Can intraoperative manometry influence the outcome of the surgical treatment of achalasia?

Introduction. Achalasia is defined as incomplete or even absent relaxation of the lower esophageal sphincter secondary to the chronic degeneration of unspecified etiology of the myenteric nerve plexus. Material and method. The retrospective study extended over 1 year. The collected variables were: age, sex, type of surgical intervention, intraoperative manometry results, and postoperative complications. Results. We identified 8 patients. The mean operative time was 100 minutes. The use of manometry determined an increase in time of 30 to 40 minutes. Manometry was successfully achieved in all cases, although in one case the sensor could not pass through the lower esophagus, so a prior pneumatic dilation was required. Manometry has proven useful during fundoplication as it offers a direct view of the pressure produced when knots set at 12 - 15 mmHg with a length of 4-5 cm were tightened. Of the 8 patients, 6 required an increase in the length of the resection of the esophagus after the results of the intraoperative manometry were reviewed. Conclusion. In our opinion, after reviewing our experience and the literature data, intraoperative manometry should become a standard procedure in the laparoscopic treatment of achalasia

Can intraoperative manometry influence the outcome of the surgical treatment of achalasia?

Introduction. Achalasia is defined as incomplete or even absent relaxation of the lower esophageal sphincter secondary to the chronic degeneration of unspecified etiology of the myenteric nerve plexus. Material and method. The retrospective study extended over 1 year. The collected variables were: age, sex, type of surgical intervention, intraoperative manometry results, and postoperative complications. Results. We identified 8 patients. The mean operative time was 100 minutes. The use of manometry determined an increase in time of 30 to 40 minutes. Manometry was successfully achieved in all cases, although in one case the sensor could not pass through the lower esophagus, so a prior pneumatic dilation was required. Manometry has proven useful during fundoplication as it offers a direct view of the pressure produced when knots set at 12 - 15 mmHg with a length of 4-5 cm were tightened. Of the 8 patients, 6 required an increase in the length of the resection of the esophagus after the results of the intraoperative manometry were reviewed. Conclusion. In our opinion, after reviewing our experience and the literature data, intraoperative manometry should become a standard procedure in the laparoscopic treatment of achalasia

Clonal Spread of emm Type 28 Isolates of Streptococcus pyogenes That Are Multiresistant to Antibiotics

Fifty-three pharyngitis-related and invasive isolates of Streptococcus pyogenes that are resistant to bacitracin were collected. They were also resistant to streptomycin, kanamycin, macrolides, lincosamides, and streptogramin B. These multiresistant isolates were of emm type 28 and clonally related as shown by pulsed-field gel electrophoresis

Changes in bioclimatic indices in the Republic of Moldova (1960–2012): consequences for tourism

This study includes a diagnostic and evolutive analysis of the bioclimate of Republic of Moldova, made by using the Wind Chill (WCI) and Cooling Power (CP) indices. The bioclimate of the cold season (October–March) had, in the time period 1960–2012), a warming trend, highlighted by the decrease of WCI values. During the warm season, the bioclimate of Republic of Moldova recorded a gradual warming, highlighted by the decrease in CP index values. The CP index values were analyzed in relation to those of the Tourism Climate Index (TCI), useful for planning the tourist activities of any kind. The actual values of TCI and the ones anticipated for the future indicate, for the Republic of Moldova, an increasing bioclimate favorability for all forms and types of tourism.El presente estudio incluye el análisis diagnóstico y evolutivo del bioclima de la República de  Moldavia según Wind Chill Index (WCI) y Cooling Power (CP). Entre 1960 y 2012,  el bioclima de la temporada fría (octubre-marzo) presentó una tendencia de calentamiento gradual, evidenciada por la baja de los valores de WCI. Durante la temporada cálida, el bioclima de la República de Moldovia registró un calentamiento gradual, evidenciado por la baja  de los valores de CP. Los valores del índice CP han sido analizados según los valores  del Índice Climático turístico  (TCI), útil para planificar actividades turísticas de cualquier tipo. Los valores actuales de TCI y los anticipados para el futuro indican un clima favorecedor para todo tipo o toda clase de turismo en la República Moldavia

Emergence of Macrolide-Resistant Streptococcus pyogenes Strains in French Children

We studied the antimicrobial susceptibility of 322 Streptococcus pyogenes throat isolates from French children and their serotype and genomic diversity. A total of 22.4% were erythromycin resistant, and 69.4, 4.2, and 26.4% of these isolates harbored ermB, ermA, and mefA, respectively. Increasing resistance in France is mainly associated with a few emm type 28 clones

Concomitant carriage of KPC-producing and non-KPC-producing Klebsiella pneumoniae ST512 within a single patient

International audienceBackground: KPC-producing Klebsiella pneumoniae of clonal group 258 are prominent in healthcare settings in many regions of the world. The blaKPC gene is mostly carried by a multireplicon IncFIIk-IncFI plasmid suspected to be highly compatible and stable in this genetic background. Here, we analysed the genetic diversity of an ST512 K. pneumoniae population in a single patient.Methods: Twelve K. pneumoniae isolates (n = 5 from urine samples and n = 7 from rectal swabs) were recovered from one patient over a 2 month period. Antimicrobial susceptibility testing, plasmid extraction and WGS were performed on all isolates. The first K. pneumoniae isolate, D1, was used as a reference for phylogenetic analysis.Results: Antimicrobial susceptibility testing, plasmid analysis and WGS revealed concomitant carriage of carbapenem-resistant and carbapenem-susceptible K. pneumoniae isolates of ST512, with the absence of the entire blaKPC-carrying plasmid in the susceptible population. Furthermore, 14 other genetic events occurred within the genome, including 3 chromosomal deletions (of 71 kb, 33 kb and 11 bp), 2 different insertions of ISKpn26 and 9 SNPs. Interestingly, most of the events occurred in the same chromosomal region that has been deleted independently several times, probably after homologous recombination involving 259 bp repeated sequences.Conclusions: Our study revealed (to the best of our knowledge) the first case of in vivo blaKPC-carrying plasmid curing and a wide within-patient genetic diversity of a single K. pneumoniae ST512 clone over a short period of carriage. This within-patient diversity must be taken into account when characterizing transmission chains using WGS during nosocomial outbreaks