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

Rosiglitazone as an option for patients with acromegaly: a case series

<p>Abstract</p> <p>Introduction</p> <p>In the patient with acromegaly, pituitary surgery is the therapeutic standard. Despite undergoing surgery, a significant number of patients with acromegaly continue to have uncontrolled growth hormone secretion. These patients require other treatments such as external irradiation and/or drug therapy.</p> <p>Case presentation</p> <p>We present the clinical and laboratory responses to six months of treatment with rosiglitazone in four cases. In all four cases, the patients had persistent growth hormone overproduction despite previous surgical treatment and other conventional therapy. Case 1 is a 57-year-old Caucasian woman, case 2 is a 51-year-old Hispanic man, case 3 is a 32-year-old Hispanic woman, and case 4 is a 36-year-old Hispanic man. In three of these patients, basal and nadir growth hormone and insulin-like growth factor 1 levels were significantly decreased (<it>P </it>< 0.05 and <it>P </it>< 0.01, respectively).</p> <p>Conclusion</p> <p>Rosiglitazone could be a treatment option in select patients with acromegaly.</p