Skipped aganglionic lengthening transposition (SALT) for short bowel syndrome in patients with total intestinal aganglionosis: technical report and feasibility.

Extended aganglionosis (TIA) is the presence of some viable aganglionic gut distal to the levelling jejunostomy. Different surgical procedures (including transplantation) have been proposed with inconclusive results. We conceived a new procedure named skipped aganglionic lengthening transposition (SALT) consisting of multiple pedicled isoperistaltic transpositions of aganglionic ileal loops interposed to normoganglionic jejunum. The innovative aspect consists of taking advantage of the propulsive effect of normoganglionated bowel to progress enteric content throughout interposed aganglionic loops down to the stoma. The procedure was adopted in a male patient who was born with 30 cm of normoganglionated jejunum. SALT was performed when the baby was 18 months. Three 5-cm pedicled isoperistaltic aganglionic loops of small bowel were interposed each 10 cm of normoganglionic jejunum with an overall 36% length gain (from 42 to 57 cm). Postoperative course was uneventful. 6 months postoperatively, an upper gastrointestinal series showed normal progression without dilatations. A laparoscopic gastrostomy was performed due to food aversion 6 months postoperatively, demonstrating impressive anatomic and functional postoperative results. The procedure provides promising and unique opportunity for patients with TIA with encouraging outlook for the near future.

El perfil de los intentadores de suicidio atendidos en el Instituto Especializado de Salud Mental "Honorio Delgado-Hideyo Noguchi" 2003 / The profile of the assisted attempter of suicide in the Specialized Institute of Mental Health

Se trata de un estudio prospectivo y descriptivo que registra a 548 pacientes atendidos en el Programa de Prevención del Suicidio del IESM.H. Delgado-H. Noguchi durante el año 2003, considerando variables sociodemográficas y clínicas. Se aprecia que el perfil que destaca está configurado por características tales como: pertenecer al sexo femenino, cada vez más jóvenes, predominantemente solteras, con educación secundaria o superior, procedentes de distritos empobrecidos, que acuden mayormente de su domicilio, acompañadas generalmente por la progenitora y que cursan con estados básicamente depresivos, generalmente comórbidos con desórdenes de la personalidad, especialmente borderline, abuso de sustancias, Bulimia Nervosa o Trastorno Disfórico Pre-Menstrual, que han tenido conflictos de pareja o familiares, y que habían presentado ya un intento de suicidio al menos en casi la mitad de casos alguna vez en su vida, y registraban antecedentes familiares o personales de violencia física o sexual, y que presentaron intercurrencias propias de su género como abortos o uso de anticonceptivos, siendo el método principal del intento de sobredosis de medicamentos. Este panorama obliga a una aproximación consistente por la tendencia al incremento y a la desintegración que provoca el intento de suicidio.

New model for kinetic studies of HDL metabolism in humans.

BACKGROUND: The aim of the study was to develop a new model for kinetic studies of Apolipoprotein A-I of HDL (Apo A-I-HDL) labelled with stable isotope by using HDL subclasses isolated with fast protein liquid chromatography (FPLC). MATERIALS AND METHODS: Apo A-I-HDL kinetics were studied by infusing [5.5.5-(2)H(3)]-leucine for 14 h in six healthy subjects. Prebeta(1) and alphaHDL were separated by FPLC and total HDL by ultracentrifugation (HDL-UC). RESULTS: The tracer-to-tracee ratios were higher in prebeta(1) HDL than in HDL-UC or alphaHDL. Leucine enrichments found in HDL-UC were higher compared with alphaHDL, suggesting that HDL-UC were composed of a mixture of Apo A-I-alphaHDL and Apo A-I-prebeta(1) HDL. Kinetic analysis of data obtained from FPLC was achieved using a multicompartmental model, including a conversion between prebeta(1) and alphaHDL compartments. The production rate of prebeta(1) HDL was 7.72 +/- 2.86 mg kg(-1) d(-1) (mean +/- SD). Prebeta(1) HDL were converted to alphaHDL at a rate of 96.24 +/- 42.99 pool d(-1), and the synthesis rate of prebeta(1) HDL from alphaHDL was 10-fold slower: 7.09 +/- 4.51 pool d(-1). Apo A-I-FCR of HDL-UC was estimated using a one-compartment model (0.165 +/- 0.074 pool d(-1)), and was higher but not significantly compared with FCR of Apo A-I-alphaHDL (0.112 +/- 0.026 pool d(-1)) calculated with the new model. CONCLUSIONS: This study reports for the first time a model involving enrichments of Apo A-I in prebeta(1) and alphaHDL which allowed the measure of Apo A-I cycling within HDL fraction and will aid better understanding of kinetics of HDL in humans.

A population pharmacokinetic model of cyclosporine in the early postoperative phase in patients with liver transplants, and its predictive performance with Bayesian fitting.

The availability of personal computer programs to individualize drug regimens has stimulated interest in modeling population pharmacokinetics. This study used the NPEM2 software to determine cyclosporine population pharmacokinetic parameter values and distributions in a first group of 25 recipients of liver transplants during their first postoperative week. On a second group of 25 patients, the authors used these values to evaluate Bayesian predictive performance of cyclosporine blood concentrations with the USC*PACK PC program. During the study period, all the patients have been treated by continuous intravenous infusion. The one-compartment model pharmacokinetic parameter-the slope of volume to body weight (Vs) and the elimination rate constant (Kel) values found (mean values: Vs = 2.177 l/kg, Kel = 0.235 h(-1); median values: Vs = 1.559 l/kg, Kel = 0.163 h(-1); the percent coefficient of variation (Vs = 92%, Kel = 79%) appear reasonable and show the ability of NPEM2 to deal with sparse data. When the predictions were studied with day 1, day 2, or day 3 concentrations, predictive bias was respectively -0.030, -0.013, and 0.013 microg/ml, suggesting a greater clearance of cyclosporine immediately after surgery, the clearance decreasing in the days after. With the first three blood levels and the Bayesian fitting procedure, it was possible to predict at least half the subsequent measured blood levels of each patient accurately (within 20%) in more than three-quarters (76%) of the second group of recipients of transplants, and for 40% of patients the authors obtained accurate predictions in 100% of the subsequent blood levels. For a few patients (12%) they found quite poor predictions. The reason for this is unclear. The results suggest that this population model and the Bayesian fitting procedure using two or three blood levels can be reasonably and carefully used to control, in real time, cyclosporine blood levels in a majority of new patients with liver transplants.