Rectal tumor recurrence: What more may we learn?

2016-11-19T14-52-56Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Antonio Manenti, Massimiliano Salati, Alberto Farinetti, Maurizio Zizzo, Emilio Simonini.
Background: Notwithstanding real progress in the treatment of rectal cancers, local recurrence remains a challenging problem. We performed a retrospective observational study focusing on anatomo-surgical data. Methods: In our retrospective study, we adopted new morphological classifications of primary tumor downstaging, after neoadjuvant treatment, and of local recurrence of rectal cancers, mainly based on CT and MRI images. Results: Different risk factors of rectal cancer recurrence were identified: its initial advanced stage, its high histological grading, and its non-responsiveness to neoadjuvant treatment. In addition, particular anatomo-surgical points have been underlined, mainly focused on the total mesorectal excision. Conclusions: We reaffirmed the value of a correct surgical technique, although other aspects of this disease demand further research.


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In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion

2016-11-19T14-52-56Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Paolo Nardi, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, Giovanni Ruvolo.
Aims: To evaluate the effect of postoperative malperfusion (PM) on operative mortality and on late survival in patients who underwent surgery for acute type A aortic dissection in a referred center for aortic emergency surgery. Patients and Methods: From January 2005 to September 2015, 237 patients were referred for aortic emergency surgery at our center. We examined complete data available on 214 patients (mean age 62.5±12.6 years, 156 males). At presentation, various types of preoperative malperfusion (cerebral, renal, mesenteric) were observed in 119 patients (55.6%). Arterial access for cardiopulmonary bypass was via femoral artery (n = 99), via axillary artery (n = 99), or into the ascending aorta (n = 22). Aortic repair was performed using an open technique in 124 patients (58%). Results: Fifty-five patients (25.7%) presented PM; operative mortality was 29% (62/214): 47.3% in PM patients vs. 22.6% in non-PM patients (P 75 years at the time of operation (OR: 1.1, P = 0.0004) and renal PM (OR: 53.5, P = 0.0027). Five-year survival was 79±7% in PM vs. 94±3% in non-PM patients (P = 0.002). Independent predictors for reduced survival were age >75 years (OR: 375, P = 0.05) and renal PM (OR: 28.6, P = 0.01). All types of PM and the location of intimal tear distal to the ascending aorta were found as risk factors for survival in the univariate analysis only (P

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Use of soluble complement receptor type 1 to prevent local and distant organ injury in a rat intestinal ischemia reperfusion model

2016-11-19T14-52-56Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Mahir Kirnap, Mahmut Can Yagmurdur, Nilufer Bayraktar, Cem Comuoglu, Gokhan Moray.
Introduction: In this experimental study we aimed to examine the in vivo effect of soluble complement receptor type 1 (sCR1) in preventing local and distant organ injury in an ischemia reperfusion model via the superior mesenteric artery (SMA). Using these data, it may be possible to determine the clinical usage of sCR1. Material and Methods: 24 male rats, weighing between 200 and 250 g, were classified into four groups. In group 1, the SMA was clamped for 60 minutes. In group 2, intravenous (IV) sCR1 was given after laparotomy. In group 3, the SMA was clamped for 60 min, at the 60th minute IV sCR1 was administered, and then 1 min later reperfusion was carried out. Group 4 was the laparotomy group. To investigate organ injury, liver function tests (serum AST and ALT levels) and kidney function tests (serum BUN and creatinine levels) were carried out. To evaluate the systemic and local effects of inflammation, total serum levels of protein, albumin, tumour necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were tested. In tissue samples, glutathione (GSH), malondialdehyde (MDA), and myeloperoxidase (MPO) positive neutrophil counts were identified. Results: According to the statistical analysis, sCR1 was shown to reduce the ischemia-reperfusion injury and have antiinflammatory effects. In addition, distant organ injury due to reperfusion was prevented by sCR1. Conclusion: sCR1 was verified to decrease both mortality and morbidity.


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A Mini Review on the Antimicrobial Treatment, Mechanisms and Patterns of Resistance among Clinical, Veterinary and Environmental isolates of Burkholderia pseudomallei

2016-11-19T09-42-10Z
Source: International Journal of Livestock Research
Muhammad Abubakar Sadiq, Latiffah Hassan, Saleha Abdul Aziz, Zunita Zakaria.
The causative agent of human and animal melioidosis, Burkholderia pseudomallei is a saprophytic organism that is widely distributed in various environmental niches such as soil and water in endemic regions. Infection results from exposure to environments containing B. pseudomallei through direct skin inoculation or contamination of wounds, and inhalation of aerosolised bacteria. The infection is usually treatable with antibiotics but the treatments are becoming difficult, because these bacteria demonstrate a high level of intrinsic resistance against most common clinically relevant antibiotics. There are various mechanisms involved in B. pseudomallei antimicrobial resistance, four among which have been established; expression of multiple drug efflux pumps of the resistance-nodulation-cell division (RND) superfamily, production of hydrolytic enzymes, β-lactamases, deletion of antibiotic target and reduced drug uptake due to outer membrane protein (Omp), BpsOmp38. Most of these mechanisms were established among clinical strains of B. pseudomallei such information among the veterinary and environmental isolates is limited. However there appears to be no distinction between antimicrobial susceptibility and resistance pattern amongst the strains isolated from human and those isolated from animal or environmental sources. The emergence of resistance particularly to ceftazidime, carbapenems, Trimethoprim/sulfamethoxazole and amoxicillin/clavulanic acid, has serious clinical implications, for therapeutic efficacy of both initial and eradication phase drugs are compromised. There is need for more investigation into clinical, veterinary and environmental isolates of B. pseudomallei to determine the antibiotic susceptibility and resistance pattern and characterization of the various antimicrobial resistance genes recognized in the B. pseudomallei genome to elucidate their role in conferring resistance to antimicrobial agents. The information about the resistance mechanisms is imperative in future efforts in design of antimicrobial agents targeting these mechanisms.


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INFLUENCE OF MICROBIAL PHYTASE ON WEIGHT GAIN, FEED CONSUMPTION, FCR, CALCIUM, PHOSPHORUS RETENTION AND ECONOMICS OF BROILER WITH OR WITHOUT FEED MATRIX

2016-11-19T09-42-10Z
Source: International Journal of Livestock Research
MANIK DHUMAL, Mahalsakant Nikam, Rajeev Marewad, shrikant Deshmukh.
An experiment was conducted to evaluate the performance of broiler by supplementation of Phytase with or without using feed matrix. 375 day old Vencobb400 straight run chicks were weighed and distributed randomly into five treatment groups viz, A, B, C, D and E with three replicates of 25 chicks each. The recommended nutritional matrix for 500 FTU and 1000 FTU was used as per manufacturer guidelines. Treatment group A was basal diet without phytase enzyme. The body weights, weight gain, feed consumption and FCR up to 6th week of age were non-significant. The performance of Phytase supplemented groups was at par to that of control even by reducing the nutrients as per matrix and best performance was observed for Treatment groups E . The serum calcium values at 42 days did not differ significantly, however serum phosphorus values showed significant (P


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An in vitro analysis to ascertain whether smokeless tobacco has any detrimental effect on the diagnostic efficacy of salivary lactate dehydrogenase

2016-11-19T08-05-21Z
Source: International Journal of Medical Science and Public Health
Tajindra Singh Saluja, Anita Spadigam, Anita Dhupar, Shaheen Syed.
Background: Salivary diagnostics promise an easily accessible, non-invasive approach for analyzing and monitoring various oral diseases including cancer. Objectives: This study was undertaken to establish the baseline salivary lactate dehydrogenase (LDH) levels in healthy controls and to discern the effect of smokeless tobacco (SLT) on the diagnostic efficacy of salivary LDH. Materials and Methods: Thirty-seven systemically and periodontally healthy individuals in the age group of 19-27 years without any deleterious habit and oral lesion participated in this study. After explaining the procedure to the participants, unstimulated whole saliva was collected by spit method under sterile conditions. Baseline LDH activity was measured spectrophotometrically. After evaluating baseline activity, 1 ml of saliva was mixed with 1 g of SLT and incubated at 37°C. LDH activity was measured at different time intervals. Results: The median value of baseline LDH levels at rest was 338 IU/L. The gender-based variation in LDH activity was found to be non-significant. Exposure of whole saliva to SLT resulted in an initial increase followed by reduction in the LDH activity. Conclusion: This study provides additional rationale for the use of salivary LDH as a biomarker to investigate the aggressiveness and biological nature of oral pathological conditions. Interpretation of changes in salivary LDH activity should be done with caution in individuals habituated to tobacco use.


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Effectiveness and comparison of reteplase versus streptokinase thrombolytic agents in the patients of acute myocardial infarction

2016-11-19T08-05-21Z
Source: International Journal of Medical Science and Public Health
Sunil Kumar Goel, Ishita Goel, Sandeep Agarwal.
Background: Streptokinase and reteplase are commonly used for thrombolytic therapy in the patients with acute myocardial infarction (AMI). A comparative study was designed to evaluate the effectiveness of both thrombolytic agents. Objective: The objective of this study was to compare the effectiveness, reperfusion rates, mortality, and safety profile of two thrombolytics (reteplase and streptokinase) in the patients of AMI. Materials and Methods: The effectiveness of both thrombolytics (reteplase and streptokinase) was compared on AMI patients during hospital stay, at 1-month and 1-year follow-up. The difference of both groups was assessed by Chi-square and Students t-test wherever required. Results: A total of 414 patients of AMI were included in the study. No significant difference was apparent between the effectiveness of both thrombolytics agents at 1-month follow-up of AMI patients. Patients thrombolysed with reteplase showed a significantly low mortality (χ2 = 3.96, d.f. = 1, P = 0.0466) at 1-year post-AMI follow-up. The mean age of patients of reteplase group was 56.7 ± 4.95 years and for patients of streptokinase was 53.2 ± 9.19 years (P

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