Management of acquired bronchobiliary fistula: 3 case reports and a literature review

Bronchobiliary fistula (BBF), which often presents with bilioptysis, is an abnormal communication between the bronchial system and biliary tree. It is a complication associated with a high mortality rate and requires a well-planned management strategy. Although hydatid disease is still the leading cause, extensive surgical interventions and invasive procedures of the liver have altered the profile of patients in recent decades. This paper presents 3 cases of BBF and reviews the literature regarding the treatment options generally mandated by clinical presentation and the underlying disease

Does partial expander deflation exacerbate the adverse effects of radiotherapy in two-stage breast reconstruction?

<p>Abstract</p> <p>Background</p> <p>The optimum protocol for expander volume adjustment with respect to the timing and application of radiotherapy remains controversial.</p> <p>Methods</p> <p>Eighteen New Zealand rabbits were divided into three groups. Metallic port integrated anatomic breast expanders of 250 cc were implanted on the back of each animal and controlled expansion was performed. Group I underwent radiotherapy with full expanders while in Group II, expanders were partially deflated immediately prior to radiotherapy. Control group did not receive radiotherapy.</p> <p>The changes in blood flow at different volume adjustments were investigated in Group II by laser Doppler flowmetry. Variations in the histopathologic properties of the irradiated tissues including the skin, capsule and the pocket floor, were compared in the biopsy specimens taken from different locations in each group.</p> <p>Results</p> <p>A significant increase in skin blood flow was detected in Group II with partial expander deflation. Overall, histopathologic exam revealed aggravated findings of chronic radiodermatitis (epidermal atrophy, dermal inflammation and fibrosis, neovascularisation and vascular changes as well as increased capsule thickness) especially around the lower expander pole, in Group II.</p> <p>Conclusions</p> <p>Expander deflation immediately prior to radiotherapy, may augment the adverse effects, especially in the lower expander pole, possibly via enhanced radiosensitization due to a relative increase in the blood flow and tissue oxygenation.</p

The Influence of Land Use on Coastal Litter: An Approach to Identify Abundance and Sources in the Coastal Area of Cilician Basin, Turkey

The Cilician Basin located in the Northeastern Mediterranean is a region that is affected by a diversity of anthropogenic pressures and is further expected to suffer from negative economic, environmental and social impacts of coastal litter. To provide a baseline for litter management plans, the standing crop of coastal macro-litter was sampled on 13 beaches following MSFD guidelines. Environmental predictors characterizing beach use and potential land based litter point sources in the vicinity of the beaches were related to litter densities to identify litter sources. The average litter density was 0.92 +/- 0.36 items/m(2). Litter items resulting from convenience food consumption and smoking made up more than half of the total litter collected, while agricultural, industrial, fishing activities together contributed only 6% of the total number of items. Plastic items on average constituted more than 80% of the dominant material type. Percentages of the litter transported with currents from neighbouring countries (transboundary litter) varied from 0 - 4.23% between beaches. Direct deposition on the beaches was identified as the main method for transport of items to the coastal environment. Our results show poor local awareness and underline the need for educational programs that can help reduce coastal litter

Microplastic litter composition of the Turkish territorial waters of the Mediterranean Sea, and its occurrence in the gastrointestinal tract of fish

Microplastic pollution of marine environment is receiving increased publicity over the last few years. The present survey is, according to our knowledge, the survey with the largest sample size analyzed, to date. In total, 1337 specimens of fish were examined for the presence of plastic microlitter representing 28 species and 14 families. In addition, samples of seawater and sediment were also analyzed for the quantification of microplastic in the same region. Samples of water/sediment were collected from 18 locations along the Mediterranean coast of Turkey. 94% of all collected plastic microlitter from the sea was in the size range between 0.1 and 2.5 mm, while the occurrence of other sizes was rare. The quantity of microplastic particles in surface water samples ranged from 16 339 to 520 213 per km(2). Fish were collected from 10 locations from which 8 were either shared with or situated in the proximity of water/sediment sampling locations. A total of 1822 microplastic particles were extracted from stomach and intestines of fish. Majority of ingested particles were represented by fibers (70%) and hard plastic (20.8%), while the share of other groups: nylon (2.7%), rubber (0.8%) and miscellaneous plastic (5.5%) were low. The blue color of plastic was the most dominant color. 34% of all examined fish had microplastic in the stomach. On average, fish which had microplastic contained 1.80 particles per stomach. 41% of all fish had microplastic in the intestines with an average of 1.81 particles per fish. 771 specimens contained microplastic in either stomach and/or intestines representing 58% of the total sample with an average of 2.36 particles per fish. Microplastic was found in all species/families that had sample size of at least 2 individuals. The number of particles present in either stomach or intestines ranged between 1 and 35. Ingested microplastic had an average diameter +/- SD of 656 +/- 803 mu m, however particles as small as 9 gm were detected. The trophic level of fish species had no influence whatsoever on the amount of ingested microplastic. Pelagic fish ingested more microplastic than demersal species. In general, fish that ingested higher number of microplastic particles originated from the sites that also had a higher particle count in the seawater and sediment