RESUMEN
Workers are exposed to dust in broiler chicken production during daily work activities. Poultry dust may contain inflammatory agents (e.g., endotoxin) and inhalation exposure has been associated with pulmonary symptoms. Current practice to reduce worker exposure to poultry dust is the use of respiratory protection (e.g., elastomeric face-piece respirator with a P100 and ammonia chemical cartridge). Limited research has been conducted to evaluate engineering controls to reduce dust and ammonia concentrations in broiler chicken production; therefore, the purpose of this research was to evaluate the effectiveness of a water sprinkling system to reduce inhalable dust and ammonia concentrations in a broiler chicken house. Inhalable dust and ammonia concentrations were measured daily for the production cycle of a flock of broiler chickens (63 days). Inhalable dust was measured gravimetrically using an inhalable sampler and ammonia was measured by a direct reading sensor. Sampling was performed on a stationary mannequin inside two broiler chicken houses. One house used a sprinkler cooling system to deliver a water mist throughout the house and the second house was an untreated control. The sprinkler system activated after day 5 of chicken placement, releasing water periodically from 6 am to 10 pm. The amount of sprinkling increased at day 10 and day 15 as recommended by the manufacturer. Geometric mean (GM) inhalable dust concentrations measured in the treatment house (5.5 mg/m3) were not different (p = 0.33) than those found in the control house (6.0 mg/m3). The GM ammonia concentrations were also not different (p = 0.34) across the treatment and control house [10.6 ppm (GSD: 1.80); GM 9.51 ppm (GSD: 1.77)], respectively. The use of cost effective engineering, administrative and personal exposure controls are needed in the poultry industry to effectively reduce worker's exposure to hazardous concentrations of dust and ammonia.
Asunto(s)
Contaminantes Ocupacionales del Aire/análisis , Polvo/análisis , Exposición por Inhalación/análisis , Exposición Profesional/análisis , Animales , Ambiente Controlado , Monitoreo del Ambiente , Humanos , Exposición por Inhalación/prevención & control , Exposición Profesional/prevención & control , Aves de CorralRESUMEN
Yeast extracts (YE) contain biological response modifiers that may be useful as alternatives to antibiotics for controlling pathogens in poultry production and mitigating the deleterious effects of production stressors. The objective of the present study was to determine the ability of a commercial dietary YE (Alphamune) to modulate the immune response in male turkey poults challenged with Escherichia coli and subjected to transport stress. Alphamune was added to turkey poult diets at 0, 500, or 1,000 g/ton. Poults were challenged by air sac injection with 60 cfu of E. coli at 1 wk of age. At 3 wk of age, these challenged birds were subjected to transport stress and birds were bled and necropsied the following morning. Blood cell numbers and percentages, hematological parameters, and clinical chemistry values were determined. Oxidative burst activity of isolated heterophils was measured using stimulation with phorbol myristate acetate and a 2',7'-dichlorofluorescein diacetate assay. Data were analyzed using GLM and least squares means procedures of the SAS program. The numbers and percentages of heterophils in peripheral blood were increased and their oxidative burst activity was stimulated by YE. The stress challenge dramatically increased oxidative burst and this increase was significantly modulated by YE treatment. Serum levels of calcium, phosphorus, and triglycerides were decreased and uric acid levels, erythrocyte numbers, hemoglobin, and hematocrit were increased by YE supplementation. Bacteria were isolated from the air sac and liver of a lower percentage of birds provided with YE. These results suggest that dietary YE has potential as a nonantibiotic alternative for decreasing bacterial pathogens in turkey production.
Asunto(s)
Suplementos Dietéticos , Infecciones por Escherichia coli/veterinaria , Estrés Fisiológico/fisiología , Transportes , Pavos/sangre , Alimentación Animal , Animales , Dieta/veterinaria , Relación Dosis-Respuesta a Droga , Masculino , Enfermedades de las Aves de Corral/prevención & control , Factores de Tiempo , LevadurasRESUMEN
Clostridium perfringens is the etiologic agent of necrotic enteritis (NE) and is ubiquitous in nature. The incidence of NE has increased in countries and commercial companies that have stopped using antibiotic growth promoters. The mechanisms of colonization of C. perfringens and the factors involved in onset of NE are not fully understood. Previously, our laboratory has demonstrated that lactose could potentially reduce Salmonella and C. perfringens in ceca of poultry. In the present investigation, we hypothesized that dietary lactose would reduce the clinical signs of NE and could be used as an alternative to antibiotics. In experiment 1, day-of-hatch broilers were fed either a nonlactose control diet, a diet with 2.5% lactose, or a diet with 4.5% lactose throughout the experiment. Birds were administered C. perfringens (10(7) cfu/mL) daily via oral gavage for 3 consecutive days starting on d 17. When evaluating the intestinal lesions associated with NE, birds fed 2.5% lactose had significantly lower (P < 0.05) lesion scores (0.70 +/- 0.52) compared with the control (1.55 +/- 0.52) or the 4.5% lactose (1.60 +/- 0.52). The data from the microbial analysis showed that the addition of lactose did not affect any bacterial populations when compared with the control birds that did not receive dietary lactose over the 21-d evaluation. The overall lesion scores in experiment 2 were significantly (P < 0.05) reduced in birds fed 2.5% lactose compared with the birds fed the control diet with mean lesion scores of 1.10 +/- 0.73 and 1.80 +/- 0.73, respectively. These experiments suggest that lactose could be used as a potential alternative to growth-promoting antibiotics to help control this costly disease.
Asunto(s)
Infecciones por Clostridium/veterinaria , Dieta/veterinaria , Enteritis/dietoterapia , Lactosa/farmacología , Enfermedades de las Aves de Corral/dietoterapia , Alimentación Animal , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Pollos , Clostridium perfringens/aislamiento & purificación , Relación Dosis-Respuesta a Droga , Femenino , Íleon/patología , Yeyuno/patología , Masculino , Necrosis/dietoterapia , Enfermedades de las Aves de Corral/microbiologíaRESUMEN
Alphamune, a yeast extract antibiotic alternative, has been shown to stimulate the immune system, increase BW in pigs, and reduce Salmonella colonization in chickens. The influence of Alphamune on gastrointestinal tract development has not been reported. Two trials were conducted to evaluate the effects of Alphamune on gut maturation of 7- and 21-d-old turkey poults. Poults were fed a standard control unmedicated turkey starter diet or the same diet supplemented with either 1 or 2 lb/ton of Alphamune (n = 18/group). Poults were weighed on d 7 and 21, euthanized, and a 2-cm section was collected from the midpoint of the duodenum, jejunum, and ileum of each bird (9 poults/d per treatment) and fixed in a 10% formalin solution for 72 h and then stained. Twenty measurements of villus height, villus surface area, lamina propria thickness, crypt depth, and density of neutral, sialomucin, and sulfomucin goblet cells were taken per section per poult. On d 7, BW were higher for the poults given the Alphamune treatments compared with control poults; however, no differences were observed on d 21. Alphamune supplementation influenced intestinal morphology differently based on gut location. Ileum villus height, surface area, lamina propria thickness, crypt depth, and neutral, sialomucin, and sulfomucin goblet cell density were enhanced with Alphamune treatments on d 7 and 21 (P < 0.05) and in a dose-dependent manner for many of the parameters evaluated. Jejunum results were mixed. Surface area, crypt depth, and sialomucin and sulfomucin goblet cells were consistently higher for the 2 lb/ton of Alphamune groups compared with the control group on d 7 and 21. Duodenum villus height, surface area, and goblet cell density were higher for the 2 lb/ton of Alphamune groups on d 7; however, intestinal morphology of the duodenum was not different between the control and treated birds on d 21. These results suggest that feed supplemented with Alphamune can accelerate gastrointestinal maturation in turkey poults and is more pronounced in the ileum than in other portions of the small intestine.
Asunto(s)
Dieta/veterinaria , Tracto Gastrointestinal/efectos de los fármacos , Tracto Gastrointestinal/crecimiento & desarrollo , Mananos/farmacología , Oligosacáridos/farmacología , Saccharomyces cerevisiae/química , Pavos/crecimiento & desarrollo , Envejecimiento , Alimentación Animal/análisis , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Suplementos Dietéticos , Tracto Gastrointestinal/citología , Células Caliciformes/fisiología , Mananos/administración & dosificación , Mananos/química , Oligosacáridos/administración & dosificación , Oligosacáridos/químicaRESUMEN
Two battery experiments were conducted to evaluate a commercial yeast extract feed supplement, Alphamune, in a cold stress-Escherichia coli challenge of 1-wk-old turkeys. Experiment 1 used 1-d-old male poults that were the progeny of 33-wk-old hens in their second week of lay. Experiment 2 used male poults of the same genetic line from 40-wk-old hens in their eighth week of lay. Poults were fed a standard unmedicated turkey starter diet or the same diet with either a low level (504 g/t) or a high level (1,008 g/t) of yeast extract. Challenged birds were exposed to intermittent cold stress during wk 1 to 3 and to a respiratory E. coli challenge at 1 wk of age. In both experiments, BW at wk 1 was increased by feeding yeast extract. In experiment 1, challenged, control-fed birds had decreased BW at wk 3 and feed conversion was protected by both levels of yeast extract supplementation. In experiment 2, challenge had no effect on control-fed birds; however, yeast extract decreased the BW of challenged birds. In experiment 1, total leukocyte numbers were decreased by challenge of control-fed birds only, and there was no effect of challenge on the heterophil/lymphocyte ratio. In experiment 2, total leukocyte numbers were decreased and the heterophil/lymphocyte ratio was increased in challenged, control-fed birds. Percentage mortality was not affected by challenge in experiment 1; however, in experiment 2, mortality was increased by challenge of control-fed birds and those fed the lower level of yeast extract. These results suggest that hen age should be considered when designing studies to evaluate antibiotic alternatives and in making decisions for incorporating such alternatives into production.
Asunto(s)
Extractos Celulares/uso terapéutico , Infecciones por Escherichia coli/veterinaria , Saccharomyces cerevisiae , Pavos/fisiología , Animales , Antibacterianos/uso terapéutico , Infecciones por Escherichia coli/prevención & control , Femenino , Aves de Corral , Enfermedades de las Aves de Corral/microbiología , Pavos/crecimiento & desarrollo , Pavos/microbiologíaRESUMEN
The immune system of neonatal chicks is functionally immature during the first week of life. Researchers have previously demonstrated that the avian humoral response can be increased with probiotics. Although the humoral response provides the chick with an effective mechanism to combat pathogens, sufficient antibody titers are not attained until 7 to 10 d postinfection. However, the innate immune system (i.e., heterophils) can respond much more quickly to pathogens. The objective of this study was to determine whether probiotic bacteria can also upregulate heterophil function. Heterophils were isolated from the peripheral blood of neonatal chickens by using a discontinuous density gradient. Oxidative burst and degranulation are bactericidal mechanisms used by heterophils to kill pathogens and were used in this study as indicators of heterophil function. We found that each of the 10 "generally recognized as safe" probiotic isolates (designated G1 to G11) tested in vitro were capable of increasing (P < 0.05) heterophil oxidative burst and degranulation when compared with unstimulated controls. Bacillus subtilis (G3), Lactococcus lactis lactis (G6), and Lactobacillus acidophilus (G8) isolates were determined to elicit the greatest heterophil response in vitro and were subsequently fed to chicks. Phosphate-buffered saline or 1 of these 3 probiotic isolates (approximately 2.5 x 10(8) cfu/chick; 50 chicks/treatment) resuspended in PBS was administered by oral gavage on the day of hatch. Heterophils were isolated from chicks from each of these 4 treatment groups 24 h posttreatment. Significant increases in heterophil degranulation and oxidative burst were observed with the G3-, G6-, and G8-treated chicks when compared with heterophils isolated from birds with no probiotic treatment. These data suggest that probiotic bacteria can significantly improve heterophil oxidative burst and degranulation in broilers. To our knowledge, this is the first study demonstrating a relationship between probiotics and avian heterophil function.
Asunto(s)
Pollos/inmunología , Granulocitos/inmunología , Inmunidad Innata , Linfocinas/inmunología , Probióticos/farmacología , Animales , Recuento de Colonia Microbiana/veterinaria , Distribución Aleatoria , Estallido Respiratorio/inmunología , Regulación hacia ArribaRESUMEN
Bismuth compounds have been used since the 18th century to treat gastrointestinal ailments in man. Colloidal bismuth subcitrate (De-Nol) is currently used in combination with antibiotics to reduce enteric Helicobacter pylori colonization as a treatment of stomach ulcers. We investigated whether bismuth citrate or its parent compound, colloidal bismuth subcitrate, would reduce colonization of the closely related foodborne pathogen, Campylobacter jejuni in chickens. In 2 studies, birds were either fed 0, 50, or 200 ppm bismuth citrate or bismuth subcitrate (De-Nol) for 10 or 21 d and were orally challenged with 7 combined strains of C. jejuni (n = 6 birds/treatment). For both treatment groups, cecal Campylobacter colonization was reduced when birds were fed 200 ppm for 10 d but not 21 d. For the 50 ppm treatment group, only birds dosed with bismuth citrate for 21 d demonstrated any reduction in cecal Campylobacter concentrations when compared with controls. These data suggest that bismuth citrate and colloidal bismuth subcitrate may reduce cecal colonization by Campylobacter in broilers, but these effects are inconsistent.
Asunto(s)
Antiácidos/farmacología , Bismuto/farmacología , Infecciones por Campylobacter/veterinaria , Campylobacter jejuni/efectos de los fármacos , Pollos , Enfermedades de las Aves de Corral/prevención & control , Administración Oral , Animales , Infecciones por Campylobacter/prevención & control , Campylobacter jejuni/crecimiento & desarrollo , Recuento de Colonia Microbiana/veterinaria , Seguridad de Productos para el Consumidor , Relación Dosis-Respuesta a Droga , Contaminación de Alimentos/prevención & control , Distribución AleatoriaRESUMEN
Campylobacter is a leading cause of food-borne illness in the United States. Recent evidence has demonstrated that bacteriocins produced by Bacillus circulans and Paenibacillus polymyxa reduce cecal Campylobacter colonization in broiler chickens infected with Campylobacter jejuni. As Campylobacter coli is the most prevalent Campylobacter isolate recovered in turkeys, the objectives of the present study were to evaluate the efficacy of these bacteriocins against C. coli colonization and their influence on the gastrointestinal architecture of young turkeys. In 3 separate trials, a total of 135 day-of-hatch poults (n = 45/trial) were orally challenged on d 3 with approximately 10(6) cfu of a mixture of 3 C. coli isolates. Immediately before bacteriocin treatment (d 10), cecal Campylobacter concentrations averaged 1.1 x 10(7) cfu/ g of cecal contents (n = 15/trial). On d 10 to 12 posthatch, 2 bacteriocin treatment groups were given free access to feed supplemented with purified, microencapsulated bacteriocins, whereas the positive control treatment group had access to untreated feed (n = 10/treatment group per trial). At the end of the 3-d dosing period, ceca and duodenal loops were collected for analysis. In each of the 3 separate trials, treatment with bacteriocin eliminated detectable ceca Campylobacter concentrations (detection limit, 1 x 10(2) cfu/g of cecal contents) vs. controls (1.0 x 106 cfu of Campylobacter/g of cecal contents). Duodenum crypt depth and goblet cell numbers were also reduced in turkeys treated with either bacteriocin vs. controls (P < 0.05). The dynamic reduction in crypt depth and goblet cell density in turkeys dosed with bacteriocin may provide clues to how bacteriocins inhibit enteric Campylobacter.
Asunto(s)
Bacteriocinas/farmacología , Infecciones por Campylobacter/veterinaria , Campylobacter/efectos de los fármacos , Tracto Gastrointestinal/anatomía & histología , Enfermedades de las Aves de Corral/tratamiento farmacológico , Pavos/microbiología , Alimentación Animal , Animales , Portador Sano , Contenido Digestivo/microbiología , Tracto Gastrointestinal/microbiología , Enfermedades de las Aves de Corral/microbiologíaRESUMEN
Genetic selection based on rapid growth rates, improved feed conversion, and increased body weights has led to a predisposition to ascites in broiler populations. Sire-family selection was applied to a commercial elite line to produce divergent lines of ascites-resistant (RES) and ascites-susceptible (SUS) broilers by the 8th generation. One objective of this research was to determine the effects of hypobaric hypoxia on gut morphology in these genetic lines. In two separate trials, pedigree broiler chickens were randomly assigned to cages in a hypobaric chamber (simulated 2,900 m above sea level) or a matching local altitude chamber (390 m above sea level). Ascites incidence was characterized by heart enlargement and fluid accumulation in the abdominal cavity. At the end of the study on d 42, all surviving birds were killed and evaluated for the presence of ascites and 2-cm sections from the duodenum and lower ileum were collected from 5 chickens per line, per altitude for each trial for morphometric analysis. At a high altitude, ascites incidence was lower in the RES line (20.9 and 3.7%) than in the SUS line (86.4 and 66.9%, Trials 1 and 2, respectively). No ascites was observed at a local altitude. Under hypoxic conditions, duodenum villus surface area was higher (P < 0.05) in the RES line (181.3 +/- 16.8 and 219 +/- 10.9 microm) compared with the SUS line (130.1 +/- 10.5 and 134.3 +/- 9.3 microm; Trials 1 and 2, respectively). No differences in ileum villus morphology were observed for any of the parameters measured. The reduced surface area in the duodenum of birds selected for ascites susceptibility suggests reduced enteric function and may provide clues as to why these birds have increased incidence of ascites.
Asunto(s)
Ascitis/veterinaria , Predisposición Genética a la Enfermedad , Hipoxia/veterinaria , Intestinos/patología , Enfermedades de las Aves de Corral/genética , Altitud , Animales , Ascitis/genética , Ascitis/patología , Pollos , Duodeno/patología , Hipoxia/patología , Íleon/patología , Enfermedades de las Aves de Corral/patología , PresiónRESUMEN
AIMS: This study evaluated the relationship between Campylobacter susceptibility and enteric fluoroquinolone concentrations in chickens treated with different doses of enrofloxacin. METHODS AND RESULTS: All chickens were challenged with seven fluoroquinolone sensitive Campylobacter jejuni (6.6 x 10(6) CFU per bird) at 2 weeks posthatch. At 26 days of age chickens were treated with 0 (n = 29 birds), 25 mg ml(-1) enrofloxacin (Baytril, Bayer Corp., Shawnee Mission, KS, USA) for 3 days (n = 45 birds) or 50 mg ml(-1) enrofloxacin for 7 days (n = 65 birds) in the drinking water. The crop, upper ileum, lower ileum, ceca and colon contents were collected from both enrofloxacin treatment groups (n = 5 birds per day per treatment group) and nonmedicated controls. The minimum inhibitory concentration (MIC) of ciprofloxacin for Campylobacter increased for isolates from both treatment groups within the first day of dosing and the daily average ranged from 1.4 to 6.5 microg ml(-1) throughout the study. Although enteric fluoroquinolone concentrations were higher (P < 0.05) in birds dosed with 50 mg ml(-1)vs 25 mg ml(-1) enrofloxacin, there were no differences between the isolates collected from these groups for MIC values. CONCLUSION: These data indicate, for the doses used, differences in gut fluoroquinolone concentrations do not produce isolates of Campylobacter with differing susceptibility to ciprofloxacin. SIGNIFICANCE AND IMPACT OF THE STUDY: Using the manufacturers lowest, shortest duration dose vs the highest, longest duration dose of enrofloxacin did not change Campylobacter susceptibility to ciprofloxacin. However, ciprofloxacin MIC values for Campylobacter determined in this study were lower than previously reported.
Asunto(s)
Antiinfecciosos/farmacología , Campylobacter jejuni/efectos de los fármacos , Fluoroquinolonas/farmacología , Tracto Gastrointestinal/microbiología , Animales , Antiinfecciosos/administración & dosificación , Antiinfecciosos/análisis , Pollos , Ciprofloxacina/análisis , Ciprofloxacina/farmacología , Ingestión de Líquidos , Esquema de Medicación , Farmacorresistencia Bacteriana , Enrofloxacina , Fluoroquinolonas/administración & dosificación , Fluoroquinolonas/análisis , Microbiología de Alimentos , Tracto Gastrointestinal/química , Masculino , Pruebas de Sensibilidad Microbiana/métodos , AguaRESUMEN
Modern broilers have been genetically selected for an increased growth rate and improved feed conversion, but they are also more susceptible to ascites. Ascites occurs when there is an imbalance between available oxygen and the oxygen demand of the broiler. We hypothesized that promoting neonatal gut development with a prebiotic, such as Aspergillus meal (Prebiotic-AM), would enhance gut efficiency, decrease the oxygen demand of the gut, and reduce ascites incidence. In this study, we compared the effect of Prebiotic-AM on ascites incidence and gut development in commercial broilers reared at a local altitude (390 m above sea level) and a simulated high altitude (2,900 m above sea level). Half of the birds received a National Research Council recommended corn-soybean ration, and the other half received the same ration supplemented with 0.2% Prebiotic-AM. These 2 groups were further divided into a local altitude group and a simulated high altitude group for a total of 4 treatment combinations. Tissues were collected on d 1, 3, 7, 14, and 21 from the duodenum and lower ileum and placed in 10% buffered formalin for morphometric analysis. At a simulated high altitude, ascites incidence was 68% for birds fed the Prebiotic-AM supplement compared with 92% ascites incidence in birds given the control feed. The simulated high altitude decreased (P < 0.05) gut development, but prebiotic-treated birds reared in hypoxic conditions had similar gut development to control birds reared at local altitude. These data suggest that a feed ration supplemented with Prebiotic-AM may reduce the effect of hypoxia on broiler gut development and ascites incidence.
Asunto(s)
Ascitis/veterinaria , Pollos/crecimiento & desarrollo , Intestinos/crecimiento & desarrollo , Oxígeno/administración & dosificación , Enfermedades de las Aves de Corral/epidemiología , Probióticos , Altitud , Animales , Ascitis/epidemiología , Ascitis/mortalidad , Aspergillus , Peso Corporal , Dieta , Duodeno/anatomía & histología , Duodeno/crecimiento & desarrollo , Hipoxia , Íleon/anatomía & histología , Íleon/crecimiento & desarrolloRESUMEN
Functionally, the innate immune system of immature chickens is inefficient during the first week posthatch. This immunological inefficiency enables pathogens such as Salmonella enterica serovar Enteritidis (SE) to invade and colonize the visceral organs of immature chickens. The objective of this study was to evaluate the effect of purified beta-glucan as an immunomodulator of the innate immune response. beta-glucan, as a feed additive, significantly provided protection against SE organ invasion in young chickens (P<0.05). The functional efficiency of heterophils isolated from neonatal chickens fed a beta-glucan ration was significantly (P<0.05) up-regulated when compared to heterophils isolated from chickens fed a control ration as determined with an array of functional assays. Phagocytosis, bactericidal killing, and oxidative burst were significantly increased in heterophils isolated from chickens fed the purified beta-glucan ration (P<0.05). To our knowledge, this is the first report of a purified beta-glucan feed additive significantly decreasing the incidence of SE organ invasion in immature chickens and up-regulating the functional abilities of heterophils isolated from immature chickens against an invading pathogen, SE.
Asunto(s)
Pollos , Inmunidad Innata , Salmonelosis Animal/inmunología , Salmonella enteritidis/inmunología , beta-Glucanos/administración & dosificación , Administración Oral , Alimentación Animal , Animales , Animales Recién Nacidos/inmunología , Masculino , Especificidad de Órganos , Fagocitosis , Distribución Aleatoria , Salmonelosis Animal/prevención & control , beta-Glucanos/farmacologíaRESUMEN
OBJECTIVE: Distinguishing between malignant and benign biliary strictures remains problematic. The aim of this study was to compare and contrast the clinical features of patients with benign and malignant biliary strictures. METHODS: Medical records of patients who underwent surgical resection for presumed cholangiocarcinoma were reviewed. Immunohistochemistry for hypoxia inducible factor-1-alpha (HIF-1-alpha) was performed on all bile ductule samples. RESULTS: Twelve patients with benign strictures (group I) were compared to 26 patients with cholangiocarcinoma (group II). Group I was predominantly female (ratio 2: 1), (p<0.01), whereas the gender ratio was 1: 1 in patients in group II. Bismuth-Corlette type strictures in group I were more likely to be type I/II, whereas type III strictures predominated in group II. The CA 19-9 was <100 U/ml in 6 and >100 U/ml in 1 patient of group I and <100 in 13 and >100 in 11 patients in group II. Half of the patients in group I had positive immunoreactivity for HIF-1-alpha in bile ductules. CONCLUSION: Benign biliary strictures masquerading as cholangiocarcinomas occur more often in women, are less often Bismuth-Corlette type III, have serum CA 19-9 values <100 U/ml, and hypoxia may play a role in a subset of these strictures.
RESUMEN
Clinical presentation and state-of-the-art imaging permit the differentiation of most cystic pancreatic neoplasms not only from other cystic pancreatic disorders but also from one another. The differentiation of serous cystic lesions from the mucinous neoplasms (cystadenoma or carcinoma and IPMT) is crucial because of the radically different biological characteristics of these two neoplasms. Although mucinous cystic neoplasms should be resected because of their premalignant or overtly malignant tendency, most patients with serous neoplasms require no operative intervention unless they are symptomatic. IPMT is best treated by a total pancreatectomy, although lesser subtotal resections should be strongly considered depending on patient age, medical comorbidity, and psychosocial situations.
Asunto(s)
Carcinoma Ductal Pancreático/patología , Cistoadenoma/patología , Quiste Pancreático/patología , Neoplasias Pancreáticas/patología , Adenocarcinoma Mucinoso/patología , Transformación Celular Neoplásica/patología , Cistoadenoma Mucinoso/patología , Cistoadenoma Papilar/patología , Cistadenoma Seroso/patología , Humanos , Quiste Pancreático/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , RadiografíaRESUMEN
Our review supports the clinical impression that periampullary cancers vary in outcome after resection. Overall survival after pancreaticoduodenectomy is greatest for patients with ampullary and duodenal cancers, intermediate for patients with bile duct cancer, and least for patients with pancreatic cancer. Moreover, survival for each tumor stage is greater for nonpancreatic periampullary cancers than for pancreatic cancers. Invasion of the pancreas by nonpancreatic periampullary cancers is a major factor adversely affecting survival. Recent data suggest that inherent differences in tumor biology rather than embryologic, anatomic, or histologic factors probably account for these differences in survival. Finally, although pancreaticoduodenectomy remains the procedure of choice for resectable periampullary cancers, further increases in survival will likely evolve through more effective neoadjuvant or adjuvant therapies rather than modifications in the surgical approach.
Asunto(s)
Ampolla Hepatopancreática , Neoplasias de los Conductos Biliares/cirugía , Neoplasias Duodenales/cirugía , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía , Ampolla Hepatopancreática/patología , Ampolla Hepatopancreática/cirugía , Neoplasias de los Conductos Biliares/diagnóstico , Neoplasias de los Conductos Biliares/epidemiología , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/epidemiología , Humanos , Metástasis Linfática , Invasividad Neoplásica , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/epidemiología , Valor Predictivo de las Pruebas , Prevalencia , Tasa de SupervivenciaRESUMEN
Ductal carcinoma of the pancreas remains a challenging problem for gastrointestinal surgeons. Significant progress has been made in diagnosis, preoperative staging, and safety of surgery; however, long-term survival after resection is unusual, and cure is rare. That said, the authors maintain their aggressive posture regarding this disease, recognizing that resection offers the only potential for cure. The authors' approach such patients in the most efficient and least invasive manner possible, relying primarily on triple phase helical abdominal CT for clinical diagnosis and staging, reserving ERCP and EUS for diagnostic dilemmas. In fit candidates with potentially resectable lesions, the authors eschew pre- or intraoperative biopsy, angiography, or endoscopic stenting and use preliminary limited staging laparoscopy selectively. Surgical palliation is chosen for fit patients who, at exploration for potentially curative resection, are found to have occult distant metastases or locally unresectable disease. Radical pancreatoduodenectomy can be performed with a mortality rate of 3% or less, and although morbidity remains significant, most can be managed with conservative measures. Quality of life after pancreatoduodenectomy is good and, if not, is generally a manifestation of recurrence rather than physiologic alterations inherent to the procedure. Adjuvant chemoradiation is standard therapy after resection, recommended for those with locally unresectable disease but used selectively for those with distant metastasis. Survival after potentially curative resection has remained disappointing. Whether extended lymphadenectomy or neoadjuvant chemoradiation improves survival has not been determined. Clearly, methods for earlier diagnosis of pancreatic cancer and more effective adjuvant therapies are sorely needed.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias Pancreáticas/cirugía , Adenocarcinoma/diagnóstico , Humanos , Escisión del Ganglio Linfático/métodos , Estadificación de Neoplasias , Cuidados Paliativos , Pancreatectomía , Neoplasias Pancreáticas/diagnóstico , Análisis de Supervivencia , Estados UnidosRESUMEN
The authors' approach to the overall surgical management of chronic pancreatitis is to treat complications, that is, pain and, less commonly, obstruction and bleeding. The authors' practice is to exhaust nearly all forms of nonsurgical intervention before suggesting a surgical approach. Nonresponders are then evaluated for severity of pain, interference of quality of life, and presence of chemical dependency. Appropriate candidates undergo imaging examinations to determine the primary site of disease, presence of pancreatic ductal dilatation, and associated peripancreatic complications. The surgical treatment approach involves classic lines of proximal resection (pylorus-preserving pancreaticoduodenectomy) for small duct disease and lateral pancreaticojejunal drainage for a dilated pancreatic duct. The authors have not yet routinely adopted the duodenum-preserving head resections of Beger and Frey, or thoracoscopic transthoracic splanchnicectomy, but they remain open-minded and avidly await good confirmatory, independent trials of these promising surgical interventions.
Asunto(s)
Pancreatitis/cirugía , Enfermedad Crónica , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Drenaje , Humanos , Dolor/etiología , Pancreatitis/complicaciones , Pancreatitis/diagnóstico , Pancreatitis/fisiopatología , Cuidados PreoperatoriosRESUMEN
In our laboratory, we have often had difficulty infecting neonatal chickens with invasive salmonellae when ambient temperatures exceed 30 C. We hypothesized that this increased resistance in chicks during warmer months may be associated with heat stress-associated maternal factors. Presently, single-comb white leghorn hens were separated into a non-heat-stressed group, reared under temperatures from approximately 10 to 24 C, and a heat-stressed group, in which environmental temperature was incrementally elevated to near 37 C and maintained for the duration of the 13-wk study. For Expt. 1, eggs from heat-stressed or control hens, collected on days 8-14 of the study, were pooled respective to treatment and incubated. At the time of egg collection, mean hen-day egg production was 51.83% or 65% for heat-stressed or control hens, respectively. On day of hatch, progeny from hens in each group were orally challenged with 0.9 x 10(4) colony-forming units (CFU) Salmonella enteritidis (SE). Rates of SE organ invasion of 97.3% or 94.4% were obtained in progeny from heat-stressed or control hens, respectively. In Expt. 2, eggs from heat-stressed or control hens from days 30-42 of the study were collected and pooled by treatment for incubation. Mean hen-day egg production was 46.5% or 72.85% for heat-stressed or control hens, respectively. On day of hatch, progeny were orally challenged with either 2.2 x 10(3) or 2.2 x 10(4) CFU SE. A 100% incidence in SE organ invasion was observed in all groups. In Expt. 3, eggs were collected from days 43 through 56 of the study. Mean hen-day egg production was 19.8% or 76.8% for heat-stressed or control hens, respectively. On day of hatch, progeny were orally challenged with 2 x 10(3) CFU SE. Rates of SE organ invasion of 95.8% or 95.6% were obtained in progeny from heat-stressed or control hens, respectively. These data suggest that factors other than elevated temperature may be responsible for seasonal resistance to invasive salmonellae infection in neonatal chickens observed in our laboratory during warmer months in Texas.
Asunto(s)
Trastornos de Estrés por Calor/veterinaria , Enfermedades de las Aves de Corral/inmunología , Salmonelosis Animal/inmunología , Salmonella enteritidis/patogenicidad , Animales , Estudios de Casos y Controles , Pollos , Recuento de Colonia Microbiana , Susceptibilidad a Enfermedades/veterinaria , Femenino , Trastornos de Estrés por Calor/complicaciones , Trastornos de Estrés por Calor/fisiopatología , Oviposición , Enfermedades de las Aves de Corral/microbiología , Enfermedades de las Aves de Corral/fisiopatología , Distribución Aleatoria , Salmonelosis Animal/fisiopatología , Salmonella enteritidis/inmunología , Estaciones del Año , Factores de TiempoRESUMEN
Interferon-gamma (IFNgamma) has been demonstrated to have potent stimulatory effects on parameters of cell-mediated immunity in chickens (11). Protection of neonatal leghorn chickens against infection by invasive salmonellae has been associated with enhanced cell-mediated indices of immunity (5). The present investigation evaluated the effect of recombinant-turkey (rt) IFN-gamma on protection of neonatal leghorn chicks from Salmonella enteritidis (SE) organ invasion after experimental challenge in three experiments. In Expt. 1, intraperitoneal (i.p.) administration of 25 microg rtIFNgamma per chick 30 min prior to per os SE challenge resulted in a 35% reduction (P < 0.01) in SE organ invasion when compared with control (vehicle injected) chicks 24 hr post-SE challenge. However, i.p. administration of 2.5 microg rtIFNy per chick was not efficacious in reducing SE organ invasion. In Expt. 2 and Expt. 3, i.p. administration of 13.75 microg rtIFNgamma per chick 30 min prior to per os SE challenge resulted in significant reductions of 38.4% (P < 0.025) and 31.58% (P < 0.01), respectively, in SE organ invasion as compared with control chicks 24 hr post-SE challenge. Administration of 2.5 or 25 microg rtIFNgamma per chick i.p. had no effect on SE organ invasion in either Expt. 2 or Expt. 3 24 hr post-SE challenge. Additionally, i.p. administration of rtIFNgamma 30 min prior to SE challenge in Expt. 2 and Expt. 3 was not associated with protection against SE organ invasion when organ culture was performed 72 hr postchallenge. Further, the oral administration of 25 microg rtIFNgamma per chick was not efficacious in conferring protection against SE organ invasion at 24 or 72 hr postchallenge when this route of administration was evaluated in Expt. 2. Similarly, the subcutaneous administration of a potential repository injection of 13.75 or 25 microg rtIFNgamma per chick did not protect chicks against SE organ invasion when evaluated 72 hr postchallenge. These data indicate a potential acute immunostimulatory activity of rtIFNgamma in chickens experimentally challenged with SE. Further, these experiments, although preliminary, are suggestive of the potential involvement of IFNgamma in cell-mediated or innate mechanisms of protective immunity against salmonellosis in chickens.
Asunto(s)
Pollos , Interferón gamma/uso terapéutico , Enfermedades de las Aves de Corral/prevención & control , Salmonelosis Animal/prevención & control , Salmonella enteritidis/inmunología , Administración Oral , Animales , Relación Dosis-Respuesta Inmunológica , Inyecciones Intraperitoneales/veterinaria , Inyecciones Subcutáneas/veterinaria , Interferón gamma/administración & dosificación , Masculino , Enfermedades de las Aves de Corral/inmunología , Enfermedades de las Aves de Corral/microbiología , Distribución Aleatoria , Proteínas Recombinantes , Salmonelosis Animal/inmunología , Salmonelosis Animal/microbiología , PavosRESUMEN
HYPOTHESIS: For most patients with chronic obstructive pancreatitis, distal pancreatectomy confers pain relief. DESIGN: Retrospective case series. Follow-up was complete in 80% of study subjects (mean follow-up, 6.7 years). SETTING: Tertiary care center. PATIENTS: Among 484 patients with chronic pancreatitis undergoing operation from 1976 to 1997, 40 with postobstructive chronic pancreatitis were identified. Criteria for selection included an isolated, dominant major pancreatic duct stricture or cutoff, changes of chronic pancreatitis in the distal pancreas, and ostensibly normal parenchyma without calcification in the proximal gland. The patients were reviewed with regard to operative procedure, postoperative course, and outcome. MAIN OUTCOME MEASURES: Outcome measures included degree of pain relief, morbidity and mortality of operation, survival, rates of endocrine and exocrine insufficiency, and ability to return to work and/or normal activities. RESULTS: All but 1 of the 40 patients had abdominal pain, and 20 (50%) had recurrent episodes of acute pancreatitis. Suspicion of malignancy was a concern in 16 patients (40%). Thirty-eight patients underwent distal pancreatectomy; 1 had a central resection and another a Roux-en-Y cystojejunostomy. There was no operative mortality, but significant morbidity occurred in 15%. Among 31 patients with preoperative pain in whom long-term follow-up was available, complete or significant pain relief was achieved in 25 (81%); 74% returned to normal social function, but about half had some element of pancreatic insufficiency. CONCLUSIONS: Distal pancreatectomy is a safe procedure and achieves pain relief and good quality of life in a large percentage of patients (80%) with presumed postobstructive chronic pancreatitis. However, some of these patients with chronic pancreatitis involving the entire gland have disease masquerading as postobstructive chronic pancreatitis secondary to an ostensibly isolated dominant pancreatic ductal stricture.