Opera and poison : a secret and enjoyable approach to teaching and learning chemistry

The storyline of operas, with historical or fictional characters, often include potions and poisons. This has prompted a study of the chemistry behind some operatic plots. The results were originally presented as a lecture given at the University of Minho in Portugal, within the context of the International Year of Chemistry. The same lecture was subsequently repeated at other universities as an invited lecture for science students and in public theaters for wider audiences. The lecture included a multimedia and interactive content that allowed the audience to listen to arias and to watch video clips with selected scenes extracted from operas. The present article, based on the lecture, demonstrates how chemistry and opera can be related and may also serve as a source of motivation and inspiration for chemistry teachers looking for alternative pedagogical approaches. Moreover, the lecture constitutes a vehicle that transports chemistry knowledge to wider audiences through examples of everyday molecules, with particular emphasis on natural products.The author is pleased to express his gratitude to Jorge Calado and Michael John Smith for useful discussions. The author also thanks the reviewers of the manuscript for their helpful comments and suggestions. Thanks are due to the Foundation for Science and Technology (FCT,Portugal), QREN and FEDER/EU for financial support through the research centers, CQ/UM PEst-C/QUI/UI0686/2011. Ciencia Viva, Portugal, is also acknowledged for financial support of the activities organized by the University of Minho during the International Year of Chemistry. The author also expresses his gratitude to Ana Paula Ferreira and Andre Cunha Leal from RTP Antena 2 who contributed immensely to the popularization of the lecture on which this paper is based on

Effect of Early Surgery vs Endoscopy-First Approach on Pain in Patients With Chronic Pancreatitis The ESCAPE Randomized Clinical Trial:The ESCAPE Randomized Clinical Trial

IMPORTANCE For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function. OBJECTIVE To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for INTERVENTIONS There were 44 patients randomized to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 patients randomized to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if needed. MAIN OUTCOMES AND MEASURES The primary outcome was pain, measured on the Izbicki pain score and integrated over 18 months (range, 0-100 [increasing score indicates more pain severity]). Secondary outcomes were pain relief at the end of follow-up; number of interventions, complications, hospital admissions; pancreatic function; quality of life (measured on the 36-Item Short Form Health Survey [SF-36]); and mortality. RESULTS Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, -12 points [95% CI, -22 to -2]; P = .02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P = .10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P <.001). Treatment complications (27% vs 25%), mortality (0% vs 0%), hospital admissions, pancreatic function, and quality of life were not significantly different between early surgery and the endoscopy-first approach. CONCLUSIONS AND RELEVANCE Among patients with chronic pancreatitis, early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months. However, further research is needed to assess persistence of differences over time and to replicate the study findings

Endoscopic and surgical management of bile duct injury after laparoscopic cholecystectomy

Laparoscopic cholecystectomy has become the first choice of management for symptomatic cholecystolithiasis. While it is associated with decreased postoperative morbidity and mortality, bile duct injuries are reported to be more severe and more common (0-2.7%), when compared to open cholecystectomy (0.2-0.5%) [New Engl. J. Med. 234 (1991) 1073; Am. J. Surg. 165 (1993) 9; Surg. Clin. N Am. 80 (2000) 1127]. These bile duct injuries include leaks, strictures, transection and removal of (part of) the duct, with or without vascular damage. Bile duct injury might be due to misidentification of the biliary tract anatomy due to acute cholecystitis, large impacted stones, short cystic duct, anatomical variations, but also due to technical errors leading to bleeding with subsequent clipping and coagulation trauma [Ann. Surg. 237 (2003) 460]. Early recognition and adequate multidisciplinary approach is the cornerstone for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature with as consequences biliary peritonitis, sepsis, abscesses, multiple organ failure, a more difficult (proximal) reconstruction and in the long run, secondary biliary cirrhosis, and liver failure. Despite increasing experience in performing laparoscopic cholecystectomy, the frequency of bile duct injuries has not decreased [Ann. Surg. 234 (2001) 549]. Therapy encompasses endoscopic stenting, percutaneous transhepatic dilatation (PTCD) and surgical reconstructio

Helicobacter pylori eradication and gastric cancer: when is the horse out of the barn?

Helicobacter pylori infection is a major risk factor for gastric cancer development. Therefore, H. pylori eradication may be an important approach in the prevention of gastric cancer. However, long-term data proving the efficacy of this approach are lacking. This report describes two patients who developed gastric cancer at, respectively, 4 and 14 years after H. pylori eradication therapy. These patients were included in a study cohort of H. pylori-infected subjects who received anti-H. pylori therapy during the early years of development of H. pylori eradication therapy and underwent strict endoscopic follow-up for several years. In both patients, gastric ulcer disease and premalignant gastric lesions, i.e., intestinal metaplasia at baseline and dysplasia during follow-up, were diagnosed before gastric cancer development. These case reports demonstrate that H. pylori eradication does not prevent gastric cancer development in all infected patients after long-term follow-up. In patients with premalignant gastric lesions, in particular in patients with a history of gastric ulcer disease, adequate endoscopic follow-up is essential for early detection of gastric neoplasi

Comparative effects of adjuvant cimetidine and omeprazole during pancreatic enzyme replacement therapy

In a double-blind, randomized crossover study, the hypotheses were tested that more powerful inhibition of gastric acid secretion by adjuvant omeprazole further improves the efficacy of pancreatic enzyme replacement therapy compared to adjuvant cimetidine and that excluding the influence of pH-related factors, by virtually complete inhibition of gastric acid secretion with 60 mg omeprazole daily, does not lead to total elimination of steatorrhea. During both adjuvant cimetidine and omeprazole treatment, fecal fat excretion was significantly lower compared to pancreatin monotherapy (P < 0.01). Omeprazole showed a trend towards a more favorable decrease of fecal fat excretion compared to cimetidine but no statistically significant difference. Steatorrhea was almost never abolished, even during 60 mg omeprazole daily. Generally, pH-related factors are considered to explain an inadequate therapeutic response during pancreatic enzyme replacement therapy. However, this study indicates that in vivo other factors also play a significant rol

Toenemende rol van angiografische embolisatie bij de behandeling van gastro-intestinale bloedingen

Endoscopy is the primary diagnostic and therapeutic modality for the vast majority of patients with haemorrhage of the upper or lower digestive tract. In many hospitals, surgery is the therapy of choice when endoscopy fails or is impossible. In patients who have considerable co-morbidity and who are actively bleeding from the digestive tract, surgery is associated with a relatively high morbidity and mortality. Angiographic embolisation for haemorrhage from the upper or lower digestive tract is effective, with success rates varying from 50 to 90%. The risk of ischaemic complications of the procedure is acceptably low ( <5%). Angiography is not very time-consuming and does not preclude subsequent surgical treatment ifangiographic embolisation does not succeed. However, performing embolisation requires skill and experience and the procedure is not available everywhere. Angiographic embolisation is a valuable alternative to surgery and should be considered in all patients with haemorrhage of the digestive tract who cannot be treated by means of endoscop

Het beloop van het benigne ulcus ventriculi; resultaten van een follow-up-onderzoek

A follow-up investigation was conducted in 112 patients in whom a benign gastric ulcer had been found endoscopically between 1978 and 1984. Nine patients had been operated upon, mainly in the earlier years. Out of 65 patients ultimately selected for the study 38 underwent gastroscopy and 35 could be evaluated. Of these 21 (60%) had complaints and another 60% used intermittent or continuous medication because of complaints referred to the stomach. In 15 patients erosions (4) or benign gastric ulcers (11) were found. In all patients in whom it was looked for Campylobacter pylori was found in the gastric mucosa. The benign gastric ulcer is a chronic, recurrent affection. We did not find a large proportion of asymptomatic recurrent ulcers. Many patients continue to use drugs. The complaints in patients with mucosal lesions are often atypica

Evaluation of the performance of commercial test kits for detection of Helicobacter pylori antibodies in serum.

We have compared the sensitivities, specificities, and predictive values of three commercial serological assays for the diagnosis of Helicobacter pylori infection. A qualitative latex method (Pyloriset; Orion Diagnostics), a semiquantitative enzyme-linked immunosorbent assay (ELISA) (GAP test IgG; Bio-Rad), and a quantiative ELISA (Helico-G; Porton Cambridge) were used in 109 untreated dyspeptic patients. The presence of H. pylori was established when the results of culture and/or histology of the gastric biopsies taken were positive. The prevalence of H. pylori infection was 62% (52% in 42 patients younger than 45 years of age and 69% in 67 patients older than 45 years of age). Sensitivities and specificities were 68 and 76% for Pyloriset, 89 and 77% for GAP test IgG, and 82 and 83% for Helico-G. The positive predictive values for all three tests were between 85 and 90%. The predictive values for the absence of disease with a negative result were 62, 82, and 74% for Pyloriset, the GAP test, and Helico-G, respectively. With Helico-G in the younger group (less than 45 years), sensitivity significantly lower (71 versus 87%) and a positive predictive value lower than those for the older group (greater than 45 years) were found. Either the sensitivities and specificities of commercial methods for the measurement of antibodies to H. pylori in serum must be improved or the relationship between the presence of antibodies and the presence of bacteria in the stomach at the time of investigation is too weak to allow the use of serological techniques instead of culture and histological investigation of gastric biopsy material