Complicaciones de la esplenectomía. Análisis de nuestra casuística / Complications in splenectomy. An analisys of our case history

La esplenectomía es una técnica quirúrgica común en los servicios de cirugía general, y sus indicaciones habituales son médicas, traumáticas e iatrogénicas. Las correspondientes al primer grupo han aumentado a pesar de la mejora de los medios diagnósticos. Las segundas han disminuido con el control en los servicios de cuidados intensivos y el uso de técnicas conservadoras. Se ha revisado la casuística de nuestro hospital, comparándola con la del resto de la bibliografía, y se ha comprobado que las complicaciones postoperatorias fundamentalmente han sido las respiratorias y el absceso subfrénico. Se corrobora, también, cómo esta última ha tenido gran incidencia en las esplenectomías iatrogénicas, siendo un factor esencial en la morbimortalidad, de tal modo que muchos autores llevan a contraindicar la esplenectomía en el transcurso de cirugía contaminada. Nuestros resultados han sido escasos en relación con la infección grave postesplenectomía, al igual que en otras series; por tanto, la profilaxis correcta (inmunoterapia y antibioterapia) ejerce un papel esencial en la disminución de su incidencia (AU)

Cell therapy to repair injured spinal cords: olfactory ensheathing glia transplantation.

The absence of spontaneous axonal regeneration in the adult mammalian central nervous system cause devastating functional consequences in patients with spinal cord injuries. During the past decades several attempts have been made in order to find a strategy to repair injured spinal cords in experimental animals, that could provide a novel therapeutic approach in humans. Cell transplantation has been broadly used as an intervention to influence neuronal survival and axonal regeneration in the severed neuraxis. Of the cell types used for transplantation, olfactory ensheathing glia (OEG) promoted a dramatic functional improvement and anatomical repair after complete transection of the adult mammalian spinal cord. These cells can be easily obtained from adult donors opening the possibility of autologous transplantation. Grafting OEG to repair injured spinal cords offers some advantages compared to injections of other cell types. Therefore, OEG have become good candidates to bring about repair in damaged spinal cords. In this article we review OEG transplantation studies, discuss the properties that could account for their axonal growth-promoting ability, and the advantages of using OEG as a repair strategy.

Functional recovery of paraplegic rats and motor axon regeneration in their spinal cords by olfactory ensheathing glia.

Axonal regeneration in the lesioned mammalian central nervous system is abortive, and this causes permanent disabilities in individuals with spinal cord injuries. In adult rats, olfactory ensheathing glia (OEG) transplants successfully led to functional and structural recovery after complete spinal cord transection. From 3 to 7 months post surgery, all OEG-transplanted animals recovered locomotor functions and sensorimotor reflexes. They presented voluntary hindlimb movements, they supported their body weight, and their hindlimbs responded to light skin contact and proprioceptive stimuli. In addition, relevant motor axons (corticospinal, raphespinal, and coeruleospinal) regenerated for long distances within caudal cord stumps. Therefore, OEG transplantation provides a useful repair strategy in adult mammals with traumatic spinal cord injuries. Our results with these cells could lead to new therapies for the treatment of spinal cord lesions in humans.

Diarrea crónica por fístula biliocolónica posperitonitis biliar / Chronic diarrhea secondary to biliary-enteric fistula developing after bile peritonitis

La fístula biliocolónica posperitonitis biliar es muy infrecuente. Su sintomatología dominante es la diarrea crónica y las consecuencias derivadas de la misma. El diagnóstico es dificultoso porque las pequeñas comunicaciones entre el árbol biliar y el colon no son fáciles de demostrar. Se comenta la historia clínica de una paciente de 84 años de edad que, tras múltiples exploraciones, fue diagnosticada por colangiografía transparietohepática (CTPH) y la reintervención quirúrgica solucionó la afección. Se aclaran los mecanismos de producción de la fuga, así como la fisiopatología de la esteatorrea. A la luz de la bibliografía se hace hincapié en la conveniencia de la colecistectomía precoz en los casos de colecistitis aguda como medio para evitar ésta y otras complicaciones (AU)

Protective effect of exogenous nitric oxide on the renal function and inflammatory response in a model of ischemia-reperfusion.

BACKGROUND: Tissue subjected to a period of ischemia undergoes morphological and functional damage that increases during the reperfusion phase. The aim of the present work was to assess the possible improvement induced by exogenous administration of nitric oxide (NO) on renal injury and inflammatory reaction in an experimental animal model of renal ischemia-reperfusion (I-R). METHODS: Ischemia was achieved by ligation of the left arteria and vein for 60 min, followed first by contralateral nephrectomy and then reestablishment of blood flow. Molsidomine, used as an NO donor, was administered by systemic injection 30 min before reperfusion. The effect of molsidomine was compared with the effect of hydralazine, a non-NO donor hypotensive agent. RESULTS: Treatment with molsidomine improved the renal dysfunction (increase in plasma creatinine and urea levels) caused by I-R. Moreover, molsidomine blunted the enhanced production of proinflammatory cytokines (tumor necrosis factor [TNF]-alpha and interleukin [IL] 1alpha), the increase in tissular levels of superoxide anions and oxygen free radical scavengers, and the neutrophilic infiltration observed in the ischemic kidney. One hundred percent survival was achieved in the group of animals treated with the NO donor, whereas the groups of animals undergoing I-R that did not receive molsidomine showed a 40% mortality from the second day after reperfusion. CONCLUSIONS: The present work demonstrated that systemic treatment with an NO donor before reperfusion improved renal function and diminished inflammatory responses in a kidney subjected to an I-R process.

Inhibition of proliferation of normal and transformed neural cells by blood group-related oligosaccharides.

A synthetic tetrasaccharide structurally related to blood groups and selectin ligands inhibited division of astrocytes, gliomas, and neuroblastomas at micromolar concentrations. The compound was cytostatic for primary astrocytes in culture, but cytotoxic for fast proliferating cell lines.

Survival of Purkinje Cells in Cerebellar Cultures is Increased by Insulin-like Growth Factor I.

Insulin-like growth factor I (IGF-I) is a trophic factor for both neurons and glia. Its presence in the developing and adult cerebellum suggests a role for this growth factor in this area of the brain. Recently, we have described the existence of an IGF-I-containing pathway in afferents of Purkinje neurons arising from the inferior olive. In addition, IGF-I receptors are present in the molecular layer of the cerebellar cortex. These observations prompted us to investigate whether the Purkinje cell is a target for IGF-I. Addition of IGF-I to rat cerebellar cultures produced a 7-fold increase in the number of Purkinje cells (calbindin-positive) together with an increase in the calbindin content of the cultures. IGF-I also doubled the number of surviving neurons and produced a moderate, non-significant increase in [3H]thymidine incorporation by the cultures. On the other hand, basic fibroblast growth factor (bFGF), which is also present in the cerebellum, produced a dramatic increase in both the proportion of astrocytes and in the mitotic activity of the cultures, without affecting neuron survival. We conclude that IGF-I is a specific promoter of Purkinje cell survival and that its effects differ from those produced by bFGF in fetal cerebellar cultures. These findings reinforce our hypothesis that the Purkinje cell is a target neuron for IGF-I action in the developing cerebellum.

Choline acetyltransferase activity in the rat brain cortex homogenate, synaptosomes, and capillaries after lesioning the nucleus basalis magnocellularis.

Stereotaxic lesions of the nucleus basalis magnocellularis were made unilaterally in male Wistar rats with either kainic or ibotenic acid, using the contralateral side as control. Differences in behavior, body weight, and survival were observed between the kainic and ibotenic acid-treated rats. One week after surgery, the rats were sacrificed and the effect of the lesions on choline acetyltransferase activity was measured in brain cortex homogenate, synaptosomes, and capillaries. In kainic acid-lesioned rats, choline acetyltransferase activity decreased in homogenate and synaptosomes of the ipsilateral side with respect to that of the contralateral side; but the ibotenic acid lesion, which also reduced the ipsilateral choline acetyltransferase activity in homogenate, showed a rather different effect on the enzymatic activity of the synaptosomes. There were also differences between the effect of kainic and ibotenic acid lesions on choline acetyltransferase activity in the capillaries of the ipsilateral side with respect to that of the contralateral one. However, capillary choline acetyltransferase activity of the treated rats was in both sides three times higher than that of unoperated rats.

Decrease of choline acetyltransferase activity of rat cortex capillaries with aging.

Choline acetyltransferase (ChAT) activity was estimated in brain cortex capillaries isolated from 3-, 12-, 18-, and 24-month-old rats. Maximum enzymatic activity was found at 12 months (55 +/- 0.3 pmol X mg-1 protein X min-1; mean +/- SEM) and then it decreased to reach a minimum at 24 months (34 +/- 3.1 pmol X mg-1 protein X min-1). A less marked decrease of enzymatic activity was also found in cortex homogenate and in a synaptosomal fraction obtained from the same groups of rats. Loss of ChAT of brain capillaries with aging could be related to a general phenomenon of cortical cholinergic deficit in that condition.

Isolation, purification and characterization of spleen ferritin of Gallus domesticus L.

The ferritin from the spleen of the chickens has been isolated by a method of salt fractionation and by a pH change followed by purification in sephadex G-200. 2. The identification of the protein was carried out by acrylamide gel electrophoresis showing a single band. 3. The characterization of ferritin has been made by determination of molecular weight, amino acids analysis and the number of iron atoms (4520) which bound the ferritin. 4. The ferritin from the spleen of chicken is compared with the ferritin from the liver of pigeon.