A bizarre foreign body in the appendix: A case report

Foreign bodies are rare causes of appendicitis and, in most cases, ingested foreign bodies pass through the alimentary tract asymptomatically. However, ingested foreign bodies may sometimes remain silent within the appendix for many years without an inflammatory response. Despite the fact that cases of foreign-body-induced appendicitis have been documented, sharp and pointed objects are more likely to cause perforations and abscesses, and present more rapidly after ingestion. Various materials, such as needles and drill bits, as well as organic matter, such as seeds, have been implicated as causes of acute appendicitis. Clinical presentation can vary from hours to years. Blunt foreign bodies are more likely to remain dormant for longer periods and cause appendicitis through obstruction of the appendiceal lumen. We herein describe a patient presenting with a foreign body in his appendix which had been swallowed 15 years previously. The contrast between the large size of the foreign body, the long clinical history without symptoms and the total absence of any histological inflammation was notable. We suggest that an elective laparoscopic appendectomy should be offered to such patients as a possible management optio

Cellular and molecular basis of progesterone-induced neuroprotection

Progesterone exerts several effects in the central nervous system not directly involved in reproduction or sex behavior. Non-reproductive effects are better observed under pathological conditions, and include stimulation of myelin formation, neurogenesis and neurosteroidogenesis, preserved mitochondrial function, neuroprotection, anti-inflammatory effects, decreased glutamate excitotoxicity, and regulation of mood, memory and cognition. In addition, the progesterone reduced derivative allopregnanolone shows anxiolytic, sedative and anesthetic properties after binding to GABAa receptors. In the present report we provide examples of [1] progesterone effects on the local synthesis of steroids (“neurosteroids”) in a demyelination model, [2] the requirement of the classical progesterone receptor for the antiinflammatory effects in mice with spinal cord injury, and [3] the protective role of progesterone and allopregnanolone in a mouse model of neurodegeneration. In conclusion, the beneficial effects observed in different experimental paradigms support the versatile properties of progesterone in animal models of central nervous system disorders.La progesterona produce varios efectos en el sistema nervioso central no relacionados a la reproducción o comportamiento sexual. Estos efectos adicionales se observan preferentemente bajo condiciones patológicas, e incluyen la estimulación de la formación de mielina, la neurogenesis y neuroesteroidogenesis, el mantenimiento de la función mitocondrial, efectos anti-inflamatorios, disminución de la excitotoxicidad del glutamato y regulación del humor, memoria y conocimiento. En agregado, el derivado reducido de progesterona – alopregnanolona – muestra propiedades ansiolíticas, sedantes y anestésicas luego de su unión al receptor GABAa. Este Minireview detalla los efectos de progesterona sobre [1] la síntesis local de esteroides (“neuroesteroides”), en un modelo de desmielinizacion, [2] ejemplifica el requerimiento del receptor clásico de progesterona para los efectos anti-inflamatorios en un modelo de injuria espinal en ratón, y finalmente [3] discute el rol protector de la progesterona y de la alopregnanolona en un modelo murino de degeneración de motoneurona. Como conclusión, los efectos beneficiosos mostrados en diferentes paradigmas experimentales apoyan las propiedades versátiles de la progesterona en modelos de patologías del sistema nervioso central.Sociedad Argentina de Fisiologí

Primary prevention with a defibrillator: are therapies always really optimized before implantation?

AIMS:Left ventricle ejection fraction (LVEF) ≤ 30-35% is widely accepted as a cut-off for primary prevention with an implantable cardiac defibrillator (ICD) in patients with both ischaemic and non-ischaemic cardiomyopathy supposedly on optimal medical therapy. This study reports evolutions of LVEF and treatments of patients implanted in our institution with an ICD for primary prevention of sudden death, after 2 years of follow-up. METHODS AND RESULTS: Among 84 patients with LVEF under 35% implanted between 2005 and 2007, 28 (33%) had improved their LVEF >35% after the 2 years of follow-up. During this period, even if Beta-blockers (98%) and renin-angiotensin system (RAS) blockers (95%) were already initially prescribed, treatments were significantly optimized with improvement of maximal doses of beta-blockers and RAS blockers at 2 year follow-up compared with initial prescription (62 vs. 37% and 68 vs. 45%, respectively). In patients with improved LVEF, a trend toward a better treatment optimization and revascularization procedures (in the sub-group of ischaemic patients) were observed compared with non-improved LVEF patients. CONCLUSIONS: In our study of patients with prophylactic ICD, one-third of them have improved their LVEF after a 2 year follow-up. Despite an optimal medical therapy at the time of implantation, we were able to further improve the maximal treatment doses after implantation. This study highlights the issue of what should be considered as \u27optimal\u27 therapy and the possibility of improvement of LVEF related to a real optimized treatment before implantation

Nuclear Progesterone Receptors Are Up-Regulated by Estrogens in Neurons and Radial Glial Progenitors in the Brain of Zebrafish

In rodents, there is increasing evidence that nuclear progesterone receptors are transiently expressed in many regions of the developing brain, notably outside the hypothalamus. This suggests that progesterone and/or its metabolites could be involved in functions not related to reproduction, particularly in neurodevelopment. In this context, the adult fish brain is of particular interest, as it exhibits constant growth and high neurogenic activity that is supported by radial glia progenitors. However, although synthesis of neuroprogestagens has been documented recently in the brain of zebrafish, information on the presence of progesterone receptors is very limited. In zebrafish, a single nuclear progesterone receptor (pgr) has been cloned and characterized. Here, we demonstrate that this pgr is widely distributed in all regions of the zebrafish brain. Interestingly, we show that Pgr is strongly expressed in radial glial cells and more weakly in neurons. Finally, we present evidence, based on quantitative PCR and immunohistochemistry, that nuclear progesterone receptor mRNA and proteins are upregulated by estrogens in the brain of adult zebrafish. These data document for the first time the finding that radial glial cells are preferential targets for peripheral progestagens and/or neuroprogestagens. Given the crucial roles of radial glial cells in adult neurogenesis, the potential effects of progestagens on their activity and the fate of daughter cells require thorough investigation

Cavernous transformation of the portal vein associated to multiorgan developmental abnormalities

Initial diagnosis of cavernous transformation of the portal vein (portal cavernoma) is rarely made in adults. Its main clinical manifestation is upper gastrointestinal hemorrhage due to variceal bleeding. More rarely, diagnosis is made from obstructive jaundice. In children, this condition is frequently associated to prehepatic portal hypertension and congenital anomalies, the most frequent of which are atrial septal defects or malformations of the biliary tract or of the inferior vena cava. We describe here a case of a 23-year-old female presenting with massive hematemesis due to the presence of esophageal and small intestinal varices. She had a cavernous transformation of the portal vein with prehepatic portal hypertension associated with heretofore unreported malformations such as right pulmonary hypoplasia, cardiac dextroposition, and right renal ectopia. A unifying hypothesis (e.g. an intrauterine vascular insult) to explain the pathogenesis of these defects seems unlikely. Appropriate tests failed to identify specific functional abnormalities in these organs. Although she bled more than once, the combination of sclerotherapy and b-blockers has been, thus far, able to control the major clinical consequences of this diseas