Primary amyloidosis with initial gastrointestinal manifestation. A case report

Introduction. Amyloidosis is a rare disease associated with extracellular accumulation of abnormal protein – amyloid in various organs and systems. This disease can be either acquired or hereditary, systemic or localized. At its core, it represents a grown, tumor-like neoplastic clone of the plasma cells in the bone marrow. Gastrointestinal amyloidosis is manifested by symptoms, such as diarrhea, steatorrhea, constipation, and very rarely – hemorrhages and perforations of the colon. Case presentation. We present a case of primary intestinal amyloidosis with recurrent hematochezia and abdominal pain in a 61-year-old woman. Colonoscopy revealed polyposis of the whole colon and a total colectomy was performed, followed by morphological and paraclinical examinations. Histologically, amyloid deposition, positive for Congo red, was found in the walls of the submucosal blood vessels and in the smooth muscle cells of the muscular layers. The laboratory tests indicated anemia, high erythrocyte sedimentation rate, and Bence-Jones proteins in urine. Conclusions. Our case is a demonstration of primary amyloidosis with intestinal localization that should be taken into consideration in the presence of recurrent hematochezia

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Heart: SEM of microvascular corrosion casting of feline models

Introduction: Scanning electron microscopy (SEM) of corrosion vascular casts of the heart allows morphological and anatomical three dimensional observations and description of the distribution, diameter and internal surface of the collected replicas. SEM method gives quantitative information for the vascularization.Aim: To investigate the microcirculatory bed of the heart in experimental feline models by SEM of corrosion vascular casts.Materials and methods: Polymerized vascular casts with following corrosion of the heart have been obtained from 14 sexually mature tomcats (Felis silvestris catus) with body weight from 2.9 kg to 4.0 kg. The obtained microvasculature replicas have been studied by SEM.Results: In the proventricular myocardium of the feline models, the capillaries are relatively S-like curved, equally distributed and form network-like structures with predominant Y-like anastomoses. In the ventricular myocardium the capillaries are grouped in tufts and form between themselves and Y-type anastomoses, as predominate these of H type.Conclusion: This finding gives us to make a motivation, regarding the hemodynamics that the observed morphological features are extremely beneficial to provide a steady and permanent blood flow, which itself favors the metabolic and gas exchange

Imaging modalities for investigation of the rabbit liver anatomy

In the modern world of science and practice the non-invasive imaging methods are included in anatomical investigation of the liver. Data concerning the rabbit liver imaging anatomical features are scarce and contradictory. The classical anatomical data are also object of discussion. There are two theories which interpret the lobar division of the rabbit liver. The anatomical images by 2D ultrasonography of the rabbit liver were in different planes. The rabbit liver was composed of five lobes. The histosonographic results demonstrated correspondence between the brightness and sharpness of the organ`s images and its histological features. 2D ultrasound study was compared to 3D ultrasound investigation. The visualization of the organ demonstrated a well visible right hepatic lobe, as the left one was subdivided into lateral and medial. The rabbit liver was visualized in three geometric planes. By color Doppler ultrasound, we obtained anatomical information in real time, which gave data for topography of the rabbit liver blood and biliary vessels, connected to variations of the color Doppler spectrum from blue to red gamma. The images of the organ at CT were anatomical scans in transverse, dorsal and sagittal planes. By axial CT study the anatomical data presented topographic features of the organ. Metric information for the size of the organ was collected. By helical CT the information was with higher value and presented the density of the liver lobes and gall bladder in Hounsfield units. The MRI images were in voxel based matrix. T2 sequence was suitable for transversal and sagittal anatomical study of the rabbit liver and its closeness to adjacent organs. T1 was used to study the organ in dorsal plane, because it gave better tissue contrast to rabbit liver toward the close structures from cranial abdominal region

Der Meister in Industrie-4.0-Fabriken

Im Rahmen des Projekts JUMP 4.0 wurden unternehmensspezifische Szenarien erstellt, die den Anwendungspartnern als Orientierungshilfe im Umfeld der Digitalisierung der Arbeit dienen. Aus den Ergebnissen wurden branchenübergreifende Szenarien für die Arbeit in produzierenden KMU abgeleitet. Im Einzelnen sind dies das Individualisierungsszenario, das Hardware-/Technologieszenario sowie das Digitalisierungsszenario. Zudem unterliegt auch das Rollenbild des Meisters deutlichen Veränderungen. Experten der Partnerunternehmen erwarten in Zukunft eine noch stärker ausgeprägte Schnittstellenfunktion und mehr Verantwortung, vor allem in der Führung, Qualifizierung und Weiterentwicklung der Mitarbeiter. Speziell für die Rolle des Meisters als Verantwortlicher für die Planung und Ausgestaltung der Qualifizierung und Weiterentwicklung der Mitarbeiter im Sinne der Unternehmensstrategie wurde im Projekt eine prozessbasierte Qualifikationsmatrix erstellt und in den JUMP Planner integriert. Unabhängig davon formuliert Prof. Dr. Hirsch-Kreinsen in seinem Gastbeitrag vier Szenarien, in denen der Meister jeweils die Rolle eines Personalmanagers (Substitution), Prozessmanagers (Upgrading) oder eines digitalen Meisters (Polarisierung) einnimmt bzw. der Meister von der Bildfläche verschwindet (Flexibilisierung/Entgrenzung)