Effect of an elevated monounsaturated fat diet on pork carcass and meat quality traits and tissue fatty acid composition from York-crossed barrows and gilts.

Fifty-seven York-crossed barrows and gilts were fed either a grain and soy diet (CONTROL with 28% C18:1) or a similar diet enriched with oleic acid (HO with 43% C18:1, Greedy-Grass OLIVA®). There were no interactions between dietary treatment and gender and there were no differences in intramuscular and subcutaneous fatty acid composition between sexes (P>0.05). Similar primal cut yields, composition of major primal cuts, and carcass and meat quality characteristics were found for HO and CONTROL fed pigs. Apart from a few significant but small differences for some fatty acids, intramuscular fatty acid composition was similar for both dietary treatments. Subcutaneous fat from HO fed pigs had a 6.9% increase in total monounsaturated fatty acids and a 9.3% reduction in total polyunsaturated fatty acids (P<0.05) compared with CONTROL fed animals, without adversely affecting carcass quality and producing suitable hams for processing by the meat industry.

Carcass and meat quality characteristics and fatty acid composition of tissues from Pietrain-crossed barrows and gilts fed an elevated monounsaturated fat diet.

Fifty-one (Landrace *Large White) *Pietrain barrows and gilts were used to compare the effect of a diet rich in oleic acid (HO) by feeding a by-product of the olive industry (Greedy-Grass OLIVA(R): 1.4% growing, 3.8% finishing) or a grain and soy diet (CONTROL) on carcass characteristics, meat quality and fatty acid profile of intramuscular and subcutaneous fat. Gilts had leaner (P<0.05) carcasses with lower fat percentage in major primal cuts, and less (P<0.05) saturated fat compared with barrows with no interaction (P>0.05) between dietary treatment and gender. Source of dietary fat had no effect (P>0.05) on primal cut yields, composition of major primal cuts, or carcass and meat quality characteristics. Intramuscular fat from HO fed pigs had higher (P<0.05) percentage of saturated (SFA) and monounsaturated (MUFA) fatty acids, and lower (P<0.05) polyunsaturated fatty acids (PUFA) and n-6:n-3 ratio compared with CONTROL animals (37.4% vs. 36.8%, 44.7% vs. 40.1%, 17.9% vs. 23.2%, and 18.9 vs. 21.8 ratio, respectively). Subcutaneous fat from pigs fed HO had greater (P<0.05) MUFA percentage, lower (P<0.05) SFA and PUFA percentage, and lower (P<0.05) n-6:n-3 ratio than pigs fed CONTROL diet (51.4% vs. 48.0%, 30.5% vs. 32.9%, 18.1% vs. 20.1%, and 9.83 vs. 11.3 ratio, respectively). Intramuscular fat had higher proportion of SFA and lower of MUFA showing a higher degree of tissue saturation compared with subcutaneous fat. Feeding Greedy-Grass increased MUFA and decreased PUFA proportions in fat depots reducing the risk of production of carcasses that are soft and oily which result in lower technological and processing quality.

[Preoperative evaluation of renal carcinoma using multi-detector CT]. / Bilan préopératoire des cancers du rein en scanner volumique.

When laparoscopic nephrectomy is performed, the limited visibility of many anatomical structures requires additional pre-operative information. However, most of this information can be highlighted by Multislice-CT which depicts all the vascular structures while providing an essential road mapping for the surgeon. Besides underlining arterial abnormalities, this technique allows to depict venous pathways and tumoral invasion. This review illustrates the various potential applications of Multislice-CT in the evaluation of renal tumors.

Massive hematuria due to right renal artery mycotic pseudoaneurysm in a patient with subacute bacterial endocarditis.

A 40-year-old woman with recently diagnosed bacterial endocarditis was admitted to the hospital with gross hematuria and anemia. Computed tomography revealed a large right upper pole renal artery pseudoaneurysm, a wedge-shaped hypoperfused region of the left kidney, and a splenic abscess. Radiographic embolization of the right renal artery was performed to stabilize the bleeding. The splenic abscess was drained. Subsequent right nephrectomy and splenectomy were performed for persistent leukocytosis. This unusual presentation of a septic embolus and its management are discussed.

Relationship between duration of pain and secondary signs of obstruction of the urinary tract on unenhanced helical CT.

OBJECTIVE: The objective of this study was to investigate the relationship between duration of flank pain and the frequency of secondary signs of ureteral obstruction on unenhanced helical CT. SUBJECTS AND METHODS: The duration of flank pain was prospectively determined in 227 consecutive patients diagnosed with acute ureterolithiasis on unenhanced helical CT. These CT studies were evaluated for the presence or absence of perinephric stranding, ureteral dilatation, perinephric fluid, collecting system dilatation, periureteral stranding, and nephromegaly. The frequency of each sign was determined as a function of the duration of pain. RESULTS: The frequency of moderate or severe perinephric stranding increased from 5% at 1--2 hr to 51% at 7--8 hr (p < 0.001); ureteral dilatation increased from 84% at 1--2 hr to 97% at more than 8 hr (p < 0.03); moderate or severe perinephric fluid increased from 0% at 1--2 hr to 22% at 3--4 hr (p < 0.03); collecting system dilatation increased from 68% at 1--2 hr to 89% at 7-8 hr (p < 0.03); periureteral stranding increased from 35% at 1--2 hr to 76% at 7--8 hr (p < 0.004); and nephromegaly increased from 40% at 1--2 hr to 54% at 7--8 hr (p < 0.36). CONCLUSION: All CT secondary signs of ureteral obstruction except nephromegaly showed a significant increase in frequency as duration of flank pain increased. This observation may explain why the CT studies of some patients with acute ureterolithiasis show negative findings for some or all CT secondary signs of obstruction. Therefore, knowledge of the duration of pain is important when interpreting unenhanced CT studies in patients with acute ureterolithiasis.

Preoperative use of 3D volume rendering to demonstrate renal tumors and renal anatomy.

With increased use of computed tomography (CT) and abdominal ultrasonography, the indications for nephron-sparing surgery are also increasing. Triphasic helical CT and three-dimensional (3D) volume rendering can be combined into a single noninvasive test to delineate renal tumors and normal and complex renal anatomy prior to nephron-sparing surgery. This combination technique has proved accurate and very useful for both preoperative and intraoperative planning by demonstrating renal position, tumor location and depth of tumor extension into the kidney, relationship of the tumor to the collecting system, and renal vascular anatomy. Knowledge of the position of the kidney relative to the lower rib cage, iliac crest, and spine helps in planning the initial surgical incision. By depicting tumor location and depth of extension, helical CT with 3D volume rendering helps ensure complete tumor excision and conservation of adjacent normal renal parenchyma. Depiction of the relationship of the tumor to the collecting system helps anticipate further tumor extension and minimize postoperative complications. Identification of normal renal vasculature and anatomic variants can help minimize ischemic injury and intraoperative bleeding. Radiologists should be familiar with current indications for nephron-sparing surgery and understand what information is required prior to surgery.

Triphasic helical CT of the kidneys: contribution of vascular phase scanning in patients before urologic surgery.

OBJECTIVE: The purpose of this study was to evaluate the potential benefits of performing vascular phase scanning of the kidneys in addition to unenhanced and parenchymal phase contrast-enhanced CT in patients being examined for urologic surgery. MATERIALS AND METHODS: Parenchymal and vascular phase images from triphasic renal helical CT of 50 patients were sequentially evaluated in a randomized, retrospective fashion by two independent observers. The number of renal arteries and veins and the presence of vein or collecting system anomalies were recorded for each scan phase along with a subjective 10-point-scale score of the visibility of the vasculature and collecting system. Correlation of these findings was made with surgical or angiographic findings in 67 of the 87 kidneys and was made by consensus review in the remaining 20 kidneys. RESULTS: Accessory renal arteries were seen significantly more often (p < .05, chi-square test) on the vascular phase scans. The subjective scores for the visibility of the renal arteries and renal veins were significantly higher on the vascular phase scans (p < .0001, Wilcoxon's rank sum test). The subjective scores for the visibility of the filling of the collecting system and renal pelvis were significantly higher for the parenchymal phase scans, despite the use of a small contrast bolus before each scan (p < .0001, Wilcoxon's rank sum test). CONCLUSION; Triphasic renal CT better reveals the artery and vein anatomy of the kidney than does parenchymal phase imaging only. Triphasic helical CT is indicated in patients undergoing planning for urologic surgery when vascular anatomy is clinically important.

3-dimensional volume rendered computerized tomography for preoperative evaluation and intraoperative treatment of patients undergoing nephron sparing surgery.

PURPOSE: Computerized tomography (CT) is the diagnostic and staging modality of choice for renal neoplasms. Existing imaging modalities are limited by a 2-dimensional (D) format. Recent advances in computer technology now allow the production of high quality 3-D images from helical CT. Nephron sparing surgery requires a detailed understanding of renal anatomy. Preoperative evaluation must delineate the relationship of the tumor to adjacent normal structures and demonstrate the vascular supply to the tumor for the surgeon to conserve as much normal parenchyma as possible. We propose that helical CT combined with 3-D volume rendering provides all of the information required for preoperative evaluation and intraoperative management of nephron sparing surgery cases. We prospectively evaluated the role of 3-D volume rendering CT in 60 patients undergoing nephron sparing surgery for renal cell carcinoma at the Cleveland Clinic Foundation. MATERIALS AND METHODS: Triphasic spiral CT was performed preoperatively in 60 consecutive patients undergoing nephron sparing surgery for renal neoplasms. A 3 to 5-minute videotape was prepared using volume rendering software which demonstrated the position of the kidney, location and depth of extension of the tumor(s), renal artery(ies) and vein(s), and relationship of the tumor to the collecting system. These videotapes were viewed by a radiologist and urologist in the operating room at surgery, and immediately correlated with surgical findings. Corresponding renal arteriograms of 19 patients were retrospectively compared to 3-D volume rendering CT and operative findings. RESULTS: A total of 97 renal masses were identified in 60 cases evaluated with 3-D volume rendering CT before nephron sparing surgery. There were no complications related to the 3-D protocol and 3-D rendering was successful in all patients. The number and location of lesions identified by 3-D volume rendering CT were accurate in all cases, while enhancement and diagnostic characteristics were consistent with pathological findings in 95 of 97 tumors (98%). Of 77 renal arteries identified at surgery 74 were detected by 3-D volume rendering CT (96%). Helical CT missed 3 small accessory arteries, including 1 in a cross fused ectopic kidney. All major venous branches and anomalies were identified, including 3 circumaortic left renal veins. Of 69 renal veins identified at surgery 64 were detected by 3-D volume rendering CT (93%). All 5 renal veins missed by CT were small, short, duplicated right branches of the main renal vein. Renal fusion and malrotation anomalies were correctly identified in all 4 patients. CONCLUSIONS: The 3-D volume rendering CT accurately depicts the renal parenchymal and vascular anatomy in a format familiar to most surgeons. The data integrate essential information from angiography, venography, excretory urography and conventional 2-D CT into a single imaging modality, and can obviate the need for more invasive imaging. Additionally, the use of videotape in an intraoperative setting provides concise, accurate and immediate 3-D information to the surgeon, and it has become the preferred means of data display for these procedures at our center.

Imaging appearances of Sister Mary Joseph nodule.

Sister Mary Joseph nodules are metastatic deposits in the periumbilical area. The purpose of this review is to demonstrate umbilical anatomy, discuss modes of metastatic spread, the various imaging appearances and their relevance to the radiologist.

Aneurysms of the pancreaticoduodenal arteries: a change in management.

Since the first report of an aneurysm involving the pancreaticoduodenal arteries a century ago, only 83 cases have been reported in our collective review of the English literature. Their presentation varies from indistinct abdominal pain to hemorrhagic shock, often making the diagnosis onerous. The mortality rate in this patient group has been significant, and in cases reported since 1980, the mortality rate remains at 17% (7 deaths/42 reported cases). Surgery has been, and continues to be, the cornerstone of therapy, with an incumbent mortality rate of 19% (5 deaths/26 patients treated surgically since 1980). This case report and 100-year review of the literature describes the causes, natural history, and historic management of pancreaticoduodenal artery aneurysms. Most importantly, it demonstrates the use of angiographic embolization in the definitive management of these aneurysms with no mortality.

Abdominal aortic aneurysectomy after kidney transplantation: case report and review of the literature.

Abdominal aortic aneurysms have been a rare finding in patients who have previously undergone renal transplantation. Previous operative strategies attempting to provide renal allograft protection during aortic cross-clamping have included extra-anatomic permanent as well as temporary bypass, heparin bonded shunts, in situ perfusion cooling of the allograft, and general hypothermia. These maneuvers, although generally successful, have recently been challenged by reports describing no specific protective measures. A case of a 5.0 cm but rapidly expanding abdominal aortic aneurysm in a patient who had undergone a prior successful kidney transplant is presented along with a literature review of 27 available cases on the subject.

[Usefulness of body surface cultures in newborns with early infection risk. Study of 735 neonates]. / Valoración de los cultivos superficiales del neonato con riesgo de infección precoz. Estudio de 735 pacientes.

OBJECTIVE: Difficulty in the diagnosis of neonatal sepsis has lead to the practice of superficial cultures. The usefulness of this practice has been criticized repeatedly. PATIENTS AND METHODS: Results of 3881 cultures performed on 735 newborns (age < or = 48 hr) with early infection risk were reviewed. The types of samples chosen were urine (UR), gastric aspirate (GA), pharyngeal (PS), external ear (ES), umbilical swab (US), meconium (MC) and blood. BBV for sepsis for the different samples is calculated, as well as which ones better reflect vertical transmission. RESULTS: At the time of the study, 342 newborns (46.5%) were already colonized. Bacteria most frequently isolated were: E. coli (92), PCN staphylococci (85), enterococci (83) and S. agalactiae (70). Twenty-nine newborns had bacteriemia, with S. agalactiae being the leading cause (16). ES correlated best with positive blood cultures (83.3%). UR culture sensitivity was significantly lower than that of all other samples. The Highest PPVs were for GA, PS and US. NPV was high and similar for all samples (98-99%). ES and US best reflected vertical transmission (p < 0.0001). MC provided the highest number of positive mixed cultures, most of them difficult to evaluate. CONCLUSIONS: Body surface sample advantages are: 1) The possibility of discarding a vertically transmitted infection. 2) Quicker positive results than those in blood whenever liquid blood culture media are employed. 3) The possible identification of the etiologic agent when the mother has been given antibiotics intrapartum. 4). Information about dangerous colonization without infection. In order not to lose this useful information, but to save cost and effort, we advise that the number of surface cultures be reduced, keeping only ES and PS?

Immediate postoperative complications following hemodialysis access procedures.

From August 1989 to August 1994, 173 arteriovenous fistules were constructed in 162 patients for permanent hemodialysis: 49 autogenous and 124 graft fistulas (polytetraflouroethylene (PTFE)-119, others-5). Previous access procedures were noted in 93 graft fistulas (76%) versus 8 autogenous fistulas (16.3%). In the immediate postoperative period, 13 graft fistulas (10.6%) developed complications (5 anastomotic hemorrhages, 4 thrombosis, 3 hypotension without hemorrhage, and 1 sepsis), while 2 (4.1%) autogenous fistulas developed immediate postoperative complications (1 anastomotic hemorrhage and 1 thrombosis). Graft fistulas had a higher, although not statistically significant incidence of immediate postoperative complications versus autogenous fistulas. These graft fistula complications were associated with multiple access procedures and required surgical exploration. Based on these results, we should make every effort to construct the autogenous fistula as the first choice of hemodialysis access procedure in properly selected patients.

Retinoic acid suppresses the response to platelet-derived growth factor in human hepatic Ito-cell-like myofibroblasts: a post-receptor mechanism independent of raf/fos/jun/egr activation.

Activated Ito-cell-like myofibroblasts proliferate in vivo during human liver injury and subsequent fibrogenesis. To examine the associated regulatory mechanisms, human liver myofibroblasts were characterized after culture purification from mixed liver-cell isolates obtained from perfused normal human livers. The cells resembled rat Ito-cell-derived myofibroblasts expressing desmin and alpha-smooth-muscle actin filaments as well as the interstitial collagens type I and III. [3H]Thymidine incorporation was inducible with platelet-derived growth factor (PDGF) and was suppressible with retinoic acid (RAc) in a concentration-dependent fashion. RAc suppression did not alter PDGF alpha- or beta-receptor abundance or activation. In addition, RAc functioned via a pathway distal or independent of cytoplasmic raf activation (i.e. phosphorylation, kinase function and perinuclear translocation) and nuclear fos, jun and egr expression, as these steps were similarly unaffected by RAc treatment. Since normal Ito cells contain abundant amounts of vitamin A which is lost during activation, these data suggest that retinoids could contribute to the maintenance of the quiescent non-proliferative state by suppressing mitogenesis at a post-cytokine receptor step distal from or independent of fos/jun/egr [e.g. via changes in activator protein-1 (AP-1) binding].