Surgical laparoscopic treatment of bowel endometriosis with transvaginal resection of the rectum using ultrasonically activated shears: a retrospective cohort study with description of technique.

BACKGROUND: To asses the results of laparoscopic surgical treatment of bowel endometriosis with transvaginal resection of the rectum employing ultrasonic energy retrospective study. METHOD: 100 patients with symptoms of narrowing or partial obstruction of colon were submitted to laparoscopic resection of rectosigmoid tract through a vaginal route. Length of surgery, blood loss, histopathological extent of rectal invasion, surgical complications, and length of hospital stay were the main analyzed outcomes. RESULTS: Mean operative time was 281 min, blood loss was 250 ml on average, length of stay was 8 days, bowel movements were after 3.5 days, the mean length of bowel-resected segments was 13.3 cm, the disease was multifocal in 64% and multicentric in 36% of surgical specimens. CONCLUSION: Laparoscopically assisted vaginal resection of rectosigmoid colon affected by endometriosis using ultrasonically activated shears with mechanical intestinal anastomoses tension free is a safe and effective procedure for surgical management of severe pelvic endometriosis with bowel involvement.

Characterization of antibody response in neuroinvasive infection caused by Toscana virus.

OBJECTIVES: Among sandfly-borne pathogens, Toscana virus (TOSV) is a prominent cause of summer meningitis in Mediterranean Europe. Here, we assessed the kinetics of anti-TOSV antibodies over time in 41 patients diagnosed with TOSV meningitis or meningoencephalitis in northeastern Italy. METHODS: Acute and follow-up serum samples were collected up to 20 months after diagnosis of TOSV infection and tested for the presence of specific antibody using immunoenzymatic and indirect immunofluorescence assays. In addition, maturation of anti-TOSV IgG over time was evaluated as well as production of neutralizing antibodies. RESULTS: Specific IgM and IgG response was present at diagnosis in 100% of patients; TOSV-specific IgM and IgG were detected in patients' sera up to 6 and 20 months after diagnosis, respectively. The avidity index (AI) increased over the first month after infection in 100% of patients and most cases exceeded 60% by Day 30 post infection. The AI subsequently plateaued then declined at 20 months after diagnosis. Finally, neutralization assay to TOSV was performed in 217 sera collected from 41 patients; 69.6% of tested samples resulted in reactive and moderate levels of neutralizing antibodies observed during all phases of infection despite high titres of total anti-TOSV IgG. CONCLUSIONS: Specific antibody response develops rapidly and is long-lasting for neuroinvasive TOSV infection. Serodiagnosis of neuroinvasive TOSV requires simultaneous detection of specific IgM and IgG. Moderate levels of neutralizing antibodies were maintained over the study period, while the protective role of antibodies lacking neutralizing activity is unclear and requires further evaluation.

Anatomy of the right liver lobe: a surgical analysis in 124 consecutive living donors.

BACKGROUND: Understanding anatomic variations of the right lobe is fundamental in adult to adult living donor liver transplantation. METHODS: We analysed anatomy in 124 right liver (RL) donors. RESULTS: Portal vein: normal anatomy was found in 85.5% donors. In 14.5% the main right portal vein (PV) was absent. Hepatic artery: single arterial inflow of the RL was identified in 96% of donors. In 4% two arterial stumps were found. Bile duct: classic anatomy was identified in 50.8% of donors; 9.7% had a trifurcation of the common bile duct; in 7.2% the right anterior and in 15.3% the right posterior bile duct opened into the left bile duct; one segmental bile duct opened directly into the common bile duct in 12.1% and two segmental bile ducts in 4.8%. Hepatic veins (HV): in 74.3% the right HV was the single outflow; in 24.2% significant accessory HV (>5 mm) were preserved, in 2.4% the middle HV was harvested. We found that patients with PV variations had high incidence of multiple bile ducts (88.9%) while patients with single right PV had lower incidence (42.4%) (p = 0.00026). CONCLUSION: While anatomic variations in the RL donor were common, no contraindication to RL harvesting was noted in this study.

Accuracy of computed tomographic colonography in a nationwide multicentre trial, and its relation to radiologist expertise.

OBJECTIVE: Reports on the accuracy of computed tomographic colonography (CTC) mainly involve series from expert institutions. The aims of this study were to assess CTC accuracy in a nationwide population and to relate it to radiologist performance in their initial training. DESIGN: Nationwide multicentre trial. SETTING: Twenty-eight radiologists, working in 26 mostly academic clinical units, were involved in the study after having attended a formal specialised 2-day training session on CTC. They worked through a training set of 52 cases with automatic feedback after an attempt at each case. PATIENTS: The study enrolled 845 patients with average and high risk of colorectal cancer, 737 of whom had both complete CTC and videocolonoscopy data, which constituted the dataset. INTERVENTIONS: Patients underwent same-day CTC followed by videocolonoscopy with segmental unblinding of CTC results. MAIN OUTCOME MEASURES: Sensitivity, specificity and positive and negative predictive values for detection of polyps ≥ 6 mm in per-patient and per-lesion analyses of CTC without computer-aided detection. RESULTS: Sensitivity, specificity and positive and negative predictive values for patients with polyps ≥ 6 mm were 69% (95% CI 61% to 77%), 91% (95% CI 89% to 94%), 67% (95% CI 59% to 74%) and 92% (95% CI 90% to 94%), respectively. Univariate analysis showed that the detection rate for polyps ≥ 6 mm was linked to neither radiologist case volume nor number of polyps, but was related to sensitivity achieved in the training set. Pooled sensitivity was 72% (95% CI 63% to 80%) versus 51% (95% CI 40% to 60%) for radiologists achieving above and below median sensitivity in the training set (61%), respectively. Multivariate analysis showed that sensitivity for polyps ≥ 6 mm in the training set was the only remaining significant predictive factor for subsequent performance. CONCLUSIONS: Radiologist sensitivity CTC for detection of polyps ≥ 6 mm in training was the sole independent predictor for subsequent sensitivity in detection of such polyps.

The influence of posterior capsule opacification on scanning laser polarimetry.

PURPOSE: To evaluate the influence of posterior capsule opacification (PCO) on GDx parameters in a population of pseudophakic, non-glaucomatous patients who underwent Nd:YAG laser capsulotomy (YLC). METHODS: The posterior capsules were photographed with a Topcon digital camera and each image was then entered into the EPCO 2000 software and evaluated independently by three examiners. The EPCO 2000 software was used to calculate the fibrosis index (FI) and the pearl index (PI) for the central 1.5, 2.5, and 3.5 mm of the posterior capsule. Scanning laser polarimetry was performed with GDx before and after YLC. We compared the GDx readings obtained before and after the YLC using paired Student's t-test. The parameters that varied significantly after YLC were subsequently used for regression analysis. Stepwise multiple linear regression was used to analyse the impact of the change in the amount of FI and PI on change in GDx parameters after YLC. RESULTS: In total, 158 patients were enrolled (74 men, 84 women). The mean age was 69.46+/-8.83 years (range 46-83 years). The interobserver agreement among the three experts was found to be good (repeatability coefficient R=1.51, 1.49, 1.49 for observer A vs B, A vs C, and B vs C respectively). One-sample Student's t-test show no difference between all GDx parameters before and after YLC except for Symmetry, Superior/Nasal ratio, Inferior Ratio, and Temporal-Superior-Nasal-Inferior-Temporal (TSNIT). Stepwise multiple regression showed that the two variables of greatest significance for changes in Symmetry were the FI in the central 1.5 and the PI in the central 3.5 mm (P=0.02). Superior/nasal ratio was shown to be most strongly correlated to the FI in the central 1.5 mm and PI in the central 3.5 mm (P<0.001), whereas the variable of greatest significance to Inferior Ratio was PI in the central 3.5 mm (P=0.03). Finally, TSNIT was most strongly correlated to FI in the central 1.5 mm and FI in the central 2.5 mm (P<0.001). CONCLUSION: Presence of capsular fibrosis seems to be more clinically relevant in the central zone, whereas pearls tend to be clinically significant in the central 3.5 mm area. Hence, it might be worthwhile assessing the amount of PCO in pseudophakic patients when performing scanning laser polarimetry. Investigators should ensure that the type of PCO and the size of the area analysed are documented in the notes in order to interpret GDx findings appropriately.

[Value of MRCP with Mangafodipir Trisodium (Teslascan) injection in the diagnosis and management of bile leaks]. / Intérêt de la cholangio-IRM avec perfusion de Mangafodipir Trisodium (Teslascan) dans le diagnostic topographique et la prise en charge des fuites biliaires.

PURPOSE: To assess the value of MRCP with Mangafodipir Trisodium (Teslascan) injection in the diagnosis and management of bile leaks. PATIENTS AND METHODS: Retrospective study of 25 patients (18 males, 7 females) with a mean age of 49.7 years and high clinical suspicion of bile leak who underwent MRCP with Mangafodipir Trisodium (Teslascan) injection between 2002 and 2006. The suspected etiology for bile leak was surgical (n=17), traumatic (n=7) or medical (n=1). The clinical suspicion was based on a combination of clinical, laboratory and imaging findings. RESULTS: MRCP with Teslascan injection demonstrated a bile leak in 20 patients. The site of leak was depicted in 17 cases: second order of smaller bile duct, (n=9), hepatic duct (n=3), confluence (n=2), cystic duct (n=1), bilioenteric anastomosis (n=2). Management based on MR findings included biloma drainage (n=7), biliary drainage (n=5), endoscopic management (n=2), repeat surgery (n=3), expectant management (n=1), and medical management (n=1). Outcome was favourable in 18 cases. Two patients died from infectious complications. CONCLUSION: In addition to confirming a diagnosis of bile leak, MRCP with Teslascan injection depicts the site of leak allowing optimal management.