Medical Library

Visual exposure using single-handed magnet-driven intra-abdominal wireless camera in minimal access surgery : Is better than 30 degrees endoscope.

BACKGROUND: The operative field of view in minimal access surgery is constrained by the location of the optical port, the direction of view of the endoscope, and the limited degrees of freedom of movement of rigid endoscopes through the access port. The aim of this study was to examine the feasibility of employing a special magnetic setup with a single external handle to fixate, drive, and orientate intra-abdominal wireless camera, and compare its visual exposure with that of a 30 degrees endoscope. METHODS: A wireless magnet-driven camera setup was developed comprising a mini wireless camera with integrated white light-emitting diodes, a specially constructed base unit for orientation control and smooth sliding motion, and an external magnetic handle to fixate and drive the camera from the outer surface of the abdominal wall. In a laboratory-based experiment, ten subjects with no laparoscopic surgical experience were asked to identify 160 randomly distributed labels in a trainer box using both a 30 degrees endoscope and the wireless camera magnetic setup in a random order. Data were analyzed using Student\’s t-test. RESULTS: The mean (standard deviation) of the number of identified labels was higher using the wireless camera magnetic setup 74.8 (16.96) compared with 30 degrees endoscope 54.7 (12.18); p < 0.001. However, the mean execution time was longer with the camera magnetic system 34.9 (4.4) min compared with the 30 degrees endoscope 24.1 (2.8) min; p < 0.001. CONCLUSION: The use of the magnetic wireless camera setup with a single external handle is feasible and has demonstrated a wider visual exposure than the 30 degrees endoscope.

Fakhry M, Gallagher B, Bello F, Hanna GB.

Department of Biosurgery and Surgical Technology, Imperial College London, St Mary’s Hospital, Praed Street, London, W2 1NY, UK.

Selection of the Internal Control Gene for Real-Time Quantitative RT-PCR Assays in Temperature Treated Leptospira.

Analysis of gene expression requires sensitive, precise, and reproducible measurements for specific mRNA sequences. To avoid bias, real-time RT-PCR is referred to one or several internal control genes. Here, we sought to identify a gene to be used as normalizer by analyzing three functional distinct housekeeping genes (lipL41, flaB, and 16S rRNA) for their expression level and stability in temperature treated Leptospira cultures. Leptospira interrogans serovar Hardjo subtype Hardjoprajitno was cultured at 30 degrees C for 7 days until a density of 10(6) cells/ml was reached and then shifted to physiological temperatures (37 degrees C and 42 degrees C) and to environmental temperatures (25 degrees C and 30 degrees C) during a 24 h period. cDNA was amplified by quantitative PCR using SYBR Green I technology and gene-specific primers for lipL41, flaB, and 16S rRNA. Expression stability (M) was assessed by geNorm and Normfinder v.18. 16S rRNA registered an average expression stability of M = 1.1816, followed by flaB (M = 1.682) and lipL41 (M = 1.763). 16S rRNA was identified as the most stable gene and can be used as a normalizer, as it showed greater expression stability than lipL41 and flaB in the four temperature treatments. Hence, comparisons of gene expression will have a higher sensitivity and specificity.

Carrillo-Casas EM, Hernández-Castro R, Suárez-Güemes F, de la Peña-Moctezuma A.

Departamento de Microbiología e Inmunología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Coyoacán, 04510, México.

An Easier Method for Locating Replication Origins Based on Real-Time Polymerase Chain Reaction.

Locating replication origins (ROs) is an old problem to which diverse answers have been previously given. However, a better and more convenient method still remains desirable because previously reported methods are time-consuming. In this study, we report an easier method for locating ROs based on real-time polymerase chain reaction. The feasibility of this method was demonstrated using Escherichia coli K-12 and Halobacterium salinarium NRC-1 as models. Our results show that this method is easy, fast, and accurate in locating ROs.

Mei Y, Chen D, Sun D, Yang Y, Huang Y, Shen P, Chen X.

State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, 430072, China.

Arterio-Ureteric Fistula Following Iliac Angioplasty.

Arterio-ureteric fistulae are rare but can be associated with significant morbidity and mortality. We describe a novel case in which an arterio-ureteric fistula occurred as a complication following external iliac artery angioplasty and stenting, in a patient who had undergone previous pelvic surgery, radiotherapy, ureteric stenting, and urinary diversion surgery. Prompt recognition enabled successful endovascular management using a covered stent.

Aarvold A, Wales L, Papadakos N, Munneke G, Loftus I, Thompson M.

St. George’s Vascular Institute, 4th Floor, St. James Wing, Blackshaw Road, Tooting, London, SW17 0QT, UK.

Prognostic Factors and Availability of D2 Lymph Node Dissection for the Patients with Stage II Gastric Cancer: Comparative Analysis of Subgroups in Stage II.

BACKGROUND: According to the fifth edition of the UICC TNM classification, stage II gastric cancer has three subgroups: T1N2M0, T2N1M0, and T3N0M0. This study was designed to investigate the prognosis of stage II gastric cancer according to the T and N category to verify the accuracy of TNM staging for stage II and to determine the prognostic factors for patients with stage II gastric cancer by subgroup. METHODS: Clinicopathologic data from 326 patients with stage II gastric cancer were studied. We stratified the patients into T2N1 and T3N0 groups and performed comparative analysis between the two groups as well as univariate and multivariate survival analyses for each group. RESULTS: The five-year survival rate for patients with T2N1 disease was 75.6%, whereas for patients with T3N0 disease it was 68.3%. There was no significant difference in survival between T2N1 and T3N0 groups (p = 0.174). Univariate survival analysis showed that age, gender, histological type, and the extent of lymph node dissection were significant prognostic factors for stage II gastric cancer. However, multivariate analysis demonstrated that only gender and the extent of lymph node dissection were significant variables. Among these variables, gender was an independent prognostic factor for survival only in the T2N1 group. On the other hand, the extent of lymph node dissection was an independent prognostic factor in the T3N0 group, not in the T2N1 group. CONCLUSIONS: There was no significant difference in survival between the T2N1 and the T3N0 groups. Thus, our data support the accuracy of the TNM staging classification for stage II gastric cancer. We found a significant survival benefit with D2 dissection for T3N0 but not T2N1. However, before recommending limited lymph node dissection for T2N1 stage disease, development of a preoperative method for prediction of depth of invasion and lymph node status is needed.

Park JM, Kim JH, Park SS, Kim SJ, Mok YJ, Kim CS.

Department of Surgery, Korea University College of Medicine Anam Hospital, 126-1 Anam-dong 5ga, Sungbuk-gu, Seoul, Korea.

Late Presentation of Intestinal Malrotation: An Argument for Elective Repair.

BACKGROUND: Midgut malrotation most commonly presents in young children. This diagnosis is not often entertained in the adolescent or adult with abdominal complaints. We reviewed our experience with this subset of malrotation patients. METHODS: A retrospective review of medical records from adolescent or adult patients identified with a diagnosis of anomaly of intestinal fixation or malrotation, who were treated within our health system between 1993 and 2004. RESULTS: A total of 33 patients were diagnosed with malrotation and treated with Ladd\’s procedure. Acute abdominal pain was present in 50%, and chronic complaints were present in the other patients. Initial work-up included computed tomography (CT) scan (28%), upper gastrointestinal (UGI) study (38%), and plain films (47%) Postoperative complications occurred more frequently in patients that were operated on emergently (60%) than in those that underwent elective surgery (22%; p = 0.04). CONCLUSIONS: This large case series of intestinal malrotation in the nonpediatric age group suggests that Ladd\’s procedure can be performed very safely. Moreover, the results suggest that patients with known malrotation should have Ladd\’s procedure performed electively rather than urgently.

Moldrem AW, Papaconstantinou H, Broker H, Megison S, Jeyarajah DR.

Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.

Value of Multidetector-row Computed Tomography in Diagnosis of Portal Vein Invasion by Perihilar Cholangiocarcinoma.

BACKGROUND: Although knowledge of cancer invasion of the portal bifurcation is vitally important in planning an operation for perihilar cholangiocarcinoma, the diagnostic capability of multidetector-row computed tomography (MDCT) for this purpose has not been assessed. We evaluated how well MDCT could identify cancer invasion of the portal bifurcation by perihilar cholangiocarcinoma. METHODS: Between April 2003 and June 2005, perihilar cholangiocarcinoma was resected in 87 patients, 83 of whom underwent MDCT within 1 month before the surgery. Three-dimensional volume-rendered (3DVR) and multiplanar reformation (MPR) images were examined for evidence of portal vein invasion. Agreement with intraoperative and pathologic findings was assessed. Portal bifurcation findings by 3DVR and MPR were classified into no portal vein stenosis, unilateral stenosis, or more extensive stenosis, and also into tumor contact with the bifurcation in no, one of two, or two projections. RESULTS: For macroscopic portal vein invasion, sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were 81.5, 91.1, 81.5, 91.1, and 88.0% in 3D portography and 96.3, 92.6, 86.7, 98.1, and 94.0% in MPR, respectively. Findings by both 3DVR and MPR were significantly correlated with depth of cancer invasion (p < 0.001). CONCLUSION: MDCT is useful in assessing cancer invasion of the portal vein bifurcation by perihilar cholangiocarcinoma.

Sugiura T, Nishio H, Nagino M, Senda Y, Ebata T, Yokoyama Y, Igami T, Oda K, Nimura Y.

Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.

Future of Plastic Surgery.

Pshenisnov KP.

Division of Plastic Surgery, Yaroslavl Medical Academy, 5 Revolutsionnaya St., Yaroslavl, 150000, Russia, kpshenisnov@plasticsurgeon.ru.

Genetic and Functional Diversity among Fluorescent Pseudomonads Isolated from the Rhizosphere of Banana.

Fluorescent pseudomonads from banana rhizospheric soil were isolated and screened for the production of enzymes and hormones such as phosphatase, indole-3-acetic acid (IAA), 1-aminocyclopropane-1-carboxylate (ACC) deaminase, protease, and antifungal metabolites. Of 95 isolates, 50 (52%) isolates solubilized tri-calcium phosphate (TCP), 63 (66%) isolates produced plant growth hormone IAA, 10 (11%) isolates exhibited ACC deaminase, and 23 (24%) isolates produced protease. Isolates were screened for antifungal activity toward phytopathogenic fungi. Gene-specific primers have identified the putative antibiotic producing isolates. These putative isolates were grown in the production media and production of antibiotics was confirmed by thin-layer chromatography (TLC) and high-performance liquid chromatography (HPLC). Genotypic analysis by BOX (bacterial repetitive BOX element)-polymerase chain reaction (PCR) resulted into three distinct genomic clusters at a 50% similarity level and 62 distinct BOX profiles. Based on the sequence similarity of 16S rRNA and construction of subsequent phylogenetic tree analysis, isolates were designated as Pseudomonas monteilii, P. plecoglossicida, P. fluorescens, P. fulva, P. mosselii, P. aeruginosa, P. alcaligenes, and P. pseudoalcaligenes. Present study revealed the genetic and functional diversity among isolates of fluorescent pseudomonads associated with rhizospheric soil of banana and also identified P. monteilii as dominant species. The knowledge on genetic and functional diversity of fluorescent pseudomonads associated with banana rhizosphere is useful to understand their ecological role and for their utilization in sustainable agriculture.

Naik PR, Sahoo N, Goswami D, Ayyadurai N, Sakthivel N.

Department of Biotechnology, Pondicherry University, Kalapet, Puducherry, 605014, India.

Elevated Lytic Phage Production as a Consequence of Particle Colonization by a Marine Flavobacterium (Cellulophaga sp.).

Bacteria growing on marine particles generally have higher densities and cell-specific activities than free-living bacteria. Since rapidity of phage adsorption is dependent on host density, while infection productivity is a function of host physiological status, we hypothesized that marine particles are sites of elevated phage production. In the present study, organic-matter-rich agarose beads and a marine phage-host pair (Cellulophaga sp., PhiS(M)) were used as a model system to examine whether bacterial colonization of particles increases phage production. While no production of phages was observed in plain seawater, the presence of beads enhanced attachment and growth of bacteria, as well as phage production. This was observed because of extensive lysis of bacteria in the presence of beads and a subsequent increase in phage abundance both on beads and in the surrounding water. After 12 h, extensive phage lysis reduced the density of attached bacteria; however, after 32 h, bacterial abundance increased again. Reexposure to phages and analyses of bacterial isolates suggested that this regrowth on particles was by phage-resistant clones. The present demonstration of elevated lytic phage production associated with model particles illustrates not only that a marine phage has the ability to successfully infect and lyse surface-attached bacteria but also that acquisition of resistance may affect temporal phage-host dynamics on particles. These findings from a model system may have relevance to the distribution of phage production in environments rich in particulate matter (e.g., in coastal areas or during phytoplankton blooms) where a significant part of phage production may be directly linked to these nutrient-rich \”hot spots.\”

Riemann L, Grossart HP.

Department of Natural Sciences, University of Kalmar, 39182, Kalmar, Sweden, Lasse.Riemann@hik.se.