Long-term (11 Years) Results of Laparoscopic Gastric Bypass: Changes in Weight, Blood Levels of Sugar and Lipids, and Late Adverse Effects : Laparoscopic Gastric Bypass Results.

PURPOSE: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains the most effective procedure to treat severe obesity with proven short- and intermediate-term benefits. The main goal is to describe the effects on weight and biochemical laboratory tests after long-term follow-up (11 years). MATERIALS AND METHODS: A prospective cohort of adults with obesity treated with LRYGB between 2004 and 2010 in one center were studied. Patients with prior bariatric or upper digestive tract surgery, hiatal hernia >4 cm, alcoholism, or decompensated conditions were excluded. The study enrolled 123 patients, with a mean follow-up of 133±29 months and a 14% loss of participants. RESULTS: The percentage of Total Weight Loss (%TWL) at one, five, and eleven years was 30.3±8.4%, 29.1±6.9%, and 23.4±7%, respectively. Of the patients, 61.3% (65/106) maintained a %TWL≥20 after eleven years. Recurrent Weight Gain (RWG) at five and eleven years was 2.6±11.4% and 11 ±11.5%, respectively. At the end of the follow-up, 31.1% (33/106) of patients had RWG≥15%. Hypercholesterolemia and hypertriglyceridemia improved in 85.7% (54/63) and 90.2% (7/61) of the cohort, respectively. Remission of diabetes occurred in 80% of this subgroup. Gallstones developed in 28% of patients, and bowel obstruction due to internal hernia occurred in 9.4%. Anemia due to iron deficiency appeared in 25 patients. CONCLUSION: After surgery, there is a significant and durable loss of weight, with a tendency for late Recurrent Weight Gain. Furthermore, the improvement in biochemical parameters is sustained over time, but surgery's adverse effects may appear later.

[Epidemiology of acute pancreatitis in Chile between 2013 and 2018]. / Epidemiología de la pancreatitis aguda en Chile entre los años 2013 y 2018.

BACKGROUND: The worldwide incidence of acute pancreatitis (AP) is increasing. AIM: To determine the national incidence of AP between 2013 and 2018. MATERIAL AND METHODS: Analysis of hospital discharge records available at the web page of the Statistical and Information Service of the Chilean Ministry of Health. We recorded the number of patients discharged with a diagnosis of AP, excluding chronic pancreatitis and pancreatic cancer, between 2013 and 2018. We also recorded length of hospital stay, age, etiology, and lethality. Rates of raw and age-adjusted incidence were calculated. RESULTS: During the study period, 46,420 patients with AP were discharged, with an incidence rate ranging between 39 and 43.7/100,000 inhabitants, and a non-significant increase along time of 8.6%. There are important differences between the average adjusted rates of Northern (Arica to Metropolitan) and Southern regions (O'Higgins to Magallanes), with rates of 36.9 and 53.6/100,000 inhabitants respectively (p < 0.01). The average hospital stay was 11 days. Two thirds of cases were aged between 20 and 64 years. The case fatality was 4.2%, with no decrease between 2013 and 2018. The mortality rate was 1.6/100,000 inhabitants. CONCLUSIONS: The annual incidence of AP is 42.6/100,000 inhabitants, with geographical differences from North to South, which can be associated with the high frequency of biliary tract disease in aboriginal ethnic groups. The age distribution and length hospital stay were stable over time.

Utilidad del dispositivo de potenciación del esfínter esofágico distal (LINX®) para pacientes con reflujo gastroesofágico / Usefulness of the distal esophageal sphincter enhancement device (LINX®) for patients with gastroesophageal reflux

Resumen La fundoplicatura de Nissen laparoscópica (FNL) es el gold standard del tratamiento quirúrgico de pacientes con reflujo gastroesofágico patológico (RGE), con perfil de seguridad y resultados a largo plazo satisfactorios en un 80%. En la última década, se ha propuesto el uso de un dispositivo de potenciación del esfínter esofágico inferior (MSA) comercializado como LINX® (de Ethicon, Johnson & Johnson), como alternativa a la cirugía antirreflujo. El dispositivo consiste en una cadena expansible de cuentas de titanio con un núcleo magnético diseñadas para aumentar el tono del esfínter esofágico inferior (EEI) y evitar su relajación inadecuada. Los resultados preliminares han sido alentadores, sin embargo, no está exento de complicaciones. Las indicaciones más aceptadas son: RGE con motilidad esofágica normal y sin esofagitis erosiva, hernia hiatal < 3 cm, IMC <35 kg/m2 y pacientes sin cirugías gastroesofágicas previas. Se instala por vía laparoscópica. Los efectos adversos más importantes son: disfagia con necesidad de dilataciones endoscópicas, y, retiro del dispositivo, entre 1% y 7% a los 2,5 años. La mayoría de los estudios tienen limitaciones metodológicas, conflictos de interés, falta de resultados objetivos y seguimientos a largo plazo, impidiendo llegar a conclusiones extrapolables respecto a la eficacia del MSA.

Laparoscopic Nissen Fundoplication (LNF) is the gold standard of surgical treatment for patients with Gastroesophageal Reflux Disease (GER), with safety profile and long term results satisfactory in 80%. In the last decade, the use of a Lower Esophageal Sphincter Enhancement Device (LESD), marketed as LINX® (from Ethicon, Johnson & Johnson), has been proposed as an alternative to Anti-Reflux Surgery. The device consists of an expandable chain of titanium beads with a magnetic core designed to increase the tone of the lower esophageal sphincter (LES) and prevent its improper relaxation. Preliminary results have been encouraging; however, it is not without complications. The most accepted indications are: GER with normal esophageal motility and without erosive esophagitis, hiatal hernia < 3 cm, BMI <35 kg/m2, and patients without previous gastroesophageal surgeries. It is installed by laparoscopy. The most important adverse effects are: dysphagia with the need for endoscopic dilations, and, removal of the device, between 1 and 7% at 2.5 years. Most of the studies have methodological limitations, conflicts of interest, lack of objective results and long-term follow-up, preventing the reaching of extrapolable conclusions regarding the efficacy of MSA.

Epidemiología de la pancreatitis aguda en Chile entre los años 2013 y 2018 / Epidemiology of acute pancreatitis in Chile between 2013 and 2018

Background: The worldwide incidence of acute pancreatitis (AP) is increasing. Aim: To determine the national incidence of AP between 2013 and 2018. Material and Methods: Analysis of hospital discharge records available at the web page of the Statistical and Information Service of the Chilean Ministry of Health. We recorded the number of patients discharged with a diagnosis of AP, excluding chronic pancreatitis and pancreatic cancer, between 2013 and 2018. We also recorded length of hospital stay, age, etiology, and lethality. Rates of raw and age-adjusted incidence were calculated. Results: During the study period, 46,420 patients with AP were discharged, with an incidence rate ranging between 39 and 43.7/100,000 inhabitants, and a non-significant increase along time of 8.6%. There are important differences between the average adjusted rates of Northern (Arica to Metropolitan) and Southern regions (O'Higgins to Magallanes), with rates of 36.9 and 53.6/100,000 inhabitants respectively (p < 0.01). The average hospital stay was 11 days. Two thirds of cases were aged between 20 and 64 years. The case fatality was 4.2%, with no decrease between 2013 and 2018. The mortality rate was 1.6/100,000 inhabitants. Conclusions: The annual incidence of AP is 42.6/100,000 inhabitants, with geographical differences from North to South, which can be associated with the high frequency of biliary tract disease in aboriginal ethnic groups. The age distribution and length hospital stay were stable over time.

Influence of the liquid viscosity on the formation of bubble structures in a 20kHz field.

The cavitation field in a cylindrical vessel bottom-insonified by a 19.7kHz large area transducer is studied experimentally. By adding controlled amounts of Poly-Ethylene Glycol (PEG) to water, the viscosity of the liquid is varied between one- and nine-fold the viscosity of pure water. For each liquid, and for various displacement amplitudes of the transducer, the liquid is imaged by a high-speed camera and the acoustic field is measured along the symmetry axis. For low driving amplitudes, only a spherical cap bubble structure appears on the transducer, growing with amplitude, and the axial acoustic pressure field displays a standing-wave shape. Above some threshold amplitude of the transducer, a flare-like structure starts to build up, involving bubbles strongly expelled from the transducer surface, and the axial pressure profile becomes almost monotonic. Increasing more the driving amplitude, the structure extends in height, and the pressure profile remains monotonic but decreases its global amplitude. This behavior is similar for all the water-PEG mixtures used, but the threshold for structure formation increases with the viscosity of the liquid. The images of the bubble structures are interpreted and correlated to the measured acoustic pressure profiles. The appearance of traveling waves near the transducer, produced by the strong energy dissipated by inertial bubbles, is conjectured to be a key mechanism accompanying the sudden appearance of the flare-like structure.

Estudio de biodisponibilidad comparativa de dos formulaciones de risperidona existentes en el mercado chileno / Comparative bioavailability study of two formulations of risperidone available in the Chilean market

BACKGROUND: Bioavailability of a particular drug can vary according to the formulation used. Therefore, studies of comparative bioavailability of different formulations of a same drug are worthwhile. AIM: To compare the bioavailability of two risperidone formulations available in the Chilean market. MATERIAL AND METHODS: The bioavailability of a local risperidone formulation (Spiron) was compared with the original formulation of the drug (Risperdal) in 12 healthy volunteers, aged 19 +/- 1 years. A single dose of 3 mg was given orally, using a randomized double blind protocol in two periods. Fifteen blood samples were obtained at regular intervals, until 24 h after drug administration. Risperidone plasma levels were measured by high pressure liquid chromatography. pharmacokinetic parameters were calculated using a computer program that is independent of compartmental analysis. RESULTS: The area under the curve of plasma concentration versus time, from 0 to infinite (ABC0-infinity) and from 0 to 24 h (ABC0-24), early exposure (ABC from 0 to maximal time) and maximal plasma concentrations were significantly lower for Spiron. Half life time and time to achieve the maximal concentration were similar for the two formulations. CONCLUSIONS: According to bioequivalence tests suggested by the Food and Drug Administration (FDA) of the United States (90 per cent confidence interval for the difference of long transformed mean pharmacokinetic parameters), the formulations Risperdal and Spiron, cannot be considered interchangeable.

[Comparison of the efficacy of intraarticular and intraarterial injections of two betamethasone preparations in patients with osteoarthritis or epicondilytis]. / Comparación de la eficacia clínica de una inyección intraarticular o intralesional de dos preparados de betametasona en pacientes con artrosis o epicondilitis.

BACKGROUND: Local infiltration with corticoids is a simple therapy for rheumatic disorders devoid of systemic adverse reactions. AIM: To compare the efficacy of two betametasone preparations from two different pharmaceutical laboratories in the treatment of patients with osteoarthritis or epicondylitis. PATIENTS AND METHODS: Fourty patients with knee osteoarthritis and 12 patients with epicondylitis were studied. Using a double blind protocol, one of the two betametasone preparations was used for local infiltration of the lesions. The change in a global score of clinical variables including pain and disability was assessed after 30 days of the infiltration. RESULTS: In patients with osteoarthritis, the global score decreased significantly with both preparations, but no differences were observed between preparations (7.3 +/- 1.8 to 3.9 +/- 2.3 with preparation A and 7.8 +/- 1.9 to 3.6 +/- 2.3 with preparation B). In patients with epicondylitis, pain was also significantly reduced but no differences between preparations was observed (7 +/- 2.1 to 1.4 +/- 2.5 for preparation A and 4.6 +/- 2.8 to 1.2 +/- 1.6 for preparation B). CONCLUSIONS: Local infiltration with both betametasone preparations was equally effective in the treatment of patients with knee osteoarthritis or epicondilytis.

[Plasma concentrations and amiodarone/desethylamiodarone relations in patients subjected to chronic treatment]. / Concentraciones plasmáticas y relación amiodarona/desetilamiodarona en pacientes sometidos a tratamiento crónico.

We measured plasma concentrations of amiodarone and desethylamiodarone by HPLC in 44 outpatients aged 24 to 67 years old (21 male), receiving the drug during at least three months. The drug was indicated for supraventricular arrhythmias in 37 patients and ventricular arrhythmias in seven. Plasma concentrations of amiodarone, desethylamiodarone and their ratio were 1.71 +/- 0.82, 0.85 +/- 0.42 micrograms/ml and 2.02 respectively, for a mean daily dose of 223 +/- 88 mg. In 41 patients, arrhytmias were successfully treated. These patients received a mean daily dose of 220 +/- 86 mg and concentrations of amiodarone, desethylamiodarone and their ratio were 1.75 +/- 0.86, 0.88 +/- 0.45 micrograms/ml and 1.99 respectively. In three patients with treatment failure, receiving a daily dose of 257 +/- 115 mg, these figures were 1.2 +/- 0.3, 0.5 +/- 0.1 micrograms/ml and 2.4 respectively. We conclude that our patients had lower plasma concentrations of desethylamiodarone and higher amiodarone/desethylamiodarone ratios than those reported in other countries.

[Amiodarone absorption and elimination after oral and intravenous administration in healthy individuals]. / Absorción y eliminación de amiodarona después de su administración oral e intravenosa en individuos sanos.

We studied amiodarone absorption and disposal in eight male healthy subjects aged 21 +/- 1 years old and weighting 69.8 +/- 7.1 kg. An intravenous dose of 5 mg/kg and an oral dose of 600 mg of amiodarone were administered. Amiodarone concentrations were measured by HPLC and calculations were performed using a compartment model independent pharmacokinetic analysis program. After oral administration a Cmax of 1.17 +/- 0.3 mg/ml was achieved at 3.25 +/- 0.46 h (tmax). Absolute bioavailability ranged from 50.4 to 87.8% (68.6 +/- 12.6%). Compared to previous reports, the variability of this parameter is similar and the mean value is one of the highest informed. After intravenous administration, Amiodarone had a half life of 7.53 +/- 0.96 h, a total body clearance of 4.25 +/- 0.73 ml/kg/min and a distribution volume of 2.99 +/- 0.71 l/kg. Except the later figure, which is in the inferior range, all other parameters are within previously reported values. It is concluded that amiodarone absorption and disposal values found in Chilean subjects are similar to those reported abroad.

[Pharmacokinetics and clearance of ciprofloxacin and amikacin in continuous hemodialysis]. / Farmacocinética y aclaramiento de ciprofloxacina y amikacina en hemodiálisis continua.

We studied the pharmacokinetic and clearance of a 200 mg ciprofloxacin and a 500 mg amikacin intravenous dose during 5 continuous hemodialysis procedures in 5 patients with acute oliguric renal failure. Hourly blood and ultrafiltrate drug concentrations were measured during 8 hours. Dialysate flux (Qd) was 16.6 ml/min during the first hours and 33.2 ml/min thereafter. For each Qd, total ciprofloxacin clearance was 1.13 +/- 0.99 and 2.8 +/- 1.71 ml/min (p < 0.001), diffusive clearance was 0.96 +/- 0.87 and 2.47 +/- 1.56 ml/min (p < 0.005) and convective clearance was 0.16 +/- 0.17 and 0.33 +/- 0.2 ml/min (p < 0.05). Likewise, total amikacin clearance was 3.47 +/- 1.31 and 4.18 +/- 0.53 ml/min (p < 0.001), diffusive clearance was 2.97 +/- 1.24 and 3.86 +/- 0.52 ml/min and convective clearance was 0.50 +/- 0.47 and 0.32 +/- 0.29 ml/min (p = NS). Protein binding was 84% for ciprofloxacin and 77% for amikacin. It is concluded that during continuous hemodialysis with cuprofan membrane, the main transport mechanism of ciprofloxacin and amikacin is diffusive. Very low amounts of ciprofloxacin are depurated by the dialyser. Likewise, the shortening of amikacin half life suggests the presence of other elimination pathway and the need to use supplementary doses every 24 hours.

Transposition of IST2 in Thiobacillus ferrooxidans.

The genome of Thiobacillus ferrooxidans contains at least two different repetitive DNA elements. One of these elements, termed IST2 has been sequenced and shown to exhibit the characteristics of a typical prokaryotic insertion sequence. Furthermore, preliminary evidence has implicated IST2 in genomic rearrangements, although the mechanism of rearrangement, whether by transposition or recombination, has not been established. In this report we provide evidence from detailed restriction enzyme analyses and DNA sequencing data that support a model of transposition, consistent with the notion that IST2 is a mobile insertion sequence.

[Determination of plasma concentration of amiodarone and desethylamiodarone with high pressure liquid chromatography. Preliminary experience]. / Determinaciones plasmáticas de amiodarona y desetilamiodarona por cromatografía líquida de alta presión. Experiencia preliminar.

A simple specific and sensitive high pressure liquid chromatography method (HPLC) to measure amiodarone and desethylamiodarone is described. The plasma sample is deproteinized with acetonitrile and a 50 ul aliquote run in the HPLC system with reverse phase column (C-18). Methanol-ammonium hydroxide is used to separate and spectrophotometric measurements are read at 254 nm.95% of the drug present in plasma is extracted with this method, with a sensitivity of 0.03 ug/ml and a day to day variation under 3%. Preliminary measurements were analyzed in 14 subjects receiving amiodarone for treatment of supraventricular arrhythmia. With a mean dose of 267 +/- 116 (SD) mg/day, plasma levels of 1.3 +/- 0.6 ug.ml for amiodarone and 0.9 +/- 0.5 mg/ml for desethylamiodarone were obtained.

Isolation and nucleotide sequence of the Thiobacillus ferrooxidans genes for the small and large subunits of ribulose 1,5-bisphosphate carboxylase/oxygenase.

The genes encoding for the large (rbcL) and small (rbcS) subunits of ribulose-1,5-bisphosphate carboxylase (RuBisCO) were cloned from the obligate autotroph Thiobacillus ferrooxidans, a bacterium involved in the bioleaching of minerals. Nucleotide sequence analysis of the cloned DNA showed that the two coding regions are separated by a 30-bp intergenic region, the smallest described for the RuBisCO genes. The rbcL and rbcS genes encode polypeptides of 473 and 118 amino acids, respectively. Comparison of the nucleotide and amino acid sequences with those of the genes for rbcL and rbcS found in other species demonstrated that the T. ferrooxidans genes have the closest degree of identity with those of Chromatium vinosum and of Alvinoconcha hessleri endosymbiont. Both T. ferrooxidans enzyme subunits contain all the conserved amino acids that are known to participate in the catalytic process or in holoenzyme assembly.

Estudio de los efectos del ultrasonido en el tejido embrionario in vitro. / Effects of ultrasound on the embryonic tissue in vitro

Esbozos de miembros de ave con 144 horas de incubacion fueron sometidos a irradiacion ultrasonica con una frecuencia de 50 kHz y una intensidad de 6.4 mW/cm2 durante 10,20 y 30 minutos respectivamente.Se desdriben los hallazgos histologicos, entre lo que llama la atencion la presencia de focos de necrosis en aquellos irradiados durante 20 minutos. El histograma mostro disminucion significativa de las mitosis en los de 10 y 20 minutos, y aumento notorio en el de 30 minutos. Se compara lo encontrado con lo descrito por la literatura la literatura