Laparoscopic treatment of cystic artery pseudoaneurysm in the presence of calculous cholecystitis.

Cystic artery pseudoaneurysm is a very rare disease in which there is an abnormal, focal dilatation of the artery supplying the gallbladder. The condition may occur as a consequence of a localised inflammatory response, such as in cholecystitis. Here, we present the case of a 56-year-old man who presented with chronic cholecystitis in whom a 1.8 cm × 2 cm cystic artery pseudoaneurysm was found incidentally during laparoscopic cholecystectomy. Prior to the operation, routine investigations such as ultrasound revealed no indication of cystic artery pseudoaneurysm, ruptured or otherwise. This case is reported to emphasise that cystic artery pseudoaneurysm may be caused by chronic or acute cholecystitis and that skilled surgeons may handle them laparoscopically.

Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis.

INTRODUCTION: Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. METHODS: The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. RESULTS: The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to 'surgeon preference/skill', was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. CONCLUSIONS: A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital.

Residual impact of the biocontrol inoculant Pseudomonas fluorescens F113 on the resident population of rhizobia nodulating a red clover rotation crop.

A field trial was previously conducted in which sugarbeet seeds were either untreated, inoculated with the biocontrol strain Pseudomonas fluorescens F113Rif, or treated with chemical fungicides. Following harvest of sugarbeet, the field site was sown with uninoculated red clover. The aim of this study was to assess the residual impact of the microbial inoculant (and the fungicide treatment) on the diversity of resident rhizobia nodulating the red clover rotation crop. The percentage of nodules yielding rhizobial isolates after surface disinfection was 67% in the control and 70% in the P. fluorescens F113Rif treatment, but only 23% in the chemical treatment. Isolates were characterized by RAPD analysis. The main RAPD cluster (arbitrarily defined at 70% similarity) was prevalent in all three treatments. In addition, the distribution of RAPD clusters followed a log series model, regardless of the treatment applied, indicating that neither the microbial inoculant nor the fungicide treatment had caused a strong perturbation of the rhizobial population. When the P. fluorescens F113Rif and control treatments were compared using diversity indices, however, it appeared that the genetic diversity of rhizobia was significantly less in the inoculated treatment. The percentage of rhizobia sensitive to 2,4-diacetylphloroglucinol (Phl; the antimicrobial metabolite produced by P. fluorescens F113Rif) fluctuated according to field site heterogeneity, and treatments had no effect on this percentage. Yet, the proportion of Phl-sensitive isolates in the main RAPD cluster was lower in the P. fluorescens F113Rif treatment compared with the control, raising the possibility that the residual impact of the inoculant could have been partly mediated by production of Phl. This impact on the rhizobial population took place without affecting the functioning of the Rhizobium-clover symbiosis.

Pseudomonas for biocontrol of phytopathogens: from functional genomics to commercial exploitation.

Pseudomonas spp. that can colonise the roots of crop plants and produce antifungal metabolites represent a real alternative to the application of chemical fungicides. Presently, much research is aimed at understanding, at the molecular level, the mechanisms that enable Pseudomonas strains to act as efficient biological control agents. This approach is facilitating the development of novel strains with modified traits for enhanced biocontrol efficacy. However, without solving some inherent problems associated with the effective delivery of microbial inoculants to seeds and without knowledge on the biosafety aspects of novel biocontrol agents, the commercial potential of Pseudomonas spp. for plant disease control will not be realised.

Small, stable shuttle vectors based on the minimal pVS1 replicon for use in gram-negative, plant-associated bacteria.

The minimal replicon of the Pseudomonas plasmid pVS1 was genetically defined and combined with the Escherichia coli p15A replicon, to provide a series of new, oligocopy cloning vectors (5.3 to 8.3 kb). Recombinant plasmids derived from these vectors were stable in growing and nongrowing cells of root-colonizing P. fluorescens strains incubated under different environmental conditions for more than 1 month.

Limited effects of HIV counseling and testing for women. A prospective study of behavioral and psychological consequences.

OBJECTIVES: To assess the consequences of human immunodeficiency virus (HIV) counseling and testing for seronegative women in terms of sexual behavior and psychological outcomes. DESIGN: The design is prospective and longitudinal, using repeated measures. Participants were interviewed at recruitment, 2 weeks later (when tested women received results), and 3 months later. SETTING: Four community health clinics in southern Connecticut; all provide HIV counseling and testing and other specialized and primary health care services. STUDY PARTICIPANTS: A sequential sample of women were recruited for two study groups: those seeking HIV counseling and testing (n = 152), and a comparison group never tested for HIV (n = 78), matched by clinic, race, and age. MAIN OUTCOME MEASURES: A composite measure of sexual risk was developed, based on sexual activity, condom use, and partner risk factors. Psychometrically valid and reliable measures of general psychological functioning and acquired immunodeficiency syndrome (AIDS)--specific psychological indicators were also used. RESULTS: Average level of sexual risk was lower for tested than nontested women at all three interviews. For both groups, there was no significant change in sexual risk from baseline to 3-month follow-up. At the individual level, there was no difference in the number of women who decreased or increased sexual risk. For tested women, intrusive thoughts about AIDS and estimated chance of getting AIDS decreased after counseling and testing. CONCLUSIONS: Behavioral and psychological consequences of HIV counseling and testing for women at risk for HIV were limited. These results have implications for further prevention interventions.

Effect of chronic stress and exogenous glucocorticoids on regional fat distribution and metabolism.

It has been proposed that increased glucocorticoid hormones and decreased sex hormones affect regional fat metabolism and distribution. In the present work, it was hypothesized that chronic, uncontrollable stress, known to affect the pituitary-adrenal and pituitary-gonadal axes might, therefore, lead to differences in regional fat accumulation. In comparison with controls, male Sprague-Dawley rats stressed for 28 days, had significantly larger adipocytes. In addition, a tendency for a heavier fat pad and an increased lipoprotein lipase activity in the mesenteric depot was suggested. No significant changes were seen in epididymal, retroperitoneal, and inguinal regions. In order to study if the effects observed could be attributed to increased glucocorticoids, the response to a direct administration of supraphysiological doses of corticosterone, given either in the drinking water or via subcutaneous implantation of corticosterone pellets, was studied. Increased fat accumulation was shown in all fat depots in a dose-response fashion, but was significantly more pronounced in the mesenteric region. It was concluded that mesenteric fat tissue may respond to stress in a different manner from other fat depots. Glucocorticoids seem to be partly, but not solely, responsible for the changes observed in adipose tissue metabolism and distribution following exposure to uncontrollable stress.

Medial hypothalamic serotonin: role in circadian patterns of feeding and macronutrient selection.

Hypothalamic serotonin (5-HT) is believed to have an inhibitory effect on food intake in a variety of species. To define more precisely the nature of this effect, this study investigated the effects of medial hypothalamic 5-HT injection on natural patterns of macronutrient intake in freely feeding rats. Serotonin (5-20 nmol) was injected directly into the paraventricular nucleus (PVN) of brain-cannulated rats maintained ad libitum on pure macronutrient diets, protein, carbohydrate and fat, and measurements of nutrient intake were taken one hour later. To assess whether the action of 5-HT on macronutrient intake varies across the light-dark cycle, these tests were conducted at 3 different times in the nocturnal feeding period, during hours 1, 6 and 11 after lights out. The results demonstrate that the suppressive effect of PVN 5-HT on food intake is dose dependent, nutrient selective, as well as time dependent. Specifically, PVN injection of 5-HT, at all doses tested, was effective at only one time of the nocturnal cycle, namely, at the onset of the active, dark period. While no behavioral effect of 5-HT was detected in the middle and late phases of the dark, a strong, dose-dependent reduction of nutrient intake was revealed immediately after lights out. This suppressive effect was characterized by a highly selective decrease in carbohydrate intake, along with a significant enhancement in preference for protein, as well as for fat, and little change in total caloric intake.(ABSTRACT TRUNCATED AT 250 WORDS)