ABSTRACT
RESUMEN Los hidrocistomas ecrinos son tumores benignos, únicos o múltiples. Se presentan con mayor frecuencia en la mediana edad y predominan en el sexo femenino. Se presenta un paciente con hidrocistomas ecrinos múltiples, masculino de 74 años.
ABSTRACT Eccrine hydrocystomas are benign tumors, which can be single or multiple. They occur most oftenly in middle aged patients or in the elderly, predominantly female. We present a case of multiple eccrine hydrocystomas, in a 74-year-old male patient.
ABSTRACT
OBJECTIVE: To compare quality of life, in patients living with HIV infection with pharmaceutical care according to the CMO methodology: capacity, motivation and opportunity versus conventional follow-up. METHODS: Longitudinal, prospective, multicenter, health intervention study, conducted between October 2019 and November 2021 in 14 centers throughout Spain. Patients over 18 years of age, receiving antiretroviral treatment and attending the consultations of the participating Pharmacy Services for 1 year were included. Patients who did not have the autonomy to complete the planned questionnaires were excluded. At baseline, participating centers were randomized to continue using the same systematics of work (traditional follow-up) or to implement the CMO model using patient stratification models, goal setting in relation to pharmacotherapy, use of motivational interviewing, as well as longitudinal follow-up enabled by new technologies. The main variable was the difference in the number of dimensions positively affected in each follow-up arm at 24 weeks of follow-up according to the MOS-HIV questionnaire. In the CMO group, the interventions performed the most frequently were recorded. RESULTS: 151 patients were included. The median age was 51.35 years. A significant improvement in quality of life was found at the end of follow-up in the CMO group, reducing the number of patients with negatively affected dimensions (2/11 vs 8/11). The most frequent interventions carried out in the CMO group, according to the taxonomy, were Motivation (51,7%) and review and validation (49,4%). CONCLUSIONS: The quality of life of patients is higher in those centers that develop Pharmaceutical Care based on the CMO methodology compared to traditional follow-up.
Subject(s)
HIV Infections , Pharmaceutical Services , Humans , Adolescent , Adult , Middle Aged , HIV Infections/drug therapy , Follow-Up Studies , Quality of Life , Prospective StudiesABSTRACT
El corioangioma es el tumor benigno placentario no trofoblástico más frecuente, con una incidencia estimada del 1% de las gestaciones. Se presenta el caso de un corioangioma diagnosticado en una ecografía rutinaria de tercer trimestre en una gestante de edad materna avanzada cuya gestación había sido obtenida mediante técnicas de reproducción asistida. Se utilizó el ecógrafo Voluson E8 con modo 2D y Doppler color. Su imagen característica corresponde a una formación redondeada e hipoecogénica localizada en la cara fetal de la placenta. Su tamaño, sobre todo cuando es superior a 5cm, tiene importantes implicaciones pronósticas y produce afectación fetal, que puede traducirse en parto pretérmino o alteración del crecimiento fetal, entre otras. Tras el diagnóstico, debe realizarse un seguimiento periódico y requerirá tratamiento en caso de afectación materno-fetal.(AU)
Placental chorioangioma is the most common subtype of non-trophoblastic placental tumours. The incidence rate is 1% of pregnancies. We present the case of a chorioangioma diagnosed in a routine third-trimester ultrasound in a pregnant woman of advanced maternal age who conceived by assisted reproductive techniques. The Voluson E 8 ultrasound machine with 2D mode and colour Doppler was used. Chorioangioma usually presents as a single nodule in the foetal surface of the placenta. Prognosis depends on tumour size producing intrauterine growth restriction or preterm birth when the chorioangioma measures more than 5cm. After diagnosis, follow-up should be performed and treated as if there were maternal-foetal involvement.(AU)
Subject(s)
Humans , Female , Middle Aged , Pregnancy Complications , Hemangioma , Fetal Membranes, Premature Rupture , Fertilization in Vitro , Ultrasonography , Pregnancy Trimester, Third , Physical Examination , Symptom Assessment , Gynecology , ObstetricsABSTRACT
RESUMEN El liquen plano (LP)es una enfermedad inflamatoria crónica que afecta piel, mucosas y anexos. Si bien existen múltiples teorías, la etiología es aún desconocida.Clínicamente se caracteriza por pápulasplanas poligonaleso placas brillantes, violáceas,con descamacióny pruriginosas. La variante unilateral es infrecuente y más común en población pediátrica. Se presenta el caso de una paciente de sexo femenino, de 41 años de edad,con un LPvariante unilateral, sin una distribución definida.
ABSTRACT Lichen planus is a chronic inflammatoryimmune-mediateddisease that affects skin, mucous membranes, nails and hair. It affects most commonly adult patients. There is an extended classification of the lichen planus variants.The classic type is characterized by pruriticpolygonal, flat-topped, violaceous papules and plaques, reticulated, with fine white scale Wickham'sstriae. It usually affects wrists and forearms, trunk, anterior aspect of thelegs and oral mucous. The unilateral variant is rare and more common in pediatric patients.When this variant is present, the clinical features are similar to the classic one. The unilateral lesions can be seenwith a methameric distribution (zosteriformdermatosis) or along the Blaschko lines (Blaschkoiddermatosis). A 41-year-old female presented a history of pruritic lesions in trunk and left limb that had appeared 4 months earlier.
ABSTRACT
Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by mutations in any of the genes encoding the phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system, responsible for the production of reactive oxygen species (ROS). CGD is marked by invasive bacterial and fungal infections and by autoinflammation/autoimmunity, of which the exact pathophysiology remains elusive. Contributing factors include decreased neutrophil apoptosis, impaired apoptotic neutrophil clearance, increased proinflammatory protein expression and reduced ROS-mediated inflammasome dampening. We have explored a fundamentally different potential mechanism: it has been reported that macrophage-mediated induction of regulatory T cells (Tregs ) depends on ROS production. We have investigated whether numerical or functional deficiencies exist in Tregs of CGD patients. As the prevalence of autoinflammation/autoimmunity differs between CGD subtypes, we have also investigated Tregs from gp91phox -, p47phox - and p40phox -deficient CGD patients separately. Results show that Treg numbers and suppressive capacities are not different in CGD patients compared to healthy controls, with the exception that in gp91phox -deficiency effector Treg (eTreg ) numbers are decreased. Expression of Treg markers CD25, inducible T cell co-stimulator (ICOS), Helios, cytotoxic T lymphocyte antigen 4 (CTLA-4) and glucocorticoid-induced tumor necrosis factor receptor (GITR) did not provide any clue for differences in Treg functionality or activation state. No correlation was seen between eTreg numbers and patients' clinical phenotype. To conclude, the only difference between Tregs from CGD patients and healthy controls is a decrease in circulating eTregs in gp91phox -deficiency. In terms of autoinflammation/autoimmunity, this group is the most affected. However, upon culture, patient-derived Tregs showed a normal phenotype and normal functional suppressor activity. No other findings pointed towards a role for Tregs in CGD-related autoinflammation/autoimmunity.
Subject(s)
Autoimmunity/immunology , Granulomatous Disease, Chronic/immunology , NADPH Oxidases/genetics , T-Lymphocytes, Regulatory/immunology , Adolescent , Adult , Apoptosis/physiology , CD4 Lymphocyte Count , Child , Child, Preschool , Female , Humans , Male , NADPH Oxidase 2/deficiency , NADPH Oxidases/deficiency , Neutrophils/immunology , Neutrophils/pathology , Reactive Oxygen Species/metabolismABSTRACT
La agricultura orgánica es una forma activa de trabajo ecológico, que se produce bajo un conjunto de procedimientos denominados orgánicos, teniendo el productor bajo su responsabilidad un territorio al que debe liberar de toda contaminación y preocuparse por estimular la diversidad de especies, protegiendo la fauna. Dichos procedimientos tienen como objetivo principal la obtención de alimentos más saludables y la protección del medio ambiente por medio del uso de técnicas no contaminantes, además de disminuir el uso de energía y de sustancias inorgánicas, sobre todo si son de origen sintético.
Subject(s)
Humans , Food, Organic , Nutritional Sciences , Organic AgricultureABSTRACT
OBJECTIVE: To assess the cost-effectiveness relationship of Ticagrelor versus Clopidogrel for the management of acute coronary syndrome in Spain. METHODS: The data from the PLATO study were used for the calculation of the events rate and health-related quality of life for Ticagrelor and Clopidogrel for the first 12 months, whereas the costs were obtained from Spanish sources. Quality of life-adjusted survival and costs were estimated according to the fact that the patients did not suffer any thrombotic event (myocardial infarction or ictus) or this one was not fatal. The lifetime cots, life years gained, and the quality of life-adjusted survival were estimated for both treatment arms. Incremental cost-effectiveness ratios were assessed through the perspective of the Spanish healthcare system for 2013, by using a macro-costs strategy based on published literature and the survival tables for the Spanish population. RESULTS: Treatment with Ticagrelor was associated to an incremental cost of 1,228 Euros per year, an increase in 0.1652 life years gained, and 0.1365 years adjusted by quality of life, as compared to Clopidogrel. The cost for one quality of life-adjusted life year was 8,997 Euros and the cost per one gained life year of 7,435 ï. The sensitivity analysis showed consistent results. CONCLUSIONS: Treatment of acute coronary syndrome for 12 months with Ticagrelor was associated with a cost per 1 life year of quality of life-adjusted cost below the cost-effectiveness limits generally accepted in Spain.
OBJETIVO: Evaluar la relación coste-efectividad de ticagrelor frente a clopidogrel en el tratamiento del síndrome coronario agudo en España. MÉTODOS: Para el cálculo de la tasa de eventos y la calidad de vida relacionada con la salud para ticagrelor y clopidogrel durante los doce primeros meses se utilizaron los datos del estudio PLATO, mientras que los costes se obtuvieron de fuentes españolas. La supervivencia ajustada por calidad de vida y los costes se estimaron en función de que los pacientes no sufrieran ningún evento trombótico (infarto de miocardio o ictus) o éste fuese no mortal. El coste a lo largo de toda la vida, los años de vida ganados y la supervivencia por calidad de vida se estimaron para ambos brazos de tratamiento. Los ratios de coste-efectividad incremental se presentaron desde la perspectiva del sistema sanitario español en 2013, empleando una estrategia de macrocostes basada en la bibliografía publicada y utilizando las tablas de supervivencia de la población española. RESULTADOS: El tratamiento con ticagrelor se asoció con un coste incremental de 1.228 ïï anuales, un aumento de 0,1652 años de vida ganados y 0,1365 años de vida ajustados por calidad comparado con clopidogrel. Se obtuvo un coste por año de vida ajustado por calidad de 8.997ïï y un coste por año de vida ganado de 7.435 ï. El análisis de sensibilidad mostró resultados consistentes. CONCLUSIONES: El tratamiento durante 12 meses del síndrome coronario agudo con ticagrelor se asoció a un coste por año de vida ajustado por calidad por debajo de los límites de costeefectividad generalmente aceptados en España.
Subject(s)
Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/economics , Adenosine/analogs & derivatives , Cost-Benefit Analysis , Platelet Aggregation Inhibitors/economics , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives , Adenosine/economics , Adenosine/therapeutic use , Aspirin/economics , Aspirin/therapeutic use , Clopidogrel , Female , Humans , Male , Middle Aged , Quality of Life , Spain , Ticagrelor , Ticlopidine/economics , Ticlopidine/therapeutic use , Time FactorsABSTRACT
Objetivo: Evaluar la relación coste-efectividad de ticagrelor frente a clopidogrel en el tratamiento del síndrome coronario agudo en España. Métodos: Para el cálculo de la tasa de eventos y la calidad de vida relacionada con la salud para ticagrelor y clopidogrel durante los doce primeros meses se utilizaron los datos del estudio PLATO, mientras que los costes se obtuvieron de fuentes españolas. La supervivencia ajustada por calidad de vida y los costes se estimaron en función de que los pacientes no sufrieran ningún evento trombótico (infarto de miocardio o ictus) o éste fuese no mortal. El coste a lo largo de toda la vida, los años de vida ganados y la supervivencia por calidad de vida se estimaron para ambos brazos de tratamiento. Los ratios de coste-efectividad incremental se presentaron desde la perspectiva del sistema sanitario español en 2013, empleando una estrategia de macrocostes basada en la bibliografía publicada y utilizando las tablas de supervivencia de la población española. Resultados: El tratamiento con ticagrelor se asoció con un coste incremental de 1.228 euros anuales, un aumento de 0,1652 años de vida ganados y 0,1365 años de vida ajustados por calidad comparado con clopidogrel. Se obtuvo un coste por año de vida ajustado por calidad de 8.997 euros y un coste por año de vida ganado de 7.435 euros. El análisis de sensibilidad mostró resultados consistentes. Conclusiones: El tratamiento durante 12 meses del síndrome coronario agudo con ticagrelor se asoció a un coste por año de vida ajustado por calidad por debajo de los límites de coste-efectividad generalmente aceptados en España (AU)
Objective: To assess the cost-effectiveness relationship of Ticagrelor versus Clopidogrel for the management of acute coronary syndrome in Spain. Methods: The data from the PLATO study were used for the calculation of the events rate and health-related quality of life for Ticagrelor and Clopidogrel for the first 12 months, whereas the costs were obtained from Spanish sources. Quality of life-adjusted survival and costs were estimated according to the fact that the patients did not suffer any thrombotic event (myocardial infarction or ictus) or this one was not fatal. The lifetime cots, life years gained, and the quality of life-adjusted survival were estimated for both treatment arms. Incremental cost-effectiveness ratios were assessed through the perspective of the Spanish healthcare system for 2013, by using a macrocosts strategy based on published literature and the survival tables for the Spanish population. Results: Treatment with Ticagrelor was associated to an incremental cost of 1,228 euros per year, an increase in 0.1652 life years gained, and 0.1365 years adjusted by quality of life, as compared to Clopidogrel. The cost for one quality of life-adjusted life year was 8,997 euros and the cost per one gained life year of 7,435 euros. The sensitivity analysis showed consistent results. Conclusions: Treatment of acute coronary syndrome for 12 months with Ticagrelor was associated with a cost per 1 life year of quality of life-adjusted cost below the cost-effectiveness limits generally accepted in Spain (AU)
Subject(s)
Humans , Acute Coronary Syndrome/drug therapy , Platelet Aggregation Inhibitors/pharmacokinetics , Time/statistics & numerical data , 50303 , Drug Costs/statistics & numerical dataABSTRACT
Exploration of the canine small intestine using conventional endoscopy is restricted to the duodenum and/or the ileum. Double balloon endoscopy (DBE) is a 'push and pull' technique that has been described in humans and permits a complete exploration of the small intestine. In this study, oral DBE was performed on 12 healthy dogs (10-34kg) to characterize for the first time the efficiency, exploration dynamics and safety of the technique. DBE was successful in 83% of dogs; the average estimated insertion depth of the endoscope was 287±36cm, and the average duration of the exploration was 84±8min. No complications or relevant adverse clinical effects were observed, and there was no indication of post-procedure pancreatitis based on serology of two specific markers of pancreatitis (amylase and lipase) and the immediate nonspecific inflammatory mediator C-reactive protein. The study showed that oral DBE is viable and safe in the dog, allowing for the diagnosis and treatment of gastrointestinal diseases deep in the small intestine to an extent that has not previously been possible using conventional endoscopy.
Subject(s)
Dogs/anatomy & histology , Double-Balloon Enteroscopy/veterinary , Amylases/blood , Animals , Biomarkers , C-Reactive Protein/metabolism , Female , Lipase/blood , MaleABSTRACT
BACKGROUND AND STUDY AIMS: In double-balloon enteroscopy (DBE) the use of a reliable and practical method to calculate the insertion depth of the endoscope could help to improve diagnosis accuracy and optimize the effort and cost of the technique. The objectives of this work were to compare and evaluate two methods of estimating the insertion depth and to obtain a descriptive model capable of representing the exploration dynamics and efficiency in terms of advanced distance and time. METHODS: Oral DBE was performed in 25 pigs. Insertion depth was calculated during the procedure by: 1) estimation of time and distance for each push and pull cycle during progression; and 2) estimation of distance during withdrawal. At the maximum insertion depth a tattoo was placed, and the observed measures for the two methods were compared with the distance between the pylorus and the mark after euthanasia and necropsy of the animals 1 week after DBE. RESULTS: The average insertion depth during progression, withdrawal, and after necropsy was 324.92 cm, 317.23 cm, and 342.05 cm, respectively (P Anova = 0.72). The Pearson correlation coefficient (r > 0.85; P < 0.001) and paired Brand - Altman plots demonstrated high agreement between progression and necropsy (0.03 % difference) and between withdrawal and necropsy (6.9 % difference). The exploration dynamics and efficiency in terms of advanced distance per cycle and time fitted to potential and logarithmic regression models, respectively. CONCLUSIONS: Measurement of insertion depth in vivo was validated in the porcine model during progression and withdrawal. Estimation during progression was more accurate and allowed exploration dynamics and efficiency to be plotted, which might be used as approximate reference values for humans.
Subject(s)
Double-Balloon Enteroscopy/methods , Animals , SwineABSTRACT
A better understanding of the mechanisms underlying neuronal death in cerebral ischemia is required for the development of stroke therapies. Here we analyze the contribution of the tropomyosin-related kinase B (TrkB) neurotrophin receptor to excitotoxicity, a primary pathological mechanism in ischemia, which is induced by overstimulation of glutamate receptors of the N-methyl-D-aspartate type. We demonstrate a significant modification of TrkB expression that is strongly associated with neurodegeneration in models of ischemia and in vitro excitotoxicity. Two mechanisms cooperate for TrkB dysregulation: (1) calpain-processing of full-length TrkB (TrkB-FL), high-affinity receptor for brain-derived neurotrophic factor, which produces a truncated protein lacking the tyrosine-kinase domain and strikingly similar to the inactive TrkB-T1 isoform and (2) reverse regulation of the mRNA of these isoforms. Collectively, excitotoxicity results in a decrease of TrkB-FL, the production of truncated TrkB-FL and the upregulation of TrkB-T1. A similar neuro-specific increase of the TrkB-T1 isoform is also observed in stroke patients. A lentivirus designed for both neuro-specific TrkB-T1 interference and increased TrkB-FL expression allows recovery of the TrkB-FL/TrkB-T1 balance and protects neurons from excitotoxic death. These data implicate a combination of TrkB-FL downregulation and TrkB-T1 upregulation as significant causes of neuronal death in excitotoxicity, and reveal novel targets for the design of stroke therapies.
Subject(s)
Brain Ischemia/metabolism , Brain/metabolism , Gene Expression Regulation , RNA, Messenger/biosynthesis , Receptor, trkB/metabolism , Stroke/metabolism , Animals , Apoptosis/genetics , Autopsy , Brain/pathology , Brain Ischemia/genetics , Brain Ischemia/pathology , Disease Models, Animal , Humans , Lentivirus , Male , Neurons/metabolism , Neurons/pathology , Plasmids , Primary Cell Culture , Protein Isoforms , Protein Structure, Tertiary , Rats , Rats, Wistar , Receptor, trkB/genetics , Signal Transduction/genetics , Stroke/genetics , Stroke/pathologyABSTRACT
The histology of the canine intestine has not been accurately defined. To establish the precise thickness of its different layers, whole wall samples of the small intestine were removed from 41 cadavers at five standardised sampling sites (duodenum, proximal jejunum, distal jejunum, proximal ileum and distal ileum). The total thickness was estimated by morphometry, as was the thickness of the mucosa, muscularis mucosae, submucosa and muscularis externa. In addition, the size of the lymphoid aggregates in the submucosa and the thickness of the circular and longitudinal layers within both the muscularis mucosae and the muscularis externa were estimated. The total intestinal thickness depended very much upon the thickness of the mucosa and submucosa. The mucosa decreased progressively from proximal to distal parts of the small intestine (47% reduction). The thickness of the submucosa, however, changed little from the duodenum to the distal jejunum, but increased significantly in the ileum; this change was positively correlated with the amount of lymphoid tissue. Sex influenced the thickness of the intestinal wall, with males displaying higher thickness values along the small intestine. Conversely, no correlation between bodyweight and intestinal thickness was found for any of the five sampling sites. This study gives absolute and relative values for the thickness of the layers of the dog intestine which might help in the diagnosis of small intestinal pathology from postmortem samples and/or endoscopic biopsies.
Subject(s)
Dogs/anatomy & histology , Intestine, Small/anatomy & histology , Animals , Body Weight , Cadaver , Dogs/genetics , Female , Male , Sex FactorsSubject(s)
Double-Balloon Enteroscopy/adverse effects , Endoscopes, Gastrointestinal/adverse effects , Pancreatitis/etiology , Abdominal Pain/etiology , Acute Disease , Aged , Argon/therapeutic use , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/drug therapy , Humans , Male , Pancreatic Function Tests , Pancreatitis/pathologyABSTRACT
BACKGROUND: The objective was to evaluate the efficacy of irinotecan-cetuximab-bevacizumab in combination as a salvage treatment for heavily pretreated metastatic colorectal cancer patients. METHODS: A total of 39 patients resistant to both oxaliplatin and irinotecan were included in this retrospective study. Treatment consisted of irinotecan 180/m(2) every 14 days, weekly cetuximab standard dose and bevacizumab 5 mg/kg every 14 days. RESULTS: Partial response was observed in 8 patients (20%), stable disease in 24 (61%) and progressive disease in 7 (18%). Overall response rate in KRAS wild type was 6/22 (27%) and in mutated KRAS it was 2/15 (13%). Median time to progression was 8 months (6.4-9.4) and median overall survival 12 months (10.1-13.8). Overall, grade 3-4 adverse events were observed in 24 patients (62%). CONCLUSIONS: This regimen is active and moderately well tolerated in heavily pretreated advanced colorectal patients. However, caution is advisable when interpreting these results, because they run against the findings of two large phase III trials.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colorectal Neoplasms/drug therapy , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Bevacizumab , Camptothecin/administration & dosage , Camptothecin/adverse effects , Camptothecin/analogs & derivatives , Camptothecin/pharmacology , Cetuximab , Drug Resistance, Neoplasm , Female , Humans , Irinotecan , Male , Middle Aged , Neoplasm Metastasis , Organoplatinum Compounds/pharmacology , Oxaliplatin , Retrospective Studies , Salvage Therapy/methodsABSTRACT
Double balloon endoscopy (DBE) enables the diagnosis and treatment of small intestinal disease. The dog is a potential animal model for DBE training and also a candidate for the clinical application of this technique. However, the anatomy of the canine small intestine may limit the use of DBE by restricting the push-and-pull manoeuvres required for DBE. To establish what these limitations are, the length and width of different portions of the small intestine as well as the mesenteric dependences were measured in 55 dogs. Several external parameters related to body size plus the age, weight, sex and breed were recorded. Potential restriction of the progress of the enteroscope due to narrow intestinal diameter is expected in the jejunum of mid- and small size dogs.
Subject(s)
Dogs/anatomy & histology , Double-Balloon Enteroscopy/veterinary , Intestine, Small/anatomy & histology , Animals , Body Size , Double-Balloon Enteroscopy/methods , Female , Jejunum/anatomy & histology , Male , Mesentery/anatomy & histology , Models, Animal , Pedigree , Reference ValuesABSTRACT
OBJECTIVE: Gastrojejunal stricture (GYS), not only is a common complication after laparoscopic gastric bypass (LGBP), but its frequency is about 15% according to bibliography. Our aim is to present our experience after 62 LGBP. PATIENTS AND METHOD: From January 2004 to September-2006, we performed 62 consecutive laparoscopic gastric bypass (Wittgrove's technique). The gastrojejunal anastomosis is performed with auto suture material type CEAA No 21 termino-lateral (ILS, Ethicon). In 4 cases (6.45%) was converted to laparotomy, perform the anastomosis in the same way. Monitoring has a range of 3-35 months, conducted in 61 patients because one patient died of pulmonary thromboembolism in the immediate postoperative period after reoperation, after two weeks of gastric bypass, by necrosis of a small fragment of the remnant gastric. In all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. When gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation (recommending dilate the anastomosis to a maximum 1.5 cm). RESULTS: Five cases (8.1%) developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and in 1 case by endoscopy. Two patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion (circumferentially sclerosis within 48 hours of surgery and sclerosis of bleeding points). All cases were resolved by endoscopic dilatation. At follow-up has not been detected re-stricture. CONCLUSION: Clinically, gastrojejunal stricture results in a progressive oral intolerance, revealing stenosis between 1 and 3 months postoperatively. The situations of sclerosis of the bleeding lesions favor, especially in cases of extensive sclerosis. In cases of suspected barium transit offers us a high diagnostic yield. Endoscopic dilatation resolved, so far, all cases.
Subject(s)
Gastric Bypass/adverse effects , Obesity, Morbid/surgery , Adult , Catheterization , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Female , Gastric Bypass/methods , Humans , Laparoscopy , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/therapyABSTRACT
BACKGROUND: Despite t-PA proven benefits related to vessel reopening, up to 13% of stroke patients suffer reocclusions after t-PA. We aimed to analyze whether a functional polymorphism in a fibrinolysis inhibitor gene [plasminogen activator inhibitor-1 (PAI-1)] might be associated with reocclusion rates after stroke thrombolytic therapy. METHODS: 165 patients with ischemic stroke who received t-PA < 3 h were studied. Reocclusion and recanalization was diagnosed by transcranial Doppler. PAI-1 4G/5G polymorphism determination was performed by sequencing. PAI-1 mRNA was studied by real-time PCR analysis. National institutes of health stroke scale (NIHSS) was serially measured since patients arrival to assess the neurological outcome, and modified ranking scale (mRS) at 3rd month was used to evaluate functional outcome following stroke. RESULTS: PAI-1 4G/4G patients had higher reocclusion rates (4G/4G = 12.5% versus other genotypes = 2.7%, p = 0.025). . In a logistic regression, the 4G/4G genotype was the only factor associated with reocclusion (OR = 15.16 95%, CI = 1.4-163.4, p = 0.025). 4G/4G genotype was also associated with poor functional outcome at 3rd month (4G/4G = 4 versus others genotypes = 3, p = 0.017) and with mRNA levels at 12 h post stroke symptoms onset (4G/4G patients = 2.01% versus other genotypes = 0.68%, p = 0.034). CONCLUSIONS: PAI-1 4G/4G genotype is associated with reocclusion rates and poor functional outcome among stroke patients treated with t-PA.
Subject(s)
Genetic Predisposition to Disease , Plasminogen Activator Inhibitor 1/genetics , Polymorphism, Genetic/genetics , Thrombolytic Therapy/adverse effects , Thrombosis/chemically induced , Thrombosis/genetics , Aged , Aged, 80 and over , Chi-Square Distribution , Female , Gene Frequency , Humans , Male , Plasminogen Activator Inhibitor 1/metabolism , RNA, Messenger/genetics , Statistics, Nonparametric , Stroke/drug therapy , Stroke/genetics , Thrombosis/diagnostic imaging , Time Factors , Ultrasonography, Doppler, Transcranial/methodsABSTRACT
Objetivo: la estenosis de la anastomosis gastroyeyunal representauna complicación nada desdeñable en la cirugía bariátricapor laparoscopia, llegándose, en algunas series, a alcanzar el15%. Presentamos nuestra casuística en una serie de 62 casosconsecutivos y el manejo realizado.Pacientes y método: desde enero-2004 a septiembre-2006hemos realizado de manera consecutiva 62 bypass gástricos porlaparoscopia según técnica de Wittgrove modificada. La anastomosisgastroyeyunal se realiza con material de autosutura tipoCEAA nº 21 término-lateral (ILS; Ethicon) y después de comprobarla estanqueidad anastomótica se dan dos puntos de válvulatipo Hoffmeister a cada lado de la anastomosis. En 4 casos(6,45%) se reconvirtió a laparotomía, realizándose la anastomosisde la misma manera. El seguimiento tiene un rango de 3-35 meses,realizado en 61 enfermos, pues un paciente falleció por tromboembolismopulmonar en el postoperatorio inmediato tras reintervención,a las dos semanas del bypass gástrico, por necrosis deun pequeño fragmento del remanente gástrico.En todos los pacientes con intolerancia persistente a la alimentaciónse realizó tránsito baritado y/o gastroscopia. Cuando seevidenció estenosis gastroyeyunal se procedió a dilatación neumáticaendoscópica (recomendando dilatar la anastomosis hastacomo máximo 1,5 cm).Resultados: en 5 casos (8,1%) se desarrolló una estenosisgastroyeyunal, en 4 de estos casos el diagnóstico inicial fue portránsito baritado y en 1 caso por endoscopia. Dos pacientes teníanantecedentes de HDA que precisaron esclerosis endoscópicade la lesión sangrante (esclerosis circunferencial a las 48 horas dela cirugía y esclerosis de puntos sangrantes). Todos los casos seresolvieron mediante dilatación endoscópica, precisando en doscasos dos sesiones de dilatación y el resto una. En el seguimientono se han detectado re-estenosis...(AU)
Objective: gastrojejunal stricture (GYS), not only is a commoncomplication after laparoscopic gastric bypass (LGBP), butits frequency is about 15% according to bibliography. Our aim isto present our experience after 62 LGBP.Patients and method: from January 2004 to September-2006, we performed 62 consecutive laparoscopic gastric bypass(Wittgrove´s technique). The gastrojejunal anastomosis is performedwith auto suture material type CEAA No 21 termino-lateral(ILS, Ethicon). In 4 cases (6.45%) was converted to laparotomy,perform the anastomosis in the same way. Monitoring has arange of 3-35 months, conducted in 61 patients because one patientdied of pulmonary thromboembolism in the immediate postoperativeperiod after reoperation, after two weeks of gastric bypass,by necrosis of a small fragment of the remnant gastric. In allpatients with persistent feeding intolerance were performed bariumtransit and/or gastroscopy. When gastrojejunal strictureshowed proceeded to endoscopic pneumatic dilation (recommendingdilate the anastomosis to a maximum 1.5 cm).Results: five cases (8.1%) developed a gastrojejunal stricture,in 4 of these cases the initial diagnosis was made by barium transitand in 1 case by endoscopy. Two patients had a history of digestivebleeding that required endoscopic sclerosis of the bleeding lesion(circumferentially sclerosis within 48 hours of surgery andsclerosis of bleeding points). All cases were resolved by endoscopicdilatation. At follow-up has not been detected re-stricture.Conclusion: Clinically, gastrojejunal stricture results in a progressiveoral intolerance, revealing stenosis between 1 and 3months postoperatively. The situations of sclerosis of the bleedinglesions favor, especially in cases of extensive sclerosis. In cases ofsuspected barium transit offers us a high diagnostic yield. Endoscopicdilatation resolved, so far, all cases(AU)
Subject(s)
Humans , Gastric Bypass/adverse effects , Laparoscopy , Bariatrics/methods , Obesity, Morbid/surgery , Anastomosis, Surgical/adverse effects , Postoperative ComplicationsABSTRACT
OBJECTIVE: The applications of endoscopic ultrasonography have diversified over recent years. The possibility of reaching cardiac territory has been successfully explored in experimental models, opening up a new field of possibilities for diagnostic and therapeutic interventions that were unthinkable until very recently. The aims set out in this study are to evaluate cardiac anatomy, its approach, the safety of the experimental procedure and the resulting morphological and histological changes after the procedure. MATERIAL AND METHODS: The study has been performed on two adult pigs. They have undergone different surgical approaches to the cardiac cavities and descending thoracic aorta with excellent results. RESULTS: Different cardiac structures have been identified and operated upon (right auricle, left auricle, left ventricle, cardiac valves), as well as major vessels. The use of contrast, both intracavitary and from a peripheral vein, enabled us to verify the anatomical spaces studied. During the procedures we monitored for arrhythmias, hemodynamic behavior, possibility of infection by obtaining sample hemocultures before and after procedures, and response to punctures. CONCLUSIONS: The present study has enabled us to evaluate access to the heart from the esophageal lumen using endoscopic ultrasonography, with results that are very similar to those described in the current bibliography. However, we offer two novelties: puncture of the right auricle through the interauricular partition and puncture of the descending thoracic aorta, both performed with ease and apparent safety.
