18 research outputs found
Effects of Algicon on the ultrastructure of the mucosa of subjects with reflux oesophagitis
No full textPlasma leptin levels after vertical banded gastroplasty for morbid obesity : effects of an acidified meal
No full textBackground: Leptin is considered One of the anorectic messengers to the central nervous system in lean subjects. Although it is secreted by the gastric mucosa, there are contradictory evidences of its involvement in mediating the acute satiety effect of the meal in obese patients. The effects of restrictive operations on meal-stimulated leptin secretion are unknown.
Methods: The effects of a standard acidified (pH 3) meal on leptin release were investigated in obese patients, before and after vertical banded gastroplasty (VBG). 8 morbidly obese patients (BMI 49.1+/-6.5) had serum leptin determination after an overnight fast. Samples were taken basally and every 30 minutes after the meal for 3 hours. The test was repeated after 20% BMI reduction. 5 lean volunteers (BMI 22.5+/-1.7) served as the control group.
Results: In obese patients, basal serum leptin fell from 62+/-20.4 to 23.8+/-15.7 ng/ml after the operation (P<0.01) but still with significant differences vs the control group (5.6+/-3 ng/ml). The meal was associated with a significant decrease of serum leptin (ANOVA test, P<0.01), and significant differences between obese patients after surgery and lean subjects were found.
Conclusion: Serum leptin was reduced by the meal in obese patients and VBG did not attain satiety through serum leptin changes
Metastatic melanoma of the gallbladder
No full textA 38-year-old man arrived at our clinic with symptoms and investigation results (U.S. scan and MR) suggestive of acute calculous cholecystitis. He gave a past history of excision of a stage I melanoma of the shoulder. Metastatic disease was suspected following measurement of CA 19.9 levels and the CT scan. The patient underwent laparotomy and cholecystectomy; pathological examination confirmed the presence of a malignant melanoma metastatic lesion of the gallbladder
Plasma cholecystokinin levels after vertical banded gastroplasty : effects of an acidified meal
No full textBACKGROUND: Although cholecystokinin (CCK) is involved in the short-term regulation of satiety, it has not been investigated in obese patients subjected to bariatric restrictive operations. METHODS: 8 morbidly obese patients (BMI 49.1 +/- 6.9), 7F and 1M, were investigated before and after vertical banded gastroplasty (VBG). 6 healthy lean volunteers served as the control group. CCK was determined (RIA) after an overnight fast and after the administration of an acidified (pH 3) liquid meal. Blood samples were taken 45 min before the meal, 5 min after it and then every 30 min for 3 hours. RESULTS: There were no differences between groups in basal CCK levels. However, the peak of CCK after the meal was significantly higher (P <0.01) in obese patients after VBG (24.9 +/- 18 pmol/l) than before VBG (9.8 +/- 6.7 pmol/l) and when compared with the control group (8.0 +/- 6.3 pmol/l).The time needed to reach the peak was longer in healthy volunteers (105 +/- 24.9 min) than in obese patients before VBG (45 +/- 40 min) and after VBG (7.5+/- 12 min) (P<0.01). CONCLUSIONS: VBG increases the peak of CCK secretion and shortens the time to reach it. These changes could contribute to the satiety effects of gastric restrictive operations
Impact of highly active antiretroviral therapy on outcome of cholecystectomy in patients with human immunodeficiency virus infection
No full textBackground: Highly active antiretroviral therapy (HAART) reduces virus proliferation and significantly decreases the rate of septic and opportunistic complications in patients infected with human immunodeficiency virus (HIV). Although surgery is performed routinely on patients receiving HAART, the effect of this treatment on surgical outcome has not been examined in detail. Methods: This retrospective study reviewed 54 consecutive patients with HIV infection who underwent surgical cholecystectomy: 31 patients were on HAART, 13 on nucleoside analogue reverse transcriptase inhibitors (NRTIs) and ten were receiving no specific therapy. Characteristics of HIV-1 infection, laboratory investigations, characteristics of the gallbladder disease, type of operation, postoperative course, morbidity and mortality were recorded. Univariable analysis and unconditional logistic regression were performed to determine factors related to postoperative complications and death. Results: The three groups were similar in terms of HIV-1 infection characteristics. In univariable analysis HAART and laparoscopic cholecystectomy were associated with a significantly lower complication rate, whereas only HAART was shown to be protective by logistic regression analysis. A low HIV RNA load and a high CD4(+) cell count were significant predictors of uncomplicated surgical outcomes. Conclusion: HAART significantly reduces the risk of complications after cholecystectomy in patients with HIV infection or acquired immune deficiency syndrome
Preliminary Analysis of the PreFlexMS Molten Salt Once-Through Steam Generator Dynamics and Control Strategy
No full textFavorable Survival of In-Hospital Compared with Out-of-Hospital Refractory Cardiac Arrest Patients Treated with Extracorporeal Membrane Oxygenation: An Italian Tertiary Care Center Experience
No full textObjective: Extracorporeal membrane oxygenation (ECMO) support has been suggested to improve survival in patients with refractory in- and out-of-hospital cardiac arrest (IHCA, OHCA). Aim of the present study was to report our experience on the use of ECMO in adult patients with refractory IHCA and OHCA. We have further examined outcome differences between IHCA and OHCA and factors accounting for such differences.
Methods: Forty-two patients (31 males) with refractory cardiac arrest, 24 IHCA and 18 OHCA, were enrolled in this single centre, retrospective, observational study, from January 2006 to December 2010.
Results: There was significant difference in the time of no-flow (duration of untreated cardiac arrest) between the OHCA and IHCA patients (p<0.001). The time of low flow (duration of CPR prior to ECMO) was also significantly longer in the OHCA group compared with the IHCA one (77 mins vs 55 mins, p<0.001). ECMO implantation was successful in 38 (90%) of the 42 patients. ECMO support was positioned: 3 times (8%) in the operating room, 6 (16%) in the cardiac surgery intensive care unit, 21 (55%) in the emergency department, 5 (13%) in the catheterization laboratory and 3 (8%) in general ward. A total of 14 IHCA (58%) and 3 OHCA (16%) patients were weaned from ECMO (p<0.05). 11 IHCA (46%) and 1 OHCA (5% p<0.05) were discharged from intensive care unit (ICU). Among IHCA patients, 10 were alive at 6 months, 9 of whom (38%) with good neurological outcome. Among OHCA patients weaned from ECMO, one was alive at six months with good neurological outcome (5%, p<0.05 vs IHCA).
Conclusions: ECMO support should be considered as a resuscitation alternative in selected patients. More specifically, patients with witnessed IHCA have more benefits from ECMO treatment compared to those who experience an out-of-hospital cardiac arrest.
Formula
Author Disclosures: L. Avalli: None. G. Greco: None. F. Sangalli: None. L. Galbiati: None. M. Trabucchi: None. F. Formica: None. C. Costa: None. G. Ristagno: None. R. Fumagalli: None
Favorable Survival of In-Hospital Compared with Out-of-Hospital Refractory Cardiac Arrest Patients Treated with Extracorporeal Membrane Oxygenation: An Italian Tertiary Care Center Experience
No full textObjective: Extracorporeal membrane oxygenation (ECMO) support has been suggested to improve survival in patients with refractory in- and out-of-hospital cardiac arrest (IHCA, OHCA). Aim of the present study was to report our experience on the use of ECMO in adult patients with refractory IHCA and OHCA. We have further examined outcome differences between IHCA and OHCA and factors accounting for such differences.
Methods: Forty-two patients (31 males) with refractory cardiac arrest, 24 IHCA and 18 OHCA, were enrolled in this single centre, retrospective, observational study, from January 2006 to December 2010.
Results: There was significant difference in the time of no-flow (duration of untreated cardiac arrest) between the OHCA and IHCA patients (p<0.001). The time of low flow (duration of CPR prior to ECMO) was also significantly longer in the OHCA group compared with the IHCA one (77 mins vs 55 mins, p<0.001). ECMO implantation was successful in 38 (90%) of the 42 patients. ECMO support was positioned: 3 times (8%) in the operating room, 6 (16%) in the cardiac surgery intensive care unit, 21 (55%) in the emergency department, 5 (13%) in the catheterization laboratory and 3 (8%) in general ward. A total of 14 IHCA (58%) and 3 OHCA (16%) patients were weaned from ECMO (p<0.05). 11 IHCA (46%) and 1 OHCA (5% p<0.05) were discharged from intensive care unit (ICU). Among IHCA patients, 10 were alive at 6 months, 9 of whom (38%) with good neurological outcome. Among OHCA patients weaned from ECMO, one was alive at six months with good neurological outcome (5%, p<0.05 vs IHCA).
Conclusions: ECMO support should be considered as a resuscitation alternative in selected patients. More specifically, patients with witnessed IHCA have more benefits from ECMO treatment compared to those who experience an out-of-hospital cardiac arrest.
Formula
Author Disclosures: L. Avalli: None. G. Greco: None. F. Sangalli: None. L. Galbiati: None. M. Trabucchi: None. F. Formica: None. C. Costa: None. G. Ristagno: None. R. Fumagalli: None
Hierarchical priority setting for restoration in a watershed in NE Spain, based on assessments of soil erosion and ecosystem services
No full text31 páginas[EN] Maintaining and enhancing ecosystem services through the restoration of degraded ecosystems have become an important biodiversity conservation strategy. Deciding where to restore ecosystems for the attainment of multiple services is a key issue for future planning, management, and human well-being. Most restoration projects usually entail a small number of actions in a local area and do not consider the potential benefits of planning restoration at broad regional scales. We developed a hierarchical priority setting approach to evaluate the performance of restoration measures in a semiarid basin in NE Spain (the Martín River Basin, 2,112 km2). Our analysis utilized a combination of erosion (a key driver of degradation in this Mediterranean region) and six spatially explicit ecosystem services data layers (five of these maps plotted surrogates for soil retention and accumulation, water supply and regulation, and carbon storage, and one plotted a cultural service, ecotourism). Hierarchical maps were generated using a geographic information system that combined areas important for providing a bundle of ecosystem services, as state variables, with erosion maps, as the disturbance or regulatory variable. This was performed for multiple scales, thereby identifying the most adequate scale of analysis and establishing a spatial hierarchy of restoration actions based on the combination of the evaluation of erosion rates and the provision of ecosystem services. Our approach provides managers with a straightforward method for determining the spatial distribution of values for a set of ecosystem services in relation to ecological degradation thresholds and for allocating efforts and resources for restoration projects in complex landscapes.This work was funded by Endesa S.A. through the collaborative agreement Endesa-CSIC for scientific research. The first author wants to thank Belinda Reyers for the fruitful conversation and helpfulness showed in every moment and two anonymous referees for their constructive suggestions. M. Trabucchi was in receipt of grant from JAE-DOC Program for Advanced Study financed by the European Social Fund (ESF), Ref. I3P-BPD-2006.Peer reviewe
