Microbiota composition and mucosal immunity in patients with asymptomatic diverticulosis and controls.

INTRODUCTION: The etiology of diverticulosis is still poorly understood. However, in patients with diverticulitis, markers of mucosal inflammation and microbiota alterations have been found. The aim of this study was to evaluate potential differences of the gut microbiota composition and mucosal immunity between patients with asymptomatic diverticulosis and controls. METHODS: We performed a prospective study on patients who underwent routine colonoscopy for causes not related to diverticular disease or inflammatory bowel disease. Participants were grouped based on the presence or absence of diverticula. Mucosal biopsies were obtained from the sigmoid and transverse colon. Microbiota composition was analyzed with IS-pro, a 16S-23S based bacterial profiling technique. To predict if patients belonged to the asymptomatic diverticulosis or control group a partial least squares discriminant analysis (PLS-DA) regression model was used. Inflammation was assessed by neutrophil and lymphocyte counts within the taken biopsies. RESULTS: Forty-three patients were enrolled. Intestinal microbiota profiles were highly similar within individuals for all phyla. Between individuals, microbiota profiles differed substantially but regardless of the presence (n = 19) of absence (n = 24) of diverticula. Microbiota diversity in both sigmoid and transverse colon was similar in all participants. We were not able to differentiate between diverticulosis patients and controls with a PLS-DA model. Mucosal lymphocyte counts were comparable among both groups; no neutrophils were detected in any of the studied biopsies. CONCLUSIONS: Microbiota composition and inflammatory markers were comparable among asymptomatic diverticulosis patients and controls. This suggests that the gut microbiota and mucosal inflammation do not play a major role in the pathogenesis of diverticula formation.

Cough-induced nonunion rib fractures and herniation: surgical repair and review.

We present the case of a 57-year-old man who had suffered pain in the left hemithorax for a year, which started after a period of severe coughing during pneumonia. The pain was triggered by lying down. A computed tomography scan revealed two nonunion costal fractures. In the operating room, intercostal diastasis with pulmonary herniation was encountered in addition to the costal fractures. This report describes the technique used to reconstruct the thoracic wall with mesh and plate-osteosynthesis.

[A woman with an umbilical swelling]. / Een vrouw met een zwelling van de navel.

A 78-year-old woman presented with a 9-month history of an ulcerative umbilical swelling, which had recently started to produce feces. An abdominal CT-scan showed a tumour in the transverse colon, infiltrating the abdominal wall and skin, but without signs of distant metastases. Histopathological examination of a biopsy specimen revealed a slime-producing adenocarcinoma. Due to a myocardial infarction, the patient died two days prior to surgery. No permission to conduct an autopsy was granted.

[Bariatric surgery with an adjustable gastric band; long-term follow-up of the first 30 patients in the Netherlands]. / Bariatrische chirurgie met een variabele maagband. Langetermijnfollow-up van eerste 30 patiënten in Nederland.

OBJECTIVE: Evaluation of the long-term results of bariatric surgery with an adjustable gastric band for the treatment of morbid obesity. DESIGN: Retrospective, descriptive. METHOD: From September 1991-September 1993, 30 patients (6 males, 24 females) received an adjustable gastric band because of morbid obesity, being the first group in the Netherlands. The long-term data on these patients: weight loss, band adjustments, complications, reoperations and patient satisfaction, were collected using a medical record survey and a questionnaire and then analysed. RESULTS: Before the operation, the mean BMI was 42.5 kg/m2 (SD: 5.7) and the mean excess body weight was 50.8 kg (SD: 16.7). The mean follow-up time for all patients was 15.3 years (SD: 5.4) and for the responders to the questionnaire, 17.7 years (SD: 0.7); three patients died during follow-up. After surgery, the mean BMI was reduced to 34.7 kg/m2 (SD: 6.4). The mean excess body weight loss of the entire group was 38.1% (SD: 67.8) and of the patients who still had a gastric band in situ, 27.9% (SD: 67.4). In 15 patients, the gastric band reservoir was replaced at least once. The gastric band was replaced in 18 patients due to complications and eventually permanently removed in 6 patients. Of the respondents, 62% were satisfied with the weight loss and 52% were satisfied with regard to possible side effects and complications. CONCLUSION: The treatment of morbid obesity with an adjustable gastric band in this very first group of patients has resulted in substantial weight loss, but also a high rate of complications and reoperations. Treatment of these kinds of complications is an important aspect of bariatric surgery today. The efficacy of gastric banding is therefore currently under debate.

Accurate perioperative flow measurement of the portal vein and hepatic and renal artery: a role for preoperative MRI?

BACKGROUND: Quantification of abdominal blood flow is essential for a variety of gastrointestinal and hepatic topics such as liver transplantation or metabolic flux measurement, but those need to be performed during surgery. It is not clear whether Duplex Doppler Ultrasound during surgery or MRI before surgery is the tool to choose. OBJECTIVE: To examine whether preoperative evaluation of abdominal blood flow using MRI could prove to be a useful and reliable alternative for the perioperative sonographic approach. METHODS: In this study portal and renal venous flow and hepatic arterial flow were sequentially quantified by preoperative MRI, preoperative and perioperative Duplex Doppler Ultrasound (DDUS). 55 Patients scheduled for major abdominal surgery were studied and methods and settings were compared. Additionally, average patient population values were compared. RESULTS: Mean (±SD) plasmaflow measured by perioperative DDUS, preoperative DDUS and MRI, respectively was 433±200/423±162/507±96 ml/min (portal vein); 96±70/74±41/108±91 ml/min (hepatic artery); 248±139/201±118/219±69 ml/min (renal vein). No differences between the different settings of DDUS measurement were detected. Equality of mean was observed for all measurements. Bland Altman Plots showed widespread margins. Hepatic arterial flow measurements correlated with each other, but portal and renal venous flow correlations were absent. CONCLUSIONS: Surgery and method (DDUS vs. MRI) do not affect mean flow values. Individual comparison is restricted due to wide range in measurements. Since MRI proves to be more reliable with respect to inter-observer variability, we recommend using mean MRI results in experimental setups.