Últimos avances en pancreatitis crónica

The most important advances in chronic pancreatitis concern its etiopathogenesis, nutritional aspects, and improvements in diagnostic techniques and some treatment options. In the etiopathogenesis of this disease, the importance of smoking and its association with alcohol have been confirmed. Exocrine pancreatic insufficiency (EPI) secondary to chronic pancreatitis is associated with bone metabolism alterations (osteopenia and osteoporosis), a reduction in liposoluble vitamins and alterations in essential amino acid levels. Endoscopic ultrasound has been confirmed as the most highly developed technique for the diagnosis of chronic pancreatitis, especially due to new image optimization technologies. Breath tests for the diagnosis of EPI continue to be developed (optimization of the C-13 mixed triglyceride test and the development of a new test based on C-13-labelled bicarbonate determination). Modest results in pain treatment have been achieved with the use of antioxidants, pancreatic enzymes and/or intravenous secretin. The association of chronic pancreatitis with pancreatic cancer requires strict follow-up, especially in patients with inflammatory masses in the context of chronic pancreatitis.     

The Role of Alpha Tocopheryl Succinate (α-TOS) as a Potential Anticancer Agent

In recent years, efforts to improve cancer therapy have focused on developing new anticancer agents, such as mitocans. These agents include vitamin E analogues and suppress cancer by inducing apoptosis by targeting mitochondria. Alpha tocopheryl succinate (α-TOS) is the most effective form of vitamin E analogues causing inhibition of proliferation and apoptosis of cancer cells. Both in vitro and in vivo studies have demonstrated that α-TOS selectively kills tumor cells with little or no effect on normal cells. Treatment with α-TOS shows great promise for future clinical applications, as it causes cell death, at least in part, by selectively inducing apoptosis by mitochondrial destabilization. This review presents an overview of perspectives on α-TOS and the potential uses of α-TOS in cancer treatment and other clinical applications.     

Diffusion of innovations in social interaction systems. An agent-based model for the introduction of new drugs in markets

The existence of imitative behavior among consumers is a well-known phenomenon in the field of Economics. This behavior is especially common in markets determined by a high degree of innovation, asymmetric information and/or price-inelastic demand, features that exist in the pharmaceutical market. This paper presents evidence of the existence of imitative behavior among primary care physicians in Galicia (Spain) when choosing treatments for their patients. From this and other evidence, we propose a dynamic model for determining the entry of new drugs into the market. To do this, we introduce the structure of the organization of primary health care centers and the presence of groups of doctors who are specially interrelated, as well as the existence of commercial pressure on doctors. For modeling purposes, physicians are treated as spins connected in an exponentially distributed complex network of the Watts-Strogatz type. The proposed model provides an explanation for the differences observed in the patterns of the introduction of technological innovations in different regions. The main cause of these differences is the different structure of relationships among consumers, where the existence of small groups that show a higher degree of coordination over the average is particularly influential. The evidence presented, together with the proposed model, might be useful for the design of optimal strategies for the introduction of new drugs, as well as for planning policies to manage pharmaceutical expenditure.     

Hypnotherapy of sexual impotence

A sleep-induction procedure requiring manual response to a repetitive auditory signal was administered to 52 Ss who had clear alpha activity in their waking EEG and whose hypnotizability was known. The occurrence of sleep was defined by physiological, behavioral, and subjective criteria. Neither the tendency to develop EEG sleep nor the ability of some Ss to respond while in EEG sleep was related to hypnotizability. Hypnotizability was related to a type of dissociation between EEG sleep and both behavioral and subjective sleep shown by 5 Ss, all highly hypnotizable.     

Molecular characterization,serotyping, and antibiotic susceptibility profile of Leptospira interrogans serovar Copenhageni isolates from Brazil

Leptospira interrogans serogroup Icterohaemorrhagiae is the major serogroup infecting humans worldwide, and rodents and dogs are the most significant transmission sources in urban environments. Knowledge of the prevalent serovars and their maintenance hosts is essential to understand the epidemiology of leptospirosis. In this study, 20 Leptospira isolates were evaluated by pulsed-field gel electrophoresis (PFGE), variable number tandem-repeat analysis (VNTR), serotyping, and determination of antimicrobial resistance profile. Isolates, originated from bovine, canine, human, and rodent sources, were characterized by microscopic agglutination test with polyclonal and monoclonal antibodies and were identified as L. interrogans serogroup Icterohaemorrhagiae serovar Copenhageni. MICs of antimicrobials often used in veterinary medicine were determined by broth microdilution test. Most of tested antibiotics were effective against isolates, including penicillin, ampicillin, and ceftiofur. Higher MIC variability was observed for fluoroquinolones and neomycin; all isolates were resistant to trimethoprim/sulfamethoxazole and sulphadimethoxine. Isolates were genotyped by PFGE and VNTR; both techniques were unable to discriminate between serovars Copenhageni and Icterohaemorrhagiae, as expected. PFGE clustered all isolates in 1 pulsotype, indicating that these serovars can be transmitted between species and that bovine, rodent, and dogs can maintain them in the environment endangering the human population.     

Percutaneous drainage of infected pancreatic necrosis: an alternative to surgery

AIM OF THE STUDY: To describe a technique of percutaneous CT guided catheter drainage of infected pancreatic necrosis and to report the results of this technique compared with those of the conventional surgical treatment and of other percutaneous drainage series. PATIENTS AND METHODS: Between 1992 and 1997, the series included 32 patients who had a severe acute necrotizing pancreatitis with a mean Ranson score of 4.6, scored into grade D (n = 10), and grade E (n = 22), according to the Balthazar radiological staging. Modified Van Sonnenberg 24 F double lumen catheters were used for continuous irrigation and aspiration. RESULTS: Forty-nine drains were inserted for 41 infected necroses and eight abscesses. Among the 32 patients, the proof of infected necrosis was obtained in 26 patients by fine needle aspiration and culture (enterococcus, staphylococcus, pseudomonas). The average delay of catheter insertion was 23 days after onset of pancreatitis; the mean duration of drainage was 43 days, and an average of three catheters per patient was required. Five patients (15%) died, and among the survivors, 16 (59%) presented 21 complications including 14 enterocutaneous or pancreatic fistulas. A subsequent surgical procedure including two necrosectomies was necessary in six patients. CONCLUSION: This study demonstrates that percutaneous drainage of infected pancreatic necrosis with a 15% mortality and 70% success rate, represents an interesting alternative to conventional surgery.     

Total Corporal Contouring with Megaliposuction (120 Consecutive Cases)

The purpose of this study is to present the authors' long-term experience with total corporal contouring with megaliposuction. The evolution of body reshaping in one operative setting including simultaneous head and neck contouring, upper and lower extremity recontouring, and creation of an aesthetic trunk and abdominal form is discussed. Patient evaluation, operative techniques, postoperative management, and long-term results are emphasized. From February 1994 to February 1997, 120 consecutive patients underwent total corporal contouring with tumescent (Hunstad formula)-technique, classic liposuction. There were 10 males and 110 females. The average age of all patients was 28 years. Preoperative evaluation emphasized corporal shape and proportions. No other open procedures were performed simultaneously in these patients. The authors' postoperative regimen is discussed. The average amount of aspirated material in these series was 14,000 ml (range, 8000–20,000 ml). No blood transfusions were required. Complications included only hypopigmentation (N= 2) and postoperative seromas requiring aspiration (N= 12). Follow-up examination took place at 3 months to 3 years, with an average of 14 months. All patients underwent a metamorphosis from an amorphic shape to one that follows the normal body contours and profiles. The goals of megaliposuction are no longer just to reduce body fat and body mass. Individually planned surgery for these patients should be based upon obtaining normal symmetrical body proportions. Total corporal contouring and reshaping can now be safely performed, offering hope and predictable outcomes to this patient population. Patient evaluation, operative technique, postoperative care, and long-term results are presented.     

Extremely High Body Mass Index is not a Contraindication to Laparoscopic Gastric Bypass

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is an effective operation for morbidly obese patients who have failed conservative weight loss treatments. It is currently indicated for patients with BMI >40 kg/m² or >35 with significant co-morbidities. Controversy exists whether there is an upper limit to BMI beyond which this operation should not be performed. Methods: Between April 1999 and February 2001, 82 patients (19 male, 63 female) underwent LRYGBP. Average age was 43.6, and average BMI was 56 kg/m². These patients were divided into those with BMI <60 and those with BMI ≥60 kg/m². Results:There were 61 patients with BMI <60 and 21 patients with BMI ≥60. The groups were similar in age, gender, distribution or incidence of co-morbid conditions (diabetes, coronary artery disease, hypertension, sleep apnea, asthma) between the groups. The BMI ≥60 group had a significantly longer length of stay (6.6 days vs 5.3 days, P <0.05), and only 1 patient (BMI 85) developed an anastomotic leak and died. 2 patients in this group (BMI 62 and 73) developed small bowel obstruction requiring lysis of adhesions. 1 patient in the BMI <60 group developed a gastrojejunal stricture requiring balloon dilatation. Conclusion: While patients with a BMI ≥60 are at higher risk for postoperative complications, they are also at higher risk from continued extreme obesity. In our series, 85% of these patients had an uneventful postoperative course and began shedding excess weight. BMI ≥60 should not be a contraindication for LRYGBP.