Comparison of one stage laparoscopic cholecystectomy combined with intra-operative endoscopic sphincterotomy versus two-stage pre-operative endoscopic sphincterotomy followed by laparoscopic cholecystectomy for the management of pre-operatively diagnosed patients with common bile duct stones: a meta-analysis.

BACKGROUND: Laparoscopic cholecystectomy (LC) for symptomatic gallstone disease is one of the most common surgical procedures. Concomitant common bile duct (CBD) stones are detected with an incidence of 4-20% and the ideal management is still controversial. The frequent practice is to perform endoscopic sphincterotomy pre-operatively (POES) followed by LC, to allow subsequent laparoscopic or open exploration if POES fails. However, POES has shown different drawbacks such as need for two hospital admissions, need of two anesthesia inductions, higher rate of pancreatitis, and longer hospital stay. Hence, an intra-operative endoscopic sphincerotomy (IOES) has been proposed. OBJECTIVE: To compare the 1 stage laparoscopic cholecystectomy (LC) combined with IOES versus 2-stage POES followed by LC for the management of pre-operatively known cholecystocholedocholithiasis. SEARCH STRATEGY: The search terms bile duct stones/calculi, ERCP, endoscopic sphincterotomy, laparoendoscopic rendezvous (LERV), and laparoscopic ductal clearance/choledochotomy/exploration were used. A comprehensive hand-based search of reference lists of published articles and review articles was performed to ensure inclusion of all possible studies and exclude duplicates. SELECTION CRITERIA: RCTs comparing 1 stage LC combined with IOES versus 2-stage POES followed by LC for the management of pre-operatively known cholecystocholedocholithiasis in adults. DATA COLLECTION & ANALYSIS: Three reviewers assessed trial quality and extracted the data. Data were entered in revman version 5.3. The trials were grouped according to the outcome measure assessed such as success rate of CBD stone clearance, incidence of pancreatitis, overall morbidity, and length of hospital stay. MAIN RESULTS: A total of 629 patients in 5 RCTs met the inclusion criteria. The success rate of CBD clearance (IOES = 93%, POES = 92%) was the same in both groups (OR 1.34; 95% CI 0.45-0.97; p = 0.60). Findings showed that IOES was associated with less pancreatitis (0.6%) than POES (4.4%) (OR 0.19; 95% CI 0.06-0.67; p = 0.01; I 2 = 43%). The incidence of overall morbidity was lower in the IOES group (6%) than the POES group (11%) (OR 0.54; 95% CI 0.31-0.96; p = 0.03; I 2 = 20%). The mean days of hospital stay for IOES group (M = 3.52, SD = 1.434, N = 5) was significantly less than the POES group (M = 6.10, SD = 2.074, N = 5), t(8) = 2.29, p <= 0.051. CONCLUSION: IOES is at par with two-stage POES in terms of CBD clearance, with less incidence of post-operative pancreatitis, overall morbidity, and less hospital stay.

Actividad antibacterial y larvicida sobre Aedes aegypty L. de extractos de Ambrosia peruviana Willd (Altamisa) / Antibacterial and larvicidal activity against Aedes aegypti L. of extracts from Ambrosia peruviana Willd (altamisa)

Introducción: en la actualidad, nuevas tendencias tecnológicas e iniciativas se están presentando en el desarrollo de productos insecticidas derivados de productos naturales, y de nuevos agentes antimicrobianos, dado que poseen bioactivos que son selectivos, biodegradables y tienen menores efectos adversos. La especie Ambrosia peruviana Willd. es de gran interés en el estudio por su gran potencial biológico y etnobotánico. Objetivo: evaluar la actividad larvicida sobre Aedes aegypty L. y la actividad antibacteriana sobre bacterias Gram positivas y Gram negativas de extractos de A. peruviana. Métodos: a partir del material vegetal seco (hojas), se obtuvieron cinco extractos de diferente polaridad en hexano (H), diclorometano (D), acetato de etilo (A) y etanol (E) y aceites esenciales (AE), los cuales fueron evaluados mediante la inhibición del crecimiento de larvas por el método recomendado de la OMS y la inhibición de las bacterias por el método de difusión en agar de Kirby-Bauer. Resultados: la tasa de mortalidad encontrada a las 24 h a una concentración de 200 ppm para todos los extractos fue del 10 por ciento. Al evaluar el paso de los insectos de larvas a adultos a las 144 h se observó a esta misma concentración una mortalidad del 100 por ciento con todos los extractos. Por otra parte, los extractos de A. peruviana presentaron inhibición sobre Bacillus cereus Frankland & Frankland y Bacillus subtilis (Ehrenberg) Cohn con halos de inhibición del extracto de diclorometano (APExtD) de 10,5 y 15,0 mm de diámetro respectivamente, al contrario sobre las cepas Serratia marcescens Bizio, Proteus mirabilis Hauser, Enterobacter cloacae (Jordan) Hormaeche & Edwards y Staphylococcus aureus Rosenbach no se presentó actividad antibacteriana. Conclusiones: esta investigación es el primer reporte de actividad larvicida sobre A. aegypty y de actividad antibacteriana sobre B. cereus y B. subtilis de varios extractos de A. peruviana con promisorios resultados en estos modelos(AU)

Introduction: New technological trends and initiatives are currently being put forth concerning the development of insecticidal products and antimicrobial agents of natural origin, since their bioactive components are selective and biodegradable, and cause fewer adverse effects. The species Ambrosia peruviana Willd. was of great interest to the present study, due to its great biological and ethnobotanical potential. Objective: Evaluate the larvicidal activity of A. peruviana extracts against Aedes aegypti L., and its antibacterial activity against gram-positive and gram-negative bacteria. Methods: Dry plant material (leaves) was processed to obtain five extracts of different polarity in hexane (H), dichloromethane (D), ethyl acetate (A), ethanol (E) and essential oils (AE), which were evaluated for larval growth inhibition with the method recommended by WHO, and for bacterial inhibition with the Kirby-Bauer agar diffusion method. Results: The mortality rate at 24 h and a concentration of 200 ppm was 10 percent for all extracts. Examination of the transition of larvae into adults at 144 h and the same concentration revealed a mortality of 100 percent with all extracts. On the other hand, the extracts of A. peruviana displayed inhibition capacity against Bacillus cereus Frankland & Frankland and Bacillus subtilis (Ehrenberg) Cohn with inhibition haloes for the dichloromethane extract (APExtD) of 10.5 and 15.0 mm in diameter, respectively, whereas no antibacterial activity was found against the strains Serratia marcescens Bizio, Proteus mirabilis Hauser, Enterobacter cloacae (Jordan) Hormaeche & Edwards and Staphylococcus aureus. Conclusions: This study is the first report of larvicidal activity againstA. aegypti and antibacterial activity against B. cereus and B. subtilis by several extracts of A. peruviana with promising results in these models(AU)

Actividad antibacterial y larvicida sobre Aedes aegypty L. de extractos de Ambrosia peruviana Willd (Altamisa) / Antibacterial and larvicidal activity against Aedes aegypti L. of extracts from Ambrosia peruviana Willd (altamisa)

Introducción: en la actualidad, nuevas tendencias tecnológicas e iniciativas se están presentando en el desarrollo de productos insecticidas derivados de productos naturales, y de nuevos agentes antimicrobianos, dado que poseen bioactivos que son selectivos, biodegradables y tienen menores efectos adversos. La especie Ambrosia peruviana Willd. es de gran interés en el estudio por su gran potencial biológico y etnobotánico. Objetivo: evaluar la actividad larvicida sobre Aedes aegypty L. y la actividad antibacteriana sobre bacterias Gram positivas y Gram negativas de extractos de A. peruviana. Métodos: a partir del material vegetal seco (hojas), se obtuvieron cinco extractos de diferente polaridad en hexano (H), diclorometano (D), acetato de etilo (A) y etanol (E) y aceites esenciales (AE), los cuales fueron evaluados mediante la inhibición del crecimiento de larvas por el método recomendado de la OMS y la inhibición de las bacterias por el método de difusión en agar de Kirby-Bauer. Resultados: la tasa de mortalidad encontrada a las 24 h a una concentración de 200 ppm para todos los extractos fue del 10 por ciento. Al evaluar el paso de los insectos de larvas a adultos a las 144 h se observó a esta misma concentración una mortalidad del 100 por ciento con todos los extractos. Por otra parte, los extractos de A. peruviana presentaron inhibición sobre Bacillus cereus Frankland & Frankland y Bacillus subtilis (Ehrenberg) Cohn con halos de inhibición del extracto de diclorometano (APExtD) de 10,5 y 15,0 mm de diámetro respectivamente, al contrario sobre las cepas Serratia marcescens Bizio, Proteus mirabilis Hauser, Enterobacter cloacae (Jordan) Hormaeche & Edwards y Staphylococcus aureus Rosenbach no se presentó actividad antibacteriana. Conclusiones: esta investigación es el primer reporte de actividad larvicida sobre A. aegypty y de actividad antibacteriana sobre B. cereus y B. subtilis de varios extractos de A. peruviana con promisorios resultados en estos modelos(AU)

Introduction: New technological trends and initiatives are currently being put forth concerning the development of insecticidal products and antimicrobial agents of natural origin, since their bioactive components are selective and biodegradable, and cause fewer adverse effects. The species Ambrosia peruviana Willd. was of great interest to the present study, due to its great biological and ethnobotanical potential. Objective: Evaluate the larvicidal activity of A. peruviana extracts against Aedes aegypti L., and its antibacterial activity against gram-positive and gram-negative bacteria. Methods: Dry plant material (leaves) was processed to obtain five extracts of different polarity in hexane (H), dichloromethane (D), ethyl acetate (A), ethanol (E) and essential oils (AE), which were evaluated for larval growth inhibition with the method recommended by WHO, and for bacterial inhibition with the Kirby-Bauer agar diffusion method. Results: The mortality rate at 24 h and a concentration of 200 ppm was 10 percent for all extracts. Examination of the transition of larvae into adults at 144 h and the same concentration revealed a mortality of 100 percent with all extracts. On the other hand, the extracts of A. peruviana displayed inhibition capacity against Bacillus cereus Frankland & Frankland and Bacillus subtilis (Ehrenberg) Cohn with inhibition haloes for the dichloromethane extract (APExtD) of 10.5 and 15.0 mm in diameter, respectively, whereas no antibacterial activity was found against the strains Serratia marcescens Bizio, Proteus mirabilis Hauser, Enterobacter cloacae (Jordan) Hormaeche & Edwards and Staphylococcus aureus. Conclusions: This study is the first report of larvicidal activity againstA. aegypti and antibacterial activity against B. cereus and B. subtilis by several extracts of A. peruviana with promising results in these models(AU)

Colonoscopy after Hinchey I and II left-sided diverticulitis: utility or futility?

BACKGROUND: Modern 64- to 128-slice computed tomography (CT) scanners have questioned the need for routine colonoscopy after hospital admission for presumed uncomplicated diverticulitis. METHODS: This is a retrospective review of all patients (>18 years) who underwent planned colonoscopy after admission for Hinchey I or II acute diverticulitis (January 2009 to January 2014). The findings on the final radiologist report were then correlated with the colonoscopy results. RESULTS: In total, 110 patients (mean age, 55.2 ± 16; 46.4% female) underwent a subsequent colonoscopy (median, 60 days) after admission for diverticulitis. Overall, 102 patients (92.7%) had CT findings consistent with definitive diverticulitis, 6 patients had a diagnosis suggestive of diverticulitis on CT scan, and 2 patients had masses on their admission CT scans. Within the group with definitive diverticulitis, follow-up colonoscopy identified diverticulosis in 99 (97.0%), whereas the other 3 had normal findings. Of the patients with CT scans suggestive of diverticulitis, follow-up colonoscopy showed 3 with diverticulosis, 2 with malignancies, and 1 with nonspecific inflammation. The reliability of CT scans for diverticulitis compared with colonoscopy was found to have a kappa = .829 (P < .001; 95% confidence interval, .629, 1.21). CONCLUSIONS: Follow-up colonoscopy should be performed when a CT scan suggests malignancy, nonspecific inflammatory findings, or the patient is otherwise due for routine screening or surveillance. In this study, there was no benefit of follow-up colonoscopy in patients with CT-confirmed diverticulitis in the absence of other concerning or indeterminate findings.