Microbial desugarization of native and treated egg white

Includes vita.Native egg white, lysozyme-reduced egg white, and the addition of iron, aluminum, and zinc chloride as substrates were used to study bacterial desugarization . Six bacteria were selected; Klebsiella pneumoniae, Klebsiella oxytoca , Lactobacillus plantarum , Lactobacillus casei , Leuconostoc mesenteroides , and Streptococcus diacetylactis. Removal of 93% of the lysozyme permitted K. oxytoca and K. pneumoniae to grow more rapidly. Gram positive bacteria also grew better in lysozyme-reduced egg white than in native egg white. The addition of iron chloride to native egg white overcame its antimicrobial properties to L. casei. Desugarization was completed within 36 hr. Agarose isoelectric focusing, an electrophoretic technique with high resolution, was used to investigate the effect of bacterial desugarization on egg white proteins. Using Pharmalyte in the pH range of 4.0-6.5 proved appropriate for the separation of egg white proteins. Bacterial desugarization reduced the level of 3 proteins ( pl = 5.09, 5.57, and 5.72) in egg white. Three forms of ovotransferrin and iron-ovotransferrin complexes were found when 0.36 mM iron chloride was added to egg white at pH 7.0. Zinc ions were loosely bound to ovotransferrin as indicated by the intensity of 3 zinc-ovotransferrin protein bands. Three metallic ions (ZnCI2 , FeCI3, and AICI3) were used at various pH and concentration levels to desugar egg white with K. oxytoca and L. casei. The growth of K. oxytoca in egg white containing iron chloride was primarily dependent on pH. Both the availability of free iron and the ability of L. casei to compete with ovotransferrin for iron appeared to be affected by pH. The concentration of iron needed to saturate ovotransferrin at pH 6.0 was 0.36 mM whereas saturation was achieved with about 1.44 mM of iron at pH 7.0. Thus, it was concluded that at the lower pH, the equilibrium was shifted toward the bound state. Combination of aluminum chloride and high pH had a positive affect on the growth of K. oxytoca . Zinc was toxic to K. oxytoca and L. casei at high concentration and at low pH.Includes bibliographical references

Comparative Study Regarding Autonomy of Final-Year Surgical Residents: A Case Study of Perception among Surgical Residents, Surgical Staff, Administrators, and Patients at Siriraj University Hospital

Objective: To identify barriers towards resident autonomy as perceived through four groups; surgical residents, surgical staff, administrators, and patients. Materials and Methods: Anonymous surveys were distributed to these four groups. Data were thematically analyzed. Results: 401 responses were collected including 231 patients. The response rate of residents, surgical staff, and administrators was 62.2% (119), 44.8% (26), and 43.1% (25) respectively. Patients had more favorable views of resident participation than administrators and surgical staff. Administrators and surgical staff indicated that residents have a positive effect on overall quality of care provided and so do the patients, however, administrators and surgical staff believed that too much autonomy for a resident deceased patient safety. When resident autonomy increased, increased cost of patient care was considered. Residents and patients have the same opinion that patients should receive a discount on medical expenses, which is opposite to administrators’ and surgical staff’s opinion. The presence of surgical staff in the operation room had a major impact on resident autonomy and a big influence on patient acceptance of operative complications. Even in complicated operations, most patients felt comfortable having a resident perform on with surgical staff controlling the operation. Surgical staff provided too much direction in either patient care or operation and did not take residents’ input as seriously as expected and seldom explained the reasons before changing treatment regimens. Conclusion: Surgical residents, surgical staff, and patients had discordant perceptions of resident autonomy in many aspects. Self-determination theory should be applied. Scaffolding strategy, mentoring program would be the solutions

Types and Levels of Colostomy in Children with Anorectal Malformation

Objective: Divided colostomy for anorectal management is often recommended due to reports of higher complications associated with loop colostomy. This study was conducted to compare outcomes and complications in colostomies in children with anorectal malformations according to type and level of colostomy. Materials and Methods: A retrospective study was performed in children with anorectal malformations who underwent a colostomy at Siriraj Hospital between December 2003 and June 2018. Results: Out of 167 patients, 159 had a loop colostomy while 8 had a divided colostomy. Overall complication rates were 33.3% for loop colostomy and 62.5% for divided colostomy (p = 0.100). Urinary tract infection was the most frequently encountered complication in both loop and divided colostomies, at 23.7% and 50%, respectively (p = 0.094). The prolapse rate in the loop colostomy group was 8.8 % and 0% in the divided colostomy group (p = 0.376). Overall complication rates with respect to location of stoma also did not differ (p = 0.706). Prolapse rates were 15.8 % in transverse colostomy and 7.1 % in sigmoid colostomy (p = 0.231). Overall complications rates of colostomy closure in loop and divided colostomy was 7.5% and 12.5%, respectively (p = 0.672). Non-inferiority was demonstrated by the differences in overall complications of loop and divided colostomy (p = 0.008). Conclusion: There was no difference in incidence of complications between type or location of colostomy performed in children with anorectal malformations. Loop colostomy was non-inferior to divided colostomy in respect to overall complications

Comparison between Anal Dilatation Protocols Following an Endorectal Pull-through for Hirschsprung Disease

Objective: The purpose of this study was to compare the mechanical obstruction rate following a transanal endorectal pull-through (TERPT) in patients with Hirschsprung disease, between regular anal dilatation (AD) and selective anal dilatation (NAD) which meant that dilatation was only performed when an obstructive symptom occurred. Materials and Methods: A retrospective chart review of patients with Hirschsprung disease who underwent TERPT/abdominal assisted TERPT at Siriraj Hospital between January 2009 and December 2021 was carried out. It was the surgeon’s preference that the dilatation protocols between the 2 groups (AD or NAD) were assigned. Mechanical obstructions included evidence of stricture, a clinical symptom of constipation, presence of Hirschsprung-associated enterocolitis (HAEC), and/or requirement of re-operation. Results: In total, 132 patients were included in this study, including 55 cases in the AD group (41.7%) and 77 cases in the NAD group (58.3%). Postoperative mechanical obstructions occurred in 84 patients (63.6%). Among the mechanical obstructions, there were 35 strictures (26.5%), 26 constipation (19.7%), 40 HAECs (30.3%), and 6 reoperation (4.5%). The mechanical obstruction rates in the AD [33/55 (60.0%)] and NAD [51/77 (66.2%)] groups were not significantly different (p = 0.582). The AD group was of a significantly younger age (p = 0.022) and lower body weight (p = 0.048) than the NAD group; however, a younger age and lower body weight were not significantly related with any of the obstructive complications. AD had a rate of anastomosis/cuff stricture [13/55 (23.6%)] similar to NAD [22/77 (28.6%)] (p = 0.665).

Incidence of Infection-related Complications and Optimal Saline Irrigation Volume for Preoperative Bowel Preparation to Reduce Postoperative Infections in Hirschsprung’s Disease

Objective: The purpose of this study was to find incidence of infection-related complications and the optimal volume and duration (days) of rectal NSS irrigation that would result in the low post-operative complications following transanal endorectal pull-through (TERPT) in patients with Hirschprung’s disease. Materials and Methods: We conducted a retrospective chart reviews of 131 patients diagnosed with Hirschsprung’s disease who underwent TERPT at Siriraj Hospital between January 2006 and December 2020. Results:  Infection-related complications were observed in 23(17.6%) patients, comprising 22(16.8%) cases of anastomotic strictures, 3(2.3%) cases of anastomotic leakages, and 2(1.5%) cases of intraabdominal collections. The median (Q1, Q3) volume of NSS irrigation (ml/kg/day) for those without complications (38.1 (33.9,50)) and those with complications (39.5 (35,45)) was statistically identical (p = 0.945). Similary, the median duration of for both groups was the same (p = 0.854). The mean (SD) volume of irrigated NSS in those with leakage (55.6 (32.7)) and those without leakage (44.3 (17.9)) showed no statistically significant difference (p = 0.291). Patients with post-operative stricture received the same amount of irrigated NSS (40.7 (11.9)) as those without stricture (45.4 (19.2)) (p = 0.138). Similarly, those with hyponatremia received the same amount of irrigated NSS as those without hyponatrema (p = 0.475). Conclusion: The volume of rectally irrigated NSS did not correlate with infection-related complications such as anastomotic leakage, stricture and intraabdominal collection. However, this study observed a low complication rate, thus, future research should cover a larger population

Prevalence and Factors Associated with Post-operative Strictures in Anorectal Malformations

Objective: Rectal strictures are a serious complication following operation for anorectal malformations (ARM). The purpose of this study was to determine the factors affecting rectal strictures following surgical treatments for ARM. Materials and Methods: Retrospective chart reviews of 204 patients with ARM who underwent surgical treatment at Siriraj Hospital between January 2003 and December 2019 were carried out. Results: Overall, the prevalence of post-operative rectal stricture was 19.6% (40/204). The higher types of ARM had higher rectal stricture rates.  In low type ARM, the stricture rate following surgery for perineal fistula, vestibular fistula was 4.1% and 14.7%, respectively. Recto-bulbar urethral fistula and recto-prostatic urethral fistula had stricture rates of 19.2% and 26.7%, respectively, but in higher types, the stricture rates were above 70%. Complications such as wound infection, dehiscence, retraction, colonic necrosis and recurrent fistula all affected the post-operative stricture rate (p = 0.029, p = 0.01, p = 0.01, p = 0.042 and p = 0.002, respectively). The operation for low type ARM using local tissue flap, such as YV and cutback anoplasty, had low complications. More complicated operations were performed for higher type ARM. The higher the complication rate, the higher the post-operative rectal stricture. Routine rectal dilatation by parents seemed to prevent rectal strictures (p = 0.056). The surgical treatments for rectal strictures composed of 57.5% anoplasty, 17.5% PSARP, 15% abdo-assisted pull-through and 10% abdo-assisted PSARP. Conclusion: Post-operative rectal stricture occurred because of complications following complicated operations for high type ARM. A meticulous operative technique is crucial

Comparison of a CO2 (Carbon Dioxide) Laser and Tissue Glue with Conventional Surgical Techniques in Circumcision

Introduction:  CO2 (Carbon Dioxide) laser application in circumcision, for cutting and coagulation, has been reported to have excellent results. Also, tissue glue has been reported to have advantages over sutures for approximation of wound edges. Most previous studies focused on comparisons between CO2 laser and scalpel, or between tissue glue and sutures. This study prospectively compared the results and complications CO2 laser and tissue glue, with standard surgical techniques in circumcision.Methods: Thirty boys were prospectively divided into two groups. Group 1 (n = 17) underwent circumcision by scalpel with approximation of the wound edges using chromic catgut sutures. Group 2 (n = 13) underwent circumcision with CO2 laser and approximation of the wound edges using tissue glue. Patient age, indications for surgery, operative time, wound swelling, bleeding, wound infection, local irritation, pain score, and cosmetic appearance were recorded.Results:  Group 1 had a significantly longer operative time (P= 0.011), higher rate of local irritation (P= 0.016), and poorer cosmetic appearance (P< 0.001) than group 2. Bleeding only occurred in one patient in group 1. There were no significant differences in pain score, wound infection rate, or cost of surgery between the two groups.Conclusions:  CO2 laser and tissue glue have advantages over standard surgical techniques in circumcision, with a significantly shorter operative time, lower rate of local irritation, and better cosmetic appearance. The cost of surgery is similar between the two groups

Blunt Abdominal Injury in Suspected Child Abuse Patients: A Three-Case Report

Objective: To identify characteristics associated with suspected child abuse in the setting of blunt abdominal trauma. Methods: Retrospective review. Results: Three cases of blunt abdominal injury caused by suspected abusive force admitted in Siriraj Hospital between May 2001 and July 2006 are reviewed. The first case is a six-year old boy who had liver laceration grade III at segment II and III. The history of trauma was refused by his parents initially. At last, the patient confessed that he was hit by the mother’s boy friend. The second case is a-10-month old girl who was operated for traumatic rupture in the 3rd part of the duodenum (90% circumference) as well as hematoma at the root of mesentery and ligament of Trietz following shopping with her family without history of traumatic event. Chest X-ray showed multiple old fractures at left posterior 6th, 7th, 8th ribs as well as a callus formation at the costochondral junction of the right 7th rib. Bone survey also demonstrated laminated periosteal reaction of the right tibia from previous fracture. The third case is a 3-year-old boy with intramural duodenal hematoma located between the 2nd part of the duodenum and the D-J junction. The patient told that he was stepped upon during lying down by his grandmother who has abused him many times before. Conclusion: Child abuse is suspected in a case of conflict between physical examination findings and history of the accidental events, especially physically damage than the mechanism of injury. The patterns of inflicted injury are also discussed in this publication. Injury to the duodenum is unusual in the pediatric trauma patients but more commonly is the result of child abuse. Diagnosis and treatments of various types of duodenal injury including intramural duodenal hematoma are elucidated in this article