Pollen adaptation to ant pollination: a case study from the Proteaceae.

BACKGROUND AND AIMS: Ant-plant associations are widely diverse and distributed throughout the world, leading to antagonistic and/or mutualistic interactions. Ant pollination is a rare mutualistic association and reports of ants as effective pollinators are limited to a few studies. Conospermum (Proteaceae) is an insect-pollinated genus well represented in the south-western Australia biodiversity hotspot, and here we aimed to evaluate the role of ants as pollinators of C. undulatum. METHODS: Pollen germination after contact with several species of ants and bees was tested for C. undulatum and five co-flowering species for comparison. We then sampled the pollen load of floral visitors of C. undulatum to assess whether ants carried a pollen load sufficient to enable pollination. Lastly, we performed exclusion treatments to assess the relative effect of flying- and non-flying-invertebrate floral visitors on the reproduction of C. undulatum. For this, we measured the seed set under different conditions: ants exclusion, flying-insects exclusion and control. KEY RESULTS: Pollen of C. undulatum, along with the other Conospermum species, had a germination rate after contact with ants of ~80 % which did not differ from the effect of bees; in contrast, the other plant species tested showed a drop in the germination rate to ~10 % following ant treatments. Although ants were generalist visitors, they carried a pollen load with 68-86 % of suitable grains. Moreover, ants significantly contributed to the seed set of C. undulatum. CONCLUSIONS: Our study highlights the complexity of ant-flower interactions and suggests that generalizations neglecting the importance of ants as pollinators cannot be made. Conospermum undulatum has evolved pollen with resistance to the negative effect of ant secretions on pollen grains, with ants providing effective pollination services to this threatened species.

Management and outcome of 308 cases of liver trauma in Bologna Trauma Center in 10 years.

INTRODUCTION: Management of Liver Trauma may vary widely from NOM +/- angioembolization to Damage Control Surgery. Multidisciplinary management is essential for achieving better outcomes. MATERIAL AND METHODS: During 2000-2009 period 308 patients with liver injury were admitted to level 1 trauma center and recorded in Trauma Registry. Collected data are demographics, AAST grade, initial treatment (operative or non-operative treatment) and outcome (failure of NOM), death. All patients were initially assessed according to ATLS guidelines. In case of haemodynamic instability and FAST evidence of intra-abdominal free fluid, the patients underwent immediate laparotomy. Hemodynamically stable patients, underwent CT scan and were admitted in ICU for NOM. RESULTS: Two hundred fourteen patients (69.5%) were initially managed with NOM. In 185 patients this was successful. Within the other 29 patients, failure of NOM was due to liver-related causes in 12 patients and non-liver-related causes in 17 Greater the grade of liver injury, fewer patients could be enrolled for NOM (85.8% in I-II and 83.3% in III against 39.8% in IV-V). Of those initially treated non-operatively, the likelihood of failure was greater in more severely injured patients (24.4% liver-related failure rate in IV-V against the 1.3% and 1.0% in I-II and III respectively). One hundred twenty-three patients (40% of the whole population study--308 patients) underwent laparotomy: 94 immediately after admission, because no eligible for NOM; 29 after NOM failure . In the 81 patients in which liver bleeding was still going on at laparotomy, hemostasis was attempted in two different ways: in the patients affected by hypothermia, coagulopathy and acidosis, perihepatic packing was the treatment of choice. In the other cases a "direct repair" technique was preferred. "Early mortality" which was expected to be worse in patients with such metabolic derangements, was surprisingly the same of the other group. This proves efficacy of the packing technique in interrupting the "vicious cicle" of hypothermia, coagulopathy and acidosis, therefore avoiding death ("early death" in particular) from uncontrollable bleeding. CONCLUSION: NOM +/- angioembolization is safe and effective in any grade of liver injury provided hemodynamic stability. DCS is Gold Standard for hemodynamically unstable patients.

IFSO Update Position Statement on One Anastomosis Gastric Bypass (OAGB).

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued a position statement on the role of one anastomosis gastric bypass (OAGB) in the field of bariatric/metabolic surgery in 2018 De Luca et al. (Obes Surg. 28(5):1188-206, 2018). This position statement was issued by the IFSO OAGB task force and approved by the IFSO Scientific Committee and IFSO Executive Board. In 2018, the OAGB task force recognized the necessity to update the position statement in the following 2 years since additional high-quality data could emerge. The updated IFSO position statement on OAGB was issued also in response to inquiries to the IFSO by society members, universities, hospitals, physicians, insurances, patients, policy makers, and media. The IFSO position statement on OAGB has been reviewed within 2 years according to the availability of additional scientific evidence. The recommendation of the statement is derived from peer-reviewed scientific literature and available knowledge. The IFSO update position statement on OAGB will again be reviewed in 2 years provided additional high-quality studies emerge.

Laparoscopic treatment of De Garengeot hernia with Progrip.

BACKGROUND: Many eponyms have been used to classify some rare conditions of incarceration of a hernia at the level of the groin and femoral canal. The incarceration of the appendix at the level of the groin canal was first described by Claudius Amyand, while the incarceration of the appendix inside the femoral canal is a condition known as De Garengeot hernia. The incidence of such an event is very low and surgical treatment is usually performed via inguinal approach. CASE PRESENTATION: We describe the case of a 63-year-old woman who presented upon arrival at the Emergency Room a sore tumefaction in the femoral region with skin erythema. The patient had never undergone surgery for groin or femoral hernias. After performing ultrasound reporting the presence of an incarcerated intestinal loop, the patient underwent surgery. Laparoscopic exploration highlighted the presence of a De Garengeot hernia. After exploration, it was decided to continue the laparoscopic operation: at first, the hernia sac was reduced, then a self-gripping mesh was put in place. Finally, after the closure of the peritoneum, the operation was completed by performing a laparoscopic appendectomy. The patient was discharged from hospital three days from surgery with an antibiotic therapy for further two days after discharge. After three months, upon clinical examination, no recurrences of hernia were evident. CONCLUSIONS: We describe a rare case of De Garengeot hernia treated laparoscopically. The treatment of such a condition is not standardized because of the few cases described. The laparoscopic approach should always be considered to perform at least an exploration of the abdominal cavity and evaluate the contents of the hernia sac. Laparoscopic hernia treatment should be carried out by experienced surgeons who are familiar with the technique and apply it routinely. KEY WORDS: Appendicitis, De Garengeot, Hernia, Laparoscopy.

Endoscopic gastrostomy for enteral nutrition in neurogenic dysphagia: Application of a nasogastric tube or percutaneous endoscopic gastrostomy.

Enteral nutrition can be administered via a nasogastric tube or, in selected patients, via a percutaneous endoscopic gastrostomy. In patients with neurogenic dysphagia, the choice of nutritional administration, and above all the timing, are crucial. Our aim was to retrospectively assess the impact of new guidelines for percutaneous endoscopic gastrostomy insertion adopted since January 2002 and compare them with our previous experience. From January 1992 to June 2007, 285 gastrostomies (168 M, 117 F) were positioned in our institute. We analysed 232 patients (139 M, 93 F) in whom a percutaneous endoscopic gastrostomy was applied for neurogenic dysphagia: Group A (from January 1992 to December 2001) consisting of 174 patients; Group B (from January 2002 to June 2007) consisting of 58 patients. The percutaneous endoscopic gastrostomy was positioned in all the cases with neurogenic dysphagia after a period of not less than 3 weeks of nutrition by nasogastric tube. A total of 6 major complications (2.3 %) occurred, almost all in group A. The mortality rate (3 patients, 2%) correlated with the complications in group A. In cases of neurogenic dysphagia we believe that greater methodological rigour in the multidisciplinary decision-making process, and a period of about 6-8 weeks' nutrition by nasogastric tube after the acute neurological damage may be useful to ensure a better prognostic evaluation of the patient and hence of the indications for percutaneous endoscopic gastrostomy.

Laparoendoscopic Percutaneous Endoscopic Gastrostomy in Adults.

BACKGROUND: Since its introduction, the placement of percutaneous endoscopic gastrostomy (PEG) has been increasing in the Western countries. Nevertheless, it is not always possible to perform this operation. Laparoscopic-assisted endoscopic gastrostomy (LAPEG) is an effective alternative solution. MATERIALS AND METHODS: Indication to PEG placement was established only for people who required a nutritional support of >4 weeks and without metastatic carcinoma. Sixteen patients underwent LAPEG after the failure of the original PEG operation. Two trocars of 5 mm and one of 12 mm were used, and a fourth trocar of 5 mm was placed when necessary to lift the liver. In four cases a gastrotomy was performed, in seven patients it was not necessary. When PEG was placed, the stomach was not fixed with stitches to the abdominal wall. RESULTS: Sixteen patients were selected for LAPEG and were all successful; in one case it was necessary to replace the PEG, and the same procedure was performed again. Median age was 73 years. Placement of laparoscopic PEG was not associated with other surgical procedures. Nutritional feeding started the day after for patients with sutureless technique and 2 days after in patients with gastrotomy. CONCLUSION: LAPEG is a safe technique with a low complication rate. It should be considered a minimal alternative in all cases where the placement of PEG is not possible.

Complications of laparoscopic gastric banding: detection and treatment.

INTRODUCTION: Laparoscopic adjustable gastric banding (LAGB) is acknownledged as a popular and effective surgical option in the management of obesity and related metabolic diseases. This procedure is a remarkably safe operation from both a general surgical and bariatric perspective. It facilitates brief hospitalization and can be performed by single incision. METHODS: We analyzed the most common LAGB complications as intraoperative and postoperative gastric perforation, stomach slippage/dilatation, port/tubing complications and intragastric band migration which occurred in our long decades clinical experience. Detection, treatment and rate of presentation of each complication was evaluated. RESULTS: LAGB showed good long term results in terms of weight loss and resolution of obesity related diseases. Moreover, mortality due to obesity and related diseases appeared significantly lower in LAGB patients than in medically treated patients. CONCLUSION: Gastric Banding has a very low rate of early and late complications; these are also less severe when compared to more invasive procedures and are likely to be managed with mini-invasive techniques. In any case referral to a bariatric surgeon is deemed appropriate. KEY WORDS: Complication, Laparoscopic gastric banding, Morbid obesity.

A New Concept in Bariatric Surgery. Single Anastomosis Gastro-Ileal (SAGI): Technical Details and Preliminary Results.

BACKGROUND: In one anastomosis gastric bypass (OAGB), the measurement of the afferent limb starting at the angle of Treitz may result in insufficient absorptive surface of the intestine of the remaining efferent limb. To address this concern, we recently modified the technique of OAGB by constructing the gastrointestinal anastomosis at a fixed distance from the ileocecal valve (i.e., 300 cm). We adopted the new concept and named it the single anastomosis gastro-ileal bypass (SAGI). METHODS: Seven consecutive patients with morbid obesity underwent the SAGI procedure. RESULTS: There were no intraoperative complications and there were no deaths. The mean excess weight (EW) loss was 55.1 % at 3 months and 82.1 % at 6 months. CONCLUSIONS: The SAGI procedure may constitute a safer alternative to the conventional OAGB.

The NOTA study: non-operative treatment for acute appendicitis: prospective study on the efficacy and safety of antibiotic treatment (amoxicillin and clavulanic acid) in patients with right sided lower abdominal pain.

BACKGROUND: Case control studies that randomly assign patients with diagnosis of acute appendicitis to either surgical or non-surgical treatment yield a relapse rate of approximately 14% at one year. It would be useful to know the relapse rate of patients who have, instead, been selected for a given treatment based on a thorough clinical evaluation, including physical examination and laboratory results (Alvarado Score) as well as radiological exams if needed or deemed helpful. If this clinical evaluation is useful, the investigators would expect patient selection to be better than chance, and relapse rate to be lower than 14%. Once the investigators have established the utility of this evaluation, the investigators can begin to identify those components that have predictive value (such as blood analysis, or US/CT findings). This is the first step toward developing an accurate diagnostic-therapeutic algorithm which will avoid risks and costs of needless surgery. METHODS/DESIGN: This will be a single-cohort prospective observational study. It will not interfere with the usual pathway, consisting of clinical examination in the Emergency Department (ED) and execution of the following exams at the physician's discretion: full blood count with differential, C reactive protein, abdominal ultrasound, abdominal CT. Patients admitted to an ED with lower abdominal pain and suspicion of acute appendicitis and not needing immediate surgery, are requested by informed consent to undergo observation and non operative treatment with antibiotic therapy (Amoxicillin and Clavulanic Acid). The patients by protocol should not have received any previous antibiotic treatment during the same clinical episode. Patients not undergoing surgery will be physically examined 5 days later. Further follow-up will be conducted at 7, 15 days, 6 months and 12 months. The study will conform to clinical practice guidelines and will follow the recommendations of the Declaration of Helsinki. The protocol was approved on November 2009 by Maggiore Hospital Ethical Review Board (ID CE09079). Trial Registration ClinicalTrials.gov identifier: NCT01096927.