Robotic complete mesocolic excision with central vascular ligation for right colonic tumours - a propensity score-matching study comparing with standard laparoscopy.

BACKGROUND: Laparoscopic complete mesocolic excision (CME) of the right colon with central vascular ligation (CVL) is a technically demanding procedure. This study retrospectively evaluated the feasibility, safety and oncological outcomes of the procedure when performed using the da Vinci® robotic system. METHODS: A prospective case series was collected over 3 years for patients with right colonic cancers treated by standardized robotic CME with CVL using the superior mesenteric vessels first approach. The CME group was compared to a 2 : 1 propensity score-matched non-CME group who had conventional laparoscopic right colectomy with D2 nodal dissection. Primary outcomes were total lymph node harvest and length of specimen. Secondary outcomes were operative time, postoperative complications, and disease-free and overall survival. RESULTS: The study included 120 patients (40 in the CME group and 80 in the non-CME group). Lymph node yield was higher (29 versus 18, P = 0.006), the specimen length longer (322 versus 260 mm, P = 0.001) and median operative time was significantly longer (180 versus 130 min, P < 0.001) with robotic CME versus laparoscopy, respectively. Duration of hospital stay was longer with robotic CME, although not significantly (median 6 versus 5 days, P = 0.088). There were no significant differences in R0 resection rate, complications, readmission rates and local recurrence. A trend in survival benefit with robotic CME for disease-free (P = 0.0581) and overall survival (P = 0.0454) at 3 years was documented. CONCLUSION: Robotic CME with CVL is feasible and, although currently associated with a longer operation time, it provides good specimen quality, higher lymph node yield and acceptable morbidity, with a disease-free survival advantage.

Early solid additional feeding of suckling rabbits from 3 to 15 days of age.

Studies have shown that nutrient requirement of suckling kits is not satisfied, but they can be fed a double quantity of milk (double nursing) resulting in improved BW and weight gain. The aim of our trials was to give additional solid feed during the early suckling period (3 to 15 days of age) when rabbit kits drink exclusively milk. Two experiments were conducted with animals from Pannon Rabbit Breeding Program. In experiment 1 (n=77 does, 734 kits) the does received commercial feed (C) or C pellet supplemented with 0.2 g powdered thyme/kg (CT). Within both dietary groups of the does three groups of litters were formed: no additional solid creep feeding (N); soya bean-based pellet (S); S pellet with 1% added powdered thyme (ST). In group S and ST, cylinder-shaped solid pellets were made. At the beginning (3 days of age) two pieces of pellets were placed daily into the nestbox after nursing. Later on it was increased to six pellets till 15 days of age. The kits consumed the additional solid feed (S and ST), however, it did not affect the BW, weight gain or survival. In experiment 2 (n=30 does, 240 kits) all does consumed commercial feed. The additional feed for kits was based on commercial piglet feed. Three groups were formed: the litters in control group were fed no additional solid feed (K), kits were fed additionally with pellets (8 mm of diameter) based on piglet feed powder, pellet adhesive and water (PI), and extra glycerin powder was added to the mixture of piglet feed powder and water (PG). The experiment lasted from the age of 3 days till 21 days. At the beginning six pellets were placed on the nest material. Later on the amount was gradually increased to 24 pellets till age of 15 days. The kits consumed the pellets. The BW of PI group differed from group PG at age of 5, 9, 12 and 21 days by +7.3%, +6.5%, +5.9%, +4.8%, respectively (P<0.05) and from group K at age of 12 days by +5.9% (P< 0.05). The differences were more expressed at age of 16 and 19 days in favour of group PI (from K by +7.1%, +6.9% and from PG by +5.9%, +5 8%, respectively, P<0.01) and at 21 days of age (from K by +6.2%, P<0.01). To find appropriate composition of creep feed for kits further studies are needed.

Rare Case of Large Bowel Injury due to Direct Blunt Trauma to a Preexisting Femoral Hernia.

We report a case of an 85-year-old man with a known asymptomatic left femoral hernia who was admitted to the emergency ward a few hours after falling from a bicycle and suffering from blunt trauma of the handlebar to the left inguinal region. The clinical findings and a computed tomography (CT) scan detecting free air in the femoral hernia sac suggested bowel perforation. Emergency laparotomy 6 hours after the incident confirmed a tear of the sigmoid colon accompanied by free blood and faeces in the left inguinal region of the abdomen. A segmental sigmoid resection and a primary end-to-end colorectal anastomosis were performed. The postoperative course was complicated by delayed oral feeding, a local infection, and a partial left testicle necrosis that led to secondary resection. The patient was discharged after 32 days of in-hospital care. Three months post trauma, we recorded a restitutio ad integrum. The case exemplifies that blunt trauma to preexisting femoral hernias may cause potentially lethal bowel perforation and that the time interval between time of injury and surgical treatment may be a prognostic factor. CT scans seem most suitable for ruling out bowel perforation. The scarce literature for blunt trauma to hernias is reviewed.

Effect of a dietary supplementation with linseed oil and selenium to growing rabbits on their productive performances, carcass traits and fresh and cooked meat quality.

The present experiment tested a dietary supplementation with linseed oil and selenium to growing rabbits. The basal diet (B) contained 3% sunflower oil, while it was substituted with 3% linseed oil in the experimental feed (S). The selenium (Se) content of the two diets was 0.10 vs. 0.46 mg/kg. Rabbits were fed with B diet from the age of 18 days. One group was fed with the B diet until 11 weeks of age (group B), whereas the experimental groups were fed with S diet for 1, 2, 3 or 4 weeks (groups S1, S2, S3 and S4, respectively), before slaughtering (11 weeks of age). Live performance and carcass traits of rabbits, fatty acid (FA) profile and selenium content of their hind leg (HL) and Longissimus thoracis et lumborum (LTL) meat were considered in this study. In addition, the effect of two different cooking methods on the nutritional value of the enriched HL meat was also assessed. The tested dietary supplementation only minimally affected the live performance and carcass traits of rabbits. The S supplementation significantly reduced the Σ n-6 FA and increased the Σ n-3 FA of the HL meat and LTL meat, compared to the B diet (p < 0.001); thus, n-6/n-3 ratio was improved (p < 0.001). In addition, HL meat and LTL meat of S fed rabbits were significantly enriched in Se reaching a twofold increase in both meat cuts (p < 0.01). Therefore, the S supplementation improved the functional value of the rabbit meat. The heat treatment affected cooking loss, Se and vitamin E contents as well as the oxidative status of the HL meat (p < 0.001), with the different cooking methods providing different results. In addition, even if the beneficial C20:5 n-3 and C22:6 n-3 decreased with cooking, the n-6/n-3 ratio remained unaffected.

Effect of genotype, housing system and hay supplementation on carcass traits and meat quality of growing rabbits.

The aim of the study was to examine the effects of genotype (Pannon Large × Pannon Ka/Large/or Hungarian Giant × Pannon Ka/Hung), housing system (Cage or small Pen) and hay supplementation (Pellet without or with Hay/P+Hay/) on carcass and meat (Longissimus dorsi/LD/ and hind leg/HL/) quality of growing rabbits. Large rabbits showed higher carcass weights, as well as higher fatness and meatiness compared to Hung rabbits. Caged rabbits were heavier, with higher prevalence of the mid part of the carcass, and showed higher fatness and lower meat toughness than Penned rabbits. Caged rabbits meat was richer in MUFA, but poorer in PUFA and Σ n-6 FA. Hay supplementation impaired carcass weight, carcass fatness, L* and a* color, and lipids content. P+Hay increased the HL meat content of C18:3 n-6 and C20:5 n-3 FA. Overall results offer further information on how alternative breeds, housing systems and feeding strategies can affect carcass traits and meat quality.

Major postoperative complications following elective resection for colorectal cancer decrease long-term survival but not the time to recurrence.

AIM: The aim of the study was to determine the effect of major complications after colorectal cancer surgery on survival and time to recurrence. METHOD: Patients having a curative colorectal cancer resection and a follow-up of at least 3 years were identified from a prospective database. Major complications were defined as Clavien-Dindo Grades 3b or 4 and their impact on time to recurrence and mortality was analysed by univariate and multivariable analysis. Postoperative death within 30 days or during the initial hospitalization (Clavien-Dindo Grade 5) was a priori excluded. RESULTS: From 2003 to 2012, 868 colorectal cancer resections resulting in 63 (7%) major postoperative complications including deaths (Clavien-Dindo ≥ 3b) were identified. After exclusion of Grade 5 complications (postoperative or in-hospital deaths), 844 resections with 39 (5%) major complications remained for analysis. Median follow-up time was 5.7 years. Using the Kaplan-Meier method, the estimated crude 5-year overall survival probability was 78% (95% CI 75-81) in the group without and 65% (95% CI 51-83) in the group with major complications (P = 0.009, log-rank test). Major complications were a significant negative predictor for overall survival (hazard ratio 2.42, 95% CI 1.41-4.14) when adjusted for sex, age, American Society of Anesthesiologists grade, tumour site (colon vs rectum), R stage and tumour stage. However, in both univariate and multivariable analysis, major complications were not a significant predictor for time to recurrence (hazard ratio 1.29, 95% CI 0.56-2.99). CONCLUSION: Non-lethal major postoperative complications seem to have a negative long-term impact on survival but not on time to recurrence.

Performance and welfare of rabbit does in various caging systems.

The objective of the study was to compare production and welfare of rabbit does and their kits housed in various types of cages. Female rabbits were randomly allocated to four groups with the following cage types: CN: common wire-mesh flat-deck cage, without footrest; CF: cage similar to the CN but with plastic footrest; ECWP: enlarged cage with wire-mesh platform; and ECPP: extra enlarged cage with plastic-mesh platform. All does were inseminated on the same day, 11 days after kindlings. Reproductive performance was evaluated during the first five consecutive kindlings. Severity of sore hocks was scored at each insemination. Location preference of the does and the platform usage of their kits were evaluated. Kindling rate, litter size (total born, born alive, alive at 21 and 35 days) and kit mortality were not significantly influenced by the cage types. The litter weight at 21 days was higher in ECWP and ECPP cages than in the CF group (3516, 3576 and 3291 g, respectively; P2.5 cm) and 3 to 4 (3=callus opened, cracks present; 4=wounds) were 58%, 60%, 78% and 48%, and 0%, 5%, 0% and 48% in groups ECPP, ECWP, CF and CN, respectively. Higher number of daily nest visits was observed for CF does than for ECWP does (12.5 v. 5.9; P2/day) was higher in the CF group than in the ECWP group (12.1 v. 3.2%; P<0.01). Within large cages, the does were observed on the platform more frequently in the ECPP cages compared with the ECWP cages (56.9% v. 31.7%; P<0.001). Similarly, 2.7% and 0.2% of kits at 21 days of age, and 33.2% and 5.2% of kits at 28 days of age, were found on the platforms of ECPP and ECWP cages, respectively. In conclusion, cages larger than the conventional ones improved kits' weaning weight, plastic footrests and plastic-mesh platforms in conventional and/or large cages reduced sore hocks' problems, plastic-mesh platforms were more used by both does and kits compared with the wire-mesh platforms.

Effect of housing conditions on production, carcass and meat quality traits of growing rabbits.

Production, carcass traits and meat quality of rabbits housed in cages or in different pens were compared. Rabbits (n=579) were sorted into 5 groups: C=cage (2 rabbits/cage); pen without platform: P11=9 rabbits/pen; P16=14 rabbits/pen; pen with platform: PW=wire net platform, 14 rabbits/pen; PD=platform with straw-litter, 14 rabbits/pen. Feed intake and average daily gain between 5 and 11 weeks, and body weight at 11 weeks were significantly higher in C rabbits than that of the mean of pen-housed groups, while the PD group had the lowest growth performance. C rabbits had the smallest hind part to reference carcass (P<0.001) and the largest percentage of perirenal and scapular fat (P<0.001). The meat/bone ratio was the largest in group C (P<0.05). Differences were recorded in a* value and lipid content of m. Longissimus dorsi. Rabbits housed in cages generally had the best performance whereas those housed in pens with platform exhibited the worst.

Comparison of performance and welfare of single-caged and group-housed rabbit does.

Although rabbit does are generally single housed on rabbit farms worldwide, it has been suggested by some specialists and recommendation of organic rabbit production systems that group housing of does is more comfortable and similar to the living conditions of the European wild rabbits. The aim of this experiment was to compare production of single-caged (S) and group-housed does (G). The S does were housed in commercial rabbit cages (floor area 0.32 m(2) and 0.3 m high). In treatment G, four does and one buck were housed in four pens measuring 7.7 m(2) (half of the floor was deep litter and the other half was plastic slat), with four nest boxes in each pen (n = 16). In treatment S, approximately half of the does (n = 18) were inseminated 2 days after kindling (S-33), whereas in the remaining does (n = 16) AI was done 11 days after kindling (S-42). A single-batch system (all of the does in the group were inseminated on the same day) was used in both S treatments. Kindling rates were 77.6%, 85.2% and 45.6% in treatments S-33, S-42 and G, respectively (P < 0.05). During the experiment, the percentage of does that kindled 0, 1, 2, 3, 4 and 5 times were 17%, 25%, 17%, 25%, 17% and 0% (G); 0%, 0%, 0%, 8%, 69% and 23% (S-33); and 0%, 0%, 17%, 58% and 25% (S-42, in this treatment does had a maximum of four kindlings). There were no significant differences among treatments for litter size. In treatments S-33, S-42 and G, suckling mortality was 14.0%, 15.2% and 38.5%, respectively (P < 0.001); survival of does was 71%, 81% and 50% (P = 0.084); and faecal corticosterone concentrations were 61, 54 and 175 nmol/g (P < 0.001). The high mortality of kits was associated with stress and aggressive behaviour of does, including scratching, biting or killing the kits, which resulted in the high rates of mortality and culling, as well as shorter lifespan of does. Because of high stress, increased mortality and morbidity, and low productivity, group housing of rabbit does resulted in poorer animal welfare and increased production costs, and therefore is not recommended.

[Solitary pulmonary nodule on CT - observation or surgical resection?]. / Lungenrundherd im CT - Beobachten oder resezieren?

Incidentally found solitary pulmonary nodules (SPN) are increasing due to liberal use of high resolution CT scans. SPNs are defined as densities up to 3cm without associated enlarged lymph nodes. Morphologic patterns of the SPN in CT or dynamic changes in serial investigations as well as the individual risk profile (age, smoking history, current or past malignant disease) are crucial to classify the likelihood of malignancy as low, intermediate or high. Whereas low risk SPNs have to be observed by serial CT scans, intermediate risk SPNs have to be evaluated by transthoracic or bronchoscopic biopsies. However, these investigations are only reliable if malignant or specific benign diseases can be clearly diagnosed in the obtained tissue. In all the other cases, SPNs remain undetermined and surgical resection is mandatory. Increasingly, FDG-PET is performed in patients with intermediate risk SPNs and a high risk for surgery aiming to further determine the pre-test probability of malignant disease. Its sensitivity is about 80%. Nodules with high FDG uptake are suspect to be malignant and surgical removal is indicated. SPN with a high likelihood to be malignant are usually resected surgically as a primary approach. In case of metastasis, excisional biopsy may be therapeutic. The surgical method of choice is the video assisted thoracoscopic (VATS) wedge resection. Ideal for this method are nodules of 1 to 2 cm in diameter not localised deeper within lung parenchyma than its own diameter. If a SPN is diagnosed intraoperatively to be a non-small cell lung cancer, anatomic resection can be performed under the same anaesthesia. SPNs diagnosed to be cancer often are early stage tumours. Therefore, lobectomy and lymphadenectomy can also be made in VATS technique. In rare cases, diagnostic thoracotomy may still be necessary to definitely determine the aetiology of a SPN. An interdisciplinary approach is crucial to plan an efficient and individualised work-up of SPNs.

Use of different areas of pen by growing rabbits depending on the elevated platforms' floor-type.

The addition of platforms to rabbit cages increases their accessible area and provides rabbits greater freedom and mobility. Different types of platforms enable rabbits to situate themselves where they are most comfortable. The objective of this experiment was to analyse preference of growing rabbits between different areas of the pen depending on the elevated platforms' floor-type. Pens with a basic area of 0.84 m2 were equipped with platforms of 0.42 m2. Three types of flooring of the elevated platforms were used as treatments: deep-litter floor and an open wire-net floor (Experiment 1), and a deep-litter floor and a wire-net floor with a manure tray beneath it (Experiment 2). Growing rabbits (n = 168; 42 per treatment) between the ages of 5 and 11 weeks were studied, based on 24 h video recordings from infra-red cameras (one recording per week) applying scan sampling method with a frequency of 30 min. When the platform was deep-litter, significantly (P < 0.001) more rabbits used the area under the platform (53.7% and 54.3% in Experiments 1 and 2, respectively) than stayed on the platform (16.7% and 7.6%). In treatments of wire-net platform with and without tray beneath the platform also significantly (P < 0.001) more rabbits stayed under the platform (43.7% and 34.7%, respectively) than on the platform (19.5% and 29.9%, respectively). The differences from the expected 33.3% staying on the platform or under the platform were significant at least at the level of P < 0.05. The results show that the wire-net platform with the manure tray provides the optimal environment as it leads to the rabbits spreading themselves more evenly in the pen (i.e. the platform expands available floor area) without the risk of soiling from above, and without adverse effects on heat dissipation, and with the possibility of seeking cover when desired.

Intraoperative duplex ultrasonography in carotid endarterectomy: the impact on indication for immediate revision and intermediate-term outcome.

BACKGROUND: Thromboembolic complications in relation to carotid endarterectomies (CEA) are frequently associated with technical errors. We analyzed prospectively the impact of intraoperative duplex ultrasonography (IODS) in CEA on immediate revision and postoperative results. PATIENTS AND METHODS: We have observed 70 patients with 74 CEA. Indications for surgery were asymptomatic high grade stenosis (70-99%) or symptomatic stenosis of > 50%. IODS findings were rated as "relevant", "minor" or "normal". Relevant findings were immediately repaired. Peri- and postoperative neurological events were analyzed in Duplex Scans controls in a median length of follow-up of 17.3 months. Outcome of patients with "minor" findings (group A) were compared with patients having "normal" or corrected "relevant" findings (group B). RESULTS: In 8/74 cases (11%) we found relevant findings leading to immediate revision. In 25/74 (34%) cases minor findings were detected which were not revised. In group A (n = 25, 34%) two asymptomatic occlusions and one recurrent high grade stenosis were found during follow-up. In group B (n = 49, 66%) we detected two high and two low grade stenosis. The 30 day death and stroke rate was 1.4% (n = 1). CONCLUSIONS: IODS is a sensitive method to detect immediately pathological findings. Its correction seems to reduce the incidence of early occlusions and therefore early neurological events.

[Bone density and laboratory parameters of bone metabolism in patients with terminal heart disease]. / Knochendichte und Laborparameter des Knochenstoffwechsels bei Patienten mit terminaler Herzerkrankung.

PURPOSE: The purpose of this study was to assess bone mineral density (BMD) and parameters for bone metabolism in patients with end-stage heart disease awaiting heart transplantation to determine whether these patients are at increased risk of bone disease. PATIENTS AND METHODS: 39 adult men (mean age 52.3, range 21-65 years) with ischemic (41%), idiopathic (43.5%), valvular (2.5%) and diverse (13%) end-stage heart disease were studied prior to heart transplantation. BMD was measured using dual-energy x-ray absorptiometry at the lumbar spine (L2-L4) and at the upper femur (Ward's triangle and femoral neck). Renal and bone biochemical profiles, parathyroid hormone (PTH), 25-OH-vitamin D3, testosterone, alkaline bone phosphatase, osteocalcin, and deoxypyridinoline and calcium excretion were measured. RESULTS: No fractures were found. Mean z-scores were -1.06 +/- 2.02 (mean +/- SD) at the lumbar spine, -1.12 +/- 2.03 at the femoral neck and -0.25 +/- 1.06 at Ward's triangle. Significantly decreased values were seen at the lumbar spine and at the femoral neck compared to age matched healthy controls. Mean values of serum creatinine and parathyroid hormone were elevated (114.4 +/- 29.5 mumol/l and 84.3 +/- 67.8 ng/l, respectively). 7 (18%), 10 (26%) and 22 (56%) of the 39 patients had values beneath the normal range of 25-OH-vitamin D3, testosterone and osteocalcin respectively. Mean urinary deoxypyridinoline/creatinine ratios were elevated (9.46 +/- 8.52 nmol/mmol, normal range 2.5-5). No correlation existed between osteocalcin and urinary deoxypyridinoline/creatinine ratio. Using a multiple linear regression model, serum PTH and cardiac ejection fraction (EF) weakly predicted BMD at the femoral neck (r2 = 0.26). CONCLUSIONS: (1.) Lumbar spine and femoral neck BMD are low in patients awaiting heart transplantation. (2.) A low EF and a high PTH weakly correlate with a decrease in BMD at the femoral neck. (3.) In patients with end-stage heart failure the coupling of bone formation to bone resorption is frequently disturbed. (4.) Testosterone and 25-OH-vitamin D3 levels are low in a number of patients and in such cases replacement therapy may be appropriate.

A rickettsia-like organism from Ixodes uriae ticks collected on the Kerguelen Islands (French Subantarctic Territories).

A rickettsia-like microorganism was isolated in suckling mice from Ixodes uriae ticks collected from penguins breeding on Mayes Island, Kerguelen Archipelago, French Subantarctic Territories. At isolation, this agent mimicked a tick-borne arbovirus. Finally, electron microscopy studies of infected suckling mouse livers showed the presence of inclusions filled with pleomorphic microorganism in the cytoplasm of some hepatocytes, sometimes dividing by binary fission and thus of obviously non-viral nature. No firm serological relationship was demonstrated with Chlamydia psittaci, C. trachomatis, C. pneumoniae, Coxiella burnetti, Cowdria ruminentium, Ehrlichia canis, E. phagocytophila, E. risticii or the WSU/1044 agent. The exact taxonomic position of the "Mayes" agent remains to be clarified.