Influence of overweight and obesity on complications in colorectal surgery.

INTRODUCTION: Overweight and obesity are recognized as risk factors for many health-related disorders like diabetes, cardiovascular disease and malignancy. On the other hand, according to recent studies, they may be a favorable prognostic factor in patients treated for various chronic diseases. Patients with increased body mass index (BMI) have a lower mortality rate, which is known as the "obesity paradox". Overweight and obese patients, as reported by several papers, also have better outcomes after surgery. The aim of our study was to evaluate this somewhat surprising phenomenon on our group of patients. METHODS: The medical records of patients diagnosed with colorectal cancer who were treated with resection and primary anastomosis from 1 January 2010 to 31 December 2017 were retrospectively analyzed. Patients after multivisceral resections or with lacking data were excluded. We did not evaluate two underweight patients. The BMI classification of the World Health Organization was used. Postoperative complications, anastomotic leak, mortality and length of stay in hospital were investigated. RESULTS: 225 patients were included. 56 (24.9%) patients had normal weight - group A, 98 (43.6%) patients were overweight - group B, 58 (25.7%) patients had class I obesity - group C, 9 (4%) patients had class II obesity and 4 (1.8%) patients class III obesity - together they form group D. The groups did not significantly differ in age, sex, comorbidities, cancer stage and locality. Complications occurred as follows: A-29%; B-25%; C-36%; D-55%. Anastomotic leak: A-9%; B-4%; C-9%; D-15%. Mortality: A-5%; B-2%; C-2%, D-0%. Average length of stay: A-11.7 days; B -11.3 days; C-12.6 days; D-47 days. We did not observe any statistically significant difference. CONCLUSIONS: Overweight surgical colorectal cancer patients had the lowest incidence of complications, anastomotic leak and the shortest length of stay. Obesity was associated with more complications but reduced inhospital mortality. Probably due to the relatively small number of patients, we did not prove any statistically significant difference. Key words: obesity paradox - BMI - colorectal cancer - resection - omplications.

[Internal hernia as a cause of small bowel obstruction]. / Vnitrní kýla jako prícina ileu tenkého streva.

Internal hernia is a rare cause of acute small bowel obstruction and may be difficult to diagnose. We would like to use two case reports to demonstrate that laparoscopy is a feasible treatment method for incarcerated internal hernias.Key words: intestinal obstruction - internal hernia - laparoscopy.

[Extraintestinal GIST--case report]. / Extraintestinální GIST--kazuistika.

Gastrointestinal stromal tumors (GISTs) represent the majority of mesenchymal neoplasms of the gastrointestinal tract. Extragastrointestinal stromal tumors (EGISTs), which are neoplasms with histological and immunohistological features overlapping with those of GISTs, are found in the abdomen outside of the gastrointestinal tract with no connection to the gastric or intestinal wall. We present a case of EGIST arising in the mesentery of a 68 years old patient.

Electrochemical and ab initio investigations to design a new phenothiazine based organic redox polymeric material for metal-ion battery cathodes.

Different N-substituted phenothiazines have been synthesized and their electrochemical behavior has been investigated in CH3CN in order to design the best polyphenothiazine based cathodic material candidate for lithium batteries. These compounds exhibit two successive reversible one-electron oxidation processes. Ab initio calculations demonstrate that the potential of the first process is a result of both the hybridization effects between the substituent and the phenothiazine unit as well as the change of conformation of the phenothiazine heterocycle during the oxidation process. More specifically, we show that an asymmetric molecular orbital spreading throughout an external cycle of the phenothiazine unit and the alkyl fragment is formed only if the alkyl fragment is long enough (from the methyl moiety onwards) and is at the origin of the bent conformation for N-substituted phenothiazines during oxidation. Electrochemical investigations supported by ab initio calculations allow the selection of a phenothiazinyl unit which is then polymerized by a Suzuki coupling strategy to avoid the common solubilization issue in carbonate-based liquid electrolytes of lithium cells. The first electrochemical measurements performed show that phenothiazine derivatives pave the way for a promising family of redox polymers intended to be used as organic positives for lithium batteries.

Breaking bad news-what patients want and what they get: evaluating the SPIKES protocol in Germany.

BACKGROUND: Evaluation of the SPIKES protocol, a recommended guideline for breaking bad news, is sparse, and information about patients' preferences for bad-news delivery in Germany is lacking. Being the first actual-theoretical comparison of a 'breaking bad news' guideline, the present study evaluates the recommended steps of the SPIKES protocol. Moreover, emotional consequences and quality of bad-news delivery are investigated. PATIENTS AND METHODS: A total of 350 cancer patients answered the MABBAN (Marburg Breaking Bad News Scale), a questionnaire representing the six SPIKES subscales, asking for the procedure, perception and satisfaction of the first cancer disclosure and patient's assign to these items. RESULTS: Only 46.2% of the asked cancer patients are completely satisfied with how bad news had been broken to them. The overall quality is significantly related to the emotional state after receiving bad news (r = -0.261, P < 0.001). Patients' preferences differ highly significantly from the way bad news were delivered, and the resulting rang list of patients' preferences indicates that the SPIKES protocol do not fully meet the priorities of cancer patients in Germany. CONCLUSIONS: It could be postulated that the low satisfaction of patients observed in this study reflects the highly significant difference between patients' preferences and bad-news delivery. Therefore, some adjunctions to the SPIKES protocol should be considered, including a frequent reassurance of listeners' understanding, the perpetual possibility to ask question, respect for prearrangement needs and the conception of bad-news delivery in a two-step procedure.

Enhanced focal adhesion assembly reflects increased mechanosensation and mechanotransduction at maternal-conceptus interface and uterine wall during ovine pregnancy.

The integrity of the fetal-maternal interface is critical for proper fetal nourishment during pregnancy. Integrins are important adhesion molecules present at the interface during implantation; however, in vivo evidence for integrin activation and focal adhesion formation at the maternal-conceptus interface is limited. We hypothesized that focal adhesion assembly in uterine luminal epithelium (LE) and conceptus trophectoderm (Tr) results from integrin binding of extracellular matrix (ECM) at this interface to provide increased tensile forces and signaling to coordinate utero-placental development. An ovine model of unilateral pregnancy was used to evaluate mechanotransduction events leading to focal adhesion assembly at the maternal-conceptus interface and within the uterine wall. Animals were hysterectomized on days 40, 80, or 120 of pregnancy, and uteri immunostained for integrins (ITGAV, ITGA4, ITGA5, ITGB1, ITGB3, and ITGB5), ECM proteins (SPP1, LGALS15, fibronectin (FN), and vitronectin (VTN)), cytoskeletal molecules (ACTN and TLN1), and a signal generator (PTK2). Focal adhesion assembly in myometrium and stroma was also studied to provide a frame of reference for mechanical stretch of the uterine wall. Large focal adhesions containing aggregates of ITGAV, ITGA4, ITGA5, ITGB1, ITGB5, ACTN, and PTK2 were detected in interplacentomal uterine LE and Tr of gravid but not non-gravid uterine horns and increased during pregnancy. SPP1 and LGALS15, but not FN or VTN, were present along LE and Tr interfaces in both uterine horns. These data support the idea that focal adhesion assembly at the maternal-conceptus interface reflects adaptation to increasing forces caused by the growing fetus. Cooperative binding of multiple integrins to SPP1 deposited at the maternal-conceptus interface forms an adhesive mosaic to maintain a tight connection between uterine and placental surfaces along regions of epitheliochorial placentation in sheep.

Calcifications simulating sialolithiasis of the major salivary glands.

Calcifications found in routine and normal radiographs of the oral and facial region may turn out to be an interesting diagnosis. Although most of the radiopacities may be sialoliths, other differential diagnoses must not be exempted, such as calcified lymph nodes, phleboliths and other vascular calcifications, tuberculosis of lymph nodes or of the salivary gland itself. Several cases are presented which simulated pathological calcifications of the orofacial region and were diagnosed primarily as sialoliths, but further examinations revealed other pathology. These cases together with several suggested diagnostic modalities are discussed in this paper.

Influence of visible light and ultraviolet irradiation on motility and fertility of mammalian and fish sperm.

OBJECTIVE: The effects of visible light irradiation on sperm motility, fertility, and reactive oxygen species (ROS) formation were investigated and compared in ram and fish (tilapia). BACKGROUND DATA: Low-energy visible light has previously been found to modulate various processes in different biological systems. In the literature, it is accepted that the first step following visible light irradiation is the formation of ROS by endogenous cellular photosensitizers. METHODS: Sperm of ram and tilapia were irradiated with various light sources (400-800 nm white light, 660 nm red light, 360 nm blue light, 294 nm UV), and their motility and fertility rates were measured. The amount of ROS generated by irradiation was estimated using electron paramagnetic resonance (EPR) technique. RESULTS: Sperm taken from tilapia showed higher motility and fertility following red and white light irradiation. In contrast, the motility and fertility of ram sperm were slightly increased only by red light. A negative effect on motility and fertility of sperm of both species was obtained following irradiation with UV and blue light. The amount of ROS produced in irradiated tilapia sperm was much higher than that of ram sperm. CONCLUSIONS: The results show that different wavelengths differentially affect tilapia and ram sperm motility and fertilization. The difference in response to the various light sources might be explained by the different amounts of ROS formation by ram and tilapia, which are in agreement with the physiology of fertilization appropriate to each of these species. Based on these results, it is suggested that in vitro fertilization in mammals should be performed in darkness or at least under red light.

Penetrating grease gun injury in the face.

We present the case of a sailor who sustained a penetrating grease gun injury to his face, and the challenging subsequent series of events.

In situ dynamic study of hydrogen oxidation on rhodium.

The reaction of hydrogen/oxygen gas mixtures with rhodium single crystals was studied using video-FIM (Field Ion Microscopy) at temperatures between 350 and 550 K and up to 2 x 10(-2) Pa total pressure. Imaging at 500 K in a hydrogen rich gas mixture (H2:O2 = 9) revealed considerable morphological changes of the (0 0 1)-oriented field emitter tip, i.e. the growth of low-index at the expense of high-index planes and strong crystal coarsening. Decreasing the hydrogen partial pressure led to chemical and structural changes of the Rh sample. Starting on the [1 1 0] planes a surface oxide formed, which spread anisotropically across the surface until it finally covered the whole visible surface area. The transformation was reversible upon increasing the hydrogen pressure back to its initial value. However, a hysteresis behavior was observed, i.e. a larger hydrogen partial pressure was found to be necessary to re-establish the initial patterns of a reactive Oad/Had layer. By varying the temperature from 400 to 500 K a phase diagram was established for the Oad/Had system. Increasing the electric field proved to shift the phase diagram towards higher H2 pressures. At 550K self-sustained kinetic oscillations with a cycle time of approximately 40s could be observed.

Patient treatment insistence and medication craving in long-term low-dosage benzodiazepine prescriptions.

BACKGROUND: Long-term low-dosage dependence on benzodiazepines in traditionally explained by withdrawal symptoms. Previous research has not given much attention to reports that suggest that many patients oppose stopping benzodiazepines long before withdrawal symptoms have developed. This study investigates the scope of and factors associated with this pre-withdrawal treatment insistence. METHODS: Patients receiving long-term low-dosage benzodiazepines in primary care were asked to take a drug-holiday of at least 3 weeks. Sociodemographic, medication, morbidity and attitudinal variables were assessed in addition to the GPs' perceptions of their patients. RESULTS: Two-thirds of the patients rejected the drug-holiday proposal. Patients who refused a drug-holiday were less educated and were using a higher percentage of long-acting benzodiazepines than patients who accepted the drug-holiday proposal. Those who refused were seen by their GPs as being more complaining, harder to satisfy and less co-operative. CONCLUSIONS: These results provide evidence for drug-seeking or craving behaviour of patients who receive low-dosage benzodiazepine prescriptions. A major problem in benzodiazepine withdrawal occurs before the withdrawal programme has even begun. These data show that benzodiazepine low-dosage dependence should be considered a real form of dependence.

cis-4-Methylsphingosine decreases sphingolipid biosynthesis by specifically interfering with serine palmitoyltransferase activity in primary cultured neurons.

The effect of six different structurally modified sphingosine analogues on biosynthesis of sphingolipids was studied in primary cultured murine cerebellar neurons. Treatment of cells with cis-4-methylsphingosine at micromolar levels resulted in a markedly decreased sphingolipid biosynthesis, whereas the other compounds examined, trans-4-methylsphingosine, cis-5-methylsphingosine, trans-5-methylsphingosine, cis-sphingosine, and 1-deoxysphingosine, inhibited sphingolipid biosynthesis less efficiently. The inhibition of sphingolipid biosynthesis by the various compounds was paralleled by a decrease of serine palmitoyltransferase activity in situ. For cis-4-methylsphingosine the inhibitory effect on serine palmitoyltransferase activity was shown to be concentration- and time-dependent. Half-maximal reduction of enzyme activity occurred after 24 h of treatment with 10 microM of the compound. The activity of other enzymes of sphingolipid biosynthesis as well as phospholipid and protein biosynthesis was not affected. Analysis of the sphingoid moiety of cellular sphingolipids suggests that the sphingosine analogues listed above were subject to degradation rather than being utilized as precursors for sphingolipid biosynthesis by cultured neurons. Except of 1-deoxysphingosine, the other five sphingosine analogues were shown to be substrates for sphingosine kinase in vitro. After 24 h of treatment of primary cerebellar neurons with the various sphingosine analogues the relative percentage of the respective intracellular 1-phosphate derivatives paralleled exactly the inhibitory effect on serine palmitoyltransferase activity observed when cells were treated with the unphosphorylated compounds. In contrast to the respective 1-phosphate derivatives of the other methyl-branched sphingosine analogues examined, cis-4-methylsphingosine 1-phosphate showed an intracellular accumulation suggesting a delayed turnover rate in cultured murine neurons for this compound. These results suggest that the inhibitory effect of the sphingosine analogues on serine palmitoyltransferase is mediated by their respective 1-phosphate derivatives and that the pronounced effect of cis-4-methylsphingosine is caused by a high intracellular concentration of cis-4-methylsphingosine 1-phosphate. cis-4-Methylsphingosine, in addition, caused drastic changes in cell morphology of primary cerebellar neurons, which were not observed when these cells were treated with one of the other sphingosine analogues examined.

Determination of psilocin and 4-hydroxyindole-3-acetic acid in plasma by HPLC-ECD and pharmacokinetic profiles of oral and intravenous psilocybin in man.

In order to investigate the pharmacokinetic properties of psilocybin (PY), the main psychoactive compound of Psilocybe mushrooms, high performance liquid chromatographic procedures with column-switching coupled with electrochemical detection (HPLC-ECD) for reliable quantitative determination of the PY metabolites psilocin (PI) and 4-hydroxyindole-3-acetic acid (4HIAA) in human plasma were established. Sample work-up includes protection of the highly unstable phenolic analytes with ascorbic acid, freeze-drying and in-vitro microdialysis. The data of two controlled clinical studies with healthy volunteers are presented. The subjects (N = 6 for both studies) received single oral PY doses of 0.224 +/- 0.02 mg/kg b.wt. (10-20 mg) and intravenous doses of 1 mg PY, respectively. Peak plasma levels of PI after oral administration of PY were measured after 105 +/- 37 min showing an average concentration of 8.2 +/- 2.8 ng PI/ml plasma. 4HIAA peak concentrations of 150 +/- 61 ng/ml plasma were found 113 +/- 41 min after ingestion of PY. After intravenous administration, a mean PI maximum plasma concentration of 12.9 +/- 5.6 ng/ml plasma was found 1.9 +/- 1.0 min after injection. The maximum plasma levels appearing within a very short period indicate a rapid dephosphorylation of PY also when administered systemically. 4HIAA was not detected after 1 mg of intravenous PY. Estimates for the absolute bioavailability of PI after oral administration of PY were 52.7 +/- 20% (N = 3).

[Early infection after surgical fracture treatment: therapy with reference to socioeconomic aspects]. / Frühinfekt nach operativer Frakturenbehandlung: Therapie unter sozio-ökonomischem Aspekt.

Early postoperative infection following open reduction and internal fracture fixation is the most serious complication in orthopedic surgery. The transformation of an acute osteitis into a chronic form marks the central problem. Every single case of chronic osteitis represents an economic disaster.

[The osteosynthesis implant and early postoperative infection: healing with or without removal of the material?]. / Osteosyntheseimplantat und früher postoperativer Infekt: Sanierung mit oder ohne Materialentfernung?

This prospective study served as a quality control of a revision concept for case of post-traumatic infection following open reduction and internal fixation in fracture treatment. It is based on clinical and microbiological criteria and has two aims: (1) eradication of the infection and avoidance of development of chronic osteitis; (2) maintenance of internal fixation, if possible. Thirty-four patients were recruited in this study. Surgical revisions were performed according to a consistent concept (debridement, irrigation, local chemotherapy, drainage) in defined time intervals (2 days). The operation site had to be bacteriologically clean after four revisions. Otherwise, the implant had to be removed. Both aims were reached in 11 cases: management of infection with maintenance of internal fixation. In 23 cases the implant material had to be removed. Nevertheless the infection was eliminated in all these patients without exception. The following risk factors for mandatory implant removal were evaluated: diabetes, arteriosclerosis, alcoholism, nicotine. This revision concept helps in the management of acute postoperative osteitis following ORIF in fracture treatment and in avoiding the development of chronic osteitis.

Differential effects of synthetic sphingosine derivatives on melanoma cell motility, growth, adhesion and invasion in vitro.

Cancer cell surface glycosphingolipids are considered to play a critical role in tumor growth and metastasis. However, the implications of glycoconjugates in the control of cell motility, which is considered to be involved in tumor invasion, are not fully understood. In this study, the effects of a series of synthetic sphingosine derivatives, obtained by the chemical transformation of azidosphingosines, on directional migration of K1735-M2 melanoma cells grown on type I collagen-coated surfaces were investigated. Following the application of 60 microM (2R, 3S, 4E)-2, 3-epimino-4-octadecen-3-ol (S4) the migration rate was 94 +/- 10 microns/day, compared with 377 +/- 22 microns/day in the control experiment. Six other analogues were not as potent. S4 also considerably down-modulated melanoma single cell motility. Inhibition of motile activity was associated with changes in the actin filament organization as well as with changes in the number and distribution of vinculin plaques. Moreover, the compound reduced the attachment abilities of melanoma cells to basement membrane Matrigel. Tumor cell invasion, however, was less affected and proliferation remained unimpaired after treatment with S4. These data suggest at least one intracellular mode of action of this particular synthetic sphingosine derivative by modulation of cytoskeletal organization. Melanoma cell motility and growth may be controlled independently via glycosphingolipids.

Financial performance in the social health maintenance organization, 1985-88.

Since early 1985, four social health maintenance organizations have delivered integrated health and long-term care services to Medicare beneficiaries under congressionally mandated waivers that included shared public-program risk for losses. Three of four sites had substantial losses in the first 3 years, primarily because of slow enrollment and resultant high marketing and administrative costs. After assuming full risk, two of the three showed surpluses in 1988. Service and management costs for expanded long-term care were similar across sites and were affordable within the framework of Medicare and Medicaid reimbursement and private premiums.

The superficial vascular hyaloid system in the eye of the frogs, Rana temporaria and Rana esculenta. Scanning electron-microscopic study of vascular corrosion casts.

The angioarchitecture of the superficial vascular hyaloid system (membrana vasculosa retinae) of the frog eye was studied by means of scanning electron microscopy of vascular corrosion casts. The terminal vessels form a single-layered sheath intimately adjacent to the vitreal side of the avascular retina. The hyaloid system is subdivided by the ventral venous trunk into three central areas: the dorsal, the temporo-ventral, and the naso-ventral area. Toward the ora serrata, the hyaloid system is bordered by an arterial ring, and by nasal and temporal venous branches forming more or less complete hemicircles. A vascular zone composed of several tongue-like sectors establishes an interconnection between the peripheral vascular rings and the central areas of the fundus. The arterial blood is supplied from the arterial ring. The drainage of the hyaloid system is provided via two routes: (1) the Y-shaped ventral trunk collects blood from the central areas, (2) the two peripheral venous branches drain the tongue-like sectors. The vessels within the dorsal area follow preferentially a dorso-ventral meridional direction. This densely capillarized territory corresponds in localization to the area centralis retinae. The ultrastructure of microvessels of the hyaloid system is characterized by features typical for capillaries of the central nervous system.