Acute mesenteric ischemia of arterial origin: importance of early revascularization

GOAL: The goal of our study was to show that survival was better when early revascularization was performed rather than gastrointestinal resection in the management of acute mesenteric ischemia of arterial origin. METHODS: The reports of patients managed in our center between January 2005 and May 2012 for acute mesenteric ischemia of arterial origin were analyzed retrospectively. Data on clinical, laboratory and radiologic findings, the interval before treatment, the operative findings and the surgical procedures were collected. Follow-up information included the postoperative course, and mortality at 48 h, 30 days and 1 year, the latter being compared between patients undergoing revascularization versus gastrointestinal resection. RESULTS: Of 43 patients treated during this period, 20 had gastrointestinal lesions deemed to be beyond all therapeutic resources, 13 were treated with gastrointestinal resection without revascularization, while 10 underwent early revascularization. There were no statistically significant differences found in the extent of involvement between the two groups (P=0.22). Mortality at 48 h, 30 days and 1 year was 8% (n=1), 30% (n=4) and 68% (n=8) in patients who underwent enterectomy vs. 0% (n=0), 0% (n=0) and 10% (n=1) in patients who underwent revascularization procedures. The difference at 1 year was statistically significant (P=0.02). At 1 year, two patients in the revascularized group had a short bowel syndrome vs. one in the non-revascularized group. CONCLUSION: Acute mesenteric ischemia of arterial origin is associated with high morbidity and mortality. Optimal management should include early revascularization

Duplication of the Gallbladder. A Case Report

Gallbladder duplication is a rare anatomic malformation, which can now be detected by preoperative imaging study. We report a case of a symptomatic duplicated gallbladder, successfully treated by laparoscopic cholecystectomy. This anomaly is important to know for surgeons because of associated anatomical variations of main bile duct and hepatic artery and increased risk of common bile duct injury

An elevated level of TSH might be predictive of differentiated thyroid cancer

Suppression therapy of thyreostimulin (TSH) using thyroid hormones improves survival of subjects operated for differentiated thyroid cancer. The TSH level might be different depending on the type of nodule. The objective of this study was to compare retrospectively the TSH level between two groups of subjects who underwent total thyroidectomy for a nodule, matched on sex, ethnicity, age and biological method of TSH measurement, one whose final histology was benign and one malignant. There was no significant difference between the two groups in terms of age, sex, family history of thyroid disease or thyroid autoimmunity. The subjects, whose final histology was malignant, had a mean TSH level significantly higher than subjects with benign disease (1.55 mU/l versus 0.96 mU/l, P=0.003). Cancer risk was greater when the TSH was in the upper tertile of normal range. There was no correlation between the risk of thyroid cancer and age, sex, family history of thyroid disease, or menopausal status. The relative risk of having thyroid carcinoma was higher when the margins of nodules were blurred or in the presence of microcalcifications. These data confirm a trend toward baseline values of TSH higher in subjects with a thyroid-differentiated cancer. However, we could not define a preoperative threshold that would reliably determine the malignant or benign nature of the nodule

Should pancreaticoduodenectomy be performed in the elderly?

BACKGROUND/AIMS: Pancreaticoduodenectomy (PD) is indicated in benign or malignant pancreatic head diseases. It is a difficult operation with high morbidity especially in elderly patients. The aim of our study was to determine whether pancreaticoduodenectomy is associated with higher morbidity and mortality in patients ≥ 70 years old. METHODOLOGY: During 17 years, 173 patients were operated by Whipple intervention, whatever the disease. From a prospective database, patients were divided in 2 groups (Group A ≥ 70 years old, Group B <70). RESULTS: Postoperative mortality was not significantly higher in elderly (12% vs. 4.1%; p=0.06). However, re-intervention and morbidity were more important in univariate analysis (p=0.03 and p=0.002 respectively). In multivariate analysis, age ≥ 70 years old was not an independent prognostic factor of mortality (p=0.27) and re-intervention (p=0.07). Whereas age (p=0.04) and preoperative morbidity (p=0.02) were independent prognostic factors of morbidity. CONCLUSIONS: PD requires careful patient selection. However, age should not be a limiting factor

Metabolomic Biomarkers of Prostate Cancer: Prediction, Diagnosis, Progression, Prognosis, and Recurrence

Metabolite profiling is being increasing employed in the study of prostate cancer as a means of identifying predictive, diagnostic, and prognostic biomarkers. This review provides a summary and critique of the current literature. Thirty-three human case-control studies of prostate cancer exploring disease prediction, diagnosis, progression, or treatment response were identified. All but one demonstrated the ability of metabolite profiling to distinguish cancer from benign, tumor aggressiveness, cases who recurred, and those who responded well to therapy. In the subset of studies where biomarker discriminatory ability was quantified, high AUCs were reported that would potentially outperform the current gold standards in diagnosis, prognosis, and disease recurrence, including PSA testing. There were substantial similarities between the metabolites and the associated pathways reported as significant by independent studies, and important roles for abnormal cell growth, intensive cell proliferation, and dysregulation of lipid metabolism were highlighted. The weight of the evidence therefore suggests metabolic alterations specific to prostate carcinogenesis and progression that may represent potential metabolic biomarkers. However, replication and validation of the most promising biomarkers is currently lacking and a number of outstanding methodologic issues remain to be addressed to maximize the utility of metabolomics in the study of prostate cancer.National Institutes of Health (U.S.) (Grant P01 CA055075)National Institutes of Health (U.S.) (Grant CA133891)National Institutes of Health (U.S.) (Grant CA141298)National Institutes of Health (U.S.) (Grant CA136578)National Institutes of Health (U.S.) (Grant UM1 CA167552

Rectal metastasis of prostate cancer: about a case

Prostate adenocarcinomas present a high risk of metastasis. We report a case of an atypical prostate cancer metastasis. A male patient presented a prostatic adenocarcinoma treated by surgery. A biological recurrence was discovered during the follow-up by an increased rate of Prostate Specific Antigen (PSA) and was treated by hormonotherapy. Several months later, there was a re-increase of the PSA rate. The CT scan showed a radiation proctitis aspect. An intermittent hormonotherapy was decided. Six months later, he presented abdominal pain. Examinations were performed and showed a rectal carcinosarcoma with prostate origins. A surgical management was realised. The outcomes were an early recurrence. A symptomatic treatment was decided. There are not any rectal localisations reported in the literature. Only loco-regional invasions of the rectum are described and no histological modification of metastasis compared to the primitive tumor has been reported. So, we report a metastasis of a prostate adenocarcinoma which transformed into a carcinosarcoma. KEYWORDS: Adenocarcinoma; Carcinosarcoma; Metastasis; Prostate; Rectal neoplasm

prebiotics offered to broiler chicken exert positive effect on meat quality traits irrespective of delivery route

Elimination of antibiotic growth promoters from poultry production has encouraged intensive search for relevant alternatives. Prebiotics are proposed as efficient replacements to stimulate colonization/expansion of beneficial microflora in chickens. The aim of this study was to deepen the knowledge on the effect of prebiotic administration on slaughter performance and meat quality traits of broiler chickens by evaluating different routes of their delivery (in ovo vs. in-water vs. in ovo + in-water). At d 12 of incubation, 1,500 eggs (Ross 308) containing viable embryos were randomly allotted into 4 groups and injected in ovo with 0.2 mL solution containing: 3.5 mg/embryo BI (Bi²tos, trans-galactooligosaccharides); 0.88 mg/embryo DN (DiNovo, extract of Laminaria spp.); 1.9 mg/embryo RFO (raffinose family oligosaccharides) and 0.2 mL physiological saline (C). All prebiotics increased final BW compared to C group (P < 0.01), irrespective of delivery route. The prebiotics injected in ovo (T1) or in ovo combined with in-water supplementation (T2) increased carcass weight as compared with in-water group (T3), while T3 had the lowest carcass yield compared to the other groups. All prebiotics increased breast muscle weight and yield (P < 0.01), as well as fiber diameter (P < 0.05). Ultimate meat pH was lower (P < 0.01) in T3 than in T2 group. Meat from chickens treated with prebiotics showed a lower redness index, while lightness and yellowness were not affected by the treatments. Saturated fatty acid (SFA), polyunsaturated fatty acid (PUFA) and n-3 fatty acids contents were higher (P < 0.01), and monounsaturated fatty acid (MUFA) level was lower (P < 0.01) in prebiotic groups compared with C group. Nutritional indexes (n-6/n-3, PUFA/SFA ratio and thrombogenic index) displayed favorable human health-promoting values in the meat of chickens which were treated with prebiotics, irrespective of delivery route. Muscle cholesterol content was not affected by prebiotics. In conclusion, this study has shown that prebiotics can exert positive effects on growth of broiler chickens, carcass and meat quality traits, irrespective of delivery route

NEW SECONDARY METABOLITES IN THE AMPHINOMID FIREWORM HERMODICE CARUNCULATA

Eight betaine-derived novel compounds were found in extracts of the Mediterranean stinging fireworm Hermodice carunculata. The identification of their structures relies on 1D and 2D NMR (Fig. 1-3) and HPLC-ESI/HRMS spectra. Two types of terminal ammonium portions A and B and a series of different alkyl chains were identified (Fig. 4a,b). Their matching provides the structures of uncharacterized secondary metabolites, named carunculines, and their related isomers. These molecules differ from already known trimethylammonium inflammatory compounds (i.e. complanines) isolated from another amphinomid species, for the structures of the terminal ammonium groups (Fig. 4c) [1]. Carunculine anatomical distribution within H. carunculata was assessed by screening through HPLC-ESI/HRMS (Fig. 5, Table 1): their occurrence was revealed in all the body parts analyzed, both involved in predator-prey interactions [2], and mainly in the digestive apparatus. The results achieved reveal an array of different novel compounds from a chemically unknown species, improving knowledge on Marine Animal Products with chemical and biological potential for bioprospection [3]. Overall, these data reinforce the necessity of studying poorly-investigated taxa to expand knowledge on animal venom biology, their mechanisms of action and exploitation as promising source of drug molecule