RESUMO
Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. Its pathophysiology and clinical course vary, depending on the cause of the primary liver injury, and can lead to high morbidity and mortality or the need for liver transplantation, despite available therapies. This syndrome involves excessive activation of the immune system, with damage in other organs, contributing to its high mortality rate. The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. Survival has improved with supportive measures, intensive therapy, complication prevention, and the use of medications, such as N-acetylcysteine. Liver transplantation is a curative option for nonresponders to medical treatment, but adequate evaluation of transplantation timing is vital for improving results. Factors such as patient age, underlying cause, and severity of organ failure influence the post-transplant outcomes and survival.
Assuntos
Falência Hepática Aguda , Humanos , Falência Hepática Aguda/terapia , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/diagnóstico , Prognóstico , Transplante de FígadoRESUMO
Affectations of the opioid system have been related to exacerbated alcohol consumption. The objectives of this work were to assess whether a deficit of ß-endorphinergic neurons differentially affects alcohol intake in female rats with low (LC) and high alcohol consumption (HC), and to determine changes in the µ-opioid receptors (MOR) related to alcohol consumption and chronic exposure to alcohol in structures of the mesolimbic system. Female wild-type rats were selected according to their baseline alcohol intake levels and then exposed to chronic voluntary alcohol consumption after a single injection of either the vehicle or estradiol valerate (EV) to produce a ß-endorphin neuronal deficit. Changes in alcohol consumption and MOR expression levels were assessed in the nucleus accumbens (NAc), amygdala (Amy) and ventral tegmental area (VTA) at 5 and 10 weeks after EV treatment. The LC rats increased alcohol intake from baseline to the initial weeks after EV treatment and this consumption remained stable throughout the studied period. In contrast, alcohol consumption increased steadily over time in the HC rats. The HC vehicle rats had a 38% higher MOR protein expression in the NAc than the LC vehicle rats. In addition, chronic alcohol consumption increased MOR expression in the Amy regardless of consumption level, whereas EV treatment produced a decrease in MOR expression in the VTA in all groups. These results suggest intrinsic differences in MOR expression related to alcohol consumption levels. Also, the EV treatment and chronic exposure to alcohol produced adaptive changes in MOR expression.
Assuntos
Consumo de Bebidas Alcoólicas/metabolismo , Tonsila do Cerebelo/metabolismo , Depressores do Sistema Nervoso Central/farmacologia , Endorfinas/metabolismo , Estradiol/farmacologia , Etanol/farmacologia , Núcleo Accumbens/metabolismo , Receptores Opioides mu/metabolismo , Área Tegmentar Ventral/metabolismo , Alcoolismo/metabolismo , Tonsila do Cerebelo/efeitos dos fármacos , Animais , Depressores do Sistema Nervoso Central/administração & dosagem , Modelos Animais de Doenças , Endorfinas/efeitos dos fármacos , Estradiol/administração & dosagem , Etanol/administração & dosagem , Feminino , Núcleo Accumbens/efeitos dos fármacos , Ratos , Ratos Wistar , Receptores Opioides mu/efeitos dos fármacos , Área Tegmentar Ventral/efeitos dos fármacosRESUMO
Se describe el caso de un canino mestizo hembra de ocho años de edad que presentó historia de diez días de letargia, anorexia, pérdida de peso, vómito ocasional, tos esporádica y dificultad respiratoria; los hallazgos clínicos, radiográficos y ultrasonográficos sugirieron como diagnóstico diferencial más probable torsión lobar pulmonar del lóbulo medio derecho, lo cual se confirmó mediante toracotomía exploratoria. El manejo terapéutico incluyó resección del lóbulo afectado; no se identificó ninguna etiología subyacente. La paciente tuvo una recuperación completa de la torsión lobar; sin embargo, dos semanas después de la cirugía presentó claudicación severa del miembro anterior derecho y se encontraron hallazgos radiográficos compatibles con neoplasia ósea en la epífisis proximal del húmero. Por decisión de los propietarios sólo se realizó manejo analgésico y un mes después se practicó eutanasia debido a una posible metástasis pulmonar. Es posible que la neoplasia y posible metástasis se tratasen de eventos concomitantes sin relación causa-efecto; sin embargo, pudo haber existido una asociación entre un proceso estresante y traumático (la torsión pulmonar) con el desarrollo y manifestación de una patología oncológica subyacente.
In this report, the case of a mixed-breed, female intact, eight-year- old dog, that was presented with a ten-day history of lethargy, anorexia, weight loss, occasional vomiting, coughing and sporadic dispnea is described; the clinical, radiographic and ultrasonographic findings suggested as the most likely diagnosis a lung lobe (right middle) torsion, which was confirmed by means of an exploratory thoracotomy; the therapy included resection of the affected lobe; no underlying etiology was identified. The patient recovered fully from the lobar torsion; however, two weeks after surgery the dog showed severe right forelimb lameness and the radiographic findings suggested a bone tumor in the proximal epiphysis of the humerus; the owners allowed only analgesic therapy and one month later the patient was euthanized due to a possible lung metastases; it is possible that the neoplasm and the metastases were concomitant events without a cause-effect relationship; however, there might also have been an association between a traumatic and stressing process (the lung torsion) with the development of an underlying oncologic process.
RESUMO
Un canino macho Cocker Spaniel de 6 meses de edad fue presentado a la Clínica para Pequeños Animales de la Universidad Nacional de Colombia, con historia de vómito y diarrea de una semana de duración. El paciente presentaba hiperkalemia, y los electrocardiogramas realizados fueron compatibles con este hallazgo. El diagnóstico de hipoadrenocorticismo primario fue confirmado mediante la realización de una prueba de estimulación con ACTH. Posteriormente a la muerte súbita del paciente, el examen microscópico de las glándulas adrenales reveló cambios histológicos compatibles con la enfermedad de Addison. El hipoadrenocorticismo primario es un desorden endocrino poco común que afecta principalmente pacientes caninos; está caracterizado por la destrucción inmunomediada de las cortezas adrenales, lo cual conduce a deficiencia de glucocorticoides, mineralocorticoides y hormonas sexuales adrenales. La historia de los pacientes afectados es variable y los signos clínicos son usualmente inespecíficos; las pruebas de laboratorio, por lo general, revelan hiperkalemia e hiponatremia, resultantes de la pérdida de la secreción de aldosterona. La historia, el examen clínico, la ecografía abdominal y los hallazgos de laboratorio pueden indicar enfermedad de Addison, sin embargo, la prueba de estimulación con hormona adrenocorticotrópica (ACTH) es considerada como la prueba de oro para el diagnóstico definitivo de la entidad. La enfermedad de Addison no tiene cura, pero puede ser manejada con terapia médica para reemplazar las deficiencias de mineralocorticoides y glucocorticoides.
Six month old, male Cocker Spaniel was presented to the Small Animal Clinic at the Universidad Nacional de Colombia with a one week history of vomiting and diarrhea. The patient was hyperkalemic and the electrocardiogram results were consistent with this finding. The diagnosis of primary hypoadrenocorticism was confirmed by performing an ACTH stimulation test. Following the patient’s sudden death, micros copic examination of the adrenal glands revealed histologic changes consistent with Addison`s disease. Primary hypoadrenocorticism is an uncommon endocrine disorder that primarily affects canine patients. The disorder is caracterized by the immune-mediated destruction of the adrenal cortices, resulting in mineralocorticoid, glucocorticoid and adrenal sex hormone deficiencies. Patient history is variable and clinical signs are often nonspecific; laboratory testing commonly reveals hyperkalemia and hyponatremia resulting from lack of aldosterone secretion. Clinical history, physical exam, abdominal ultrasound and laboratory findings may indicate Addison disease, however, the adrenocorticotrophic hormone (ACTH) stimulation test is considered to be the gold standard for definitive diagnosis of primary hypoadrenocortisism. Addison disease is not curable but can be managed with pharmaceutical therapy that replaces the mineralocorticoids and glucocorticoids deficiency.
RESUMO
The use of small-diameter portosystemic shunts for the treatment of bleeding esophageal varices caused by portal hypertension has emerged as an outgrowth of the development of polytetrafluoroethylene vascular grafts, which allow the use of a narrow lumen. We report our experience with this type of graft over a 10-year period. Thirty-three patients with good liver function (Child-Pugh class A) were electively operated. The average age of these patients was 45 years (range 17 to 71 years). Twenty-nine patients had liver cirrhosis, one had portal fibrosis, and three had idiopathic portal hypertension. Operative mortality was 3%, and the rebleeding rate was 15%. Postoperative encephalopathy was observed in 14 patients (11%), three of whom had grade III to IV encephalopathy. The remaining 11 patients, had mild encephalopathy that was easily controlled. Postoperative angiography showed shunt patency in 81% of the patients, reduction in portal vein diameter in 33% of the patients, and portal vein thrombosis in 6%. Good postoperative quality of life was observed in 63% of the patients. Survival according to the Kaplan-Meier actuarial method was 81% at 12 months, 56% at 60 months, and 36% at 10 years. These shunts are a good alternative for patients being considered for surgery in whom other portal blood flow preserving procedures (i.e., elective shunts, devascularization with esophageal transection) are not feasible.
Assuntos
Implante de Prótese Vascular , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Hipertensão Portal/etiologia , Veias Mesentéricas/cirurgia , Derivação Portossistêmica Cirúrgica/métodos , Veias Cavas/cirurgia , Adolescente , Adulto , Idoso , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/complicações , Humanos , Cirrose Hepática/complicações , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
OBJECTIVE: To compare three options for the elective treatment of portal hypertension during a 10-year period. METHODS: Patients included in the trial were 18 to 76 years old, had a history of bleeding portal hypertension, and had undergone no prior treatment. Treatment options were beta-blockers (propranolol), sclerotherapy, and portal blood flow-preserving procedures (selective shunts and the Sugiura-Futagawa operation). RESULTS: A total of 119 patients were included: 40 in the pharmacology group, 46 in the sclerotherapy group,and 33 in the surgical group. The three groups showed no differences in terms of age, Child-Pugh classification, and cause of liver disease. The rebleeding rate was significantly lower in the surgical group than in the other two groups. The rebleeding rate was only 5% in the Child A surgical group, compared with 71% and 68% for the sclerotherapy and pharmacotherapy groups, respectively. Survival was better for the low-risk patients (Child A) in the three groups, but when the three options were compared, no significant difference was found. CONCLUSIONS: Portal blood flow-preserving procedures offer the lowest rebleeding rate in low-risk patients undergoing elective surgery.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Hemorragia/etiologia , Hemorragia/terapia , Hipertensão Portal/complicações , Hipertensão Portal/terapia , Propranolol/uso terapêutico , Escleroterapia , Varizes/etiologia , Varizes/terapia , Adolescente , Adulto , Idoso , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escleroterapia/métodos , Fatores de TempoRESUMO
En el manejo de las disfonías y de las diferentes patologías laríngeas la estroboscopia es la ayuda diagnóstica más precisa, pues nos permite un análisis de las diferentes estructuras laríngeas tanto en fonación como en reposo. Este método de diagnóstico clínico de consultorio, permite observar la función de las cuerdas vocales y analizar en detalle sus características vibratorias a saber: perceptuales (simetría, periodicidad, cierre glótico, amplitud, onda mucosa); y acústicas (frecuencia fundamental e intensidad)
Assuntos
Equipamentos para Diagnóstico/tendências , Doenças da LaringeRESUMO
A technique for intrahepatic reconstruction of the biliary tree after complex high injuries is described. The fundament of the procedure is the removal of a wedge of segment IV at the level of the hilar plate. When the hilar plate is reached and no adequate exposure of the ducts can be obtained, removing a 1 x 1-in wedge of segment IV between the gallbladder bed and the round ligament exposes the left and right ducts. An anteroposterior view of the plate is obtained instead of a caudocephalic dissection, exposing healthy, nonscarred ducts for reconstruction. We have used this approach in 22 patients, and adequate exposure of the ducts has been obtained, with a high success rate of patency of the anastomosis at a mean follow-up of 3 years. Twenty patients have a patent anastomosis, with a good quality of life and no restenosis.
Assuntos
Ductos Biliares/lesões , Ductos Biliares/cirurgia , Complicações Intraoperatórias/cirurgia , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Heat shock protein 101 (HSP101) cDNA and genomic clones from maize have been isolated. The structure of maize HSP101 reveals the presence of six exons interrupted by five introns. Maize HSP101 contains a predicted open reading frame that translates into a 912-aa sequence with a mass of 101kDa. Initiation of transcription was mapped 146 bases upstream of the AUG codon. Five heat shock element (HSE) boxes were found within the proximal 289 bases of the promoter region. Southern blot analysis of genomic DNA indicates that the maize genome contains only one copy of HSP101. A protein sequence comparison showed that maize Hsp101 belongs to the heat shock 100kDa and caseino-lytic protease B protein family (Hsp100/ClpB) that plays important roles in bacteria and yeast in the survival to extremely high temperatures and the control of proteolysis. Accumulation of HSP101 mRNA was strong under heat shock conditions, but not detectable after cold or osmotic stress treatments or by exogenous application of ABA. The analysis of the predicted supersecondary structure of maize Hsp101 showed that a coiled-coil located in the middle region of the protein is evolutionarily conserved in all members of the Clp A, B and C subfamilies. It is proposed that these supersecondary structures may have important roles in Clp function.
Assuntos
Proteínas de Choque Térmico/genética , Proteínas de Plantas/genética , Fatores de Transcrição/genética , Zea mays/genética , Sequência de Bases , Clonagem Molecular , Evolução Molecular , Regulação da Expressão Gênica de Plantas/genética , Dados de Sequência Molecular , Filogenia , Regiões Promotoras Genéticas , Estrutura Secundária de Proteína , RNA Mensageiro/metabolismo , Fatores de Transcrição/química , Transcrição GênicaRESUMO
PIP: The impact of the mass media on woman's status was addressed at two 1995 conferences: the Fourth World Conference on Women, held in Beijing, China, and the Congress of the World Association for Christian Communication, held in Puebla, Mexico. The globalization process facilitated by the mass media has served to increase the power of patriarchy, with no advantages to the cause of women's rights. Coverage of popular movements has been suppressed out of deference to male-controlled governments. Coverage of the Beijing Conference highlighted celebrities and personal stories, to the exclusion of the economic and political issues under debate. Television has commodified women, reinforcing their oppression. On the other hand, the alternative media, which tend to be decentralized, democratic, low-cost, and low in technology, are presenting women as subjects rather than objects and deconstructing gender stereotypes. Of concern, however, is the tendency of computer technology to widen the gap between social classes and developed and developing countries. Women must use information networks to disseminate information on women's rights and strengthen the links between women throughout the world.^ieng