Partial agenesis of dorsal pancreas. Report of two cases

Introduction: Agenesis of the dorsal pancreas (ADP) is a rare congenital anomaly resulting in missing corpus and cauda of the pancreas. The possibility of finding this disorder is increasing with the use of advanced radiological techniques like CT scan or MRI. Presentation of case: We reported 2 cases of a partial ADP as radiological finding: the first one was a 79-year-old asymptomatic patient who presented to perform a CT staging scan for bladder tumor, while the second case was a 73-year-old patient with obstructive jaundice and with suspected common bile duct calculi. In the second patient US, CT scan and MRI were performed, and after that also an ERCP was scheduled. Discussion: The prevalence of agenesis of the dorsal pancreas is not exactly known; in the literature, only 50 cases have been reported. Its cause and pathogenesis are not fully understood. Some patients experience no symptoms, while others may develop hyperglycemia, diabetes mellitus, bile duct obstruction, abdominal pain, pancreatitis, or other conditions. Conclusion: Considering that dorsal agenesis is sporadically found, often do not have related symptoms and it does not require a specific treatment, whether further examinations are needed to determine the type of agenesis remains questioned

BIOLOGIC THERAPY IN PEDIATRIC RHEUMATOLOGY

The article presents data on unique worldwide experience of biologic agents use in pediatric rheumatology. 433 children with different types of juvenile arthritis (JA) were treated with biologic drugs in Rheumatological Department of Scientific Center of Children’s Health, Russian Academy of Medical Sciences from November 2002 to September 2010: 270 patients received infliximab, 74 — adalimumab, 55 — rituximab, 34 — tocilizumab. Results of a study showed that differentiated biological therapy unlike classic immunosuppressive agents (methotrexate, cyclosporine, leflunomide, etc.) results in clinical and laboratory remission in 70% patients with JA and decrease of disease’s activity in 20% of children in one year. Treatment with genetically engineered biologic drugs increase quality of life of children with JA and their families, provides normal growth and development of patients, and changes a prognosis of this previously incurable autoimmune disease

Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps’ vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Torsadogenic risk of antipsychotics : combining adverse event reports with drug utilization data across Europe

Antipsychotics (APs) have been associated with risk of torsade de Pointes (TdP). This has important public health implications. Therefore, (a) we exploited the public FDA Adverse Event Reporting System (FAERS) to characterize their torsadogenic profile; (b) we collected drug utilization data from 12 European Countries to assess the population exposure over the 2005-2010 period. FAERS data (2004-2010) were analyzed based on the following criteria: (1) ≥ 4 cases of TdP/QT abnormalities; (2) Significant Reporting Odds Ratio, ROR [Lower Limit of the 95% confidence interval>1], for TdP/QT abnormalities, adjusted and stratified (Arizona CERT drugs as effect modifiers); (3) ≥ 4 cases of ventricular arrhythmia/sudden cardiac death (VA/SCD); (4) Significant ROR for VA/SCD; (5) Significant ROR, combined by aggregating TdP/QT abnormalities with VA and SCD. Torsadogenic signals were characterized in terms of signal strength: from Group A (very strong torsadogenic signal: all criteria fulfilled) to group E (unclear/uncertain signal: only 2/5 criteria). Consumption data were retrieved from 12 European Countries and expressed as defined daily doses per 1,000 inhabitants per day (DID). Thirty-five antipsychotics met at least one criterium: 9 agents were classified in Group A (amisulpride, chlorpromazine, clozapine, cyamemazine, haloperidol, olanzapine, quetiapine, risperidone, ziprasidone). In 2010, the overall exposure to antipsychotics varied from 5.94 DID (Estonia) to 13.99 (France, 2009). Considerable increment of Group A agents was found in several Countries (+3.47 in France): the exposure to olanzapine increased across all Countries (+1.84 in France) and peaked 2.96 in Norway; cyamemazine was typically used only in France (2.81 in 2009). Among Group B drugs, levomepromazine peaked 3.78 (Serbia); fluphenazine 1.61 (Slovenia). This parallel approach through spontaneous reporting and drug utilization analyses highlighted drug- and Country-specific scenarios requiring potential regulatory consideration: levomepromazine (Serbia), fluphenazine (Slovenia), olanzapine (across Europe), cyamemazine (France). This synergy should be encouraged to support future pharmacovigilance activities

Məktəb psixoloqunun işində korrelyasiya analizinin tətbiq edilməsi

Təcrübələr psixologiyanı dəqiq elm hesab edir. Yalnız düzgün şəkildə aparılmış eksperiment nəzəri ehtimalları elmi nəticələrə çevirə, psixoloji və sosial fenomenlərin əsl obyektiv səbəblərini tapmağa kömək edə bilər. Eksperimentdə nəticələrin alınması üçün əsas və vacib olan verilənlərin statistik emalı metodudur.&#x0D; Bu metodlar mürəkkəbliuinə və tətbiq sahələrinə görə fərqlənirlər. Bunlara həm sadə orta riyazi, həm də faktorlu reqressiya analizinin hesablanması aiddir. Statistik metodların eksperimentdə tətbiqi nəticəsi isə seçmələrin elə bir nəticəsidir ki, onu məlum dərəcədə ehtimal payı ilə baş məcmuya yaymaq olar.&#x0D; Misal üçün belə bir fakt məlumdur ki, insan haqqında fikir yaratmaq üçün ilkin təəssüratlar daha mühüm hesab olunur və sonrakı təəssüratla müqayisədə daha çox rol oynayır.</jats:p

Etiology of Mental Retardness

The causes of mental retardation can be various: internal and external factors, hereditary disorders, infectious diseases during pregnancy, birth injuries, metabolic disorders, disorders of genetic metabolism in cells, injuries and others

EXPERIENCE OF TREATMENT WITH ABATACEPT IN PATIENTS WITH JUVENILE RHEUMATOID ARTHRITIS

The article presents a case report of a patient with juvenile rheumatoid arthritis refractory to the treatment with metothrexate. Combined therapy with metothrexate and leflunomide induced development of unfavorable effects resulted in cancellation of leflunomide. Successful administration of biological agent inhibitor of T-lymphocytes co-stimulation abatacept is described. Treatment with abatacept resulted in remission of a disease; it increased patient and her family’s quality of life