Don't Forget about the Sump! An Uncommon Complication Many Years after a Choledochoduodenostomy.

Bilioenteric anastomoses were common interventions before the rise of minimal invasion procedures, specifically, before endoscopic retrograde cholangiopancreatography. During a choledochoduodenostomy (CDS) the distal part of the common bile duct is excluded from the bile drainage and behaves as a "sump," a poorly drained part that works as a reservoir which is responsible of the development of complications of the bilio-pancreatic tract. The consequent sump syndrome is a rare medical complication that presents a diversity of symptoms, for which there is no well-defined diagnostic algorithm. We present the case of a 72-year-old male patient with multiple comorbidities. He presented to the ER because of recurrent episodes of cholangitis; after having obtained the patient's medical records, lab and image studies, the latter showed pneumobilia. After considering all the results plus the pneumobilia we suspect the presence of this uncommon complication of CDS. The patient was subjected to an unsuccessful endoscopic treatment followed by surgery, after which he showed signs of improvement and adequate evolution till hospital discharge.

Orientación sexual y deseo reproductivo / Sexual orientation and reproductive desires

OBJETIVOS: El objetivo principal del presente estudio es obtener datos sobre la orientación sexual y los deseos reproductivos de una población española no seleccionada. Objetivos secundarios han sido recabar información sobre las actitudes sexuales de esa misma muestra poblacional, la visión de gays y lesbianas de sus posibilidades reproductivas y su relación con los centros públicos y privados de medicina reproductiva. MATERIAL Y MÉTODOS: Una encuesta diseñada a tal efecto fue implementada en el portal del Colectivo Lambda de la Comunidad Valenciana, en internet. El Colectivo Lambda ofreció su colaboración desinteresada y animó a sus miembros a cumplimentarla. Los centros de reproducción integrados en el Grupo EIRE solicitaron a sus pacientes la cumplimentación de la encuesta. Las respuestas a las distintas preguntas correspondientes a las 404 encuestas cumplimentadas fueron transportadas a una hoja Excel y, posteriormente, al programa SPSS, para su tratamiento estadístico. RESULTADOS: A partir de las respuestas obtenidas puede afirmarse que homosexualidad y bisexualidad no son situaciones excluyentes sino que entre homo y heterosexualidad existe una gradación. También ha sido confirmado que la gran mayoría de los individuos desea reproducirse, independientemente de su orientación sexual y que la aceptación de las técnicas de reproducción asistida para resolver los problemas reproductivos de lesbianas y gays, incluida la maternidad subrogada es amplia. En torno al 90% de los encuestados consideran que las personas o parejas LGTB tienen los mismos derechos a ser atendidos en los centros de sanidad pública que las parejas heterosexuales que padecen esterilidad. Considerando el determinismo de la orientación sexual de los seres humanos, es posible aceptar que gays, lesbianas y otros LGTB presentan esterilidad constitucional y que, como tal, deben ser ayudados a tener descendencia biológica sin menoscabo de su dignidad humana

OBJECTIVES: The main objective of this study was to obtain data on sexual orientation and reproductive desires of an un selected Spanish population formed by gays, lesbians, transsexuals and bisexuals (LGTB), without excluding heterosexual persons. Secondary objectives have been obtaining information about the sexual attitudes of this same population sample, as well as the view of gays and lesbians of their reproductive potential and their relationship with public and private reproductive medicine centers. MATERIAL AND METHODS: A survey designed to that effect was implemented on the portal of the Colectivo Lambda of Valencia, on the internet. The collective Lambda offered their generous collaboration and encouraged its members to fill it out. The centers of reproductive medicine integrated in the EIRE group asked their patients filling out the survey. The responses to the different questions corresponding to the 404 completed surveys were transported to an Excel worksheet and, later, to the program SPSS for statistical processing. RESULTS: From the answers it can be argued that homosexuality and bisexuality are not mutually exclusive situations but that between homo and heterosexuality there is a gradation. It has also been confirmed that the vast majority of individuals wish to reproduce, regardless of their sexual orientation and that assisted reproduction techniques are widely accepted to solve reproductive problems of lesbians and gays, including surrogate motherhood. Around 90% of respondents considered that persons or LGBT couples have the same rights to be cared for in reproductive centers of public health than heterosexual couples presenting infertility. Whereas the determinism of the sexual orientation of human beings, it is possible to accept that gays, lesbians and other LGBT present constitutional infertility and that, as such, they must be helped to have biological offspring without detriment to their human dignity

Maternal, neonatal and collection factors influencing the haematopoietic content of cord blood units.

BACKGROUND AND OBJECTIVES: Umbilical cord blood (UCB) contains haematopoietic stem cells and can be used as an alternative to bone marrow transplantation in certain cases. Engraftment was dependent upon the haematopoietic progenitor cell content of the cord blood units. This study was designed to investigate the influence of obstetric, neonatal and collection factors on the volume and haematopoietic content of UCB donations. MATERIAL AND METHODS: A retrospective analysis of obstetric and neonatal factors was performed from 300 cord blood donations in Valencia Cord Blood Bank. Maternal, neonatal and collection factors influencing cord blood quality measured as volume, total nucleated cell count, CD34+ cells and colony-forming units (CFU) were analysed. RESULTS: Bigger babies produced cord blood units with larger volume, higher cells counts, CFU and CD34 cell counts. In the multivariate analysis, we found that both placental weight and mode of collection were predictor variables for total nucleated cell count, CD34 cells and CFU. CONCLUSION: Our study concludes that cord blood units must be collected before placental delivery and that birth weight, as an estimation of the placental weight, could be added to standard cord blood donors criteria in order to improve the bank efficiency.