Surgical treatment of a colon neoplasm of the splenic flexure: a multicentric study of short-term outcomes.

AIM: The optimal surgical treatment of splenic flexure neoplasm is still not well defined. Extended right hemicolectomy (ERH) and left colic resection (LCR) have been proposed but conclusive evidence concerning postoperative morbidity and oncological results is lacking. The aim of this study was to analyse the short-term outcomes after surgery for splenic flexure cancer with regard to surgical procedure and surgeon's specialty. METHODS: This was a multicentre study on patients who underwent surgery for primary colon cancer of the splenic flexure. RESULTS: From 2004 to 2015, 324 patients fulfilled the criteria for inclusion into the study; 270 (83.4%) had elective surgery while 54 (16.6%) had emergency resection: 158 (48.8%) underwent ERH and 166 (51.2%) LCR; 176 (54.3%) procedures were performed by colorectal surgeons, 148 (46.7%) by general surgeons. In the ERH group a significantly higher rate of emergency operations was carried out (P = 0.005). After elective surgery, no significant differences between ERH and LCR concerning 30-day mortality (3.3% vs 2.0%) and the need for reoperation (10.6% vs 7.4%) were found. Nodal harvesting was significantly higher in the ERH and colorectal surgeon groups in any clinical scenario. At multivariate analysis, age and smoking habit were predictive of the need for reoperation and major morbidity while the general surgeon group showed a higher risk of anastomotic failure (OR = 1.92; P = 0.168). CONCLUSION: We analysed the largest series in literature of curative resections for splenic flexure tumours. The optimal procedure still remains debatable as ERH and LCR appear to achieve comparable short-term outcomes. Surgeon's specialty seems to positively affect patient's outcomes.

Impact of birth weight and daily weight gain during suckling on the weight gain of weaning piglets / Impacto do peso ao nascimento e ganho de peso na maternidade sobre o ganho de peso dos leitões na creche

This study evaluated the effect of birth weight and weight gain during the suckling phase on the piglet daily weight gain during the nursery phase (21-61 days of age). Piglets (n= 534) derived from 55 first-parity sows were weighed at birth, weaning, and end of the nursery phase. The data were analyzed according to a completely randomized experimental design, with three classes of birth weight (BW) and two classes of weight gain during the suckling phase (SDWG). High BW and low SDWG piglets were 0.2kg lighter at weaning than low BW and high SDWG animals (P< 0.05). However, at the end of the nursery phase, this situation was inverted, with high BW and low SDWG piglets 2.20kg heavier (P< 0.05). Low BW and high SDWG piglets were heavier at weaning and at the end of the nursery phase than low BW and low SDWG piglets (P< 0.05). At the same time, intermediate and high BW and low and high SDWG piglets presented body weight differences at weaning (P< 0.05), but not at the end of the nursery phase (P< 0.05). Piglets with 1.25 to 2.30kg BW and low weight gain during suckling presented a partial compensatory growth during the nursery phase.(AU)

Objetivou-se avaliar o efeito do peso dos leitões ao nascimento e do seu ganho de peso na maternidade sobre seu desempenho na fase de creche (21-61 dias de idade). Quinhentos e trinta e quatro leitões, provenientes de 55 primíparas, foram pesados ao nascimento, no desmame e na saída da creche. Os animais foram distribuídos em um delineamento inteiramente ao acaso, em três classes de peso ao nascimento (PN) e duas classes de ganho de peso diário (GPD) na maternidade. Os animais com alto PN e baixo GPD na maternidade desmamaram 0,2kg mais leves que os animais com baixo PN e alto GPD na maternidade (P<0,05). Porém, os animais com alto PN e baixo GPD na maternidade saíram da creche 2,10kg mais pesados (P<0,05). A diferença aos 21 dias entre os dois tratamentos (alto e baixo GPD) com animais de baixo PN foi de 1,18kg e passou para 2,20kg ao final da creche (P<0,05). No caso dos animais com médio e alto PN, a diferença ao desmame era de 1,14 e 1,26kg e passou para 0,90 e 0,70kg na saída da creche (P<0,05), respectivamente. Leitões com peso ao nascimento entre 1,25 e 2,30kg, com baixo ganho de peso diário na maternidade, apresentaram efeito compensatório parcial no ganho de peso diário durante a creche.(AU)

Growth of suckling piglets in litters standardized by weight.

This study examined the relationship between birth weight and growth performance when suckling piglets were reared in litters standardized by birth weight. Forty-four gilts (Landrace × Large White) due to farrow during the same week were selected. Piglets born to those gilts were individually weighed at birth and cross-fostered to obtain litters with 11 piglets and standardized birth weight (CV, lower than 5%). Based on average birth weight, 4 litter weight classes were established: class 1 (> 1.10 kg to ≤ 1.33 kg), class 2 (> 1.34 kg to ≤ 1.46 kg), class 3 (> 1.47 kg to ≤ 1.57 kg), and class 4 (> 1.58 kg to ≤ 1.88 kg). At 21 d of age, piglets were weighed to determine BW and calculate ADG and weight gain relative to birth weight. A completely randomized experimental design was used with birth weight classes as treatments. At 21 d of age, the average BW of piglets from the heaviest birth weight class (5.67 kg) was greater (P < 0.05) than the lightest class (5.06 kg); however, all classes had the same ADG (P < 0.05). There was a positive correlation (r = 0.184; P < 0.01) between birth weight and weight at 21 d of age, but birth weight was not correlated (r = -0.040; P = 0.37) with ADG during the suckling phase. Therefore, piglet birth weight did not influence weight gain when piglets were reared by sows in litters with standardized birth weight.

Extensor triggering in de Quervain's stenosing tenosynovitis.

Extensor triggering is an uncommon but recognized component of de Quervain's stenosing tenosynovitis. In a retrospective review of 827 patients with the diagnosis of de Quervain's disease over a 5-year period, 11 patients with 13 affected wrists were identified who had demonstrable triggering by both history and physical examination (prevalence of 1.3%). One wrist underwent surgical release without conservative treatment. The remaining 12 wrists were initially treated with nonoperative modalities. Failure of conservative treatment as defined by recurrent triggering and pain occurred in 7 wrists, of which 5 underwent surgical release. At the time of surgery, all wrists were noted to have synovitis, separate compartments for the extensor pollicis brevis and abductor pollicis longus tendons, and no intratendinous nodules. After an average follow-up period of 42 months (range, 5.7-94.5 months) there were no recurrences of triggering after surgical treatment. Seven of 12 wrists with triggering de Quervain's stenosing tenosynovitis failed nonoperative treatment. Triggering or locking in extension is an uncommon symptom in de Quervain's stenosing tenosynovitis and demonstrates a more recalcitrant course when treated nonoperatively.

Effect of link protein and free hyaluronic acid binding region on spacing of proteoglycans in aggregates.

Aging of articular cartilage results in accumulation of aggrecan fragments of various sizes that retain their ability to aggregate even though they may have relatively few glycosaminoglycan chains. Residual binding of partially degraded aggrecan may prevent binding of newly synthesized aggrecan subunits that have greater numbers of glycosaminoglycan chains. This study was undertaken to determine the effects of various relative molar ratios of intact aggrecan, link proteins, and hyaluronic acid binding region fragments on the structure of reconstituted aggregates. High molar ratios of link proteins relative to aggrecan decreased the spacing between adjacent aggrecan subunits; low molar ratios of hyaluronic acid binding region relative to aggrecan (4:1 or less) had no significant effect on spacing, and high molar ratios resulted in an increase in the spacing and a decrease in the percentage of aggrecan subunits found in aggregates. These data suggest that the density of aggrecan subunits on the aggregate is determined primarily by steric hindrance of the glycosaminoglycan chains of the aggrecan subunits and that, to a limited extent, partial degradation of aggrecan in an aggregate allows attachment of more aggrecan subunits.