Surgery in postoperator alkaline desease

Clinica de Chirurgie Generală şi Esofagiană, Spitalul Clinic “Sfânta Maria” Bucureşti, România, 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 2011Introducere: Se analizează retrospectiv experienţa clinicii pe 30 de ani (1981-2010) privind diversia duodenală totală Y-Roux (DDT) în tratamentul bolii alcaline de reflux postoperator(BARP). Materiale şi metodă, rezultate: Din 89 de pacienţi cu gastrojejunostomie Y-Roux după rezecţie gastrică distală cu diverse indicaţii, am selecţionat 29 de pacienţi la care procedeul s-a folosit în tratamentul BARP. Am exclus 9 cazuri cu DDT pentru patologie primară de reflux alcalin. În 20 cazuri DDT a fost practicată ca o modalitate reconstructivă pe “stomac operat”: degastrogastrectomie sau conversie a montajului anastomotic preexistent (la bolnavi cu 1-3 operaţii în antecedente, cu tulburări severe de motilitate). Se constată o scădere a numărului de cazuri în ultimii ani. La 9 pacienţi DDT a fost utilizată ca intenţie curativă antireflux după chirurgia biliară:colecistectomie ± coledocoduodenostomie, constatând creşterea numărului de cazuri în ultima perioadă. Criteriile de indicaţie chirurgicală: clinice, radiologice, endoscopice, histologice au selecţionat pentru intervenţie cazurile severe. Se prezintă particularităţile tehnice ca şi consecinţele morfofuncţionale ale DDT. Rezultatele imediate sunt foarte bune: morbiditate minimă (o reintervenţie precoce pentru ocluzie digestivă înaltă) şi mortalitate postoperatorie zero. Rezultatele la distanţă –evaluate clinic, radiologic, endoscopic şi histologic- arată o ameliorare postoperatorie certă, cu excepţia anumitor forme histologice. Concluzii: Incidenţa BARP după chirurgia gastrică a scăzut, prin scăderea drastică a indicaţiei operatorii pentru boala ulceroasă; în schimb creşte relativ incidenţa acestei entităţi după chirurgia biliară. DDT este o procedură eficientă dar de rezervă, indicată în cazuri bine selecţionate. Se constată o ameliorare postoperatorie certa clinică, endoscopică şi histologică, cu excepţia gastritei atrofice şi a metaplaziei intestinale, care se ameliorează în mică măsură.Introduction. We analyzed the experience of the Clinic on past 30 years (1981-2010) regarding total duodenal diversion (TDD) with Roux- en- Y gastrectomy for postoperator alkaline reflux disease (PARD). Materials and method, results: Among 89 patients presenting Y-Roux gastrojejunostomy after gastric distal resection for various indications, we selected 29 patients in which the procedure was used as treatment of PARD. We excluded 9 patients with TDD for primary alkaline reflux disease. In 20 cases TDD was used as a reconstructive procedure on “operated stomach” : degastrogastrectomy or conversion of the existing anastomotic assembly (at patients with history of 1-3 gastric operations, with severe motility disorders). It is ascertained a decrease in the number of such cases in recent years. At another 9 patients TDD was used as an antireflux cure after biliary surgery: colecistectomy ± choledocoduodenostomy, noting the increase number of such cases lately. The criteria for surgery indication: clinicals, radiologycals, endoscopicals, histologicals selected for intervention severe cases. There are presentated techniques particularities and morfofunctional consequences of TDD. Immediate results were very good: minimal morbidity ( one early reintervention for acute digestive occlusion) and no postoperator mortality. Long time results – clinical, radiological, endoscopic and histological evaluated- showed a certain postoperator improvement, excepting some definite histological forms. Conclusions: PARD incidence after gastric surgery has decreased through drastically decrease of surgical indication for patients with gastroduodenal ulcer; after biliar surgery. TDD is an efficient procedure but as a backup, being indicated only in cases very carefully selected. It is observed a definite clinical, endoscopic and histological postoperator improvement excepting atrophic gastritis which is less improved

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

A survey of zoonotic pathogens carried by non-indigenous rodents at the interface of the wet tropics of North Queensland, Australia

In 1964, Brucella was isolated from rodents trapped in Wooroonooran National Park (WNP), in Northern Queensland, Australia. Genotyping of bacterial isolates in 2008 determined that they were a novel Brucella species. This study attempted to reisolate this species of Brucella from rodents living in the boundary area adjacent to WNP and to establish which endo- and ecto-parasites and bacterial agents were being carried by non-indigenous rodents at this interface. Seventy non-indigenous rodents were trapped [Mus musculus (52), Rattus rattus (17) and Rattus norvegicus (1)], euthanized and sampled on four properties adjacent to the WNP in July 2012. Organ pools were screened by culture for Salmonella, Leptospira and Brucella species, real-time PCR for Coxiella burnetii and conventional PCR for Leptospira. Collected ecto- and endo-parasites were identified using morphological criteria. The percentage of rodents carrying pathogens were Leptospira (40%), Salmonella choleraesuis ssp. arizonae (14.29%), ectoparasites (21.42%) and endoparasites (87%). Brucella and C. burnetii were not identified, and it was concluded that their prevalences were below 12%. Two rodent-specific helminthic species, namely Syphacia obvelata (2.86%) and Nippostrongylus brasiliensis (85.71%), were identified. The most prevalent ectoparasites belonged to Laelaps spp. (41.17%) followed by Polyplax spp. (23.53%), Hoplopleura spp. (17.65%), Ixodes holocyclus (17.64%) and Stephanocircus harrisoni (5.88%), respectively. These ectoparasites, except S. harrisoni, are known to transmit zoonotic pathogens such as Rickettsia spp. from rat to rat and could be transmitted to humans by other arthropods that bite humans. The high prevalence of pathogenic Leptospira species is of significant public health concern. This is the first known study of zoonotic agents carried by non-indigenous rodents living in the Australian wet-tropical forest interface

Tracking transparent monogenean parasites on fish from infection to maturity

The infection dynamics and distribution of the ectoparasitic fish monogenean Neobenedenia sp. (Monogenea: Capsalidae) throughout its development was examined on barramundi, Lates calcarifer (Bloch) (Latidae), by labelling transparent, ciliated larvae (oncomiracidia) with a fluorescent dye. Replicate fish were each exposed to approximately 50 fluorescent oncomiracidia and then examined for parasites using an epifluorescence stereomicroscope at 10 time intervals post-exposure (15, 30, 60, 120 min, 24, 48 h, four, eight, 12, and 16 days). Fluorescent labelling revealed that parasites attached underneath and on the surface of the scales of host fish. Parasite infection success was 20% within 15 min, and peaked at 93% two days post-exposure, before gradually declining between four and sixteen days. Differences in parasite distribution on L. calcarifer over time provided strong evidence that Neobenedenia sp. larvae settled opportunistically and then migrated to specific microhabitats. Parasites initially attached (<24 h) in greater mean numbers on the body surface (13 ± 1.5) compared to the fins (4 ± 0.42) and head region (2 ± 0.41). Once larvae recruitment had ceased (48 h), there were significantly higher mean post-larvae counts on the head (5 ± 3.4) and fins (12 ± 3) compared to previous time intervals. Neobenedenia sp. aggregated on the eyes, fins, and dorsal and ventral extremities on the main body. As parasites neared sexual maturity, there was a marked aggregation on the fins (22 ± 2.35) compared to the head (4 ± 0.97) and body (9 ± 1.33), indicating that Neobenedenia sp. may form mating aggregations

Characterization of stage-specific and cross-reactive antigens from Eimeria acervulina by chicken monoclonal antibodies

The characterization of five chicken monoclonal antibodies (mAbs) that were developed against apical complex antigens of Eimeria acervulina sporozoites is realized and the mAbs reactivity to merozoites belonging to this species is tested. Using immuno-fluorescence assay (IFA), one mAb (HE-4) that recognized apical antigens common to sporozoites of E. acervulina and E. brunetti bound antigens localized on the apical tip of merozoites from all stages of development examined. The mAb 8E-1, reactive with antigens found on the apical tip of all chicken Eimeria sporozoites, also showed binding to antigens common to merozoites from all generations. Another mAb, 8C-3, which identified an antigen shared by sporozoites apical tip and sporocysts wall of E. acervulina reacted very weak and inconstantly with the merozoites from all generations whereas the mAbs 5D-11 and 8D-2 that recognized antigens shared by the sporozoites of E. acervulina and E. maxima (mAb 5D-11) and E. acervulina and E. brunetti (mAb 8D-2) did not react with the merozoites from any generation. Collectively, these results showed that the invasive stages of chicken Eimeria share cross reactive apical complex antigens which are inter-species and inter-generation-specific that might be components of a potential recombinant vaccine

Reverse vaccinology approach to identify Rhipicephalus (Boophilus) microplus tick vaccine candidates

Of 899 tick species [subclass Acari, order Parasitiformes], approximately 50 are significant medical and veterinary ectoparasites. Rhipicephalus microplus [cattle tick, family Ixodidae] infestations impacts cattle production costing $US2.5bn world-wide. Capitalising on an EST database (BmiGI), novel ESTs from suppressive subtractive hybridizations, Ixodes scapularis genome and bioinformatics, we are applying a reverse vaccinology approach and have identified 208 putative tick vaccine candidates. Predicted proteins include lipocalins, proteases, protease inhibitors, lipoprotein receptors, extracellular matrix, membrane, cuticle enzymes, chitin binding and 146 proteins of unknown function. In parallel, we have undertaken an extensive immune and gene expression analysis of cattle with differential responses to ticks, and have developed novel in vitro candidate screening tools. Epitope screening, functional analysis and the ability to direct protective immune responses will further refine the candidates for in vivo screening