RESUMEN
BACKGROUND: The management of intestinal failure has evolved dramatically over the last 2 decades. In addition, improved management of patients requiring parenteral nutrition-associated liver disease is creating a paradigm shift in both intestinal failure management and in the evolving indications for intestinal transplantation. OBJECTIVES: We conducted an evaluation measuring current awareness among house officers (HO) regarding nutritional and transplant principles in the management of intestinal disease. Our goal was to use board-style questions with a single correct response to measure current knowledge level between HO. METHODS: A survey was distributed to HO via email to measure knowledge regarding 3 areas: principles of intestinal failure (PI), medical management of intestinal disease (MI), and transplantation for intestinal disease (TI). This was evaluated at 3 busy nontransplant centers (NTC) and a tertiary care intestine transplant center (TC). Statistical analysis was conducted using the independent samples t test and multiple linear regression analysis. RESULTS: Surveys were distributed to a total of 1068 HO; 208 (19.47%) responded. We received 139 responses (67%) from NTC and 69 (33%) from TC. 82% were postgraduate year (PGY) 1-3 and 18% were PGY 4-7. Of the respondents, 27% correctly answered questions regarding PI, 40% about MI, and 21% on TI. HO in NTC demonstrated more knowledge regarding PI than those in TC (P = .000). There was, otherwise, no difference between PGY 1-3 and PGY 4-7 (P > .05). CONCLUSIONS: This evaluation demonstrates potential deficiencies in the basic understanding of issues surrounding intestinal disease that can be used for implementation of an educational program regarding intestinal disease and transplantation.
Asunto(s)
Educación Médica Continua , Conocimientos, Actitudes y Práctica en Salud , Enfermedades Intestinales/cirugía , Intestinos/trasplante , Trasplante de Órganos/educación , Nutrición Parenteral Total/métodos , Médicos/normas , Femenino , Humanos , Enfermedades Intestinales/rehabilitación , MasculinoRESUMEN
Abdominal actinomycosis is a disease that is difficult to diagnose nonoperatively. Usual manifestations are abscesses and draining sinus tracts. Treatment is typically surgical and requires prolonged intravenous antibiotics. Presented is a patient who underwent surveillance colonoscopy after resection for colon carcinoma. Diagnosis of colonic actinomycosis and subsequent resolution was demonstrated endoscopically after lengthy oral penicillin therapy (2 g/day for 1 yr). This case documents that resection may not be necessary to effect cure of abdominal actinomycosis.
Asunto(s)
Actinomicosis/diagnóstico , Actinomicosis/tratamiento farmacológico , Colitis/diagnóstico , Colitis/tratamiento farmacológico , Anciano , Enfermedad Crónica , Colonoscopía , Femenino , Humanos , Penicilinas/uso terapéuticoRESUMEN
A 77-yr-old male developed primary gastric squamous cell carcinoma 33 yr after gastric resection for peptic ulcer disease. At the time of diagnosis, he was being endoscopically followed for large irregular stomal polyps. Infiltrating squamous cell carcinoma with focal keratinization and stomal polypoid hypertrophic gastritis was found. Previous reports describe adenocarcinoma and adenosquamous carcinoma in gastric remnants. There are various theories as to how such a tumor may arise in this setting.
Asunto(s)
Carcinoma de Células Escamosas , Gastrectomía , Neoplasias Gástricas , Anciano , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/patología , Humanos , Masculino , Úlcera Péptica/cirugía , Neoplasias Gástricas/etiología , Neoplasias Gástricas/patologíaRESUMEN
The effects of various long-chain acyl-carnitines (AC) on mitochondrial functions and red cell membrane stability were studied. Lower concentrations slightly stimulate respiration-dependent functions such as phosphorylation rate and Ca++ uptake velocity, whereas higher concentrations inhibit these functions with concomitant depression of the ATP/O ratio. The order of effectiveness among the AC is very similar for different mitochondrial functions. The differences among AC in their actions on red cell stability in hypotonic media and their differences in influence on mitochondrial functions exhibit less resemblance. The relative order of erythrolytic concentrations of AC follows the order of their critical micellar concentrations. Model calculations indicate that the concentrations of AC found in ischemic hearts are below those which exhibit inhibitory effects in vitro. Ultrastructural changes in mitochondria incubated with AC are different from those found in ischemic tissue. From this, it seems questionable whether the elevated AC levels in ischemic hearts are indeed as important for the development of membrane damage as is often supposed.