RESUMEN
Mesenteric arteriovenous vasculopathy (MAVD/V) is an extremely rare and poorly understood disease and its incidence is probably underestimated. It is an uncommon, non-inflammatory and non-atherosclerotic form of mesenteric vascular injury, first reported in 2016, with characteristic histopathologic evidence of fibromuscular dysplasia-like vascular changes. We present the case of a chronically ill 84-year-old female with a 5 year history of recurrent small bowel obstruction, who underwent segmental resection of the small bowel. Intraoperative examination showed bowel stricture with fibrosis, intraluminal pill fragments and creeping mesenteric adipose tissue clinically compatible with Crohn's disease. Histological examination showed acute and chronic mucosal injury characterized by crypt distortion, ulcerations with granulation tissue, pseudo-pyloric metaplasia, areas of fibrosis and serosal adhesions. Multiple blood vessels (including both veins and arteries) demonstrated wall hyalinization, elastic degeneration and non-atherosclerotic luminal occlusion. The pattern of the mucosal injury is, in this case, potentially a consequence of acute and chronic ischemic processes secondary to mesenteric arteriovenous vasculopathy.
Asunto(s)
Malformaciones Arteriovenosas/patología , Enfermedad de Crohn/patología , Mesenterio/irrigación sanguínea , Tejido Adiposo/patología , Anciano de 80 o más Años , Arterias/anomalías , Arterias/patología , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/patología , Diagnóstico Diferencial , Femenino , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/patología , Intestino Delgado/cirugía , Mesenterio/patología , Tomografía Computarizada por Rayos X , Venas/anomalías , Venas/patologíaRESUMEN
Introduction Enhanced recovery programmes have been established in some areas of elective surgery. This study applied enhanced recovery principles to elective oesophageal and gastric cancer surgery. Methods An enhanced recovery programme for patients undergoing open oesophagogastrectomy, total and subtotal gastrectomy for oesophageal and gastric malignancy was designed. A retrospective cohort study compared length of stay on the critical care unit (CCU), total length of inpatient stay, rates of complications and in-hospital mortality prior to (35 patients) and following (27 patients) implementation. Results In the cohort study, the median total length of stay was reduced by 3 days following oesophagogastrectomy and total gastrectomy. The median length of stay on the CCU remained the same for all patients. The rates of complications and mortality were the same. Conclusions The standardised protocol reduced the median overall length of stay but did not reduce CCU stay. Enhanced recovery principles can be applied to patients undergoing major oesophagogastrectomy and total gastrectomy as long as they have minimal or reversible co-morbidity.
Asunto(s)
Adenocarcinoma/cirugía , Procedimientos Quirúrgicos Electivos , Neoplasias Esofágicas/cirugía , Esofagectomía , Gastrectomía , Atención Perioperativa/métodos , Neoplasias Gástricas/cirugía , Adenocarcinoma/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Protocolos Clínicos , Procedimientos Quirúrgicos Electivos/mortalidad , Neoplasias Esofágicas/mortalidad , Esofagectomía/mortalidad , Femenino , Estudios de Seguimiento , Gastrectomía/mortalidad , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Atención Perioperativa/normas , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Neoplasias Gástricas/mortalidad , Resultado del TratamientoRESUMEN
BACKGROUND: Recent interest has focused on the role of perioperative epidural analgesia in improving cancer outcomes. The heterogeneity of studies (tumour type, stage and outcome endpoints) has produced inconsistent results. Clinical practice also highlights the variability in epidural effectiveness. We considered the novel hypothesis that effective epidural analgesia improves cancer outcomes following gastro-oesophageal cancer surgery in patients with grouped pathological staging. METHODS: Following institutional approval, a database analysis identified 140 patients, with 2-year minimum follow-up after gastro-oesophageal cancer surgery. All patients were operated on by a single surgeon (2005-2010). Information pertaining to cancer and survival outcomes was extracted. RESULTS: Univariate analysis demonstrated a 1-year 14% vs. 33% (P = 0.01) and 2-year 27% vs. 40% [hazard ratio (HR)=0.59; 95% CI, 0.32-1.09, P = 0.087] incidence of cancer recurrence in patients with (vs. without) effective (> 36 h duration) epidural analgesia, respectively. Multivariate analysis demonstrated increased time to cancer recurrence (HR = 0.33; 95% CI: 0.17-0.63, P < 0.0001) and overall survival benefit (HR = 0.42; 95% CI: 0.21-0.83, P < 0.0001) at 2-year follow-up following effective epidural analgesia. Subgroup analysis identified epidural-related cancer recurrence benefit in patients with oesophageal cancer (HR = 0.34; 95% CI: 0.16-0.75, P = 0.005) and in patients with tumour lymphovascular space infiltration (LVSI), (HR = 0.49; 95% CI: 0.26-0.94, P = 0.03). Effective epidural analgesia improved estimated median time to death (2.9 vs. 1.8 years, P = 0.029) in patients with tumour LVSI. CONCLUSIONS: This study found an association between effective post-operative epidural analgesia and medium-term benefit on cancer recurrence and survival following oesophageal surgery. A prospective study that controls for disease type, stage and epidural effectiveness is warranted.
Asunto(s)
Analgesia Epidural , Neoplasias Esofágicas/prevención & control , Neoplasias Esofágicas/cirugía , Recurrencia Local de Neoplasia/prevención & control , Neoplasias Gástricas/prevención & control , Neoplasias Gástricas/cirugía , Anciano , Neoplasias Esofágicas/epidemiología , Esófago/patología , Esófago/cirugía , Femenino , Estudios de Seguimiento , Gastrectomía , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estómago/patología , Neoplasias Gástricas/epidemiología , Análisis de SupervivenciaRESUMEN
BACKGROUND: The National Institute for Clinical Excellence (NICE) guidelines of 2002 recommended the use of ultrasound (US) for central venous catheterization in order to minimize complications associated with central line placement. An ongoing audit of line placement by anaesthetists in the theatre complex of a tertiary referral centre looked at the associated complication rates. The objective of the study was to compare complication rates pre- and post-implementation of NICE guidelines. METHODS: This prospective, single centre audit looked at all patients in whom a central venous catheter was placed for surgery. Complication rates were assessed for procedures that were performed pre- and post-implementation of NICE guidelines. In total, 438 patients were identified for the study, and the procedures were performed either by trainee or by consultant anaesthetists. RESULTS: The pre- and post-implementation complication rates were 10.5% (16/152) and 4.6% (13/284), respectively, representing an absolute risk reduction of 5.9% (95% CI 0.5-11.3%). Comparison of those procedures in which US was used when compared with the landmark technique after implementation found a reduction of 6.9% in complications (95% CI 1.4-12.4%). The reduction in complication rates was larger for specialist registrars than for consultants (11.2% vs 1.6%). CONCLUSIONS: The implementation of NICE guidelines has been associated with a significant reduction in complication rates in our tertiary referral centre. In the light of the cross-speciality evidence of US superiority and our results, it is imperative that routine use of US guidance becomes more widespread.
Asunto(s)
Cateterismo Venoso Central/métodos , Guías de Práctica Clínica como Asunto , Ultrasonografía Intervencional , Cateterismo Venoso Central/efectos adversos , Medicina Basada en la Evidencia , Adhesión a Directriz/estadística & datos numéricos , Humanos , Londres , Auditoría Médica , Selección de Paciente , Estudios Prospectivos , Procedimientos Quirúrgicos OperativosRESUMEN
The lipase- and esterase-catalyzed acylations of hydroxylamine and hydrazine derivatives with octanoic acid and ethyl octanoate are described. The influence of solvent and nucleophile on the initial reaction rate was investigated for a number of free and immobilized enzymes. Initial rates were highest in water, but the overall productivity was optimal in dioxane. Octanoic acid (250 g/L) was converted for 93% into the hydroxamic acid in 36 h with only 1% (w/w) Candida antarctica lipase B (Novozym 435) in dioxane at 40 degrees C. This translates to a catalyst productivity of 68.5 g. g(-1). day(-1) and a space time yield of 149 g. L(-1). day(-1), unprecedented figures in the direct reaction of an acid with a nitrogen nucleophile in an organic solvent.
Asunto(s)
Biotecnología/métodos , Esterasas/metabolismo , Lipasa/metabolismo , Nitrógeno/metabolismo , Acilación , Candida/metabolismo , Carcinógenos/metabolismo , Hidrazinas/metabolismo , Hidroxilamina/metabolismo , Solventes , AguaRESUMEN
A previously undescribed species of hemolytic Actinobacillus was isolated from six waterfowl, three with periocular serous exudation and two with airsacculitis and bronchopneumonia. Cultural and biochemical characteristics were compared with those of Actinobacillus and Pasteurella spp, using a numerical technique.
Asunto(s)
Actinobacillus/aislamiento & purificación , Enfermedades de las Aves/microbiología , Actinobacillus/crecimiento & desarrollo , Actinobacillus/metabolismo , Animales , Aves , Bronconeumonía/microbiología , Bronconeumonía/veterinaria , Oftalmopatías/microbiología , Oftalmopatías/veterinaria , HemólisisAsunto(s)
Infecciones por Pasteurella/veterinaria , Yersinia/aislamiento & purificación , Absceso/microbiología , Absceso/veterinaria , Animales , Enfermedades de las Aves/microbiología , Aves , Carnívoros , Gansos , Enfermedades Intestinales/microbiología , Enfermedades Intestinales/veterinaria , Absceso Hepático/microbiología , Absceso Hepático/veterinaria , Ontario , Infecciones por Pasteurella/microbiología , Mapaches , Infecciones por Yersinia pseudotuberculosis/veterinariaAsunto(s)
Enfermedades de los Peces , Vibriosis/veterinaria , Pruebas de Aglutinación , Animales , Enfermedades de los Peces/inmunología , Enfermedades de los Peces/microbiología , Enfermedades de los Peces/patología , Peces , Agua Dulce , Cobayas , Vibrio/inmunología , Vibrio/aislamiento & purificación , Vibrio/patogenicidad , Vibriosis/inmunología , Vibriosis/microbiología , Vibriosis/patologíaRESUMEN
An epidemic of acute respiratory disease in a colony of CFE rats is described, the main laboratory findings are recorded and its aetiology discussed.The epidemic showed that severe respiratory disease varying from peracute to chronic was associated with infection of the lungs with a mycoplasma but that mycoplasmas could be present in rats, even in the lungs, without signs of disease, thus suggesting that one or more other factors were involved. It is also evident that there are strain differences in the susceptibility of rats to this disease.