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Abstract

Introduction:Obesity is reaching epidemic proportions in the United States, and as patients at the extremes of morbid obesity come under the care of surgeons, routine procedures may become increasingly complex in the face of greater body mass. We prospectively evaluated the success rate of percutaneous endoscopic gastrostomy (PEG) placement in a group of morbidly obese patients outside the current classification systems used to stratify obesity.Methods:Patients with a body mass index (BMI) greater than 60 kg/m2 who presented for PEG over a one year period were prospectively enrolled. Each patient underwent attempted PEG placement using the pull method by a single surgeon. Outcome variables included: successful PEG, wound infection, tube dislodgement, or bleeding.Results:Six patients with BMI > 60 kg/m2 presented for PEG. All patients were in a surgical critical care unit maintained on mechanical ventilation. All underwent successful PEG placement with standard techniques and sustained no post-procedural complications.Conclusion:In the hands of an experienced surgical endoscopist, percutaneous endoscopic gastrostomy can be safely performed in patients at the extremes of morbid obesity. Future studies are warranted to validate the results of our small series.

gDocs

SíNDROME DE CUSHING 

Se conoce con el nombre de síndrome de Cushing a la situación que se produce como consecuencia de una aumento mantenido de la producción del cortisol por las glándulas suprarrenales o por la toma excesiva de derivados de la cortisona, en cuyo caso recibe el nombre de síndrome de Cushing yatrogénico. El nombre de Cushing proviene del apellido del neurocirujano inglés (Harvey Cushing) que descubrió por primera vez este cuadro clínico.

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ADDISON’S DISEASE

Addison’s disease (also Addison disease, chronic adrenal insufficiency,  hypocortisolism, and hypoadrenalism) is a rare, chronic endocrinedisorder in which the adrenal glands do not produce sufficient steroid hormones (glucocorticoids and often mineralocorticoids). It is characterized by a number of relatively nonspecific symptoms, such as abdominal pain and weakness, but under certain circumstances, these may progress toAddisonian crisis, a severe illness which may include very low blood pressure and coma. The condition arises from problems with the adrenal gland, "primary adrenal insufficiency", and can be caused by damage by the body's own immune system, certain infections, or various rarer causes. Addison's disease is also known as chronic primary adrenocortical insufficiency, to distinguish it from acute primary adrenocortical insufficiency, most often caused by Waterhouse-Friderichsen syndrome. Addison's disease should also be distinguished from secondary and tertiary adrenal insufficiency, which are caused by deficiency of ACTH (produced by the pituitary gland) and CRH(produced by the hypothalamus), respectively. Despite this distinction, Addisonian crises can happen in all forms of adrenal insufficiency. Addison's disease and other forms of hypoadrenalism are generally diagnosed via blood tests and medical imaging Treatment involves replacing the absent hormones (oral hydrocortisone and fludrocortisone).Lifelong, continuous steroid replacement therapy is required, with regular follow-up treatment and monitoring for other health problems.Addison’s disease is named after Dr. Thomas Addison, the British physician who first described the condition in 1849. The adjective "Addisonian" is used to describe features of the condition, as well as patients suffering from Addison’s disease

Pubget

Effects of the tropical ginger compound,1'-acetoxychavicol acetate, against tumor promotion in K5.Stat3C transgenic mice.

The purpose of the current study was to determine whether a tropical ginger derived compound 1'-acetoxychavicol acetate (ACA), suppresses skin tumor promotion in K5.Stat3C mice. In a two-week study in which wild-type (WT) and K5.Stat3C mice were co-treated with either vehicle, ACA, galanga extract, or fluocinolone acetonide (FA) and tetradecanoyl phorbol acetate (TPA), only the galanga extract and FA suppressed TPA-induced skin hyperproliferation and wet weight. None of these agents were effective at suppressing p-Tyr705Stat3 expression. However, ACA and FA showed promising inhibitory effects against skin tumorigenesis in K5.Stat3C mice. ACA also suppressed phospho-p65 NF-κB activation, suggesting a potential mechanism for its action.

Pubgle

[Summary of the practice guideline 'Sore throat' (second revision) from the Dutch College of General Practitioners]. Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschap, Postbus 323I, 3502 GE Utrecht.  The second version of the practice guideline 'Sore throat' has been updated from the 1999 version. --Infections of the throat generally cure spontaneously within 7 days. In most cases the sore throat is caused by a virus. Group A beta-haemolytic streptococci (GABHS) are the most important bacterial cause ofa sore throat. --In diagnostics, the main focus is placed on evaluating how sick the patient is in general. --In adolescents who have had a sore throat for more than 7 days, the possibility of mononucleosis infectiosa should be borne in mind. This diagnosis can be verified by a test for IgM against Epstein-Barr-virus. --Additional investigations to detect GABHS are not recommended. --Prescribing antibiotics is only recommended for patients who have a severe throat infection or an increased risk of complications. Pheneticillin or phenoxymethylpenicillin remains first choice. --Referral for tonsillectomy should meet the following criteria: 5 or more episodes of sore throat per year or 3 or more episodes per year in the last 2 years.

Jurn

Púrpura trombocitopénica trombótica. Descripción del diagnóstico y manejo de una entidad poco frecuente y de alta mortalidad.

Presentamos dos casos con diagnóstico de púrpura trombocitopénica trombótica idiopática refractarios al tratamiento con recambio plasmático y en los cuales fue necesario emplear un tratamiento adicional. En uno de los casos hubo una adecuada respuesta con rituximab. También analizamos el papel de los niveles de ADAMTS 13 para el manejo y diagnóstico de esta enfermedad.

Jane

The temporomandibular joint in juvenile idiopathic arthritis: frequently used and frequently arthritic.
Abstract:
Recent recognition of the markedly high prevalence of temporomandibular joint (TMJ) arthritis in children with juvenile idiopathic arthritis (JIA) coupled with the significant morbidity associated with TMJ damage has prompted increased interest in both the clinical and pathological aspects of TMJ arthritis. This review focuses on the prevalence of TMJ arthritis in JIA, the imaging modalities used to detect TMJ arthritis, and the treatment of TMJ arthritis in children with JIA.