Ultrasonic Versus Standard Electric Dissection in Laparoscopic Colorectal Surgery: A Prospective Randomized Clinical Trial

OBJECTIVE: To assess the safety and efficacy of the ultrasonic dissection (UC) compared with standard electrosurgery (ES) in laparoscopic colorectal surgery. BACKGROUND DATA: High-frequency ultrasound energy was introduced in laparoscopic surgery to improve dissection and coagulation. Very limited data have been published on its use in laparoscopic colorectal surgery. METHODS: Patients eligible for elective laparoscopic right or left hemicolectomy (RH and LH), sigmoidectomy (SG), or low anterior resection (LAR) were randomized to either UC or ES. The following data were collected and analyzed: preoperative data (individual patient data, indication for surgery), intraoperative data (conversion to open surgery, conversion ES to UC, operative time, blood loss, complication rate), and postoperative data (morbidity and mortality, volume of drainage, hospital stay). RESULTS: Between January 2002 and December 2003, 171 patients underwent elective laparoscopic colorectal resection. Twenty-5 patients did not satisfy the inclusion criteria and were excluded. The diagnosis of the remaining 146 patients was diverticulitis (44), colonic adenoma (31), adenocarcinoma (70), or epidermoid carcinoma (1). These patients underwent laparoscopic RH (28), LH (31), SG (47), or LAR (40). There were no differences in preoperative data. The overall conversion rate to open surgery was 11.6%, with no differences between the two groups; 20.8% undergoing ES were converted to UC, more frequently during right hemicolectomy or low anterior resection. Operative time, the primary endpoint of this study, did not differ between the two groups: UC 93 minutes versus ES 102.6 minutes (P = 0.46). Intraoperative blood loss was significantly less in UC 140.8 mL versus ES 182.6 mL (P = 0.032). No differences were observed in postoperative morbidity or other preoperative or postoperative parameters. CONCLUSIONS: UC is a useful device in laparoscopic colorectal surgery that facilitates completion of difficult cases and reduces intraoperative blood loss. Nevertheless, the majority of laparoscopic procedures can be completed with ES. Therefore, selective use of UC appears to be the most cost-effective policy

Lipopeptide secondary metabolites from the phytopathogenic bacterium Pseudomonas syringae.

Over the past twenty years or so, significant advances have been made in the study of the secondary metabolism of the widespread phytopathogenic Gram-negative bacterium Pseudomonas syringae. Interdisciplinary approach, which required the expertise of plant pathologists, chemists, biochemists and molecular biologists, led to the discovery of a new family of bioactive peptide secondary metabolites. The determination of their structures was pivotal for the investigations on their biosynthetic pathways, their relevance in the development of plant disease, and for the understanding of the molecular bases of their biological activities in plant, microbial and animal cells. In particular, the antibiotic activities of some of these compounds appear very interesting in the perspective of their utilization both in medicine and in agriculture. The goal of this chapter is to summarize the present knowledge in various areas of research on P. syringae peptide metabolites