Angiotomografía de la arteria cística en preoperatorio y comorbilidad en colecistectomía laparoscópica por colelitiasis / Angiotomography of the cystic artery in preoperative and comorbidity in laparoscopic cholecystectomy for cholelithiasis

La colecistectomía laparoscópica es el tratamiento de elección de la colelitiasis; sin embargo, se acompaña de comorbilidades y no está exenta de complicaciones mayores que pueden ser letales; la identificación del trígono cistohepático con disección y ligadura de la arteria cística son pasos obligatorios de la cirugía; la identificación de las variaciones de la arteria cística y los conductos biliares pueden minimizar las eventuales complicaciones. Al protocolo preoperatorio se implementó una angiotomografía con Tomógrafo Siemens Somatón Sensation ® de 64 cortes para identificar la arteria cística en pacientes con colelitiasis de la Unidad de Cirugía General del Hospital de Especialidades Teodoro Maldonado Carbo IESS de Guayaquil. Se escogieron 60 pacientes femeninos en forma aleatoria (edades 19-70 años, promedio 44,25 años) y la muestra se dividió en dos grupos de 30; al grupo estudio se aplicó angiotomografía hasta un mes antes de la cirugía y al grupo control se le aplicó el protocolo convencional. Se evaluó morbilidades relacionadas con: hemorragia operatoria por lesión de la arteria cística y en el posoperatorio: infección de herida operatoria, íleo y drenaje. La angiotomografía permitió identificar la arteria cística en el preoperatorio y contribuyó a disminuir comorbilidades que acompañan a la colecistectomía laparoscópica.

Laparoscopic cholecystectomy is the treatment of cholelithiasis of choice; however, it is accompanied by comorbidities and is not exempt from major complications that can be lethal; the identification of the cystohepatic trigone with dissection and ligation of the cystic artery are mandatory steps of surgery; the identification of the variations of the cystic artery and the bile ducts can minimize the possible complications. The preoperative protocol was implemented with an angiotomography with Siemens Somatón Sensation ® 64-slice Tomograph to identify the cystic artery in patients with cholelithiasis of the General Surgery Unit of the Teodoro Maldonado Carbo IESS Specialty Hospital of Guayaquil. 60 female patients were chosen at random (ages 19 -70 years, average 44.25 years) and the sample was divided into two groups of 30; Angiotomography was applied to the study group up to one month before surgery and the conventional protocol was applied to the control group. Morbidities related to: operative haemorrhage due to cystic artery and postoperative injury: operative wound infection, ileus and drainage were evaluated. Angiotomography allowed to identify the cystic artery in the preoperative period and contributed to decrease comorbidities that accompany laparoscopic cholecystectomy.

Anxiety can significantly explain bolus perception in the context of hypotensive esophageal motility: Results of a large multicenter study in asymptomatic individuals.

BACKGROUND: Previous studies have not been able to correlate manometry findings with bolus perception. The aim of this study was to evaluate correlation of different variables, including traditional manometric variables (at diagnostic and extreme thresholds), esophageal shortening, bolus transit, automated impedance manometry (AIM) metrics and mood with bolus passage perception in a large cohort of asymptomatic individuals. METHODS: High resolution manometry (HRM) was performed in healthy individuals from nine centers. Perception was evaluated using a 5-point Likert scale. Anxiety was evaluated using Hospitalized Anxiety and Depression scale (HAD). Subgroup analysis was also performed classifying studies into normal, hypotensive, vigorous, and obstructive patterns. KEY RESULTS: One hundred fifteen studies were analyzed (69 using HRM and 46 using high resolution impedance manometry (HRIM); 3.5% swallows in 9.6% of volunteers were perceived. There was no correlation of any of the traditional HRM variables, esophageal shortening, AIM metrics nor bolus transit with perception scores. There was no HRM variable showing difference in perception when comparing normal vs extreme values (percentile 1 or 99). Anxiety but not depression was correlated with perception. Among hypotensive pattern, anxiety was a strong predictor of variance in perception (R2 up to .70). CONCLUSION AND INFERENCES: Bolus perception is less common than abnormal motility among healthy individuals. Neither esophageal motor function nor bolus dynamics evaluated with several techniques seems to explain differences in bolus perception. Different mechanisms seem to be relevant in different manometric patterns. Anxiety is a significant predictor of bolus perception in the context of hypotensive motility.

The Chicago Classification 3.0 Results in More Normal Findings and Fewer Hypotensive Findings With No Difference in Other Diagnoses.

OBJECTIVES: High-resolution manometry (HRM) is the preferred method for the evaluation of motility disorders. Recently, an update of the diagnostic criteria (Chicago 3.0) has been published. The aim of this study was to compare the performance criteria of Chicago version 2.0 (CC2.0) vs. 3.0 (CC3.0) in a cohort of healthy volunteers and symptomatic patients. METHODS: HRM studies of asymptomatic and symptomatic individuals from several centers of Spain and Latin America were analyzed using both CC2.0 and CC3.0. The final diagnosis was grouped into hierarchical categories: obstruction (achalasia and gastro-esophageal junction obstruction), major disorders (distal esophageal spasm, absent peristalsis, and jackhammer), minor disorders (failed frequent peristalsis, weak peristalsis with small or large defects, ineffective esophageal motility, fragmented peristalsis, rapid contractile with normal latency and hypertensive peristalsis) and normal. The results were compared using McNemar's and Kappa tests. RESULTS: HRM was analyzed in 107 healthy volunteers (53.3% female; 18-69 years) and 400 symptomatic patients (58.5% female; 18-90 years). In healthy volunteers, using CC2.0 and CC3.0, obstructive disorders were diagnosed in 7.5% and 5.6%, respectively, major disorders in 1% and 2.8%, respectively, minor disorders in 25.2% and 15%, respectively, and normal in 66.4% and 76.6%, respectively. In symptomatic individuals, using CC2.0 and CC3.0, obstructive disorders were diagnosed in 11% and 11.3%, respectively, major disorders in 14% and 14%, respectively, minor disorders in 33.3% and 24.5%, respectively, and normal in 41.8% and 50.3%, respectively. In both groups of individuals, only an increase in normal and a decrease in minor findings using CC3.0 were statistically significant using McNemar's test. DISCUSSIONS: CC3.0 increases the number of normal studies when compared with CC2.0, essentially at the expense of fewer minor disorders, with no significant differences in major or obstructive disorders. As the relevance of minor disorders is questionable, our data suggest that CC3.0 increases the relevance of abnormal results.

In vitro digestibility, crystallinity, rheological, thermal, particle size and morphological characteristics of pinole, a traditional energy food obtained from toasted ground maize.

Flour obtained from toasted ground maize grains is widely consumed by different ethnic groups of Northern Mexico and Southwest USA as an energy source. In this work the in vitro digestibility, crystallinity, rheological, thermal, particle size distribution and morphological characteristics of toasted ground white and blue maize flours were studied. X-ray diffraction studies showed that the crystallinity content was reduced, but that the hydrolysis rate and the in vitro digestibility of starch were greatly improved by the toasting process. The relative amount of rapidly digestible starch showed an important increase at the expense of resistant starch content reduction. The thermal properties of white maize starch increased slightly, but those of the blue maize starch decreased slightly after toasting. Aqueous dispersions formed with 10% (w/w) flour were heated at 90°C for 5min to induce starch gelling, in order to resemble thin porridges. The dispersed gels exhibited higher elastic modulus (G') than loss modulus (G'') in the linear viscoelastic region, with blue maize dispersions displaying higher moduli magnitudes. At higher shear strain amplitudes, G' decreased but G'' first increased and then decreased (overshoot phenomenon). The effects of toasting on the structure and functionality of maize starch are explained on the basis of limited gelatinization of the granules. The results in this work provide insights for understanding the extensive use of pinole by impoverished ethnic groups, and more recently by high performance ultra-runners and athletes, as an energy food.

Acid hydrolysis of native corn starch: morphology, crystallinity, rheological and thermal properties.

The acid hydrolysis of native corn starch at 35 °C was monitored during 15 days. After this time, the residual solids were about 37.0 ± 3.0%. First-order kinetics described the hydrolysis data, giving a constant rate of kH = 0.18 ± 0.012 days(-1). Amylose content presented a sharp decrement of about 85% and X-ray diffraction results indicated a gradual increase in crystallinity during the first 3 days. SEM micrographs showed that hydrolysis disrupted granule morphology from an initial regular shape to increasingly irregular shapes. Fractal analysis of SEM images revealed an increase in surface roughness. Fast changes in the thermal effects were caused by molecular rearrangements after fast hydrolysis of amylose in the amorphous regions in the first day. Steady shear rate and oscillatory tests showed a sharp decrease of the apparent viscosity and an increase of the damping factor (tan(δ)) caused by amylose degradation.

In vitro digestibility, physicochemical, thermal and rheological properties of banana starches.

Banana starches (BS) were isolated from Enano, Morado, Valery and Macho cultivars. The BS possessed B-type crystallinity and an amylose content varying from 19.32 to 26.35%. Granules had an oval morphology with different major-to-minor axis ratios, exhibiting both mono- and bi-modal distributions and mean particle sizes varying from 32.5 to 45 µm. BS displayed zeta-potential values ranging between -32.25 and -17.32 mV, and formed gels of incipient to moderate stability. The enthalpy of gelatinization of BS affected the crystalline order stability within the granules. In-vitro digestibility tests showed fractions as high as 68% of resistant starch. Rheological oscillatory tests at 1 Hz showed that BS dispersions (7.0%, w/w) exhibited Type III behaviour, attributed to the formation of a continuous phase complex three-dimensional amylose gel reinforced by swollen starch granules acting as fillers. Amylose content and granules morphology were the main factors influencing the BS properties.