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If for some year starts only after Carnival, for many began only in March. Brazilian culture is a difficult change. Actually we are starting the year in earnest this week. Hopefully everyone is with the batteries recharged, with a lot of energy to make this one of the best years of their lives.

But for us to start the year well, patients are the most important to place implants or make your dentures. If for general practice the situation is difficult for implants (if writing in the plural), is harder still (that singular). And something needs to be done to change and not wait for better days, not arriving.

If patients do not come by spontaneous generation, the old theory of Charles Darwin, we need to generate them by artificial insemination, or how stem cells are more fashionable, using concepts of marketing Philip Kotler.

For they do not perceive a need, we have to be subtle. And modern. To much is given an information system implantológicas associated with your database. Fast and cheap, almost free of charge. See how easy it is.

Alcoholism is the leading risk factor for the health of Brazilians

Alcoholism is the leading risk factor for health in Brazil. The information is from the Global Burden of Disease 2010, document organized by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington and partnership with dozens of universities around the world. The result of the overall effort, which will be published today in The Lancet, lists 67 issues that most affect people around the world. On the planet, the greatest evil is high blood pressure, which in 2010, the survey reference, killed 9 million people and affects 173 million individuals.
Each region, however, has a particular list. Brazil was placed in an area called "Latin America Tropical," which also includes Paraguay. The estimate of the study is that alcoholism affects about 5.64 million people in these countries. In 2010, there were approximately 151 000 deaths for the problem. The second risk factor is high blood pressure, responsible for more deaths (about 274 thousand), but that affects around 5.3 million people. Thirdly, obesity, with four million patients and 141,000 deaths this year.
Points in the study, decreased importance of risks related to malnutrition. Infant mortality fell by 60% problem between 1970 and 2010. Increased from 16.4 million to 6.8 million per year.
- For 20 years, people did not have enough to eat. Today, there are lots of food and unhealthy food, even in developing countries - says Majid Ezzati, an author of the study from the School of Public Health at Imperial College London, England.
To the psychiatrist Nelson Caldas, Division of Psychiatry and Medical Psychology, University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), the study shows that there was a concern regarding the increase in life expectancy, but not with awareness of healthy habits.
- Alcoholism can lead to many problems like, including obesity and high blood pressure who are at the top of the list - the psychiatrist says Nelson Caldas, Division of Psychiatry and Medical Psychology, University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ). - It's a case of thinking up campaigns warning about the problem have been really effective.

Acute Pancreatitis, terrible consequence

Acute Pancreatitis, terrible consequence ...
Acute pancreatitis is a condition resulting from acute inflammation of the pancreas. The main function of the pancreas is to produce digestive enzymes, insulin and glucagon to regulate blood sugar levels.

In pancreatitis, pancreatic enzymes that are normally released in the small intestine to aid in digestion are activated inside the pancreas and start to damage it. If the crisis is severe or prolonged, or if outbreaks of acute pancreatitis occur repeatedly, permanent damage to the pancreas may occur and lead to a condition called chronic pancreatitis.

The two most common causes of pancreatitis are gallstones and bile alcoholism (alcohol abuse). Since the pancreatic duct, which carries digestive enzymes from the pancreas into the small intestine is common to the bile duct, which has gallbladder and liver, gall stones which prevents clogging the canal pancreatic enzymes from reaching the intestine, being accumulated within liver and since being activated, eroding the body inside. Although most people who drink alcohol do not develop pancreatitis, drinking large amounts of alcohol can turn pancreatitis.

Other factors that can sometimes cause pancreatitis include:

Abdominal trauma (traumatic pancreatitis)
Abdominal surgery, drugs, including certain antibiotics (metronidazole, tetracycline and sulfa), thiazide diuretics and estrogen, calcium or High levels of triglycerides in the blood, Some infections, such as mumps or viral hepatitis,
Endoscopic procedures involving pancreatic and bile duct,
Idiopathic (no cause is found).

Symptoms

Symptoms of acute pancreatitis includes:

a Upper abdominal pain which may be tolerable to the piercing in range at the time of the stomach, both right and left;

Projection of the pain to the back, chest, flank or down

Worsening of the pain with food, especially fatty

the nausea and vomiting,

o Loss of appetite

the Abdominal distention (swelling),

The Fever,

o Lack of air

Fatigue,

the hypotension and shock (very low pressure disabling the functioning of organs).


Diagnosis

The patient's medical history will reveal the abuse of alcohol which, when absent, especially in women, is strongly suggestive of gallbladder calculi, confirmed by ultrasound examination.

Blood tests reveal elevated levels of pancreatic enzymes, amylase and lipase confirming the diagnosis of pancreatitis. The decrease in blood calcium signal is worsened, as well as the increase of leukocytes, glucose, urea and creatinine.

In some cases of pancreatitis the blood amylase may be normal as it rises rapidly at first and then decreases, signifying no improvement.

In some cases, a CT scan of abdomen when there is suspicion of swelling of the pancreas and the presence of fluid in the abdomen. A CT scan can also reveal pancreatic pseudocysts that are cavities containing pancreatic enzymes that develop in some cases of severe pancreatitis in chronic pancreatitis. Serious complications can occur when the cysts burst and the enzymes come in contact with the surface of the abdomen (peritonitis).

Prevention

Avoid the abuse of alcohol if the person never had pancreatitis,

Never drink the most, if the person has had an episode of alcohol-induced pancreatitis,

it is believed to maintain a normal body weight and to prevent rapid weight loss may prevent the development of gallstones,

Avoid the indiscriminate use of antibiotics and oral contraceptives-based estrogen.



Treatment


· General Measures:



Rest in hospital

Fasting to "rest" the pancreas,

the replacement fluid intravenously

the passage of a catheter through the nose into the stomach to control the vomiting,

The parenteral nutrition (for a vein thick) may be required in more severe cases,



· Medications to protect stomach ulcers from stress. Includes H2 blockers (ranitidine hydrochloride) and proton pump inhibitors (omeprazole, pantoprazole, esomeprazole, etc.)



· Antibiotics are indicated only in severe cases and when the cause is gallstones by the frequent presence of infection of the gallbladder - cholecystitis.



· Surgery is indicated in the following situations:



the definitive treatment of gallstones (cholecystectomy)

Infection with the documented pancreatic abscess (collection of pus)

The Necrosis (deterioration) wide pancreas,

The major bleeding,

Shock that does not improve

the failure of multiple organs.

Call your doctor?

The patient with severe abdominal pain that does not improve with home measures, or is accompanied by intense vomiting or nausea, you should look for a surgeon general or be treated at an emergency room.

Prognosis.

Pancreatitis often mild improvement in the first week without complications and without any additional problems, but severe cases can last several weeks. Chronic pancreatitis may develop if there is a significant lesion of the pancreas or if the patient had several attacks over time.

Nearly 10 percent of patients develop complications such as abscesses and necrosis of the pancreas that may require surgical treatment.

The pancreatitis caused by alcohol in crises occur from time to time, if the patient insists on drinking. Approximately 10 percent of patients with acute pancreatitis develop alcohol-related chronic pancreatitis.

OPERATE OR NOT OPERATE the GALLBLADDER? The EIS ISSUE

OPERATE OR NOT OPERATE the GALLBLADDER? The EIS ISSUE


When working and silent, the bleb is where is stored bile, a greenish liquid, bitter and slimy, secreted by the liver and which, through its own system of channels, led to the duodenum, participating so important digestion. But, sometimes, one dysfunction, a change occurs in the production of bile, the formation of precipitate crystals, which, little by little increasing in size and will give rise to so-called gallstones. Most people who have no symptoms calculations. Although laparoscopic surgery is widespread, it is only indicated in certain cases. What is the evolution of asymptomatic gallstones? The frequency of symptoms and complications of gallstones discovered by chance is relatively small. In general, those with gallstones never present symptoms or complications from calculations asymptomatic gallstones. Still, many researchers have been trying to establish which patients could present problems bile throughout his life. To our knowledge, there seems no relationship between symptoms and age, sex and number of calculations. So far, there is consensus that the evolution of the calculations that have no symptoms is benign and requires no intervention. What is the evolution of symptomatic gallstones? Moreover, since the calculations cause typical symptoms of biliary disease, risk of persistence of the problems is relatively high. Moreover, most of the complications of biliary calculus disease is preceded by an attack of biliary colic. Therefore, since the patient had biliary colic, the trend is that these episodes recur to culminate in some complication, if nothing is done. As the biliary colic manifests? The main complaint of patients with symptoms is biliary colic. Most clinicians agree that biliary colic - the most characteristic symptom of calculating gallbladder - is not an appropriate name because the pain is not the cramping. Rather, it is a very intense and continuous pain in the upper abdomen, and during which alternate periods of worsening and improvement. This pain lasts from 15 minutes to hours and is commonly accompanied by nausea and vomiting. Frequently evolves without precipitating factors. The interval between episodes can vary from days to months or even years, and rarely, daily symptoms can be attributed to gallstones. The biliary colic should be distinguished from nonspecific symptoms that characterize functional dyspepsia. Gas, heartburn, abdominal discomfort, intolerance to fatty foods are frequent complaints in clinics. However, both occurring in patients with stones as in patients without gallstones. This differentiation is critical to successful treatment, since this is only indicated for biliary colic. In the episode of biliary colic without complications are not detected changes in laboratory tests. The main test to confirm the diagnosis of gall calculation is the abdominal ultrasound. What are the main complications of gallstones? When the framework persists for more than six hours, the suspicion of acute cholecystitis should be rejected. Most patients with acute cholecystitis have previous episodes of biliary colic. The pain of acute cholecystitis is more prolonged, can be located more precisely on the right side of the upper abdomen and is associated with fever. In the presence of acute cholecystitis, a gallbladder wall is thickened on ultrasound examination. Once the vesicle becomes inflamed, signs of infection and elevated liver enzymes appear in blood tests. In some patients, the calculations can escape from the vesicle. If they are small, they can pass through the bile ducts to the gut, leaving faeces. If they are slightly larger, can become lodged in the bile ducts, causing complications such as jaundice, cholangitis or pancreatitis. The obstruction of the passage of bile results in jaundice (yellowing of skin and whites of the eyes) and itching. Calculations in the main bile duct are frequently associated with infection, resulting in the serious situation of acute cholangitis, which is characterized by biliary colic, jaundice, fever and chills, requiring urgent treatment. Acute pancreatitis (inflammation of the pancreas) can also be caused by passing through the channel biliary calculi. Some experts recommend the removal of the gallbladder with calcified walls (also called vesicle porcelain) the risk of developing bladder cancer. Although calculations (larger than 3 cm) may be associated with bladder cancer, withdrawal prophylaxis is still controversial. What is the best treatment option? There is consensus that the calculations should not be treated asymptomatic. Only calculations with symptomatic or calcified gallbladder complications and should be treated. Options include surgery (cholecystectomy), dissolution or fragmentation of the calculations. Surgery is the only definitive treatment. It is a simple and safe surgery, and indicated for most patients with stones. Currently, laparoscopic cholecystectomy facilitated the procedure with a shorter hospital stay, fewer complications and quicker return the patient to their routine. It is for this reason that cholecystectomy has become choice for most patients with gall stones. However, in about 5% of cases and the presence of complications, the conventional cholecystectomy may be a better option. The non-surgical treatment is reserved for patients who do not want to undergo surgery or have a very high surgical risk. Importantly, both the dissolution as the fragmentation of the calculations are not definitive procedures. As the bladder is not removed, the calculations can, over time reappear. The calculations present in the bile ducts can be removed through an endoscopic examination, called endoscopic retrograde cholangiopancreatography (ERCP). This test may be performed before, during or after cholecystectomy. Symptoms may persist after cholecystectomy? The persistence of symptoms after cholecystectomy should be observed and discussed with patients before subjecting them to surgery. Many physicians tend to indicate the occurrence of cholecystectomy versus nonspecific symptoms such as intolerance to fatty foods, gas, belching, heartburn, nausea. Although some patients may improve such symptoms after surgery, several studies have shown that these may be present in the presence or absence of gallstones, and therefore are not disease specific bile. Perform a cholecystectomy just to see if these symptoms improve is not recommended. Furthermore, the cholecystectomy procedure is not innocuous and may cause other symptoms such as diarrhea post-cholecystectomy. For the broad spectrum of clinical presentations, the possibility of improvement in some patients and ease offered by laparoscopic cholecystectomy, surgery may even occasionally be required in patients with such symptoms, provided they are intolerable have negative investigation for other causes, or the subject has been previously discussed with the patient and the same has accepted the possibility that the symptoms are not relieved by surgery.