Spontaneous splenic rupture two days after laparoscopic sleeve gastrectomy.

IntroductionSleeve gastrectomy is a common bariatric procedure to manage morbid obesity. Splenic injury such as splenic rupture after sleeve gastrectomy is a rare complication which can be treated both with a splenectomy or conservative approach, called spleen-preserving surgery.Patients and methodsA 42 year old male, in whom we performed a sleeve gastrectomy, presented with splenic rupture, within 48 hours postoperative, for which spleen-preserving surgery was performed. As splenic rupture is a very rare complication, we performed an extensive literature search in PubMed database. After obtaining patient informed consent, we aim to describe a sixth presentation of this rare surgical complication.ResultTo the best of our knowledge, only five cases of splenic rupture after laparoscopic sleeve gastrectomy have been described before, all treated with a splenectomy. Furthermore, we are the first to describe spleen-preserving surgery.ConclusionWe present the sixth case of spontaneous splenic rupture after laparoscopic sleeve gastrectomy, and the first to treat it with spleen-preserving surgery.

Development of a reference material for analysing naturally occurring radioactive material from the steel industry.

Accurate measurement of naturally occurring radionuclides in blast furnace slag, a by-product of the steel industry, is required for compliance with building regulations where it is often used as an ingredient in cement. A matrix reference blast furnace slag material has been developed to support traceability in these measurements. Raw material provided by a commercial producer underwent stability and homogeneity testing, as well as characterisation of matrix constituents, to provide a final candidate reference material. The radionuclide content was then determined during a comparison exercise that included 23 laboratories from 14 countries. Participants determined the activity per unit mass for 226Ra, 232Th and 40K using a range of techniques. The consensus values obtained from the power-moderated mean of the reported participant results were used as indicative activity per unit mass values for the three radionuclides: A0(226Ra) = 106.3 (34) Bq·kg-1, A0(232Th) = 130.0 (48) Bq·kg-1 and A0(40K) = 161 (11) Bq·kg-1 (where the number in parentheses is the numerical value of the combined standard uncertainty referred to the corresponding last digits of the quoted result). This exercise helps to address the current shortage of NORM industry reference materials, putting in place infrastructure for production of further reference materials.

Acute chest pain while exercising: a case report of Bochdalek hernia in an adolescent.

We present the case of a 17-year old male patient with a symptomatic congenital posterolateral diaphragmatic hernia with acute onset of symptoms. He was admitted to our emergency department a few days after the onset of symptoms. A large thoracic herniation on the left side was seen on chest X-ray. Further investigation by computed tomography showed the presence of stomach, spleen and colon in the herniation. Semi-urgent surgery was performed by a laparoscopic approach. The diaphragmatic defect was closed with interrupted sutures. The operation and postoperative recovery were uneventful.

Labile synthetic cadmium complexes are not bioavailable to Pseudokirchneriella subcapitata in resin buffered solutions.

The Free Ion Activity Model (FIAM) predicts that cadmium (Cd) uptake by organisms is identical for solutions with the same free Cd(2+) concentration and inorganic composition. Clear exceptions to the FIAM have been shown for Cd uptake by plant roots, periphyton and human cells where labile Cd complexes increase bioavailability and which has been attributed to their role in enhancing Cd diffusion towards the uptake cells. Here, we assessed the role of labile Cd complexes on Cd uptake by algae, for which diffusion limitations should be less pronounced due to their smaller size. Long-term (3 days) Cd uptake by the green algae Pseudokirchneriella subcapitata was measured in resin buffered solutions with or without synthetic ligands and at three Cd(2+) ion activities (pCd 8.2-5.7). The free Cd(2+) activity was maintained during the test using a metal-selective resin located in the algal bottles. Total dissolved Cd increased up to 35-fold by adding the synthetic ligands at constant Cd(2+) activity. In contrast, Cd uptake by algae increased maximally 2.8 fold with increasing concentration of the synthetic ligands and the availability of the complexes were maximally 5.2% relative to Cd(2+) for NTA and CDTA complexes. It is concluded that labile Cd complexes do not greatly enhance Cd bioavailability to the unicellular algae and calculations suggest that Cd transport from solution to these small cells is not rate limiting.

Labile complexes facilitate cadmium uptake by Caco-2 cells.

The Free Ion Activity Model (FIAM) predicts that metal uptake in biota is related to the free ion activity in the external solution and that metal complexes do not contribute. However, studies with plants have shown that labile metal complexes enhance metal bioavailability when the uptake is rate-limited by transport of the free ion in solution to the uptake site. Here, the role of labile complexes of Cd on metal bioavailability was assessed using Caco-2 cells, the cell model for intestinal absorption. At low Cd(2+) concentration (1 nM), the CdCl(n)(2-n) complexes contributed to the uptake almost to the same extent as the free ion. At large Cd(2+) concentration (10 µM), the contribution of the complexes was much smaller. At constant Cd(2+) concentration, Cd intake in the cells from solutions containing synthetic ligands such as EDTA increased as the dissociation rate of the cadmium complexes increased, and correlated well with the Cd diffusion flux in solution measured with the Diffusive Gradient in Thin Films technique (DGT). The Cd intake fluxes in the cells were well predicted assuming that the specific uptake is limited by diffusion of the free Cd(2+) ion to the cell surface. Our results underline that speciation of Cd has a major effect on its uptake by intestinal cells, but the availability is not simply related to the free ion concentration. Labile complexes of Cd enhance metal bioavailability in these cells, likely by alleviating diffusive limitations.

Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?

AIM: The aetiology, pathophysiology, diagnostic delineation and treatment of chronic fatigue syndrome (CFS) remain a matter of debate. Here some aspects of the debate are elucidated, with a particular focus on the patients' decreased motor performance. HYPOTHESIS: The pathophysiological basis of decreased motor performance in CFS may, theoretically, involve three components: (1) a peripheral energetic deficit (impaired oxidative metabolism and/or physical deconditioning); (2) a central perceptual disturbance (higher effort sense or increased 'interoception'); and (3) a fundamental failure of the neurobiological stress system, leading to an abnormal 'sickness response'. It is proposed that the first two components may lead to low effort capacity, while the third component may lead to reduced effort tolerance. Although there is evidence for low effort capacity influencing symptoms and functional limitations in CFS, it is assumed that reduced effort tolerance might be the primary disturbance in CFS. DIAGNOSTIC IMPLICATIONS: Distinguishing low effort capacity and reduced effort tolerance may contribute to a refinement of current diagnostic criteria of CFS and the identification of subgroups. THERAPEUTIC IMPLICATIONS: The above-mentioned distinction may make it possible to formulate a rationale for an effective implementation and adequate outcome evaluation of rehabilitation strategies in CFS. RESEARCH IMPLICATIONS: This new heuristic framework may inform future research aimed at disentangling the complex determination of impaired motor performance in CFS, as well as studies aimed at customizing treatment to different subtypes of patients.

A review on 161 subtrochanteric fractures--risk factors influencing outcome: age, fracture pattern and fracture level.

The results obtained in 161 subtrochanteric fractures of the femur following treatment with a 95 degrees condylar blade plate or a dynamic condylar screw or a gamma nail were retrospectively analyzed. A 95 degrees angular blade plate was used in 107 cases, a dynamic condylar screw in 25, and a gamma nail in 29. There were 114 patients who were admitted after a simple fall and 47 who had sustained a high-energy trauma. In the type of trauma, associated lesions, ISS, pre-existing diseases and finally age we found statistically significant difference (P < 0.001) between patients admitted after a simple fall and patients admitted after a high-energy trauma. The mean operating times for the 95 degrees angled blade plate, the dynamic condylar screw and the gamma nail were 86, 85 and 74 min, respectively. Of the 161 patients, 18 required a revision operation. Of these 18 patients, 8 were initially treated using a 95 degrees condylar blade plate, 2 with a dynamic condylar screw and finally 8 with insertion of a gamma nail; 5 of these patients were less than 70 years old, while the other 13 were older than 70 years (P = 0.025; Fisher's exact test P = 0.042). The post-injury roentgenogram showed a fracture at the level of the lesser trochanter in 11 of the patients older than 50 years (P = 0.017; Fisher exact P = 0.053). Among the 18 patients who underwent revision operations, the post-injury roentgenograms showed 6 type IIIA fractures and 5 type V fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Local thrombolysis for occluded arterial grafts: is the yield worth the effort?

This study reports the results and complications of local thrombolytic therapy of 50 recently occluded grafts. These occurred in 41 patients with acute severe but still reversible ischemia. The majority were infra-inguinal synthetic grafts. Thrombolysis was induced with urokinase (n = 1), streptokinase (n = 11) or alteplase (n = 38) via an intra-arterial catheter. Complete angiographical lysis was obtained in 36 grafts (72%) and partial lysis in 6 (12%). The highest lysis rate was obtained with alteplase (32/36; 89%). Complementary endovascular and/or surgical intervention was needed in 17 patients to correct an underlying stenosis and/or to save the limb. Fifteen complications occurred (30%) of which distal embolization (n = 4) and bleeding (n = 8 of which 3 fatal) were the most frequent. Six of the bleeding episodes occurred in patients on chronic aspirin intake. The late results were poor. At six months, the primary patency of successfully lysed grafts dropped to 19% and the limb salvage rate to 64%. Thrombolytic therapy is far from the ideal management of thrombosed grafts: maintenance of restored patency is the challenge.

Listeria monocytogenes infection of a prosthetic vascular graft.

A 75-year-old man was admitted for acute ischaemia of his right leg for which he had undergone vascular prosthetic surgery at another hospital, ten and three years before. Cultures of the thrombosed graft and the clots removed on re-operation were positive for Listeria monocytogenes. After parenteral treatment with amoxicillin-clavulanic acid and gentamicin, the patient died from cardiorespiratory failure.