Esophagectomy with Ileocoloplasty,Last Treatment for a Leak After Laparoscopic Sleeve: “From Less to More”

Obesity Surgery - Laparoscopic sleeve gastrectomy (LSG) is increasingly playing a key role in obesity management. Such operations, however, carry complications sometimes including leaks. The...     

Syncope in Patients With Severe Aortic Stenosis: More Than Just an Obstruction Issue

BackgroundSevere aortic stenosis (AoS) is considered a primary cause of syncope. However, other mechanisms may be present in these patients and accurate diagnosis can have important clinical implications. The aim of this study is to assess the different etiologies of syncope in patients with severe AoS and the impact on prognosis of attaining a certain or highly probable diagnosis for the syncope.MethodsOut of a cohort of 331 patients with AoS and syncope, 61 had severe AoS and were included in the study. Main cause of syncope and adverse cardiac events were assessed.ResultsIn 40 patients (65.6%), we reached a certain or highly probable diagnosis of the main cause of the syncope. AoS was considered the primary cause of the syncope in only 7 patients (17.5% of the patients with known etiology). Atrioventricular block (14 patients, 35.0%) and vasovagal syncope (6 patients, 15.0%) were the most frequently diagnosed causes. The presence of a known cause for syncope during the admission was not associated with a lower incidence of recurrence during follow-up (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.20-2.40). Syncope of unknown etiology was independently associated with greater mortality during 1-year follow-up (HR 5.4, 95% CI 1.3-21.6) and 3-year follow-up (HR 3.5, 95% CI 1.2-10.3).ConclusionsIn a high proportion of patients with severe AoS admitted for syncope, the valvulopathy was not the main cause of the syncope. Syncope in two-thirds of this population was caused by either bradyarrhythmia or reflex causes. Syncope of unknown cause was associated with increased short- and medium-term mortality, independently from treatment of the valve disease. An exhaustive work-up should be conducted to determine the main cause for syncope.     

Bone defect formation during implant placement following alveolar distraction

PURPOSE: This retrospective study was designed to evaluate the volume of hard tissue generated at the time of implant placement in distracted alveolar bone. MATERIALS AND METHODS: All patients who underwent distraction osteogenesis between 2000 and 2003 were included. The preoperative bone height, amount of distraction performed, and presence or absence of complications affecting implant placement were recorded. The augmentation achieved was correlated with insufficient bone formation using the Spearman correlation and the Fisher exact test. RESULTS: The study included 43 implants placed in 17 cases of alveolar distraction. Of the 34 implants placed in bone augmented by 4.5 to 6.5 mm, bone defects were observed with 12. All 9 implants placed in ridges augmented by 7 to 10.5 mm demonstrated a bone defect. The "defect" and "no-defect" implant groups differed significantly with respect to preoperative bone height and amount of distraction performed (P < .001 for both). Significantly more defects were formed in bone augmented by > 25% compared to bone augmented by < 25% (P < .001). CONCLUSIONS: When considering distraction osteogenesis, augmentation of up to 25% of the initial bone height seems more predictable and less likely to be associated with complications at the time of implant placement. In distractions greater than 25% of the original height, additional treatment should be considered.     

Cardiac monitoring for patients with palpitations

Palpitations are one of the most common reasons for medical consultation. They tend to worry patients and can affect their quality of life. They are often a symptom associated with cardiac rhythm disorders, although there are other etiologies. For diagnosis, it is essential to be able to reliably correlate the symptoms with an electrocardiographic record allowing the identification or ruling out of a possible rhythm disorder. However, reaching a diagnosis is not always simple, given that they tend to be transitory symptoms and the patient is frequently asymptomatic at the time of assessment. In recent years, electrocardiographic monitoring systems have incorporated many technical improvements that solve several of the 24-h Holter monitor limitations. The objective of this review is to provide an update on the different monitoring methods currently available, remarking their indications and limitations, to help healthcare professionals to appropriately select and use them in the work-up of patients with palpitations.     

Gemcitabine plus vinorelbine in nonsmall cell lung carcinoma patients age 70 years or older or patients who cannot receive cisplatin. Oncopaz Cooperative Group.

BACKGROUND: Although the prevalence of nonsmall cell lung carcinoma (NSCLC) is high among elderly patients, few data are available regarding the efficacy and toxicity of chemotherapy in this group of patients. Recent reports indicate that single agent therapy with vinorelbine (VNB) or gemcitabine (GEM) may obtain a response rate of 20-30% in elderly patients, with acceptable toxicity and improvement in symptoms and quality of life. In the current study the efficacy and toxicity of the combination of GEM and VNB in elderly patients with advanced NSCLC or those with some contraindication to receiving cisplatin were assessed. METHODS: Forty-nine patients with advanced NSCLC were included, 38 of whom were age >/= 70 years and 11 were age < 70 years but who had some contraindication to receiving cisplatin. All patients were evaluable for response and toxicity. Treatment was comprised of VNB, 25 mg/m(2), plus GEM, 1000 mg/m(2), both on Days 1, 8, and 15 every 28 days. Patients received a minimum of three courses unless progressive disease was detected. RESULTS: One hundred sixty-five courses were administered, with a median of 3. 6 courses per patient. The overall response rate was 26% (95% confidence interval, 15-41%). Two patients attained a complete response (4%) and 11 patients (22%) achieved a partial response. Eastern Cooperative Oncology Group performance status improved in 35% of those patients with an initial value > 0, whereas relief of at least 1 symptom without worsening of other symptoms was noted in 27 patients (55%). The median time to progression was 16 weeks and the 1-year survival rate was 33%. Toxicity was mild. Six patients (12%) had World Health Organization Grade 3-4 neutropenia, 2 patients (4%) had Grade 3-4 thrombocytopenia, and 2 patients (4%) had Grade 3 neurotoxicity. Three patients with severe neutropenia (6%) died of sepsis. The median age of those patients developing Grade 3-4 neutropenia was significantly higher than that of the remaining patients (75 years vs. 72 years; P = 0.047). CONCLUSIONS: The combination of GEM and VNB is moderately active and well tolerated except in patients age >/= 75 years. This age group had an increased risk of myelosuppression. Therefore the prophylactic use of granulocyte-colony stimulating factor should be considered with this treatment. New chemotherapy combinations with higher activity and lower toxicity are needed for elderly patients with advanced NSCLC.     

Identification and quantification of flavonoids in traditional cultivars of red and white onions at harvest

Onions are rich in different types of phenolics, mainly flavonols, and in red varieties anthocyanins are also present. This is significant because these classes of phenolics are antioxidants and hence may impart important functional properties to onions. The aim of the present work was to simultaneously determine flavonol and anthocyanin concentrations in different onion varieties, two white (Branca da Póvoa and the hybrid SK409) and three red (landrace Vermelha da Póvoa, a selected line of Vermelha da Póvoa and Red Creole). Flavonols (quercetin 7,4-diglucoside, quercetin 3,4-diglucoside, isorhamnetin 3,4-diglucoside, quercetin 3-glucoside, quercetin 4-glucoside and isorhamnetin 4-glucoside) were the predominant polyphenolic compounds. White cultivars had the lowest total flavonol content, with values of 89.3 ± 38.5 and 101.0 ± 18.9 mg quercetin/kg fresh weight for Branca da Póvoa and the hybrid SK409, respectively. The red onions had the highest levels of flavonols, especially the selected population of Vermelha da Póvoa and Red Creole, with values of 280.2 ± 41.5 and 304.3 ± 81.2 mg quercetin/kg fresh weight, respectively. Red onions are not only richer in flavonols, but also contain anthocyanins. Four anthocyanins (cyanidin 3-glucoside, cyanidin 3-laminaribioside, cyanidin 3-(6″-malonylglucoside), and cyanidin 3-malonylaminaribioside) were quantified in all red onions, with Red Creole presenting the highest concentration (28.6 ± 8 mg cyanidin/kg fresh weight). Red onions may be recommended for their major potential functional properties. A distinct gradient in total flavonoid content was found between the outer, central and inner edible scales and along the longitudinal axis of the bulb. Differences in flavonol levels between small- and large-sized onions were also found. All of these factors are of paramount importance for sampling and characterizing onions with regard to flavonoids.     

The striatum beyond reward: caudate responds intensely to unpleasant pictures

The involvement of striatum in affective processes has been consistently reported in recent years. However, studies within this field have mainly focused on positive affect, revealing the involvement of striatum in reward situations. The present research aimed to explore the involvement of striatum in negative affect through fMRI. To that aim, participants (n=18) were presented with negative, positive and neutral pictures while they performed an indirect task, a strategy repeatedly recommended to avoid cognitive interferences. Positive and negative stimuli did not differ in their arousal levels, as assessed by participants themselves. Analyses of variance showed that caudate nucleus was sensitive to the emotional content of stimulation, negative pictures eliciting greater caudate responses than positive and neutral. Regression analyses indicated that both valence and arousal content of visual stimuli synergically contributed to explain the activation of caudate, whose strong response to negative pictures supports models proposing striatum as a key element in withdrawal situations.     

Ultrastructural differences between leukoplakia with and without dysplasia]

Leukoplakias with similar clinical appearances have presented with very different histopathological characteristics. In this study we investigate in depth the cellular ultrastructure of the tissues which determines the clinical behaviour of these lesions.     

Scanning electron microscope study of dentin treated with sodium N-monochloro-DL2-aminobutyrate (NMAB)

This paper report a scanning electron microscope study of the dentinal surface after treatment with sodium N-monochloro-DL2-aminobutyrate (NMAB). The carious cavity shows a rugous and irregular surface. There are detaching plates of the dentin dissolved by the NMAB. At high magnification the compact dentin and the detaching plates show a acid-etched surface.