A Double-Blinded Randomized Clinical Study on the Therapeutic Effect of Gastrografin in Prolonged Postoperative Ileus After Elective Colorectal Surgery

BACKGROUND

Postoperative ileus is a common problem with significant clinical and economic consequences. We hypothesized that Gastrografin may have therapeutic utility by accelerating the recovery of postoperative ileus after colorectal surgery. The aim of this trial was to study the impact of oral Gastrografin administration on postoperative prolonged ileus (PPI) after elective colorectal surgery.

METHODS

The main endpoint of this randomized, double-blinded, controlled trial was time of resolution of PPI. The secondary endpoints were overall hospital length of stay, time to start oral intake, time to first passage of flatus or stools, time of need of nasogastric tube, and need of parenteral nutrition. Included criteria were patients older than 18 years, operated for colonic neoplasia, inflammatory bowel disease, or diverticular disease. There were two treatments: Gastrografin administration and placebo. The sample size was calculated taking into account the average length of postoperative ileus after colorectal resection until tolerance to oral intake. Statistical analysis showed that 29 subjects in each group were needed.

RESULTS

Twenty-nine patients per group were randomized. Groups were comparable for age, gender, ASA Physical Status Classification System, stoma construction, and surgical technique. No statistical differences were observed in mean time to resolution between the two groups, 9.1 days (CI 95%, 6.51-11.68) in Gastrografin group versus 10.3 days (CI 6.96-10.29) in Placebo group (P = 0.878). Even if not statistically significant, time of resolution of PPI, overall length of stay, time of need of nasogastric tube, and time to tolerance of oral intake were shorter in the G group.

CONCLUSIONS

Gastrografin does not accelerate significantly the recovery of prolonged postoperative ileus after elective colorectal resection when compared with placebo. However, it seems to clinically improve all the analyzed variables.

Spermatozoon ultrastructure of Thysanotaenia congolensis (Cyclophyllidea, Anoplocephalidae, Inermicapsiferinae): phylogenetic implications

The mature spermatozoon of Thysanotaenia congolensis, an intestinal parasite of black rat Rattus rattus from Cape Verde, is described by means of transmission electron microscopy. The ultrastructural organization of the sperm cell of T. congolensis follows Levron et al.'s type VII of the Eucestoda. It corresponds to a uniflagellate spermatozoon that presents crested bodies, periaxonemal sheath and intracytoplasmic walls, spiralled cortical microtubules and nucleus spiralled around the axoneme. These characteristics are also present in the spermatozoa of other inermicapsiferines and differ from the characters found in species belonging to the remaining subfamilies of anoplocephalids, namely Anoplocephalinae, Linstowiinae and Thysanosomatinae. Several authors consider the family Anoplocephalidae as a polyphyletic group, and its relationships with the Davaineidae are a matter of controversy. The phylogenetic implications of spermatological ultrastructural features present in inermicapsiferines and in the remaining anoplocephalids are discussed, and the available data on anoplocephalids are compared to similar results in davaineids in order to contribute to a better knowledge of relationships between these cyclophyllidean families.

First report of Filaria martis Gmelin, 1790 in the European mink, Mustela lutreola (Linnaeus, 1761)

The riparian European mink (Mustela lutreola), currently surviving in only three unconnected sites in Europe, is now listed as a critically endangered species according to the IUCN. Habitat loss and degradation, anthropic mortality, interaction with the feral American mink (Neovison vison), and infectious diseases are among the principal causes of its decline. Surveys of helminth parasites of this host that also include focus on subcutaneous potentially pathogenic helminths such as those belonging to the genus Filaria are very scarce. We report here the presence of specimens of Filaria martis in the subcutaneous connective tissues of three M. lutreola individuals from Spain. This is the first finding of a subcutaneous nematode in a representative of the genus Mustela. The report also enlarges the known range of the definitive hosts of this nematode. These worms were mainly located in the dorsal region of mink and more rarely in the knees, elbows, and hips. Skin sloughing was only observed in one M. lutreola with both septicaemia and an associated high burden of F. martis. Therefore, more attention should be paid to potentially pathogenic helminths when designing conservation programs dedicated to M. lutreola.

Echinococcus multilocularis Leuckart, 1863 (Taeniidae): new data on sperm ultrastructure

The present study establishes the ultrastructural organisation of the mature spermatozoon of Echinococcus multilocularis, which is essential for future research on the location of specific proteins involved in the sperm development in this species and also in Echinococcus granulosus. Thus, the ultrastructural characteristics of the sperm cell are described by means of transmission electron microscopy. The spermatozoon of E. multilocularis is a filiform cell, which is tapered at both extremities and lacks mitochondria. It exhibits all the characteristics of type VII spermatozoon of tapeworms, namely a single axoneme, crested bodies, spiralled cortical microtubules and nucleus, a periaxonemal sheath and intracytoplasmic walls. Other characteristics observed in the male gamete are the presence of a >900-nm long apical cone in its anterior extremity and only the axoneme in its posterior extremity. The ultrastructural characters of the spermatozoon of E. multilocularis are compared with those of other cestodes studied to date, with particular emphasis on representatives of the genus Taenia. The most interesting finding concerns the presence of two helical crested bodies in E. multilocularis while in the studied species of Taenia, there is only one crested body. Future ultrastructural studies of other species of the genus Echinococcus would be of particular interest in order to confirm whether or not the presence of two crested bodies is a characteristic of this genus.

Fertilization in the cestode Echinococcus multilocularis (Cyclophyllidea, Taeniidae)

Fertilization in the taeniid cestode Echinococcus multilocularis with uniflagellate spermatozoa was examined by means of transmission electron microscopy (TEM). Fertilization in this species occurs in the oviduct lumen or in the fertilization canal proximal to the ootype, where the formation of the embryonic capsule precludes sperm contact with the oocytes. Cortical granules are not present in the cytoplasm of the oocytes of this species, however, several large bodies containing granular material where frequently observed. Spermatozoa coil spirally around the oocytes and syngamy occurs by lateral fusion of oocyte and sperm plasma membranes. In the ootype, one vitellocyte associates with fertilized oocyte, forming a membranous capsule which encloses both cell types. In this stage, the spirally coiled sperm body adheres partly to the external oocyte surface, and partially enters into the perinuclear cytoplasm. The electron-dense sperm nucleus becomes progressively electron-lucent within the oocyte cytoplasm after penetration. Simultaneously with chromatin decondensation, the elongated sperm pronucleus changes shape, forming a spherical male pronucleus, which attains the size of the female pronucleus. Cleavage begins immediately after pronuclear fusion.

Effect of Intestinal Tapeworm Clestobothrium crassiceps on Concentrations of Toxic Elements and Selenium in European Hake Merluccius merluccius from the Gulf of Lion (Northwestern Mediterranean Sea)

The capacity for heavy metal bioaccumulation by some fish parasites has been demonstrated, and their contribution to decreasing metal concentrations in tissues of parasitized fish has been hypothesized. The present study evaluated the effect of the cestode Clestobothrium crassiceps on the accumulation of trace elements in 30 European hake, Merluccius merluccius, in Spain (half of them infested by C. crassiceps). Tissue samples from all M. merluccius and specimens of C. crassiceps from the infected hakes were collected and stored until element analysis by inductively coupled plasma mass spectrometry (ICP-MS). Arsenic, mercury, and selenium were generally present in lower levels in the cestode than in all hake tissues. The mean value of the muscular Se:Hg molar ratio in the infested subsample was higher than that in hakes without cestodes. Values indicate that the edible part of infested hakes presents a lower amount of Cd and Pb in relation to noninfested hakes.

First spermatological study in the Atractotrematidae (Digenea, Haploporoidea): the case of Atractotrema sigani, intestinal parasite of Siganus lineatus

The ultrastructural organization of the mature spermatozoon of the digenean Atractotrema sigani (from Siganus lineatus off New Caledonia) was investigated by transmission electron microscopy. The male gamete of A. sigani exhibits the general morphology described in digeneans with the presence of two axonemes of different lengths showing the 9 + “1” pattern of the Trepaxonemata, a nucleus, two mitochondria, two bundles of parallel cortical microtubules, external ornamentation, spine-like bodies and granules of glycogen. However, the mature spermatozoon of A. sigani has some specific characters such as the morphology of its anterior region and the submembranous electron-dense material. Although similar structures have been reported in some digenean species, the presence of a submembranous electron-dense material describing a complete ring is reported here for the first time in the mature spermatozoon of A. sigani. In addition, sperm characteristics are compared between the Haploporoidea and their supposed close superfamilies, and possible phylogenetic implications of these findings for the Digenea are discussed.

Psoriasis and obesity in French children: a case-control, multicentre study

BACKGROUND

Obesity is more common in adults with psoriasis than in the general population, but there is a lack of data available regarding this association in children.

OBJECTIVES

To evaluate whether obesity was more common in French children with psoriasis of any clinical type or severity.

METHODS

A multicentre case-control study was performed in 23 French dermatology centres. Children without chronic or genetic inflammatory disease were selected as controls and matched for age, sex and dermatology centre. We used three weight cut-off categories to compare the two groups: overweight, overweight with abdominal obesity and overweight with obesity according to the French Health Authority guidelines.

RESULTS

A total of 261 children with psoriasis were included. The mean age was 9.8 years, 126 were boys and 135 were girls. Overall, 42.5% of these children had plaque psoriasis and 32.2% had severe psoriasis. There was no difference between the psoriasis and control groups when the frequency of children who were overweight was compared (20·7% in psoriasis group vs. 17·1% in control group; P = 0·18). Overweight with abdominal obesity including obesity (18·4% vs. 10·4%; P = 0·009) and obesity alone (10·0% vs. 3·1%; P = 0·001) were more common in the psoriasis group.

CONCLUSIONS

This study shows that being overweight with abdominal obesity and being obese is more common in children with psoriasis than in controls. The risk factors are the same as those that affect the French general population, i.e. female sex and having a parent who was overweight. The severity and clinical type of psoriasis do not affect overweight and obesity.

Ultrastructure of the spermatozoon of the trematode Notocotylus noyeri (Digenea: Notocotylidae), a parasite of Microtus arvalis (Rodentia: Cricetidae)

In the present paper, we describe the ultrastructure of the spermatozoon of the notocotylid Notocotylus noyeri (Joyeux, 1922) by means of transmission electron microscopy. The mature spermatozoon of N. noyeri exhibits the general pattern described in the majority of digeneans: two axonemes of the 9 + "1" pattern of the Trepaxonemata, nucleus, mitochondria, parallel cortical microtubules, spine-like bodies and ornamentation of the plasma membrane. The glycogenic nature of the electron-dense granules was evidenced applying the test of Thiéry. The ultrastructural features of the spermatozoon of N. noyeri present some differences in relation to those of the Pronocephalidea described until now, but confirm a general pattern for the Notocotylidae, namely a spermatozoon with two mitochondria and an anterior region with ornamentation of the plasma membrane associated with spine-like bodies. The posterior extremity of the spermatozoon exhibits only some microtubules after the disorganisation of the second axoneme. The present study confirms that some ultrastructural characters of the sperm cell such as the presence or absence of lateral expansions, the number of mitochondria and the morphology of both anterior and posterior spermatozoon extremities are useful for phylogenetic purposes within the Pronocephaloidea. Thus, unlike notocotylids, pronocephalids exhibit external ornamentation and a lateral expansion in the anterior spermatozoon region. Moreover, notocotylid spermatozoa present two mitochondria, whereas pronocephalid spermatozoa exhibit a single mitochondrion. Finally, pronocephalids are characterised by a type 2 posterior spermatozoon extremity, whereas notocotylids exhibit a type 3 posterior spermatozoon extremity.

Collyricloides massanae (Digenea, Collyriclidae): spermatozoon ultrastructure and phylogenetic importance

The spermatological characteristics of Collyricloides massanae (Digenea: Collyriclidae), a parasite of Apodemus sylvaticus caught in France, were studied by means of transmission electron microscopy. The mature sperm of C. massanae presents two axonemes of different lengths with the 9 + “1” pattern of the Trepaxonemata, two bundles of parallel cortical microtubules, external ornamentation of the plasma membrane, spine-like bodies, one mitochondrion, a nucleus and granules of glycogen. An analysis of spermatological organisation emphasised some differences between the mature spermatozoon of C. massanae and those reported in the Gorgoderoidea species studied to date, specially belonging to the families Dicrocoeliidae, Paragonimidae and Troglotrematidae. The ultrastructural criteria described in C. massanae such as the morphology of both anterior and posterior spermatozoon extremities, the association “external ornamentation + cortical microtubules”, the type 2 of external ornamentation and the spine-like bodies would allow us to bring closer the Collyriclidae to Microphalloidea. However, further ultrastructural and molecular studies are needed particularly in the unexplored taxa in order to fully resolve the phylogenetic position of the Collyriclidae.

Spermatological characteristics of the genus Taenia inferred from the ultrastructural study on Taenia hydatigena

The present study attempts to establish the sperm ultrastructure baseline for Taenia hydatigena, which is essential for the future research on the location of specific proteins involved in spermatogenesis in this species. Thus, the ultrastructural organisation of the mature spermatozoon is described by means of transmission electron microscopy. Live tapeworms were obtained from an experimentally infected dog in the Department of Pathology and Public Health of the Agronomic and Veterinary Institute Hassan II of Rabat (Morocco). The spermatozoon of T. hydatigena is a filiform cell, which is tapered at both extremities and lacks mitochondria. It exhibits all the characteristics of type VII spermatozoon of tapeworms, namely a single axoneme, a crested body, spiralled cortical microtubules and nucleus, a periaxonemal sheath and intracytoplasmic walls. Other interesting characteristics are the presence of a 2000 nm long apical cone in its anterior extremity and only the axoneme in its posterior extremity. The ultrastructural characters of the spermatozoon of T. hydatigena are compared with those of other cestodes studied to date, with particular emphasis on representatives of the genus Taenia.

Ultrastructural evidence for completion of the entire miracidial maturation in intrauterine eggs of the digenean Brandesia turgida (Brandes, 1888) (Plagiorchiida: Pleurogenidae)

Results of this TEM study provide ultrastructural evidence that miracidial morphogenesis is fully completed within the intrauterine eggs situated in the most posterior uterine regions of the pleurogenid trematode Brandesia turgida (Brandes, 1888). The ultrastructural characteristic of different larval organelles and cell types of these eggshell-enclosed, but fully formed, cilated miracidia is described. The body wall of the pyriform mature miracidium of B. turgida is composed of ciliated epidermis and underlying peripheral body musculature. Two miracidial flame cells of the protonephridial excretory system are localized in the central region of the ciliated larvae. Three types of miracidial glands were observed: a single apical gland, two lateral glands, and several small vesiculated glands; each gland type contains characteristic, but different types of secretory granules. The anterior end of each miracidium consists of an apical papilla on which are situated the exits of the three main larval glands: an exit of a single apical gland as well as the individual exits of two lateral glands. The exits of vesiculated glands, containing characteristic spherical membrane-bound and highly electron-dense granules, evidently different from the two other types of secretory granules of apical and lateral glands, were not identified. Germinative cells, grouped together in a sac-like germinative follicle, are situated in the medioposterior part of the larva, the germatophore. The germinative cells contain numerous electron-dense heterochromatin islands arranged in the form of a network or chain-like pattern and distributed mainly in the karyoplasm adjacent to the nuclear membrane. The thin layer of granular cytoplasm is rich in free ribosomes and contains a few small mitochondria. Both nuclear and cytoplasmic features if these cells indicate their great developmental potential for further growth and multiplication in postembryonic stages of the life cycle. In the mature eggs, the areas of focal cytoplasmic degradation were frequently observed and may be involved in the autolysis of some embryonic structures. Obtained results are compared with available literature data on the functional ultrastructure of the miracidia of other digeneans.