Minimally invasive surgery of small intestine

Since the first laparoscopic surgery was performed by Erick Mühe in 1986, multiple minimally invasive techniques have been developed. The small intestine presents several technical difficulties for the application of these techniques, namely: its size, mobilization inside the abdominal cavity, difficulty defining the site under manipulation and the distension association by an ileo or an occlusion. The development of new technology with better cameras and coagulation equipment such as the Harmonic Scalpel and the Ligasure, cutting linear staplers, have permitted the evolution of surgical techniques for the small intestine. Indications for the use of minimally invasive interventions in the treatment of the small intestine are classified as urgent and elective. Lesions secondary to an abdominal cavity puncture were the first to be treated in the small intestine. Abdominal trauma due to a sharp instrument can also be treated through this method. Intestinal occlusion treated without a great dilation can be solved in 55 to 65% of cases. Crohn's disease various surgical treatments are performed by laparoscopy. Obesity surgical treatments, particularly derivative gastroplasty have been carried out successfully by minimally invasive surgery. Gastrojejunoanastomosis or cystojejunoanastomosis are specialized techniques which are performed with minimal invasion; any kind of digestive or urinary stoma can be performed with these techniques. As the surgeon's surgical skills evolve, surgical minimally invasive indications for the small intestine become wider.     

Management of the metabolic syndrome as a strategy for preventing the macrovascular complications of type 2 diabetes: controversial issues

The metabolic syndrome is known to increase cardiovascular morbidity and precede the development of type 2 diabetes. Even before the appearance of hyperglycemia, the components of the metabolic syndrome play a crucial role in the pathogenesis of the macrovascular complications. Thus, the recognition and treatment of the metabolic syndrome may be a strategy to prevent the most likely cause of death (i.e. cardiovascular events) in cases that eventually develop type 2 diabetes. In this review, controversial issues regarding the treatment of the two main components of the metabolic syndrome (i.e dyslipidemia and arterial hypertension) are discussed. Several disparities in the current NCEP-ATPIII recommendations, when applied to patients with the metabolic syndrome, are pointed out. In population-based studies, the number of individuals with the metabolic syndrome who would need LDL cholesterol lowering treatment following these guidelines is remarkably low compared to subjects belonging to the same risk strata (10 year risk 10-20%). Subjects with the metabolic syndrome do not fall into the same risk category, resulting in differing LDL-C targets. Also, the Framingham tables underestimate the cardiovascular risk associated with the metabolic syndrome; hence fewer cases qualify for drug therapy. In addition, LDL-C underestimates the number of atherogenic particles and is therefore not the ideal target for these patients. The selection of antihypertensive medication in the metabolic syndrome is also controversial. Thus, there is sufficient evidence for a review of the current management of the metabolic syndrome as part of a strategy to prevent the macrovascular complications in type 2 diabetes.     

Infected dogs as a risk factor in the transmission of human Trypanosoma cruzi infection in western Venezuela

A total of 565 mongrel dogs from rural localities of Venezuela were examined by serological (DAT, IFAT and ELISA) and parasitological tests to address the status of Trypanosoma cruzi infection and to evaluate their role in the transmission of the infection to human population. The overall percentage of sero-positive infected dogs shown to be 67.6% (382/565):253 (61.7%) from 47 villages belonging to 8 states located at 4 different geographical regions of western Venezuela and 129 (33.5%) dogs from 48 households located in areas where Chagas disease is endemic. From 101 sampled dogs living in close proximity to 30 acute chagasic patients, 84% expressed specific anti-T. cruzi antibodies (Ab) with 12 of them (14%) showing blood circulating parasites (BCP). In these houses a high proportion of sero-positive people (20%) and frequent indoor infestation by triatomine-bugs (70%) was also recorded. The analysis revealed that from the 47 rural villages sampled during the study, 91.5% had the presence of T. cruzi sero-positive dogs, ranging from 62% positive localities at the states of Falcon and Cojedes to 100% in the other six studied Venezuelan states. This demonstrates that T. cruzi-infected dogs are found throughout all the geographical regions of western Venezuela irrespective of their ecological differences. Molecular typing of T. cruzi isolates from infected dogs using ribosomal and mini-exon gene markers, revealed the presence of both T. cruzi I and T. cruzi II lineages. The coincidence in the circulation of T. cruzi II in dog and human populations at the same locality and at the same time is reported and its significance is discussed. The combined serological, parasitological, epidemiological and molecular data is gathered here to call the attention on the presence of infected dogs as a risk factor in the maintenance of T. cruzi as a source for infection to humans.     

Poor sensitivity of polymerase chain reaction assays of genital skin swabs and urine to detect HPV 6 and 11 DNA in men

BACKGROUND: A possible reason for the failure to detect human papillomavirus (HPV) DNA in asymptomatic men who are likely to be infected is the sensitivity of the detection methods. GOAL: The goal of this study was to identify a method for sampling the anogenital skin of men that was simple and well tolerated and that would permit the detection of asymptomatic or subclinical HPV infection, which is thought to occur commonly in sexually active men. STUDY DESIGN: Swabs of genital skin and urine from men at high and low risk of infection with types 6 and 11 were tested for HPV by polymerase chain reaction. RESULTS: These specimens had a low sensitivity for HPV detection, often because inadequate material was collected on the swab. CONCLUSION: Noninvasive sampling of genital skin to identify individuals with subclinical HPV infection remains a challenge. Future studies should involve the use of more abrasive sampling devices (such as cytobrushes), perhaps combined with some type of soap to dislodge more epithelial cells.     

Nurses bring primary health care to industrial workers

Progress in bringing health care to the workplace lags considerably behind progress in bringing health care to where people live. Experience in Botswana shows that the family nurse practitioner--a registered nurse midwife with one year of post-basic training--can provide useful preventive and curative services to people in their places of work.     

Trisomy 9: An additional case with unique manifestations

We report on an infant with multiple congenital anomalies and mosaic trisomy 9. Clinical findings are presented, and compared with those of the 24 cases previously reported. Some unusual characteristics found in this patient include macrocephaly, an extreme degree of palatal hypoplasia, and abnormally shaped long bones. © 1992 Wiley-Liss, Inc.     

Development of a program of behavior modification directed to the rehabilitation of drug-dependent patients: treatment and follow-up of 223 cases.

The study reports treatment and follow-up of compulsive drug-consuming patients (mainly of coca paste). The program used was based on a behavioral cognitive and instructional model. The traditional functional analysis was modified to include the therapeutical work in seven behavioral areas: (1) drug use; (2) behavior during free time; (3) behavior at work; (4) social behavior; (5) self- and environmental management behaviors; (6) problem solving and decision-making behaviors; (7) recognition, evaluation, and modification of irrational beliefs. For each area objectives, therapeutical procedures, control and evaluation methods, and termination criteria were determined. Patients engaged in a multiple activity program and received individual and group therapy. Out of 223 male patients, 130 were discharged (that is, they fulfilled all the conditions stated by the program) and 93 patients abandoned treatment. For evaluation purposes a test was used to determine the accomplishment of the behavioral objectives. Follow-up interviews after 6 to 72 months showed that although 24 patients relapsed to drug use, 106 (81.48%) of the patients who had finished the program restrained from using drugs and obtained high scores in all seven behavioral areas.