Multidisciplinary Conservative Treatment of Difficult Bile Duct Stones: A Real Alternative to Surgery

56 patients with large CBD or intrahepatic stones underwent endoscopic and/or percutaneous treatment followed by extracorporeal shock wave lithotripsy. Percutaneous access to the biliary tract was chosen when an endoscopic approach was not possible (hepaticojejunostomy in 5 patients, 1 juxtapapillary diverticulum and I inflammatory bile duct stricture). Visualization of stones was achieved radiologically in 32 patients and by ultrasound in 24. The procedure was successful in 47 of 56 treated patients (83.9%). Clearance of the biliary tract was obtained in 25 cases (53%), whereas in 22 cases (47%) complete clearing of biliary tract was obtained only after endoscopic extraction of fragments (17 cases) or percutaneous (5 cases). The median number of shock waves in each session was 1725 (range 300–3166), which were applied during one (n=30), two (n=22) or three sessions (n=4). The only complications were 1 case of symptomatic hyperamylasemia and 3 cases of macrohematuria. In conclusion, extracorporeal lithotripsy combined with endoscopic and/or percutaneous treatment is a real alternative to surgery for difficult stones

Octreotide 24‐h prophylaxis in patients at high risk for post‐ERCP pancreatitis: results of a multicenter, randomized, controlled trial

Background:Pharmacological prophylaxis of post‐ERCP pancreatitis is costly and not useful in most non‐selected patients, in whom the incidence of pancreatitis is 5% or less. However, it could be useful and probably cost‐effective, in patients at high risk for this complication, where the post‐procedure pancreatitis rate is 10% and more.Aim:To assess the efficacy of octreotide in reducing the incidence and severity of post‐ERCP pancreatitis and procedure‐related hospital stay, in subjects with known patient‐related risk factors.Methods:A total of 120 patients were randomly allocated to receive octreotide or not, in a multicentre, randomized, controlled trial. The drug was given subcutaneously, 200 μg t.d.s., starting 24 h before the ERCP procedure, in patients with either sphincter of Oddi dysfunction, or a history of relapsing pancreatitis or post‐ERCP pancreatitis, or who were aged under 35 years, or who had a small common bile duct diameter (< 8 mm).Results:A total of 114 patients (58 in the octreotide group and 56 in the control group) completed the trial. Post‐procedure pancreatitis occurred in seven octreotide‐treated patients (12.0%) and eight controls (14.3%). The two groups showed no significant differences in the incidence or severity of pancreatitis. Twenty‐four hours after the procedure, severe hyperamylasemia (more than five times the upper normal limit) without pancreatic‐like pain was recorded in three octreotide‐treated patients (5.2%) and six controls (10.7%), the difference being not significant.Conclusion:Twenty‐four‐hour prophylaxis with octreotide proved ineffective in preventing post‐ERCP pancreatitis and in avoiding 24‐h severe hyperamylasemia in high‐risk patients

Drivers of success in implementing sustainable tourism policies in urban areas

The existing literature in the field of sustainable tourism highlights a number of barriers that impede the implementation of policies in this area. Yet, not many studies have so far considered the factors that would contribute to putting this concept into practice, and few address the case of urban areas. The concept of sustainability has only received limited attention in urban tourism research, even though large cities are recognised as one of the most important tourist destinations that attract vast numbers of visitors. Adopting a case study approach, this paper discusses a number of drivers of success identified by policy-makers in London to contribute to the implementation of sustainable tourisms policies at the local level, and briefly looks at the relationship between these drivers and the constraints perceived by the respondents to hinder the implementation of such policies in practice. These findings may help policy-makers in other large cities to successfully develop and implement policies towards sustainable development of tourism in their area

Nurses and Clinical Research Coordinators (CRCs) collaboration to improve quality in clinical trials

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Elastic scattering with weakly bound projectiles

Possible effects of the break-up channel on the elastic scattering threshold anomaly has been investigated. We used the weakly bound 6,7Li nuclei, which is known to undergo break-up, as projectiles in order to study the elastic scattering on a 27Al target. In this contribution we present preliminary results of these experiments, which were analyzed in terms of the Optical Model and compared with other elastic scattering data using weakly bound nuclei as projectile. © 2007 American Institute of Physics.Fil:Figueira, J.M. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina.Fil:Fernández Niello, J.O. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina.Fil:Arazi, A. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina.Fil:Capurro, O.A. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina.Fil:Martí, G.V. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina.Fil:Pacheco, A.J. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina

Role of serum-free light chain assay for defining response and progression in immunoglobulin secretory multiple myeloma

The International Myeloma Working Group (IMWG) guidelines recommend using electrophoresis and immunofixation to define response and progressive disease (PD) in immunoglobulin (Ig) secretory multiple myeloma (Ig-MM), whereas the role of serum-free light chain (sFLC) is controversial. We retrospectively analyzed the value of adding sFLC assays in the definition of response and PD according to IMWG criteria in 339 Ig-MM patients treated with a first-line novel agent-based therapy (median follow-up 54 months). sFLC PD was defined according to conventional criteria plus increased sFLC levels, or sFLC escape (sFLCe); progression/sFLCe-free survival (ePFS) was the time from the start of treatment to the date of first PD or sFLCe, or death; overall survival after PD/sFLCe (OS after Pe) was the time from first PD or sFLCe to the date of death. 148 (44%) patients achieved a complete response and 198 (60%) a normal sFLC ratio (sFLCR). sFLCR normalization was an independent prognostic factor for extended PFS (HR&nbsp;=&nbsp;0.46, p&nbsp;=&nbsp;0.001) and OS (HR&nbsp;=&nbsp;0.47, p&nbsp;=&nbsp;0.006) by multivariable analysis. 175 (52%) patients experienced PD according to the IMWG criteria, whereas 180 (53%) experienced PD or sFLCe. Overall, a sFLCe was observed in 31 (9%) patients. Median PFS and ePFS were both equal to 36 (95% CI&nbsp;=&nbsp;32–42, and 32–40, respectively) months. sFLC PD adversely affected the OS after Pe compared to PD with increasing monoclonal Ig only (HR&nbsp;=&nbsp;0.52, p&nbsp;=&nbsp;0.012). Our results support the inclusion of the sFLC assay for defining response and PD in Ig-MM

Bootstrap method for constructing covariance matrices of optical-model parameters in the study of the threshold anomaly

The parameters of optical-model potentials are usually obtained by adjusting theoretical calculations to the corresponding experimental elastic-scattering data. It has been observed that the use of conventional covariance matrices for the evaluation of the uncertainties of the parameters obtained in this way, leads in general to unrealistically small values. This underestimate may be caused by either, an incorrect use of the statistical recipes, or by the lack of a systematic study of the robustness of the uncertainty values against the inclusion or exclusion of experimental data points within a given data set. In the present contribution we explore both factors. Regarding the first aspect we use a re-normalization for χ2, similar to the one proposed by R.T. Birge. In the second case we use the Bootstrap method to create synthetic sets based on all the available experimental data in order to derive an effective covariance matrix. These procedures were applied to the re-analysis of elastic-scattering data for several heavy-ion systems at energies close to the Coulomb barrie

Effect of the break-up on the fusion and elastic scattering of weakly bound projectiles on 64^{64}Zn

We study the behavior of the fusion, break-up, reaction and elastic scattering of different projectiles on $^{64}$Zn, at near and above barrier energies. We present fusion and elastic scattering data with the tightly bound $^{16}$O and the stable weakly bound $^{6}$Li, $^{7}$Li and $^{9}$Be projectiles. The data were analyzed by coupled channel calculations. The total fusion cross sections for these systems are not affected by the break-up process at energies above the barrier. The elastic (non-capture) break-up cross section is important at energies close and above the Coulomb barrier and increases the reaction cross sections. In addition we also show that the break-up process at near and sub-barrier energies is responsible for the vanishing of the usual threshold anomaly of the optical potential and give rise to a new type of anomaly.Comment: 24 pages, 10 figure