Deep Pelvic Surgical Site Infection After Radiotherapy and Surgery for Locally Advanced Rectal Cancer.

BACKGROUND: High morbidity, increased mortality, and impaired long-term oncologic outcome have been reported after deep surgical site infection (SSI) in rectal cancer surgery. The rate, risk factors and consequences of deep SSI after (chemo)radiotherapy [(C)RT], and surgery for locally advanced rectal cancer (LARC) in a tertiary university hospital single centre cohort of 540 patients are presented. METHODS: Patients with LARC, operated between January 1, 2007 and December 31, 2015, were identified in the institutional prospective database. All patients had tumours threatening the mesorectal fascia or invading adjacent organs, with a high rate of T4 tumours (60 %), and all received (C)RT. Risk factors for deep SSI were calculated by multivariable logistic regression analysis. Morbidity data were assessed. Overall survival (OS) and disease-free survival (DFS) between patients with or without deep SSI were estimated. RESULTS: Of 540 patients, 104 (19 %) experienced a deep SSI, with the highest rate in the abdominoperineal resection (APR) group with 25 %. APR, good response to (C)RT (low tumour regression grade), age, and operative blood loss were identified as significant (P < 0.05) risk factors for deep SSI in multivariable analysis. No difference was found in OS (P = 0.995) or DFS (P = 0.568). Hospital stay increased with 5 days (P < 0.001), and complete wound healing at the 3-month follow-up decreased from 86 to 45 % (P < 0.001) after deep SSI. CONCLUSIONS: Deep SSI is a frequent and major complication after rectal surgery for LARC, with high morbidity, increased hospital stay and protracted wound healing. Interestingly, deep SSI did not influence long-term oncologic outcome.

3D for D3: role of imaging for right colectomy in a case with congenital superior mesenteric vein aneurysm and co-existing anomalous irrigation.

BACKGROUND: The D3 right colectomy for cancer requires dissection in the vicinity of the superior mesenteric vessels, which requires preoperative 3D imaging in these patients. CASE REPORT: We present a patient with a caecum adenocarcinoma cancer which underwent D3 resection of the right colon, preceded by pre-operative MDCT with 2D multiplanar reconstruction and 3D volume rendering. RESULTS: The dataset analysis revealed a rare congenital aneurysm of the superior mesenteric vein below the spleno-mesenteric confluence and a co-existing anomalous irrigation in the form of an ileo-mesenteric trunk. The surgical procedure was carried out as planned and the patient presents no signs of recurrence of the disease one year after the intervention. CONCLUSIONS: The case presented - with a rare and complicated vascular situs - illustrates particularly well that multimodal post-processing of the CT dataset for volume rendering allows proper assessment of the arrangement of pertinent blood vessels, and, consequently in the planning, setup and accomplishing the delicate operation, avoiding the surgical pitfalls and iatrogenic injuries.

3D relations between right colon arteries and the superior mesenteric vein: a preliminary study with multidetector computed tomography.

BACKGROUND: 3-D relations between the ileocolic (ICA), right colic artery (RCA) with the superior mesenteric vein (SMV) have been described in cadavers. However, no data exists on preoperative evaluation of these relations. AIM: To define the length of crossing and 3-D position of the ICA and RCA to the SMV in patients undergoing multidetector computerized tomography (MDCT) angiography. METHODS: MDCT angiographies were analyzed with the aid of Osirix v.3.0.2. image processing application. All the datasets included arterial and venous phase, undergoing multimodal visualization: 2D multiplanar reconstruction with maximum intensity projection and 3D Volume rendering. The anatomical relations were analyzed in various planes (orthogonal and oblique), depending upon their particular course. When a clear spatial reference was achieved, the distance of the colic artery from their origin on the aorta to the right border of the SMV was measured, and its position noted. RESULTS: 50 MDCT were analyzed (29 male). RCA occurred in 27 patients (54.0%), 25 (92.6%) passed anterior to the SMV. Length of crossing was 22.7±8.1 (8.3-41.3) mm. The ICA occurred in 48 (96%) passing under the SMV in 38 (79.2%). Length of crossing 15.4±5.8 (14.0-26.6) mm. CONCLUSIONS: RCA occurs in 54% patients, passes over the SMV in 92.6% specimens and leaves a 22.7 mm stump. ICA passes under the SMV in most cases, leaving a 15.4 mm stump. These data could be of crucial importance to the surgeon facing laparoscopic right colectomy for cancer.

Global plant trait relationships extend to the climatic extremes of the tundra biome.

The majority of variation in six traits critical to the growth, survival and reproduction of plant species is thought to be organised along just two dimensions, corresponding to strategies of plant size and resource acquisition. However, it is unknown whether global plant trait relationships extend to climatic extremes, and if these interspecific relationships are confounded by trait variation within species. We test whether trait relationships extend to the cold extremes of life on Earth using the largest database of tundra plant traits yet compiled. We show that tundra plants demonstrate remarkably similar resource economic traits, but not size traits, compared to global distributions, and exhibit the same two dimensions of trait variation. Three quarters of trait variation occurs among species, mirroring global estimates of interspecific trait variation. Plant trait relationships are thus generalizable to the edge of global trait-space, informing prediction of plant community change in a warming world.

Bronchial hyperactivity in bakers and its relation to atopy and skin reactivity.

Data from literature suggests that a significant percentage of bakers develop occupational asthma and chronic obstructive bronchitis, the primary reason for this being the strong allergenic properties of flour. The aim of this study was to evaluate the prevalence of bronchial hyperactivity in bakers, as well as to correlate bronchial hyperactivity with positive skin tests and atopy. A group of 100 bakers (54 males and 46 females) employed in bread production for an average of 14.8 +/- 8.8 years, were examined from 1996 to 1999. Bronchial challenge tests with methacholine (cumulative dose of 4 mg) and flour were performed. It was considered positive if a FEV1 reduction of at least 20% from normal values had occurred. Additionally, skin prick tests were performed with wheat flour extracts, as well as standard environmental inhalation allergens. Total IgE were assessed using the ELISA method. Results showed that 11% of bakers demonstrated a positive methacholine test, 2% of bakers responded to the specific bronchial challenge test with wheat flour. The skin prick test with wheat flour was positive in 15% of bakers, while the same test using standard inhalation allergens was positive in 12% of bakers. Atopic status was found in 18% of bakers. The frequency of positive methacholine test was 33% in bakers with atopic status, compared to 6.1% (P < 0.01) in those without atopic status. Among the bakers who displayed a positive skin test to wheat flour, specific bronchial challenge test with flour was positive in two (13.3%) bakers, while no response to the bronchial challenge test with flour was observed in bakers with negative skin test. This is in agreement with known results.