores into the soil. Overall, the percentage of oospore recovery and the percentage of germination of oospores were not affected significantly by soil source and burial depth but both the oospore recovery and oospore germination were significantly (P = 0.001) affected by the duration of oospore burial. The rate of oospore recovery from soil samples was 61.06, 16.69, 10.28, 1.05, 0.30, 0.06, 0.05, and 0.004% after 1 day and 3, 6, 12, 24, 30, 36, and 48 months, respectively, following incorporation of oospores into the soil; and mean oospore germination was 47.17, 30.53, 21.33, 15.64, 7.42, 2.67, 2.61, and 0.00%, respectively. Survival of P. capsici oospores was compared in soil samples stored in a laboratory at 22°C versus on the soil surface or buried 2, 10, or 25 cm deep in a field. Oospores were recovered 1, 3, 6, 12, and 24 months after incorporation for both storage locations. The percentage of oospores recovered from samples stored in the laboratory was significantly (P = 0.004) greater than recovery from samples stored in the field, regardless of the depth of burial. Twenty-four months after incorporation of oospores, 26.52% of oospores were recovered from soil samples in the laboratory, whereas only 0.12% of oospores were recovered from soil samples in the field. Overall, the percentages of germination of oospores recovered from samples in the laboratory and field over 24 months were not significantly different. In both experiments, germinated oospores produced mycelia, sporangia, and zoospores, and were virulent on 'California Wonder' bell pepper. This study showed that oospores of P. capsici can survive and remain virulent in Illinois soils for more than 36 months but oospores were no longer viable after 48 months in soil in a field environment.

Distinct patterns of Fos immunoreactivity in striatum and hippocampus induced by different kinds of novelty in mice.

In this study the immediate-early gene Fos was used to investigate the response to different novel stimuli in a wide array of brain regions including the hippocampus, the rhinal cortex, the frontal cortex and different components of the striatal complex. Independent groups of CD-1 mice were exposed to three different novelty conditions: (1) novel environment (empty open field); (2) complex novel environment (i.e. open field containing objects); and (3) identity-based detection of novel objects. We observed that a complex novel environment and a knowledge-based novelty modulated Fos levels in both the dorsal and the ventral components of the striatum, while Fos immunoreactivity in the medial temporal lobe was only increased after exposure to novel environments, regardless of their complexity. Finally, we observed a strong increase of Fos levels in the prefrontal cortex in all the three novel conditions examined, indicating a major involvement of this structure in novelty assessment. Overall the present study demonstrates that distinct brain regions are recruited in different kinds of novelty and emphasizes the role of the striatal complex in processing complex novel information.

Role of the vomeronasal system in intersexual attraction in female mice.

Although it is generally accepted that rodents' sociosexual behavior relies mainly on chemosignals, the specific roles played by the vomeronasal and olfactory systems in detecting these signals are presently unclear. This work reports the results of three experiments aimed at clarifying the role of the vomeronasal system on gender recognition and intersexual attraction, by analyzing the effects of lesions of the accessory olfactory bulbs (AOB) in chemically naïve female mice. The first experiment demonstrates that lesions of the AOB abolish the preference that females show for male-soiled bedding in tests in which the females can contact the bedding, thus having access to both volatile and involatile male chemosignals. The second experiment shows that airborne male-derived chemosignals are not attractive to intact, chemically naïve females but tend to be preferentially explored by females whose AOB has been lesioned. However, repeated exposure to male-soiled bedding has opposite effects in sham-operated and AOB-lesioned female mice. Whereas after this experience sham-operated females show an (acquired) attraction toward male airborne chemosignals, in AOB-lesioned females the same experience makes male-derived volatiles aversive. Finally, in the third experiment we have confirmed that our AOB-lesioned females are able to detect urine-borne male odorants, as well as to discriminate them from the synthetic terpene geraniol. These findings strongly suggest that in mice, the involatile male sexual pheromone that is intrinsically attractive is detected by the vomeronasal system of the females. In addition, the repeated experience of females with male-soiled bedding would probably allow the association of this pheromone, acting as unconditioned stimulus, with olfactory stimuli (odorants) that therefore would become conditioned attractors to the females.

Quantification of Phytophthora capsici Oospores in Soil by Sieving-Centrifugation and Real-Time Polymerase Chain Reaction.

A procedure was developed to quantify Phytophthora capsici oospores in soil by combining a sieving-centrifugation method and a real-time quantitative polymerase chain reaction (QPCR) assay. Five soil samples representing three different soil textures were infested with oospores of P. capsici to produce 101, 102, 103, 104, or 105 spores per 10 g of air-dried soil. Each 10-g sample of infested soil was suspended in 400 ml of water and then passed through 106-, 63-, and 38-µm metal sieves. The filtrate was then passed through a 20-µm mesh filter. Materials caught on the filter were washed with water into two 50-ml centrifuge tubes and spun for 4 min (900 × g). The pellet was suspended in 30 ml of 1.6 M sucrose solution and centrifuged for 45 s (190 × g). The supernatant was passed through the 20-µm mesh filter. The sucrose extraction process of oospores was repeated five times to maximize oospore extraction. Materials caught on the 20-µm mesh filter were washed with water into a 50-ml tube and spun for 4 min (900 × g). The pellet was suspended in 1 ml of water, and the number of oospores was determined with a haemocytometer. The relationship between number of oospores recovered from the soil and number of oospores incorporated into the soil was Y = -0.95 + 1.31X - 0.03X2 (R2 = 0.98), in which Y = log10 of number of oospores recovered from the soil and X = log10 of number of oospores incorporated into the soil. The oospores were germinated after treatment with 0.1% KMnO4 solution for 10 min to induce germination. On the basis of the detection of ribosomal DNA, a QPCR method for P. capsici oospores was developed. PCR inhibitors were eliminated by extracting oospores from the soil by sieving-centrifugation. DNA was extracted and quantified from P. capsici oospores with suspensions of 101, 101.5, 102, 102.5, 103, 103.5, 104, 104.5, and 105 oospores per ml of water. The relationship between the DNA quantities and number of P. capsici oospores was Y = -3.57 - 0.54X + 0.30X2 (R2 = 0.93), in which Y = log10 (nanogram of P. capsici DNA) and X = log10 (number of oospores). The relationship between the quantity of DNA of P. capsici oospores recovered from the soil and the number of oospores incorporated into the soil was determined by Y = -3.53 - 0.73X + 0.32X2 (R2 = 0.955, P < 0.05), in which Y = log10 (DNA quantity of P. capsici oospores recovered from the soil) and X = log10 (number of P. capsici oospores incorporated into the soil). Utilizing the sieving-centrifugation and QPCR methods, oospores of P. capsici were quantified in soil samples collected from commercial fields.

[Subhepatic abscess as a late complication of missed intraperitoneal gallstone after laparoscopic cholecystectomy]. / Absceso subhepático como complicación tardía de un cálculo intraperitoneal abandonado tras una colecistectomía laparoscópica.

Laparoscopic cholecystectomy is the treatment of choice in symptomatic cholelithiasis. Despite its many advantages over the conventional laparotomic approach, accidental perforation of the gallbladder with spilled stones and bile leakage is frequent during this procedure. Complications from missed gallstones are uncommon, although they can sometimes lead to severe consequences. Great effort must be made to achieve laparoscopic retrieval of all the gallstones missed into the peritoneal cavity and conversion to an open procedure should be used only in selected cases. We report a case of subhepatic abscess as a late complication of a missed gallstone during a previous laparoscopic cholecystectomy.

[Primary hepatic actinomycosis]. / Actinomicosis hepática primaria.

Primary hepatic actinomycosis is a rare infection that can clinically be confused with hepatic pyogenous abscesses or neoproliferative processes. We present the case of a 71-year-old man who had previously undergone total gastrectomy for gastric adenocarcinoma. After 4 years of favorable clinical course he presented a space-occupying lesion in the right hepatic lobe. Diagnostic tests were nonspecific and the diagnosis was confirmed by histological study of a biopsy of the lesion obtained through laparotomy. Prolonged antibiotic treatment produced a complete response. The etiopathogenesis and diagnostic-therapeutic options of hepatic actinomycosis are reviewed.

Enfisema submucoso gástrico / Gastric Submucosal emphysema

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Rotura espontánea de la vena ilíaca / Spontaneous iliac vein rupture

Se presenta el caso de un paciente varón intervenido quirúrgicamente por shock hipovolémico secundario a una rotura espontánea de la vena ilíaca común izquierda, tratado con ligadura de la vena. La rotura espontánea de la vena ilíaca es una rara urgencia vascular de etiología incierta, con frecuencia confundida con un sangrado arterial intraabdominal. Se realiza una revisión de los casos descritos en la literatura, comentando las formas más frecuentes de presentación, posibles mecanismos desencadenantes y manejo perioperatorio. Las medidas intensivas de estabilización y un tratamiento quirúrgico urgente son fundamentales para poder reducir la elevada mortalidad de esta causa infrecuente de hemorragia exanguinante (AU)

Splenic and adrenal lymphangiomatosis.

Lymphangiomatosis is a rare syndrome that can affect different organs, although simultaneous splenic and adrenal involvement is exceptional. We report the case of a young female with a symptomatic massive splenomegaly and no-nhypersecreating bilateral adrenal masses incidentally discovered that represented a diagnostic challenge. The management of adrenal incidentalomas is controversial, as the presence of large sized bilateral masses are highly indicative of malignancy. Despite the different diagnostic techniques available, it is sometimes impossible to reach an accurate preoperative diagnosis. Elective splenectomy and left adrenalectomy were performed, preserving the functioning of the right adrenal gland, radiologically similar to the left one, to prevent the development of definitive adrenal insufficiency. Postoperative evolution has been favourable without initial increase of the size of the right adrenal lesion. However, the persistence of this mass obligated long-term follow-up and shall assist us in better understanding the behavior of this bening lesion.

Miofibroblastoma de mama en un paciente varón / Myofibroblastoma of the breast in a male patient

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Tratamiento de lumbalgias en el puerperio mediante reeducación sensitivo-perceptivo-motriz / Treatment back pain in the puerperant with sensory-perceptive-motor re-education

Durante el embarazo se producen una serie de alteraciones mecánicas en el segmento lumbopélvico que conllevarán una lesión total o parcial de algunos receptores, con la consiguiente modificación de la cantidad y calidad del mensaje aferente sensorial, que a su vez alterará la percepción y en consecuencia los programas motores. Esto puede provocar una lumbalgia mecánica crónica debido a una perturbación del bucle funcional sensitivo perceptivo motor entre el sistema nervioso y el efector (músculo, articulación). Para resolver el problema no debemos contentarnos con reeducar únicamente el aspecto motor, ya que no es suficiente estimular una parte del bucle para que el paciente se recupere de la patología, hay que estimular el conjunto funcional. Para prevenir nuevos episodios lumbálgicos enseñaremos al paciente cómo proteger mecánicamente su segmento lumbopélvico mediante ejercicios de reeducación sensitivo perceptivo motriz, para ello atenderemos a una serie de etapas: estimulación de receptores cutáneos, estimulación de receptores articulares y musculares, toma de conciencia de la posición del raquis lumbar, solicitaciones sobre planos estables y posteriormente sobre planos inestables. (AU)

Human renal cell carcinoma xenografts in SCID mice: tumorigenicity correlates with a poor clinical prognosis.

To establish human renal cell carcinoma (RCC) xenografts for preclinical studies, 55 renal tumors (33 primary and 22 metastatic lesions) were transplanted subcutaneously into severe combined immunodeficient mice. Twenty of 49 evaluable tumors (40.8%) grew with a median latency period of 89 days (36 to 209 days) from the day of engraftment. Tumor growth was stabilized after the fifth passage with a median time between passages of 38 days (19 to 80 days). Tumorigenicity was correlated with the metastatic phenotype of the tumor (54% success rate, p = 0.007) and with reduced survival of patients. Despite a possible evolution of histological features and tumor grading, established RCC xenografts were comparable to parental tumors, as assessed by karyotype and DNA-ploidy analyses. Molecular cytogenetic analysis also revealed specific genetic alterations characterizing distinct RCC types that were constant in parental and corresponding xenografts. In addition, this xenograft model has permitted the selection of minor tumor subclones with a proliferative advantage and minimal overexpressed chromosomal regions. We conclude that severe combined immunodeficient mice are useful recipients for the establishment of long-term RCC xenografts that can be used as valuable tools to evaluate the activity of new therapeutic approaches and to study biological parameters determining in vivo aggressiveness of human RCC.

Management of lower gastrointestinal bleeding in colonic diverticular disease.

AIM: To evaluate the clinical course, diagnostic approach, therapeutic measures and results, in a series of 13 patients with colonic bleeding diverticula. MATERIAL AND METHODS: From 1973 to 1995, 72 patients were admitted with the diagnosis of lower gastroin testinal bleeding. Thirteen presented a colonic diverticula bleeding. Mean age was 65.2 years. Medical history, symptoms, diagnosis, treatment (conservative or surgical) and pathology were recorded. RESULTS: Main bleeding time was 3 days. Eight patients needed blood transfusion. All patients underwent colonoscopic examination and it was diagnostic in every patient. Four patients underwent surgery: one case, because of massive hemorrhage and the other three cases due to bleeding recurrence. Pancolectomy was performed in one patient, ileal resection in another and the other two were treated with a sigmoidectomy and a left hemicolectomy. Pathology analysis corroborated colonic diverticula diagnosis. There was no postoperative mortality. Bleeding recurrence did not occur either in postoperative period or in the follow-up. CONCLUSIONS: Colonic diverticular bleeding usually stops spontaneously, obtaining high rates of preoperative diagnosis with colonoscopy. Less than a third of the cases requires surgical resection.

Overrepresentation of 7q31 and 17q in renal cell carcinomas.

Xenografts from four metastatic renal cell carcinomas (RCCs) were established in immunodeficient mice. All tumors exhibited cytogenetic features specific for the papillary subtype, namely, partial or total polysomy of chromosomes 7 and 17 and integrity of 3p. Cytogenetic analysis of the initial and xenografted tumors indicated that although clonal characteristics were consistently maintained in xenografts derived from metastases, a minor clone had been selected for in the xenografts derived from the primary tumors. Reverse painting and comparative genomic hybridization (CGH) allowed us to localize minimal overrepresented genomic regions to 7q31, where the MET protooncogene is located, and to 17q. Other overrepresented regions were 8q in all xenografts and Xq22-qter in three of them. The gain of genetic material from these regions may be a key factor ensuring the papillary nature of RCCs and their survival in xenografts.

Diagnostic and treatment of Zenker's diverticulum: review of our series pharyngo-esophageal diverticula.

BACKGROUND/AIMS: Clinical aspects and preneoplastic potential of Zenker's diverticulum justify its surgery. The clinical signs of the patients and the size of the diverticulum determine the surgical technique. METHODOLOGY: Between January 1974 and December 1995, 32 patients underwent surgery in our department. In order to compare the surgical technique, we divided the patients into 3 groups: group A (cricopharyngeus myotomy: 15 patients (46.9%)), group B (myotomy with diverticulectomy: 15 patients (46.9%)) and group C (myotomy with diverticulopexy: 2 patients (6.7%)). The chi-square test was used for statistical analysis, p < 0.05. RESULTS: Local or regional anaesthesia was used in 7 patients from group A (46.6%); 5 patients from group B (33.3%) and all the patients from group C (100%). General anaesthesia was used in 8 patients from group A (53.4%), 10 patients from group B (66.7%) and 0 patients from group C (0%). The overall mortality was 0%. The mean postoperative stay in group A was 6 +/- 2 days (3-10 days); in group B was 11.6 +/- 6.4 days (5-25 days) and in group C was 3.5 +/- 0.7 days (3-4 days). The mean postoperative stay in patients with local or regional anaesthesia was 5.3 +/- 1.6 days (3-9 days) and in patients with general anaesthesia, 10.9 +/- 6.1 days (4-25 days). No statistically significant difference was found between the anaesthetic technique and the surgical technique (p = 0.193), between the surgical technique and the mean postoperative stay (p = 0.596) and between the anaesthetic technique and the mean postoperative stay (p = 0.166). CONCLUSIONS: Cricopharyngeus myotomy is the main surgical technique, however, in diverticula longer than 3 cm of diameter it is mandatory to associate diverticulectomy. Diverticulopexy is indicated in patients of advanced age with a high surgical risk. Local or regional anaesthesia facilitates the identification of the diverticulum intraoperatively and reduce the mean postoperative stay, however, there is no statistical significant difference.

Hematological reconstitution and gene therapy: retroviral transfer of the bacterial beta-galactosidase activity into human hematopoietic CD34+ cell populations and into T lymphocytes derived from the peripheral blood.

We report the possibility to transfer marker genes coding for beta-galactosidase activity using retroviral vectors into human peripheral blood CD34+ cells, peripheral blood T-lymphocytes and into the growth factor-dependent human hematopoietic cell line TF-1. Using the MFG-nisLacZ and the FLac vector and various packaging cell lines, we demonstrated retroviral transfer and high expression of a bacterial beta-galactosidase activity induced by the nisLacZ gene or the Sh-ble/LacZ gene. Kinetics of expression of the transgenes were analyzed both in primary cells and cell lines. Absence of cytotoxicity related to the expression of the bacterial beta-galactosidase was assessed in both cell types. These results open interesting prospectives for the use of the beta-galactosidase activity to mark and follow the fate of genetically modified cells isolated from patients prior to reimplantation.

Retroviral transfer of the nlsLacZ gene into human CD34+ cell populations and into TF-1 cells: future prospects in gene therapy.

Few data are available concerning behavior of reimplanted human hematopoietic cells after autologous stem cell transplantation. This paper reports the possibility to transfer gene markers coding for beta-galactosidase (beta-Gal) activity by retroviral vectors into a human leukemic growth factor-dependent cell line, TF-1, and into human hematopoietic progenitors isolated from peripheral blood or bone marrow. Using various combinations of retroviral vectors and packaging cell lines, we demonstrated high expression of a bacterial beta-Gal activity induced by the LacZ gene, the nlsLacZ gene, or the Sh-ble/LacZ gene, in human hematopoietic cells. The expression of the nlsLacZ construct was stable until the end of the culture in infected CD34+ cell-enriched cell populations, and a slow decrease of transgene expression was observed in a transduced TF-1 cell population during a 1-year long-term culture. Data obtained with the nlsLacZ gene demonstrate that both retroviral transfer and corresponding gene expression were not found to modify the pattern of cell proliferation and differentiation. These results open interesting prospectives for the use of the nlsLacZ gene to mark and follow the fate of progenitor cells isolated from patients with cancers prior to reimplantation.