Valor diagnostico de la colangioresonancia para la detección de coledocolitiasis en pancreatitis aguda Hospital Mederi-Bogotá

La pancreatitis aguda (PA) es una patología clínica común que abarca un espectro desde leve hasta fatal, donde se produce una inflamación del páncreas por auto digestión enzimática con grado variable de compromiso sistémico. Es una emergencia abdominal grave con una mortalidad del 9-23%. En el 40% de los casos de pancreatitis aguda se encuentra que es de origen biliar. La prevalencia de enfermedad biliar a nivel mundial en adultos varía entre 5,9% y 21,9%, con grandes variaciones geográficas y regionales, se encuentran en el 12% de los hombres y el 24% de las mujeres. La prevalencia aumenta con la edad. Latinoamérica es una región con alta prevalencia. En pacientes con colelitiasis del 5-15 % tienen coledocolitiasis. La alta prevalencia de la patología biliar en nuestro país hace que esta sea una causa frecuente de consulta médica por dolor abdominal. El factor común presente en la gran mayoría de las enfermedades de la vía biliar es la Colelitiasis. La complicación más frecuente, la Coledocolitiasis, se ha reportado con cifras hasta de un 20% y como complicación de esta la pancreatitis. La pancreatitis aguda de origen biliar (PAB) es causada por una obstrucción transitoria o persistente de la ampolla de Váter por barro biliar o por cálculos. En el diagnostico de la PAB se emplean métodos invasivos como la colangiopancreaticografia endoscópica retrograda (CPRE) la cual trae consigo morbilidad y mortalidad asociada y métodos no invasivos como la colangiopancreaticografia magnética (CRM) que emerge como modalidad prometedora en el diagnostico y manejo de la PAB en centros de tercer y cuarto nivel de complejidad. El manejo actual de la PAB es la remoción de la obstrucción del conducto biliar común (CBC) seguida de su tratamiento definitivo, la colecistectomía o CPRE con papilotomia. En nuestro país no se han publicado estudios con datos locales acerca de la utilidad de la CRM para la detección de coledocolitiasis, en las guías de manejo de coledocolitiasis de la asociación colombiana de cirugía publicadas en el año 2004, hace referencia de la utilidad de la CRM para el diagnostico de esta entidad tomando como base una revisión sistemática de estudios publicados en Medline, Pubmed y Cocrane los cuales no incluyen experiencia a nivel nacional. En este estudio pretendimos determinar cuáles son los pacientes que se benefician de la realización de CRM temprana en el marco de la PAB leve para la detección de coledocolitiasis.

Dinámica del anillo mitral en pacientes con insuficiencia mitral isquemica

OBJETIVOS: Describir y comparar los cambios dinámicos de la geometría del anillo mitral durante todo el ciclo cardiaco en pacientes con insuficiencia mitral isquémica y pacientes con válvula mitral normal. MATERIALES Y MÉTODOS: Los estudios ecocardiográficos analizados fueron 37, 23 con insuficiencia mitral isquémica y 14 con válvula mitral normal. La reconstrucción del anillo se realizó en la estación de trabajo Xcelera (Philips Medial Systems) mediante la herramienta de análisis mitral (MVQ), en 5 momentos del ciclo cardiaco: Comienzo de Sístole, Mitad de Sístole, Final de Sístole, Mitad de Diástole y Final de Diástole. RESULTADOS: El anillo del grupo control, fue más dinámico, con sus menores dimensiones al final de la diástole, presentando incremento progresivo durante la sístole. Los cambios en el perímetro y el área, fueron significativos entre el comienzo y mitad de la sístole (p:0.087 y p: 0.055). En el grupo con insuficiencia mitral isquémica, el anillo fue más estático. Todas las dimensiones en este grupo, fueron mayores en los cinco momentos del ciclo cardiaco. (p < 0.1). El anillo también fue más plano, con un índice morfológico anular menor al del grupo control (p:0.087). DISCUSIÓN Y CONCLUSIONES: En pacientes sin insuficiencia mitral, el anillo es una estructura dinámica. Durante la sístole, las menores dimensiones se produjeron al comienzo de este periodo y la conformación en silla de montar se mantuvo, protegiendo contra la insuficiencia mitral. El anillo del grupo con insuficiencia mitral fue más estático y plano, perdiendo los mecanismos protectores.

Comparación de CPRE temprana y tardia en pacientes con pancreatitis aguda severa de origen biliar

INTRODUCCION: La obstrucción biliar es la principal causa de pancreatitis aguda y su curso es moderado a leve aunque un 20% desarrollan formas severas. La remoción de los cálculos por CPRE se ha empleado como terapéutica aunque su rol es controversial y no se ha demostrado su utilidad en forma temprana. El propósito de este estudio es observar la evolución de los pacientes con PASB en quienes se realice CPRE con respecto al curso de la enfermedad. METODOLOGIA: Estudio retrospectivo observacional descriptivo en pacientes con PASB llevados a CPRE. Entre junio y octubre de 2012 se encontraron 72 pacientes con PASB y patrón biliar obstructivo, 49 (68.06%) en los cuales se realizo de forma temprana (antes de 72 horas) y 23 (31,94 %) de forma tardía (después de las 72 horas). RESULTADOS: No se encontraron diferencias en la morbilidad entre los dos grupos observados. Se encontró una mayor incidencia de PASB en mujeres, no hubo complicaciones asociadas al procedimiento y no hubo mortalidad asociada en ninguno de los grupos. DISCUSION: El estudio no muestra que la realización de CPRE tardía influya de forma desfavorable en los pacientes con PASB. Se encontró mayor incidencia de PASB en mujeres y edad media de 61 años. Deben realizarse mas estudios como el presente con un mayor número de pacientes para demostrar que no hay aumento en la morbimortalidad en los pacientes que sean llevados a CPRE después de 72 horas de inicio de los síntomas y poder generar recomendaciones de manejo locales.

The pattern of fall of serum bilirubin after operative relief of obstructive jaundice. A preliminary report

This is the beginning of a prospective study on patients who have obstructive jaundice to see how the serum bilirubin falls after operative relief of the obstruction. Seven of such patients have been studied; four had carcinoma of the head of the pancreas while the other three had choledocholithiasis. The patients with carcinoma had relief of the jaundice through a biliary-enteric anastomosis and those with common bile duct stones had choledochotomy with stone extraction which was completed with insertion of a T-tube. Serial bilirubin estimations were then performed post-operatively to chart the pattern and rate of descent of this in each patient. Our observations suggest that the pattern of fall of serum bilirubin after successful decompression of the extra-hepatic biliary tree exhibit a distinct pattern regardless of the surgical procedure performed for the relief of the obstruction.

Diabetes gestacional como factor de riesgo para incontinencia urinaria: revisión sistemática de la literatura

La diabetes mellitus es una de las patologías frecuentes durante el embarazo, existe literatura que la ha relacionado con un mayor riesgo de aparición de incontinencia urinaria en el postparto patología que de manera clara afecta la calidad de vida de las mujeres, pero a la fecha la literatura no es concluyente. Con la presente revisión sistemática se pretendió evaluar la evidencia relacionada con la diabetes gestacional como causa de incontinencia urinaria en el postparto.

Role of alpha 2,3-sialyltransferases ST3Gal III and ST3Gal IV in pancreatic ductal adenocarcinoma

Este trabajo demuestra que los genes que codifican para los enzimas beta-galactosido alfa-2,3-sialiltransferasa 3 (ST3Gal III), y en menor medida beta-galactosido alfa-2,3-sialiltransferasa 4 (ST3Gal IV), están directamente implicados en etapas clave de la progresión tumoral como la adhesión, la migración y la formación de metástasis en las líneas de adenocarcinoma pancreático humano Capan-1 y MDAPanc-28. También, que las Especies Reactivas del Oxígeno (ROS) generadas durante los procesos de proliferación y diferenciación celular o debido a estímulos oxidantes externos, desempeñan un importante papel en el control de la síntesis de ST3Gal III y SLex, y por lo tanto en la regulación del fenotipo metastático. Además, junto al papel pro-adhesivo de la E-Selectina, este trabajo ha descrito efectos prometastáticos adicionales para esta molécula como inductora de la migración y de la secreción de VEGF a través de un mecanismo E-Selectina-SLex dependiente.

Melanoníquia em pacientes HIV positivos utilizando zidovudina

Um dos eventos adversos da zidovudina, um fármaco anti-retroviral, é o desenvolvimento de melanoníquia. Foram avaliados 19 pacientes adultos tratados com zidovudina evidenciando linhas ungueais, um efeito colateral incomum por vezes relatado. As funções hepática, renal, pancreática, bem como a função metabólica destes doentes também foram avaliados. Foram também obtidos marcadores imunológicos e a taxa de adesão ao tratamento.Os nossos resultados sugerem que a melanoníquia, como a macrocitose, podem estar associadas à utilização de terapia anti-retroviral.

Vertical structure of anthropogenic zonal-mean atmospheric circulation change

The atmospheric circulation changes predicted by climate models are often described using sea level pressure, which generally shows a strengthening of the mid-latitude westerlies. Recent observed variability is dominated by the Northern Annular Mode (NAM) which is equivalent barotropic, so that wind variations of the same sign are seen at all levels. However, in model predictions of the response to anthropogenic forcing, there is a well-known enhanced warming at low levels over the northern polar cap in winter. This means that there is a strong baroclinic component to the response. The projection of the response onto a NAM-like zonal index varies with height. While at the surface most models project positively onto the zonal index, throughout most of the depth of the troposphere many of the models give negative projections. The response to anthropogenic forcing therefore has a distinctive baroclinic signature which is very different to the NAM

The impact of the stratosphere on the troposphere during the southern hemisphere stratospheric sudden warming, September 2002

Recent research has established that a small but statistically significant link exists between the stratosphere and the troposphere in the northern hemisphere extratropics. In this paper it is shown that a similar link exists between the stratosphere and troposphere during the unprecedented September 2002 sudden warming in the southern hemisphere. Two ensemble forecasts of the stratospheric sudden warming are run which have different stratospheric initial conditions and identical tropospheric initial conditions. Stratospheric initial conditions have an impact on the tropospheric flow at the peak of the major warming (5 days into the run) and on longer time-scales (18 days into the run). The character of this influence is a localized, equatorward shift of the tropospheric storm track. The averaged impact of the change in the position of the storm-track maps strongly onto the Southern Annular Mode structure, but does not have an annular character.

Mass and size distribution measurement of particulates from a gas turbine combustor using modern mobility analyzer and particle sizer

SMPS and DMS500 analysers were used to measure particulate size distributions in the exhaust of a fully annular aero gas turbine engine at two operating conditions to compare and analyse sources of discrepancy. A number of different dilution ratio values were utilised for the comparative analysis, and a Dekati hot diluter operating at a temperature of 623°K was also utilised to remove volatile PM prior to measurements being made. Additional work focused on observing the effect of varying the sample line temperatures to ascertain the impact. Explanations are offered for most of the trends observed, although a new, repeatable event identified in the range from 417°K to 423°K – where there was a three order of magnitude increase in the nucleation mode of the sample – requires further study.

A continuum of sudden stratospheric warmings

The k-means cluster technique is used to examine 43 yr of daily winter Northern Hemisphere (NH) polar stratospheric data from the 40-yr ECMWF Re-Analysis (ERA-40). The results show that the NH winter stratosphere exists in two natural well-separated states. In total, 10% of the analyzed days exhibit a warm disturbed state that is typical of sudden stratospheric warming events. The remaining 90% of the days are in a state typical of a colder undisturbed vortex. These states are determined objectively, with no preconceived notion of the groups. The two stratospheric states are described and compared with alternative indicators of the polar winter flow, such as the northern annular mode. It is shown that the zonally averaged zonal winds in the polar upper stratosphere at 7 hPa can best distinguish between the two states, using a threshold value of 4 m s−1, which is remarkably close to the standard WMO criterion for major warming events. The analysis also determines that there are no further divisions within the warm state, indicating that there is no well-designated threshold between major and minor warmings, nor between split and displaced vortex events. These different manifestations are simply members of a continuum of warming events.

Arctic oscillation or North Atlantic oscillation?

The definition and interpretation of the Arctic oscillation (AO) are examined and compared with those of the North Atlantic oscillation (NAO). It is shown that the NAO reflects the correlations between the surface pressure variability at its centers of action, whereas this is not the case for the AO. The NAO pattern can be identified in a physically consistent way in principal component analysis applied to various fields in the Euro-Atlantic region. A similar identification is found in the Pacific region for the Pacific–North American (PNA) pattern, but no such identification is found here for the AO. The AO does reflect the tendency for the zonal winds at 35° and 55°N to anticorrelate in both the Atlantic and Pacific regions associated with the NAO and PNA. Because climatological features in the two ocean basins are at different latitudes, the zonally symmetric nature of the AO does not mean that it represents a simple modulation of the circumpolar flow. An increase in the AO or NAO implies strong, separated tropospheric jets in the Atlantic but a weakened Pacific jet. The PNA has strong related variability in the Pacific jet exit, but elsewhere the zonal wind is similar to that related to the NAO. The NAO-related zonal winds link strongly through to the stratosphere in the Atlantic sector. The PNA-related winds do so in the Pacific, but to a lesser extent. The results suggest that the NAO paradigm may be more physically relevant and robust for Northern Hemisphere variability than is the AO paradigm. However, this does not disqualify many of the physical mechanisms associated with annular modes for explaining the existence of the NAO.

Observed and simulated precursors of stratospheric polar vortex anomalies in the Northern Hemisphere

The Northern Hemisphere stratospheric polar vortex is linked to surface weather. After Stratospheric Sudden Warmings in winter, the tropospheric circulation is often nudged towards the negative phase of the Northern Annular Mode (NAM) and the North Atlantic Oscillation (NAO). A strong stratospheric vortex is often associated with subsequent positive NAM/NAO conditions. For stratosphere–troposphere associations to be useful for forecasting purposes it is crucial that changes to the stratospheric vortex can be understood and predicted. Recent studies have proposed that there exist tropospheric precursors to anomalous vortex events in the stratosphere and that these precursors may be understood by considering the relationship between stationary wave patterns and regional variability. Another important factor is the extent to which the inherent variability of the stratosphere in an atmospheric model influences its ability to simulate stratosphere–troposphere links. Here we examine the lower stratosphere variability in 300-year pre-industrial control integrations from 13 coupled climate models. We show that robust precursors to stratospheric polar vortex anomalies are evident across the multi-model ensemble. The most significant tropospheric component of these precursors consists of a height anomaly dipole across northern Eurasia and large anomalies in upward stationary wave fluxes in the lower stratosphere over the continent. The strength of the stratospheric variability in the models was found to depend on the variability of the upward stationary wave fluxes and the amplitude of the stationary waves.

Major advances in fundamental dairy cattle nutrition

Fundamental nutrition seeks to describe the complex biochemical reactions involved in assimilation and processing of nutrients by various tissues and organs, and to quantify nutrient movement (flux) through those processes. Over the last 25 yr, considerable progress has been made in increasing our understanding of metabolism in dairy cattle. Major advances have been made at all levels of biological organization, including the whole animal, organ systems, tissues, cells, and molecules. At the whole-animal level, progress has been made in delineating metabolism during late pregnancy and the transition to lactation, as well as in whole-body use of energy-yielding substrates and amino acids for growth in young calves. An explosion of research using multicatheterization techniques has led to better quantitative descriptions of nutrient use by tissues of the portal-drained viscera (digestive tract, pancreas, and associated adipose tissues) and liver. Isolated tissue preparations have provided important information on the interrelationships among glucose, fatty acid, and amino acid metabolism in liver, adipose tissue, and mammary gland, as well as the regulation of these pathways during different physiological states. Finally, the last 25 yr has witnessed the birth of "molecular biology" approaches to understanding fundamental nutrition. Although measurements of mRNA abundance for proteins of interest already have provided new insights into regulation of metabolism, the next 25 yr will likely see remarkable advances as these techniques continue to be applied to problems of dairy cattle biology. Integration of the "omics" technologies (functional genomics, proteomics, and metabolomics) with measurements of tissue metabolism obtained by other methods is a particularly exciting prospect for the future. The result should be improved animal health and well being, more efficient dairy production, and better models to predict nutritional requirements and provide rations to meet those requirements.

Net nutrient absorption and liver metabolism in lactating dairy cows fed supplemental dietary biotin

The effect of feeding supplemental biotin on net absorption and metabolism of nutrients by the portal-drained viscera (PDV; the gut, pancreas, spleen and associated fat) and liver of lactating dairy cows was measured. Three cows in early to mid-lactation catheterised for measurements of net nutrient absorption and metabolism by the PDV and liver were fed a total-mixed ration with or without supplemental biotin at 20 mg/day using a switch-back design (ABA v. BAB) with three 2-week periods. There were no effects of feeding biotin on dry matter intake (22.2 kg/day), milk yield (29.5 kg/day) or milk composition. There was also no effect of feeding biotin on net release of glucose by the liver, net liver removal of glucose precursors (propionate, alanine, lactate) or net liver release of p-hydroxybutyrate. Feeding biotin increased net PDV release of ammonia. Reasons for the response are not certain, but a numerical increase in net PDV release of acetate suggests that rumen or hindgut fermentation was altered. Results of the present study do not support the hypothesis that supplemental biotin increases liver glucose production in lactating dairy cows.