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En este artículo exploro la historia de la Soka Gakkai de Mérida, un nuevo movimiento religioso laico budista con sede en Japón. El objetivo principal es analizar el proceso de institucionalización para comprender su establecimiento en un contexto ajeno, reconociendo las fuerzas disruptivas que surgen como parte de la complejización organizacional. En primer lugar, presento una síntesis histórica de la Soka Gakkai y sus antecedentes religiosos, procedentes del budismo de Nichiren. Posteriormente divido en fases (organización incipiente, eficiencia y formalismo) el desarrollo de la agrupación para ubicar las coyunturas históricas que expliquen la condición actual de la Soka Gakkai en Mérida. Finalmente, expongo una visión en conjunto proveniente del análisis.

In a patient with a mid-common bile duct stone, the traction wires of a mechanical lithotriptor snapped, resulting in lithotriptor basket impaction. Simultaneous occurrence of these two potential complications of endoscopic stone extraction is very rarely reported. Extracorporeal shock wave lithotripsy failed to fragment the stone entrapped within the impacted basket. Endoscopic intracorporeal electrohydraulic shock wave lithotripsy successfully fragmented the stone under direct visualization through a cholangioscope. The entrapped stone within the basket could subsequently be pulled into the supra-ampullary bile duct for the final fragmentation with an extra-endoscopic mechanical lithotriptor cable. The present report is the first to describe a safe and effective use of endoscopic intracorporeal electrohydraulic shock wave lithotripsy followed by extra-endoscopic mechanical lithotripsy in the management of an impacted lithotriptor basket.

BACKGROUND: Data on current endoscopic retrograde cholangiopancreatography (ERCP) practice patterns drawn from large population-based samples are limited.METHODS: Patterns of ERCP use were determined using billing records for ERCP, sphincterotomy, stone extraction or stent placement performed between April 1, 1994 and March 31, 2002 in Alberta from a population-based administrative database. Age-sex adjusted rates (per 1000 population) were calculated using the 1991 Canadian population as the standard.RESULTS: The eight-year average ERCP rate was 0.98 without evidence of an increasing or decreasing trend over time. The ERCP rate was 0.85 in men and 1.12 in women. Significant regional variation in ERCP rates was seen, ranging from a low of 0.64 to a high of 1.27. The proportion of procedures that were therapeutic increased from 33% in 1994 to 70% in 2001. The likelihood of a procedure being considered therapeutic varied with the age and sex of the patient as well as the health region in which the procedure was performed.CONCLUSIONS: The ERCP rate remained relatively stable over an eight-year time period, but the proportion of procedures that were therapeutic increased dramatically. Important regional variation in ERCP rates and therapeutic procedures exists.

To assess the effect of propofol on the canine sphincter of Oddi (SO), sphincter of Oddi manometry (SOM) was performed in fasting dogs which had undergone cholecystectomy and placement of modified Thomas duodenal cannulae. Using two water-perfused, single-lumen manometric catheters, SO and duodenal pressures were measured simultaneously. Baseline SO activity was recorded for at least one complete interdigestive cycle followed by bolus injections of propofol (Diprivan ®) (N = 31) from 0.1 to 4.0 mg/kg during Phase I of the Migrating Motor Complex (MMC).

Anatomic anomalies of the exrrahepatic biliary tree are common and often incidental findings at endoscopic retrograde cholangiopancreatography; however, they rarely complicate therapeutic procedures such as stone extraction. The cases of two patients with biliary obstruction due to stones are presented, who were found to have the cystic duct a rising almost directly from the ampulla. This rare anatomic variant posed problems both in terms of interpretation of the cholangiogram and removal of stones. Therapeutic endoscopists should be aware of this and other anomalies of the biliary tract and of the potential problems faced in both interpretation of the cholangiogram and in therapeutic procedures.