Short communication: Molecular characterization and antimicrobial resistance of pathogenic Escherichia coli isolated from raw milk and Minas Frescal cheeses in Brazil.

The aim of this study was to quantify, identify, evaluate antimicrobial resistance, and characterize the virulence factors of enteropathogenic (EPEC), Shiga-toxigenic (STEC), and enterohemorrhagic (EHEC) Escherichia coli in raw milk (RM) and legal (LMFC) and illegal (IMFC) Minas Frescal cheeses in southern and northeast Brazil. Illegal cheeses are those made without official inspection service or sanitary surveillance. We evaluated samples of RM produced in Paraná (southern) and Maranhão (northeast) States, LMFC produced using pasteurized milk in inspected industries, and IMFC potentially produced with raw milk. Mean total coliform counts were 8.4 × 104 cfu/mL for RM, 1.4 × 107 cfu/mL for LMFC, and 2.9 × 107 cfu/mL for IMFC. Mean E. coli counts were 2.4 × 103 cfu/mL for RM, 1.9 × 102 cfu/mL for LMFC, and 1.1 × 105 cfu/mL for IMFC. Among the 205 E. coli isolates from RM, 9.75% were identified as EPEC, mainly (90%) in samples from Paraná. Of the total isolates from the cheese samples, 97.4% (n = 111) came from IMFC, of which 1.8 and 2.7% were identified as EPEC and STEC, respectively; no EHEC was detected. The phylogenetic group A (60%) and typical EPEC (68%) predominated, which confirms the possible human origin of pathogenic isolates in RM and IMFC. Of these, 50% were resistant to at least one antibiotic, and streptomycin was the antimicrobial with the highest number (8) of EPEC and STEC resistant isolates. This study reports the first isolation of serogroup O28ac in Brazilian milk. We found no predominance of a specific serogroup of EPEC or STEC in milk or cheese or clonal isolates in the same sample, indicating different origins of the contamination in these products, presumably mostly related to poor hygienic handling.

Prospective, randomized and controlled study of mesh displacement after laparoscopic inguinal repair: fixation versus no fixation of mesh.

INTRODUCTION: Repair of inguinal hernia is one of the most common elective operations performed in general surgery practice. Mesh hernia repair became the gold standard because of its low recurrence rate in comparison with non-tension-free repair. Laparoscopic approach seems to have potential advantages over open techniques, including faster recovery and reduced acute and chronic pain rate. Laparoscopic mesh fixation is usually performed using staples, which is associated with higher cost and risk for chronic pain. Recently, the role of mesh fixation has been questioned by several surgeons. AIM: To evaluate mesh displacement in patients undergoing laparoscopic inguinal hernia repair comparing mesh fixation with no fixation. METHODS: From January 2012 to May 2014, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups: control group--10 patients underwent totally extraperitoneal (TEP) repair with mesh fixation; NO FIX group-50 patients underwent TEP repair with no mesh fixation. Mesh was marked with three 3-mm surgical clips at its medial inferior, medial superior and lateral inferior corners. Mesh displacement was measured by comparing an initial X-ray, performed in the immediate postoperative period, with a second X-ray obtained 30 days later. RESULTS: The mean displacement of all three clips in control group was 0.1-0.35 cm (range 0-1.2 cm), while in NO FIX group was 0.1-0.3 cm (range 0-1.3 cm). The overall displacement of control and NO FIX group did not show any difference (p = 0.50). CONCLUSION: Fixation of the mesh for TEP repair is unnecessary. TEP repair with no mesh fixation is safe and is not associated with increased risk of mesh displacement.

Laparoscopic inguinal hernioplasty after radical prostatectomy: is it safe? Prospective clinical trial.

INTRODUCTION: Despite inguinal hernia repair being one of the most common elective operations performed in general surgical practice, there are many controversies including indications for repair and selection of the surgical technique. In recent years, laparoscopic repair has gained wider acceptance because it is associated with fewer postoperative complications and less chronic pain when compared with conventional approaches with similar recurrence rate. However, patients with lower abdominal surgery are contraindicated for laparoscopic approach. There are few studies that evaluated whether patients who have been subjected to radical prostatectomy might be subjected to laparoscopic hernia repair with the same benefits as those without previous radical prostatectomy. METHODS: Between March 2010 and March 2013, 20 consecutive patients, who had been subjected to prior radical prostatectomy, underwent laparoscopic transabdominal inguinal repair and were followed prospectively. Surgical procedure was performed using a standard technique. RESULTS: Mean operative time was 67.5 min. There was only one (5%) intraoperative minor complication, an injury to the inferior epigastric vessels, which was managed by clipping of the vessels. There were no major postoperative complications. After 24 h and on the seventh postoperative day, 85 and 90% of patients had no pain or only complained of discomfort, respectively. Nine patients (45%) did not need any analgesics postoperatively. The mean time to return to leisure activities and to work was 3.1 and 5.6 days, respectively. There was no conversion to open surgery. All patients were discharged within 24 h. After a mean follow-up of 14 months, none of the patients presented recurrence. CONCLUSION: TAPP after prostatectomy is safe and effective. It seems that patients undergoing laparoscopic repair after radical prostatic resection have the same benefits as those without prostatectomy.

Detection of bacterial DNA in acute and chronic cholecystitis.

BACKGROUND: The incidence of bacterbilia in cholelithiasis remains controversial. The positivity of cultures ranges from 0 to 73 per cent. The aim of this study was to employ the polymerase chain reaction (PCR) to detect bacterial DNA in gallbladder bile extracted during elective laparoscopic cholecystectomy, and to compare PCR findings with those of bile culture. METHODS: Bile samples from 84 laparoscopic cholecystectomies were collected for culture and PCR analysis. RESULTS: Positive results for bacterbilia were found in 42 (50 per cent) of 84 patients by PCR but in only 16 patients (19 per cent) by culture (P < 0.001). Agreement between the two methods was seen in 44 samples (52 per cent), which were negative in 35 cases. Pathological examination showed chronic cholecystitis in 69 cases (82 per cent) and acute cholecystitis in 15 (18 per cent). Thirty-three (48 per cent) of the patients with chronic cholecystitis were PCR positive but only ten (14 per cent) were culture positive (P < 0.001). Only culture results correlated with findings on pathological examination (P = 0.033). CONCLUSION: PCR is more sensitive in detecting bacterial contamination of gallbladder bile in cholecystitis than conventional culture. The clinical relevance of this high sensitivity remains unclear.

The role of transperineal ultrasonography in the assessment of the internal opening of cryptogenic anal fistula.

PURPOSE: The aim of this study was to assess the reliability of transperineal ultrasonography (TPUS) in the pre-operative identification of the internal opening of anal fistulas compared to conventional proctological examination and operative findings. METHODS: Forty-three patients with anal fistula were assessed by TPUS with and without the use of hydrogen-peroxide injection (E-TPUS) in an attempt to identify the internal opening. Results were compared to preoperative conventional examination and operative findings. RESULTS: Operative assessment showed an anterior internal opening in 29 patients (67.4%) and a posterior opening in 14 (32.6%). Compared to the operative findings, the agreement rate for the identification of the internal opening was 74.4% for physical examination alone, 93.0% for TPUS and 90.7% for E-TPUS. Physical examination was less accurate in detecting the internal opening than both TPUS (p=0.014) and E-TPUS (p=0.026). CONCLUSIONS: TPUS and E-TPUS are superior to physical examination in the identification of internal openings in anal fistulas. Hydrogen peroxide injection does not provide additional advantages.

Effect of pantoprazole administered subcutaneously on the healing of sutured gastric incisions in rats.

BACKGROUND: The properties of proton pump inhibitors most investigated are related to peptic diseases and upper gastrointestinal bleeding, but their influence on the healing of sutured gastric incisions has not been assessed. In the present study we evaluated the effect of subcutaneously administered pantoprazole on the healing of sutured gastric incisions in rats. METHODS: Sixty rats were divided into a pantoprazole group and a control group. All rats were submitted to gastric suture in the gastric body and in the gastric fundus and had their gastric pH measured. The pantoprazole group received 20 mg/kg pantoprazole and the control group received 0.9% isotonic NaCl, both subcutaneously t.i.d. Healing analysis was carried out using collagen picrosirius red F3BA staining, and breaking strength was measured on the 4th and 7th postoperative days in all groups. RESULTS: Gastric pH was higher in the pantoprazole group. In the fundus, the pantoprazole group had a higher measurement of breaking strength and a higher proportion of type-I over type-III collagen on the 7th postoperative day. In the body, the pantoprazole group had a higher proportion of type-I over type-III collagen on the 4th and 7th postoperative days. CONCLUSIONS: Pantoprazole given subcutaneously promoted a reduction in gastric acid secretion and was associated with improved healing of the sutured gastric incision in the fundus (squamous epithelium) of rats. These findings suggest that pantoprazole has healing properties in sutured gastric incisions with potential benefits in gastric surgery.

Custo do transplante hepático no Hospital de Clínicas da Universidade Federal do Paraná / Cost of liver transplantation at the Clinical Hospital of Parana, Brazil

Objetivo. Determinar o custo do transplante hepático no Hospital de Clínicas da Universidade Federal do Paraná. Método. Os dados do prontuário de 24 pacientes submetidos a 25 transplantes hepáticos foram avaliados do dia da internaçao para o transplante hepático até a data da alta hospitalar ou óbito para determinar o número de dias de internaçao, o local de internaçao, a quantidade de material e medicamentos usados, os exames complementares e procedimentos realizados. Honorários médicos nao foram incluídos no estudo. Resultados. A idade dos pacientes variou de 6 a 56 anos, tendo seis deles menos que 14 anos de idade. Cinco pacientes foram a óbito durante a internaçao hospitalar. Retransplante foi realizado em somente um paciente. O custo médio da retirada do fígado do doador foi de US$ 2,783.19. O custo total do transplante hepático variou amplamente entre os pacientes, na dependência de ocorrência de complicaçoes pós-operatórias, do número de dias de internaçao hospitalar e da quantidade de transfusao de hemoderivados. O custo total variou de US$ 6,359.84 a US$ 75,434.18, com média de US$ 21,505.53. O item mais caro do transplante hepático foi o custo com a hemoterapia, seguido do custo com medicamentos e diária hospitalar. Conclusao. O custo do transplante hepático varia muito entre os pacientes e pode ser realizado no Brasil a um custo inferior ao relatado nos Estados Unidos e na Europa.

Doaçäo de órgäos: opiniäo e conhecimento de médicos intensivistas da cidade de Curitiba / Organ donation: opinion and knowledge of intensive care unit physicians in the city of Curitiba

Com o objetivo de avaliar as opiniöes e conhecimentos de médicos intensivistas sobre doaçäo de órgäos, todos os intensivistas dos 13 hospitais de Curitiba com unidade de terapia intensiva de adulto participaram do estudo. De 81 intensivistas entrevistados, 75 (92,6 por cento) responderam o questionário. Todos responderam que säo favoráveis à doaçäo de órgäos, 74 (98,7 por cento) doariam seus próprios órgäos e 72 (96 por cento) autorizariam a doaçäo de órgäos de um membro da sua família. Sessenta e três (84 por cento) intensivistas näo conheciam ou näo souberam explicar a legislaçäo atual sobre doaçäo de órgäos. Quarenta e um (54,7 por cento) responderam errado ou näo sabiam os critérios médicos e legais para doaçäo de órgäos. Cinco (6,7 por cento) desconheciam a necessidade do doador ter morte encefálica, três (4 por cento) acreditavam que o doador deveria ter morte cardíaca para ser doador e 44 (58,7 por cento) näo souberam explicar o que é morte encefálica. A maioria desconhecia a sobrevida atual dos pacientes submetidos a transplante dos vários órgäos. Conclui-se deste estudo que quase todos os médicos intensivistas de Curitiba säo favoráveis a doaçäo de órgäos e estäo dispostos a participar ativamente na obtençäo de consentimento de familiares para doaçäo. O conhecimento básico sobre a legislaçäo brasileira e os vários aspectos médicos do transplante de órgäos é insatisfatório.

Surgical management of common bile duct stones

A remocao dos calculos coledocianos permanece um problema importante na cirurgia biliar. A alta incidencia de calculos residuais ressalta a importancia da remocao cuidadosa dos calculos coledocianos durante a primeira operacao biliar. Hoje existem disponiveis varios metodos cirurgicos e nao-cirurgicos de tratar tais pacientes. O objetivo do presente estudo e rever nossa experiencia com esses metodos. Foram revisados os prontuarios de 85 pacientes, tratados pelo mesmo cirurgiao, por litiase da via biliar principal, num periodo de 26 anos. Apenas 9,4 por cento dos pacientes nao tinham historia previa de ictericia e 69 por cento estavam ictericos no momento da cirurgia. Colecistectomia havia sido realizada previamente em 16 pacientes, e em dois desses o coledoco havia sido explorado. Oito pacientes foram operados durante um episodio de colangite aguda supurativa. Em tres casos havia calculos coledocianos sem a presenca concomitante de colelitiase. Colecistectomia, exploracao do coledoco, remocao dos calculos e drenagem a Kehr foi realizada em 48 pacientes. Foi associado um procedimento de drenagem em 21 pacientes: em 18 casos anastomose coledocoduodenal latero-lateral, hepaticojejunostomia em um caso e esfincteroplastia em dois. Os 16 pacientes restantes haviam sido submetidos previamente a colecistectomia...