Blind loop syndrome after biliopancreatic diversion: a diagnostic challenge

Background: Biliopancreatic diversion (BPD) according to Scopinaro's method is a safe and effective technique for treatment of morbid obesity.In this operation a side-to-side enteroenterostomy is created 60 cm proximal to the ileocecal valve. Malabsorption of fat and starch is one of the main goals of the BPD. Ingestion of an excess of fat leads to steatorrhea. As a side-effect, malabsorption of iron, calcium and other elements can occur causing anemia and hypocalcemia.The blind loop syndrome gives the same symptoms. Methods: A lady was admitted with a long history of steatorrhea, anemia and hypocalcemia due to a blind loop syndrome after a BPD. The diagnostic problem in this patient is illustrated. Results: The diagnosis was only made at exploratory laparotomy. Conclusion: The blind loop syndrome was then treated with resection of the blind loop and antibiotics.     

Control of Milk Secretion and Apoptosis DuringMammary Involution

Lactation depends on regular suckling or milkingof the mammary gland. Without this stimulus, milksecretion stops and mammary involution is induced.Involution caused by abrupt cessation of milk removal is characterized by de-differentiation andapoptosis of mammary epithelial cells, the extent andtime course of the latter varying between species.Apoptosis is inhibited and milk secretion is restored by re-suckling, if milk stasis is of shortduration. Mammary involution and apoptosis also occurduring weaning, even in concurrently-pregnant animalswhen the interval between lactations is restricted, suggesting that tissue remodeling is essentialfor subsequent lactation. Declining milk production inruminants after peak lactation is also associated with,and probably results from, net cell loss by apoptosis. Involution and apoptosis arecontrolled by changes in systemic galactopoietic hormonelevels, and by intra-mammary mechanisms responsive tomilk removal. Milk stasis precipitated by litter removal or cessation of milking may involveintra-mammary control related to physical distension ofthe epithelium. Local control of apoptosis in rodentsduring weaning, and after peak lactation in dairyanimals, may be due to the actions of milk-bornesurvival factors or their inhibitors, and can bemanipulated by frequency of milk removal.     

Student evaluation: its worth for course tutors

As part of their evaluation of the 9-week 'Medicine in the Community' course, final-year medical students completed a terminal evaluation questionnaire. Items and subject groupings were scored using a scale of 1–5 for 'value', 'interest', and 'presentation', and mean evaluations were calculated for each group of students. The results, summarized in tabular form, were posted to the seventy-three course tutors together with the mean evaluations of the course as a whole. It was hoped that this feedback on the course would help tutors to improve the standard of their contributions.
After 2 years of this evaluation, a questionnaire was sent to the course tutors to examine whether student opinion is useful to them in the planning of teaching. Findings indicate that student opinion is actively sought and the results are useful, but only if tutors can identify their individual contributions from the tabulated summary.     

国产模块LOOP环改良法合成11C-蛋氨酸

目的 用国产11C-多功能合成模块经LOOP环法合成放射性药物11C-蛋氨酸(11C-MET), 与C-18柱固相法合成11C-蛋氨酸进行比较。 方法 对国产模块LOOP环法制备11C-MET的合成工艺进行探讨, 研究碱当量、溶剂效应及前体量等影响因素。 结果 LOOP环法制备11C-MET优化后的合成条件:前体量2~3 mg溶于NaOH溶液(2 mol/L), 碱当量5.6~11.5 eq, 加入乙醇100 μl, 室温反应。此条件下11C-MET的合成效率为(65.31±4.32)%(n=24, 11C-CH₃I未校正效率), 产品的放化纯度>95%, 产量为(6.61±1.38) GBq。 结论 LOOP环法提高了11C-MET合成效率, LOOP环可以多次重复利用, 降低了生产成本, 提高了合成产量, 实现了稳定、全自动化合成11C-MET, 且产品能满足临床需求。     

Oxyntomodulin Reduces Hydromineral Transport Through Rat Small Intestine

Glicentin (GLIC) and oxyntomodulin (OXM) arereleased from the ileum and colon during digestion. Bothhormones reduce fluid and proton secretion in thestomach. The luminal concentration of sodium andchloride underlying the nutrient absorption, the effectof OXM on electrolyte transport through the smallintestine, was assessed in vivo using ligated loops andin vitro using Ussing chambers. In vivo , a zero transport state, estimated by the net water,chloride, and sodium fluxes, was observed when an 80 mMNaCl normoosmolar solution (274 mosm) was administeredintraluminally. Active secretion was observed with hyperosmotic challenge (474 mosm). Theamplitude of this active secretion increased 2.5- to3-fold when an electrogenic challenge (NaCl 40 mM) wassubstituted to the hyperosmotic one. OXM (800 fmol/ml plasma) did not modify the basal transport inthe duodenum or in the jejunum (t = 45 min). When activesecretion was induced by the hyperosmotic challenge, OXM(200 fmol/ml plasma) had no effect on duodenal or jejunal transport (t = 50 min). When activesecretion was induced by an electrogenic challenge, OXM(300 fmol/ml plasma) preferentially reduced thehydromineral transport in jejunum. In vitro , OXM also induced a reduction in the ion transporttowards the jejunal lumen (EC₅₀ = 20 pM), theamplitude of which depended upon the integrity of thetetrodotoxin-sensitive neurons. In conclusion, OXM wasable to reduce the large secretion induced in ratjejunum in vivo by an electrogenic gradient. In vitro,the antisecretory effect of OXM was partly mediated bythe neurons present in the intrajejunal wall.     

Relationships Between Gastric Emptying and Intestinal Absorption of Nutrients and Energy in Mini Pigs

Little is known about the relationship betweengastric emptying of nutrients regulated by feedbackmechanisms and the absorptive capacity of the gut.Therefore, we wanted to elucidate theseinterrelationships. A 150-cm jejunal segment was perfused (1-8kcal/min) with three different nutrient solutions(either 60% of energy as carbohydrate, or 60% asprotein, or 33.3% of each nutrient). In separateexperiments, gastric emptying was measured afteradministration of three different meals with the samenutrient composition as the perfusion solutions. Thejejunal absorption of carbohydrate, protein, fat, andenergy demonstrated saturation kinetics. The kineticsdiffered among the three nutrients; carbohydrates wereabsorbed at higher rates than fat and protein.Interactions among the nutrients altered the kinetics providing a constant absorption of energy.After meals, the stomach emptied equal amounts of energydespite large variations in meal composition. Theavailable intestinal absorptive capacity for protein was utilized by 96%, whereas that forcarbohydrate, fat and energy were utilized only by46-62%. Besides reserves in the absorptive capacity, theintestine provided reserves in total length available for absorption. The results indicate a closerelationship between the energy-dependent absorption ofnutrients and the energy-dependent feedback inhibitionof gastric emptying.     

The Mini-Gastric Bypass: Experience with the First 1,274 Cases

Background: Results of the laparoscopic Mini-Gastric Bypass (MGB) are reported. Methods: 1,274 MGB patients are continuously monitored as part of an online computer tracking data-base system. Results: Mean preoperative weight (± Standard Deviation) was 132 ± 21 kg, BMI 47 ± 7. Mean excess weight loss was 51% at 6 months, 68% at 12 months and 77% at 2 years. The mean operating-time was 36.9 ± 33.5 minutes. The shortest time was 19 minutes. Hospital stay was 1.5 ± 1.6 days. The overall complication rate has been 5.2%.The overall rate of deep vein thrombosis and pulmonary embolism was 0.08% and 0.16% respectively. The leak rate was 1.6%. There was one hospital death, 0.08%. Associated medical illnesses were either completely reversed or markedly improved. Conclusions: The MGB is safe, results in major weight loss, has a short operating-time, and has a short hospital stay.The MGB appears to meet many of the criteria of an "ideal" weight loss operation.