Antonio José Torres García

Induction of bistability in low-magnetostriction amorphous ribbons

Abstract Bistability phenomena recently observed in amorphous wires can be explained by magnetoelastic coupling between two zones with different anisotropy. In this work we show the induction of bistability in amorphous ribbons with low magnetostriction (Metglas 2705M) using the exchange coupling in zones with a continuous varying anisotropy direction.

Right-Angled Stapled Latero-lateral Duodenojejunal Anastomosis in the Duodenal Switch

A simplified technique to perform the duodeno-enteral anastomosis in the duodenal switch is presented. A linear stapled duodeno-jejunal side-to-side anastomosis is performed. The technique is easy and rapid to perform, avoids passing an anvil through the mouth of the patient and is safe for the patient, with satisfactory short-term results.

¿Es rentable operar a los obesos mórbidos en tiempos de crisis? Análisis coste-beneficio de la cirugía bariátrica

Morbid obesity is a serious health problem whose prevalence is increasing. Expensive co-morbidities are associated to these patients, as well as a reduction in the survival. Bariatric surgery resolves the co-morbidities (type 2 diabetes mellitus, 86.6%; cardiovascular risk, 79.0%; obstructive sleep apnea syndrome, 83.6%; hypertension, 61.7%), reduces the mortality rate (among 31-40%), and increases the morbid obese patients survival over a 10-years period. It provides significant savings for the National Health System. The obese patients consume a 20% plus of health resources and 68% plus of drugs than general population. Bariatric surgery requires an initial investment (diagnosis-related group cost: 7,468 €), but it is recovered in a cost-effectiveness ratio of 2.5 years. Significant savings are obtained from the third year. To the direct economic benefits associated with reduced health expenditures it should be added an increase in tax collection (sick leave and unemployment reduction is estimated in 18%, with a productivity increase of 57% for self-employed people). Bariatric surgery is one of the most cost-effective procedures in the healthcare system.

First case with antithrombin deficiency, mesenteric vein thrombosis and pregnancy: Multidisciplinary diagnosis and successful management

Mesenteric venous thrombosis (MVT) is a rare localization of thrombosis that is difficult to diagnose due to its non-specific clinical manifestations [1]. The main deleterious consequence of MVT is intestinal ischemia, which has a mortality of 20–50% [1]. Different prothrombotic states caused by heritable or acquired factors associated with MVT [1]. Antithrombin deficiency is the congenital risk factormost frequently associated with MVT [2]. However, as the levels of this key endogenous anticoagulant may be low in patients with acute thrombosis due to its fast consumption, deficiency of antithrombin in MVT may be difficult to be diagnosed by using functional methods. Accordingly, a correct identification of antithrombin deficiency in MVT should be performed by careful follow-up studies with serial antithrombin estimation, familial studies, or genetic tests. Pregnancy is an acquired hypercoagulable state that is worsened with underlying thrombophilia [3]. Thrombosis during pregnancy mainly locates at lower limbs, and only 12 cases with MVT have been described in pregnant women. We here present an exceptional case of a 7 week pregnant woman, with MVT and a new mutation in SERPINC1 responsible for a type I antithrombin deficiency.

Utilización de adhesivos biológicos a base de fibrina en la prevención de fugas anastomóticas en anastomosis del tubo digestivo de alto riesgo:: resultados preliminares del ensayo clínico fase iv multicéntrico, prospectivo, aleatorizado y controlado simple ciego: Protissucol001

INTRODUCTION A multicentre, prospective, randomised, controlled, and simple blind clinical trial was started in January 2007, with the aim of demonstrating the efficacy of fibrin-based biological adhesives in the prevention of anastomotic leaks in the high risk digestive tract. MATERIAL AND METHODS A study on the prevention of anastomotic healing defects by applying biological adhesives along the suture line began in January 2007, and included the hospitals, Gregorio Marañón, Universitario de San Carlos, and Hospital del Sureste, in Madrid. The enrolled patients were randomised to one of 2 groups: the study group in which the adhesive was applied to the suture line, and a control group in which it was not applied. The primary outcome of the study was the presence or absence of leaks. The trial was approved by the corresponding Clinical Research Ethics Committees and the Spanish Medicines Agency (AEMPS) and registered www.clinicaltrials.gov (NCT01306851). The authors declared not to have any conflict of interests with the company, Baxter, which markets the product in Spain. RESULTS A total of 104 patients were recruited between January 2007 and November 2010, of whom 52 were randomised to the study group, and 52 to the control group. A total of 22 anastomotic leaks were recorded, of which 7 (13.4%) were in the study group, and 15 (28.8%) in the control group (P=.046). The leak risk index was 0.384, which means that there was a 61% reduction in leaks in the patients who had the fibrin-based biological adhesive applied. There were 3 (5.7%) further surgeries in the study group, compared to 12 (23%) in the control group (P=.12). On analysing the mortality, it was observed that 3 patients in the study group and 4 patients in the control group died (5.7% vs. 7.7%, P=.5). No other significant differences were found as regards the type of suture, surgical time, or pre-surgical history, except that the use of drainages appeared to be a protective factor of anastomotic leak (P=.041), although the use or not of a drainage was not a controlled factor, but at the discretion of each surgeon. CONCLUSIONS Our study demonstrates, significantly, that in the 104 patients in the study that fibrin based biological adhesives are capable of preventing anastomotic leaks in the high risk digestive tract, reducing the risk of leaks by 61% and a further surgeries. This is the first clinical trial that shows these significant results. If our results are maintained at the end of the study, it will show that anastomotic leaks can be prevented with the application of these adhesives, thus their application may be recommended in all the anastomosis of the high risk digestive tract.

Magnetic behavior of amorphous ribbons with induced helical anisotropy

Abstract Amorphous samples with helical induced anisotropy show magnetization processes that can be controlled by applying a longitudinal magnetic field simultaneously with an alternating current flowing through the sample. By varying the current amplitude and the phase difference between the current and the applied field, a wide range of coercivity and susceptibility values can be achieved.

Initial Approach to Childhood Obesity in Spain. A Multisociety Expert Panel Assessment

PurposeIn recent years, the incidence of childhood obesity in Europe, and Spain in particular, has increased dramatically. Bariatric surgery could play a major role in treating of adolescents with severe obesity. However, no specific guidelines for bariatric surgery currently exist in Spain.MethodsThe Board of the Spanish Society for Obesity Surgery and Metabolic Diseases (SECO) proposed a study of childhood obesity by using the Delphi method. This prospective study involved 60 experts from nine national societies. Each society leader recruited experts from their society in obesity-related fields. Two online questionnaires were taken, and consensus on guidelines for various obesity treatments was reached according to the percentage of answers in favor or against inclusion of a given guideline. Based on these results, preoperative, surgical management and follow-up of childhood obesity management among others were analyzed.ResultsThe survey results indicated significant concern among all societies regarding obesity. There was strong consensus with regard to adolescents and obesity, medical treatment, dietary recommendations, environmental and social factors, and goals for adolescents with obesity. Consensus on the use of intragastric balloons and other techniques was not reached. However, biliopancreatic diversion was rejected as a primary treatment, and mandatory psychological/psychiatric assessment was agreed upon. Inclusion criteria accepted were similar to those for adults with the exception of surgery in those with a body mass index <40.ConclusionsSpanish obesity-related societies are aware of the societal problem of childhood obesity. Multisociety development of national approaches may arise from consensus-building studies among specialists.

A new method to quantify β-antithrombin glycoform in plasma reveals increased levels during the acute stroke event.

INTRODUCTION β-antithrombin, the minor antithrombin glycoform in plasma, is probably the major thrombin inhibitor in vivo because of its high heparin affinity. The levels and variability of this glycoform in general population and its relevance in thromboembolic diseases is unknown since there is no specific method to measure this glycoform in clinical samples. METHODS Plasma and recombinant α- and β-antithrombins were purified by heparin affinity chromatography. An anti-FXa chromogenic method in presence of pentassacharide was used with two NaCl concentrations (15mM and 1.1M). This method was applied to plasma samples from 97 healthy subjects and 117 consecutive patients with ischemic cerebrovascular disease during the acute event and one year later. SERPINC1 sequencing was done in cases with antithrombin deficiency. RESULTS High salt concentrations specifically restricted the pentassacharide-induced activation of antithrombin to the β glycoform. β-antithrombin displayed a normal distribution in the general population (89.5%-103.5%), with no significant variations according to age or sex. In patients, whole antithrombin values remained within the normal range. Only five cases had antithrombin deficiency during the thrombotic event, one carrying the L99F mutation in SERPINC1. Interestingly, both β-antithrombin and the β/whole antithrombin ratio were significantly higher in patients during the acute event but normalized after one year. CONCLUSIONS We have developed a rapid, simple, sensitive and specific method to quantify β-antithrombin activity using 1μL of plasma. β-antithrombin significantly increases in patients with ischemic cerebrovascular disease during the acute event, probably by its release from the vasculature.

Magnetization processes in samples with modulated anisotropy under the action of nonuniform magnetic fields

In this paper we study the magnetic behavior of amorphous ferromagnetic ribbons having helical anisotropy with the helix axis perpendicular to the sample surface. It is shown that the magnetization processes under the action of a longitudinal magnetic field can be controlled by the nonuniform field produced by an alternating current, of the same frequency than the exciting field, flowing through the sample. Hysteresis loops with very different susceptibilities and coercive fields have been obtained by varying the amplitude of the current intensity and the phase differences between the exciting magnetic field and the current through the sample.

Squamous Cell Carcinoma of the Peristomal Skin of a Gastrostomy: Case Study

BACKGROUND: Primary skin tumors that develop at enteral feeding stomas are extremely rare. Ongoing surveillance of these stomas, including the peristomal skin, is essential to early diagnosis and treatment of these tumors. CASE: A 73-year-old man with an esophageal chemical burn caused by swallowing sodium hypochlorite (bleach) approximately 50 years earlier that was initially managed with esophageal exclusion and placement of a gastrostomy device for enteral feeding presented with an exophytic and painful mass of the skin adjacent to his gastrostomy site. The pathologic report confirmed differentiated squamous cell skin carcinoma. CONCLUSION: Skin tumors arising from chronic wounds or ulcers of the skin surrounding a gastrostomy device are rare but should be considered if hypergranulation tissue or a peristomal lesion appears to be nonhealing. WOC nurses are frequently consulted for care of granulomas, and close monitoring is essential for avoiding this potentially fatal complication.