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BACKGROUND: Mollusks display a striking morphological disparity, including, among others, worm-like animals (the aplacophorans), snails and slugs, bivalves, and cephalopods. This phenotypic diversity renders them ideal for studies into animal evolution. Despite being one of the most species-rich phyla, molecular and in silico studies concerning specific key developmental gene families are still scarce, thus hampering deeper insights into the molecular machinery that governs the development and evolution of the various molluscan class-level taxa. RESULTS: Next-generation sequencing was used to retrieve transcriptomes of representatives of seven out of the eight recent class-level taxa of mollusks. Similarity searches, phylogenetic inferences, and a detailed manual curation were used to identify and confirm the orthology of numerous molluscan Hox and ParaHox genes, which resulted in a comprehensive catalog that highlights the evolution of these genes in Mollusca and other metazoans. The identification of a specific molluscan motif in the Hox paralog group 5 and a lophotrochozoan ParaHox motif in the Gsx gene is described. Functional analyses using KEGG and GO tools enabled a detailed description of key developmental genes expressed in important pathways such as Hedgehog, Wnt, and Notch during development of the respective species. The KEGG analysis revealed Wnt8, Wnt11, and Wnt16 as Wnt genes hitherto not reported for mollusks, thereby enlarging the known Wnt complement of the phylum. In addition, novel Hedgehog (Hh)-related genes were identified in the gastropod Lottia cf. kogamogai, demonstrating a more complex gene content in this species than in other mollusks. CONCLUSIONS: The use of de novo transcriptome assembly and well-designed in silico protocols proved to be a robust approach for surveying and mining large sequence data in a wide range of non-model mollusks. The data presented herein constitute only a small fraction of the information retrieved from the analysed molluscan transcriptomes, which can be promptly employed in the identification of novel genes and gene families, phylogenetic inferences, and other studies using molecular tools. As such, our study provides an important framework for understanding some of the underlying molecular mechanisms involved in molluscan body plan diversification and hints towards functions of key developmental genes in molluscan morphogenesis.

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BACKGROUND: Outcome assessment after surgical treatment of intra-abdominal infections and pancreatic necrosis has concentrated on postoperative complications and survival, while long-term results have received little attention. OBJECTIVES: To evaluate hospital costs and long-term outcome for patients undergoing open treatment of intra-abdominal infection or pancreatic necrosis and to determine whether results justify costs. DESIGN: Cohort study and cost-effectiveness analysis. SETTING: Referral center. PATIENTS: From January 1, 1988, through June 30, 1996, we used open treatment for 147 patients with pancreatic necrosis (n=75; group 1), severe intra-abdominal infections due to benign diseases (n=50; group 2), and infections due to malignant neoplasm (n=22; group 3). All surviving patients (n=92) were followed up. Fifty-seven patients in group 1, 25 patients in group 2, and 10 patients in group 3 survived. INTERVENTIONS: The effective costs of treatment per surviving patient (including restorative surgery) were calculated. The patients were interviewed, and the residence location, medical treatment, degree of recovery, functional state, and employment status were assessed. We assessed the quality of life by using the short general health survey (SF-36). MAIN OUTCOME MEASURES: Costs, survival, and long-term outcome. RESULTS: The effective costs per survivor studied were $175000 (group 1) and $232400 (groups 2 and 3). Most patients experienced good long-term results, ie, employment status was unchanged for 69 (75%) of the patients, and the functional state was unchanged for 81 (88%) of the patients. Readmission to a hospital was necessary for 14 (15%) of the patients, and 5 (6%) required care in nursing homes. Of the patients studied, 75% described their quality of life as good. Patients in group 3 had significantly worse results for survival, functional status, and quality of life (P<.01, log-rank test). CONCLUSIONS: Our study demonstrated that open treatment of severe intra-abdominal infection and pancreatic necrosis is a cost-effective treatment with good long-term results for most patients. However, patients with malignant neoplasms did not benefit from this therapy and, therefore, should not be treated by laparostomy.

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BACKGROUND/AIMS: Colonic involvement is a rare but serious event in necrotizing pancreatitis. Early detection of this complication is difficult; a delay of diagnosis may lead to perforation and peritonitis. Two strategies of therapy have been developed in the past few years: an aggressive regimen of early resection and a conservative approach by ileostomy and observation. MATERIALS AND METHODS: Fourteen of 118 patients treated for necrotizing pancreatitis from 1988 to 1995 presented with colonic necrosis. The diagnosis of necrosis was made if the color of the bowel wall demonstrated ischemia or hemorrhagic infarction or pulsations of the mesocolic vessels could not be palpated. The first two patients were treated by a conservative approach, the following 12 patients by immediate large bowel resection. Follow-up results of all surviving patients were obtained. RESULTS: Patients with colonic lesions demonstrated an advanced septic state compared to patients who did not present this complication. Differences in the average Apache 2 scores on admission and the incidence of multiple organ failure were significant (Apache 2 score; 16.6 versus 11.9, p = 0.028, Wilcoxon; multiple organ failure; 71% versus 35%, p = 0.028, Fisher's exact test). Results after establishment of early discontinuity-resection of colonic necrosis compared favorably to those of a conservative strategy (mortality 4/12; 33% versus 2/2; 100%). The overall mortality was 43% (6 of 14 patients). Restorative surgery was performed in 6 patients without substantial morbidity and no mortality. Follow-up results were satisfactory in the majority of the patients. CONCLUSIONS: Early resection of colonic lesions improves results in this dangerous complication of necrotizing pancreatitis.

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BACKGROUND/AIMS: Colonic involvement is a rare but serious event in necrotizing pancreatitis. Early detection of this complication is difficult; a delay of diagnosis may lead to perforation and peritonitis. Two strategies of therapy have been developed in the last few years: an aggressive regimen of early resection and a conservative approach with ileostomy and observation. MATERIALS AND METHODS: Fourteen of 118 patients treated for necrotizing pancreatitis from 1988 to 1995 presented with colonic necrosis. The diagnosis of necrosis was made if the color of the bowel wall demonstrated ischemia or hemorrhagic infarction or pulsations of the mesocolic vessels could not be palpated. The first two patients were treated by a conservative approach the following 12 by immediate large bowel resection. Follow-up results of all surviving patients were obtained. RESULTS: Patients with colonic lesions demonstrated an advanced septic state compared to patients who did not present this complication. Differences in the average Apache 2 scores on admission and the incidence of multiple organ failure were significant (Apache 2 score; 16.6 versus 11.9, p = 0.028, Wilcoxon; multiple organ failure; 71% versus 35%, p = 0.028, Fisher's exact test). Results after establishment of early discontinuity-resection of colonic necrosis compared favorably to those of a conservative strategy (mortality 4/12; 33% versus 2/2; 100%). The overall mortality was 43% (6 of 14 patients). Restorative surgery was performed in 6 patients without substantial morbidity and no mortality. Follow-up results were satisfactory in the majority of the patients. CONCLUSIONS: Early resection of colonic lesions improves results in this dangerous complication of necrotizing pancreatitis.

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This paper discusses the long-term results after surgical treatment of necrotizing pancreatitis. Thirty-one patients were examined 3 years after the operation. The development of diabetes was the main problem in 29% of the patients and depended on the amount of pancreatic tissue resected (never after necrosectomy, in 47% after pancreatic resection; P = 0.005, Fischer's exact test). Of the patients, 77% were in good general condition and 68% were able to work. In 50% of the patients abdominal wall function was impaired but most of them could cope with this insufficiency. Of the patients with alcohol-induced pancreatitis, 75% were abstinent. Considering the severity of the disease, long-term results after surgical treatment of necrotizing pancreatitis are satisfactory.

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The aim of our study was to evaluate the clinical usefulness of a monoclonal antibody (MAB; BW 250/183; Behringwerke, Germany) in patients with suspected perioperative septic foci. The MAB is directed against the nonspecific crossreacting antigen (NCA 95) which has been found on the surface of human neutrophil granulocytes and which represents a murine immunoglobulin isotype of IgG1. Immunoscintigraphy was performed by labelling the MAB with 740 MBq (20mCi) Tc-99m. Data acquisition followed 4 and 18 to 24 hours after administration by a digital Anger camera (APEX 409A, Elscint). 53 patients were investigated (31 female, 22 male; average age 39 years), 4 patients were twice, 1 patient was 3 times evaluated, which results in a total of 59 studies. 45 patients experienced operation within 12 hours after our investigation, which resulted in 36 true positive, 5 true negative, 3 false negative, and 1 false positive findings. This means a sensitivity of 92%, and specificity of 83%. Immunoscintigraphy with granulocyte antibodies can be performed at any time, the preparation of the radiopharmaceutical is simple, the image quality is high; the obtained information concerning localization and size of perioperative septic infections permits the determination of the optimal point of time for surgical intervention. The accumulation of activity was visible as early as 4 hours post application. SPECT would enhance the diagnostic accuracy, but this technique cannot be applied in all such patients.

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