Laparoscopic longitudinal pancreaticojejunostomy for chronic pancreatitis: Systematic review of the literature.

BACKGROUND: Longitudinal pancreaticojejunostomy, also known as modified Puestow or Partington-Rochelle procedure, is a technique for the treatment of chronic pancreatitis. It is usually performed by laparotomy, but in a very small number of cases it has been performed using a laparoscopic or robot-assisted approach. We carried out a systematic literature review to clarify the current status of laparoscopic longitudinal pancreatojejunostomy (LLPJ). METHODS: Adhering to the PRISMA guidelines, a systematic search for LLPJ was performed in PubMed, Embase, and Cochrane Library, for articles published up to 31 December 2017. RESULTS: 357 articles were evaluated for eligibility and 17 were included for critical appraisal: eight case reports, eight retrospective case series, and one series of cases and controls without randomization. All of them had a grade of recommendation C and a level of evidence 4 according to the CEBM. Patients were relatively young (mean age 37 years), with a slight preponderance of males (ratio 1.3: 1). All had long-standing disease, ERCP prior to surgery and a dilated pancreatic duct (mean 11 mm). The surgery was usually performed laparoscopically using four trocars; the conversion rate was low (5%), bleeding was minimal, the morbidity rate was 11% and no mortality was reported. Mean hospital stay was 5.6 days. The follow-up period varied but was usually short (less than two years). The results for pain control were very good since 90% of patients reported no pain, although visual analog scales were rarely used. CONCLUSIONS: In conclusion, LLPJ seems to be a safe, feasible and effective technique in patients with chronic pancreatitis. However, the number of descriptions published to date is very small, and there are no studies with high scientific evidence comparing LLPJ with open surgery or with endoscopic treatment that would allow us to draw firmer conclusions at the present time.

The T-box transcription factor gene TBX22 is mutated in X-linked cleft palate and ankyloglossia.

Formation of the secondary palate is a complex step during craniofacial development. Disturbance of the events affecting palatogenesis results in a failure of the palate to close. As a consequence of deformity, an affected child will have problems with feeding, speech, hearing, dentition and psychological development. Cleft palate occurs frequently, affecting approximately 1 in 1,500 births; it is usually considered a sporadic occurrence resulting from an interaction between genetic and environmental factors. Although several susceptibility loci have been implicated, attempts to link genetic variation to functional effects have met with little success. Cleft palate with ankyloglossia (CPX; MIM 303400) is inherited as a semidominant X-linked disorder previously described in several large families of different ethnic origins and has been the subject of several studies that localized the causative gene to Xq21 (refs. 10-13). Here we show that CPX is caused by mutations in the gene encoding the recently described T-box transcription factor TBX22 (ref. 14). Members of the T-box gene family are known to play essential roles in early vertebrate development, especially in mesoderm specification. We demonstrate that TBX22 is a major gene determinant crucial to human palatogenesis. The spectrum of nonsense, splice-site, frameshift and missense mutations we have identified in this study indicates that the cleft phenotype results from a complete loss of TBX22 function.

Pancreatic Surgery in Chronic Pancreatitis Complicated by Extrahepatic Portal Hypertension or Cavernous Transformation of the Portal Vein: A Systematic Review.

OBJECTIVES: Chronic pancreatitis produces disabling pain and loss of pancreatic endocrine/exocrine function. Almost half of the patients will need surgery during the course of the disease. Certain conditions, such as extrahepatic portal hypertension or cavernous transformation of the portal vein, can increase the risk of morbidity and mortality. These complications must be borne in mind in the design of the surgical treatment of chronic pancreatitis. This study is a systematic review on the coexistence of chronic pancreatitis and extrahepatic portal hypertension/cavernous transformation in patients undergoing pancreatic surgery. METHODS: We conducted an unlimited search updated on 10 December 2017, which yielded 535 results. We selected 11 articles. RESULTS: Main indication for surgery was intractable pain. Presence of extrahepatic portal hypertension and/or cavernous transformation increased intraoperative bleeding and general postoperative morbidity, though the increase in general morbidity was less when the different postoperative complications were analyzed individually. Case series showed a higher mortality in patients with extrahepatic portal hypertension. CONCLUSION: Little is known about the presence of extrahepatic portal hypertension in patients undergoing pancreatic surgery for chronic pancreatitis. More studies are needed in order to standardize criteria for vascular involvement in patients with chronic pancreatitis, in order to select the surgical technique and, if necessary, to establish contraindications, in this subgroup of patients.

Systematic review of the mesopancreas: concept and clinical implications.

BACKGROUND: In 2007, Gockel et al. coined the term mesopancreas (MP). In the next 10 years, a limited number of publications about MP have been published, but little is known about the oncological benefit of MP resection. We performed a systematic review of the literature on MP. METHODS: An electronic search was performed in PubMed, EMBASE, Cochrane, Latindex, Scielo, and Koreamed databases until 15 June 2017 to identify all published articles dealing with the subject of MP. Some language restriction was done (Chinese and Rumanian). RESULTS: The search yielded 51 articles; 28 articles were selected as relevant. All were retrospective studies focused more on describing technical variants, feasibility and safety than on the cancer results. The R0 rate in patients with MP resection ranged between 57 and 96.7%. In all the articles with a control group, the R0 rate was higher in the MP excision group. Survival data were explicitly stated only in five series. CONCLUSION: MP is a difficult-to-excise retropancreatic area. In theory, it is agreed that MP excision raises the rate of R0 resections, which in turn reflected in an improvement in the oncological results; however, at present there are no randomized studies to prove this. Achieving a worldwide consensus on its concept, landmarks, excision technique and oncological results is essential.

Differential Ca2+ and Sr2+ regulation of intracellular divalent cations release in ventricular myocytes.

The regulation of the Ca2+ -induced Ca2+ release (CICR) from intracellular stores is a critical step in the cardiac cycle. The inherent positive feedback of CICR should make it a self-regenerating process. It is accepted that CICR must be governed by some negative control, but its nature is still debated. We explore here the importance of the Ca2+ released from sarcoplasmic reticulum (SR) on the mechanisms that may control CICR. Specifically, we compared the effect of replacing Ca2+ with Sr2+ on intracellular Ca2+ signaling in intact cardiac myocytes as well as on the function of single ryanodine receptor (RyR) Ca2+ release channels in panar bilayers. In cells, both CICR and Sr2+ -induced Sr2+ release (SISR) were observed. Action potential induced Ca2+ -transients and spontaneous Ca2+ waves were considerably faster than their Sr2+ -mediated counterparts. However, the kinetics of Ca2+ and Sr2+ sparks was similar. At the single RyR channel level, the affinities of Ca2+ and Sr2+ activation were different but the affinities of Ca2+ and Sr2+ inactivation were similar. Fast Ca2+ and Sr2+ stimuli activated RyR channels equally fast but adaptation (a spontaneous slow transition back to steady-state activity levels) was not observed in the Sr2+ case. Together, these results suggest that regulation of the RyR channel by cytosolic Ca2+ is not involved in turning off the Ca2+ spark. In contrast, cytosolic Ca2+ is important in the propagation global Ca2+ release events and in this regard single RyR channel sensitivity to cytosolic Ca2+ activation, not low-affinity cytosolic Ca2+ inactivation, is a key factor. This suggests that the kinetics of local and global RyR-mediated Ca2+ release signals are affected in a distinct way by different divalent cations in cardiac muscle cells.

Differential thermal lensing in extended samples.

We present a new scheme for a pump-probe mode-mismatched thermal lensing experiment aimed at extracting the value of low-absorbing components in the presence of a high-absorbing background. The method allows for the use of large path-length samples. Changes in the background absorption of a column of ethanol of 20 cm of 1% and a pollutant concentration detection limit of 0.04 ppm are obtained when using a pump light power of 34 mW.

Coupled map networks as communication schemes.

Networks of chaotic coupled maps are considered as string and language generators. It is shown that such networks can be used as encrypting systems where the cipher text contains information about the evolution of the network and also about the way to select the plain text symbols from the string associated with the network evolution. The secret key provides the network parameters, such as the coupling strengths.

[The usefulness of the application of nonlinear dynamics in the analysis of electrocardiograms in Chagas' disease patients]. / Utilidad de la aplicación de técnicas de modelado no lineal en el análisis de electrocardiogramas de pacientes con infección chagásica.

INTRODUCTION AND OBJECTIVES: The application of nonlinear techniques allows the definition of early risk markers in patients with Chagas infection and without any evidence of cardiac involvement evaluated by standard diagnostic test. Nonlinear modeling techniques have proved to be effective in cardiac rhythm analysis, thereby justifying its use in Chagas' disease. PATIENTS AND METHOD: The routine noninvasive test and heart rate variability analysis were performed in Chagas' disease patients and in a group of healthy subjects. In a second phase we used nonlinear analysis in the evaluation of patients with Chagas infection and no evidence of heart disease, Chagasic patients with minimal electrocardiographic abnormalities and healthy controls. RESULTS: Twenty-four-hour electrocardiographic ambulatory monitoring and heart rate variability allowed us to establish differences between the healthy subjects and patients with Chagas infection without evidence of cardiac disease (p c 0.05 and p <0.005). In sharp contrast nonlinear analysis characterized 4 subgroups in Chagasic patients without cardiac involvement (sensitivity and specificity of 1 00%). CONCLUSIONS: Our findings suggest that nonlinear modeling techniques have a high sensitivity and specificity in the early detection of cardiac involvement and very early autonomic disturbance. We recommend that these techniques be applied to patients with high risk of cardiac disease other than Chagasic myocarditis. Our findings should be corroborated with studies in larger populations. We are currently developing a prospective study to this end.

Can the use of an evidence-based algorithm for the treatment of intertrochanteric fractures of the hip maintain quality at a reduced cost?

In March 2012, an algorithm for the treatment of intertrochanteric fractures of the hip was introduced in our academic department of Orthopaedic Surgery. It included the use of specified implants for particular patterns of fracture. In this cohort study, 102 consecutive patients presenting with an intertrochanteric fracture were followed prospectively (post-algorithm group). Another 117 consecutive patients who had been treated immediately prior to the implementation of the algorithm were identified retrospectively as a control group (pre-algorithm group). The total cost of the implants prior to implementation of the algorithm was $357 457 (mean: $3055 (1947 to 4133)); compared with $255 120 (mean: $2501 (1052 to 4133)) after its implementation. There was a trend toward fewer complications in patients who were treated using the algorithm (33% pre- versus 22.5% post-algorithm; p = 0.088). Application of the algorithm to the pre-algorithm group revealed a potential overall cost saving of $70 295. The implementation of an evidence-based algorithm for the treatment of intertrochanteric fractures reduced costs while maintaining quality of care with a lower rate of complications and re-admissions.

Carcinoma papilar de quiste de conducto tirogloso sincrónico con carcinoma papilar de tiroides / Synchronous papillary carcinoma of thyroglossal duct cyst and papillary thyroid carcinoma

Presentamos el caso de un paciente diagnosticado de quiste de conducto tirogloso y un nódulo tiroideo ístmico en el que se evidenciaron focos de carcinoma papilar intraquístico concomitantes con carcinoma papilar en el nódulo tiroideo. La indicación terapéutica en estos casos es controvertida, y dependerá en la mayoría de los casos del estudio microscópico de la muestra. En nuestro caso se realizó en un primer tiempo la intervención de Sistrunk asociada a una istmectomía y tras conocer el resultado de ambas muestras se decidió realizar tiroidectomía total.

We report the case of a patient with a thyroglossal duct cyst and a nodule at the thyroid isthmus which showed intracystic papillary carcinoma foci concomitant with papillary carcinoma in the thyroid nodule. The therapeutic indication in these cases is controversial. In our case it was done in a first intervention a Sistrunk technique associated to an isthmectomy and after knowing the results of both samples was decided to perform a total thyroidectomy.

Correlation between strand asymmetry and phylogeny in mitochondrial DNA.

An evolutionary distance is introduced in order to propose an efficient and feasible procedure for phylogeny studies. Our analysis are based on the strand asymmetry property of mitochondrial DNA, but can be applied to other genomes. Comparison of our results with those reported in conventional phylogenetic trees, gives confidence about our approximation. Our findings support the hypotheses about the origin of the skew and its dependence upon evolutionary pressures, and improves previous efforts on using the strand asymmetry property of genomes for phylogeny inference. For the evolutionary distance introduced here, we observe that the more adequate technique for tree reconstructions correspond to an average link method which employs a sequential clustering algorithm.

[Ascaris hepatic abscess]. / Absceso hepático ascaridiano.

An 18 months old infant with hepatic abscesses was studied. Ultrasonographic examination of the liver revealed 2 abscesses in the right lobe of the liver containing elongated hyperecogenic structures compatible with ascaris lumbricoides. Antibiotic and antihelmintic treatment was followed by complete clinical recovery.

Nonlinear modeling technique for the analysis of DNA chains.

Using a simple computational procedure, we examine DNA chains from different species in order to prove their nonlinear deterministic structures. This procedure applies a nonlinear modeling technique based upon quantitative comparison of the neighborhoods from similar DNA subsegments of size d. Our results reveal that noncoding regions exhibit a deterministic signature at sizes larger than a characteristic dimension d(c). Applications to evolutionary categories and recognition of different DNA regions are discussed.

Spatial Ca(2+) distribution in contracting skeletal and cardiac muscle cells.

The spatiotemporal distribution of intracellular Ca(2+) release in contracting skeletal and cardiac muscle cells was defined using a snapshot imaging technique. Calcium imaging was performed on intact skeletal and cardiac muscle cells during contractions induced by an action potential (AP). The sarcomere length of the skeletal and cardiac cells was approximately 2 micrometer. Imaging Rhod-2 fluorescence only during a very brief (7 ns) snapshot of excitation light minimized potential image-blurring artifacts due to movement and/or diffusion. In skeletal muscle cells, the AP triggered a large fast Ca(2+) transient that peaked in less than 3 ms. Distinct subsarcomeric Ca(2+) gradients were evident during the first 4 ms of the skeletal Ca(2+) transient. In cardiac muscle, the AP-triggered Ca(2+) transient was much slower and peaked in approximately 100 ms. In contrast to the skeletal case, there were no detectable subsarcomeric Ca(2+) gradients during the cardiac Ca(2+) transient. Theoretical simulations suggest that the subsarcomeric Ca(2+) gradients seen in skeletal muscle were detectable because of the high speed and synchrony of local Ca(2+) release. Slower asynchronous recruitment of local Ca(2+) release units may account for the absence of detectable subsarcomeric Ca(2+) gradients in cardiac muscle. The speed and synchrony of local Ca(2+) gradients are quite different in AP-activated contracting cardiac and skeletal muscle cells at normal resting sarcomere lengths.

Evaluación de los niveles séricos de la interleuquina-8 y de la proteína C reactiva en sujetos obesos / Serum interleukin-8 levels and C-reactive protein in obese subjects

La obesidad incrementa el riesgo de sufrir enfermedad cardiovascular y favorece el desarrollo de aterosclerosis. Los mecanismos que unen la obesidad con la aterosclerosis están en estudio. La IL-8 es una citoquina con propiedades aterogénicas y la proteína C reactiva (PCR) es una molécula proinflamatoria. El objetivo de este estudio es determinar las concentraciones séricas de IL-b y de PCR en sujetos obesos y relacionar las concentraciones séricas de IL-8 y de PCR con los parámetros antropométricos y bioquímicos. La población en estudio estuvo conformada por 48 sujetos obesos y 25 sujetos normopeso como grupo control. Los niveles séricos de IL-8 y de PCR se determinaron en estado de ayuno, así como los parámetros bioquímicos sanguíneos y los parámetros antropométricos. No se observó un aumento de los niveles séricos de IL-8 en los sujetos obesos en comparación con el grupo control (p = 0,57). Las concentraciones séricas de IL-8 no se correlacionan con el índice de masa corporal (IMC) ni con el índice cintura-cadera (ICC) en ninguno de los grupos estudio. Los niveles de PCR se encontraron aumentados en sujetos obesos en comparación con sujetos normopeso (p = 0,006). Los niveles séricos de PCR se correlacionan positivamente con el IMC en sujetos obesos (r = 0,22 p = 0,29). En conclusión, aunque el tejido adiposo puede producir IL-8, esta producción contribuye poco con los niveles séricos de IL-8 en sujetos obesos. Los niveles séricos de PCR se encuentran aumentados en sujetos obesos, los cual puede ser consecuencia del exceso de tejido adiposo

Embarazo ectópico-diagnóstico y tratamiento / Ectopic pregnancy: diagnosis and treatment

Se presenta un estudio de 509 embarazos ectópicos observados en la Maternidad Concepción Palacios, en los años 1985-88, entre 114.057 embarazos. La frecuencia fue de 4,26 por mil. La edad promedio de las pacientes fue de 28,9 años. La amenorrea ocurrió en el 86% de los casos, dolor en 84% y sangrado en 74,8%. El método diagnóstico más comúnmente utilizado fue el ultrasonido (75,4%). El embarazo fue tubárico en el 96,3%; hubo cuatro ováricos, cuatro intraligamentales y tres abdominales. El diagnóstico pre-operatorio fue correcto en el 97,8%. Sólo en quince casos (2,9%) se hizo cirugía conservadora. No hubo muertes maternas

Prevalencia de presión arterial elevada y otros factores de riesgo de enfermedad cardiovascular en trabajadores de cafetines de la Universidad Central de Venezuela (ciudad universitaria) / Prevalence high blood pressure and others risk factors of cardiovascular disease in workers of cafe the cafeterias the Universidad Central de Venezuela (university city)

Se realizó un estudio transversal en una muestra de 100 sujetos, trabajadores de cafetines de la Universidad Central de Venezuela, en la cual predonimó el sexo masculino con el 62 por ciento y frente a 38 por ciento del femenino, con media 35+6 años de antiguedad en el oficio; el 72 por ciento tenían oficio de cocinero, "lonchero" y personal de limpieza y el 28 por ciento de cajero y personal administrativo o gerencial. En su mayoría el nivel de enseñanza fue de 7° año o menos. La prevalencia de la presión arterial elevada fue de 33 por ciento y presión de pulso elevada 46.7 por ciento. La media de la presión sistólica, ajustada a la edad, en personas con más de 5 años en el oficio (135 Hg./mm) estaba significativamente aumentada