What is Changing in Indications and Treatment of Focal Nodular Hyperplasia of the Liver. Is There any Place for Surgery?

ABSTRACT Focal nodular hyperplasia (FNH) is a common benign liver tumor, which occurs in the vast majority of the cases in young women. FNH represents a polyclonal lesion characterized by local vascular abnormalities and is a truly benign lesion without any potential for malignant transformation. A retrospective single institution analysis of 227 FNH patients, treated from 1990 to 2016 and a review of studies reporting surgical therapy of overall 293 patients with FNH was performed. Indications for resection with a focus on diagnostic workup, patient selection, surgical mode and operative mortality and morbidity have been analysed. Ninety three patients underwent elective hepatectomy and 134 patients observation alone, where median follow-up was 107 months. Postoperative complications were recorded in 14 patients, 92% of patients reported an improvement with respect to their symptoms. Overall among 293 patients underwent surgery in the series, included to this review, there was a morbidity of 13%, where median follow-up was 53 months. Systematic follow-up remains the gold standard in asymptomatic patients with FNH. Flowever elective surgery should be considered in symptomatic patients, in those with marked enlargement and in case of uncertainty of diagnosis. Surgery for FNH is a safe procedure with low morbidity and very good long term results as far as quality of life after surgery is concerned and surely an integral part of the modern management of FNH.

Prevalence and Correlates of Current and Former Smoking among Urban Transit Workers

Transit workers constitute a blue-collar occupational group that have elevated smoking rates relative to other sectors of employed adults in the United States. This study analyzed cross-sectional tobacco survey data from 935 workers (60% African American; 37% female) employed at an urban public transit agency in California. Prevalence of current and former smoking was 20.3% and 20.6%, respectively. Younger workers were less likely than older workers to be current or former smokers. Having a complete home smoking ban was associated with decreased likelihood of being a smoker [odds ratio (OR) = 0.04, 95% confidence interval (CI) = 0.01–0.17], as were neutral views about whether it is easy for a smoker to take a smoking break during their shift (OR = 0.50, 95% CI 0.28–0.88). Current smoking among the sample is > 50% higher than the adult statewide prevalence. Potential points of intervention identified in this study include perceived ease of worksite smoking breaks and establishing home smoking bans. Tailored cessation efforts focusing on older transit workers more likely to smoke are needed to reduce tobacco-related disparities in this workforce.

Intoxicación con etilenglicol. Presentación de casos y revisión de la literatura / Intoxication with ethylene glycol. Presentation of cases and review of literature

El etilénglicol es un producto utilizado en la industria química. La ingesta o aspiración de esta sustancia es una emergencia médica que se debe diagnos� ticar y tratar de inmediato. Inicialmente produce un cuadro conocido como "embriaguez sin aliento alcohólico", seguido de toxicidad cardiopulmonar y renal con grave acidosis metabólica con brecha aniónica aumentada. En la mayoría de los Centros, no es posible determinar la concentración de eti� lénglicol en sangre, por lo que el diagnóstico inicial se basa en la anamnesis y en la presencia de acidosis metabólica grave con brecha aniónica elevada. El tratamiento consiste en soporte vital, adecuada infusión de fluidos y bicar� bonato de sodio, administración de etanol o fomepizol para antagonizar la enzima alcohol deshidrogenasa y, en algunos casos, hemodiálisis.(AU)

The ethylene glycol is a product used in the chemical industry. The intake or inhalation of this substance is a medical emergency that should be diagnosed and treated early. Initially it causes a condition known as "drunkenness with� out alcoholic breath", followed by cardiopulmonary and renal dysfunctions with severe metabolic acidosis and increased anion gap. Determination of blood levels is not available in most health care centers, so initial diagnosis should be based on history and the presence of metabolic acidosis with el� evated anion gap. Treatment consists of vital support, adequate fluid and bicarbonate infusion, administration of ethanol o fomepizole to antagonize the � genase and, in some cases, hemodialysis.(AU)

comparative study of dissolution characteristics of polymeric and wax granulations of theophylline and their tablets

Matrix [non disintegrating] granules of theophylline have been formed and their dissolution characteristics investigated for sustained release application. The polymeric granulations were formed by massing the drug powder with a concentrated [40%w/w] ethanolic solution of an acrylatemethacrylate copolymer [ERS100R]. Wax granulations were also formed by massing the drug powder with previously melted carnuba wax followed by screening and drying. The content of polymer or wax in the resulting granules was 16.7%w/w. Conventional granules of theophylline were formed by massing the drug powder with starch mucilage [20%w/v]. Resulting granules were subjected to particle size analysis and in vitro dissolution tests. The granules were further compressed to tablets [weight 500 +/- 4.2mg each] at a constant load [30 arbitrary units on the load scale]. The tablets were subjected to hardness, disintegration and dissolution tests. The dissolution kinetics were also considered. The mean granule size was 646.5 +/- 4.3 micro m [convention al], 821.4 +/- 4.8 micro m [polymeric granulations] and 892.7 +/- 5.4 micro m [wax granulations], the matrix granules were therefore larger than the conventional granules. Dissolution of the granules generally followed a first order rate kinetic. The rate constant [k1] for the conventional, polymeric and wax granulations were [h-1]: 0.53, 0.31 and 0.27 respectively. Thus, the wax granulations appeared to be more effective than the polymeric granulations in retarding drug release from the granules but the difference was not statistically significant [p > 0.05]. The tensile strength of tablets derived from the conventional, polymeric and wax granulations were [MNm-2] 0.85, 1.68 and 1.96 respectively, indicating that the matrix granules [compared with the conventional granules] produced harder tablets at the same compression load. The corresponding first order dissolution rate constants were [h-1]: 0.46, 0.28 and 0.21. Thus, tableting of the matrix granules produced a slight but significant decrease in dissolution rates, attributabl e to the disintegration of the tablets to more compact particles