Laparoscopic Approach to Colonic Perforation due to Colonoscopy

Background  

Iatrogenic perforation due to colonoscopy is the most serious complication of this procedure. Usually, resolution of this event requires segmental resection. The laparoscopic approach could be an option to minimize the outcome of this complication. The aim of the present study was to assess the effectiveness of the laparoscopic approach in treating colonic perforations due to colonoscopy.     

Induction of ovulation with pulsatile GnRH: comparison between subcutaneous and intravenous administration in the same patients

In this study we compared the results obtained during GnRH pulsatile therapy for ovulation induction in the same patients receiving successively GnRH by subcutaneous (10 mcg/90') and intravenous route (2.5 or 5 mcg/90'). Our data suggest that intravenous administration is the most effective procedure for restoring fertility, either in terms of hormonal levels (oestradiol and gonadotropin peaks) or ovulation rate (100% of ovulatory cycles on GnRH treatment versus 25% on subcutaneous administration). With regard to intravenous GnRH therapy, the dose of 2.5 mcg/90' may be more advisable and safe from ovarian overstimulation.     

Effect of a single dose of pamidronate administered at the time of surgery in a rabbit posterolateral spinal fusion model

Spinal fusion is usually performed on patients who receive bisphosphonates (BP); however, limited data on their action on spinal fusion are available. Previous studies in animal models have shown that chronic administrations of BP reduced spinal fusion rates, and only one study has shown that a single dose administration of zolendronic acid increased fusion rate. The objective of the present study was to evaluate if pamidronate (PA), which was previously demonstrated to reduce spinal fusion rate when administered continuously for 8 weeks, would increase the spinal fusion rate if administered in a single dose at the time of surgery in a rabbit model. Thirty-two New Zealand rabbits underwent an L5–L6 posterolateral intertransverse fusion with iliac crest autograft. Animals were randomized to receive either PA 3 mg/kg in a single dose immediately after surgery, or normal saline. Animals were killed 8 weeks after surgery and fusion was determined by manual palpation and radiographic analysis. Fusion healing was obtained in eight rabbits (50%) in the PA group and in four animals (25%) in the control group, p = 0.137. In a rabbit model, a single dose of PA did not decrease lumbar spinal arthrodesis consolidation rates, but it obtained a nonsignificant higher spinal fusion rate.     

Alcohol Abstinence and Orthotopic Liver Transplantation in Alcoholic Liver Cirrhosis

Patients diagnosed with acute alcoholic hepatitis (AAH) are routinely managed medically and not considered suitable for orthotopic liver transplantation (OLT). The eligibility for OLT in these patients has been questioned due to the social stigma associated with alcohol abuse, based on the fact that AAH is “self-induced” with an unacceptably high recidivism rate. Many centers in Europe and the United States require abstinence periods between 6 and 12 months before OLT listing. AAH outcomes in the literature are poor, in particular due to patient noncompliance during the immediate 3 months preceeding OLT. Between January 1997 and December 2007, 246 patients were evaluated in our center for alcoholic liver disease: 133 (54%) were listed for OLT (I-OLT), including 110 (83%) who underwent transplantation and 8 (6%) still listed as well as 15 (11%) removed from consideration. One hundred thirteen (46%) patients had no indication for OLT (NO I-OLT), including 18 (16%) who died, 81 (71%) still monitored, and 14 (12%) lost to follow-up. Patient survival rates post-OLT were 79%, 74%, 68%, and 64% at 1, 3, 5, and 10 years, respectively. Explant (native liver) pathologic examination revealed AAH in 8 (7.2%) patients who underwent OLT. In this group, patient survival and the post-OLT recidivism rate were statistically identical to the overall group of transplant recipients.     

Laparoscopic-assisted proctocolectomy using complete intracorporeal dissection

Purpose Although many studies have demonstrated good results using laparoscopic proctocolectomy in patients with ulcerative colitis (UC), most surgical procedures require at least one additional incision larger than 5 cm to complete the surgery. The aim of this study was to evaluate the use of laparoscopic proctocolectomy with ileoanal J pouch, with a complete intracorporeal dissection using a 4–5 cm right lower quadrant (RLQ) incision. Methods Data were collected prospectively from all patients with UC that were subjected to a proctocolectomy with ileoanal J pouch between August 2003 and December 2006. The dissection was performed completely by laparoscopy using a medial–lateral approach for the colon and a total mesorectal excision for the rectum. Once the rectum was resected laparoscopically, a 4–5 cm incision in the RLQ was performed to resect the specimen and then an end or a loop ileostomy was implanted at the RLQ wound. The surgery was performed in two (proctocolectomy with ileoanal J pouch and loop ileostomy) or three steps (subtotal colectomy and end ileostomy with sigmoid fistula; proctectomy with ileoanal J pouch; and loop ileostomy). Results A total of 47 surgical procedures were performed in 32 patients with a mean age of 34.5 ± 15.7 years, of which 56% were male. The mean body mass index was 21 ± 16 kg/m²; 50% of patients underwent surgery in two steps and the other 50% in three steps. Surgery was converted in five (10.6%) cases due to megacolon in one case, narrow pelvis in two, and difficult rectal dissection in two; the overall morbidity rate was 14.9%. Two patients required reoperation and no mortality was registered. The mean operative time was 248 ± 62 min; proctocolectomy 292 ± 61 min, subtotal colectomy 203 ± 43 min, and proctectomy 248 ± 47 min. The mean hospital stay was 4.8 ± 1.9 days, and the mean interval time to close loop ileostomies was 64 ± 12 days. Conclusions A complete laparoscopic proctocolectomy dissection is feasible and safe for surgical treatment of UC.     

Pathogenic bacteria associated with oysters (Crassostrea brasiliana) and estuarine water along the south coast of Brazil

Oysters and estuarine water samples were collected monthly, from June 1998 to March 1999, in the Cananéia estuary, on the south coast of São Paulo, Brazil, and analyzed for bacterial hazards with and without depuration in filtered estuarine water. Aeromonas spp., Plesiomonas shigelloides, Vibrio cholerae O1, Vibrio parahaemolyticus, and Vibrio vulnificus were counted in oyster samples using the most probable number (MPN) and their presence verified in the surrounding estuarine water samples. The presence of Salmonella, Shigella, Escherichia coli O157:H7, and fecal coliforms counts were determined in oysters and in water samples too. Sixty percent of water samples contained fecal coliforms ranging from <1 to >200 CFU/100 ml and 100%, 30%, 20% and 10% were positive for V. parahaemolyticus, Salmonella, Aeromonas, and V. vulnificus in 5 l of water samples, respectively. In oyster samples, the fecal coliforms concentration ranged from <3.0 to ≥2.4 × 10³ MPN/g in 40% of untreated and from <3.0 to 1.1 × 10³ MPN/g in 40% of treated samples. Vibrio parahaemolyticus Kanagawa-negative was detected in all oyster samples and their concentration varied from 3.6 to ≥2.4 × 10³ MPN/g. For the untreated oyster samples 80%, 70%, and 10% were positive for V. vulnificus (<3 – 11.0 MPN/g), Aeromonas (<3 – 15 MPN/g), and Salmonella (presence in 25 g), respectively. However, for treated oyster samples 60%, 30%, and 0% of them contained the same bacteria, respectively. Escherichia coli O157:H7, Shigella spp., P. shigelloides, and V. cholerae O1 were not detected in any of the samples. Fecal indicators did not correlate with Vibrio presence (p>0.05), although the isolation of Aeromonas species had a positive correlation (p = 0.017). The results showed no correlation between temperature, salinity, and bacteria (p > 0.05). The comparison between bacterial concentration in treated and untreated oyster samples, showed that only Aeromonas was higher in untreated oyster samples (p = 0.039). This study contributes toward creating a more global understanding of food-borne bacterial pathogens. The presence and concentration of viable bacterial hazards in oysters and water surrounding areas was determined for the first time on the south coast of São Paulo and it helps to define better the true microbial hazard in the aquatic environment and oysters.