Laparoscopic surgery in situs inversus: a literature review and a report of laparoscopic sigmoidectomy for diverticulitis in situs inversus

Background Situs inversus (SI) is a rare autosomal recessive congenital defect in which the position of abdominal and/or thoracic organs is a mirror image of the normal one, in the sagittal plain. In 25% of these cases, SI is part of the Kartagener syndrome, together with bronchiectasis and chronic sinusitis.Methods We present a case of a patient with Kartagener syndrome and complete SI that was laparoscopically operated on for diverticulitis. We also review the published English information available on this rare condition.Results A review of the literature revealed another single case of laparoscopic sigmoidectomy and 27 cases of other laparoscopic interventions in the presence of SI. Those laparoscopic procedures included basic procedures such as explorations and cholecystectomies, as well as advanced procedures such as gastrectomy and gastric bypass.Conclusion The laparoscopic approach is feasible in cases of SI, although technically more complicated because of the different position of the organs and the different laparoscopic view of the anatomy.     

Maternal adaptive immunity influences the intestinal microflora of suckling mice

The microflorae in the intestine of breast-fed infants are distinct from those that typically populate the intestine of formula-fed infants. Although the acquisition of passive immunity through breast-feeding may play a critical role in influencing the pattern of bacterial colonization of the gut, the precise mechanisms underlying the differences in the commensal microflorae of breast and formula-fed children have not been established. We hypothesized that the assemblage of commensal microflorae in suckling and weaned mice may be influenced by the maternal adaptive immune system. To test this hypothesis, we analyzed the intestinal microflorae of mice reared in the presence (wild-type) or absence of an intact maternal immune system (T- and B-cell deficient). Several types of bacteria (Lactobacillus, Enterococcus, Clostridium perfringens, Bifidobacterium, and Bacteroides) were isolated and enumerated from both the small and large intestine of 10-, 18-, 25- and 40- to 60-d old mice using selective media. The densities of bacteria were significantly lower in the small intestine of weaned mice that were reared by wild-type (WT) compared with immunodeficient (ID) dams. However, the microflorae were generally more abundant in the large intestine of suckling pups reared by WT compared with ID dams. Our results indicate that intestinal microflorae change throughout the suckling phase of development and that the maternal adaptive immune system influences the pattern and abundance of bacteria within the gut in an age- and site-specific manner.     

Involvement of betamimetics in increased survival during fetal surgery in sheep

Fetal surgery is a therapeutic reality. Available only in a few centres worldwide. Experimental animal models are needed to continue research in this field. The target problem being the control of preterm labour.     

Weissella confusa infection in primate (Cercopithecus mona)

We describe systemic infection by Weissella confusa in a mona monkey (Cercopithecus mona) on the basis of microbiologic, molecular genetic, and histologic data. The same strain of W. confusa, as determined by pulsed-field gel electrophoresis, was isolated in pure culture from the primate’s brain, liver, spleen, and intestine. Histologic lesions showed inflammatory infiltrates mainly composed of neutrophils, indicating an acute septicemic process.Weissella microorganisms are gram-positive, catalase-negative coccobacilli, which have been isolated from a wide variety of habitats such as soil, fresh vegetables, fermented foods, or meat and meat products (1,2). The genus Weissella is peculiar since it currently includes 11 validated species, but only Weissella confusa (basonym Lactobacillus confusus) and W.eissella cibaria have been isolated from human or animal clinical sources. W. cibaria has been isolated from human bile and feces, the liver of a canary, and ear samples from a dog (1). W. confusa has been isolated from feces of children with bacteremic infections (3) and liver transplants (4), and from the peritoneal fluids and abdominal walls of two patients (5). In animals, W. confusa has been isolated from necropsy specimens from a dog and from the ear of a dog with otitis (1). However, with the exception of a thumb abscess caused by W. confusa in a healthy 49-year-old man (6), the clinical significance of all other clinical isolates was not clearly established. This article describes the first well-documented systemic infection caused by W. confusa in a primate.     

Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring

Multichannel intraluminal impedance (MII) is a new technique for evaluating esophageal function and gastroesophageal reflux. This technique depends on changes in resistance to alternating current between two metal electrodes produced by the presence of bolus inside the esophageal lumen. Combined MII and manometry (MII-EM) provides simultaneous information on intraluminal pressure changes and bolus movement, whereas combined MII and pH (MII-pH) allows detection of pH episodes irrespective of their pH values (ie, acid and non-acid reflux). Combined MII-EM studies are performed very similarly to standard manometry. Based on studies in healthy volunteers and patients, combined MII-EM challenges current existing criteria that define the effectiveness of esophageal body function. Combined MII-pH testing brings a shift in gastroesophageal reflux testing paradigm. In MII-pH studies, reflux events are no longer detected by pH. Refluxate presence, distribution, and clearing are primarily detected by MII and simply characterized as acid versus non-acid based on pH change and as liquid, gas, or mixed based on MII. MII determines refluxate clearance time, whereas pH measures acid clearance time. MII-pH shows promise to become an important clinical tool, particularly to assess gastroesophageal reflux in the postprandial period and in patients with persistent symptoms on therapy and with atypical symptoms.