Intragastric pH effect of 20mg of levo-pantoprazole versus 40mg of racemic pantoprazole the first seven days of treatment in patients with gastroesophageal reflux disease. / Efecto sobre el pH intragástrico de 20mg de levopantoprazol versus 40mg de pantoprazol racémico durante los primeros 7 días de tratamiento en pacientes con enfermedad por reflujo gastroesofágico.

INTRODUCTION/AIM: Levo-pantoprazole, the S-enantiomer of pantoprazole, is a proton pump inhibitor that has been shown in animal studies to be faster and stronger than its racemic formulation. There are no studies on humans and therefore our aim was to evaluate the effects of levo-pantoprazole versus racemic pantoprazole on intragastric pH. MATERIALS AND METHODS: A randomized controlled study was conducted on patients with erosive gastroesophageal reflux disease that were given 20mg of levo-pantoprazole (n = 15) versus 40mg of racemic pantoprazole (n = 15) for 7 days. Baseline and end-of-treatment symptom evaluation and intragastric pH measurement were carried out. RESULTS: There were no differences between the groups in the baseline evaluations. From 40 to 115min after the first dose of levo-pantoprazole, the mean intragastric pH was higher, compared with that of racemic pantoprazole (p < 0.05). After one week, levo-pantoprazole and racemic pantoprazole significantly reduced intragastric acid production and its esophageal exposure (p < 0.05). Even though there was no statistically significant difference, a larger number of patients that received levo-pantoprazole stated that their heartburn improved within the first 3 days. CONCLUSIONS: The S-enantiomer of pantoprazole (levo-pantoprazole) had a faster and stronger effect with respect to acid suppression, compared with its racemic formulation. Although the effect on symptoms was faster with levo-pantoprazole, occurring within the first days of treatment, it was equivalent to that of the racemate at one week of treatment.

CASE-REPORT Case study of a patient presenting both type II bipolar affective disorder and Klinefelter syndrome.

Klinefelter syndrome (KS) is the most common sex chromosomal disorder with an estimated prevalence of 1 in 500-1000. Increased incidences of anxiety, depression, substance abuse, psychotic and behavioral disorders, and sexual disorders have been reported in patients with KS. The aim of this case study was to report a case of a man with untreated KS who was also diagnosed with type II bipolar disorder. This case report raises awareness regarding psychiatric diagnoses that may be associated with such a highly prevalent condition. A 46-year-old man who had previously been diagnosed with an untreated KS was examined in our Psychiatric Department with an acute hypomanic episode. Clinical improvement was observed within 4 days and psychiatric symptoms were resolved in 7 days without use of medication. A psychiatric history of a depressive episode and at least two hypomanic episodes, as well as a family history of two relatives diagnosed with bipolar disorder, strongly suggest that our patient has type II bipolar disorder. Bipolar disorder may be a comorbid disorder in patients with KS. Routine screening for mood disorders and appropriate referral and evaluation should be performed. Future genetic research is warranted to explore why some chromosomal abnormalities (e.g., duplications), especially those located on the X chromosome, such as Klinefelter syndrome, may be associated with a bipolar or psychotic disorder in some individuals but not in others.

Hematoma masivo de pared abdominal y hemoperitoneo secundario a la administración subcutánea de heparina de bajo peso molecular / Massive abdominal wall hematoma and hemperitoneum secondary to subcutaneous infusion of low molecular weight heparin

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The effects of food restriction on maternal endocrine adaptations in pregnant rats.

The aim of this study was to characterize hemodynamic, electrolytic and endocrine alterations produced by food restriction (50%) in pregnant rats for the purpose of evaluating the importance of these parameters on the plasma volume expansion and fetal growth. One hundred seventy six pregnant rats were divided into two groups, a control group (C) with an ad libitum diet and another with a restricted diet (U) (50% by weight of the diet of the control group). On days 5, 10, 15 and 20 of pregnancy, the weight of the mother, water intake, urine output, urine and plasma sodium concentration, plasma potassium concentration, blood pressure and heart rate, osmolality, plasma renin activity (PRA) and vasopressin were recorded. The number and weight of the fetuses were determined on days 15 and 20 of gestation. Food restriction results in inadequate weight gain in the mother and retardation of fetal growth. Water and sodium balance (p< or =0.001) were decreased in U group and basal PRA (p< or =0.001) was increased in U group. Food restriction did not significantly alter urine sodium excretion, plasma osmolality, plasma sodium and potassium values, blood pressure and basal vasopressin values. We conclude that the higher values of PRA, described in food restriction situations during pregnancy, seem to be caused by the adaptation to low sodium intake.

Role of 17-beta-estradiol and progesterone on glucose homeostasis: effects of food restriction (50%) in pregnant and non pregnant rats.

The role of 17-beta-estradiol and progesterone on glucose homeostasis was examined in pregnant and non pregnant rats with or without food restriction (50%). Blood glucose and insulin levels were significantly decreased in food restricted pregnant (PM) compared with control pregnant (PC) and in food restricted non pregnant (M) compared with non pregnant control (C). The plasmatic level of progesterone was similar in PC and PM, while the plasmatic level of 17-beta-estradiol was significantly decreased in PM compared with PC at 15 and 20 days. In spite of food restriction, the changes in the insulin/glucose ratio throughout gestation were similar in PC and PM. A positive and significant relation between 17-beta-estradiol and the level of insulin at day 5 of gestation, and a negative and significant relation between the level of 17-beta-estradiol and level of insulin at day 15 of gestation were found in PC. A negative and significant relation between the levels of progesterone and the levels of insulin at day 5 of gestation, at day 10 this relation is positive and significative, and at day 15 a positive and significant relation exists between levels of 17-beta-estradiol and levels of insulin were found in PM. These results suggest that 17-beta-estradiol acts directly on beta-cells to control insulin secretion. Food restriction does not alter the changes in the sensitivity of tissues to the insulin action, and does modify the action of 17-beta-estradiol and progesterone on beta-cell.

Lower lip reconstruction following resection of large lesions.

Good cosmetic and functional results have been obtained following wide resection of large lower lip lesions. A simple method is described for reconstruction.