Cystic lymphangioma presenting as an acute abdomen in an adult male with congenital aortic stenosis.

Abdominal cystic lymphangioma rarely presents as an acute abdomen. In this article, we describe a young adult male with congenital aortic stenosis who initially presented with abdominal pain and raised inflammatory markers. The imaging in the form of a computed tomography scan was unfortunately inconclusive. In the evolution of this diagnostic dilemma, we describe the importance of early operative management as well as explore the link between cardiac and lymphatic malformations.

Minimally invasive (laparoscopic and robot-assisted) versus open approach for central pancreatectomies: a single-center experience.

BACKGROUND: There continues to be an interest in minimally invasive approaches to pancreatic surgery. At our institution, there has been a progressive change from an open to minimally invasive surgery (MIS) (laparoscopic, robotic, or laparoscopic-robotic) approach for central pancreatectomies (CP). The aim of this study was to evaluate surgical outcomes with open CP (O-CP) versus minimally invasive CP (MI-CP). METHODS: A retrospective medical review of patients who underwent CP between 1993 and 2018 at Yonsei University Health System, Seoul, Korea was performed. Short-term perioperative outcomes were compared between O-CP and MI-CP. RESULTS: Thirty-one CPs (11 open, 20 MIS) were identified during the study period. No difference was observed in admission days between O-CP and MI-CP (21.2 vs. 16.7 days, p = 0.340), although operating time was significantly increased in the MI-CP group (296.8 vs. 374.8 min, p = 0.036). Blood loss was significantly less in MI-CP vs. O-CP (807.1 vs. 214.0 mls, p = 0.001), with no difference in post-operative new-onset diabetes (9% vs. 5%). The overall post-operative pancreatic fistula rate was 25.8%, and no significant difference between O-CP and MI-CP or complication rates (45% vs. 40%) was observed. CONCLUSION: Despite increased operative time, MI-CP is feasible and comparable to conventional O-CP with regard to surgical outcomes in well-selected patients.

Initial experiences of robotic SP cholecystectomy: a comparative analysis with robotic Si single-site cholecystectomy.

PURPOSE: The da Vinci SP robotic surgical system (Intuitive Surgical) offers pure SP with 4 lumens, which accommodates the fully-wristed endoscope and 3 arms with multijoint feature. We herein present our initial experience of the da Vinci SP surgical system in robotic single-site cholecystectomy. METHODS: Thirty consecutive patients with a preoperative diagnosis of gallstones and/or chronic cholecystitis who underwent robotic SP cholecystectomy (RSPC) using da Vinci SP surgical system from January to May 2019 were reviewed. The perioperative outcomes were assessed and compared with those performed using Si-robotic single-site surgical system. RESULTS: Mean docking time was 5.2 minutes. The mean actual dissection time was 14.6 minutes while the mean operation time was 75.1 minutes. Postoperative course was unremarkable and patients were discharged after a mean hospital stay of 1.5 days. In comparative analysis, operation time (109.5 ± 30.0 minutes vs. 75.1 ± 17.5 minutes, P = 0.001), docking time (11.9 ± 4.3 minutes vs. 5.2 ± 1.9 minutes, P = 0.001), actual dissection time (34.6 ± 18.4 minutes vs. 14.6 ± 5.1 minutes, P = 0.001), console time (58.7 ± 23.0 minutes vs. 32.4 ± 11.6 minutes, P = 0.001), immediate postoperative pain (4.6 ± 1.3 vs. 3.2 ± 1.0, P = 0.001), and pain prior to discharge (2.0 ± 0.6 vs. 1.4 ± 0.0, P = 0.002) were significantly improved in RSPC. CONCLUSION: RSPC is feasible, safe, and effective. The perioperative outcomes are better compared with Si-robotic single-site surgical systems.

The structure of sucrose phosphate synthase from Halothermothrix orenii reveals its mechanism of action and binding mode.

Sucrose phosphate synthase (SPS) catalyzes the transfer of a glycosyl group from an activated donor sugar, such as uridine diphosphate glucose (UDP-Glc), to a saccharide acceptor D-fructose 6-phosphate (F6P), resulting in the formation of UDP and D-sucrose-6'-phosphate (S6P). This is a central regulatory process in the production of sucrose in plants, cyanobacteria, and proteobacteria. Here, we report the crystal structure of SPS from the nonphotosynthetic bacterium Halothermothrix orenii and its complexes with the substrate F6P and the product S6P. SPS has two distinct Rossmann-fold domains with a large substrate binding cleft at the interdomain interface. Structures of two complexes show that both the substrate F6P and the product S6P bind to the A-domain of SPS. Based on comparative analysis of the SPS structure with other related enzymes, the donor substrate, nucleotide diphosphate glucose, binds to the B-domain of SPS. Furthermore, we propose a mechanism of catalysis by H. orenii SPS. Our findings indicate that SPS from H. orenii may represent a valid model for the catalytic domain of plant SPSs and thus may provide useful insight into the reaction mechanism of the plant enzyme.

Expression, purification and preliminary crystallographic analysis of sucrose phosphate synthase (SPS) from Halothermothrix orenii.

This is the first report of the crystallization of a sucrose phosphate synthase (SPS; EC 2.4.1.14). It also constitutes the first study of a sucrose phosphate synthase from a non-photosynthetic thermohalophilic anaerobic bacterium, Halothermothrix orenii. The purified recombinant spsA protein has been crystallized in the monoclinic space group C2, with unit-cell parameters a = 154.2, b = 47.9, c = 72.3 A, beta = 103.16 degrees, using the hanging-drop vapour-diffusion method. The crystal diffracts X-rays to a resolution limit of 3.01 A. Heavy-metal and halide-soaking trials are currently in progress to solve the structure.