Диагностика и лечение травматических повреждений пищевода

Catedra chirurgie nr. 2, clinica 2, USMF „Nicolae Testemiţanu”Traumatic iatrogenic injuries and spontaneous ruptures of the esophagus are always serious, and are sometimes followed by pronounced and irreversible complications which include postoperative mortality rates of 30% in the first 24 hours and 60% after 24 hours. Perforation of the esophagus during esophagoscopy with fiber optic endoscopes was found in 0.007% of the observations, while the frequency of blind probing scar stricture of such damage increased by 15%.Травматические повреждения пищевода ятрогенного характера, как и спонтанный разрыв пищевода, считаются наиболее тяжелыми травмами. После таких травм наступают выраженные, иногда необратимые осложнения, с высокой послеоперационной летальностью, в первые 24 часа до 30%, а среди больных, оперированных позднее 24 часов после повреждения, показатель осложнений достигает 60%. Перфорация пищевода при эзофагоскопии эндоскопами на волоконной оптике встречается в 0,007% наблюдений, а при слепом бужировании его рубцовой стриктуры частота такого повреждения возрастает до 15%

Abdominal wall hernias after laparoscopic cholecystectomy

USMF ”N. Testemițanu”, Catedra chirurgie 2, Clinica chirurgie II, SCM ”Sfînta Treime”, Chișinău, Republica Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Scopul studiului: colecistectomia laparoscopică a fost rapid acceptată și dominată de un proses tehnic avansat ca alternativă a colecistectomiei clasice în tratamentul litiazei veziculare, însă până în prezent nu sunt definitiv studiate consecințele postoperatorii.Material și metode: Studiul se bazează pe o analiză a 502 bolnavi operați în clinică laparoscopic, dintre care pentru colecistită cronică calculoasă – 398, iar pentru colecistită acută calculoasă – 104. În 24 cazuri au fost depistate hernii poslaparoscopice, din care 8 pacienti au fost operați în diferite instituții medico-sanitare publice, iar în 4 cazuri au fost operați de urgență după hotarele țării. Femei au fost 480, bărbați – 22, cu vîrsta medie de 48,2 ani.Rezultate: Eventrații postoperatorii au fost la 24 pacienți. Mai frecvent herniile au avut loc în lotul de bolnavi operați în mod urgent pentru colecistită acută calculoasă – 18 cazuri, la cei cu colecistita cronică calculoasă eventrațiile au fost în 6 cazuri. La 8 bolnavi herniile au fost multiple (2), în regiunea epigastrală și ombilicală. Un rol important în dezvoltarea heniilor a avut starea peretelui abdominal, vîrsta, obezitatea, cînd situația intraoperatorie a impus lărgirea plăgii din cauza vezicii biliare cu pereții ingroșați și mărită, flegmonos schimbată, cât și prezența calculilor mari în ea și nesuturarea defectului aponeurotic. Hernioplastia s-a efectuat sub anestezie locală cu soluție 0,3% Lidocaină 60-80 ml cu țesuturi proprii în 20 cazuri, iar în 4 cazuri s-a efectuat sub anestezie generală oro-traheală cu plasă sintetică de propilen. În perioada postoperatorie precoce și tardivă complicații nu s-au înregistrat. Concluzii: Pentru prevenirea herniilor postoperatorii după colecistectomia laparoscopică este obligatoriu să se sutureze aponeuroza în toate cazurile după înlăturarea trocarelor cît și a vezicii biliare, ca metode de preîntîmpinare a herniilor peretelui abdominal.Aim: Laparoscopic cholecystectomy was quickly accepted and dominated by a technically advanced process as an alternative to conventional cholecystectomy in the treatment of gallbladder lithiasis, but so far the postoperative consequences have not been definitively studied. Material and methods: The study is based on an analysis of 502 patients that were operated using laparoscopic surgery, from them with chronic cholecystitis -398, and for acute calculus cholecystitis – 104. In 24 hernia cases were detected after laparoscopic operations, from which 8 patients were operated on in different public medical institutions, and in 4 cases patients were operated abroad. The study has 480 cases – women, men - 22, average age 48.2 years. Results: Postoperative eventrations occurred at 24 patients. More frequently hernias occurred in the group of patients that were operated urgently for acute calculus cholecystitis -18 cases, for those patients which had chronic calculus cholecystitis eventrations happened in 6 cases. 8 patients had multiple hernias(2), in epigastric and umbilical region. An important role in hernias development had the abdominal wall condition, age, obesity, when the intraoperative situation required a widening of the surgical wound due to enlarged gallbladder with thickened walls, with phlegmon changes, and the presence of large stones in it and no sutures of the aponeurotic defect. The plasty of hernia was performed under local anesthesia with 0.3 % Lidocaine solution 60-80 ml with own tissue in 20 cases, and in 4 cases was performed under general oro-tracheal anesthesia with propylene synthetic mesh. During the early and late postoperative periods, no complications were observed. Conclusions: To prevent postoperative hernia after laparoscopic cholecystectomy is mandatory in all cases to put aponeurotic sutures after removal of trocars as well as of gallbladder, as a method of preventing abdominal wall hernias

Полиорганная недостаточность в хирургии

Department of Surgery N 2, State University of Medicine and Pharmacy "Nicolae Testemitanu"Multiple organ insufficiency syndromes complicate the postoperative evolution in urgent surgery in 10-28% of cases. In purulent complications of acute abdominal inflammatory diseases, its frequency can be up to 60%. Difficulties in appropriate diagnoses and treatment and high lethality, which can be up to 95%, determined the actuality of this study. The main cause of multiple organ insufficiency syndromes are infectious complications, particularly in inadequate management, which cause immune, metabolic, and homeostatic disturbances. Синдром полиорганной недостаточности осложняет течение послеоперационного периода в 10-28% случаев. При гнойных осложнениях острых воспалительных заболеваний органов брюшной полости, частота его достигает 60%. Трудность своевременной диагностики и лечения, высокая летальность, достигающая 95%, обусловили особую актуальность и сложность исследования этой проблемы. Основной причиной развития синдрома полиорганной недостаточности являются инфекционные осложнения, особенно при их несвоевременной диагностике или неадекватном лечении, вызывающие нарушения иммунного статуса больных, метаболизма, а также системы гомеостаза

The Suppressor of AAC2 Lethality SAL1 Modulates Sensitivity of Heterologously Expressed Artemia ADP/ATP Carrier to Bongkrekate in Yeast

The ADP/ATP carrier protein (AAC) expressed in Artemia franciscana is refractory to bongkrekate. We generated two strains of Saccharomyces cerevisiae where AAC1 and AAC3 were inactivated and the AAC2 isoform was replaced with Artemia AAC containing a hemagglutinin tag (ArAAC-HA). In one of the strains the suppressor of ΔAAC2 lethality, SAL1, was also inactivated but a plasmid coding for yeast AAC2 was included, because the ArAACΔsal1Δ strain was lethal. In both strains ArAAC-HA was expressed and correctly localized to the mitochondria. Peptide sequencing of ArAAC expressed in Artemia and that expressed in the modified yeasts revealed identical amino acid sequences. The isolated mitochondria from both modified strains developed 85% of the membrane potential attained by mitochondria of control strains, and addition of ADP yielded bongkrekate-sensitive depolarizations implying acquired sensitivity of ArAAC-mediated adenine nucleotide exchange to this poison, independent from SAL1. However, growth of ArAAC-expressing yeasts in glycerol-containing media was arrested by bongkrekate only in the presence of SAL1. We conclude that the mitochondrial environment of yeasts relying on respiratory growth conferred sensitivity of ArAAC to bongkrekate in a SAL1-dependent manner. © 2013 Wysocka-Kapcinska et al

Effects of low-frequency whole-body vibration on motor-evoked potentials in healthy men.

addresses: Sport and Exercise Science Research Centre, Faculty of Engineering, Science and The Built Environment, London South Bank University, 103 Borough Road, London SE1 0AA, UK. [email protected] is the author's post-print version of an article published in Experimental Physiology, 2009, Vol. 94, Issue 1, pp. 103 - 116 Copyright © 2009 Wiley-Blackwell /The Physiological Society. The definitive version is available at www3.interscience.wiley.comThe aim of this study was to determine whether low-frequency whole-body vibration (WBV) modulates the excitability of the corticospinal and intracortical pathways related to tibialis anterior (TA) muscle activity, thus contributing to the observed changes in neuromuscular function during and after WBV exercise. Motor-evoked potentials (MEPs) elicited in response to transcranial magnetic stimulation (TMS) of the leg area of the motor cortex were recorded in TA and soleus (SOL) muscles of seven healthy male subjects whilst performing 330 s continuous static squat exercise. Each subject completed two conditions: control (no WBV) and WBV (30 Hz, 1.5 mm vibration applied from 111 to 220 s). Five single suprathreshold and five paired TMS were delivered during each squat period lasting 110 s (pre-, during and post-WBV). Two interstimulus intervals (ISIs) between the conditioning and the testing stimuli were employed in order to study the effects of WBV on short-interval intracortical inhibition (SICI, ISI = 3 ms) and intracortical facilitation (ICF, ISI = 13 ms). During vibration relative to squat exercise alone, single-pulse TMS provoked significantly higher TA MEP amplitude (56 +/- 14%, P = 0.003) and total area (71 +/- 19%, P = 0.04), and paired TMS with ISI = 13 ms provoked smaller MEP amplitude (-21 +/- 4%, P = 0.01) but not in SOL. Paired-pulse TMS with ISI = 3 ms elicited significantly lower MEP amplitude (TA, -19 +/- 4%, P = 0.009; and SOL, -13 +/- 4%, P = 0.03) and total area (SOL, -17 +/- 6%, P = 0.02) during vibration relative to squat exercise alone in both muscles. Tibialis anterior MEP facilitation in response to single-pulse TMS suggests that WBV increased corticospinal pathway excitability. Increased TA and SOL SICI and decreased TA ICF in response to paired-pulse TMS during WBV indicate vibration-induced alteration of the intracortical processes as well

The Mediterranean diet for Polish infants: a losing struggle or a battle still worth fighting?

The Mediterranean diet is well known for its health-promoting effects. Among its key ingredients, olive oil is the most characteristic. Processing industries have been successfully manufacturing and marketing jarred baby foods with the use of vegetable oils, including olive oil, as well as other sources of visible fat. We aimed to survey manufacturer claims concerning added fat in jarred infant foods supplied to the Polish market. A total of 124 kinds of infant foods from six suppliers were analyzed. Corn, canola, and soybean oil occupied the first three positions, respectively, in rank order of vegetable oils used in jarred baby foods. In our sample, only one type of ready-to-eat jars with vegetables contained olive oil. 11% of products contained cow milk butter or cream. 61% of jarred “dinners” contained poultry or fish, which are typical sources of animal protein in the Mediterranean diet. Given that commercial baby foods currently available in the Polish market contain no olive oil, we advocate considering home preparation of infant foods with the use of visible fat. Medical professionals should encourage food manufacturers to return to the concepts of the Mediterranean diet for young consumers, aimed at long-term health

Simulation study of the link between molecular association and reentrant miscibility for a mixture of molecules with directional interactions

The reentrant liquid-liquid miscibility of a symmetrical mixture with highly directional bonding interactions is studied by Gibbs ensemble Monte Carlo simulation. The resulting closed loop of immiscibility and the corresponding lower critical solution temperature are shown to be a direct consequence of the dramatic increase in association between unlike components as the temperature is lowered. Our exact calculations for an off-lattice system with a well-defined anisotropic potential confirm the findings of previous theoretical studies.Dirección General de Investigación Científica y Técnica PB94-144

Development of a new marker system for identifying the complex members of the low-molecular-weight glutenin subunit gene family in bread wheat (Triticum aestivum L.)

Low-molecular-weight glutenin subunits (LMW-GSs) play an important role in determining the bread-making quality of bread wheat. However, LMW-GSs display high polymorphic protein complexes encoded by multiple genes, and elucidating the complex LMW-GS gene family in bread wheat remains challenging. In the present study, using conventional polymerase chain reaction (PCR) with conserved primers and high-resolution capillary electrophoresis, we developed a new molecular marker system for identifying LMW-GS gene family members. Based on sequence alignment of 13 LMW-GS genes previously identified in the Chinese bread wheat variety Xiaoyan 54 and other genes available in GenBank, PCR primers were developed and assigned to conserved sequences spanning the length polymorphism regions of LMW-GS genes. After PCR amplification, 17 DNA fragments in Xiaoyan 54 were detected using capillary electrophoresis. In total, 13 fragments were identical to previously identified LMW-GS genes, and the other 4 were derived from unique LMW-GS genes by sequencing. This marker system was also used to identify LMW-GS genes in Chinese Spring and its group 1 nulli–tetrasomic lines. Among the 17 detected DNA fragments, 4 were located on chromosome 1A, 5 on 1B, and 8 on 1D. The results suggest that this marker system is useful for large-scale identification of LMW-GS genes in bread wheat varieties, and for the selection of desirable LMW-GS genes to improve the bread-making quality in wheat molecular breeding programmes

Mediterranean winter rainfall in phase with African monsoons during the past 1.36 million years

Mediterranean climates are characterized by strong seasonal contrasts between dry summers and wet winters. Changes in winter rainfall are critical for regional socioeconomic development, but are difficult to simulate accurately1 and reconstruct on Quaternary timescales. This is partly because regional hydroclimate records that cover multiple glacial–interglacial cycles2,3 with different orbital geometries, global ice volume and atmospheric greenhouse gas concentrations are scarce. Moreover, the underlying mechanisms of change and their persistence remain unexplored. Here we show that, over the past 1.36 million years, wet winters in the northcentral Mediterranean tend to occur with high contrasts in local, seasonal insolation and a vigorous African summer monsoon. Our proxy time series from Lake Ohrid on the Balkan Peninsula, together with a 784,000-year transient climate model hindcast, suggest that increased sea surface temperatures amplify local cyclone development and refuel North Atlantic low-pressure systems that enter the Mediterranean during phases of low continental ice volume and high concentrations of atmospheric greenhouse gases. A comparison with modern reanalysis data shows that current drivers of the amount of rainfall in the Mediterranean share some similarities to those that drive the reconstructed increases in precipitation. Our data cover multiple insolation maxima and are therefore an important benchmark for testing climate model performance

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety