RESUMO
1. The hypothesis that air-classified faba bean protein fraction (FBP) can replace soybean meal (SBM) in pelleted or extruded broiler diets without adverse effect on performance or nutrient digestibility was tested.2. At 17 d of age, male broilers were randomly distriibuted among four dietary treatments consisting of either SBM or FBP (main dietary protein source) and pelleting or extrusion as processing methods. Treatments had 10 replicate pens containing five birds each.3. Compared to SBM, birds fed FBP had significantly lower feed intake, less weight gain and had poorer feed conversion.4. Pellet durability was high (above 92%) for all diets. In pelleted diets, FBP was harder than SBM whereas extruded diets had similar hardness. Pelleting increased water stability compared to extrusion. FBP diets were more water stable than the SBM diets.5. Gizzard content weight was 2.2-fold higher (P = 0.002) for birds given FBP compared to those fed SBM. The weight of the jejunum and ileum with contents was 1.4-fold lower for the FBP diets, and this effect was larger (P < 0.05) for the extruded FBP diet.6. Birds fed FBP diets had significantly higher nitrogen digestibility in the lower jejunum and ileum compared to those given SBM diets, while the starch digestibility coefficient was above 0.980 in all treatments.7. The high nutrient digestibility of FBP diets indicates that the poor performance of the FBP group was due to lower feed intake which was not explained by the differences in pellet durability or hardness. The reduced palatability of the FBP and the longer retention of the FBP diets in the upper gut are more likely to have depressed feed intake.
Assuntos
Glycine max , Vicia faba , Ração Animal/análise , Fenômenos Fisiológicos da Nutrição Animal , Animais , Galinhas , Dieta/veterinária , Digestão , MasculinoRESUMO
1. An in vitro test to study the effect of pH reduction on phytic acid degradation over time for four commercial phytases was conducted. Changing the pH level affected phytate degradation over time differently for the various phytases (P < 0.05).2. The phytase with the largest response of pH reduction in the in vitro test and a feed pH level of 4.5 was chosen for the broiler experiment. The effect of intermittent feeding, addition of 500 FYT C. braakii-derived phytase and 1% formic acid were tested in a 2 x 2 x 2 factorial arrangement. Ten pens containing 10 birds each were fed each of the treatment combinations from 15 to 36 d of age. Ad libitum fed birds had two 4-h dark periods with 2-h light in-between, while intermittently fed birds in addition had restricted access to the feed through except for four 1-h and one 2-h feeding bouts.3. In addition to assessing performance, excreta were collected on a pen basis. The tibia and contents from jejunum and ileum were collected from one bird per pen. In addition, crop contents were collected from the intermittently fed birds 80, 160 and 240 min after the start of feeding.4. Phytase improved performance, ileal and jejunal P digestibility, P retention and tibia ash and P concentration (P < 0.001). Intermittent feeding increased jejunal P digestibility and P retention (P < 0.001), but ileal P digestibility increased only in the intermittently fed birds compared to the ad libitum fed birds without phytase addition (P = 0.025). Acidification increased jejunal P digestibility only in the ad libitum fed birds (P = 0.019). There was a considerable inositol hexakisphosphate degradation into lower isomers in the crop after 80 min for diets with phytase (InsP3 and 4:P < 0.001), and acidification further increased this degradation (InsP4:P = 0.007). After 160 min retention time, the effect of phytase and acidification was even higher with more significant (P < 0.05) interactions.5. The current data showed that prolonged retention time in the crop combined with feed acidification increased phytase efficacy by improving the phytate degradation.
Assuntos
6-Fitase , Ração Animal/análise , Fenômenos Fisiológicos da Nutrição Animal , Animais , Galinhas , Dieta/veterinária , Suplementos Nutricionais , Digestão , Concentração de Íons de Hidrogênio , Ácido FíticoRESUMO
1. The hypothesis behind the study was that a high dietary starch level (HS) would lead to impaired gut health compared to a low-starch diet (LS) in Eimeria-challenged broilers. The effects of two diets with different starch to fat ratios on intestinal histomorphometry, Clostridium perfringens counts and toxin profile, necrotic enteritis prevalence and abundance of short-chain fatty acids (SCFAs) were examined. 2. A total of 1,920 one-day-old Ross 308 broiler chickens were fed one of two isocaloric diets formulated either with high (32:1) or low (2:1) starch to fat ratios from d 10 to 29 of age. Each treatment group had 12 pen replicates containing 80 broilers each. On d 17, the chickens were challenged with Eimeria vaccine strains. Samples were collected on d 16, 21-23 and 29. 3. Whereas villus length increased gradually throughout the study in the HS group, a peak level was reached on d 21-23 in the LS group. On d 29, the HS group had significantly longer villi than the LS group. 4. Caecal SCFA concentrations were higher in the HS group compared to the LS group on d 16. In both groups, the SCFA level peaked on d 21-23, with the most pronounced increase seen in the LS group. 5. The C. perfringens netB:cpa ratio increased from d 16 to 29 in the HS group. C. perfringens counts and necrotic enteritis prevalence were similar between the two groups. 6. Diet affected the dynamics of small intestinal villus length and caecal SCFA abundance. These findings suggest that structural remodelling of the small intestine is an adaptation to different dietary starch levels, and that caecal SCFA abundance is associated with the availability of substrate for the microbiota in the posterior intestinal segments. Chickens adapted to higher levels of dietary starch might be more robust against Eimeria infections due to increased mucosal surface area. Studies with other dietary starch sources are required to clarify the impact of dietary starch levels on intestinal health in Eimeria-challenged broilers.
Assuntos
Infecções por Clostridium , Coccidiose , Eimeria , Enterite , Doenças das Aves Domésticas , Ração Animal/análise , Animais , Galinhas , Infecções por Clostridium/veterinária , Clostridium perfringens , Coccidiose/veterinária , Dieta/veterinária , Suplementos Nutricionais , Enterite/veterinária , Ácidos Graxos Voláteis , AmidoRESUMO
1. A 2 × 2 factorial arrangement was used to test the hypothesis that, in pelleted diets, legume starch is digested less rapidly and to a lesser extent than cereal starch, and that increased gelatinisation through extrusion would eliminate the differences between the starch sources. In addition, the trial examined whether a lower ratio of starch to nitrogen disappearance rate (SNDR) could improve feed conversion ratio (FCR).2. At 17 d of age, male broilers were randomly distributed among four dietary treatments, consisting of either wheat or faba bean starch-rich fraction (FBS) as the sole starch source and pelleting or extrusion as processing methods. Each treatment had 10 replicate pens containing five birds each.3. Extrusion resulted in a more extensive starch gelatinisation compared to pelleting, as expected.4. No difference in weight gain at 29 d of age was observed between birds fed starch sources. However, birds fed wheat tended (P = 0.080) to have better FCR than those fed FBS, while the effect of processing methods was insignificant. Thus, there was no interaction between starch source and processing method on FCR.5. In pelleted diets, FBS had lower and slower starch digestibility compared to wheat in all intestinal segments (P < 0.05). The interaction between starch source and processing method in all intestinal segments (P < 0.001) demonstrated that FBS responded more to gelatinisation through extrusion than did wheat. Thus, differences in starch digestibility between the wheat and FBS were eliminated with extrusion.6. Feeding extruded diets significantly increased the upper jejunal expression of GLUT1, GLUT2 and SGLT1 compared to pelleted diets, which suggested that glucose absorption was less likely to be a limiting factor for starch utilisation.7. Pelleting resulted in a lower ratio (P < 0.001) of SNDR compared to extrusion (on average 1.4-fold) but did not improve FCR.
Assuntos
Galinhas , Amido , Ração Animal/análise , Fenômenos Fisiológicos da Nutrição Animal , Animais , Dieta/veterinária , Digestão , MasculinoRESUMO
BACKGROUND: Nomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including 'inlay', 'sublay' and 'underlay', can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes. METHODS: A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons. Different terms describing anterior abdominal wall planes were identified via literature review and expert consensus. The initial list comprised 59 possible terms. Panellists completed a questionnaire that suggested a list of options for individual abdominal wall planes. Consensus on a term was predefined as occurring if selected by at least 80 per cent of panellists. Terms scoring less than 20 per cent were removed. RESULTS: Voting started August 2018 and was completed by January 2019. In round 1, 43 terms (73 per cent) were selected by less than 20 per cent of panellists and 37 new terms were suggested, leaving 53 terms for round 2. Four planes reached consensus in round 2, with the terms 'onlay', 'inlay', 'preperitoneal' and 'intraperitoneal'. Thirty-five terms (66 per cent) were selected by less than 20 per cent of panellists and were removed. After round 3, consensus was achieved for 'anterectus', 'interoblique', 'retro-oblique' and 'retromuscular'. Default consensus was achieved for the 'retrorectus' and 'transversalis fascial' planes. CONCLUSION: Consensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies.
ANTECEDENTES: La nomenclatura de la inserción de una malla para la reparación de una hernia incisional ventral (ventral hernia, VH) es inconsistente y confusa. En la literatura indexada se usan varios términos, tales como 'inlay', 'sublay', y 'underlay' que pueden referirse a los mismos planos anatómicos. Este hecho frustra las comparaciones de técnicas quirúrgicas e invalida los metaanálisis que comparan resultados quirúrgicos en función del plano de inserción de la malla. En consecuencia, el objetivo de este estudio fue establecer una clasificación internacional de los planos de la pared abdominal (International Classification of Abdominal Wall Planes, ICAP). MÉTODOS: Se realizó un estudio Delphi, en el que participaron 20 cirujanos de pared abdominal reconocidos internacionalmente. Se identificaron diferentes términos que describían los planos de la pared abdominal anterior mediante la revisión de la literatura y el consenso de expertos. La lista inicial incluía 59 términos posibles. Los panelistas completaron un cuestionario que sugería una lista de opciones para los planos individuales de la pared abdominal. El consenso sobre un término fue predefinido cuando dicho término había sido seleccionado por ≥ 80% de panelistas. Se eliminaron los términos con una puntuación < 20%. RESULTADOS: La votación comenzó en agosto de 2018 y se completó en enero de 2019. Durante la Ronda 1, 43 (73%) términos fueron seleccionados por < 20% de los panelistas y se sugirieron 37 términos nuevos, dejando 53 términos para la Ronda 2. Cuatro planos alcanzaron un consenso en la Ronda 2 con los términos 'onlay', 'inlay', 'pre-peritoneal' e 'intra-peritoneal'. Treinta y cinco (66%) términos fueron seleccionados por < 20% de los panelistas y fueron eliminados. Después de la Ronda 3, se logró un consenso para 'anterectus' (ante-recto), 'interoblique' (inter-oblicuo), 'retrooblique' (retro-oblicuo) y 'retromuscular'. Se alcanzó un consenso por defecto para los planos 'retrorectus' (retro-recto) y 'transversalis fascial' (fascial transverso). CONCLUSIÓN: La ICAP ha sido desarrollada por el consenso de 20 cirujanos reconocidos internacionalmente. Su implementación debería mejorar la comunicación y la comparación entre cirujanos y estudios de investigación.
Assuntos
Parede Abdominal/cirurgia , Consenso , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Próteses e Implantes/classificação , Telas Cirúrgicas/classificação , Humanos , Recidiva , Estudos RetrospectivosRESUMO
1. The hypothesis was that a diet with a high starch to fat ratio (HS) impairs nutrient digestibility and growth performance, as compared to a diet with a low starch to fat ratio (LS) in Eimeria-challenged broilers. From days 10 to 29, 12 replicate pens of birds were given isocaloric and isonitrogenous steam-pelleted diets with either HS or LS, by replacing the wheat starch in one diet by a mixture of rapeseed oil and inert sand in the other. On d 17, a 10-fold dose of live vaccine strains of Eimeria spp. was administered via drinking water. Ileal samples were collected on days 16 and 29. 2. Starch content in the ileum tended to be higher on d 16 and was significantly higher on d 29 in the HS group. 3. The HS diet did not induce exceedingly high levels of starch in the ileum, suggesting there was no starch overload in the gut. Ileal starch digestibility was improved with increasing dietary starch level from 23% to 45%. This demonstrated the capacity of the broiler chicken to digest high levels of starch regardless of Eimeria spp. infection. Ileal energy digestibility was not affected by the treatments. 4. Weight gain did not differ between treatments; however, birds fed the LS diet were less efficient in feed conversion as compared to those fed the HS diet. 5. The use of isolated starch and the unintended higher extent of starch gelatinisation in the HS diet may have contributed to the higher starch digestibility in birds given the HS diet. Thus, the hypothesis that high ratios of starch to fat in pelleted diets may impair starch digestibility and production performance in Eimeria-challenged broiler chickens was not verified. Further work is required to clarify this research question, taking into consideration the physical form of starch source and the potentially confounding role of feed processing on starch availability.
Assuntos
Galinhas , Eimeria , Ração Animal/análise , Fenômenos Fisiológicos da Nutrição Animal , Animais , Dieta/veterinária , Suplementos Nutricionais , Digestão , Nutrientes , AmidoRESUMO
1. A 2 × 2 factorial design was used to test the hypothesis that impaired intestinal starch digestibility is attributable to rapid passage of digesta from the gizzard to the intestine, and that, compared to steam pelleting, increasing the availability of starch through extrusion cooking may alleviate the potential negative effect of rapid digesta flow on starch utilisation. 2. Thus, 7-d-old-broiler chickens were distributed to 48 cages and given a wheat-based (WB) pelleted diet containing either coarse oat hulls (OH-Pel) or fine cellulose (Cel-Pel) until d 19 to stimulate divergent development of the gizzard. Thereafter, both groups were further subdivided and challenged with a WB diet containing cellulose in either pelleted (Cel-Pel) or extruded (Cel-Ext) form on d 20 and 22. Either excreta or intestinal contents were collected at time intervals after feeding and analysed for marker and starch. 3. OH-Pel increased gizzard size and holding capacity. No excessively high starch levels (maximum 25 g/kg) were detected in the excreta. However, 8 h feed-deprived birds given Cel-Pel and challenged with Cel-Pel exhibited higher starch excretion and showed large individual variation during the first 135 min of collection. 4. Contrary to the OH-Pel group, more digesta and starch passed to the jejunum at 1 and 2 h and ileum at 2 and 3 h after feeding for birds given Cel-Pel, resulting in lower jejunal and ileal starch digestibility. 5. Increased starch gelatinisation through extrusion processing significantly improved starch digestibility regardless of gizzard function. However, at 1, 2 and 3 h after feeding, more digesta was retained in the foregut of birds given Cel-Ext. 6. The current data showed that starch degradation rate is associated with the flow of digesta which is linked to gizzard development, and that enzymatic hydrolysis of intact starch granules may be limited with more rapid feed passage through the gut.
Assuntos
Ração Animal/análise , Galinhas/fisiologia , Digestão , Moela das Aves/fisiologia , Amido/metabolismo , Fenômenos Fisiológicos da Nutrição Animal/efeitos dos fármacos , Animais , Avena/química , Celulose/química , Dieta/veterinária , Moela das Aves/efeitos dos fármacos , Moela das Aves/crescimento & desenvolvimento , Masculino , Distribuição AleatóriaRESUMO
1. A series of experiments were carried out to study the effect of grit on broiler performance, gizzard development and fate of grit in the digestive tract. 2. In Experiment 1, performance, gizzard weight and content of grit in the gizzard of broiler chickens given access to granite-type grit was investigated. In Experiment 2, the effect of grit stones on performance and gizzard development was assessed in diets with or without whole wheat. 3. In Experiment 3, the effect of grit in the form of zeolite, granite or marble on gizzard development and digestive tract grinding and passage was studied in diets with or without whole wheat. 4. Grit stones had no effect on performance of broiler chickens, which may be explained by the fact that grit stones did not stimulate gizzard development to the same extent as with other structural materials. 5. The lack of stimulation is at least partly due to the fact that a majority of the grit stones eaten pass through the small intestine without being retained in the gizzard. 6. Grit in the form of marble reduced feed intake and weight gain.
Assuntos
Ração Animal/análise , Galinhas/fisiologia , Dieta/veterinária , Digestão , Moela das Aves/crescimento & desenvolvimento , Fenômenos Fisiológicos da Nutrição Animal/efeitos dos fármacos , Animais , Carbonato de Cálcio/administração & dosagem , Galinhas/crescimento & desenvolvimento , Dióxido de Silício/administração & dosagem , Aumento de Peso/efeitos dos fármacos , Zeolitas/administração & dosagemRESUMO
PURPOSE: The New England VA Hernia Registry was created in 2011 to prospectively collect relevant details of ventral hernia repairs, with the intention to assess and improve long term outcomes. The goal of this study is to assess registry compliance. METHODS: All ventral hernia operations performed in five VA hospitals between 2011-2022 were obtained. We assessed compliance at the hospital and surgeon level. RESULTS: 3,516 cases were performed. Overall compliance with registry entry was 37.5%, ranging from 10.8% to 67.2% across hospitals. At the hospital level, there was a negative correlation between average yearly hernia volume per surgeon and registry compliance (r2 = 0.53). Surgeon compliance varied within hospitals and over time. CONCLUSION: Registry compliance was low and highly variable. Lack of interest, incentives, oversight, and surgeon turnover are possible factors for noncompliance. Building a registry with these factors in mind, providing timely feedback, and conducting frequent audits may improve compliance.
Assuntos
Hérnia Ventral , Herniorrafia , Sistema de Registros , Humanos , Hérnia Ventral/cirurgia , Estudos Prospectivos , Bases de Dados Factuais , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais de Veteranos , Estados Unidos , Cirurgiões/estatística & dados numéricos , New EnglandRESUMO
BACKGROUND: Surveillance is an effective strategy for reducing surgical site infections (SSIs); however, current identification methods are resource-intensive. Therefore, we sought to validate an electronic SSI triaging tool for detection of probable infections and identify operational barriers and challenges. METHODS: A retrospective cohort study was conducted among all Veterans Affairs Surgical Quality Improvement Program (VASQIP)-reviewed surgeries at 2 Veterans Affairs medical centers from October 1, 2011-September 30, 2014. During the postoperative period, clinical and administrative variables associated with SSI (relevant microbiology order, antibiotic order, radiology order, and administrative codes) were extracted from the electronic medical record and used to score the probability (high, intermediate, and low) that an SSI occurred. VASQIP manual chart review was used as the gold standard of comparison. RESULTS: VASQIP manual review identified 118 SSIs out of 3,700 surgeries (3.2%). There were 2,041, 1,428, and 231 surgeries that met criteria for low, intermediate, and high probability for SSI. The tool's area under the curve was 0.86 (95% confidence interval, 0.82-0.89). The sensitivity among low-probability surgeries was 92.4%, and the specificity among high-probability surgeries was 95.1%. CONCLUSIONS: The electronic SSI tool has the potential to be used for triaging VASQIP surveillance toward the high-probability surgeries and to avoid manual review of surgeries with low probability of SSI.
Assuntos
Procedimentos Cirúrgicos Operatórios/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Estudos de Coortes , Interpretação Estatística de Dados , Registros Eletrônicos de Saúde , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Padrões de Prática Médica , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Triagem , Estados Unidos , United States Department of Veterans Affairs , Estudos de Validação como AssuntoRESUMO
The role of active oxygen species and lipid peroxidation in the antitumor effect of hyperthermia was studied in an experimental rabbit model. VX2 tumors were transplanted into rabbit hind legs, and the effect of hyperthermia on tumor growth was measured at 7 and 14 days after heating. As an index of lipid peroxidation, thiobarbituric acid-reactive substances in the tumor tissue were measured prior to hyperthermia and 3, 6, 12, and 24 h after hyperthermia. Tumor growth in rabbits treated with hyperthermia was significantly reduced, and thiobarbituric acid-reactive substances in the tumor tissue treated with hyperthermia were significantly increased until 6 h after hyperthermia. In addition, alpha-tocopherol in the tumor tissue was significantly decreased after hyperthermia. The antitumor effect of hyperthermia and the increase of thiobarbituric acid-reactive substances in the tumor tissue treated with hyperthermia were significantly inhibited by the administration of superoxide dismutase and catalase or dimethyl sulfoxide. These results suggest that lipid peroxidation mediated by active oxygen species plays an important role in the antitumor effect of hyperthermia.
Assuntos
Hipertermia Induzida , Peroxidação de Lipídeos/fisiologia , Neoplasias Experimentais/terapia , Espécies Reativas de Oxigênio/metabolismo , Animais , Sequestradores de Radicais Livres , Masculino , Transplante de Neoplasias , Neoplasias Experimentais/metabolismo , Coelhos , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo , Fatores de Tempo , Vitamina E/metabolismoRESUMO
Signet ring cell carcinoma is a poorly differentiated adenocarcinoma in which the tumour cells invade singly or in small groups. Early stages of the disease can be missed easily when using regular haematoxylin and eosin staining. This is a report of a case in which routine screening of gastric biopsies with the Genta stain was responsible for rapid identification of signet ring carcinoma. The patient, a 29 year old woman, had a large portion of the antrum excised surgically for signet ring cell gastric carcinoma. Follow up endoscopy six years later showed no evidence of tumour. Twenty six large cup biopsies were obtained and a single focus of signet ring tumour cells infiltrating the surface mucosa in single files was seen. The diagnosis was missed on haematoxylin and eosin stain by three senior pathologists but owing to the Alcian blue component of the Genta stain the tumour cells were recognised easily. Thus, the Genta stain not only facilitates detection of Helicobacter pylori but also allows for simultaneous visualisation of gastric morphology as well as signet ring carcinoma that can be missed with conventional stains.
Assuntos
Carcinoma de Células em Anel de Sinete/diagnóstico , Corantes , Infecções por Helicobacter/diagnóstico , Helicobacter pylori , Neoplasias Gástricas/diagnóstico , Adulto , Azul Alciano , Feminino , HumanosRESUMO
Tension pneumopericardium is a rare entity typically described in premature infants requiring positive-pressure ventilation. However, recent reports suggest an increase in its occurrence in adults. A case of delayed postoperative tension pneumopericardium in an adult patient is presented with a review of the history, pathophysiology, presentation, and treatment of this entity.
Assuntos
Lesão Pulmonar , Pulmão/cirurgia , Pneumoperitônio/etiologia , Traumatismos Torácicos/cirurgia , Toracotomia/efeitos adversos , Ferimentos por Arma de Fogo/cirurgia , Adulto , Evolução Fatal , Hemotórax/etiologia , Humanos , Masculino , Síndrome do Desconforto Respiratório/etiologiaRESUMO
We examined two women with orbital hematomas that occurred during labor. Both women developed sudden diplopia, proptosis, and orbital pain. The location of the hematoma was confirmed by orbital echography and computed tomography. The patients were observed without surgical intervention. Neither patient developed clinical or echographic signs of compressive optic neuropathy. Clinical resolution occurred during the following two weeks. Serial standardized orbital echographic examinations documented resolution of the hematomas.
Assuntos
Hematoma/etiologia , Complicações do Trabalho de Parto , Doenças Orbitárias/etiologia , Adulto , Feminino , Hematoma/diagnóstico , Hematoma/diagnóstico por imagem , Humanos , Oftalmoplegia/etiologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/diagnóstico por imagem , Gravidez , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Squamous cell carcinoma of the pancreas is a controversial entity. Although some reports show that it is metastatic from another source, others demonstrate that it is a primary tumor. Between 1988 and 1997, fourteen cases of pancreatic squamous cell carcinoma were identified in the records of our pathology department. In seven instances the features were consistent with squamous cell carcinoma with no adenomatous component. The records of six of these patients were available for review and constitute the basis for this report. Five patients were diagnosed by means of percutaneous CT-guided fine-needle aspiration, whereas the sixth patient was diagnosed using a transduodenal core needle biopsy. At the time of diagnosis four patients had lung lesions, three patients had liver lesions, and two patients had lytic bone lesions. One patient had a 6 cm esophageal lesion. Surgical intervention had no impact on treatment or palliation in one of the patients. Chemotherapy and radiation therapy, alone or in combination, were ineffective in all patients. Median survival from the time of diagnosis was 2 months. We conclude that in cases of squamous cell carcinoma of the pancreas, every effort should be made to exclude adenomatous components histologically within the tumor and to exclude another primary source of squamous cell carcinoma. This will allow a better understanding of this entity and a refinement of therapy.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Controversy continues to exist concerning the optimal diagnostic approach to a pancreatic head lesion suspected of being a neoplasm. The objective of this study was to evaluate the impact of needle biopsy in suspicious pancreatic head neoplasia and its effect on therapy and outcome. Seventy-three patients with symptoms or signs of periampullary neoplasia and a pancreatic head lesion identified on CT scan were reviewed retrospectively. Forty patients with potentially resectable lesions underwent intraoperative transduodenal core needle biopsy of the head of the pancreas. Thirty-three patients underwent CT-guided percutaneous fine-needle aspiration. The sensitivity and specificity of core needle biopsy were 76% and 100%, respectively. One death was directly related to the procedure and therapy was adversely affected in one patient with a false negative result. The sensitivity and specificity of percutaneous fine-needle aspiration were 85% and 92%, respectively, and were not significantly different from the core needle biopsy results (P >0.3). Three false negative fine-needle aspiration biopsies occurred in patients with potentially resectable lesions and a low clinical suspicion for malignancy. In patients with a mass in the head of the pancreas on CT scan, fine-needle aspiration biopsy offers results similar to those of intraoperative transduodenal core needle biopsy. In patients estimated to have resectable disease, a pancreaticoduodenectomy should be performed without a biopsy. For patients with unresectable disease, cytologic examination of fine-needle aspirate should be performed. If this examination is positive, it offers the advantage of facilitating the construction of a rational plan for palliation.
Assuntos
Biópsia por Agulha , Carcinoma/diagnóstico , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico , Biópsia por Agulha Fina , Biópsia por Agulha/efeitos adversos , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma/cirurgia , Citodiagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Radiografia Intervencionista , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
The murine double minutes 2 (MDM2) oncoprotein inhibits p53-mediated tumor suppression. MDM2 has been shown to be overexpressed in sarcomas and more recently was implicated in the pathogenesis of carcinomas. The purpose of this study was to determine the expression pattern of MDM2 in adenomas and colorectal adenocarcinomas and decide whether there is a correlation between MDM2 and p53 protein status. Paraffin-embedded tissues from 52 colorectal cancer (CRC) specimens and their adjacent normal tissue (N-CRC) were studied. In addition, 56 sporadic adenomas were investigated for the immunohistochemical expression of MDM2 and p53 proteins. Immunoreactivity of p53 indicating p53 gene mutation (p53+) was significantly higher in CRC (44%) compared to adenomas (23.2%) (P <0.01). None of the N-CRC specimens expressed the immunoreactive p53 protein. MDM2 overexpression (MDM2+) was similar in adenomas (30.3%) and CRC (25%), but only 2 (3.8%) of 52 N-CRC specimens showed overexpression of MDM2. In most cases MDM2 expression was associated with negative p53 expression (wild-type p53) in both adenomas (r = 0.59, P <0.001) and CRC (r = 0.69, P <0. 0001). No correlation was found between MDM2, p53 expression, and either the histologic grade, nodal stage or morphology of the tumors. There is greater p53 mutation in CRC compared to adenomas and N-CRC. The data indicate that MDM2 is overexpressed in CRC and is significantly associated with wild-type p53 compared to N-CRC specimens from the same patient. The MDM2 expression pattern is similar in adenomas and CRC, which may suggest that MDM2 overexpression is an early event in the progression of CRC.
Assuntos
Adenocarcinoma/metabolismo , Neoplasias Colorretais/metabolismo , Proteínas de Neoplasias/metabolismo , Proteínas Nucleares , Proteínas Proto-Oncogênicas/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Adenoma/metabolismo , Animais , Colo/metabolismo , Humanos , Imuno-Histoquímica , Camundongos , Proteínas Proto-Oncogênicas c-mdm2RESUMO
BACKGROUND: Opinions regarding the appropriate clinical management of pancreatitis-related common bile duct (CBD) stricture vary considerably. PATIENTS AND METHODS: Nineteen patients with chronic pancreatitis and proven stricture of their CBD were included in this study. Their mean duct diameter was 16 mm, bilirubin was 8.4 mg/dL, and alkaline phosphatase was 784 mIU/mL. RESULTS: Five patients initially treated with endoscopic biliary stent placement are doing well at a mean follow-up of 7 months with only 1 patient requiring a biliary-enteric bypass. Four patients underwent a pancreaticoduodenectomy and the other 10 patients underwent a biliary-enteric bypass. Mean bilirubin and alkaline phosphatase at 13 months after therapy were 0.9 mg/dL and 144 mIU/mL. CONCLUSION: An endoscopically placed biliary stent will relieve obstruction due to the stricture for several months and allow the inflammatory process to follow its natural course. In patients with long-standing permanent biliary stricture, pancreatitis limited to the head of the pancreas, duodenal obstruction, or suspected pancreatic head carcinoma, pancreaticoduodenectomy is the operation of choice. Biliary-enteric bypass in association with gastric or pancreatic bypasses should be reserved for patients with severe inflammatory changes preventing a safe pancreaticoduodenectomy.
Assuntos
Colestase Extra-Hepática/terapia , Doenças do Ducto Colédoco/terapia , Pancreatite/complicações , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Colestase Extra-Hepática/diagnóstico , Colestase Extra-Hepática/etiologia , Doença Crônica , Doenças do Ducto Colédoco/diagnóstico , Doenças do Ducto Colédoco/etiologia , Constrição Patológica , Humanos , Masculino , Pessoa de Meia-Idade , StentsRESUMO
BACKGROUND: This study evaluated the impact of Goldman's index (GI), radionuclide ventriculography (RVG), and dipyridamole-thallium scintigraphy (DTS) on predicting cardiac outcome after vascular operations. METHODS: A total of 463 consecutive patients undergoing vascular operations were divided into those who had no DTS, those who had reversible ischemia by DTS, and those who had no reversible ischemia by DTS. GI, ejection fraction, wall motion abnormalities, rate of coronary angiography, and revascularization were determined for each group. RESULTS: Coronary revascularization was ultimately performed in 8% of patients with no DTS, 7% of patients with no ischemia by DTS, and 9% of patients with ischemia by DTS. The GI of 6.1 in patients who died postoperatively was significantly higher than the GI of 3.6 in patients who survived (P = 0.02). RVG did not predict mortality, morbidity, or need for coronary revascularization. CONCLUSION: Clinical assessment remains a good predictor for cardiac outcome in patients undergoing vascular operations. More extensive cardiac testing should be reserved for patients with higher GI and active cardiac problems.
Assuntos
Dipiridamol , Ventriculografia com Radionuclídeos , Radioisótopos de Tálio , Doenças Vasculares/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares , Idoso , Humanos , Masculino , Seleção de Pacientes , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Doenças Vasculares/cirurgiaRESUMO
In conclusion, surgical myocardial revascularization has utilized diverse methods to increase blood flow to the starving myocardium. These methods initially used the microcirculation as the portal to reach myocytes until angiography showed that the obstructions were macrovascular. This resulted in a 30-year era of direct attack on the coronary blockages by coronary bypass. Surgical conduits unfortunately have longevity considerably less than that of native arteries and are limited in number. Alternative conduits, both biologic and prosthetic, have not yet proved to have the same clinical results as the ITA. More patients are living long enough to have the extensiveness of their disease exhaust conventional therapies. Newer therapy, restricted thus far to untreatables, revisits the microcirculation by making laser channels. These many innovative procedures have benefited hundreds of thousands of patients. They emerged from the probity and innovation of many individual surgeons.