Esophageal anastomotic leaks: preliminary results of treatment with balloon dilation

Disruption of a cervical esophagogastric or esophagocolonic anastomosis shortly after surgery is a common complication, and fistula drainage from the leaking anastomosis may be prolonged. Narrowing of the anastomosis apparently contributes to the development and maintenance of the fistula. Fluoroscopically guided balloon dilation of anastomotic strictures was performed in three patients with anastomotic leaks. Preliminary results suggest that the procedure is safe and promotes healing of the fistula.     

Increased insulin action and clearance in hyperthyroid newly diagnosed IDDM patient. Restoration to normal with antithyroid treatment

In a patient with hyperthyroidism and newly diagnosed insulin-dependent diabetes mellitus (IDDM), insulin action and clearance were studied before the initiation of antithyroid treatment and at 3-mo intervals for 1 yr thereafter. The sequential euglycemic clamp technique (5 mM) was used with insulin infusion rates of 0.5, 1.0, 2.0, and 5.0 mU.kg-1.min-1 in four steps of 2 h. The data were compared with nine control subjects and nine newly diagnosed euthyroid IDDM patients treated with insulin for 0.5 mo. Insulin sensitivity was increased in the patients (ED50 40 vs. 52 mU/L, range 43-70, in controls and 70 mU/L, range 59-120, in IDDM subjects). Insulin responsiveness was markedly elevated; the steady-state glucose infusion rate (SSGIR) of step 4 was 104 vs. 64 mumol.kg-1.min-1 (range 50-79) in controls and 61 mumol.kg-1.min-1 (range 47-69) in IDDM subjects. Insulin clearance was elevated in all steps (1-3, 20-23 vs. 9-15 ml.kg-1.min-1; 4, 18 vs. 6-12 ml.kg-1.min-1 in control and IDDM subjects). Parallel to the normalization of thyroid metabolism, insulin action (ED50 60 mU/L, SSGIR in step 4, 51 mumol.kg-1.min-1) and insulin clearance (steps 1-3, 11-14 ml.kg-1.min-1; step 4, 7 ml.kg-1.min-1) returned to the normal range in 6 mo. Both remained within the normal range until 12 mo. In the patient with newly diagnosed IDDM, the initial marked increases of insulin action and clearance were due to coexistent hyperthyroidism. With the amelioration of the hyperthyroid state, both processes became normal. The parallelism between insulin action and clearance suggests a functional relationship.     

Red cell compatibility testing in baboon xenotransplantation

BACKGROUND: Although baboon ABO group and human anti-baboon heteroagglutinin (HA) titers have been considered in the selection of baboon donors for clinical hepatic xenotransplantation, the biologic role of these antibodies is not yet known. However, because of the potential importance of ABO hemagglutinins, a method for baboon ABO group determination is described, as are the titers of HA observed in both baboons and normal human donors. STUDY DESIGN AND METHODS: The ABO group of 62 baboons was determined by modified reverse typing. Baboon sera were heated and absorbed with human group O red cells. Reverse typing was then performed by standard techniques. HA titers at room temperature (RT) and in the antiglobulin test (AGT) were assessed in 10 baboons by using human red cells and in 33 normal donors by using baboon red cells. RESULTS: Ten (16%) baboons were group A, 29 (47%) were group B, 23 (37%) were group AB, and none were group O. In tests using human group O red cells, HA titers in 10 baboons ranged from 1 to 32 at RT and from negative to 64 in the AGT. All 33 normal human sera contained anti-baboon HA. Under a hemagglutination scoring system, group A persons had the lowest HA scores (17 +/− 15 at RT, 31 +/− 19 in the AGT), and group B persons had the highest HA scores (67 +/− 4 at RT, 85 +/− 9 in the AGT). CONCLUSION: Baboon ABO group can be easily determined by modified reverse serum typing. Both baboons and humans possess HAs of variable titer. Among humans, titers appear to be highest in group B individuals and lowest in group A. Additional studies are needed to determine the clinical significance of these antibodies.     

Management of type 2 diabetes: a challenge for patient and physician

Type 2 diabetes mellitus is a chronic disease, associated with serious complications and co-morbidity and considerable costs. The number of people with diabetes mellitus is expected to increase with 40% in the next decade, due to prolonged life expectancy, the ageing of the population and developments in the health care sector, including more active screening strategies. The majority (40-60%) of type 2 diabetes patients in routine GP practice have a poor metabolic control (HbA1c > 8% or fasting blood glucose > 11 mmol/l). In this paper the obstacles in routine clinical practice for optimal type 2 diabetes care are discussed. Long-term complications are the major cause of morbidity and mortality in type 2 diabetes patients. Therefore, the primary aim of type 2 diabetes management is the prevention of complications, by lowering blood glucose levels and reducing the cardiovascular risk profile. An important component of type 2 diabetes management is an active role of the patient: diet, smoking habits, physical exercise and self-care behavior often need to change. In addition, the patient has to adhere to life long medical therapy. Motivating the patient for this active role is the challenge for health care providers. A complicating factor is that changes in lifestyle do not give immediate benefit for the patient, as the effects are seen in the reduction of the development of long-term complications. The cornerstones of health care to support active patient participation are: to guarantee the continuity of care, to integrate education in health care and to encourage the patient's attendance. It is the challenge for physicians to give type 2 diabetes patients the tools for active participation in the management of the disease.     

The association of Triatoma maculata (Ericsson 1848) with the gecko Thecadactylus rapicauda (Houttuyn 1782) (Reptilia: Squamata: Gekkonidae): a strategy of domiciliation of the Chagas disease peridomestic vector in Venezuela?

Objective

To investigate the bioecological relationship between Chagas disease peridomestic vectors and reptiles as source of feeding.

Methods

In a three-story building, triatomines were captured by direct search and electric vacuum cleaner search in and outside the building. Then, age structure of the captured Triatoma maculata (T. maculata) were identified and recorded. Reptiles living in sympatric with the triatomines were also searched.

Results

T. maculata were found living sympatric with geckos (Thecadactylus rapicauda) and they bit residents of the apartment building in study. A total of 1 448 individuals of T. maculata were captured within three days, of which 74.2% (1 074 eggs) were eggs, 21.5% were nymphs at different stages, and 4.3% were adults.

Conclusions

The association of T. maculata and T. rapicauda is an effective strategy of colonizing dwellings located in the vicinity of the habitat where both species are present; and therefore, could have implications of high importance in the intradomiciliary transmission of Chagas disease.