Bariatric reduction system - BARS: device, technique and first clinical experience.

BACKGROUND: Roux-en-Y gastric by-pass (RYGB) is one of the most effective bariatric procedures, but the rate of weight regain (WR) can reach 63% after the second year. Enlargement of the gastrojejunal anastomosis is one of the reported causes. A newly CE-marked flexible endoscopic system, Bariatric Anastomotic Reduction System (BARS) (Ovesco Endoscopy, Tuebingen, Germany), derivative of the well-established endoscopic over-the-scope-clip (OTSC) clipping system, has been recently developed. It was tested in pre-clinical and preliminary clinical use for feasibility and effectiveness in bariatric anastomotic reduction. MATERIAL AND METHODS: Using a single-channel endoscope with external supplemental working channel, the BARS device captures the two limbs of the anastomosis, reducing its size, thus slowing food passage. After preclinical assessment, six patients with at least a 15% WR and the presence of an enlarged gastrojejunostomy > 20 mm were enrolled. The mean patient age was 49 years (range 24-67). Average interval between gastric bypass and BARS procedure: 8 years (4-13). RESULTS: All procedures were safely performed without complications. Mean procedure time: 52 min (37 - 75). Preliminary results: mean weight loss 6 kg (4-9) at a 3-month FU. CONCLUSIONS: BARS could be a promising endoscopic system in case of WR after gastric bypass due to enlargement of the anastomosis.

Efficacy and safety of the remOVE System for OTSC® and FTRD® clip removal: data from a PMCF analysis.

INTRODUCTION: The remOVE System (Ovesco Endoscopy AG, Tuebingen, Germany) is a medical device for the endoscopic removal of OTSC or FTRD clips (Ovesco Endoscopy AG, Tuebingen, Germany). The aim of this paper is to assess the efficacy and safety of this system. MATERIAL AND METHODS: A total of 74 patients underwent clip extraction. The standard removal procedure comprises fragmenting the clip by applying an electrical direct current pulse at two opposing sides of the clip. RESULTS: Clip fragmentation was successful in 72 of 74 patients (97.3%). In two cases (2.7%) clip fragmentation was not possible. In nine cases (12.2%) a clip fragment could not be removed and was left in place. Complications occurred in three cases (4.1%): two minor bleedings near the clip removal site (2.7%), and one superficial mucosal tear resulting from clip fragment extraction (1.4%). DISCUSSION: Based on this study, the use of the remOVE System for OTSC or FTRD clip removal can be considered safe and effective.

1,25-Dihydroxyvitamin D(3) induced cell cycle arrest in the human primary liver cancer cell line HepG2.

The inhibitory effect of 1,25-dihydroxyvitamin D(3) (1,25-(OH)(2)D(3)) on the proliferation of a number of human and rat liver cancer cell lines has recently been reported. In this study we have demonstrated that these cell lines express functional receptors able to specifically bind [3H]1,25-(OH)(2)D(3). The highest level of functional receptor were found in the human liver cancer cell line HepG2 which had previously been shown to be the most sensitive in 1,25-(OH)(2)D(3) growth inhibition assays. The identity of the binding protein with the Vitamin D3 receptor was confirmed by PCR analysis of HepG2 cell mRNA. Additionally, the inhibitory effect of 1,25-(OH)(2)D(3) on growth of the human liver cancer cell line HepG2 resulted from arrest in the G0/G1 phase of the cell cycle. Increases in the fraction of cells in G0/G1 were dependent upon the concentration of 1,25-(OH)(2)D(3) and were accompanied by complementary decreases in the number of cells in S phase. There was no change in the number of cells in G2+M at any concentration of the hormone. Clonal growth of HepG2 cells in response to 1,25-(OH)(2)D(3) was also dose dependent over three orders of magnitude, thus indicating heterogeneity in cell cycle arrest by this hormone.

Solid-state graft copolymer electrolytes for lithium battery applications.

Battery safety has been a very important research area over the past decade. Commercially available lithium ion batteries employ low flash point (< 80 °C), flammable, and volatile organic electrolytes. These organic based electrolyte systems are viable at ambient temperatures, but require a cooling system to ensure that temperatures do not exceed 80 °C. These cooling systems tend to increase battery costs and can malfunction which can lead to battery malfunction and explosions, thus endangering human life. Increases in petroleum prices lead to a huge demand for safe, electric hybrid vehicles that are more economically viable to operate as oil prices continue to rise. Existing organic based electrolytes used in lithium ion batteries are not applicable to high temperature automotive applications. A safer alternative to organic electrolytes is solid polymer electrolytes. This work will highlight the synthesis for a graft copolymer electrolyte (GCE) poly(oxyethylene) methacrylate (POEM) to a block with a lower glass transition temperature (Tg) poly(oxyethylene) acrylate (POEA). The conduction mechanism has been discussed and it has been demonstrated the relationship between polymer segmental motion and ionic conductivity indeed has a Vogel-Tammann-Fulcher (VTF) dependence. Batteries containing commercially available LP30 organic (LiPF6 in ethylene carbonate (EC):dimethyl carbonate (DMC) at a 1:1 ratio) and GCE were cycled at ambient temperature. It was found that at ambient temperature, the batteries containing GCE showed a greater overpotential when compared to LP30 electrolyte. However at temperatures greater than 60 °C, the GCE cell exhibited much lower overpotential due to fast polymer electrolyte conductivity and nearly the full theoretical specific capacity of 170 mAh/g was accessed.

Randomized Phase II Trial of weekly paclitaxel alone versus trastuzumab plus weekly paclitaxel as first-line therapy of patients with Her-2 positive advanced breast cancer.

BACKGROUND: A randomized Phase II study evaluated the activity of weekly paclitaxel versus its combination with trastuzumab for treatment of patients with advanced breast cancer overexpressing HER-2. PATIENTS AND METHODS: Among 124 patients randomized, 123 are assessable for toxicity and 118 for response. Patients received weekly paclitaxel single agent (80 mg/m2) or combined with trastuzumab (4 mg/kg loading dose, then weekly 2 mg/kg). HER-2 overexpression was determined by immunohistochemistry (IHC). Patients with 2+/3+ IHC scores were eligible. IHC was compared with HER-2 serum extracellular domain (ECD). RESULTS: Patient characteristics were similar in the two arms. Both treatments were feasible and well tolerated with no grade 4 hematologic toxicity. No patient developed cardiac toxicity. The combined treatment was statistically significant superior for overall response rate (ORR) (75% vs. 56.9%; P = 0.037), particularly in the subset of IHC 3+ patients (84.5% vs. 47.5%; P = 0.00050). A statistically significant better median time to progression was seen in the subgroup with IHC 3+ (369 vs. 272 days; P = 0.030) and visceral disease (301 vs. 183 days; P = 0.0080) treated with combination. Multivariable analysis of predictive factors showed that only IHC score retained statistically significant value for ORR (P = 0.0035). CONCLUSION: Weekly paclitaxel plus trastuzumab is highly active and safe and it is superior to paclitaxel alone in patients with IHC score of 3+.

Cost-Effectiveness Analysis of Waste Gas Treatment Plants for the Glass Industry.

Cost-effectiveness of different plant solutions for glass furnace waste gas cleaning is compared in the present paper. Plant arrangements based on electrostatic precipi-tator or fabric filter dust collectors and wet, semi-dry, or dry processes for acid gas removal have been considered. A critical survey of each solution's advantages and disadvantages has been presented, taking into account both effectiveness and costs resulting from each available system. Finally, a quantitative assessment has been provided with reference to a case study involving actual float glass production lines at SIV plants located in northern and central Italy.

Polyfunctional Plants for Industrial Waste Disposal-Part II: Economics and Model Evaluation.

This is the second part of a two-part paper dealing with the preliminary design and costing of polyfunctional waste treatment plants. In this article, we present some criteria for estimating capital investment and annual operating costs of polyfunctional plants for industrial waste treatment. The process and equipment design methods presented in Part I of this article, together with the economic approach proposed here, allow for complete technical/economic analyses. The overall mathematical model appears to be a useful tool in economic feasibility studies. The accuracy of the developed computer mathematical model has been demonstrated, referring to actual cost data from the literature.

Polyfunctional Plants for Industrial Waste Disposal-Part I: Process and Equipment Design.

This article is the first of two papers dealing with development of a design and costing procedure for polyfunctional waste treatment plants. Part I reviews equipment sizing aspects. Part II defines and validates the cost estimation procedure. In this article, the structure of a general purpose polyfunctional plant for liquid and solid industrial waste treatment is discussed, highlighting the high level of process integration obtainable and the consequent benefits. The plant comprises an incineration section, a section for chemical/physical/biological treatments, and a stabilization/solidification section. Each section is briefly described, and an overview of the sizing procedure for main equipment is presented. Such a procedure forms the basis of a computer model for process and equipment preliminary design to be used in economic feasibility evaluation studies.

[Premature rupture of membranes: maternal - perinatal morbidity and mortality in the Dominican Republic]. / Ruptura prematura de membranas: morbi-mortalidad materno perinatal en Dominicana.

PIP: Premature rupture of membranes is defined as expulsion of the amniotic liquid occurring at least 1 hour before initiation of uterine contractions and without apparent cervical changes. According to the literature, premature rupture of membranes occurs in 2-15% of all pregnancies, with an average of 10%. The etiology is considered multifactorial, and treatment remains controversial. A retrospective review was conducted to determine the occurrence of maternal or perinatal morbidity and mortality in 230 cases of premature rupture of membranes in a social security hospital in Santo Domingo, Dominican Republic, observed between 1983-88. Premature rupture occurred in 3.5% of cases according to the records. 37.4% of affected mothers were 21-25 years old and 69.6% were 21.30. 62.9% of the women were nulliparas. 2.2% had had no prenatal care, 59.1% had insufficient prenatal care, defined as 1-5 visits and only 36.1% had 6 or more visits. 81.3% of ruptures occurred at 37-42 weeks of gestation. In 64.8% of cases the pregnancy was terminated within 1-24 hours and 35.2% were considered prolonged. Prematurity and low birth weight was the most common perinatal disorders, affecting 10.9%. Respiratory difficulty syndrome affected 4.3%. 60% of infants with respiratory problems were born at less than 37 weeks gestation. Neonatal sepsis occurred in 3% of cases and prolapse of the umbilical cord in 1.3%. Perinatal mortality averaged 2.6%. Prematurity was a factor in all cases. Respiratory distress syndrome and neonatal sepsis were each present in 50% of cases and hyperbilirubinemia in 33%. 8.7% of the mothers developed chorioamnionitis. Only 23.9% terminated their pregnancies spontaneously. Oxytocin was used to induce labor in 30.4% and cesareans were performed in 44.8%.^ieng

Cefalea asociada a enfermedades cerebrovasculares / Headache asociated to cerebrovascular disease

Se estudiaron mediante métodos invasivos y no invasivos a 163 pacientes con diagnóstico de enfermedad cerebrovascular en fase aguda ingresados en las salas de Medicina Interna y Cardiología del Instituto Médico "José Gregorio Hernández" en el lapso comprendido durante los dos últimos años. Todos presentaron síntomas y signos clínicos de focalización neurológica característicos y el diagnóstico fue confirmado mediante métodos imagenológicos que permitieron visualizar el área cerebral afectada. Se realizaron también otros estudios para determinar la presencia de patologías cardiovasculares con potencial embolígeno comprobado. Concluimos que un porcentaje significativo de pacientes representado por el 39,2 por ciento presentó cefalea junto con la aparición del cuadro neurológico. Dentro de este subgrupo la aparición de cefalea nucho más frecuente en los casos de tipo hemorrágico observándose que un 60 por ciento de estos presentaron cefalea, mientras que esta sólo se documentó en el 31,7 por ciento de eventos trombóticos, 35,8 por ciento eventos embólicos y 14,2 por ciento de ataques isquémicos transitorios. La localización de la cefalea en estos pacientes fue global en el 50 por ciento de los casos, parietal ipsilateral en el 25 por ciento; occipital en el 17,1 por ciento y temporal ipsilateral en el 7,8 por ciento. Fueron excluidos del estudio, pacientes con hemorragia intracraneal distinta a la intraparenquimatosa, aquellos a los que no se le realizaron estudios imagenológicos o con presencia de alguna otra patología intracraneal. Es evidente, que la cefalea es un síntoma subjetivo importante dentro de las enfermedades vasculares cerebrales, siendo también importante dentro de sus génesis el proceso patológcio subyacente, lo cual hace resaltante la necesidad de que el clínico preste atención a este síntomas, el cual con cierta frecuencia es ignorado o descrito de manera incompleta en el interrogatorio del paciente, perdiéndose un elemento semiológico de valor para hacer el diagnóstico con mayor rapidez y precisión

Pancreatitis agudas biliares; indicaciones y resultados de las esfinteropapilotomías / Biliary acute pancreatitis; results and indication of the papillotomies

En 1 serie de 134 pancreatitis agudas biliares de las cuales 127 fueron operadas, presentamos nuestra experiencia en 23 esfinteropapilotomías (18,1%); 17 fueron quirúrgicas y 6 endoscópicas. Las indicaciones fueron de necesidad en todos los casos, de extracción por litiasis coledociana en los 23 pacientes, asociada en 1 caso a liberación por una "odditis" concomitante. Las endoscópicos constituyeron un gesto definitivamente curativo en 3 casos de litiasis residuales; en 1 enfermo de 89 años con una cardiopatía grave se evitó la intervención quirúrgica. La evolución fue favorable en los 23 pacientes sin complicaciones inherentes a la técnica implicada.

Hemorragias digestivas altas graves postoperatorias: tratamiento médicoquirúrgicos y resultados / Severe postoperative digestive hemorrhage: clinico-surgical treatment and results

En una serie de 500 casos de hemorragias digestivas altas graves, de las cuales 30 eran postoperatorias (6%) el 60% de éstas, se presentó luego de un acto quirúrgico abdominal; la cirugía urológica ocupó el 2§ lugar (26,2%). El tratamiento médico practicado en todos los pacientes detuvo la hemorragia en 21 casos. Seis enfermos fallecieron posteriormente por sepsis (28,5%). El volumen de la hemorragía, la persistencia o el carácter recidivante de la misma orientó al tratamiento quirúrgico en 8 pacientes. Se practicaron 5 intervenciones conservadoras (algunas incompletas por la gravedad de los enfermos) y 3 gastrectomías subtotales, con una mortalidad del 62,5%. La mortalidad global fue del 40% y debe relacionarse con la gravedad de la hemorragia, la edad, el compromiso uni o multiparenquimatoso, el estado inmunológico y nutricional de los pacientes y el tipo de lesiones agudas

Pancreatitis aguda: necrosis capsular superficial e interstical / Acute Pancreatitis: peripheric and interstitial necrosis tissue

Presentamos 14 casos de pancreatitis aguda con necrosis peripancreática, limitada al tejido capsular superficial e intersticial, señalando los factores etiológicos asociados y la metodología diagnóstica, particularmente a partir de l980 en que se incorpora la ultrasonografía y tomografía computada. Todos fueron operados, practicando 12 necrosectografía y 4 resecciones pancreáticas. Fallecieron 6 pacientes (42,8%). En las lesiones necróticas del páncreas la apreciación del tipo anatomopatológico y de su real interpretación orientan a gestos quirúrgicos correctos, evitando las pancreatectomías abusivas. Señalamos la gravedad de los 2 tipos de necrosis, peripancreática y parenquimatosa, enfatizando que la mortalidad difiere según la anatomía de la necrosis y el gesto quirúrgico practicado.

Adenoma gástrico como enfermedad precancerosa / Gastric adenoma as precancerous disease

Se presentan 8 enfermos portadores de adenomas gástricos: 3 con degeneración atípica inicial, 2 se presentaron con un síndrome subobstructivo pilórico y 4 con hemorragia digestiva, una de ellas, grave. Se hacen consideraciones sobre la patología de los adenomas y displasias gástricas. Se recomienda la cirugía con criterio oncológico, lo que ha demostrado óptimos resultados, con la curación de todos los enfermos así tratados