The usefulness of the timeliness of endoscopic sphincterotomy in severe acute pancreatitis of biliary origin

There are evidence indicating that endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP+S) reduces the rate of complications in patients with severe acute biliary pancreatitis (ABP). The aim of this study was to analyze our experience in the treatment of severe ABP with ERCP+S and compare the evolution of the patients treated early (3 days or less following admission) with those treated late (after the 3rd day). A retrospective review of the clinical histories of the 16 patients with severe ABP treated with ERCP+S over the last two years is presented, analyzing their clinical features on admission and evolution. Biliary stones or biliary sludge was observed in 11 cases (69%). Nine patients had undergone early, and 7 late, ERCP+S. The patients of the latter group presented a greater number of complications during evolution than the former group (43% vs 0%; p = 0.025). The mortality of the patients of the late ERCP+S was also greater although without statistical significance (28.6% vs 0%; p = 0.15). No complication secondary to ERCP+S was detected. These findings confirm the fact that ERCP+S performed early in severe ABP significantly reduces the number of complications and is associated with a lower mortality.     

Prevalence of hepatitis A antibodies in southeastern Spain: a population-based study

OBJECTIVES: To identify variables, other than legal definitions, that may have influenced North Cheshire's Coroner in returning a verdict of 'suicide' or an 'open verdict' on unexpected deaths of the elderly. DESIGN: Retrospective review of all coroner's verdicts in North Cheshire during a 5-year period 1989-1993. MATERIAL: Forty-seven 'suicide' and 'open verdict' deaths in North Cheshire between 1989 and 1993 as defined in ICD classification 'E' codes E950-E959 and E980-E989, respectively, that were returned on the deceased aged 65 and above who died within North Cheshire. FINDINGS: Logistic regression analysis suggests that the Coroner's decision may be influenced by: intimation of intent, psychiatric history and method of death. Sex of the deceased, history of attempted suicide, social setting and history of alcohol problems did not appear significantly associated with coroner's verdict.     

Effect of tiger nut fibre on quality characteristics of pork burger

Horchata is a refreshing beverage obtained from tiger nut tubers that yields high amount of by-products. These by-products have a high content of fibre that allows its application in the development of dietary fibre rich foods. The utilization of increasing levels (0%-control, 5%, 10% and 15%) of tiger nut fibre (TNF), in the formulation of pork burgers was evaluated. This evaluation was based on: chemical composition, physicochemical, cooking characteristics and sensory properties of burgers. Pork burgers elaborated with TNF had higher nutritional value (higher fibre content) and better cooking characteristics (higher cooking yield, fat retention and moisture retention) than control burgers. Some of the negative changes in colour (a* decrease and b* increase) and texture (chewiness and springiness increase) parameters due to TNF addition observed in raw burgers were masked by the stronger modifications due to the cooking process. Burgers with TNF were perceived as less greasy, less juicy, more grainy and with less meaty flavour than controls; although this perception did not reduce the overall acceptability of burgers. Overall acceptability scores were slightly lower in burgers with 15% TNF, although no significant differences were detected with the scores of control, 5% and 10% TNF burgers. TNF addition to burgers is a promising and convenient application as dietary fibre of burgers was significantly increased without changes in sensory acceptance.     

Effect of processing temperature on the bitumen/MDI-PEG reactivity

Reactive polymers are lately gaining acceptance to give added value to a residue of the crude oil refining process such as bitumen. The resulting material should display enhanced mechanical properties to be considered for advanced applications in construction. In the present paper, we report the effect of processing temperature on the reaction between bitumen compounds and an isocyanate-based reactive polymer, synthesized by reaction of polymeric MDI (4,4′-diphenylmethane diisocyanate) with a low molecular weight polyethylene-glycol (PEG). Rheokinetics experiments, viscosity measurements at 60 °C, atomic force microscopy (AFM) characterization, thin layer chromatography (TLC-FID) analysis and thermogravimetric studies (TGA) were performed on the reactive polymer and on samples of MDI-PEG modified bitumen containing 2 wt.% of the polymer. Results showed the existence of an optimum processing temperature arisen as a consequence of opposite effects: microstructural availability for the formation of a polymer–bitumen network, reaction ability and polymer thermal degradation. Consequently, this study aims to serve as a guideline for the refining and asphalt industries facing the stage of selecting the optimum processing parameters.     

Nucleation in Dilute 3He-4He Liquid Mixtures at Low Temperatures

We present a study of phase separation from supersaturated ³ He- ⁴ He liquid mixtures at low temperatures addressing both the degree of critical supersaturation x_cr and the thermal-to-quantum crossover temperature T* for the nucleation process. Two different nucleation seeds are investigated, namely ³ He droplets and ⁴ He vortex lines with cores filled with ³ He. We have found that the experimental T* is reproduced when we consider that nucleation proceeds from ³ He droplets, whereas x_cr is reproduced when we consider ⁴ He vortex lines filled with ³ He. However, neither nucleation configuration is able to simultaneously reproduce the current experimental information on x_cr and T*.     

Von Willebrand disease: characteristics and response to desmopressin. Study of 103 cases

BACKGROUND: To describe the main characteristics and response to desmopressin infusion in 103 patients suffering from von Willebrand disease (vWD). PATIENTS AND METHODS: The criteria for diagnosis were (except for type 2N) the coexistence of von Willebrand factor ristocetin cofactor (vWF:RCo) activity < 50 U/dl with bleeding disease or one of the following data: von Willebrand factor antigen (vWF:Ag) activity < 50 U/dl, factor VIII (FVIII) activity < 50 U/dl or the existence of a increased bleeding time (BT). Multimeric studies of vWF were performed in 51 cases and ristocetin induced platelet aggregation (RIPA) was also performed. RESULTS: Spontaneous bleeding was found in 36 patients, while in 18 cases the diagnosis was done after surgical bleeding. Thirteen patients (6 presenting with mild bleeding) were studied for abnormalities in the routine preanestesic tests. Other 22 patients were diagnosed with vWD by familial studies. There were 3 patients with type 2B, 1 case with type 2N and other patient with type 3. BT was found increased in 26 out of 58 patients. The activities of vWF:CoR and vWF:Ag were 38.4 (9.4) U/dl and 45.8 (23.2) U/dl, respectively, while the activity of FVIII was 49.9 (20.8) U/dl. Prophylactic DDAVP (desmopressin) was infused in 32 patients. After 1 h, basal activities of vWF:CoR and vWF:Ag were increased by 3.1 (3.2) and 3.4 (3.1) times, respectively, and maintained for 3 h. FVIII activity increased 3.6 (2.3) times the basal levels decreasing after 3 h (2.9 [2.1]; p < 0.01). The BT was corrected in 8 out of ten patients. CONCLUSIONS: vWD is a major cause of surgical bleeding. Preanestesic anamnesis and coagulation tests can be useful to identify vWD. Many patients with vWD have normal BT. A failure in the response to desmopressin infusion is unusual.     

Postoperative outcome of Crohn's disease in 30 children

BACKGROUND: Thirty children operated on for Crohn's disease (CD) were reviewed (1975-1994). The aim of the study was to assess their postoperative outcome. PATIENTS: 19 boys and 11 girls, aged 15.3 (2) years (range 11.3-20) at surgery were studied. RESULTS: Surgical indications were acute complications of CD and chronic intestinal illness. Six months after surgery, 11 of 12 patients had been weaned off steroids, and 22 of 23 patients were weaned off nutritional support; 17 patients without recurrence had a mean (SD) weight gain of 2.1 (8) kg and a height gain of 3.36 (3) cm. During 3.1 (2.7) years follow up, 12 patients (40%) had a recurrence of the disease after 19.4 (14) months (means (SD)): supra-anastomotic recurrence (six), severe perianal disease (two), and chronic illness (four). Six of 14 patients who were treated with mesalazine (13) or azathioprine (one) had recurrences. The postoperative recurrence rate was 50% at two years. CONCLUSION: Surgical treatment modifies the immediate outcome of severe or complicated CD, but does not prevent recurrence, despite localised resection or prophylactic postoperative treatment. Extension of the disease before surgery seems to be a major risk factor for postoperative recurrence in children.     

Rectal hemorrhage as a first sign of renal cell adenocarcinoma

We present a 3-year-old patient with stenotic kinking of the left internal carotid artery (ICA) who developed an ischaemic infarction of the left brain hemisphere followed by severe neurological sequelae after a prolonged generalized seizure. At time of the seizure the boy was in biological remission of a nephrotic syndrome and received prednisolone and cyclosporin A (CsA) treatment. The haemodynamic consequences of inborn kinking of the ICA is discussed controversely in the literature. The presented case shows that stenotic kinking of the ICA may significantly impair the blood flow towards the homolateral hemisphere and therefore may result in an ischaemic infarction. The influence of CsA on seizure activity is discussed. CONCLUSION: This case provides clinical and radiological evidence supporting an association between stenotic kinking of the carotid artery and homolateral hemispheric brain infarction.