Effects of intraoperative pyloric stretch procedure on outcomes after esophagectomy.

Various methods have been described to aid pyloric drainage in patients undergoing esophagectomy with gastric reconstruction. These techniques are intended to prevent delayed gastric empting following esophagectomy that can be associated with early morbidity and long-term functional complaints. The current study aims to review the safety and efficacy of a pyloric stretch procedure performed at the time of esophagectomy. To achieve this, a retrospective review of 100 consecutive patients undergoing esophagectomy during the period 2011-2016 was performed. Until May 2013, no patients received intraoperative pyloric intervention. After May 2013, all patients (N = 50) underwent intraoperative pyloric stretch procedure that involved bidirectional mechanical dilatation of the pylorus. Postoperative outcomes including result of routine oral contrast swallow and early morbidity were evaluated. Intraoperative pyloric stretching was performed safely and without local complications in all patients. Delayed gastric emptying was observed significantly less frequently in patients who received intraoperative pyloric stretching (48% vs. 22%, P = 0.006). No significant differences were observed in postoperative outcomes. When considering all patients as a single cohort, the presence of delayed gastric emptying was associated with significantly higher rates of postoperative pneumonia (71% vs. 45%, P = 0.010), cardiac complications (57% vs. 25%, P = 0.001) as well as longer hospital say (12 vs. 15 days, P < 0.001) and delay to free oral fluid intake (7 vs. 9 days, < 0.001). Binary logistic regression identified age and postoperative delayed gastric emptying as independent risk factors for postoperative pneumonia. In conclusion, this study has demonstrated the safety and efficacy an intraoperative pyloric stretch procedure for the prevention of delayed gastric emptying following esophagectomy.

Effect of perioperative blood transfusion on the long-term survival of patients undergoing esophagectomy for esophageal cancer: a systematic review and meta-analysis.

Perioperative blood transfusion has been linked to poorer long-term survival in patients undergoing esophagectomy, presumably due to its potential immunomodulatory effects. This review aims to summarize existing evidence relating to the influence of blood transfusion on long-term survival following esophagectomy for esophageal cancer. A systematic literature search (up to February 2017) was conducted for studies reporting the effects of perioperative blood transfusion on survival following esophagectomy for esophageal cancer. Meta-analysis was used to summate survival outcomes. Twenty observational studies met the criteria for inclusion. Eighteen of these studies compared the outcomes of patients who received allogenic blood transfusion to patients who did not receive this intervention. Meta-analysis of outcomes revealed that allogenic blood transfusion significantly reduced long-term survival (HR = 1.49; 95% CI 1.26 to 1.76; P < 0.001). There appeared to be a dose-related response with patients who received ≥3 units of blood having lower long-term survival compared to patient who received between 0 and 2 units (HR = 1.59; 95% CI 1.31 to 1.93; P < 0.001). Two studies comparing patients who received allogenic versus autologous blood transfusion showed superior survival in the latter group. Factors associated with the requirement for perioperative blood transfusion included: intraoperative blood loss; preoperative hemoglobin; operative approach; operative time, and; presences of advanced disease. These findings indicate that perioperative blood transfusion is associated with significantly worse long-term survival in patients undergoing esophagectomy for esophageal cancer. Autologous donation of blood, meticulous intraoperative hemostasis, and avoidance of unnecessary transfusions may prevent additional deaths attributed to this intervention.

The effects of host size and temperature on the emergence of Echinoparyphium recurvatum cercariae from Lymnaea peregra under natural light conditions.

The production of cercariae from their snail host is a fundamental component of transmission success in trematodes. The emergence of Echinoparyphium recurvatum (Trematoda: Echinostomatidae) cercariae from Lymnaea peregra was studied under natural sunlight conditions, using naturally infected snails of different sizes (10-17 mm) within a temperature range of 10-29 degrees C. There was a single photoperiodic circadian cycle of emergence with one peak, which correlated with the maximum diffuse sunlight irradiation. At 21 degrees C the daily number of emerging cercariae increased with increasing host snail size, but variations in cercarial emergence did occur between both individual snails and different days. There was only limited evidence of cyclic emergence patterns over a 3-week period, probably due to extensive snail mortality, particularly those in the larger size classes. Very few cercariae emerged in all snail size classes at the lowest temperature studied (10 degrees C), but at increasingly higher temperatures elevated numbers of cercariae emerged, reaching an optimum between 17 and 25 degrees C. Above this range emergence was reduced. At all temperatures more cercariae emerged from larger snails. Analysis of emergence using the Q10 value, a measure of physiological processes over temperature ranges, showed that between 10 and 21 degrees C (approximately 15 degrees C) Q10 values exceeded 100 for all snail size classes, indicating a substantially greater emergence than would be expected for normal physiological rates. From 14 to 25 degrees C (approximately 20 degrees C) cercarial emergence in most snail size classes showed little change in Q10, although in the smallest size class emergence was still substantially greater than the typical Q10 increase expected over this temperature range. At the highest range of 21-29 degrees C (approximately 25 degrees C), Q10 was much reduced. The importance of these results for cercarial emergence under global climate change is discussed.

The effects of temperature on the distribution and establishment of Echinoparyphium recurvatum metacercariae in Lymnaea peregra.

The establishment and distribution of Echinoparyphium recurvatum metacercariae in the second intermediate host, Lymnaea peregra, were investigated at a temperature range of 5-29 degrees C. Preliminary studies on the survival and infectivity of E. recurvatum cercariae showed that both parameters were temperature dependent. No cercarial transmission occurred at 5 or 10 degrees C. Nevertheless, the transmission efficiency (1/H0) indicated that transmission was temperature independent in the temperature range 17-25 degrees C and was much lower than in previous studies using this host-parasite system. These differences were attributed to low cercarial densities used in this study. The effect of temperature on encystment site choice (mantle cavity, kidney, pericardium) by metacercariae showed that the mantle cavity was the prime site of encystment, followed by the pericardium and the kidney. Temperatures at the lower and upper ranges (14 and 29 degrees C), however, caused a significant reduction in encystment in the mantle cavity but not in the pericardium or kidney. The importance of cercarial densities, the physiological mechanisms influencing metacercarial distribution and their implications for parasite transmission to the definitive host are discussed.

The role of Bithynia tentaculata in the transmission of larval digeneans from a gravel pit in the Lower Thames Valley.

The freshwater snail, Bithynia tentaculata (Gastropoda: Prosobranchia), is frequently found in gravel pits and its role in the transmission of larval digeneans was assessed in one of these unstable water bodies from the Lower Thames Valley (UK) from June 1982 to December 1984. Eight species of cercarial and five species of metacercarial infections were reported from B. tentaculata, with up to 7.7% and 4.7% prevalence of infections, respectively, occurring in the snail, making it the most important host at this site. Seasonal peaks in cercarial infections occurred in late autumn/early winter but little seasonality was apparent in the occurrence of metacercarial infections. The life history characteristics of both hosts and parasites, which can affect intramolluscan digenean dynamics, are discussed.

Metacercarial utilization of a naturally infected single species (Lymnaea peregra) snail community by Echinoparyphium recurvatum.

Utilization of a single-species molluscan community of Lymnaea peregra by metacercariae of Echinoparyphium recurvatum over a summer (July-September) period in south-east England showed an increase in the mean number of cysts per host with host size and time of exposure. Aggregation resulting from host and habitat-related factors increased with host size and time of exposure. Encystment within the host was restricted to the peripheral organs in smaller juvenile snails but as snails increased in size, metacercariae were distributed throughout the tissues.

Sites of encystment by the metacercariae of Echinoparyphium recurvatum in Lymnaea peregra.

Experimental infection of Echinoparyphium recurvatum von Linstow (Digenea: Echinostomatidae) cercariae in the snail second intermediate host Lymnaea peregra Müller shows that metacercarial encystment takes place on the lining of the mantle cavity, pericardial cavity and kidney lumen, with the mantle cavity the most preferred site. All three sites are accessible via the body openings. The metacercariae appear to be more susceptible to encapsulation in the visceral mass than in the cavity of the mantle, pericardium and the lumen of the kidney.

Glycated haemoglobin and other biochemical parameters in Sudanese diabetics.

Fasting levels of glycated haemoglobin, cholesterol and triglycerides were studied in 44 patients with non-insulin-dependent diabetes mellitus (NIDDM), 31 patients with insulin-dependent diabetes mellitus (IDDM) and 28 healthy Sudanese individuals. Results confirmed previous observations showing correlation of glycated haemoglobin with fasting blood glucose in NIDDM (r = 0.634; P less than 0.001), and with cholesterol in IDDM (r = 0.355; P less than 0.05). No correlation of glycated haemoglobin with triglycerides was observed in either group of diabetics. A negative correlation was demonstrated between glycated haemoglobin and the duration of diabetes (r = -0.552; P less than 0.01) in IDDM. It seemed that control improved in these patients as their diabetes progressed, probably through self-education.