Surgical revision of biliopancreatic diversion

Biliopancreatic diversion is a very effective method for weight reduction. In some instances it is too effective and needs to be revised.     

Iotrol versus metrizamide in lumbar myelography: a double-blind study

In a prospective, randomized, double-blind study, 49 patients underwent lumbar myelography using iotrol (24 patients) or metrizamide (25 patients). The diagnostic imaging adequacy of iotrol was comparable with that of metrizamide. After iotrol myelography, adverse reactions were fewer, less severe, and of shorter duration than were those following metrizamide myelography. Thirteen of 24 patients (54%) receiving iotrol reported some adverse reactions compared with 24 of 25 patients (96%) receiving metrizamide. Five moderate and one severe adverse reaction occurred in the group receiving iotrol. Fourteen moderate and eight severe adverse reactions occurred in the group receiving metrizamide. Thirty-eight patients underwent electroencephalography both before and after myelography (19 iotrol and 19 metrizamide). None of the EEGs obtained after iotrol myelography changed from baseline, while seven of the EEGs obtained after metrizamide myelography showed changes from baseline. Iotrol was judged superior to metrizamide as a contrast medium in this patient population.     

IDENTIFYING THE TARGETS FOR GLAU-COMA CARE

The intraocular pressure (IOP) of glaucoma patients has been a fundamental therapeutic target for over 100 years, however, it is only recently that rigorous clinical trials have demonstrated definitively that lowering IOP delays vision loss. The Advanced Glaucoma Intervention Study (2000), the Collaborative Initial Glaucoma Treatment Study (2001), and the Early Manifest     

Synthesis of a 11-deoxyprostanoid in the area of preclavulones: (+-)-8,12-trans-(5Z-14Z)-9-oxo-prosta-5,14-dienoic acid from 2-allyl-2-cyclopenten-1-one.

Following our research on the arachidonic acid metabolites and their derivatives with potential biological activity, we describe the synthesis of the (+-)-8,12-trans-(5Z, 14Z)-9-oxo-prosta-5,14-dienoic acid, a 11-deoxyprostanoid correlated to the class of Preclavulones, one of the unusual families of marine eicosanoids from the coral Clavularia Viridis with considerable biological interest.     

Follistatin and activin A production by the male reproductive tract

Follistatin is a binding protein for the activin and inhibin family of hormones, regulating their biological activity. In the male reproductive tract, the interaction of these factors is likely to be involved in the regulation of the proliferation of several cell types. We have investigated the presence of follistatin and activin A in seminal plasma using specific immunoassays and have localized follistatin and activin/inhibin subunits in the adult human testis, prostate and seminal vesicle to establish their likely sources. High concentrations of immunoreactive follistatin were present in seminal plasma in normal men (mean 97.9 ng/ml; 1.43 ng/ml in peripheral plasma) and were similar in men with oligo/azoospermia and following vasectomy. Follistatin immunoreactivity was localized to both Leydig and Sertoli cells of the testis, and to epithelial cells of the prostate gland and seminal vesicle, which are likely to be the predominant sources of the hormone in seminal plasma. Activin A was also present in seminal plasma in normal men but was undetectable following vasectomy, thus deriving from the testis. Consistent with this finding, the betaA-subunit was immunolocalized in Sertoli and Leydig cells but was not present in seminal vesicle or prostate gland. The functional significance of the high concentrations of follistatin secreted into seminal plasma by the prostate gland and/or seminal vesicle is uncertain, but they may regulate the biological activity of testis-derived activin A and inhibin B.      

Aktuelle Indikationen zur pyloruserhaltenden Duodenopankreaskopfresektion beim Malignom

Zusammenfassung Die Pankreaskopfresektion in der Modifikation nach Traverso-Longmire, mit Erhaltung eines funktionierenden Pylorus, hat gegenüber der Kausch-Whipple-Operation die Vorteile, daß Anastomosenulzera vermieden werden und daß die Patienten postoperativ eine bessere und schnellere Gewichtszunahme haben. Indikationen waren bisher die Papillenkarzinome und periampulare Tumoren. Bei den Adenokarzinomen lassen sich mit der Pyloruserhaltung gleich gute Überlebensraten erzielen. Unsere Ergebnisse von 56 Pyloruserhaltungen, davon 32 beim duktalen Karzinom und 28 Kausch-Whipple-Operationen in den Jahren von 1985–1993, belegen gleiche Überlebensraten, wie dies bereits für das Papillenkarzinom gezeigt werden konnte. Die Überlebenskurven zeigen, daß die Radikalität nicht von der Magenteilentfernung, sondern von der Resektion an den posterioren und retroperitonealen Resektionsrändern abhängt.

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Current indications for pylorus preservation in duodenopancreatic head resection in malignancies

The Whipple procedure has been improved by preservation of a functioning pylorus. A functioning pylorus is important because marginal ulceration is avoided and, compared to the standard Whipple procedure with gastric resection, more patients can gain weight postoperatively. The most common indications are carcinomas of ampulla of Vater and periampullary tumors. In patients with pancreatic adenocarcinoma the pylorus-preserving variety results in equal or better survival rates. In 56 patients with pylorus preservation, 32 with ductal carcinoma, and 28 with Kausch-Whipple between 1985 and 1993, our results showed slightly better survival rates and better post-operative nutrition. The weakest aspect of the radical resection addresses the retroperitoneal margin of the pancreas head and not the gastric resection.