125 A Case of Mistaken Identity: An Obsolete Anti-Reflux Device in An Older Patient with Variable Gastrointestinal Symptoms

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Squires ◽  
R Porter ◽  
B Ward
Keyword(s):  
Significant Proportion ◽  
Gastrointestinal Symptoms ◽  
Surgical Removal ◽  
Mistaken Identity ◽  
Early Results ◽  
Left Hypochondrium ◽  
Lower Oesophagus ◽  
Gastrointestinal Complaints ◽  
Unusual Appearance

Abstract Background A frail 93-year-old lady presented with delirium and hypoxia, on a background of heart failure, constipation, cerebrovascular disease, and osteoporosis. A CTPA on admission revealed an unusual appearance of the left hypochondrium, leading to subsequent CT abdomen. This unexpectedly reported the presence of a gastric band. We therefore considered a possible misidentification as this procedure seemed unlikely in someone of her age. Her GP records revealed that she underwent surgical insertion of an Angelchik prosthesis in 1984. It transpired that our patient had experienced several longstanding symptoms, including reflux, bloating and constipation, which have all been observed in patients with Angelchik prostheses in situ. Discussion The Angelchik prosthesis is an anti-reflux device for patients with chronic reflux disease with or without hiatus hernia, introduced in 1979. It comprised of an elastomer shell ring filled with silicone gel, that was sited at the lower oesophagus and secured with DACRON tapes. It was initially lauded for its replicable insertion technique and promising early results with around 30,000 being inserted in mainly British and American Hospitals. However, over time it became apparent that a significant proportion of patients reported ongoing gastrointestinal symptoms due to device failure. Serious complications such as gastric perforations were also recognised. Surgical removal was noted to be technically complex, providing further challenges. The Angelchik prosthesis therefore fell from favour after a period of use of only fifteen years, and is now rarely encountered. We discovered that our patient had experienced multiple long-standing gastrointestinal complaints potentially linked to her prosthesis, though this association had not previously been considered. Whilst her frailty meant that removal would not be pragmatic, it is uncertain if this could have been a possible consideration in the past. This device is relevant to geriatricians as many recipients are now elderly, and may report ongoing symptoms.

scholarly journals Rock Surface Fungi in Deep Continental Biosphere—Exploration of Microbial Community Formation with Subsurface In Situ Biofilm Trap

2020 ◽  
Vol 9 (1) ◽  
pp. 64
Author(s):  
Maija Nuppunen-Puputti ◽  
Riikka Kietäväinen ◽  
Lotta Purkamo ◽  
Pauliina Rajala ◽  
Merja Itävaara ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Debaryomyces Hansenii ◽  
Fungal Communities ◽  
Fungal Colonization ◽  
Rock Surface ◽  
Mica Schist ◽  
Deep Subsurface ◽  
Bacterial Phyla ◽  
In Situ Conditions

Fungi have an important role in nutrient cycling in most ecosystems on Earth, yet their ecology and functionality in deep continental subsurface remain unknown. Here, we report the first observations of active fungal colonization of mica schist in the deep continental biosphere and the ability of deep subsurface fungi to attach to rock surfaces under in situ conditions in groundwater at 500 and 967 m depth in Precambrian bedrock. We present an in situ subsurface biofilm trap, designed to reveal sessile microbial communities on rock surface in deep continental groundwater, using Outokumpu Deep Drill Hole, in eastern Finland, as a test site. The observed fungal phyla in Outokumpu subsurface were Basidiomycota, Ascomycota, and Mortierellomycota. In addition, significant proportion of the community represented unclassified Fungi. Sessile fungal communities on mica schist surfaces differed from the planktic fungal communities. The main bacterial phyla were Firmicutes, Proteobacteria, and Actinobacteriota. Biofilm formation on rock surfaces is a slow process and our results indicate that fungal and bacterial communities dominate the early surface attachment process, when pristine mineral surfaces are exposed to deep subsurface ecosystems. Various fungi showed statistically significant cross-kingdom correlation with both thiosulfate and sulfate reducing bacteria, e.g., SRB2 with fungi Debaryomyces hansenii.

A Novel Subxiphoid Approach for Bilateral Internal Thoracic Artery Harvesting

2021 ◽  
pp. 155698452098106
Author(s):  
Hossein Amirjamshidi ◽  
Jude S. Sauer ◽  
Bryan Barrus ◽  
Peter A. Knight ◽  
Sunil M. Prasad
Keyword(s):  
Minimally Invasive ◽  
Porcine Model ◽  
Internal Thoracic Artery ◽  
Experimental Testing ◽  
Bypass Graft ◽  
Arterial Revascularization ◽  
Early Results ◽  
Tissue Manipulation ◽  
Bilateral Internal Thoracic Artery

Objective Bilateral internal thoracic artery (BITA) bypass can enable more complete arterial revascularization procedures. Minimally invasive cardiac surgery (MICS) can offer significant patient benefits. New minimally invasive technology for sternal retraction and tissue manipulation is needed to enable ergonomic and reliable minimally invasive ITA harvesting. The goal of this research was to develop technology and techniques, along with experimental testing and training models, for a sternal-sparing approach to in situ BITA harvesting through a small subxiphoid access site. Methods This study focused on optimizing custom equipment and methods for subxiphoid BITA harvesting initially in a porcine model (19 pig carcasses, 36 ITAs) and subsequently in 7 cadavers (14 ITAs). Results Fifty consecutive ITAs were successfully harvested using this remote access approach. The last 20 ITA specimens harvested from the porcine model were explanted and measured; the average length of the free ITA grafts was 12.8 ± 0.9 cm (range 10.8 to 14.2 cm) with a mean time of 23.3 ± 5.2 minutes (range 13 to 25 minutes) for each harvest. Conclusions Early results demonstrate that both ITAs can be reliably harvested in a skeletonized fashion in situ through sternal-sparing, small subxiphoid access in 2 experimental models. This innovative approach warrants further exploration toward facilitating complete arterial revascularization and the further adoption of minimally invasive coronary artery bypass graft surgery.

scholarly journals The Digestive Health among Participants of the Woodstock Rock Festival in Poland—A Cross-Sectional Survey

2018 ◽  
Vol 15 (10) ◽  
pp. 2256 ◽  
Author(s):  
Karolina Skonieczna-Żydecka ◽  
Ewa Stachowska ◽  
Dominika Maciejewska ◽  
Karina Ryterska ◽  
Joanna Palma ◽  
...  
Keyword(s):  
Digestive Tract ◽  
Electronic Device ◽  
Functional Gastrointestinal Disorders ◽  
Gastrointestinal Symptoms ◽  
Intestinal Barrier ◽  
Study Participant ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Paper Version ◽  
Gastrointestinal Complaints

Alterations of gut microbiota, intestinal barrier and the gut-brain axis may be involved in pathophysiology of functional gastrointestinal disorders. Our aim was to assess the prevalence of digestive tract symptoms and identify common variables potentially disrupting the gut-brain axis among participants of the Woodstock Festival Poland, 2017. In total 428 people filled in a questionnaire assessing health of their digestive tract. The investigator collected answers on an electronic device, while the study participant responded using a paper version of the same questionnaire. Liver and gallbladder related symptoms were the most prevalent among our study group (n = 266, 62%), however symptoms related to altered intestinal permeability were found to be the most intensive complaints. In females the intensity of gastrointestinal complaints was higher compared to men (p < 0.05), as well as the incidence of factors with the potential to alter gut-brain axis (p < 0.0001). Chronic psychological distress, intake of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, were the most common associations with gastrointestinal symptoms, which were the most prevalent in females. Further attention should be focused on stress as one of the main factors negatively influencing public health.

Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence

2008 ◽  
Vol 108 (3) ◽  
pp. 525-532 ◽  
Author(s):  
Marco Losa ◽  
Pietro Mortini ◽  
Raffaella Barzaghi ◽  
Paolo Ribotto ◽  
Maria Rosa Terreni ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Postoperative Radiotherapy ◽  
Residual Tumor ◽  
Benign Tumors ◽  
Surgical Removal ◽  
Tumor Diameter ◽  
Tumor Removal ◽  
Early Results ◽  
Results Of Surgery

Object Nonfunctioning pituitary adenomas (NFPAs) are benign tumors of the pituitary gland that typically cause visual and/or hormonal dysfunction. Surgery is the treatment of choice, but patients remain at risk for tumor recurrence for several years afterwards. The authors evaluate the early results of surgery and the long-term risk of tumor recurrence in patients with NFPAs. Methods Between 1990 and 2005, 491 previously untreated patients with NFPA underwent surgery at the Università Vita-Salute. Determinations of recurrence or growth of the residual tumor tissue during the follow-up period were based on neuroradiological criteria. Results Residual tumor after surgery was detected in 173 patients (36.4%). Multivariate analysis showed that invasion of the cavernous sinus, maximum tumor diameter, and absence of tumor apoplexy were associated with an unfavorable surgical outcome. At least 2 sets of follow-up neuroimaging studies were obtained in 436 patients (median follow-up 53 months). Tumors recurred in 83 patients (19.0%). When tumor removal appeared complete, younger age at surgery was associated with a risk of tumor recurrence. In patients with incomplete tumor removal, adjunctive postoperative radiotherapy had a marked protective effect against growth of residual tumor. Conclusions Complete surgical removal of NFPAs can be safely achieved in > 50% of cases. Visual symptoms and, less frequently, pituitary function may improve after surgery. However, tumor can recur in patients after apparently complete surgical removal. In patients with incomplete tumor removal, radiation therapy is the most effective adjuvant therapy for preventing residual tumor growth.

scholarly journals Stereotactic Vacuum-Assisted Breast Biopsy in Ductal Carcinoma in situ: Residual Microcalcifications and Intraoperative Findings

Breast Care ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. 386-391
Author(s):  
Benedict Krischer ◽  
Serafino Forte ◽  
Gad Singer ◽  
Rahel A. Kubik-Huch ◽  
Cornelia Leo
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Significant Proportion ◽  
Invasive Cancer ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
High Grade ◽  
Surgical Specimen

Purpose: The question of overtreatment of ductal carcinoma in situ (DCIS) was raised because a significant proportion of especially low-grade DCIS lesions never progress to invasive cancer. The rationale for the present study was to analyze the value of stereotactic vacuum-assisted biopsy (VAB) for complete removal of DCIS, focusing on the relationship between the absence of residual microcalcifications after stereotactic VAB and the histopathological diagnosis of the definitive surgical specimen. Patients and Methods: Data of 58 consecutive patients diagnosed with DCIS by stereotactic VAB in a single breast center between 2012 and 2017 were analyzed. Patient records from the hospital information system were retrieved, and mammogram reports and images as well as histopathology reports were evaluated. The extent of microcalcifications before and after biopsy as well as the occurrence of DCIS in biopsy and definitive surgical specimens were analyzed and correlated. Results: There was no correlation between the absence of residual microcalcifications in the post-biopsy mammogram and the absence of residual DCIS in the final surgical specimen (p = 0.085). Upstaging to invasive cancer was recorded in 4 cases (13%) but occurred only in the group that had high-grade DCIS on biopsy. Low-grade DCIS was never upgraded to high-grade DCIS in the definitive specimen. Conclusions: The radiological absence of microcalcifications after stereotactic biopsy does not rule out residual DCIS in the final surgical specimen. Since upstaging to invasive cancer is seen in a substantial proportion of high-grade DCIS, the surgical excision of high-grade DCIS should remain the treatment of choice.

scholarly journals Peptide-Based Formulation from Lactic Acid Bacteria Impairs the Pathogen Growth in Ananas Comosus (Pineapple)

Coatings ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 457 ◽  
Author(s):  
Gabriela N. Tenea ◽  
Daniela Olmedo ◽  
Clara Ortega
Keyword(s):  
Significant Proportion ◽  
High Capacity ◽  
Total Cell ◽  
Ananas Comosus ◽  
Street Vending ◽  
E Coli ◽  
Cell Counts ◽  
Total Cell Density

Worldwide, street vending commerce has grown exponentially, representing in some countries, including Ecuador, a significant proportion of food consumed by the urban population. Pineapple is one of the common fruits sold as ready-to-eat slices by ambulant vendors in the street or on public transport at risk of contamination by various microorganisms. Previously, we selected Lactobacillus plantarum UTNCys5-4 and Lactococcus lactis subsp. lactis Gt28 strains producing peptides with high capacity to inhibit pathogen growth in vitro. In this study, the effect of different edited formulations containing a mixture of Cys5-4/Gt28 peptides was evaluated in vitro and ex vitro against a pathogenic cocktail containing E. coli (2), Salmonella (2) and Shigella (1). The growth of bacterial cocktail co-inoculated with cell-free supernatant containing peptides (formulation T1) and precipitated peptides (formulation T6), in a ratio of Cys5-4/Gt28:1:1 (v/v), results in a decrease of total cell viability with 1.85 and 1.2 log CFU/mL orders of magnitude at 6 h of incubation. About the same decrease (1.9 log CFU/g) was observed when pineapple slices artificially inoculated with the pathogenic cocktail were coated with T1 formulation, indicating the capacity to diminish simultaneous pathogens in situ, thus demonstrating its great biological control and protection. However, the E. coli cell counts reduced by 2.08 log CFU/g while Salmonella and Shigella cell counts reduced by 1.43 and 1.91 log CFU/g, respectively, at 5 days of refrigeration. In the untreated pineapple slices, the total cell density was maintained during storage, suggesting the adaptation of the pathogens to the fruit matrix. The peptide-based formulation exerted a bacteriolytic mode of action inducing pathogenic cell death. The results indicate that coating pineapple slices with peptide-based formulation is a promising approach to protect them from further contamination by microbial spoilage as well as an alternative to increase the food safety.

Metastatic ovarian carcinoma one year after surgical removal of colon carcinoma during pregnancy: a case report

2006 ◽  
Vol 16 (Suppl 1) ◽  
pp. 330-333 ◽  
Author(s):  
A. Gurbuz ◽  
G. Kir ◽  
A. Karateke ◽  
B. Haliloglu ◽  
C. Kabaca
Keyword(s):  
Colorectal Carcinoma ◽  
Colon Carcinoma ◽  
Abdominal Mass ◽  
Rare Event ◽  
Gastrointestinal Symptoms ◽  
Fetal Distress ◽  
Surgical Removal ◽  
Ovarian Metastases ◽  
Appropriate Treatment ◽  
One Year

Colorectal carcinoma during pregnancy is a very rare event. We presented a woman with metachronous metastatic ovarian tumor existing 1 year after surgical removal of perforated sigmoid colon carcinoma encountered during cesarean section of woman of 36-week gestation for fetal distress. Pregnant women with suspicious abdominal mass should be evaluated for a possible colorectal carcinoma even in the absence of any other gastrointestinal symptoms associated with it and undergo rectal examination and sigmoidoscopy. In addition, as synchronous and metachronous ovarian metastases are common in these patients, ovaries must be evaluated carefully by bisection during operation for possible metastasis, and in women who do not have a desire for fertility, prophylactic oophorectomy seems an appropriate treatment modality for resecting synchronous metastasis and preventing future metastasis.

scholarly journals Phylogenetic Analysis and In Situ Identification of Bacteria Community Composition in an Acidic Sphagnum Peat Bog

2006 ◽  
Vol 72 (3) ◽  
pp. 2110-2117 ◽  
Author(s):  
Svetlana N. Dedysh ◽  
Timofei A. Pankratov ◽  
Svetlana E. Belova ◽  
Irina S. Kulichevskaya ◽  
Werner Liesack
Keyword(s):  
16S Rrna ◽  
16S Rrna Gene ◽  
Community Composition ◽  
Significant Proportion ◽  
Peat Bog ◽  
Rrna Gene ◽  
Bacterial Phyla ◽  
Cell Counts ◽  
Novel Strategy

ABSTRACT The Bacteria community composition in an acidic Sphagnum peat bog (pH 3.9 to 4.5) was characterized by a combination of 16S rRNA gene clone library analysis, rRNA-targeted fluorescence in situ hybridization (FISH), and cultivation. Among 84 environmental 16S rRNA gene clones, a set of only 16 cloned sequences was closely related (≥95% similarity) to taxonomically described organisms. Main groups of clones were affiliated with the Acidobacteria (24 clones), Alphaproteobacteria (20), Verrucomicrobia (13), Actinobacteria (8), Deltaproteobacteria (4), Chloroflexi (3), and Planctomycetes (3). The proportion of cells that hybridized with oligonucleotide probes specific for members of the domains Bacteria (EUB338-mix) and Archaea (ARCH915 and ARC344) accounted for only 12 to 22% of the total cell counts. Up to 24% of the EUB338-positive cells could be assigned by FISH to specific bacterial phyla. Alphaproteobacteria and Planctomycetes were the most numerous bacterial groups (up to 1.3 × 107 and 1.1 × 107 cells g−1 peat, respectively). In contrast to conventional plating techniques, a novel biofilm-mediated enrichment approach allowed us to isolate some representatives of predominant Bacteria groups, such as Acidobacteria and Planctomycetes. This novel strategy has great potential to enable the isolation of a significant proportion of the peat bog bacterial diversity.

Talactoferrin alfa may prolong progression-free survival in advanced renal carcinoma patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4600-4600 ◽  
Author(s):  
S. Srinivas ◽  
W. M. Stadler ◽  
R. Bukowski ◽  
R. Figlin ◽  
T. Hayes ◽  
...  
Keyword(s):  
Adverse Events ◽  
Tumor Response ◽  
Phase 1 ◽  
Tumor Biology ◽  
Gastrointestinal Symptoms ◽  
Progression Free Survival ◽  
Cancer Center ◽  
Intermediate Risk ◽  
Free Survival ◽  
Early Results

4600 Background: Talactoferrin alfa (formerly known as recombinant human lactoferrin, rhLF) is a novel immunomodulatory 80 kD protein with demonstrated oral anti-tumor properties in animal models, and promising early results in patients with advanced renal cell carcinoma (RCC) in Phase 1/2 trials. Methods: An open label Phase 2 study of Talactoferrin Oral Solution at 1.5 g talactoferrin alfa b.i.d. given up to a maximum of 4 cycles of 12 weeks on, 2 weeks off was conducted at 6 sites. Eligibility included predominantly clear cell histology, failure of at least one prior systemic therapy, tumor progression within the prior 9 months, a performance status of <2 (ECOG) and adequate organ function. The primary endpoints were the incidence of 14-week progression-free survival (PFS) and overall tumor response (by RECIST). The statistical plan specified an objective of 12.5% response rate or a progression-free survival rate of ≥40% at 14 weeks. Secondary endpoints included median PFS and median overall survival (OS). Results: Forty-four patients were enrolled. Eighteen patients (41%) were considered low risk and twenty-six (59%) considered intermediate risk based on the Memorial Sloan-Kettering Cancer Center (MSKCC) criteria. There were no talactoferrin-related Grade 3 or 4 adverse events or laboratory abnormalities. The most common related grade 1 or 2 adverse events were gastrointestinal symptoms. There was one unconfirmed tumor response and the 14-week PFS was 55%. The median PFS was 21 weeks (46 weeks and 9.4 weeks in the patients with low and intermediate risk prognostic factors, respectively). The median OS has not yet been reached. Conclusions: Talactoferrin alfa is well tolerated. The 14-week PFS met the pre-specified criteria for success (>40%). Due to the heterogeneity of tumor biology of RCC, any further evaluation of talactoferrin in this population should be in a larger randomized trial. [Table: see text]

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