Primary or idiopathic intestinal pneumatosis: a rare casual endoscopic finding.

A 66-year-old male patient with no specific prior medical history consulted due to constipation without other associated symptoms. A colonoscopy was performed and multiple pseudonodular lesions were detected from the sigmoid to splenic angle in the form of air bubbles with normal-appearing mucosa and a preserved vascular pattern. Gas was released when the biopsies were being taken. An abdominal computed tomography (CT) scan was performed due to the suspicion of an idiopathic or primary intestinal pneumatosis, in which the findings confirmed the diagnosis.

An assessment of bacterial overgrowth and translocation in the non-alcoholic fatty liver of patients with morbid obesity.

BACKGROUND: small intestinal bacterial overgrowth (SIBO) and bacterial translocation across the intestinal wall have been allegedly associated with non-alcoholic fatty liver (NAFL). Our goal was to study such alleged association in morbidly obese patients. PATIENTS AND METHODS: patients with morbid obesity were consecutively included prior to bariatric surgery. Exclusion criteria included normal liver biopsy, other causes of liver disease, and duodenal mucosal atrophy. A gastroscopy was performed for duodenal aspirate culture and duodenal biopsy, and peripheral venous blood was drawn to assess lipopolysaccharide (LPS) and LPS-binding protein (LBP) levels. A liver biopsy was carried out during surgery. RESULTS: seventy-one patients were included; 26 were excluded because of normal liver biopsy. Forty-five had NAFL. Eighteen were male, mean age was 45.8 years (22-69), and BMI was 47.8 kg/m2 (37-58). A total of 25% had SIBO in their duodenal aspirate culture. There was statistical significance for the association of LBP levels and SIBO with steatosis grade (p < 0.05 and p = 0.077, respectively). There was no statistical association with non-alcoholic steatohepatitis (NASH) index, but a trend towards association was found. LPS levels were not associated with steatosis grade or NASH index. CONCLUSIONS: the higher the grade of liver steatosis, the higher were the circulating LBP levels and SIBO rates seen in patients with morbid obesity and NAFL.

[Patient opinion and perception of their participation in family medicine consultation decision making]. / Opiniones y percepciones de los pacientes sobre su participación en la toma de decisiones en las consultas de medicina de familia.

OBJECTIVES: To find out the views of the patient on their participation in decision making (DM) when visiting their family physician. DESIGN: A cross-sectional, qualitative and quantitative study. SETTING AND PARTICIPANTS: Patients attending their family doctors in diverse geographical Health Centres. MEASUREMENTS: Personal interviewing using different kinds of questions (close-ended, close-ended with options and open-ended questions). RESULTS: Patients participation: 658 (52 ± 17.4 years, 62% females, consulting with 97 doctors (from urban centres: 36 (458); rural centres: 22 (200). Most patients (94%; 620) declared to be satisfied with DM and up to 41% (266) thought that DM should be taken only by the doctor. Nevertheless, after the consultation 60% of patients (360) confirmed that they would have liked the physician to have asked them for their opinion, but the doctor did not encourage them to do this. Furthermore, patients considered information, discussion about options, ways to make decisions, medical advice, active listening and empathy as key aspects to encourage them to participate. CONCLUSIONS: After a medical consultation, most patients wanted to give their opinion about the proposals of treatment. Nevertheless, they felt that their doctors offered them these opportunities on very few occasions. Some types of questions are better than others in detecting of these kinds of needs, and are more useful to design strategies for involving patients in the DM process.