Mixed models identify physic nut genotypes adapted to environments with different phosphorus availability.

The aim of this study was to screen physic nut (Jatropha curcas) genotypes that differ in their phosphorous (P) use, using mixed models. The experiment was conducted in a greenhouse located in the experimental area of the Centro de Ciências Agrárias of the Universidade Federal do Espírito Santo, in Alegre, ES, Brazil. The experiment was arranged in a randomized block design, using a 10 x 3-factorial scheme, including ten physic nut genotypes and two environments that differed in their levels of soil P availability (10 and 60 mg/dm3), each with four replications. After 100 days of cultivation, we evaluated the plant height, stem diameter, root volume, root dry matter, aerial part dry matter, total dry matter, as well as the efficiency of absorption, and use. The parameters were estimated for combined selection while considering the studied parameters: stability and adaptability for both environments were obtained using the harmonic mean of the relative performance of the predicted genotypic values. High genotype by environment interactions were observed for most physic nut traits, indicating considerable influences of P availability on the phenotypic value. The genotype Paraíso simultaneously presented high adaptability and stability for aerial part dry matter, total dry matter, and P translocation efficiency. The genotype CNPAE-C2 showed a positive response to P fertilization by increasing both the total and aerial part dry matter.

Biometry and diversity of Arabica coffee genotypes cultivated in a high density plant system.

The present study was developed to respond to the need for an increase in crop yield in the mountain region of Caparaó (southern Espírito Santo State, Brazil), an area of traditional coffee production. This study aimed to analyze the diversity and characterize the crop yield of genotypes of Coffea arabica L. with potential for cultivation in high plant density systems. In addition, it also aimed to quantify the expression of agronomic traits in this cultivation system and provide information on the genotypes with the highest cultivation potential in the studied region. The experiment followed a randomized block design with 16 genotypes, four repetitions, and six plants per experimental plot. Plant spacing was 2.00 x 0.60 m, with a total of 8333 plants per hectare, representing a high-density cultivation system. Coffee plants were cultivated until the start of their reproductive phenological cycles and were evaluated along four complete reproductive cycles. Genotypes with high crop yield and beverage quality, short canopy, and rust resistance were selected. C. arabica genotypes showed variability in almost all characteristics. It was possible to identify different responses among genotypes grown in a high plant density cultivation system. Although the chlorophyll a content was similar among genotypes, the genotypes Acauã, Araponga MG1, Sacramento MG1, Tupi, and Catuaí IAC 44 showed a higher chlorophyll b content than the other genotypes. Among these, Sacramento MG1 also showed high leafiness and growth of vegetative structures, whereas Araponga MG1, Pau-Brasil MG1, and Tupi showed high fruit production. In addition, Araponga MG1 had also a higher and more stable crop yield over the years.

Evidence of genetic tolerance to low availability of phosphorus in the soil among genotypes of Coffea canephora.

The expansion of agriculture to new areas in order to increase the competitiveness of coffee producing countries has resulted in cultivation expanding into regions with lower natural fertility. This scenario has created the need to differentiate genotypes of Conilon coffee based on their tolerance to low levels of nutrients in the soil, especially phosphorus, which imposes high limitations on crop yield in tropical regions. In this context, the objective of this study was to identify differential tolerance among genotypes of Conilon coffee cultivated in environments with different levels of phosphorus availability in the soil. The experiment was conducted in a controlled environment, following a completely randomized design, with three replications in a factorial scheme 13 x 3, the factors were as follows: 13 genotypes of Conilon coffee from groups of different ripening cycles and three environments with different levels of phosphorus availability in the soil (fertilization without phosphorus supply, and phosphorus supply at 50 and 100% of recommendations). Discrimination of tolerance was based on 14 variables, including vegetative growth, accumulation of dry matter, nutrient content, and nutritional efficiencies. Estimates of genetic parameters indicated high genotypic variability for genotypes cultivated in environments with low phosphorus availability in the soil. It was possible to classify genotypes 22, 23, 24, 67, 76, 77, and 83 as tolerant of a low availability of phosphorus in the soil during early development. There was no clear relationship between ripening cycles and the tolerance of the genotypes to low phosphorus availability in the soil.

Immunoglobulin production is impaired in protein-deprived mice and can be restored by dietary protein supplementation.

Most contacts with food protein and microbiota antigens occur at the level of the gut mucosa. In animal models where this natural stimulation is absent, such as germ-free and antigen-free mice, the gut-associated lymphoid tissue (GALT) and systemic immunological activities are underdeveloped. We have shown that food proteins play a critical role in the full development of the immune system. C57BL/6 mice weaned to a diet in which intact proteins are replaced by equivalent amounts of amino acids (Aa diet) have a poorly developed GALT as well as low levels of serum immunoglobulins (total Ig, IgG, and IgA, but not IgM). In the present study, we evaluated whether the introduction of a protein-containing diet in 10 adult Aa-fed C57BL/6 mice could restore their immunoglobulin levels and whether this recovery was dependent on the amount of dietary protein. After the introduction of a casein-containing diet, Aa-fed mice presented a fast recovery (after 7 days) of secretory IgA (from 0.33 to 0.75 mg/mL, while in casein-fed mice this value was 0.81 mg/mL) and serum immunoglobulin levels (from 5.39 to 10.25 mg/mL of total Ig). Five percent dietary casein was enough to promote the restoration of secretory IgA and serum immunoglobulin levels to a normal range after 30 days feeding casein diet (as in casein-fed mice--15% by weight of diet). These data suggest that the defect detected in the immunoglobulin levels was a reversible result of the absence of food proteins as an antigenic stimulus. They also indicate that the deleterious consequences of malnutrition at an early age for some immune functions may be restored by therapeutic intervention later in life.

Can lactate be used as a fuel by wounded tissue?

The role of lactate in the metabolism of the healing wound is poorly understood. The purpose of the present studies was to determine if despite a net lactate production, wounded (Wx) tissue could metabolize lactate and use it as an oxidative fuel. The extensor digitorum longus muscles (EDL) of weanling, male, Fischer rats were injured with lambda-carrageenan or injured thermally, and 5 and 3 days later, respectively, were incubated in a standard incubate that contained varying amounts of lactate (0 to 6 mmol/L added). Lactate uptake and oxidation, occurred in lambda-carrageenan Wx EDL, thermally injured EDL and non-Wx EDL in a dose-dependent manner. At lactate concentrations of less than 3 mmol/L in the incubate, there was net lactate production, but at lactate concentrations of 6 mmol/L there was no net lactate production by both Wx and non-Wx EDL. The increase in lactate oxidation was not associated with an alteration in the tissue content of adenosine triphosphate or creatine phosphate. It was associated with a reduction in glucose oxidation in Wx and non-Wx EDL and by a decrease in glucose uptake by Wx EDL. These data suggest that lactate may be used as an oxidative fuel by wounded tissue and in this regard may substitute for glucose.

Reversal of benign intracranial hypertension by surgically induced weight loss.

Weight loss is recommended in the treatment of benign intracranial hypertension (BIH) but is difficult to achieve because of the administration of steroids. A 24-year-old morbidly obese woman with BIH presented with headache, a cerebrospinal fluid pressure of 300 mm H2O, enlargement of the blind spot in the right eye, and bilateral papilledema. Treatment with steroids for one year produced an increase in weight with worsening symptoms and visual findings. Gastric exclusion surgery produced a 37-kg weight loss in six months that was associated with cessation of symptoms, reduction in cerebrospinal fluid pressure to 170 mm H2O, marked improvement in visual fields, and resolution of papilledema. This raises the possibility that gastric exclusion surgery may be an effective means to achieve weight loss and ultimately a remission in obese patients with BIH.

The effect of endotoxin on glucose metabolism in skeletal muscle requires the presence of plasma.

The administration of endotoxin in vivo results in an increase in glucose utilization through an as yet undetermined mechanism. This study evaluated (1) the contribution of blood to the increased glucose utilization noted following endotoxemia, (2) the direct action of endotoxin on skeletal muscle glucose uptake in an isolated hindlimb perfusion system and in incubated muscle, and (3) the possibility that the increased glucose uptake in skeletal muscle mediated by endotoxin requires the presence of plasma. Incubation of blood with 50 and 100 mg/L of endotoxin increased glucose uptake and lactate production in a dose-dependent manner. Muscle incubations and perfusions in the absence of plasma and white blood cells showed that glucose uptake and lactate production were not affected by the presence of 50 to 250 mg/L of endotoxin, while 500 mg/L of endotoxin produced a 26.2% decrease in glucose uptake. In contrast, incubation of muscle in the presence of plasma and endotoxin increased glucose uptake by 37%. These findings suggest that (1) the increased glucose utilization of endotoxemia is only partially explained by increased glucose metabolism by blood, (2) endotoxin does not have a direct effect on the glucose uptake of skeletal muscle, and (3) an interaction of endotoxin with a component of plasma is required for an endotoxin-mediated increase in glucose utilization by skeletal muscle.

Vertebral artery pseudoaneurysm. A rare complication of subclavian artery catheterization.

The present case report details a previously unreported complication of subclavian vein catheterization, vertebral artery pseudoaneurysm. Attention to this problem was brought about in the patient by the development of stridor and dysphagia noted 5 days following placement of the subclavian catheter. A computed tomographic scan of the neck revealed a superior mediastinal, contrast-enhancing mass in the region of the right subclavian artery with a "bull's-eye" sign suggestive of a pseudoaneurysm. Arteriography subsequently proved the pseudoaneurysm to be of vertebral origin. The pseudoaneurysm was ligated via a neck incision together with a median sternotomy to obtain vascular control. The evaluation and treatment options of this problem are discussed.

Gallbladder disease in the morbidly obese.

During a 7 year period, 200 consecutive morbidly obese patients underwent a standardized gastric exclusion procedure. Group A was composed of the first 120 patients and Group B of the last 80 patients. In Group A, 22 patients had undergone a previous cholecystectomy and 12 patients had a cholecystectomy at the time of gastric exclusion because of positive diagnostic studies or palpation of stones. Of the remaining 87 patients in this initial group who were at risk for the development of gallbladder disease, 24 (27.6 percent) required a cholecystectomy in the first 3 postoperative years (mean 15.6 months). Twelve patients had acute cholecystitis, 3 patients had choledocholithiasis, and 1 patient had acute gallstone pancreatitis. In Group B, 18 patients had a previous cholecystectomy, 15 had positive diagnostic studies (ultrasonography and oral cholecystography) preoperatively, and 47 had negative studies. Cholecystectomy was routinely performed at the time of gastric exclusion surgery in the 62 patients with gallbladders in Group B. Of the 47 patients who had normal preoperative diagnostic studies, 40 (85.1 percent) had abnormal histologic findings in the gallbladder. Only seven patients in Group B had a normal gallbladder (14.7 percent). We conclude that gallbladder disease is considerably more frequent in the morbidly obese population (91.3 percent) than has previously been recognized, that diagnostic studies are frequently inaccurate, and that postoperative gallbladder disease is common (28.7 percent). On the basis of these results, routine cholecystectomy at the time of gastric exclusion surgery is recommended.

Complications and weight loss in 150 consecutive gastric exclusion patients. Critical review.

Results of extensive follow-up for weight loss and complications in 150 consecutive patients who underwent a standardized gastric exclusion procedure have been presented. A comparative review of the literature has also been presented. All patients were followed for up to 6 years (mean 27.8 months). Only one patient was lost to follow-up. Complications during this period occurred in 54.7 percent of our patients. These were mainly postsurgical biliary disease and ventral hernias. Our recent experience has suggested that the latter complications could have been prevented. The absence of pulmonary embolism, pneumonia, and stomal ulcer in our series, as well as the low incidence of perforations, thrombophlebitis, and stomal and pouch complications suggest that the occurrence of these complications can be minimized as well. Patients in this series lost an average of 75 percent of their excess weight, 38 percent of their original weight, and stabilized at 30 percent above their ideal body weight. Ninety percent of the weight loss occurred in the first 12 months. Eighty percent of the patients, however, continued to lose weight 18 months postoperatively and 40 percent lost weight up to 24 months postoperatively. Weight loss has been maintained from 2 to 5 years. In conclusion, analysis of available data has demonstrated that careful patient selection, attention to technical detail, and close follow-up are of paramount importance for providing successful results and minimizing complications in the morbidly obese population who undergo gastric exclusion surgery.

Prospective metabolic evaluation of 150 consecutive patients who underwent gastric exclusion.

The effect of weight loss produced by gastric exclusion on the metabolism of previously morbidly obese persons was examined. A standardized gastric exclusion procedure was performed in 150 morbidly obese patients during a 6 year period. These patients were followed for from 6 to 60 months (mean 27.8 months). The mean excess weight loss was 75 percent and was maintained from 2 to 5 years. A small but significant decrease was noted during the first 3 to 6 postoperative months in the parameters of protein metabolism examined. Although this may reflect mild depletion in protein stores, of greater importance was the demonstration that these parameters spontaneously corrected themselves by 12 months. Mild abnormalities in serum electrolyte concentrations were noted in the postoperative period. They appeared to be related to dehydration, were not clinically significant, and also resolved spontaneously. Clinically significant abnormalities in divalent ions were absent. Significant and sustained reductions in blood pressure, fasting glucose concentration, serum triglyceride values, and uric acid and hepatic enzyme concentrations were demonstrated in the entire population. A small and non-sustained decrease in cholesterol was seen. Hypertension was eliminated in 96 percent of the affected subpopulation, diabetes in 100 percent, gout in 100 percent, hyperlipidemia in 92 percent, and improved hepatic function was found in 95 percent. These changes should reduce the overall morbidity and mortality of the patient population in the future.

Laparosonic coagulating shears: alternative method of hemostatic control of unsupported tissue.

Ultrasonic energy is now available as a hemostatic tool to aid dissection during surgery. A new device, the Laparosonic Coagulating Shears (LCS-Ethicon/Ultracision, N. Smithfield, RI), has been developed to allow hemostatic coagulation and division of tissue. We describe the mechanism of action and its effects in the porcine model. In addition, we compare this modality with conventional electrosurgery.

Laparoscopic unroofing of symptomatic renal cysts: three distinct surgical approaches.

Although they are rarely associated with complaints, benign renal cysts may be the cause of pain, hypertension, or other problems. Simple aspiration is rarely definitive treatment. We have had good results with three laparoscopic approaches to cyst unroofing: transperitoneal, with reflection of the colon medially or dissection through the mesocolon and direct retroperitoneoscopy. We recommend initial percutaneous aspiration with cytology study both to rule out malignancy and to identify those cysts clearly in need of unroofing.

Keeping up with the Jones's: open donor nephrectomy in the laparoscopic era.

Several new approaches have been developed to perform donor nephrectomy. These include laparoscopic donor nephrectomy and open donor nephrectomy performed through small incisions, herein referred to as "mini-open donor nephrectomy". In the past, we performed open donor nephrectomy via a standard flank incision. In October 2002, we introduced mini-open donor nephrectomy via an anterior, retroperitoneal approach. Contemporaneously, we offered the option of laparoscopic donor nephrectomy. Herein, we review our single-center experience with these three techniques. Mini-open donor nephrectomy was comparable to the laparoscopic approach for duration of narcotic requirement and donor length of stay. The laparoscopic procedure was more expensive. Both procedures demonstrated improvement over the flank approach by eliminating the risk of pneumothorax, neuropathy, and flank bulge. In addition, length of stay and narcotic requirements were higher with the flank approach. Mini-open donor nephrectomy provides a good alternative to laparoscopic surgery, offering the donor an equivalent convalescence at lower cost and potentially with reduced morbidity.

Late recurrence of Hodgkin's disease after partial splenectomy.

The use of laparotomy and splenectomy for staging purposes in patients with Hodgkin's disease (HD) gained popularity in the early 1970s. Accurate staging and more effective treatment regimens, including combined chemotherapy and irradiation, have resulted in improved patient survival rates. Similarly, an increased number of late complications have been reported, including the development of thyroid disease, second malignancies, and septic complications related to splenectomy. Partial splenectomy has been proposed as one method of preventing overwhelming postsplenectomy sepsis. The authors present a case of recurrence of HD, which occurred in the splenic remnant 13 years after the initial treatment. This case demonstrates that the spleen is a potential for recurrent intraabdominal Hodgkin's disease after partial splenectomy; thus, the use of partial splenectomy for HD should be discouraged.

Timing of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy in the treatment of choledocholithiasis.

Although experience with laparoscopic approaches to common duct stones is increasing, endoscopic retrograde cholangiopancreatography (ERCP) performed either before or after laparoscopic cholecystectomy (LC) remains the most common approach. Debate remains as to the best timing for ERCP in patients with suspected choledocholithiasis. Because clinical, laboratory, and radiological data are poor predictors of choledocholithiasis, many ERCPs done before LC give negative results. ERCP performed after LC with a positive intraoperative cholangiogram (i.o.p.) would eliminate many unnecessary preoperative endoscopic studies. This is a retrospective analysis of the treatment of choledocholithiasis with the combination of LC and ERCP. All patients included could have had ERCP preoperatively or postoperatively; therefore, those with cholangitis requiring emergent preoperative ERCP were excluded. Two groups of patients were compared: those who underwent ERCP followed by LC and those who underwent LC and IOC followed by ERCP. No significant differences were found with respect to age, gender, health status, clinical presentation, laboratory values (most liver functions, white blood cell count, hemoglobin, and serum amylase), surgery time, blood loss, ERCP time, time between treatment modalities, and days to regular diet. However, the preoperative ERCP group was found to have a longer hospital stay (6.7 days vs. 3.5 days, p = 0.003) and higher hospital cost ($9,406.39 vs. $12,816.23, p = 0.05). The preoperative ERCP group had two patients requiring two ERCPs to clear the common duct, one patient requiring conversion to open procedure because of failed LC, and four minor complications. The postoperative ERCP group had no failed LC, IOC, or postoperative ERCPs and one minor complication. The rate of false positive IOC was 6.7% and of negative preoperative ERCP, 43%. We conclude that in the absence of cholangitis requiring emergent endoscopic decompression, suspected choledocholithiasis can be successfully managed first with LC, ERCP being reserved for patients with a positive IOC. This eliminates many negative preoperative ERCPs.

Laparoscopic complete excision of a splenic epidermoid cyst.

Splenic epidermoid cysts are rare lesions traditionally treated by splenectomy. Concerns about overwhelming postsplenectomy sepsis have led to the development of splenic preservation procedures in the treatment of cystic diseases of the spleen. We present the first case report of successful laparoscopic complete excision of a splenic epidermoid cyst.

Thoracoabdominal injuries in the athlete.

Although thoracoabdominal injuries are uncommon in the athlete, they can be catastrophic if unrecognized or if diagnosis and treatment are delayed. This article reviews thoracic, intrathoracic, abdominal, and groin injuries in the athlete, and how they can be diagnosed and managed.

Ultrasonic energy in laparoscopic surgery.

The ideal energy form for use in laparoscopic surgery should provide controlled, hemostatic cutting. A good dissection technique should be further characterized by minimal thermal injury to surrounding tissue, no smoke obscuring the visual field, cutting ability equal to or superior to a conventional scalpel, coagulative ability equal to or greater than electrosurgery, lack of danger to the patient such as from stray energy, no toxins from exposure to smoke in the pneumoperitoneum elevating patient levels of methemoglobin or carboxyhemoglobin, no need for special preparation of the patient (grounding pad) or surgeon (glasses), and no need for special training. For a technology to replace that which is the current standard, this should all be provided at a cost similar to the cost associated with electrosurgery.

Laparoscopic nissen fundoplication using ultrasonic cutting and coagulation.

Gastroesophageal reflux disease (GERD) is the most common foregut disorder, with 7% of Americans experiencing heartburn daily. Symptoms of GERD are many and varied, including heartburn, chest pain, regurgitation, dysphagia, nocturnal aspiration, morning hoarseness, chronic cough, and wheezing. Fifty percent of symptomatic patients develop esophagitis, while 20% of patients with esophagitis develop complications, including ulceration, stricture, Barrett's esophagus, and aspiration pneumorritis.