Improved Results for Resection of Periampullary Adenocarcinoma

Background: This study evaluates the indications for and effects of pancreaticoduodenectomy (102 patients) or total pancreatectomy (15 patients) with extensive lymph node dissection performed upon 117 patients for treatment of periampullary adenocarcinoma

Biodegradation of mixtures of pesticides by bacteria and white rot fungi

The objective of this study was to examine the potential for degradation of mixtures of pesticides (chlorpyrifos, linuron, metribuzin) by a range of bacteria and fungi and to relate this capability to enzyme production and quantify the rates of degradation of the components of the mixture of xenobiotic compounds. Overall, although bacteria (19 Bacillus and 4 Pseudomonas species) exhibited tolerance to the individual and micture of pesticides actual degradation was not evident. Five species of white rot fungi were grown on minimal salts agar plates amended with 0, 10 and 30 mg L-1 of chlorpyrifos, linuron and metribuzin, individually and as a mixture with a total concentration 15 and 30 mg L-1. Four of these, T. versicolor, P. gigatea, P.coccineus and P.ostreatus, exhibited very good tolerance to the pesticides. They were also grown on a nutritionally poor soil extract agar amended with a mixture of the pesticides at different concentrations (0-70 mg L-1). Subsequently, the ability of T. versicolor, P. gigatea, P. coccineus to degrade lignin and production of laccase in the presence of mixture of the pesticides was examined as well as their capacity to degrade the pesticide mixture at different concentrations (0-50 mg L-1) in soil extract broth was quantified using HPLC. This showed that only T.versicolor had the ability to degrade linuron, after three weeks incubation although all tested species produced laccase. Subsequently, the temporal degradation rates of T.versicolor was examined in relation to temporal degradation of a mixture of the pesticides chlorpyrifos, linuron and metribuzin with total concentrations 0-50 mg L-1 and the temporal laccase production was quantified over a six week period in relation to ionic and non-ionic water potential stress (-2.8 MPa). These studies showed that the test isolate had the ability to produce very high levels of laccase at -2.8 MPa water potential adjusted non-ionically by using glycerol and quite lower levels in soil extract broth without stress while T.versicolor did not produce laccase at -2.8 MPa when the medium was modified ionically. Finally, T.versicolor was able to degrade the pesticide linuron in all tested water regimes, after five weeks incubation, regardless of the concentration of the mixture. In contrast, about 50% of the metribuzin was degraded, only at at -2.8 MPa water potential adjusted non-ionically with glycerol. Chlorpyrifos and its main metabolite TCP were not detected, possibly, due to a combination of hydrolysis, photolysis and volatilization degradation. The capacity of T.versicolor to degrade linuron in mixtures of pesticides and the production of high levels of laccase, in a nutritionally poor soil extract broth, even under water stress suggests potential application of this fungus in bioremediation.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The incidence and nature of in-hospital adverse events: a systematic review

INTRODUCTION: Adverse events in hospitals constitute a serious problem with grave consequences. Many studies have been conducted to gain an insight into this problem, but a general overview of the data is lacking. We performed a systematic review of the literature on in-hospital adverse events. METHODS: A formal search of Embase, Cochrane and Medline was performed. Studies were reviewed independently for methodology, inclusion and exclusion criteria and endpoints. Primary endpoints were incidence of in-hospital adverse events and percentage of preventability. Secondary endpoints were adverse event outcome and subdivision by provider of care, location and type of event. RESULTS: Eight studies including a total of 74 485 patient records were selected. The median overall incidence of in-hospital adverse events was 9.2%, with a median percentage of preventability of 43.5%. More than half (56.3%) of patients experienced no or minor disability, whereas 7.4% of events were lethal. Operation- (39.6%) and medication-related (15.1%) events constituted the majority. We present a summary of evidence-based interventions aimed at these categories of events. CONCLUSIONS: Adverse events during hospital admission affect nearly one out of 10 patients. A substantial part of these events are preventable. Since a large proportion of the in-hospital events are operation- or drug-related, interventions aimed at preventing these events have the potential to make a substantial differenc

Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis

Objective: Published evidence indicates that surgical drainage of the pancreatic duct was more effective than endoscopic drainage for patients with chronic pancreatitis. This analysis assessed the cost-effectiveness of surgical versus endoscopic drainage in obstructive chronic pancreatitis. Design: This trial-based cost-utility analysis (ISRCTN04572410) was conducted from a UK National Health Service (NHS) perspective and during a 79-month time horizon. During the trial the details of the diagnostic and therapeutic procedures, and pancreatic insufficiency were collected. The resource use was varied in the sensitivity analysis based on a review of the literature. The health outcome was the Quality-Adjusted Life Year (QALY), generated using EQ-5D data collected during the trial. There were no pancreas-related deaths in the trial. All-cause mortality from the trial was incorporated into the QALY estimates in the sensitivity analysis. Setting: Hospital. Participants: Patients with obstructive chronic pancreatitis. Primary and secondary outcome measures: Costs, QALYs and cost-effectiveness. Results: The result of the base-case analysis was that surgical drainage dominated endoscopic drainage, being both more effective and less costly. The sensitivity analysis varied mortality and resource use and showed that the surgical option remained dominant in all scenarios. The probability of cost-effectiveness for surgical drainage was 100% for the base case and 82% in the assessed most conservative case scenario. Conclusions: In obstructive chronic pancreatitis, surgical drainage is highly cost-effective compared with endoscopic drainage from a UK NHS perspective

Body image, cosmesis, quality of life, and functional outcome of hand-assisted laparoscopic versus open restorative proctocolectomy: long-term results of a randomized trial

BACKGROUND: This study aimed to compare quality of life (QOL), functional outcome, body image, and cosmesis after hand-assisted laparoscopic (LRP) versus open restorative proctocolectomy (ORP). The potential long-term advantages of LRP over ORP remain to be determined. The most likely advantage of LRP is the superior cosmetic result. It is, however, unclear whether the size and location of incisions affect body image and QOL. METHODS: In a previously conducted randomized trial comparing LRP with ORP, 60 patients were prospectively evaluated. The primary end points were body image and cosmesis. The secondary end points were morbidity, QOL, and functional outcome. A body image questionnaire was used to evaluate body image and cosmesis. The Short Form-36 Health Survey and the Gastrointestinal Quality of Life Inventory were used to assess QOL. Body image and QOL also were assessed preoperatively. RESULTS: A total of 53 patients completed the QOL and functional outcome questionnaires. There were no differences in functional outcome, morbidity, or QOL between LRP and ORP. At a median of 2.7 years after surgery, 46 patients returned the questionnaires regarding body image, cosmesis, and morbidity. The body image and cosmesis scores of female patients were significantly higher in the LRP group than in the ORP group (body image, 17.4 vs 14.9; cosmesis, 19.1 vs 13.0, respectively). The female patients in the ORP group had significantly lower body image scores than the male patients (14.9 vs 18.3). CONCLUSIONS: This study is the first to show that ORP has a negative impact on body image and cosmesis as compared with LRP. Functional outcome, QOL, and morbidity are similar for the two approaches. The advantages of a long-lasting improved body image and cosmesis for this relatively young patient population may compensate for the longer operating times and higher costs, particularly for wome

Evaluation of POSSUM for Patients Undergoing Pancreatoduodenectomy

Comparison of operative morbidity rates after pancreatoduodenectomy between units may be misleading because it does not take into account the physiological variable of the condition of the patients. The aim of the present study was to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) for pancreatoduodenectomy patients and to look for risk factors associated with morbidity in a high-volume center. Between January 1993 and April 2006, 652 patients underwent a pancreatoduodenectomy, 502 of them for malignant disease. POSSUM performance was evaluated by assessing the "goodness-of-fit" with the linear analysis method. Overall, 332 of the 652 patients (50.9%) had one or more complication after pancreatoduodenectomy, and 9 patients (1.4%) died. POSSUM had a significant lack of fit using goodness-of-fit analysis. In multivariate analysis, one statistically significant factor associated with morbidity and not incorporated in POSSUM (P < 0.05) was identified: ampulla of Vater adenocarcinoma (OR = 1.73, 95% CI: 1.07-2.80). Overall, there is a lack of calibration of POSSUM among patients who undergo pancreatoduodenectom

Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis.

Published evidence indicates that surgical drainage of the pancreatic duct was more effective than endoscopic drainage for patients with chronic pancreatitis. This analysis assessed the cost-effectiveness of surgical versus endoscopic drainage in obstructive chronic pancreatitis