Gallstone Ileus: Clinical Presentation of a Benign Mechanical Intestinal Obstruction

Gallstone ileus is a rare cause of small bowel obstruction which usually presents in elderly female patients and which has been associated with high morbidity and mortality rates. We present the case of a 63-year-old man who presented at our institution with symptoms of bowel obstruction. Abdominal X-ray and exploratory laparotomy revealed a large gallstone in the terminal ileus

Tendencies in medical publications

AbstractObjectivesTo describe the trends of research design in publications from high-impact medical journals.MethodsA cross-sectional, descriptive study was conducted by searching the 2011 electronic publications of the journals: New England Journal of Medicine, Journal of the American Medical Association, The Lancet, British Medical Journal, and Annals of Internal Medicine. Studies were classified as primary and secondary. The journal impact factor was taken from the Journal Citation Report website. Descriptive statistics were used to analyze and interpret the data.ResultsWe analyzed 1130 publications: 804 primary and 326 secondary studies, which represented 71.2% and 28.8% of the total publications, respectively. Among the primary studies, randomized clinical trials (30.4%) were the most prevalent, followed by cohort studies (21.9%) and case reports (9.0%).ConclusionsThese findings can have implications in Evidence-Based Medicine programs. Literature review should focus on reviewing secondary articles first, then experimental studies and finally, observational studies

Response of obesity-resistant BALB/c mice to a ketogenic diet

Introduction. The ketogenic diet (KD) is a high-fat, low-carbohydrate diet in which the body undergoes metabolic adjustments that stimulate ketogenesis, thereby increasing circulating ketone bodies. Loss of body weight is attributed to these adjustments, as well as neuroprotective properties. However, the mechanisms involved are still not fully elucidated. That aim of this work was to evaluate the effect of a ketogenic diet on body composition, feeding behavior and glucose metabolism in mice of the BALB/c strain, a mouse model resistant to obesity. Materials and methods. BALB/c mice of both sexes, 12 weeks old, were divided into KD and control groups, which received a ketogenic diet (Research Diets) or standard chow (LabDiet 5001), respectively, for 23 days. Throughout the experiment, body weight gain, water and food intake were measured, whereas body mass index (BMI), the percentage of interscapular, inguinal, and visceral adipose tissue and blood b-hidroxybutyrate levels were measured at the end of the protocol. In addition, glucose tolerance tests were carried out at the beginning and at the end of the experiment. Results. Similar body weight gain (10%) was observed in males and females on KD compared to the control group (p\u3c0.05). However, a higher BMI was observed only in males. The KD group consumed 50% less food in both sexes, whereas water consumption was diminished 25% in males and 50% in females, compared to the control (p= 0.0001). The estimated energy intake was lower (12 Kcal) in males on ketogenic diet, but not in females. Regarding the metabolic state at day 23, in KD mice levels of b-hidroxybutyrate increased to 0.4 mmol/L in males and 0.7 mmol/L in females. Mice of both sexes on KD showed increased inguinal and visceral fat, when compared to the control group on standard chow. At day 23, the glucose tolerance test showed an increase in the area under the curve, indicating impaired glucose tolerance, in both males and females on KD. Conclusions. In obesity-resistant BALB/c mice, the consumption of a ketogenic diet for a short period induces a state of nutritional ketosis accompanied by weight gain, increased fat tissue, and impaired glucose intolerance

LASIK monocular en pacientes adultos con ambliopía por anisometropía

ResumenObjetivoDeterminar la eficacia y la seguridad del LASIK en el tratamiento de la ambliopía por anisometropía en pacientes adultos.MétodosSerie de casos. Estudiamos a 12 pacientes adultos ambliopes por anisometropía a los cuales se realizó LASIK monocular de nuestro servicio de Córnea y Cirugía Refractiva. Evaluamos el error refractivo pre y postoperatorio, equivalente esférico (ES), la agudeza visual sin corrección (AVSC) y la agudeza visual mejor corregida (AVMC). La agudeza visual medida por la cartilla de Snellen fue convertida a LogMAR con fines de análisis estadístico.ResultadosLa edad promedio fue de 31.92 (± 12.13) años. El ES preoperatorio promedio en el ojo tratado fue de –3.49 D (± 3.24), el ES promedio del ojo no tratado fue de 0.25 D (± 0.30). La AVSC preoperatoria fue de 1.12 (± 0.3) LogMAR y la AVMC preoperatoria fue 0.31 (± 0.1) LogMAR. El seguimiento promedio fue de 19.1 (rango 6-74) meses. El ES promedio postoperatorio disminuyó a –0.28 (± 0.48). Cinco pacientes (42%) ganaron una línea de visión, un (8%) paciente ganó 2 líneas de visión y un (8%) paciente ganó 3 líneas de visión. El resto (42%) permaneció sin cambios comparados a la AVMC preoperatoria. Se encontraron diferencias estadísticamente significativas entre la AVSC preoperatoria (1.12 [±0.3]) y la AVSC postoperatoria (0.27 [±0.1]) (p=0.002, Z-Wilcoxon) y entre la AVMC postoperatoria (0.23 [±0.12]) y la AVMC preoperatoria (0.31 [±0.1]) (p=0.014, Z-Wilcoxon). No hubo complicaciones relacionadas con la cirugía.ConclusionesLa cirugía refractiva monocular en pacientes con ambliopía por anisometropía es una opción terapéutica segura y efectiva que ofrece resultados visuales satisfactorios, preservando o incluso mejorando la AVMC preoperatoria.AbstractPurposeTo investigate the efficacy and safety of LASIK for the correction of anisometropic amblyopia in adult patients.MethodsA retrospective, case series. We found 12 amblyopic adult patients that underwent monocular LASIK for anisometropía in our Cornea and Refractive service. We evaluated the preoperative and postoperative refractive error, spherical equivalent (SE), uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). Snellen visual acuity measurements were converted to LogMAR for statistical purposes.ResultsThe mean age was 31.92 (±12.13) years. The average preoperative SE in the treated eyes was -3.49 (±3.24), the average SE of the untreated eye was 0.25(±0.30). Preoperative UCVA was 1.12 (±0.3) and average preoperative BCVA was 0.31 (±0.1). All patients had LASIK with an average follow-up time of 19.1(6-74) months. The average postoperative SE decreased to -0.28 (±0.48). Five patients (42%) gained 1 line of vision, 1 (8%) patient gained 2 lines of vision, 1 (8%) patient gained 3 lines of vision and the rest (42%) remained unchanged compared to preoperative BCVA. Statistically significant differences were observed between the preoperative UCVA [1.12 (±0.3)] with the postoperative UCVA [0.27 (±0.1)](p=0.002, Z-Wilcoxon) and between the postoperative BCVA [0.23 (±0.12)] with the preoperative BCVA [0.31 (±0.1)] (p=0.014, Z-Wilcoxon). There were no complications related to the surgical procedures.ConclusionsMonocular refractive surgery in adult patients with anisometropic amblyopia is a safe and effective therapeutic option that offers a satisfactory visual outcome, preserving or even improving the preoperative BCVA