Acute Intestinal Obstruction Due To Gallstone Ileus [abdome Agudo Por Obstrução Por Ileobiliar]

Objective: Small bowel obstruction (SBO) due to gallstones (gallstone ileus) is an uncommon complication of cholelithiasis, for which there is no defined surgical procedure. The objective of this study was to perform a systematic review of the history, available image exams and clinical approach to the diagnosis and treatment of gallstone ileus. Method: We conducted a retrospective study in a university hospital including all cases of SBO treated over a period of 23 years. According to the surgical treatment, the patients were divided into two groups: (1) enterolithotomy with posterior cholecystectomy (two-stage surgery); and (2) enterolithotomy, cholecystectomy and fistula closure (one-stage surgery). Results: Twelve patients were included in the study, including 11 females (91,6%), with a mean age of 72.2 years. All patients presented associated diseases, mainly arterial hypertension (75%). All except one patient had multiple SBO symptoms. Gallstone ileus diagnosis was made before laparotomy in six patients (50%). There were eight patients in group 1 and four in group 2, and the morbidity was, respectively, 33.3% and 8.3%. Overall mortality was 16.6% (one patient in each group). Conclusion: Gallstone ileus should be suspected in the elderly with SBO symptoms. Early diagnosis can reduce post-operative complications. Treatment is urgent laparotomy and the surgical approach must be individualized for each case. The majority of patients in this study were treated with enterolithotomy, with cholecystectomy being performed later in two symptomatic patients.404275280Martin, F., Intestinal obstruction due to gall-stones: With report of three successful cases (1912) Ann Surg., 55 (5), pp. 725-743Reisner, R.M., Cohen, J.R., Gallstone ileus: A review of 1001 reported cases (1994) Am Surg., 60 (6), pp. 441-446Lobo, D.N., Jobling, J.C., Balfour, T.W., Gallstone ileus: Diagnostic pittfalls and therapeutic successes (2000) J Clin Gastroenterol., 30 (1), pp. 72-76Hayes, N., Saha, S., Recurrent gallstone Ileus (2012) Clin Med Res., 10 (4), pp. 236-239Carrascosa, M.F., Riego-Martín, M.D., Salcines Caviedes, J.R., González Gutiérrez, P., Gallstone ileus (2012) BMJ Case Rep., , Feb 21;2012Rojas-Rojas, D.J., Martínez-Ordaz, J.L., Romero-Hernández, T., Biliary ileus: 10-years experience (2012) Cir Cir., 80 (3), pp. 228-232Tucker, A., Garstin, I., A peculiar cause of bowel obstruction (2013) Int J Surg Case Rep., 4 (5), pp. 473-476Halabi, W.J., Kang, C.Y., Ketana, N.K., Lafaro, K.J., Nguyen, V.K., Stamos, M.J., Surgery for gallstone ileus: A nationwide comparison of trends and outcomes (2013) Ann Surg., , jan 4 [Epub ahead of print]Pronio, A., Piroli, S., Caporilli, D., Ciamberlano, B., Coluzzi, M., Castellucci, G., Recurrent gallstone ileus: Case report and literature review (2013) G Chir., 34 (1-2), pp. 35-37McHado, M.A.C., Jukemura, J., Volpe, P., Abdo, E.E., Penteado, S., Bacchella, T., Fístulas biliares internas: Estudo de 13 casos e revisão da literatura (1995) Hos Clin Fac Med S Paulo., 50 (1), pp. 45-48Ayantunde, A.A., Agrawal, A., Gallstone Ileus: Diagnosis and management (2007) World J Surg., 31 (6), pp. 1292-1297Ravikumar, R., Williams, J.G., The operative management of gallstone ileus (2010) Ann R Coll Surg Engl., 92 (4), pp. 279-281Day, E.A., Marks, C., Gallstone ileus: Review of literature and presentation of thirty-four new cases (1975) Am J Surg., 129 (5), pp. 552-558Deitz, D.M., Standage, B.A., Pinson, C.W., McConnell, D.B., Krippaehne, W.W., Improving the outcome in gallstone ileus (1986) Am J Surg., 151 (5), pp. 572-576Bouveret, L., Stenose du pylore, adherent a la vesicule calculeuse (1896) Rev Med., 16, pp. 1-16Gajendran, M., Muniraj, T., Gelrud, A., A challenging case of gastric outlet obstruction (Bouveret's syndrome): A case report (2011) J Med Case Rep., 5, p. 497Costil, V., Jullès, M.C., Zins, M., Loriau, J., Bouveretś syndrome. An unusual localization of gallstone ileus (2012) J Visc Surg., 149 (4), pp. e284-e286Kasahara, Y., Umemura, H., Shiraha, S., Kuyama, T., Sakata, K., Kubota, H., Gallstone ileus. Review of 112 patients in the Japanese literature (1980) Am J Surg., 140 (3), pp. 437-440van Hillo, M., van der Vliet, J.A., Wiggers, T., Obertop, H., Terpstra, O.T., Greep, J.M., Gallstone obstruction of the intestine: An analysis of ten patients and a review of the literature (1987) Surgery., 101 (3), pp. 273-276Nuño-Guzmán, C.M., Arróniz-Jáuregui, J., Moreno-Pérez, P.A., Chávez-Solís, E.A., Esparza-Arias, N., Hernández-González, C.I., Gallstone ileus: One-stage surgery in a patient with intermittent obstruction (2010) World J Gastrointest Surg., 2 (5), pp. 172-176Clavien, P.A., Richon, J., Burgan, S., Rohner, A., Gallstone ileus (1990) Br J Surg., 77 (7), pp. 737-742Murphy, K.P., Kearney, D.E., Mc Laughlin, P.D., Maher, M.M., Complete radiological findings in gallstone ileus (2012) J Neurogastroenterol Motil., 18 (4), pp. 448-449Huang, S.T., Huang, M.Y., Gallstone ileus: A diagnostic challenge by plain radiography (2013) Emerg Med J., 30 (5), p. 370Lasson, A., Lorén, I., Nilsson, A., Nirhov, N., Nilsson, P., Ultrasonography in gallstone ileus: A diagnostic challenge (1995) Eur J Surg., 161 (4), pp. 259-263Mishin, I., Ghidirim, G., Zastavnitsky, G., Non-operative treatment for gall-stone ileus-a case report (2011) Pol Przegl Chir., 83 (4), pp. 223-226Conzo, G., Mauriello, C., Gambardella, C., Napolitano, S., Cavallo, F., Tartaglia, E., Gallstone ileus: One-stage surgery in an elderly patient: One-stage surgery in gallstone ileus (2013) Int J Surg Case Rep., 4 (3), pp. 316-318Mallipeddi, M.K., Pappas, T.N., Shapiro, M.L., Scarborough, J.E., Gallstone ileus: Revisiting surgical outcomes using National Surgical Quality Improvement Program data (2013) J Surg Res., , May 31. 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Production of vegetable oil blends and structured lipids and their effect on wound healing

Two oil blends (sunflower/canola oils 85/15 (BL1) and canola/linseed oils 70/30 (BL2)), were prepared and enzymatically interesterified to be applied to surgically-induced wounds in rats. Following surgery, the animals were submitted to the Treatment with Physiological Saline (TPS) (control group), Blends (TBL), and Structured Lipids (TSL). The control group (TPS) received physiological saline solution for 15 days. In TBL, BL1 was administered during the inflammation phase (days 0-3) and BL2 in the tissue formation and remodeling phase (days 4-15). In TSL, Structured Lipid 1 (SL1) and Structured Lipid 2 (SL2) were used instead of BL1 and BL2, respectively. The aim of this study was to compare wound closure evolution among rats treated with the blends or structured lipids versus control rats treated with physiological saline. The wound healing process was evaluated by measuring the wound areas along the treatments and the concentrations of cytokines. An increase in the areas of wounds treated with the blends and structured lipids in the inflammatory phase was observed, followed by a steeper closure curve compared to wounds treated with physiological saline. The changes observed during the inflammatory phase suggest a potential therapeutic application in cutaneous wound healing which should be further investigated.</p

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Efficacy and Safety of Three Antiretroviral Regimens for Initial Treatment of HIV-1: A Randomized Clinical Trial in Diverse Multinational Settings

Background:Antiretroviral regimens with simplified dosing and better safety are needed to maximize the efficiency of antiretroviral delivery in resource-limited settings. We investigated the efficacy and safety of antiretroviral regimens with once-daily compared to twice-daily dosing in diverse areas of the world.Methods and Findings:1,571 HIV-1-infected persons (47% women) from nine countries in four continents were assigned with equal probability to open-label antiretroviral therapy with efavirenz plus lamivudine-zidovudine (EFV+3TC-ZDV), atazanavir plus didanosine-EC plus emtricitabine (ATV+DDI+FTC), or efavirenz plus emtricitabine-tenofovir-disoproxil fumarate (DF) (EFV+FTC-TDF). ATV+DDI+FTC and EFV+FTC-TDF were hypothesized to be non-inferior to EFV+3TC-ZDV if the upper one-sided 95% confidence bound for the hazard ratio (HR) was ≤1.35 when 30% of participants had treatment failure.An independent monitoring board recommended stopping study follow-up prior to accumulation of 472 treatment failures. Comparing EFV+FTC-TDF to EFV+3TC-ZDV, during a median 184 wk of follow-up there were 95 treatment failures (18%) among 526 participants versus 98 failures among 519 participants (19%; HR 0.95, 95% CI 0.72-1.27; p = 0.74). Safety endpoints occurred in 243 (46%) participants assigned to EFV+FTC-TDF versus 313 (60%) assigned to EFV+3TC-ZDV (HR 0.64, CI 0.54-0.76; p<0.001) and there was a significant interaction between sex and regimen safety (HR 0.50, CI 0.39-0.64 for women; HR 0.79, CI 0.62-1.00 for men; p = 0.01). Comparing ATV+DDI+FTC to EFV+3TC-ZDV, during a median follow-up of 81 wk there were 108 failures (21%) among 526 participants assigned to ATV+DDI+FTC and 76 (15%) among 519 participants assigned to EFV+3TC-ZDV (HR 1.51, CI 1.12-2.04; p = 0.007).Conclusion: EFV+FTC-TDF had similar high efficacy compared to EFV+3TC-ZDV in this trial population, recruited in diverse multinational settings. Superior safety, especially in HIV-1-infected women, and once-daily dosing of EFV+FTC-TDF are advantageous for use of this regimen for initial treatment of HIV-1 infection in resource-limited countries. ATV+DDI+FTC had inferior efficacy and is not recommended as an initial antiretroviral regimen.Trial Registration:http://www.ClinicalTrials.gov NCT00084136

Combination of searches for heavy spin-1 resonances using 139 fb−1 of proton-proton collision data at √s = 13 TeV with the ATLAS detector

A combination of searches for new heavy spin-1 resonances decaying into diferent pairings of W, Z, or Higgs bosons, as well as directly into leptons or quarks, is presented. The data sample used corresponds to 139 fb−1 of proton-proton collisions at √s = 13 TeV collected during 2015–2018 with the ATLAS detector at the CERN Large Hadron Collider. Analyses selecting quark pairs (qq, bb, tt¯, and tb) or third-generation leptons (τν and τ τ ) are included in this kind of combination for the frst time. A simplifed model predicting a spin-1 heavy vector-boson triplet is used. Cross-section limits are set at the 95% confdence level and are compared with predictions for the benchmark model. These limits are also expressed in terms of constraints on couplings of the heavy vector-boson triplet to quarks, leptons, and the Higgs boson. The complementarity of the various analyses increases the sensitivity to new physics, and the resulting constraints are stronger than those from any individual analysis considered. The data exclude a heavy vector-boson triplet with mass below 5.8 TeV in a weakly coupled scenario, below 4.4 TeV in a strongly coupled scenario, and up to 1.5 TeV in the case of production via vector-boson fusion

Measurement of vector boson production cross sections and their ratios using pp collisions at √s = 13.6 TeV with the ATLAS detector

Abstract available from publisher's website

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries