Marijuana safety study completed: weight gain,no safety problems

No safety problems specific to HIV or protease inhibitors were found in a study in which volunteers stayed in a research hospital 24 hours a day and were randomly assigned to either smoke marijuana, take oral THC, or take an oral placebo. Marijuana and THC use was associated with weight gain.     

Median arcuate ligament syndrome

Opinion statement Median arcuate ligament syndrome (MALS) can cause a range of symptoms, including abdominal pain, nausea, vomiting, and weight loss. Because all patients have some degree of celiac artery compression by the median arcuate ligament (MAL), it may be difficult to discern which patients have a pathologic compression. Based on the multiple theories of MALS etiology, it is unlikely that we know the true cause of this syndrome. In fact, there are many physicians who question the validity of the diagnosis of MALS. Before offering intervention for MALS, a thorough gastrointestinal evaluation should be performed, including consideration of diagnostic temporary percutaneous celiac ganglion block. Patients who are on chronic narcotics preoperatively have a lower likelihood of postoperative symptom relief and therefore should be evaluated by a pain specialist preoperatively. The most reliable treatment comprises open surgical treatment with division of the MAL, removal of surrounding celiac ganglion, evaluation of the celiac artery with pressure measurements or ultrasound, and celiac artery reconstruction if indicated. Laparoscopic and endovascular interventions are novel treatments and may be considered in select patients who cannot undergo an open surgical procedure.     

Ursodeoxycholic acid therapy in gallbladder disease,a story not yet completed

Gallstone disease represents an important issue in the healthcare system.The principal non-invasive nonsurgical medical treatment for cholesterol gallstones is still represented by oral litholysis with bile acids.The first successful and documented dissolution of cholesterol gallstones was achieved in 1972.Since then a large number of investigators all over the world,have been dedicated in biochemical and clinical studies on ursodeoxycholic acid(UDCA),demonstrating its extreme versatility.This editorial is aimed to provide a brief review of recent developments in UDCA use,current indications for its use and,the more recent advances in understanding its effects in terms of an antiinflammatory drug.     

Median eminence equivalence of the neurohypophysis of the hagfish, Eptatretus burgeri

Three substances of different molecular size were injected into the ventricular space (III) of the neurohypophysis of anesthetized hagfish, Eptatretus burgeri, to learn whether such substances could diffuse across the connective tissue barrier between the neuro- and adenohypophysis. The substances tested were trypan blue, a vital dye that is a fine particulate colloid; horseradish peroxidase (HRP), an enzyme protein whose distribution in tissue can be revealed through its chromogenic action on a substrate; and ferric ion, whose distribution can be revealed through the Prussian blue reaction. All three substances were transferred across the neurohypophyseal wall to the extracerebral area within a few minutes, the trypan blue and HRP apparently through action by tanycytes. The trypan blue, within a 15-min period, moved no further. The HRP protein diffused through connective tissue as far as the dorsal (2 min) and ventral (5 min) borders of the adenohypophysis, but did not enter the secretory cells themselves. The ferric ion reached the adenohypophysis quickly (2 min) and entered the secretory cells in higher concentration than it was in the surrounding connective tissue. These data indicate that the hagfish ventral neurohypophysis is functionally capable of supplying neurosecretory regulatory factors to the adenohypophysis. It is thus a "diffusional median eminence." We can propose that the cyclostome median eminence, lacking a portal relation to the adenohypophysis, represents the phylogenetically primitive brain--pituitary relationship.     

Sugiura's operation: a Japanese exclusive?

Fifteen patients with liver cirrhosis (11) or intrahepatic non cirrhotic portal hypertension (4) and previous variceal bleeding were electively treated by Sugiura's operation. There were no operative death. One patient (6.6 p. 100) had recurrent variceal bleeding 58 months postoperatively. One other patient had a self-limited episode of encephalopathy The 5-year actuarial survival rate was 81 p. 100. Four of the cirrhotic patients operated more than 5 years ago were alive at 5 years. The operation resulted in portal vein thrombosis in 2 patients, one of whom died. Results of this small series are quite similar to those of the largest Japanese series. They suggest that Sugiura's procedure has a low operative risk, is very efficient in preventing variceal rebleeding and does not result in encephalopathy.     

Biliary cannulation with contrast and guide-wire versus exclusive guide-wire: A prospective,randomized, double-blind trial

BackgroundThe use of exclusive guide-wire cannulation (e-GW) instead of contrast injection reduces post-ERCP pancreatitis (PEP) and pre-cutting and increases cannulation rate. Herein, we intend to compare e-GW with the hybrid technique (GW-C and/or contrast injection).MethodsProspective single-center randomized comparative study, which included all patients referred to ERCP to our unit. Patients with non-naïve papilla; previous ERCP; direct infundibulotomy, ampullectomy, Billroth II gastrectomy or pancreatic sphincterotomy and patients lost to follow up were excluded.Results727 consecutive patients were assessed. Of these, 588 naïve papilla patients were included and randomized to receive e-GW (n = 299) or GW-C (n = 289) for selective biliary cannulation. The mean age was 60.3 years and 60.5% were women. PEP occurred in 15(5%) cases in e-GW group and 9(3.1%) in the GW-C group (p = 0.29). Time to reach deep cannulation was faster in the latter group (75% < 5 min vs. 50.2% < 5 min, p<0.001). > 10 min until cannulation was observed in 21% vs. 10% of the ERCPs (groups e-GW and GW-C, respectively, p < 0.001). Total ERCP time was also shorter in the GW-C group (12 vs. 10 min; p < 0.001). Pre-cut (23.8 vs.11.8%, p < 0.001) and pancreatic sphincterotomy as a pre-cut technique (15.8 vs. 5.6%, p < 0.001) were used more frequently in the e-GW group.ConclusionsCompared to exclusive G-W- assisted biliary cannulation, the hybrid technique did not significantly reduce the PEP rate, however it promoted faster cannulation and, consequently, reduced the total procedure time and the use of pre-cut techniques.