Impact of preoperative bevacizumab on complications after resection of colorectal liver metastases: case-matched control study.

BACKGROUND: Chemotherapy may increase postoperative morbidity and mortality after liver surgery. Especially bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), could have a detrimental effect. To assess the impact of neoadjuvant bevacizumab on clinical outcome after hepatectomy for colorectal liver metastases (CRLMs) this case-matched control study was initiated. METHODS: The multicentric data collection was performed in the Swiss HPB Center of the University Hospital Zurich (CH), the Department of Digestive Surgery and Transplantation Strasbourg (F), and the Division of Hepato-biliary-pancreatic surgery of "Josep Tureta" Hospital Girona (E). Consecutive patients operated onbetween July 2005 and December 2007 due to CRLMs who received neoadjuvant chemotherapy were assessed. Patients were divided in two groups: group A had neoadjuvant chemotherapy with bevacicumab, and group B had it without bevacizumab. RESULTS: No differences in overall morbidity (56 vs. 40% in the bevacizumab and control groups, respectively, p = 0.23) or mortality could be documented. Similarly, the incidence of severe postoperative complications was not statistically different between the bevacizumab and control groups (31 and 18%, respectively, p = 0.31). Wound complications were comparable (11% in the bevacizumab group compared and 9% in the control group, p = 1.00). However, bevacizumab was associated with a significantly decreased incidence of postoperative hepatic insufficiency (7 vs. 20%, p = 0.03). CONCLUSIONS: No impact on the incidence or severity of complications by bevacizumab could be shown. Bevacizumab may even reduce the incidence of liver failure after liver surgery.

An immunohistochemical study of endocrine cells in the digestive tract of Varanus salvator (Reptile: Varanidae).

AIM: The aim of the study was to identify the distribution pattern and frequency of endocrine cell types in the digestive tract of Varanus salvator. MATERIALS AND METHODS: The presence of endocrine cells (glucagon, somatostatin, and serotonin) in the digestive tract (esophagus, stomach, and intestine) was detected using the avidin-biotin complex (ABC) method. RESULTS: Three types of endocrine cells immunoreactive to antisera glucagon, serotonin, and somatostatin were found in the caudal portion of the small and large intestines but were not observed in the esophagus, stomach, and caput and medial sections of the small intestine. Endocrine cells distributed in the digestive tract of V. salvator vary in color intensity, from weak to sharp, in response to the primer antibody. CONCLUSION: Endocrine cells in the digestive tract that is immunoreactive to glucagon, somatostatin, and serotonin are those found in the caudal portion of the small and large intestines. They are varied in distribution pattern, frequency, and color intensity.

Techno-economic analysis of bio-briquette from cashew nut shell waste.

The implementation of this research consists of 2 (two) aspects: the making and testing of bio-briquettes called technological aspects and economic analysis called economic aspects. Bio-briquettes is made from cashew nutshell waste obtained from Southeast Sulawesi, Indonesia. It is followed by pyrolysis, which is carried out in a simple batch type reactor by heating using liquefied petroleum gas (LPG). The bio-briquettes product has a calorific value of 29.49 MJ/kg, moisture content of 5.3%, ash content of 4.96%, volatile substances content of 17.16%, and carbon content of 72.62%, which meets the universally accepted bio-briquettes standard (SNI 016235-2000), Japanese, English and ISO 17225. The bio-briquettes product is suitable as an energy source. The economic analysis of the cashew nutshell was analyzed to determine its economic feasibility. For the bio-briquettes production capacity in 2,000 tons/year, cashew nut shell-briquettes products can be sold at 1,052,878 USD/year. The total production cost is USD842,304/year. The net profit is of USD147,402/year. The cost of LPG for 2,000 tons/year production capacity is USD954,358/years. The replacement of LPG with cashew seed bio-briquettes tends to help the average household of Muna Regency community to reduce the annual cost by 37.00%. In conclusion, bio-briquettes production's economic feasibility as analyzed from the investment rate is 23.55%, payout time is 3.42 years, and break-even point is 50.09%.

The role of "fatty pancreas" and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy.

INTRODUCTION: Pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is still a serious complication. We hypothesized that the amount of fatty tissue in the pancreatic parenchyma could be associated with the occurrence of PF after PD with pancreatogastrostomy. MATERIAL AND METHODS: From January 2004 to December 2006, 111 consecutive patients underwent PD with pancreatogastrostomy. The microscopic amount of fatty tissue in the pancreas was evaluated. RESULTS: The morbidity and mortality rates were 35.1% and 1.8%, respectively. PF occurred in 10.8% (n = 12). PF was of grade A in nine, grade B in two, and grade C in one patient. Univariate analysis showed that a body mass index (BMI) > 25 (P = 0.035), a soft pancreatic parenchyma (P = <0.003), a pancreatic duct size <3 mm (P = 0.015), and a fatty infiltration of the pancreas of more than 10% (P = 0.0003) were associated with the occurrence of PF. The advanced age (P = 0.049) and the BMI (P < 0.0001) were significantly associated with the presence of >10% of pancreatic fat. CONCLUSIONS: A pancreatic fatty infiltration of the pancreas over 10% constitutes a risk factor for PF after PD. Age and BMI are useful preoperative predictors of the percentage of pancreatic fat.