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1.
Biol Invasions ; 25(5): 1403-1419, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36713465

RESUMEN

Rose-ringed parakeets (Psittacula krameri) are one of the most widespread invasive avian species worldwide. This species was introduced to the island of Kaua'i, Hawai'i, USA, in the 1960s. The rapidly increasing population has caused substantial economic losses in the agricultural and tourism industries. We evaluated the efficacy of a roost culling program conducted by an independent contractor from March 2020 to March 2021. We estimated island-wide minimum abundance was 10,512 parakeets in January 2020 and 7,372 in April 2021. Over 30 nights of culling at four roost sites, approximately 6,030 parakeets were removed via air rifles with 4,415 (73%) confirmed via carcasses retrieval. An estimated average of 45 parakeets were removed per hour of shooter effort. The proportion of adult females removed in 2020 was 1.9 × greater when culled outside of the estimated nesting season. Of the four roosts where culling occurred, the parakeets fully abandoned three and partially abandoned one site. Of the three fully abandoned roosts, an estimated average of 29.6% of birds were culled prior to roost abandonment. The roost culling effort was conducted during the COVID-19 pandemic, when tourist numbers and foot traffic were greatly reduced. It is unknown how public perception of roost culling in public areas may impact future efforts. Findings suggest roost culling can be utilized for management of nonnative rose-ringed parakeet populations when roost size is small enough and staff size large enough to cull entire roosts in no greater than two consecutive nights (e.g., if two shooters are available for three hours per night, roost culling should only be attempted on a roost with ≤ 540 rose-ringed parakeets). Supplementary Information: The online version contains supplementary material available at 10.1007/s10530-022-02984-3.

2.
Behav Brain Res ; 432: 113978, 2022 08 26.
Artículo en Inglés | MEDLINE | ID: mdl-35753530

RESUMEN

Although rodents have represented the most intensely studied animals in neurobiological investigations for more than a century, few studies have systematically compared neural and endocrine differences between wild rodents in their natural habitats and laboratory strains raised in traditional laboratory environments. In the current study, male and female Rattus norvegicus rats were trapped in an urban setting and compared to weight-and sex-matched conspecifics living in standard laboratory housing conditions. Brains were extracted for neural assessments and fecal boli were collected for endocrine [corticosterone and dehydroepiandrosterone (DHEA)] assays. Additionally, given their role in immune and stress functions, spleen and adrenal weights were recorded. A separate set of wild rats was trapped at a dairy farm and held in captivity for one month prior to assessments; in these animals, brains were processed but no hormone data were available. The results indicated that wild-trapped rats exhibited 31% heavier brains, including higher densities of cerebellar neurons and glial cells in the bed nucleus of the stria terminalis. The wild rats also had approximately 300% greater spleen and adrenal weights, and more than a six-fold increase in corticosterone levels than observed in laboratory rats. Further research on neurobiological variables in wild vs. lab animals will inform the extensive neurobiological knowledge base derived from laboratory investigations using selectively bred rodents in laboratory environments, knowledge that will enhance the translational value of preclinical laboratory rodent studies.


Asunto(s)
Corticosterona , Neuroglía , Animales , Encéfalo , Femenino , Masculino , Ratas
3.
Ecol Appl ; 32(2): e2522, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34918411

RESUMEN

Disruption of plant-pollinator interactions by invasive predators is poorly understood but may pose a critical threat for native ecosystems. In a multiyear field experiment in Hawai'i, we suppressed abundances of globally invasive predators and then observed insect visitation to flowers of six native plant species. Three plant species are federally endangered (Haplostachys haplostachya, Silene lanceolata, Tetramolopium arenarium) and three are common throughout their range (Bidens menziesii, Dubautia linearis, Sida fallax). Insect visitors were primarily generalist pollinators, including taxa that occur worldwide such as solitary bees (e.g., Lasioglossum impavidum), social bees (e.g., Apis mellifera), and syrphid flies (e.g., Allograpta exotica). We found that suppressing invasive rats (Rattus rattus), mice (Mus musculus), ants (Linepithema humile, Tapinoma melanocephalum), and yellowjacket wasps (Vespula pensylvanica) had positive effects on pollinator visitation to plants in 16 of 19 significant predator-pollinator-plant interactions. We found only positive effects of suppressing rats and ants, and both positive and negative effects of suppressing mice and yellowjacket wasps, on the frequency of interactions between pollinators and plants. Model results predicted that predator eradication could increase the frequency of insect visitation to flowering species, in some cases by more than 90%. Previous results from the system showed that these flowering species produced significantly more seed when flowers were allowed to outcross than when flowers were bagged to exclude pollinators, indicating limited autogamy. Our findings highlight the potential benefits of suppression or eradication of invasive rodents, ants, and yellowjackets to reverse pollination disruption, particularly in locations with high numbers of at-risk plant species or already imperiled pollinator populations.


Asunto(s)
Ecosistema , Especies Introducidas , Polinización , Animales , Hormigas , Abejas , Flores , Ratones , Ratas , Avispas
4.
Gastrointest Endosc Clin N Am ; 31(4): 709-718, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34538410

RESUMEN

The future private gastroenterology practice will be a large multidisciplinary practice including a clinic, AEC, pathology services, infusion services, anesthesia services, pharmacy services, and imaging centers. Delivery of gastrointestinal (GI) services will be a team-based clinic with AEC access and improved quality of care. Competing technologies will drive practices to promote the value of colonoscopy as the best screening test for colon cancer. Artificial intelligence (AI) may significantly alter our approach to clinic and endoscopic services. The creative and intellectual capital of practice leaders will continue to define the private GI practice of the future.


Asunto(s)
Gastroenterología , Instituciones de Atención Ambulatoria , Inteligencia Artificial , Colonoscopía , Predicción , Humanos
5.
Evol Appl ; 14(5): 1421-1435, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34025776

RESUMEN

Introduced rodent populations pose significant threats worldwide, with particularly severe impacts on islands. Advancements in genome editing have motivated interest in synthetic gene drives that could potentially provide efficient and localized suppression of invasive rodent populations. Application of such technologies will require rigorous population genomic surveys to evaluate population connectivity, taxonomic identification, and to inform design of gene drive localization mechanisms. One proposed approach leverages the predicted shifts in genetic variation that accompany island colonization, wherein founder effects, genetic drift, and island-specific selection are expected to result in locally fixed alleles (LFA) that are variable in neighboring nontarget populations. Engineering of guide RNAs that target LFA may thus yield gene drives that spread within invasive island populations, but would have limited impacts on nontarget populations in the event of an escape. Here we used pooled whole-genome sequencing of invasive mouse (Mus musculus) populations on four islands along with paired putative source populations to test genetic predictions of island colonization and characterize locally fixed Cas9 genomic targets. Patterns of variation across the genome reflected marked reductions in allelic diversity in island populations and moderate to high degrees of differentiation from nearby source populations despite relatively recent colonization. Locally fixed Cas9 sites in female fertility genes were observed in all island populations, including a small number with multiplexing potential. In practice, rigorous sampling of presumptive LFA will be essential to fully assess risk of resistance alleles. These results should serve to guide development of improved, spatially limited gene drive design in future applications.

6.
Sci Rep ; 9(1): 15821, 2019 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-31676762

RESUMEN

Invasive species pose a major threat to biodiversity on islands. While successes have been achieved using traditional removal methods, such as toxicants aimed at rodents, these approaches have limitations and various off-target effects on island ecosystems. Gene drive technologies designed to eliminate a population provide an alternative approach, but the potential for drive-bearing individuals to escape from the target release area and impact populations elsewhere is a major concern. Here we propose the "Locally Fixed Alleles" approach as a novel means for localizing elimination by a drive to an island population that exhibits significant genetic isolation from neighboring populations. Our approach is based on the assumption that in small island populations of rodents, genetic drift will lead to alleles at multiple genomic loci becoming fixed. In contrast, multiple alleles are likely to be maintained in larger populations on mainlands. Utilizing the high degree of genetic specificity achievable using homing drives, for example based on the CRISPR/Cas9 system, our approach aims at employing one or more locally fixed alleles as the target for a gene drive on a particular island. Using mathematical modeling, we explore the feasibility of this approach and the degree of localization that can be achieved. We show that across a wide range of parameter values, escape of the drive to a neighboring population in which the target allele is not fixed will at most lead to modest transient suppression of the non-target population. While the main focus of this paper is on elimination of a rodent pest from an island, we also discuss the utility of the locally fixed allele approach for the goals of population suppression or population replacement. Our analysis also provides a threshold condition for the ability of a gene drive to invade a partially resistant population.


Asunto(s)
Alelos , Biodiversidad , Animales , Islas
7.
Am J Bot ; 106(2): 313-324, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30768870

RESUMEN

PREMISE OF THE STUDY: Over one-third of the native flowering plant species in the Hawaiian Islands are listed as federally threatened or endangered. Lack of sufficient pollination could contribute to reductions in populations, reproduction, and genetic diversity among these species but has been little studied. METHODS: We used systematic observations and manual flower treatments to quantify flower visitation and outcrossing dependency of eight native (including four endangered) plant species in a dryland ecosystem in Hawaii: Argemone glauca, Bidens menziesii, Dubautia linearis, Haplostachys haplostachya, Sida fallax, Silene lanceolata, Stenogyne angustifolia, and Tetramolopium arenarium. KEY RESULTS: During 576.36 h of flower observations, only insects visited the flowers. Out of all recorded flower visits, 85% were performed by non-native species, particularly the honeybee (Apis mellifera) and flies in the family Syrphidae. Some plant species received little visitation (e.g., S. angustifolia received one visit in 120 h of observation), whereas others were visited by a wide diversity of insects. The endangered plant species were visited by fewer visitor taxa than were the common native plant species. For six of the focal plant species, bagging of flowers to exclude pollinators resulted in significant reductions in seed set. CONCLUSIONS: The flower visitor community in this system, although heavily dominated by non-native insects, appears to be facilitating pollination for multiple plant species. Non-native insects may thus be sustaining biotic interactions otherwise threatened with disruption in this island ecosystem. This may be particularly important for the studied endangered plant species, which exhibit fewer partners than the more common plant species.


Asunto(s)
Insectos , Especies Introducidas , Magnoliopsida , Polinización , Animales , Hawaii
8.
J Clin Gastroenterol ; 53(1): 34-39, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29112048

RESUMEN

BACKGROUND: Current bowel preparations for colonoscopy include a clear liquid diet (CLD) along with consumption of a laxative. This dietary restriction along with large volume bowel preparations are barriers to compliance and willingness among patients in scheduling screening examinations. The aim of our study was to compare the efficacy and tolerability of a low-volume split dose magnesium citrate bowel preparation in patients on a low-residue diet (LRD) with those on a CLD. METHODS: In this single center, single blinded, randomized controlled trial, patients scheduled for outpatient colonoscopies were assigned to either a CLD or a LRD 1 day before the examination. Both groups received a split dose magnesium citrate preparation. The quality of the preparation was rated using the Boston Bowel Preparation Scale (BBPS). Patient satisfaction and side effects were evaluated using a questionnaire. RESULTS: We were unable to detect a significant difference in the BBPS scores between the LRD and CLD groups (P=0.581). A significantly higher percentage of patients in the LRD group rated the diet as easy compared with the CLD group (P<0.001). Satisfaction scores were significantly higher in the LRD group, compared with the CLD group (P<0.001). The side effect profiles of both arms were similar. CONCLUSIONS: There was no significant difference between LRD and CLD in patients using a magnesium citrate bowel preparation for screening and surveillance colonoscopies. Patient satisfaction scores were higher with a LRD compared with a CLD. We believe the LRD should be the recommended diet in patients using a standard bowel preparation for screening and surveillance colonoscopy.


Asunto(s)
Catárticos/administración & dosificación , Ácido Cítrico/administración & dosificación , Colonoscopía/métodos , Dieta , Compuestos Organometálicos/administración & dosificación , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Satisfacción del Paciente , Método Simple Ciego
9.
J Environ Manage ; 219: 115-124, 2018 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-29738931

RESUMEN

After its inadvertent introduction to Guam, the brown tree snake (Boiga irregularis, BTS) extirpated most of the island's native terrestrial vertebrates, presented a health hazard to small children, and had considerable economic ramifications. Management of BTS is aimed at a number of objectives, the foremost of which has been to deter its dispersal from Guam to other locations. Further objectives include reclaiming areas on Guam as snake-free for reintroduction of native wildlife, to protect small sensitive sites on Guam from BTS intrusion (e.g, power stations, bird nesting sites), to contain and capture stowaway BTS incoming to vulnerable destinations, and to control incipient populations in other areas beyond their native range. A number of control tools have been developed, and the efficacy of each control method depends on the situation to which it is applied. Integration of control methods provides the most efficacious results for all objectives. Here, we outline the different objectives for managing BTS, and the tools and methods available for BTS management. We complete the picture by describing which tools and methods are best suited to accomplish each management objective.


Asunto(s)
Animales Salvajes , Especies Introducidas , Control de Plagas , Serpientes , Animales , Niño , Guam , Humanos , Islas , Árboles
10.
Conserv Biol ; 31(4): 761-771, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-27982493

RESUMEN

Invasive rats are one of the world's most successful animal groups that cause native species extinctions and ecosystem change, particularly on islands. On large islands, rat eradication is often impossible and population control, defined as the local limitation of rat abundance, is now routinely performed on many of the world's islands as an alternative management tool. However, a synthesis of the motivations, techniques, costs, and outcomes of such rat-control projects is lacking. We reviewed the literature, searched relevant websites, and conducted a survey via a questionnaire to synthesize the available information on rat-control projects in island natural areas worldwide to improve rat management and native species conservation. Data were collected from 136 projects conducted over the last 40 years; most were located in Australasia (46%) and the tropical Pacific (25%) in forest ecosystems (65%) and coastal strands (22%). Most of the projects targeted Rattus rattus and most (82%) were aimed at protecting birds and endangered ecosystems. Poisoning (35%) and a combination of trapping and poisoning (42%) were the most common methods. Poisoning allows for treatment of larger areas, and poison projects generally last longer than trapping projects. Second-generation anticoagulants (mainly brodifacoum and bromadiolone) were used most often. The median annual cost for rat-control projects was US$17,262 or US$227/ha. Median project duration was 4 years. For 58% of the projects, rat population reduction was reported, and 51% of projects showed evidence of positive effects on biodiversity. Our data were from few countries, revealing the need to expand rat-control distribution especially in some biodiversity hotspots. Improvement in control methods is needed as is regular monitoring to assess short- and long-term effectiveness of rat-control.


Asunto(s)
Biodiversidad , Conservación de los Recursos Naturales , Especies Introducidas , Islas , Ratas , Animales , Australasia , Ecosistema
11.
AoB Plants ; 72015 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-26019231

RESUMEN

Mammalian herbivores can limit plant recruitment and affect forest composition. Loulu palms (Pritchardia spp.) once dominated many lowland ecosystems in Hawai'i, and non-native rats (Rattus spp.), ungulates (e.g. pigs Sus scrofa, goats Capra hircus) and humans have been proposed as major causes of their decline. In lowland wet forest, we experimentally determined the vulnerability of seeds and seedlings of two species of Pritchardia, P. maideniana and P. hillebrandii, by measuring their removal by introduced vertebrates; we also used motion-sensing cameras to identify the animals responsible for Pritchardia removal. We assessed potential seed dispersal of P. maideniana by spool-and-line tracking, and conducted captive-feeding trials with R. rattus and seeds and seedlings of both Pritchardia species. Seed removal from the forest floor occurred rapidly for both species: >50 % of Pritchardia seeds were removed from the vertebrate-accessible stations within 6 days and >80 % were removed within 22 days. Although rats and pigs were both common to the study area, motion-sensing cameras detected only rats (probably R. rattus) removing Pritchardia seeds from the forest floor. Captive-feeding trials and spool-and-line tracking revealed that vertebrate seed dispersal is rare; rats moved seeds up to 8 m upon collection and subsequently destroyed them (100 % mortality in 24-48 h in captivity). Surprisingly, seedlings did not suffer vertebrate damage in field trials, and although rats damaged seedlings in captivity, they rarely consumed them. Our findings are consistent with the hypothesis generated from palaeoecological studies, indicating that introduced rats may have assisted in the demise of native insular palm forests. These findings also imply that the seed stage of species in this Pacific genus is particularly vulnerable to rats; therefore, future conservation efforts involving Pritchardia should prioritize the reduction of rat predation on the plant recruitment stages preceding seedling establishment.

12.
PLoS One ; 10(4): e0123064, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25910229

RESUMEN

The nematode Angiostrongylus cantonensis is a rat lungworm, a zoonotic pathogen that causes human eosinophilic meningitis and ocular angiostrongyliasis characteristic of rat lungworm (RLW) disease. Definitive diagnosis is made by finding and identifying A. cantonensis larvae in the cerebral spinal fluid or by using a custom immunological or molecular test. This study was conducted to determine if genomic DNA from A. cantonensis is detectable by qPCR in the blood or tissues of experimentally infected rats. F1 offspring from wild rats were subjected to experimental infection with RLW larvae isolated from slugs, then blood or tissue samples were collected over multiple time points. Blood samples were collected from 21 rats throughout the course of two trials (15 rats in Trial I, and 6 rats in Trial II). In addition to a control group, each trial had two treatment groups: the rats in the low dose (LD) group were infected by approximately 10 larvae and the rats in the high dose (HD) group were infected with approximately 50 larvae. In Trial I, parasite DNA was detected in cardiac bleed samples from five of five LD rats and five of five HD rats at six weeks post-infection (PI), and three of five LD rats and five of five HD rats from tail tissue. In Trial II, parasite DNA was detected in peripheral blood samples from one of two HD rats at 53 minutes PI, one of two LD rats at 1.5 hours PI, one of two HD rats at 18 hours PI, one of two LD rats at five weeks PI and two of two at six weeks PI, and two of two HD rats at weeks five and six PI. These data demonstrate that parasite DNA can be detected in peripheral blood at various time points throughout RLW infection in rats.


Asunto(s)
Angiostrongylus cantonensis/genética , Enfermedades de los Animales/parasitología , Parasitemia , Infecciones por Strongylida/veterinaria , Animales , Femenino , Corazón/parasitología , Pulmón/parasitología , Masculino , Ratas , Reacción en Cadena en Tiempo Real de la Polimerasa , Bazo/parasitología
13.
J Vet Diagn Invest ; 27(2): 241-4, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25691507

RESUMEN

Rats (Rattus spp.) are among the most damaging invasive species worldwide. The accidental introduction of rats has caused significant detriment to native flora and fauna, crops, structures, and human livelihoods. Rats are vectors of disease and carriers of various zoonotic parasites. Capillaria hepatica (syn. Callodium hepaticum) is a parasitic nematode found primarily in rodents but is known to infect over 140 mammal species, including human beings and several species of domestic animals. In this case study, the presence of C. hepatica infection in black rats on Diego Garcia, British Indian Ocean Territory, is reported. Liver samples from 20 black rats (Rattus rattus) were collected during a concurrent population density estimation study. Histology revealed 15 (75%) of the rats sampled had a current or previous infection with C. hepatica. In addition, a larval cestode compatible in size and shape with Cysticercus fasciolaris, the larval stage of Taenia taeniaeformis of cats, was found in 3 (15%) of the rats sampled. The high prevalence of C. hepatica infection in rats on Diego Garcia has implications for human health given the high population density of rats found on the island.


Asunto(s)
Capillaria/aislamiento & purificación , Reservorios de Enfermedades , Infecciones por Enoplida/veterinaria , Enfermedades de los Roedores/epidemiología , África Oriental/epidemiología , Animales , Animales Salvajes , Infecciones por Enoplida/epidemiología , Infecciones por Enoplida/parasitología , Infecciones por Enoplida/transmisión , Femenino , Hígado/parasitología , Masculino , Prevalencia , Ratas , Enfermedades de los Roedores/parasitología , Zoonosis
14.
J Pharmacol Exp Ther ; 325(2): 475-83, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18272810

RESUMEN

Pressor effects of the vasoconstrictor hormone arginine vasopressin (AVP), observed when systemic AVP concentrations are less than 100 pM, are important for the physiological maintenance of blood pressure, and they are also the basis for therapeutic use of vasopressin to restore blood pressure in hypotensive patients. However, the mechanisms by which circulating AVP induces arterial constriction are unclear. We examined the novel hypothesis that KCNQ potassium channels mediate the physiological vasoconstrictor actions of AVP. Reverse transcriptase polymerase chain reaction revealed expression of KCNQ1, KCNQ4, and KCNQ5 in rat mesenteric artery smooth muscle cells (MASMCs). Whole-cell perforated patch recordings of voltage-sensitive K+ (Kv) currents in freshly isolated MASMCs revealed 1,3-dihydro-1-phenyl-3,3-bis(4-pyridinylmethyl)-2H-indol-2-one (linopirdine)- and 10,10-bis(4-pyridinylmethyl)-9(10H)-anthracenone (XE-991)-sensitive KCNQ currents that were electrophysiologically and pharmacologically distinct from other Kv currents. Suppression of KCNQ currents by AVP (100 pM) was associated with significant membrane depolarization, and it was abolished by the protein kinase C (PKC) inhibitor calphostin C (250 nM). The KCNQ channel blocker linopirdine (10 microM) inhibited KCNQ currents in MASMCs, and it induced constriction of isolated rat mesenteric arteries. The vasoconstrictor responses were not additive when combined with 30 pM AVP, and they were prevented by the L-type Ca2+ channel blocker verapamil. Ethyl-N-[2-amino-6-(4-fluorophenylmethylamino)pyridin-3-yl] carbamic acid (flupirtine) significantly enhanced KCNQ currents, and it reversed constrictor responses to 30 pM AVP. In vivo, i.v. administration of linopirdine induced a dose-dependent increase in mesenteric artery resistance and blood pressure, whereas flupirtine had the opposite effects. We conclude that physiological concentrations of AVP induce mesenteric artery constriction via PKC-dependent suppression of KCNQ currents and L-type Ca2+ channel activation in MASMCs.


Asunto(s)
Canales de Potasio KCNQ/fisiología , Arterias Mesentéricas/efectos de los fármacos , Células Musculares/efectos de los fármacos , Proteína Quinasa C/fisiología , Vasoconstrictores/farmacología , Vasopresinas/farmacología , Aminopiridinas/farmacología , Animales , Presión Sanguínea/efectos de los fármacos , Canales de Calcio Tipo L/fisiología , Frecuencia Cardíaca/efectos de los fármacos , Indoles/farmacología , Canales de Potasio KCNQ/agonistas , Canales de Potasio KCNQ/antagonistas & inhibidores , Masculino , Arterias Mesentéricas/citología , Arterias Mesentéricas/fisiología , Células Musculares/fisiología , Bloqueadores de los Canales de Potasio/farmacología , Piridinas/farmacología , Ratas , Ratas Sprague-Dawley , Resistencia Vascular/efectos de los fármacos
15.
Gastrointest Endosc ; 66(2): 248-52, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17451700

RESUMEN

BACKGROUND: Roux-en-Y gastric bypass is the most frequently performed bariatric surgery for morbid obesity. Gastrojejunal anastomotic strictures are a relatively frequent postoperative complication. OBJECTIVE: To evaluate the clinical outcomes and therapeutic response to through-the-scope balloon dilation performed to treat anastomotic strictures after Roux-en-Y gastric bypass surgery. DESIGN: Single-center, retrospective study. SETTING: Academic medical center. PATIENTS: Between 1997 and 2005, 801 patients with morbid obesity underwent Roux-en-Y gastric bypass surgery at our institution. MAIN OUTCOME MEASUREMENTS: The development of an anastomotic stricture after Roux-en-Y gastric bypass surgery. The response to through-the-scope balloon dilation after diagnosis. RESULTS: Forty-three of 801 patients (5.4%) developed an anastomotic stricture (26 of 294 open surgeries [8.8%]; 17 of 507 laparoscopic surgeries [3.4%]; P < .001). Strictures were dilated to 15.5 +/- 0.4 mm. There were no perforations or clinically significant bleeding after dilation; 93% of the strictures were successfully managed with 1 or 2 endoscopic sessions. Dilation to at least 15 mm did not affect weight loss at 1 year when compared with the group without a stricture (percentage excess weight loss: stricture group, 76%; no stricture group, 74%). LIMITATIONS: Single-center, retrospective study. CONCLUSIONS: Endoscopic balloon dilation is a safe and effective method for the management of gastrojejunostomy strictures after Roux-en-Y gastric bypass. Dilation to at least 15 mm is safe and decreases the need for further endoscopic dilation.


Asunto(s)
Cateterismo , Endoscopía Gastrointestinal , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Adulto , Anastomosis en-Y de Roux/efectos adversos , Constricción Patológica/terapia , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad
18.
Gastrointest Endosc ; 59(2): 300-4, 2004 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-14745412

RESUMEN

BACKGROUND: Aorto-enteric fistula is rare but can result in exsanguination without timely surgery or endovascular stent placement. METHODS: Four cases of aorto-enteric fistula were reviewed in which the presentation was unusual and diagnosis difficult. OBSERVATIONS: The first patient had an aorto-sigmoid fistula in the setting of an aorto-bi-femoral graft. Two patients had a primary aorto-enteric fistula, one to the stomach from a suprarenal aortic aneurysm, and the other, to the duodenum in the setting of retroperitoneal spread of renal cancer. The aortoduodenal fistula recurred in the 4th patient within 3 months of surgical repair; this patient is the only one who survived long term. CONCLUSIONS: When presentation is atypical, the diagnosis of aorto-enteric fistula can be extremely difficult. Because investigative studies are not consistently useful in making a definitive pre-operative diagnosis, a strong index of clinical suspicion and a willingness to consider surgical exploration are essential for timely and successful management.


Asunto(s)
Enfermedades de la Aorta/diagnóstico , Fístula Gástrica/diagnóstico , Fístula Intestinal/diagnóstico , Enfermedades del Sigmoide/diagnóstico , Fístula Vascular/diagnóstico , Anciano , Enfermedades Duodenales/diagnóstico , Endoscopía Gastrointestinal , Femenino , Humanos , Masculino , Persona de Mediana Edad
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