Laparoscopic cholecystectomy for biliary dyskinesia in patient with an extended spectrum of ejection fraction on hepatobiliary iminodiacetic acid scan

Background: Biliary dyskinesia is a condition where the gallbladder motility is seen as abnormal. Diagnostic imaging studies for biliary dyskinesia usually include a negative or inconclusive abdominal ultrasound or computed tomography followed by a hepatobiliary iminodiacetic acid (HIDA) scan. The HIDA scan is used to visualize the gallbladder and access its motility. The motility is reported in the form of an ejection fraction (EF). Billiary dyskinesia is diagnosed if the EF is less than 35%. However, there are many patients with an EF of greater than 35% but are exhibiting all the signs and symptoms for biliary dyskinesia. Aim: This study evaluated the efficacy of laparoscopic cholecystectomy as a treatment modality in symptomatic patients diagnosed with biliary dyskinesia with three distinct HIDA scan EF results. Materials and methods: They were a total of 654 verified case of laparoscopic Cholecystectomy done between January, 2013 and December 2016 at Westlake and West Suburban Hospital. A total of 163 cases out of the 654 had HIDA scan with calculated EF, therefore meeting the criteria to be included in this study. The patients pre and post-operative course was reviewed from their medical records and resolution of symptoms was determined by in phone interview. Results: A total of 29 (18%) patients were lost to follow up. Out of the 99 cases interviewed in the first group (EF <35%) 91 (92%) cases reported complete symptom resolution post cholecystectomy. Out of the 18 cases interviewed in the second group (EF between 35%-50%) 13 (72%) cases reported Lincey Alexida, Frederick M. Tiesenga. Laparoscopic cholecystectomy for biliary dyskinesia in patient with an extended spectrum of ejection fraction on hepatobiliary iminodiacetic acid scan. IAIM, 2017; 4(11): 14-17. Page 15 complete resolution post cholecystectomy. Out of the 17 cases interviewed in the last group (EF> 75%) 11 (65%) cases reported complete resolution of their symptoms Conclusion: Our study indicates that patient suffering with symptomatic biliary dyskinesia and has a HIDA with EF less than 50% or EF greater than 75% will most likely benefit from laparoscopic Cholecystectomy and could be a reasonable option to offer symptomatic patients.

Adjunctive acupuncture for pain and symptom management in the inpatient setting: protocol for a pilot hybrid effectiveness-implementation study / 中西医结合学报

<p><b>BACKGROUND</b>Effective pain management among hospitalized patients is an important aspect of providing quality care and achieving optimal clinical outcomes and patient satisfaction. Common pharmacologic approaches for pain, though effective, have serious side effects and are not appropriate for all inpatients. Findings from randomized controlled trials (RCTs) support the efficacy of acupuncture for many symptoms relevant to inpatients including postoperative pain, cancer-related pain, nausea and vomiting, and withdrawal from narcotic use. However, the extent to which findings from RCTs translate to real-world implementation of acupuncture in typical hospital settings is unknown.</p><p><b>METHODS/DESIGN</b>In partnership with the launch of a clinical program offering acupuncture services to inpatients at the University of California San Francisco's Mount Zion Hospital, we are conducting a pilot study using a hybrid effectiveness-implementation design to: (1) assess the effectiveness of acupuncture to manage pain and other symptoms and improve patient satisfaction; and (2) evaluate the barriers and facilitators to implementing an on-going acupuncture service for inpatients. During a two-month pre-randomization phase, we evaluated and adapted clinical scheduling and treatment protocols with acupuncturists and hospital providers and pretested study procedures including enrollment, consent, and data collection. During a six-month randomization phase, we used a two-tiered consent process in which inpatients were first consented into a study of symptom management, randomized to be offered acupuncture, and consented for acupuncture if they accepted. We are also conducting in-depth interviews and focus groups to assess evidence, context, and facilitators of key provider and hospital administration stakeholders.</p><p><b>DISCUSSION</b>Effectiveness research in "real-world" practice settings is needed to inform clinical decision-making and guide implementation of evidence-based acupuncture practices. To successfully provide clinical acupuncture services and maintain a rigorous research design, practice-based trials of acupuncture require careful planning and attention to setting-specific, contextual factors.</p><p><b>TRIAL REGISTRATION</b>This trial has been registered in ClinicalTrials.gov. The identifier is NCT01988194, registered on November 5, 2013.</p>

Combination and monotherapy of Leishmania major infection in BALB/c mice using plant extracts and herbicides.

Background & objectives: Leishmaniasis is a growing health problem in many parts of the world. Efforts to find new chemotherapeutics for leishmaniasis remain a priority. This study was carried out to determine the effect of combination and monotherapies using plant extracts and herbicides on Leishmania major infection in BALB/c mice. Methods: The herbicides and saponin extract were purchased from Sigma. Roots of Plumbago capensis were collected from Karura forest, Nairobi, Kenya. Plant extractions were done in KEMRI at Center for Traditional Medicines and Drugs Research. Results: Lesion sizes after infection of BALB/c mice were similar in all the experimental groups till the onset of therapeutic treatments (p >0.05). At 15 days post-treatment, significant differences (p < 0.05) were discerned in the lesion sizes of the BALB/c mice in all the mono- and combined-treated groups. However, the combined therapies caused total elimination of the parasites from the lesions and significantly reduced parasite burden in liver and spleen compared to the untreated controls at the end of the experiment. Interpretation & conclusion: The results of this study demonstrate that combination therapy using alternative administration of saponin, acriflavine, trifluralin and plumbagin is effective in treating L. major infection in mice. In this regard, an investigation into the efficacy of these combined therapies against other Leishmania strains should be explored further. Furthermore, studies with these combination therapies should be done on non-human primates such as the vervet monkey (Cercopithecus aethiops).

Clinicopathological study of exfoliative dermatitis.

A clinicopathological study of exfoliative dermatitis involving 25 fresh cases was carried out. Males were predominantly affected with a peak incidence between 21-30 years. Pruritus, shivering, erythema and scaling were the common clinical manifestations. Psoriasis and eczema were the most common aetiological factors and the histopathological findings were correlating with the same.

Combination treatment for osteosarcoma with baculoviral vector mediated gene therapy (p53) and chemotherapy (adriamycin)

The insect baculovirus Autographa californica multiple nuclear polyhedrosis virus (AcMNPV) has been evaluated as a vector for gene delivery to human tumor cells. A human osteogenic sarcoma cell line, Saos-2, was found to be highly susceptible to infection with a baculoviral vector, with nearly 100% of Saos-2 cells being able to express a lacZ reporter gene after a brief exposure to the virus at a m.o.i. of 30 pfu/cell. The production of beta-galactosidase protein was 18-times greater than that in HepG2 cells which were previously thought to be the mammalian cells most susceptible to the baculovirus. The possibility of developing a baculovirus as a cytotoxic vector for p53-defective cancer was tested by destruction of Saos-2 cells (p53-/-) with a recombinant baculovirus containing the wild type p53 gene (BV-p53) in vitro. The p53 baculovirus induced apoptotic cell death in tumor cells in a dose-dependent manner with approximately 60% killing at an m.o.i. of 160 pfu/cell. Combined treatments of gene therapy (p53) and chemotherapy (adriamycin) resulted in synergistic and potent killing of the osteogenic sarcoma cells. For example, greater than 95% of Saos-2 cells were killed by the combination of BV-p53 (m.o.i. of 100) and adriamycin (35 ng/ml), whereas approximately 50% and approximately 55% cells were killed by BV-p53 and adriamycin alone, respectively. These results indicate that a baculoviral gene delivery vector can be used to efficiently target certain types of mammalian cells and the combination treatment of gene-therapy mediated by a baculovirus and chemotherapy may enhance induction of apoptosis in cancer cells.

Patologia do trabalho

Aborda questöes de saúde-doença, faz uma exposiçäo dos temas mais atuais como a adaptaçäo e suas implicaçöes, os problemas ligados à higiene ocupacional, à seleçäo de instrumentos de pesquisa, bem como às principais propostas para a organizaçäo e intervençäo em sistemas de turnos

Broncoscopia pediátrica contemporânea / Contemporary pediatric bronchoscopy

De 1984 a 1989, 419 broncoscopias foram realizadas em 196 crianças no Serviço de Cirurgia Pediátrica do Hospital Universitário da Faculdade de Medicina do Estado do Colorado USA. As principais indicaçöes foram; pneumonia recorrente/atelectasia (21 por cento), doença reativa crônica da árvore brônquica (15 por cento), estridor persistente (11 por cento), complicaçäo pós traqueostomia (11 por cento), aspiraçäo de corpo estranho(9 por cento), dependencia do ventilador (8por cento) e doença obstrutiva crônica da árvore brônquica (8 por cento). As broncoscopias foram realizadas no bloco cirúrgico, sob anestesia geral, sendo usado o broncoscópio rígido de STORZ. A broncoscopia foi normal em 7 por cento dos pacientes. Setenta pacientes se submeteram a tratamento cirúrgico adicional: traqueostomia em 22; dilataçäo de estenose cicatricial 11; aortopexia em 11; retirada de corpo estranho em 10; traqueoplastia ou ressecçäo traqueal em 10; dilataçäo traqueal em 8; foto-ablaçÝo com "laser" de estenose traqueal em sete; injeçäo de corticoesteroide em estenose traqueal em cinco. Outras cicurgias näo endobrônquicas se seguiram a broncoscopia: cirurgia antirefluxo gastroesofogeano em vinte pacientes e lobectomia pulmonar em três pacientes. Näo houve mortalidade cirúrgica e a morbidade consistiu de cinco pequenas complicaçöes. As indicaçöes pra broncoscopia tem mudado na última década, sobretudo no sentido da investigaçäo das doenças crônicas da vias aéreas. Existe uma alta resoluçäo de lesöes cirurgicamente corrigíveis (39 por cento nesta série), muitas das quais säo inesperadas e, melhor tratadas pelas técnicas endoscópicas endobrônquicas atuais