Simultaneous TAPP inguinal repair and laparoscopic cholecystectomy: results of a case series.

BACKGROUND: Cholecystectomy and inguinal hernioplasty are the most frequent surgeries in Chile and the world. Laparoscopic inguinal hernioplasty, being a clean surgery, reports mesh infection rates of less than 2% and adding a simultaneous laparoscopic cholecystectomy is controversial due to an increase in the risk of mesh infection. The aim of this paper is to report the results of simultaneous TAPP hernioplasty with laparoscopic cholecystectomy. METHOD: Retrospective analysis of the digestive surgery database. We identified cases in which laparoscopic inguinal TAPP repair and simultaneous laparoscopic cholecystectomy were performed. Demographic, clinical information, hernia type and size, data from the surgery and its complications were also retrieved and analyzed. RESULTS: We identified 21 patients, 86% male and with an average age of 61 years range 46-84. 72% of the hernias were unilateral, predominating indirect 50%, direct 28% and the remaining were femoral and mixed. The average hernia size was 2.2 cm. The meshes used were 56% polypropylene, 37% polyester and 5% PVDF. We report one gallblader perforation. At a median time of 40 months of follow-up (range 4-89 months), one hernia recurrence was found (3.7%), there were no reoperations at the time of the interview and there were no cases of mesh infection. Complications of surgery includes one ipsilateral testicular atrophy 4.8% and 1 ipsilateral inguinal seroma 4.8%. CONCLUSIONS: In this series of cases, adding clean contaminated surgery to the inguinal TAPP hernioplasty was not associated with an increase in the infection of the mesh.

Dexmedetomidine metabolic clearance is not affected by fat mass in obese patients.

BACKGROUND: Obesity has been associated with reduced dexmedetomidine clearance, suggesting impaired hepatic function or reduced hepatic blood flow. The aim of this study was to clarify the effect of obesity in dexmedetomidine metabolic clearance. METHODS: Forty patients, ASA I-III, 18-60 yr old, weighing 47-126 kg, scheduled for abdominal laparoscopic surgery, were enrolled. Anaesthetic agents (propofol, remifentanil, and dexmedetomidine) were dosed based on lean body weight measured by dual X-ray absorptiometry. Serial venous samples were drawn during and after dexmedetomidine infusion. A pharmacokinetic analysis was undertaken using non-linear mixed-effect models. In the modelling approach, the total body weight, lean body weight, and adjusted body weight were first tested as size descriptors for volumes and clearances. Hepatic blood flow, liver histopathology, liver enzymes, and gene expression of metabolic enzymes (UGT2B10 and UGT1A4) were tested as covariates of dexmedetomidine metabolic clearance. A decrease in NONMEM objective function value (ΔOFV) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. RESULTS: A total of 637 dexmedetomidine serum samples were obtained. A two-compartmental model scaled to measured lean weight adequately described the dexmedetomidine pharmacokinetics. Liver blood flow was a covariate for dexmedetomidine clearance (ΔOFV=-5.878). Other factors, including fat mass, histopathological damage, and differential expression of enzymes, did not affect the dexmedetomidine clearance in the population studied (ΔOFV<3.84). CONCLUSIONS: We did not find a negative influence of obesity in dexmedetomidine clearance when doses were adjusted to lean body weight. Liver blood flow showed a significant effect on dexmedetomidine clearance. CLINICAL TRIAL REGISTRATION: NCT02557867.

Effect of flaxseed supplementation rate and processing on the production, fatty acid profile, and texture of milk, butter, and cheese.

Health and nutrition professionals advise consumers to limit consumption of saturated fatty acids and increase the consumption of foods rich in n-3 fatty acids. Researchers have previously reported that feeding extruded flaxseed, which is high in C18:3n-3, improves the fatty acid profile of milk and dairy products to less saturated fatty acids and to more C18:3n-3. Fat concentrations in milk and butter decreased when cows were fed higher concentrations of extruded flaxseed. The objective of this study was to determine the optimal rate of flaxseed supplementation for improving the fatty acid profile without decreasing production characteristics of milk and dairy products. By using a double 5 × 5 Latin square design, 10 mid- to late-lactation Holstein cows were fed extruded (0, 0.91, 1.81, and 2.72 kg/d) and ground (1.81 kg/d) flaxseed as a top dressing for 2-wk periods each. At the end of each 2-wk treatment period, milk and serum samples were taken. Milk was subsequently manufactured into butter and fresh Mozzarella cheese. Increasing supplementation rates of extruded flaxseed improved the fatty acid profile of milk, butter, and cheese gradually to less saturated and atherogenic fatty acids and to more C18:3n-3 by increasing concentrations of C18:3n-3 in serum. The less saturated fatty acid profile was associated with decreased hardness and adhesiveness of refrigerated butter, which likely cause improved spreadability. Supplementation rates of extruded flaxseed did not affect dry matter intake of the total mixed ration, milk composition, and production of milk, butter, or cheese. Flaxseed processing did not affect production, fatty acid profile of milk, or texture of butter and cheese. Feeding up to 2.72 kg/d of extruded flaxseed to mid- to late-lactation Holstein cows may improve nutritional and functional properties of milk fat without compromising production parameters.

Hatching egg and newly hatched chick yolk sac total IgY content at 3 broiler breeder flock ages.

During the first week of the posthatching period, before the immune system is mature enough to produce its own B lymphocytes, a chick's humoral immunity depends on maternal antibodies (IgY) received from the egg yolk. During incubation and after hatching, the yolk sac (YS) membrane transfers nutrients (including IgY) from the egg yolk to the developing embryo or newly hatched chick. The objective of this study was to determine the effects of breeder flock age on the total IgY content of egg yolks and chick YS from a commercial broiler breeder strain. Hatching eggs from the same broiler breeder flock were collected at 32, 40, and 55 wk of age. One group of eggs per flock age was used to determine the egg yolk total IgY content. Another group of eggs was incubated for 21.5 d, and upon hatching, the YS of newly hatched chicks were collected to determine the total IgY content. Egg and egg yolk weight increased with flock age, but YS weights did not reflect egg yolk weight. The total IgY content per gram of egg yolk increased with flock age; this fact plus the observed yolk weight increase with flock age notably increased the total IgY contained in yolks of eggs laid by 55-wk-old breeders. However, chicks hatching from 55-wk-old breeders had less IgY per gram of YS than chicks from 32- and 40-wk-old breeders. Whether there are differences in the rates of YS absorption between chicks of different breeder ages is unknown. This research provided total IgY values for broiler breeder egg yolk and chick YS of a commonly used meat-type chicken strain. Differences in egg yolk and YS total IgY contents due to flock age in this type of bird had not been previously reported. Research on the physiological consequences of YS absorption rates in chicks from different breeder ages is advised.

Antioxidative effect of dietary Camelina meal in fresh, stored, or cooked broiler chicken meat.

Camelina sativa is an oilseed crop of the Brassica (Cruciferae) family that has gained increased popularity as a biofuel source. The present study was conducted to investigate the effects of feeding C. sativa meal to broiler birds on phenolic compounds, tocopherols, flavonoids, antioxidant capacity, and lipid peroxidation in chicken thigh meat during short (4°C for 2 or 7 d) or long-term (-20°C for 90 d) storage and cooking. One hundred sixty 1-d-old Cobb chicks were fed a corn-soybean meal-based diet with added Camelina meal at 0% (control), 2.5% (CAM2.5), 5% (CAM5), and 10% (CAM10). The experimental diets were fed for a period of 42 d. Feeding Camelina meal at 5 or 10% led to a 1.6-fold increase in γ-tocopherols in the thigh meat when compared with control birds (P < 0.05). No effect of diet on γ-tocopherols in the breast meat and α-tocopherols in the thigh and breast meat was observed (P > 0.05). Antioxidant activity measured as 2,2-azino-bis [3-ethylbenzo-thiazoline-6-sulfonic acid] radical scavenging capacity in the thigh meat from CAM2.5, CAM5, and CAM10 was higher than control birds (P < 0.05). In the breast meat, 2,2'-azino-bis (3-ethylbenzo-thiazoline-6-sulfonic acid) diammonium salt radical scavenging capacity was highest in CAM10 (P < 0.05). Feeding Camelina meal at 5 or 10% led to reductions in thigh TBA reactive substances (TBARS) during short-term (2 d) and long-term storage (P < 0.05). The TBARS of thigh meat from CAM5 and CAM10 were reduced up to 49 or 36% during 2- or 90-d storage, respectively, when compared with control (P < 0.05). However, no effect of diet on thigh meat TBARS at 7 d of storage was observed among treatment groups. Overall, TBARS were highest in the thigh meat from control and CAM2.5 birds (P < 0.05). Upon cooking, TBARS were lowest in thigh meat from CAM10 birds, which was over 48% lower than in meat from birds fed the control diet (P < 0.05). The current study showed that Camelina meal could be effective in inhibiting lipid oxidation and enhancing antioxidant capacity. However, the effect was more prominent in the thigh than breast meat.

[Isolated manifestation of necrotizing vasculitis of the bladder: a case report]. / Isolierte Manifestation einer nekrotisierenden Vaskulitis an der Harnblase: Ein Fallbericht.

Isolated vasculitis involving the bladder is rare. We describe a case of irritative voiding and hematuria with slightly elevated inflammatory parameters. In order to exclude a neoplastic process we performed cystoscopy and computed tomography. Secondary systemic causes such as lupus erythematosus or rheumatoid arthritis were excluded. Cytopathological examination of the biopsies showed necrotizing vasculitis of the small bladder vessels, which responded to treatment with steroids and cyclophosphamide.

Hypertension and the cardiometabolic syndrome in Chile: a review of concepts and consequences for the developing world.

We review some recent developments regarding the concept of cardiometabolic syndrome and its relation with hypertension and overall cardiovascular disease risk. We emphasize how this new clinical entity has helped to understand multimorbidity in chronic diseases. This concept has important consequences for individual patient treatment as well as public health policy. The challenge derived from cardiovascular disease and other chronic conditions is increasing worldwide, but the highest burden is located in the developing world. Thus, new and cost-effective approaches are needed for diseases that are mainly occurring in the poorest and less educated populations. We illustrate this situation analyzing hypertension and cardiometabolic syndrome data derived from a recent national health survey in Chile.