External contamination of broilers by Campylobacter spp. increases from the farm to the slaughterhouse.

1. In this study, classical and molecular microbiological methods for detection and quantification of Campylobacter spp. were used to estimate their prevalence in faecal samples and skin swabs collected from 31 broiler flocks (20 farms) in Portugal, and measure the impact of transport-related factors on the expected rising excretion rates from the farm to the slaughterhouse. 2. Data on husbandry practices and transport conditions were gathered, including time in transit, distance travelled or ante-mortem plant-holding time. 3. A generalised linear mixed model was used to evaluate the significance of a potential post-transport rise in Campylobacter spp. counts and to assess risk determinants. 4. At least one flock tested positive for Campylobacter spp. in 80% of the sampled farms. At the slaughterhouse, Campylobacter spp. were detected in all faecal samples, C. jejuni being the most commonly isolated. 5. A post-transport rise of Campylobacter spp. counts from skin swabs was observed using classical microbiological methods (from a mean of 1.43 to 2.40 log10 CFU/cm2) and molecular techniques (from a mean of 2.64 to 3.31 log10 genome copies/cm2). 6. None of the husbandry practices or transport-related factors were found to be associated with Campylobacter spp. counts. 7. This study highlights the need for more research to better understand the multi-factorial nature of Campylobacter spp., a public health threat that was found to be highly prevalent in a sample of Portuguese poultry farms.

Heparin is biocompatible and can induce differentiation of human dental pulp cells.

AIM: To investigate the biocompatibility, osteogenic bioactivity and mRNA expression of the osteo/odontogenic markers bone morphogenetic protein 2 (BMP-2), osteocalcin (OC) and alkaline phosphatase (ALP), induced by heparin in human dental pulp cells (hDPCs). METHODOLOGY: hDPCs were exposed to the heparin, and cell viability was assessed by 3-(4,5-dimethylthiazol)-2,5-diphenyltetrazolium bromide (MTT), and cell death was evaluated by flow cytometry. Osteogenic bioactivity was evaluated by the alkaline phosphatase (ALP) assay, and the detection of calcium deposits by alizarin red staining (ARS). The gene expression of BMP-2, OC and ALP was quantified with real-time PCR. Statistical analysis was performed with ANOVA and Bonferroni or Tukey post-test and t-test (α = 0.05). RESULTS: Heparin had no cytotoxic effect and did not induce apoptosis. After 3 days, heparin had significantly higher ALP activity in comparison with the control (P < 0.05). Heparin had a significant (P < 0.05) stimulatory effect on the formation of mineralized nodules. BMP-2 and OC mRNA expressions were significantly higher in cells exposed to heparin than control group after 1 day (P < 0.05). CONCLUSIONS: Heparin was biocompatible in hDPCs, induced osteogenic bioactivity and enhanced mRNA expression of osteo/odontogenic markers BMP-2 and OC. These results suggest that heparin has potential to induce osteo/odontogenic cell differentiation of hDPCs.

Contamination of public transports by Staphylococcus aureus and its carriage by biomedical students: point-prevalence, related risk factors and molecular characterization of methicillin-resistant strains.

OBJECTIVES: To analyse the contamination of public transports by Staphylococcus aureus and assess its carriage by biomedical students, focussing on the point-prevalence, related risk factors and molecular characterization of methicillin-resistant strains. STUDY DESIGN: Cross-sectional survey. METHODS: Methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) isolated from handrails of buses (n = 112) and trains (n = 79) circulating in Porto and from nasal swabs of local university students (n = 475) were quantified, characterized by molecular typing methods and related to possible risk factors. RESULTS: The MRSA prevalence in buses (16.1%) was not significantly different from trains (8.9%). There was also no identifiable association between the counts of MSSA and MRSA in buses and trains and the number of travellers in each sampling day, specific routes (including those passing by main hospitals) or other risk factors. Of the students, 37.1% carried S. aureus, and having a part-time job or smoking were found to be risk factors for carriage. EMRSA-15 (ST22-SCCmecIVh) was the prevalent MRSA clonal lineage, found not only in the buses (n = 14) and trains (n = 2) but also in the single MRSA-carrier among the students. The characteristics of the community-associated Southwest Pacific MRSA clone were found in a single ST30-IVa isolate, which may suggest a recent SCCmec acquisition by an MSSA background in the community. CONCLUSIONS: The spread of EMRSA-15, a common hospital-associated lineage, among different public transports and as a nasal coloniser is of concern and warrants adequate public health control measures.

A rare neoplastic growth on the ear lobe.

We report a case of an 83-year-old previously healthy female patient presenting with a swiftly evolving erythematous violaceous, infiltrative, ulcerated onion like mass with hyperkeratotic surface on the left ear lobe. The lesion was excised and resulted as an atypical fibroxanthoma, an extremely rare neoplastic growth, being a superficial variant of pleomorphic malignant fibrous histiocytoma. A brief review of dia-gnosis, treatment and prognosis is discussed.

Neuroadaptive Bayesian optimisation to study individual differences in infants' engagement with social cues.

Infants' motivation to engage with the social world depends on the interplay between individual brain's characteristics and previous exposure to social cues such as the parent's smile or eye contact. Different hypotheses about why specific combinations of emotional expressions and gaze direction engage children have been tested with group-level approaches rather than focusing on individual differences in the social brain development. Here, a novel Artificial Intelligence-enhanced brain-imaging approach, Neuroadaptive Bayesian Optimisation (NBO), was applied to infant electro-encephalography (EEG) to understand how selected neural signals encode social cues in individual infants. EEG data from 42 6- to 9-month-old infants looking at images of their parent's face were analysed in real-time and used by a Bayesian Optimisation algorithm to identify which combination of the parent's gaze/head direction and emotional expression produces the strongest brain activation in the child. This individualised approach supported the theory that the infant's brain is maximally engaged by communicative cues with a negative valence (angry faces with direct gaze). Infants attending preferentially to faces with direct gaze had increased positive affectivity and decreased negative affectivity. This work confirmed that infants' attentional preferences for social cues are heterogeneous and shows the NBO's potential to study diversity in neurodevelopmental trajectories.

Real-time monitoring of CdTe quantum dots growth in aqueous solution.

Quantum dots (QDs) are remarkable semiconductor nanoparticles, whose optical properties are strongly size-dependent. Therefore, the real-time monitoring of crystal growth pathway during synthesis gives an excellent opportunity to a smart design of the QDs luminescence. In this work, we present a new approach for monitoring the formation of QDs in aqueous solution up to 90 °C, through in situ luminescence analysis, using CdTe as a model system. This technique allows a detailed examination of the evolution of their light emission. In contrast to in situ absorbance analysis, the in situ luminescence measurements in reflection geometry are particularly advantageous once they are not hindered by the concentration increase of the colloidal suspension. The synthesized particles were additionally characterized using X-ray diffraction analysis, transition electron microscopy, UV-Vis absorption and infrared spectroscopy. The infrared spectra showed that 3-mercaptopropionic acid (MPA)-based thiols are covalently bound on the surface of QDs and microscopy revealed the formation of CdS. Setting a total of 3 h of reaction time, for instance, the QDs synthesized at 70, 80 and 90 °C exhibit emission maxima centered at 550, 600 and 655 nm. The in situ monitoring approach opens doors for a more precise achievement of the desired emission wavelength of QDs.

Bioenergetic failure of human peripheral blood monocytes in patients with septic shock is mediated by reduced F1Fo adenosine-5'-triphosphate synthase activity.

OBJECTIVE: Increasing evidence points to the role of mitochondrial dysfunction in the pathogenesis of sepsis. Previous data indicate that mitochondrial function is affected in monocytes from septic patients, but the underlying mechanisms and the impact of these changes on the patients' outcome are unknown. We aimed to determine the mechanisms involved in mitochondrial dysfunction in peripheral blood mononuclear cells from patients with septic shock. DESIGN: A cohort of patients with septic shock to study peripheral blood mononuclear cell mitochondrial respiration by high-resolution respirometry analyses and to compare with cells from control subjects. SETTING: Three intensive care units and an academic research laboratory. SUBJECTS: Twenty patients with septic shock and a control group composed of 18 postoperative patients without sepsis or shock. INTERVENTIONS: Ex vivo measurements of mitochondrial oxygen consumption were carried out in digitonin-permeabilized peripheral blood mononuclear cells from 20 patients with septic shock taken during the first 48 hrs after intensive care unit admission as well as in peripheral blood mononuclear cells from control subjects. Clinical parameters such as hospital outcome and sepsis severity were also analyzed and the relationship between these parameters and the oxygen consumption pattern was investigated. MEASUREMENTS AND MAIN RESULTS: We observed a significant reduction in the respiration specifically associated with adenosine-5'-triphosphate synthesis (state 3) compared with the control group (5.60 vs. 9.89 nmol O2/min/10(7) cells, respectively, p < .01). Reduction of state 3 respiration in patients with septic shock was seen with increased prevalence of organ failure (r = -0.46, p = .005). Nonsurviving patients with septic shock presented significantly lower adenosine diphosphate-stimulated respiration when compared with the control group (4.56 vs. 10.27 nmol O2/min/10(7) cells, respectively; p = .004). Finally, the presence of the functional F1Fo adenosine-5'-triphosphate synthase complex (0.51 vs. 1.00 ng oligo/mL/10(6) cells, p = .02), but not the adenine nucleotide translocator, was significantly lower in patients with septic shock compared with control cells. CONCLUSION: Mitochondrial dysfunction is present in immune cells from patients with septic shock and is characterized as a reduced respiration associated to adenosine-5'-triphosphate synthesis. The molecular basis of this phenotype involve a reduction of F1Fo adenosine-5'-triphosphate synthase activity, which may contribute to the energetic failure found in sepsis.

Management of latrogenic perforation after gastrointestinal endoscopy.

BACKGROUND/AIMS: Gastrointestinal perforation during endoscopy is a rare but severe complication. Most instances occur during colonoscopy. PATIENTS AND METHODS: We retrospectively evaluated the cases of 23 patients with iatrogenic perforation (13 women, 10 men; mean age = 71 years [range, 49-89]). We identified 6 esogastric perforations, 2 endoscopic retrograde cholangiopancreatography (ERCP)-related perforations, and 15 colonic perforations. Demographics, type and aim of endoscopy, mechanism of perforation, delay of treatment, operative procedure, postoperative hospital stay, and mortality rate were analyzed. RESULTS: Three perforations occurred during diagnostic gastroscopy and 3 during therapeutic gastroscopy. ERCP-related perforations occurred during therapeutic procedures. Nine colonic perforations occurred during interventional colonoscopy. ERCP-related perforations always required laparotomy. For esogastric perforations, surgical treatment usually required laparotomy; only two patients (33%) could be managed by laparoscopy. In contrast, colon perforations could be managed by a laparoscopic approach (suturing and drainage or by laparoscopic resection) in 86.6% of cases. Overall mortality was 13% and occurred exclusively after esogastric perforation. CONCLUSION: Most gastrointestinal perforations occurred during therapeutic colonoscopy; these perforations could be treated by laparoscopy in most cases. Esogastric perforations and perforations after ERCP are rare and must be treated on a case-by-case basis; in most cases, laparotomy is required.

Impacts on human mortality due to reductions in PM10 concentrations through different traffic scenarios in Paris, France.

OBJECTIVES: Air pollution is a well-known burden for population health and health systems worldwide. Reduction in air pollution is associated with improvements in mortality and rates of respiratory, cardiovascular and other diseases. Though air quality is a problem globally, efforts to lower air pollutant concentrations are usually regional or local. In industrialized countries, most urban air pollution is caused by vehicles, suggesting reductions in traffic would result in reductions of pollution. However, detailed data on how such reductions can be achieved and impact public health is just beginning to emerge, and other influencing factors, including vehicle flow or urban landscape are largely unaccounted for. METHODS: We utilized a unique combination of vehicle emission measurements combined with simulations of traffic and vehicle variations, as well as urban topographies, to quantify health impacts of PM10 reduction in a single district of Paris, France, for various methods of traffic improvement. Here we rank and evaluate improvements in non-accidental mortality for thirteen possible scenarios to reduce traffic related PM10 emissions. RESULTS: The maximum impact scenario requires all passenger vehicles to meet Euro 5 standards and excludes diesel vehicles, resulting in long-term decreases in non-accidental mortality of 148.79 people per year, or 104.40 per 100,000 people. Similar reductions hold for the scenario requiring a completely electric passenger fleet, with long-term annual reductions of 137.14 premature mortalities. Removing all diesel vehicles is the third most impactful scenario, preventing 135.55 deaths yearly. DISCUSSION: PARTLESS provides comparisons between thirteen different traffic-related air quality reduction mechanisms in terms of improvements in mortality rates. Improving emissions standards, increasing electric vehicle use and removing diesel vehicles can prevent more than 148 deaths per year in this district alone. Further improvements in mortality reduction may require changes to the composition of vehicle components, asphalt or to the management of resuspended particulate matter.

Is there still a role for autopsy in abdominal surgery in 2008?

INTRODUCTION: Although autopsy has been shown to play an important role in certain surgical disciplines as cardiac surgery, few studies have been performed in digestive surgery. The purpose of the study is to determine if autopsy still has a role to play in abdominal surgery in 2008. TYPE OF STUDY: Retrospective study for the period 01.01.1996 to 31.12.2005. METHODS: 8,586 patients underwent abdominal surgery during this period. The average age was 55.2 years and male/female sex ratio was 1.1. Surgery was elective in 82% and emergency in 18% of cases. The surgical approach was laparoscopic in 65% and open surgery in 35% of cases. In-hospital morbidity, reintervention and mortality rates were 9.5%, 0.9% and 2.4% respectively. RESULTS: Among the 210 patients who died, thirty-three with generalized cancer or an extensive mesenteric infarct did not have an indication for autopsy ; 74 of the remaining 177 patients, (42%) had an autopsy. The most frequent causes of death were respiratory complications, sepsis and cardiac complications. In 8% of cases, a surgical complication may have caused death. In 44.5% of cases, the results of autopsy showed either a missed major diagnosis that would have changed the patient's prognosis (Goldman class I: 18.9%), or a missed major diagnosis that would not have changed the patient's prognosis (Goldman class II: 25.6%). CONCLUSION: Despite technological progress, autopsy still has an important role to play in the assessment and improvement of the quality of surgical practice.

A retrospective study of 74 laparoscopic repairs of abdominal incisional hernias.

INTRODUCTION: A laparoscopic procedure is used more and more frequently to treat incisional hernia with the potential benefits of shorter hospitalisation and a decrease in postoperative pain. The purpose of this retrospective study was to analyse the results of the laparoscopic treatment of incisional hernia at our institution and to identify potential risk factors for recurrence. METHODS: The medical data (pre-operative, peri-operative, and postoperative) of patients who received a laparoscopic repair of their incisional hernia between January 2003 and February 2007 were recorded. The follow-up was based on a retrospective analysis of the information found in the patients' medical records. RESULTS: Seventy-four laparoscopic interventions were performed on 71 patients. Polyester implants with an average size of 412.16 cm2 were used to cover the hernia. The mean operative time was 76.8 +/- 55.6 min (range, 20 to 295 min) and the mean duration of post-operative hospitalisation was 3.75 +/- 2.3 days (range, 2 to 12 days). One breach in the small intestine (1.4%) (sutured with 3/0 silk thread) and 1 conversion to laparotomy (1.4%) for a voluminous incisional hernia occurred during surgery. The post-operative morbidity was 8.2%, the rate of long-term complications was 27%, and 13 recurrences (including 3 with complications) were noted (17.6%) during a mean follow-up of 13 months. There was no postoperative mortality. Recurrences were linked to the use of large meshes corresponding to large incisional hernia diameter (p < 0.05). CONCLUSION: Although the morbidity/mortality rates are acceptable, technical improvements must be found to reduce the recurrence rate, in particular for large incisional hernias.

Restoration of digestive continuity after Hartmann's procedure: ASA score is a predictive factor for risk of postoperative complications.

BACKGROUND/AIMS: Re-establishment of colonic continuity (RDC) following Hartmann's procedure is associated with high morbidity (anastomotic leak 4-16%) and mortality (0-4%) rates. The aim of this retrospective study was to evaluate the morbidity of RDC following Hartmann's procedure, and analyse the various factors that may influence the rate of complications. METHODOLOGY: From 1996 to 2008, 158 patients were treated by Hartmann's colectomy. Hartmann's procedure is generally indicated in cases with infection in the abdominal cavity, combined with a distended or non-prepared intestine, or both. Of the 158 patients, 111 (70.3%) underwent a re-establishment of colonic continuity. The mean patient age was 63.4 years (26-91 years) ; the female/male ratio was 1:64. RESULTS: The mean delay between the Hartmann's procedure and the RDC was 169.7 days (21-1095 days) and the mean duration of the hospital stay was 16.7 days (8-57 days). The mortality rate was 0.9% and incidence of anastomotic stricture was 3.6%. The morbidity was 38.7%. The majority of patients presenting complications had an ASA score > II, and most of the patients without complications were classified as ASA < or = II. CONCLUSIONS: The RDC is an intervention performed safely after a 3 to 5-month delay with acceptable morbidity and negligible mortality. The ASA score is a determining factor for the risk of complications (p < 0.05).

[May still in 2010 a surgeon decide alone to operate a digestive cancer?]. / Un chirurgien peut-il en 2010 décider seul d'opérer un cancer digestif?

The authors raise the question whether a surgeon in 2010 may still decide by himself to operate a digestive cancer. Progresses in oncology and surgery have been considerable over the past 50 years. The appearance of laws over the past decade and the emergence of the concept of Evidence Based Medicine (EBM) have refocused the role of the surgeon in the care of digestive cancers. The emergence of quality systems such as peer review, 150 certification to analyze surgical procedures and results place the surgeons in the very front. The evolution of the surgical and oncological disciplines will change the role of the surgeon again in the future. The surgeon may always decide to operate a cancer in a coordinate way with the other care givers.

Integration and Vascular Ingrowth of a Collagen Meniscal Implant: A Case Report.

Meniscectomy is the most common surgery in orthopaedics. The absence of meniscal tissue might be related to irreversible damage to the articular cartilage. Meniscal replacement is a tissue-engineering technique for post-meniscectomy syndrome. Its success depends on the implant integration which was vastly proven in animal model studies. Histological evidence is hard to obtain in humans due to ethical issues. We report a clinical case in which a collagen scaffold meniscal implant was harvested six months after implantation due to mechanical failure. Histological analysis was performed revealing vascularisation not only of the peripheral attachment of the implant but also on the anterior horn. These morphologic findings demonstrate that this implant allows the colonisation by precursor cells and vessels, leading to the formation of a fully functional tissue. This present report is one of the few independent reports of scaffold biological integration in the literature.

Effect of immunocastration and caponization on fatty acid composition of male chicken meat.

Recently, immunocastration with Improvac (ImmC). has been tested in broilers and a considerable reduction in serum testosterone concentration (reduced by 79% compared to roosters) was observed. The aim of this study was to evaluate the effect of immunocastration on meat fatty acid (FA) composition and its comparison with caponized and intact males (roosters). The study was conducted with 3 experimental groups: control group (roosters), the group of birds submitted to surgical caponization (SurgC), and the group of birds submitted to immunocastration with Improvac. The comparison of breast meat partial FA sums of castrated (SurgC and ImmC) with control birds (roosters) revealed that castrated birds showed significantly higher content of n-3 polyunsaturated fatty acids (n-3 PUFA) than control birds (1.76 vs. 1.46 g/100 g of total FA; superiority of 20.2%), which has contributed to the occurrence of significant differences on both the n-6/n-3 ratio and the atherogenicity index (AI). In contrast, on leg meat portion, castrated birds displayed higher contents of both total saturated and monounsaturated fatty acids (SFA and MUFA, with 2.2 and 4.1% more, respectively) and lower total n-6 PUFA content (8.3% less) than was observed in control birds, which contributed to significant differences in the AI index. On the other hand, the comparison of breast meat portion from SurgC with ImmC showed that immunocastration contributed to lower total SFA and higher total n-6 PUFA, which have contributed to significant differences on both Polyunsaturated/Saturated (P/S) and n-6/n-3 ratios. Whereas, on leg meat portion no significant differences were observed on partial sums and a single difference was observed on the thrombogenicity index. Immunocastration of broilers has contributed to minor changes in the FA profile, but has improved the overall lipid quality indexes in both breast and leg meat portions. Therefore, immunocastration could be applied as an alternative method to caponization without negative consequences in meat FA profile.

Sepsis induces brain mitochondrial dysfunction.

OBJECTIVE: Mitochondrial dysfunctions have been associated with the pathogenesis of sepsis. A systematic survey of mitochondrial function in brain tissues during sepsis is lacking. In the present work, we investigate brain mitochondrial function in a septic mouse model. DESIGN: Prospective animal study. SETTING: University research laboratory. SUBJECTS: Male Swiss mice, aged 6-8 wks. INTERVENTIONS: Mice were subjected to cecal ligation and perforation (sepsis group) with saline resuscitation or to sham operation (control group). MEASUREMENTS AND MAIN RESULTS: Oxygen consumption was measured polarographically in an oximeter. Brain homogenates from septic animals presented higher oxygen consumption in the absence of adenosine 5'-diphosphate (state 4) compared with control animals. The increase in state 4 respiration in animals in the cecal ligation and perforation group resulted in a drastic decrease in both respiratory control and adenosine 5'-diphosphate/oxygen ratios, indicating a reduction in the oxidative phosphorylation efficiency. Septic animals presented a significant increase in the recovery time of mitochondrial membrane potential on adenosine 5'-diphosphate addition compared with control animals, suggesting a proton leak through the inner mitochondrial membrane. The septic group presented a general reduction in the content of cytochromes. Moreover, the activity of cytochrome c oxidase was specifically and significantly decreased in the brain during sepsis. Hydrogen peroxide generation by brain mitochondria from septic mice did not respond to substrates of electron transport chain or to adenosine 5'-diphosphate, showing that mitochondrial function may be compromised in a critical level in the brain during sepsis. CONCLUSIONS: The mitochondrial dysfunctions demonstrated here indicate that uncoupling of oxidative phosphorylation takes place in the brain of septic mice, compromising tissue bioenergetic efficiency.

Surgical resection for colon cancer: laparoscopic assisted vs. open colectomy.

BACKGROUND/AIMS: Laparoscopic surgery has been considered for more than a decade for treatment of colorectal cancer. Although its benefits in term of postoperative comfort and parietal preservation are commonly accepted, its efficiency to achieve proper oncologic resection and to prevent tumor recurrence are still debated. The purpose of this retrospective study is to compare results of a minimally invasive laparoscopic approach to these of open surgery for treatment of colorectal cancer. METHODOLOGY: From January 1st 1999 to September 30th 2004, 239 patients underwent colorectal cancer resections; 28 of these patients underwent surgery in an emergent context and were excluded from this study. Accurate follow-up was available for 165 of the 239 patients (69%). For the study, 165 patients were divided into 3 groups: 39 patients underwent a laparoscopically assisted surgery (L group), 120 patients underwent an open colectomy (O group) and 6 patients initially treated with a laparoscopic approach were converted to open colectomy (L/O group) (conversion rate: 8.8%). RESULTS: Sex ratio, mean age and A.S.A. score, as well as patients' past records were similar in the 3 groups. Histological staging was more often stages 3 and 4 in the O group (62.5%) comparing to the L group (41%) (p < 0.5). Mean operating time was slightly longerwhen a laparoscopically assisted approach was used. Overall early mortality rate of this study was 1.8%. Combined local and general overall morbidity rate was 36%. Overall incidence of anastomotic fistulae was 4% and reintervention rate during the early postoperative period was 8%. Postoperative ileus period was often longer for patients of the O group but without statistical significance. Mean duration of hospital stay was similar in the 3 groups. Data concerning surgical resection did not show any difference between groups. None of the patients experienced a metastatic skin settlement. Overall anastomotic stenosis rate was low (2%). The overall locoregional recurrence rate was 12%, without difference between the 3 groups. Forty-two percent of these recurrences were secondarily treated by curative surgery. Similar survival rates as well as oncological spreading frequencies were found. CONCLUSIONS: Results obtained when comparing minimal invasive laparoscopically assisted surgery to open procedure are similar and efficient.

Laparoscopic management of acute small bowel obstruction: a retrospective study on 156 patients.

BACKGROUND/AIMS: Laparoscopic treatment of small bowel obstruction (SBO) has been proposed in selected patients. This study reports an experience and tries to establish indications for laparoscopy. METHODOLOGY: 156 patients underwent laparoscopic or open approach for SBO. Demographics, clinical, biological, radiological and previous surgery were recorded. Obstruction causes, conversion rates and postoperative complications were retrospectively analyzed. RESULTS: Laparoscopic approach was undertaken for 96 patients (61%) and completed in 62 (65%), whereas 34 (35%) required conversion. 60 patients (39%) underwent a direct open approach. Mortality was 10% and morbidity 38%. Postoperative adhesion was the predominant etiology. Conversion rate and type of approach was directly influenced by cause of obstruction and type of previous surgery, but not by number of previous surgeries. Conversions and open approach increase morbidity, mortality, length of stay and return to transit. CONCLUSIONS: Laparoscopy is an elegant tool for management of selected patients with SBO. A single band of obstruction appearing after minor surgery appears to be a good indication for laparoscopy. Nevertheless, conversion rate and morbidity are still high. On the contrary, laparoscopy seems contraindicated for patients with prior history of major abdominal surgery, neoplasia or multiple laparotomies, and a direct open approach is then advocated. Prospective randomized studies comparing laparoscopy and open approach are required to evaluate their respective efficacy and safety in management of SBO.

Laparoscopic cholecystectomy for acute cholecystitis in the elderly: a retrospective study of 100 patients.

BACKGROUND: The objective of this retrospective study is to evaluate the use oflaparoscopic cholecystectomy in the treatment of acute cholecystitis in elderly patients, and to identify risk factors for mortality. METHODOLOGY: In this study we have included patients with acute cholecystitis aged 75 years and older. Patients were diagnosed after anatomical and pathological examination of an operative sample. We retrospectively examined 100 patients who underwent cholecystectomy between June 1991 and February 2007. Seventy-nine patients (79%) underwent laparoscopic cholecystectomy, 12 patients (12%) needed a conversion, and 15 patients (15%) were considered unfit to undergo a laparoscopic approach, due to their hemodynamic condition or for other reasons. RESULTS: American Society of Anesthesiologists Scores (ASA), inflammatory syndrome, length of postoperative stay, number of days in the Intensive Care Unit, local complications, and mortality rate are all significantly higher in the 'laparotomy and conversion'. There was not a significant difference in age or general complications between groups. The mortality risk factors include a high level of CRP, biliary peritonitis, emergency, and the necessity of laparotomy. CONCLUSION: Acute cholecystitis is a severe pathology in the elderly associated with a high rate of morbidity and mortality. Due to the mortality risk factors associated with acute cholecystitis, we recommend elective laparoscopic cholecystectomy for aged patients with symptomatic cholelithiasis, due to its low morbidity and mortality rates.

Management of sigmoid diverticulitis: a retrospective study of 268 patients.

BACKGROUND/AIMS: The therapeutic management of acute diverticulitis has evolved over the last years in favour of an initial conservative approach with laparoscopy rather than a primary anastomosis. We studied the management of sigmoid diverticulitis in the Digestive Surgical Unit to assess it in comparison to actual practice. METHODOLOGY: A retrospective review of patients admitted to our unit from January 1998 to June 2006 for diverticular disease. We divided the patients into 3 groups (Urgent Medical Group (UM), Urgent Surgical Group (US) and Scheduled Surgical Group (SS)), and analysed demographic data, the severity and recurrence of diverticulitis, pathology results, length of stay, morbidity and mortality. RESULTS: The mean age was 60.5+/-14.9 years. The overall mortality was 3% (14.5% for the Acute Surgical Group and 0 % for the Elective Surgical Group); overall morbidity 38.4%; the incidence of neoplasm 4.8% in urgent colectomies and 0.9% in scheduled colectomies. CONCLUSIONS: Based on our study and published reviews, we recommend elective colectomy after 2 recurrent episodes of acute diverticulitis, one episode of complicated acute diverticulitis managed conservatively, or if the patient is younger than 50 years-old. This approach would reduce the number of acute operations, which are associated with high morbidity and mortality.