Bronchobiliary fistula: a rare complication after biliodigestive surgery for bile duct injury

A bronchobiliary fistula (BBF) is an abnormal communication between the biliary and bronchial systems. It is a rare condition with an unclear etiology. The principal causes are hepatic hydatid cysts, obstructive and iatrogenic processes. Presenting symptoms are variable and range from productive cough to recurrent pneumonia. The finding of bilioptisis is patognomonic. This case report presented a 22-year-old female patient who underwent a Roux-en-Y hepaticojejunostomy (RYHJ) for a bile duct injury and who later on, developed a bronchobiliary fistula

Biliar reflux by incompetence of the sphincter of oddi post endoscopic retrograde cholangiopancreatography, as cause of cholangiolar abscesses and cardiac vegetations

The term sphincter of Oddi dysfunction (SOD) encompasses a heterogeneous group of patients with a clinical syndrome characterized by abdominal pain (biliary colic or pancreatic pain), attributed to motor alterations of the SO that cause obstruction of the flow of bile and pancreatic juice (intermittent or fixed acalculous obstruction) or reflux of the same through the sphincter. Its diagnosis and treatment are controversial. We presented the case of a patient with sphincter of Oddi incompetence as a rare cause of jaundice, abdominal pain and cholangiolar abscesses due to sphincter incompetence from multiple endoscopic procedures and a history of cholecystectomy. We review the epidemiology, etiology, diagnostic criteria and management, both conservative and surgical

Effectiveness of the Epley’s maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial

BACKGROUND: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley’s maneuver performed by general practitioners (GPs) in the treatment of BPPV. METHODS/DESIGN: This study is a randomized clinical trial conducted in the primary care setting. The study’s scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley’s maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients’ report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher’s exact test will be conducted to compare categorical measures and Student’s t-test or Mann–Whitney U-test will be used for intergroup comparison variables. DISCUSSION: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01969513

Effectiveness of the Epley's maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial

Background: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. Methods/Design: This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher's exact test will be conducted to compare categorical measures and Student's t-test or Mann-Whitney U-test will be used for intergroup comparison variables. Discussion: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients

HTLV-1 infection in solid organ transplant donors and recipients in Spain

HTLV-1 infection is a neglected disease, despite infecting 10-15 million people worldwide and severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1 associated illnesses due to immunosuppression, screening is being widely considered in the transplantation setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ transplants in a survey conducted in Spain. All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients attended since the year 2008. A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312 (42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards represented nearly 80%. Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients. Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in dialysis but otherwise asymptomatic. The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along with the rapid development of subacute myelopathy

Occurrence of bioactive phenolic compounds in dietary fibre fractions from lentils and dark beans

Trabajo presentado a la XXV International Conference on Polyphenols, celebrada en Montpellier (Francia) del 23 al 27 de agosto de 2010.Peer reviewe

Evaluation of phenolic profile and antioxidant properties of Pardina lentil As affected by industrial dehydration

This study presents the effects of soaking, cooking, and industrial dehydration treatments on phenolic profile and also on antioxidant properties in Pardina lentil. HPLC-PAC and HPLC-MS (ESI) analysis identified a total of 35 phenolic compounds in raw and processed lentil flours, corresponding to catechins and procyanidins (69% of the total of identified phenolic compounds), flavonols (17%), flavones, and flavanones (5%), and hydroxybenzoic and hydroxycinnamic compounds (5 and 4%, respectively). During the industrial process, catechins and procyanidins, flavonols, flavones, and flavanones decreased, while hydroxybenzoic compounds exhibited an important increase. In addition, raw lentils showed high values of the antioxidant activity (66.97 μmol Trolox/g); although the thermal processing promotes decreased, the levels of antioxidant activity were still relevant. Thus, the significant occurrence of bioactive phenolic compounds along with the interesting antioxidant capacity of dehydrated lentil flours make them useful for daily inclusion in the human diet as ready-to-use for special meals to specific populations. © 2010 American Chemical Society.Peer Reviewe

Phenolic profile and antioxidant capacity of chickpeas (Cicer arietinum L.) as affected by a dehydration process

This study presents the effects of soaking, cooking and industrial dehydration on the phenolic profile, and antioxidant capacity in two chickpea varieties (Sinaloa and Castellano). Chromatographic analysis identified a total of 24 phenolic components, being isoflavones the main phenolics in raw and processed Sinaloa and Castellano flours. The impact of the industrial dehydration was different depending on the chickpea variety. Although Castellano chickpea exhibited the highest levels of phenolic compounds (103.1 μg/g), significant reductions were observed during processing; in contrast, the dehydration did not cause any further effects in Sinaloa flours. Interestingly, Sinaloa variety showed high thermal stability of isoflavones during processing. As expected, the levels of antioxidant capacity were in accordance with the behavior of phenolic compounds exhibiting noticeable reductions in Castellano chickpea and not relevant changes in Sinaloa chickpea. Thus, the significant occurrence of bioactive phenolic compounds along with the relevant antioxidant capacities of dehydrated chickpea flours make them to be considered functional ingredients for their beneficial health effects, especially in case of Sinaloa. © 2011 Springer Science+Business Media, LLC.Peer Reviewe