Septic processes in colonic surgery

USMF “Carol Davila”, Clinica Chirurgie, Spitalul Clinic de Urgență “Bagdasar-Arseni”, Bucureşti, Serviciul de laborator, Spitalul “Bagdasar Arseni”, București, Catedra Informatică, Facultatea de Medicină, București, 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: În studiul prospectiv a 174 pacienți cu media vârstei de 64,3 ani (limite:19-84 ani) au fost operați pentru afecțiuni chirurgicale ale colonului. Material și metoda: Pentru cancer au fost operați 111(63,79%) pacienți: stadiul clinic II(n = 29;27,3%) și stadiul IV(n = 54;31,03 %). Rezultate: S-a intervenit în urgență la 45(25,86%) pacienți pentru semne clinice ale proceselor septice intraperitoneale (n = 15;13,51%) și pentru sindroame ocluzive (n = 30; 27,02%) dintre care ocluzii intestinale (n = 12;19,04%) în patologia netumorală. Pentru afecțiuni netumorale au fost operați 63(36,21%) pacienți pentru: diverticulita colică (n = = 24;13,79%), polipi colici (n = 20;11,60%), volvulus sigmoid (n = 11;6,32 %), rectocolită ulcerohemoragică și purulentă (n=5;2,29%), boala Crohn (n=3;1,72%). Complicațiile postoperatorii au fost reprezentate de manifestările locale și generale ale proceselor septice intraperitoneale (n = 30;17,24%) și complicațiile septice parietale (n=27%;15,81%). Complicațiile postoperatorii mai frecvente în prima săptămână postoperator: hidroelectrolitice (66,66%), a patra decadă postoperator: septice. Au fost efectuate operații în urgență (n=74;44,2%). Operațiile radicale-11,36%. Prezența preoperatorie a sindromului raspunsului inflamator sistemic și evoluția sa postoperatorie a condus la declansarea sindromului de insuficiență multiplă a organelor, factor de predicție a letalitații postoperatorii (p<0,001). S-au înregistrat 37(21,22%) decese postoperatorii. Dezunirea liniei de anastomoza s-a soldat cu mortalitatea de 100 %. Concluzii: Complicațiile septice în chirurgia colonului au valoare predictivă pozitivă de 60 % în producerea deceselor postoperatorii.Introduction: In a prospective study of 174 patients with mean age of 64.3 years (range:19-84 years) were operated for surgical diseases of the colon.Material and methods: For cancer were operated 111(63.79%) patients: clinical stage II (n = 29,27.3%), IV (n = 54,31.03%).Results: We operated in emergency 45(25.86%) patients for clinical signs of intraperitoneal septic processes (n = 15,13.51%) and occlusive syndromes (n = 30,27.02%) from which intestinal occlusion (n = 12,19.04%) with nontumoral pathology. For nontumoral diseases were operated 63(36.21%) patients for: colic diverticulosis (n = 24, 13.79%), colic polyps (n = 20,11.60%), sigmoid volvulus (n = 11,6.32%), ulcerative ulcerohemorrhagic colitis and purulent (n = 5,2.29%), Crohn’s disease (n = 3,1.72%). Postoperative complications were represented by local and general manifestations of septic processes intraperitoneal (n = 30,17.24%) and parietal septic complications (n = 27%, 15.81%).More frequent postoperative complications in the first week after surgery: electrolytes disorders (66.66% ), the fourth decade after surgery: septic complications. Emergency surgery: n = 74,44.2%;11,36% radical operations. This preoperative systemic inflammatory response syndrome and postoperative evolution led to the outbreak of the syndrome multiple organ failure, a predictor of postoperative lethality (p < 0.001). There were 37(21.22%) postoperative deaths. Dehiscence of anastomosis line resulted in 100% mortality.Conclusions: Septic complications of colon surgery were 60% positive predictive value in producing postoperative deaths

Endoscopic Endonasal Transsphenoidal Approach in the Management of Sellar and Parasellar Lesions: and Standard Surgical Technique (Part I)

Transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. In the past decade, however, the endoscopic endonasal transsphenoidal approach has been proposed as a minimally invasive procedure for the treatment of pathologies of the sellar region. This procedure introduces various advantages compared with the transsphenoidal microsurgical approach, such as an improved vision of the surgical field, less traumatism of the nasal structures and reduced complications. Patients’ quick recovery, short hospital stays and minimal postoperative discomfort have been observed. More recently, the standard endoscopic endonasal technique has been extended to provide access to parasellar lesions. This expansion carries significant potential for the resection of skull base lesions. In this article, the authors review the indications of the endoscopic endonasal transsphenoidal approach and define the main phases of the standard surgical technique. Preoperative evaluation, equipment, preoperative and postoperative care are presented. Endoscopic endonasal technique is a safe and effective method for removal of most sellar and some parasellar masses, providing more complete lesion excision and reducing complications

Endoscopic endonasal transsphenoidal approach in the management of sellar and parasellar lesions: Alternative surgical techniques, results, complications (Part II)

The endoscopic endonasal transsphenoidal approach is a minimally invasive surgical technique for the removal of sellar and parasellar lesions. It allows panoramic vision of the surgical target and surrounding structures, with minimal trauma and a low complication rate. The procedure has been gaining in popularity in recent years. There are now surgical instruments intentionally conceived to respond to the specific characteristics of the neuroendoscopy.&nbsp;The widespread use of the endoscope in transsphenoidal surgery has recently contributed to the extension of the approach superior, inferior or lateral. This expansion carries significant potential for the resection of skull base lesions. For selected patients, the various techniques of the endoscopic endonasal transsphenoidal approach are valid alternatives to transcranial approaches. Macroadenomas, suprasellar or even intraventricular craniopharyngiomas, tuberculum sellae or even planum sphenoidale meningiomas and clival tumors become accessible for removal via an endoscopic approach.&nbsp;The authors review the main alternative surgical techniques of the endoscopic endonasal transsphenoidal approach. They also present the results and the complications of the endoscopic transsphenoidal surgery. Due to an improvement and refinement of the surgical procedures, the endoscopic endonasal transsphenoidal approach can be considered a good choice for the excision of the sellar and parasellar lesions

Retinal nerve fibre layer thickness profile in normal eyes using third-generation optical coherence tomography

Aims To establish four normal retinal nerve fibre layer (RNFL) thickness radial profiles based on third-generation optical coherence tomography (OCT) and to compare them with previously reported histologic measurements.Methods A total of 20 normal eyes were studied. A circular scan was adjusted to the size of the optic disc and three scans were performed with this radius and every 200 mu m thereafter, up to a distance of 1400 mu m. Four different radial sections (superotemporal, superonasal, inferonasal, and inferotemporal) were studied to establish RNFL thickness OCT profiles. Additionally, two radial scans orientated at 45 and 1351 crossing the optic disc centre were performed in six of 20 eyes, and RNFL thickness was measured at disc margin.Results Quadrant location and distance from disc margin interaction in RNFL thickness was statistically significant (P < 0.001). the RNFL thickness decreased (P < 0.001) as the distance from the disc margin increased for all sections. the measurements automatically generated by the OCT built-in software were thinner (P < 0.001) than histologic ones close to the disc margin.Conclusions Four normal OCT RNFL profiles were established and compared with histological data obtained from the same area. RNFL measurements assessed by OCT 3 were significantly thinner close to the optic disc margin.Hosp Olhos Araraquara, Glaucoma Sect, BR-14802530 Araraquara, SP, BrazilHosp Olhos Araraquara, Retina Diagnost & Treatment Div, BR-14802530 Araraquara, SP, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUSP, Inst Fis Sao Carlos, Sao Carlos, SP, BrazilUniv So Calif, Doheny Eye Inst, Dept Ophthalmol, Los Angeles, CA USAUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

A Compact Multiphoton 3D Imaging System for Recording Fast Neuronal Activity

We constructed a simple and compact imaging system designed specifically for the recording of fast neuronal activity in a 3D volume. The system uses an Yb:KYW femtosecond laser we designed for use with acousto-optic deflection. An integrated two-axis acousto-optic deflector, driven by digitally synthesized signals, can target locations in three dimensions. Data acquisition and the control of scanning are performed by a LeCroy digital oscilloscope. The total cost of construction was one order of magnitude lower than that of a typical Ti:sapphire system. The entire imaging apparatus, including the laser, fits comfortably onto a small rig for electrophysiology. Despite the low cost and simplicity, the convergence of several new technologies allowed us to achieve the following capabilities: i) full-frame acquisition at video rates suitable for patch clamping; ii) random access in under ten microseconds with dwelling ability in the nominal focal plane; iii) three-dimensional random access with the ability to perform fast volume sweeps at kilohertz rates; and iv) fluorescence lifetime imaging. We demonstrate the ability to record action potentials with high temporal resolution using intracellularly loaded potentiometric dye di-2-ANEPEQ. Our design proffers easy integration with electrophysiology and promises a more widespread adoption of functional two-photon imaging as a tool for the study of neuronal activity. The software and firmware we developed is available for download at http://neurospy.org/ under an open source license

Repeatability of Foveal Measurements Using Spectralis Optical Coherence Tomography Segmentation Software

PURPOSE: To investigate repeatability and reproducibility of thickness of eight individual retinal layers at axial and lateral foveal locations, as well as foveal width, measured from Spectralis spectral domain optical coherence tomography (SD-OCT) scans using newly available retinal layer segmentation software. METHODS: High-resolution SD-OCT scans were acquired for 40 eyes of 40 young healthy volunteers. Two scans were obtained in a single visit for each participant. Using new Spectralis segmentation software, two investigators independently obtained thickness of each of eight individual retinal layers at 0°, 2° and 5° eccentricities nasal and temporal to foveal centre, as well as foveal width measurements. Bland-Altman Coefficient of Repeatability (CoR) was calculated for inter-investigator and inter-scan agreement of all retinal measurements. Spearman's ρ indicated correlation of manually located central retinal thickness (RT0) with automated minimum foveal thickness (MFT) measurements. In addition, we investigated nasal-temporal symmetry of individual retinal layer thickness within the foveal pit. RESULTS: Inter-scan CoR values ranged from 3.1μm for axial retinal nerve fibre layer thickness to 15.0μm for the ganglion cell layer at 5° eccentricity. Mean foveal width was 2550μm ± 322μm with a CoR of 13μm for inter-investigator and 40μm for inter-scan agreement. Correlation of RT0 and MFT was very good (ρ = 0.97, P 0.05); however this symmetry could not be found at 5° eccentricity. CONCLUSIONS: We demonstrate excellent repeatability and reproducibility of each of eight individual retinal layer thickness measurements within the fovea as well as foveal width using Spectralis SD-OCT segmentation software in a young, healthy cohort. Thickness of all individual retinal layers were symmetrical at 2°, but not at 5° eccentricity away from the fovea

Human Bone Marrow-Derived Stem Cells Acquire Epithelial Characteristics through Fusion with Gastrointestinal Epithelial Cells

Bone marrow-derived mesenchymal stem cells (MSC) have the ability to differentiate into a variety of cell types and are a potential source for epithelial tissue repair. Several studies have demonstrated their ability to repopulate the gastrointestinal tract (GIT) in bone marrow transplanted patients or in animal models of gastrointestinal carcinogenesis where they were the source of epithelial cancers. However, mechanism of MSC epithelial differentiation still remains unclear and controversial with trans-differentiation or fusion events being evoked. This study aimed to investigate the ability of MSC to acquire epithelial characteristics in the particular context of the gastrointestinal epithelium and to evaluate the role of cell fusion in this process. In vitro coculture experiments were performed with three gastrointestinal epithelial cell lines and MSC originating from two patients. After an 8 day coculture, MSC expressed epithelial markers. Use of a semi-permeable insert did not reproduce this effect, suggesting importance of cell contacts. Tagged cells coculture or FISH on gender-mismatched cells revealed clearly that epithelial differentiation resulted from cellular fusion events, while expression of mesenchymal markers on fused cells decreased over time. In vivo cell xenograft in immunodeficient mice confirmed fusion of MSC with gastrointestinal epithelial cells and self-renewal abilities of these fused cells. In conclusion, our results indicate that fusion could be the predominant mechanism by which human MSC may acquire epithelial characteristics when in close contact with epithelial cells from gastrointestinal origin . These results could contribute to a better understanding of the cellular and molecular mechanisms allowing MSC engraftment into the GIT epithelium