Sigmoidectomy following sigmoid volvulus: who is at risk of anastomotic failure?

BACKGROUND: Anastomotic leak following elective sigmoidectomy performed due to sigmoid volvulus (SV) is a devastating complication. The aim of this study was to identify the incidence and risk factors associated with leak in this specific group of patients. METHODS: A retrospective study was performed at two university-affiliated tertiary centres in Israel. All consecutive patients between January 2014 and April 2020 treated for SV with elective sigmoidectomy and primary anastomosis were reviewed and those suffering from anastomotic leak identified. Factors associated with this complication were assessed using univariate analysis and odds ratios subsequently calculated. RESULTS: Of the 99 patients initially identified, 58 were included in the study group [45 males and 13 females (77.6% versus 22.4% respectively) mean age 67.4 years, range 13-97]. There were 10 anastomotic leaks identified (17.2%). On univariate analysis recurrent decompression (OR 8.28, p = 0.027), age > 80-years (OR 6.88, p = 0.027), open rather than laparoscopic surgery (OR = 5.83, p = 0.005) and ASA grade 3/4 (OR 0.132, p = 0.023) were significantly associated with anastomotic leak. Male sex approached but not reach statistical significance. CONCLUSIONS: Recurrent endoscopic decompression, age > 80 years, open surgery and ASA grade 3/4 are associated with anastomotic leak and these patients should be considered for formation of a colostomy instead. If an anastomosis is performed, patients should be appropriately counselled and monitored in the perioperative period.

The Added Value of Technetium-99 m Sestamibi Scan in Patients with Primary Hyperparathyroidism and Positive Ultrasound.

BACKGROUND: Neck ultrasound (US) and Technetium-99 m Sestamibi (MIBI) scan are the most commonly used imaging studies for preoperative localization of parathyroid adenomas. The aim of this study was to determine the added value of MIBI scan and its effect on the operative plan via a hypothetical model where a stepwise approach is conducted and MIBI is considered only after the ultrasound is evaluated. METHODS: Patients who underwent parathyroidectomy for primary hyperparathyroidism (PHPT) between 2012 and 2019 at two tertiary centers were included. Data collected included demographic data, preoperative workup, operative findings and follow-up. The added value of MIBI scans was determined for patients with positive ultrasound. RESULTS: A total of 513 patients with positive US result and a MIBI scan were included. If a stepwise approach was conducted then MIBI scan would not change the operative plan in 492 (95.9%). Among the remaining 21 patients, MIBI scan would correctly change the ultrasound-based operative plan in only 12 (2.3%) patients, while incorrectly change the plan in 9 (1.8%), resulting in unnecessary exploration of the contralateral side. In patients with sonographic appearance of a parathyroid gland larger than 1.2 cm, MIBI scan would correctly change the operative plan in only 1 of the 287 (0.35%) patients. CONCLUSIONS: Our study suggests that the routine use of MIBI scans may have limited added value in patients with PHPT and a positive neck ultrasound, especially in those with adenoma size larger than 1.2 cm. Positive ultrasound alone may be sufficient for the preoperative localization of parathyroid disease.

[Violations of higher mental functions and their correction in patients undergoing video laparoscopic cholecystectomy under conditions of inhalation anesthesia with sevoflurane]. / Narusheniya vysshikh psikhicheskikh funktsii i ikh korrektsiya u bol'nykh, perenesshikh videolaparoskopicheskuyu kholetsistektomiyu v usloviyakh ingalyatsionnoi anestezii sevofluranom.

OBJECTIVE: To substantiate the advisability of using cytoflavin to correct postoperative cognitive dysfunction (POCD) in patients undergoing video laparoscopic cholecystectomy (VLCE) under conditions of inhalation anesthesia with sevoflurane. MATERIAL AND METHODS: The data of two representative groups of patients (n=60) who underwent video-laparoscopic cholecystectomy under the conditions of inhalation anesthesia with sevoflurane were analyzed. At the stages of the perioperative period, in order to monitor the state of higher mental functions, neuropsychological testing was performed: anxiety and depression scales (HADS), the Montreal scale of cognitive dysfunction (MoCA), and frontal dysfunction batteries (FAB). Patients of the first group (n=19) were not corrected for POKD. For the correction of cognitive impairment, patients of the second group (n=41) were treated with Cytoflavin according to the 20 ml regimen per 250 ml of 0.9% sodium chloride solution intravenously once before the operation, then within 4 days of the postoperative period. RESULTS: Neuropsychological testing in group I patients revealed the development of moderate POCD. The inclusion of Cytoflavin in the treatment regimen in the II group of patients contributed to an improvement in the state of HMF, accompanied by a decrease in the level of anxiety and depression. CONCLUSION: The inclusion of Cytoflavin in treatment regimens helps prevent the development of POKD and is accompanied by an improvement in the state of higher mental functions, which is manifested by a decrease in the level of anxiety and depression, favorably affecting the emotional background of patients.

[Analgesia of labor in women with diabetes mellitus].

UNLABELLED: The article deals with a study of duration of physiological labors in women with diabetes mellitus. PATIENTS AND METHODS: 120 women were devided into three groups according to method of analgesia. We assessed data of central haemodynamics, efficacy of analgesia, glucose level in blood, conditions of fetus and newborn. RESULTS: We found that epidural analgesia with bupivacaine hydrochloride was an optimal method of labor analgesia in women with diabetes mellitus. This method provided a stabilization of glucose level in blood, normalization of data of central haemodynamics and allowed to avoid anomalies of labor CONCLUSIONS: Analgesia with promedol and paracetamol is a preferable method in case of presence of epidural analgesia contraindications.

Phosphorylation of mitochondrial proteins in isolated porcine ovarian follicles after treatment with luteinizing hormone.

LH treatment of isolated medium (3- to 7-mm) follicles from porcine ovaries stimulated pregnenolone synthesis by mitochondria isolated from these tissues. This LH stimulation of pregnenolone synthesis was observed regardless of whether exogenous cholesterol was added to the mitochondrial assay system, suggesting that factors besides cholesterol availability may be important for mitochondrial steroidogenesis. Since ovarian mitochondria contain AMP-dependent protein kinase activity, we investigated the role of protein phosphorylation in regulating mitochondrial steroidogenesis. Mitochondria were isolated from different sized follicles and corpora lutea and incubated for 10 min with [gamma-32P]ATP in the absence or presence of 2 microM cAMP. Mitochondrial proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and 32P labeling of mitochondrial proteins was determined by autoradiography. In all mitochondrial preparations from the various ovarian tissues, 32P labeling was found only for proteins with apparent mol wt of 44,000 and 55,000. While cAMP addition was necessary for phosphorylation of the 44,000 mol wt mitochondrial protein(s), phosphorylation of the 55,000 mol wt mitochondrial protein(s) occurred independently of cAMP. Intact medium follicles were preincubated for 120 min in medium 199D containing 32Pi, and then incubated in nonradioactive medium without or with LH (1 microgram/ml) for up to 2 h. Mitochondria were isolated from these follicles, and their proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. While several mitochondrial proteins were labeled in these experiments, only the 44,000 and 55,000 mol wt proteins were studied. After 30 min of incubation, LH treatment stimulated the phosphorylation of a mitochondrial protein with apparent mol wt of 44,000. However, 32P labeling of this 44,000 mol wt mitochondrial protein decreased in LH-treated follicles after incubation for 60 and 120 min. In untreated follicles, 32P labeling of the 44,000 mol wt mitochondrial protein did not change after 30 min of incubation, but phosphorylation did increase after 60- and 120-min incubations. 32P labeling of the 55,000 mol wt mitochondrial protein increased linearly with time in both untreated and LH-treated follicles. Although cAMP treatment of isolated follicular mitochondria was similar to the LH stimulation of intact follicles with respect to phosphorylation of the 44,000 mol wt mitochondrial protein, cAMP treatment of isolated follicular mitochondria did not stimulate pregnenolone synthesis.(ABSTRACT TRUNCATED AT 400 WORDS)

Characterization of ATPase in sarcoplasmic reticulum from two strains of dystrophic mice.

The ATPase activities and phosphoenzyme levels have been determined in sarcoplasmic reticulum (SR) membranes prepared from two animal models of muscular dystrophy, myodystrophic (myd/myd) and strain 129 dystrophic (129 dy/dy) mice. In both myd/myd and 129 dy/dy SR membranes, the basal ATPase activities are elevated above control levels, while the Ca-dependent ATPase activities are normal. The addition of 0.1% Triton X-100 not only lowers the basal ATPase activity of myodystrophic control SR membranes by 60%, but also lowers the elevated basal ATPase activity of myd/myd SR membranes to a similar level. The Ca-dependent ATPase activities of myodystrophic control and myd/myd SR membranes are increased approximately threefold by the addition of Triton. The addition of 0.1% Triton X-100 lowers the basal ATPase activities of 129 control and 129 dy/dy SR membranes to similar levels, but stimulates the CA-dependent ATPase activity of 129 dy/dy SR membranes to a level that is only 60% of that of 129 control SR membranes. The level of phosphoenzyme intermediate is decreased approximately 15% in myd/myd SR membranes and approximately 30% in 129 dy/dy SR membranes.

Impaired substrate utilization in mitochondria from strain 129 dystrophic mice.

Mitochondria from skeletal muscle, heart and liver of strain 129/ReJ-dy dystrophic mice and their littermate controls were characterized with respect to their respiratory and phosphorylating activities. Skeletal muscle mitochondria from dystrophic mice showed significantly lower state 3 respiratory rates than controls with both pyruvate + malate and succinate as substrates (P less than 0.01). ADP/O and Ca2+/O ratios were found to be normal. A decreased rate of NADH oxidation (0.01 less than P less than 0.05) by sonicated mitochondrial suspensions from dystrophic mice was also seen. High respiratory rates with ascorbate + phenazine methosulfate as substrates indicated that cytochrome oxidase was not rate limiting in the oxidation of either pyruvate + malate or succinate. Skeletal muscle mitochondria from dystrophic mice showed no deficiency in any of the cytochromes or coenzyme Q. Mg2+-stimulated ATPase activity was higher in dystrophic muscle mitochondria than in controls, but basal and oligomycin-insensitive activities were virtually identical to those of controls. A significant reduction inthe intramitochondrial NAD+ content (0.01 less than P less than 0.02) was seen in dystrophic skeletal muscle as compared to controls. Heart mitochondria from dystrophic mice showed similar, though less extensive abnormalities while liver mitochondria were essentially normal. We concluded from these results that skeletal muscle mitochondria from strain 129 dystrophic mice possess impairments in substrate utilization which may result from (1) an abnormality in the transfer of electrons on the substrate side of coenzyme Q in the case of succinate oxidation; (2) a defect on the path of electron flow from NADH to cytochrome c, and (3) a deficiency of NAD+ in the case of NAD+-linked substrates.

Defective oxidative metabolism of myodystrophic skeletal muscle mitochondria.

A small-scale procedure for preparing tightly coupled intact skeletal muscle mitochondria from myodystrophic (myd/myd) mice is described. Mitochondrial preparations derived from heart, liver, and skeletal muscle of myd/myd and their littermate (+/?) controls are characterized with respect to their cytochrome content and their oxidative and phosphorylative capacities. Our data indicate that there is an impairment in the NADH CoQ region of the respiratory chain of myodystrophic skeletal muscle mitochondria. Both heart and liver mitochondria of myd/myd exhibited normal activities of respiratory chain-linked oxidative phosphorylation.