Isoperistaltic versus antiperistaltic side-to-side anastomosis after right laparoscopic hemicolectomy for cancer (ISOVANTI) trial: study protocol for a randomised clinical trial.

BACKGROUND: It is believed that loosing ileocecal valve is well tolerated in patients who do not have short bowel syndrome or Crohn disease. From the hypothesis of colonic peristalsis and transit is regulated by that ileocecal valvular mechanism, we try to find out if the creation of a new pseudo-valvular mechanism as antiperistaltic anastomosis could be considered after right hemicolectomy can cause any short- or long-term changes in gastrointestinal habits. PURPOSE: The purpose of the study at primary endpoint is to compare early (occurring within 30 days of surgery) and late (occurring during the follow-up) postoperative complications between both groups The purpose of the study at secondary endpoint is to compare intraoperative and postoperative events between experimental and control groups in terms of operating time, first oral tolerance day, first flatus and faeces, length of hospital stay and orocecal transit; comparing rates of gastrointestinal life quality and comparing mortality rates between both groups. METHODS: The ISOVANTI trial is a randomized controlled single-centre trial comparing isoperistaltic versus antiperistaltic side-to-side anastomosis after right laparoscopic hemicolectomy. It is designed as a parallel group superiority trial. CONCLUSIONS: It is unknown if a pseudo-valvular mechanism as antiperistaltic anastomosis can be considered has short- or long-term consequences in gastrointestinal habit. Considering the impact that ileocolic anastomosis configuration could have on the restitution of bowel transit after right hemicolectomy, we think it is indicated and necessary a randomized trial comparing iso- and antiperistaltic modalities. TRIAL REGISTRATION: NCT02309931.

Intracorporeal ileocolic anastomosis in patients with laparoscopic right hemicolectomy.

BACKGROUND: Since the introduction of laparoscopic colorectal surgery, there has been a controversy between creating an intracorporeal or extracorporeal ileocolic anastomosis in right hemicolectomy. The purpose is to report our experience in intracorporeal anastomosis following right hemicolectomy in both malignant and benign pathologies. STUDY DESIGN: A retrospective review of a prospectively collected database was conducted at Virgen de la Arrixaca Clinical University Hospital (Murcia) between January 2000 and April 2014. The study includes all surgery patients who received a laparoscopic right hemicolectomy with an intracorporeal ileocolic anastomosis. The criteria for exclusion were conversion to open surgery during the procedure due to technical difficulties during dissect. Tumours considered T4 were not excluded, nor were stage IV patients or those with a history of previous abdominal surgery. RESULTS: There were 173 patients (63 females) aged 67 (range 14-91) years, with body mass index of 27 (17-52) kg/m(2) and ASA 1:2:3:4 of 12:78:68:15; 41% had previous abdominal surgery and 70% had a pre-existing comorbidity. Operating time was 142 (60-270) min. Specimen extraction site incision length was 8.1 (6-11.1) cm. Conversion rate was 9.2%, and there were 39 complications (22.54%) and 9 reoperations (5.2%). Readmission rate was 5.2%. Length of stay was 5.7 (1-35) days. CONCLUSION: The intracorporeal procedure is a safe and feasible alternative for creating an ileocolic anastomosis. It involves a similar rate of complications and may prevent some of the drawbacks presented by extracorporeal anastomosis.

Stapling Versus Hand Suture for Gastroenteric Anastomosis in Roux-en-Y Gastric Bypass: a Randomized Clinical Trial.

BACKGROUND: Different anastomotic techniques have been evaluated during a laparoscopic Roux-en-Y gastric bypass (RYGB); however, no techniques have proven to be better than any other regarding complications and the percentage of weight loss (excess weight loss (%EWL)), and there are few controlled prospective studies to compare them. METHODS: A randomized, prospective study was conducted in 238 patients undergoing RYGB for morbid obesity between July 2008 and September 2012 to compare the early and late postoperative complications between the two surgical techniques: gastrojejunal hand-sutured anastomosis (HSA) and circular-stapled anastomosis (CSA). Minimum follow-up was 24 months. RESULTS: The two groups of patients were similar for demographic data and preoperative comorbidities. There were no significant differences between the surgical techniques regarding %EWL at 3, 12, and 24 months. The patients with CSA had a greater frequency of postoperative gastrointestinal bleeding (GIB) (4.2 vs. 0%, p = 0.024) and surgical wound infection (11.1 vs. 3.4%, p = 0.025) than the patients with HSA, with no significant differences in the other early complications. There were no significant differences in either group for late complications (gastrojejunal anastomosis (GJA) stricture, marginal ulcer, GJA perforation, bowel obstruction, and eventration). No significant differences were observed in operative time, rate of reoperation and postoperative length of hospital stay. CONCLUSIONS: HSA and CSA were techniques with similar safety and effectiveness in our study. HSA had a lower rate of bleeding complications and surgical wound infection, although it does require greater experience in laparoscopic hand suturing.

Stimulation of the efferent limb before ileostomy closure: a randomized clinical trial.

BACKGROUND: Postoperative ileus is the most common complication after ileostomy closure with an increase in morbidity, hospital stay, and health care costs. OBJECTIVE: The aim of this study is to assess the utility of a new technique for reducing postoperative ileus after protective ileostomy closure. DESIGN: This is a prospective randomized study registered at ClinicalTrials.gov (NCT01881594). Patients were randomly assigned to undergo either stimulation through the efferent limb of the ileostomy before surgery or nonstimulation before surgery. SETTING: This study was conducted at the Department of Surgery of the Virgen de la Arrixaca Clinical University Hospital (Murcia). PATIENTS: Seventy patients underwent surgery for ileostomy closure. In 35 patients, during the 2 weeks before surgery, daily stimulation of the defunctionalized stomal segment was performed by using a thick solution (500 mL of physiological saline associated with 30 g of thickening agent, Nestle Resource, Vevey, Switzerland). In the other 35 patients, stimulation was not performed before surgery. MAIN OUTCOME MEASURES: The primary outcome was postoperative ileus. The secondary outcomes included time to tolerating a diet and postoperative stay. RESULTS: Both groups of patients were homogenous for demographic data, characteristics of the first rectal cancer operation, and intersurgery periods. After ileostomy closure, the stimulated group of patients had an earlier return to oral tolerance (1.06 vs 2.57 days; p = 0.007) and passage of flatus or stool (1.14 vs 2.85 days; p <0.001) than the nonstimulated group of patients. The incidence of postoperative ileus (2.85% vs 20%; p = 0.024) and hospital stay (2.49 vs 4.61 days; p = 0.002) was also lower in the stimulated patients. LIMITATIONS: Small numbers of patients means that no definitive statements can be made regarding the effectiveness of this technique. CONCLUSIONS: Stimulation of the efferent limb of the ileostomy before closure is a safe technique that reduces postoperative ileus and fosters early intestinal transit and oral tolerance with a shorter postoperative hospital stay.

Daily sap flow and maximum daily trunk shrinkage measurements for diagnosing water stress in early maturing peach trees during the post-harvest period.

We compared the sensitivity of two continuously recorded plant-based water stress indicators (sap flow, SF, and maximum daily trunk shrinkage, MDS) to detect changes in the water status of 4-year-old early maturing peach trees (Prunus persica (L.) Batsch cv. Flordastar grafted on GF-677 peach rootstock) during a cycle of deficit irrigation and recovery. The feasibility of obtaining SF and MDS reference equations for use in irrigation scheduling during the post-harvest period was also studied in trees irrigated in excess of crop water requirements. We found that MDS was a more sensitive and reliable detector of changes in plant water status than SF, making it a more precise tool for irrigation scheduling. Baseline relationships between SF or MDS and the climatic variables (air temperature, vapor pressure deficit (VPD) and crop reference evapotranspiration (ETo)) were established, despite some scatter in the data. Among the climatic variables, SF correlated more closely with ETo, whereas MDS correlated more closely with mean daily air temperature (T (m)). The fits of the regressions between MDS and ETo, midday air temperature and T (m) for individual periods were better than those obtained in the overall regressions, confirming that daily stem diameter variations must be considered not only in the context of plant water status but also in the context of plant carbon status.

Familial transmission of a duplication-deficiency X chromosome associated with partial Turner syndrome.

A rearranged X chromosome Xqter-->q13::Xp11.4-->qter was found in a mother and her two daughters, who were affected with short stature, cubitus valgus and hypothyroidism. The mother's menstrual cycles were normal until the age of premenopause. Similar previously reported cases are considered in an attempt to explain the possible origin of this X recombinant, fertility and clinical traits.

Duplication 16q12----qter arising from 3:1 segregation in a 46,XX,t(13;16) (q12;q12) mother.

A congenitally abnormal female baby was found to have the karyotype 46, XX, +der (16) t (13; 16) (q12;q12) mat. GTG, QFQ, CBG, THA and Ag-NOR banding techniques allowed the identification of the abnormal chromosomes in the proposita and in the translocation carriers through three generations. Duplication 16q resulted from 3:1 segregation in the carrier mother. The hypothesis of a specific meiotic segregation for this translocation is discussed. The phenotypic effects of proximal 16q duplications are analysed together with other four reported cases, which have similar duplicated segment and no other relevant chromosomal abnormality.

Unusual chromosome 20 anomaly arising "de novo" to give dic(20)qs.

An unusual anomaly is reported involving the long arm of chromosome 20. The appropriate cytogenetic techniques showed it to be a de novo dic(20)qs.

C-band length variability and reproductive wastage.

The possible influence of total Y chromosome length and the C-band size variability of chromosomes 1, 9, 16, and Y, on reproductive wastage was investigated. One hundred couples with recurrent reproductive wastage and 106 control couples with at least two healthy children and no miscarriages were cytogenetically studied. Total Y chromosome length was evaluated as the Y/F index and the C-band size was analyzed quantitatively according to the linear measurement method of Balicek et al. (1977). The different degrees of mitotic contraction were corrected on the basis of the linear correlation found between heterochromatin and euchromatin length. Statistical comparison between results of Y chromosome from both samples demonstrated, in the test group, an increase in the mean value of the Y/F index, but the increase of Y C-band length did not reach significance. In addition mean values of C-band length on chromosomes 1, 9, and 16 in couples from the test group and especially those who had had two or more abortions, were lower than those in the controls. Among the latter the frequency of chromosomes included in the category of very large heterochromatin size is higher. However these length differences have been demonstrated only in specific subgroups, and in each one for a different chromosome. Our results indicated that Y chromosome length as well as C-band size variabilities are not directly related to reproductive wastage.

Infertility associated with two accessory bisatellited chromosomes.

Two extra bisatellited chromosomes identified as inv dup (15) (pter----q11.2::q11.2----pter) were found in an oligoasthenospermic male. Analysis of Ag-staining in the proband and in one fertile brother with a normal karyotype revealed that nucleolar organizer region (NOR) activity was significantly increased in the patient. The frequency of satellite associations was also significantly higher in the index case, but no correlation was found between NOR activity and acrocentric associations. These results suggest that extra NOR activity and the elevated frequency of satellite associations could predispose to gametogenic impairment.

New insights into the effects of extra nucleolus organizer regions.

Chromosome studies were carried out in four members of a sibship with a 15p+ chromosome. Two carriers had normal offspring, one was unmarried, and the index case had three abortions and no live children. By means of different banding techniques, up to four satellites and four stalks could be observed on the abnormal chromosome. The Ag-I method showed from zero to four silver precipitates on the 15p+ marker. Mean Ag-staining for 15p+ and the ten acrocentric chromosomes were obtained in the carriers. Statistically significant differences between sibs were found. These results suggest the existence of: (a) An interindividual and intercellular variation of nucleolus organizer region (NOR) activity in man. (b) An optimal threshold of NOR activity, so that disturbances at the meiotic level could occur when it is exceeded. Our conclusions lead us to advise analysis of NOR activity in individuals with extra nucleolus organizer regions.

Yq deletion (q11.21) in a H-Y+ azoospermic male.

A large deletion of the long arm (q11.21) of chromosome Y without mosaicism was found in a 28-year-old male. The proband has a normal height and normal male habitus but with azoospermia. The occurrence of H-Y+ level, azoospermia and loss of a great portion of euchromatic Yq in the proband is analyzed.

A complex balanced rearrangement involving four chromosomes in an azoospermic man.

A complex chromosomal rearrangement involving chromosomes 1, 5, 10, and 12 is described. The patient was an infertile, phenotypically normal male. Cytogenetic analyses of his parents showed that the complex translocation arose de novo. Testicular histology showed spermatogenic arrest.

Comparison between the meiotic activities in the male with hypogonadotropic hypogonadism and in the human fetal ovocytes.

In the testicles of males with postpuberal hypogonadotropic hypogonadism, we have detected a preleptotene phase similar to that described in the human ovary. The two characteristic stages of this phase, contraction and despiralization, were noted. In this paper the origin and the significance of preleptotene in relation to the hormonal levels are discussed.

Familial pericentric inversion (10) and its effect on two offspring.

A pericentric inversion (10)(p15q24) was observed in three generations of a family. One daughter of the inversion carrier was found to have the inv(10) and trisomy 18. The other offspring had a recombinant (10) chromosome.