Gallstone ileus caused by a gallstone impacted at a cecum neoplasm - A case report

BACKGROUND

Gallstone ileus is an infrequent complication of biliary disease that produces a mechanical intestinal obstruction. It is caused by a gallstone passing through a bilio-digestive communication, usually a cholecystoduodenal fistula. The presence of neoplasms can decrease the bowel lumen size and may cause the gallstone to impact at the narrowing site.

CASE SUMMARY

In this report, we present a unique case of gallstone ileus due to a gallstone impacted in a cecum tumor, causing obstruction at the level of the ileocecal valve. The patient needed an urgent right hemicolectomy to solve both his problems. The gallbladder and the enterobiliary fistula remained in situ.

DISCUSSION

The clinical presentation is not always straightforward and sometimes the diagnosis is only made by imaging, mostly resorting to an abdominal CT. The mainstay of management is surgical relief of the gastrointestinal obstruction, with the surgical method being based on what is found intra-operatively and according to the patient general condition.

CONCLUSION

Although a rare disease, gallstone ileus should be suspected in elderly patients with intestinal obstruction and a previous history of biliary problems, keeping in mind that other conditions may be present and can alter the surgical treatment of choice.

Massive gastric dilation caused by gastric outlet obstruction in the setting of peptic ulcer disease-A case report

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Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer disease.

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We present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery due to perforation.

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We present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery.

Background

The prevalence of Peptic Ulcer Disease has decreased as did its elective surgical treatment, however its complications continue to occur.

Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer disease.

Case summary

In this report, we present a case of massive gastric dilation due to gastric outlet obstruction, that needed emergency surgery due to perforation. A subtotal gastrectomy with a Billroth II reconstruction was performed.

Discussion

Usually non-operative management is tried first, with medical therapy and endoscopic dilation. Emergent surgery is rarely needed, but in this patient, despite trying to optimize his condition first, the ulcer perforation precipitated surgical management.

Conclusion

Although Gastric Outlet Obstruction is the least frequent complication of Peptic Ulcer Disease and usually non-operative treatment is tried first, surgery may be necessary.

Ultra-processed food consumption and its effects on anthropometric and glucose profile: A longitudinal study during childhood

BACKGROUND AND AIMS

Obesity and insulin resistance development are related to known risk factors (such as diet) that begin in childhood. Among dietary factors, the consumption of ultra-processed foods has received attention. The present study investigated the association between ultra-processed foods consumption at preschool age and changes in anthropometric measurements from preschool to school age and glucose profile at school age.

METHODS AND RESULTS

The present study was a follow-up of a randomized controlled trial, conducted with 307 children of low socioeconomic status from São Leopoldo, Brazil. At ages 4 and 8 years, children's anthropometric assessments were collected from preschool to school age including body-mass index (BMI) for-age, waist circumference (WC), waist-to-height ratio (WHtR) and skinfold. At the age 8 years, blood tests were performed to measure glucose profile. Dietary data were collected through 24-h recalls and the children's ultra-processed food intake was assessed. Linear regression analysis was used to assess the relationship between ultra-processed food consumption and the outcomes. The percentage of daily energy provided by ultra-processed foods was 41.8 ± 8.7 (753.8 ± 191.0 kcal) at preschool age and 47.8 ± 8.9 (753.8 ± 191.0 kcal) at school age, on average. The adjusted linear regression analyses showed that ultra-processed food consumption at preschool age was a predictor of an increase in delta WC from preschool to school age (β = 0.07; 95%CI 0.01-0.14; P = 0.030), but not for glucose metabolism.

CONCLUSION

Our data suggest that early ultra-processed food consumption played a role in increasing abdominal obesity in children. These results reinforce the importance of effective strategies to prevent the excessive consumption of ultra-processed foods, especially in early ages.

Exploring physical and chemical properties in new multifunctional indium-, bismuth-, and zinc-based 1D and 2D coordination polymers

Main group element coordination polymers (MGE-CPs) are important compounds for the development of multifunctional materials. However, there has been a shortage of studies regarding their structural, optical, catalytic, mechanical, and antibacterial properties. This work presents an exhaustive study of a set of crystalline MGE-CPs obtained from bismuth and indium metals and iminodiacetate, 1,2,4,5-benzenetetracarboxylate, and 2,2'-bipyridine as building blocks. An in-depth topological analysis of the networks was carried out. Additionally, nanoindentation studies were performed on two representative low-dimensional compounds in order to find the relationships between their structural features and their intrinsic mechanical properties (hardness and elasticity). The solid-state photoluminescence (SSPL) properties were also studied in terms of excitation, emission, lifetimes values, and CIE chromaticites. Moreover, the heterogeneous catalytic activities of the compounds were evaluated with the cyanosilylation reaction using a set of carbonylic substrates under solvent-free conditions. Finally, the inhibitory effect of the Bi-CPs on the growth of microorganisms such as Escherichia coli, Salmonella enterica serovar Typhimurium, and Pseudomonas aeruginosa, which are associated with relevant infectious diseases, is reported.

Circulating concentrations, cerebral output of the CINC-1 and blood–brain barrier disruption in Wistar rats after pneumococcal meningitis induction

Pneumococcal meningitis is a severe infectious illness of the central nervous system (CNS), with high rates of lethality and morbidity, being that the microorganism and the host's inflammatory response are responsible for cerebral complications. Moreover, the blood–brain barrier (BBB) itself secretes cytokines and, because of the bipolar nature of the BBB, these substances can be secreted into either the CNS compartment or in the blood, so patients with acute bacterial meningitis frequently develop sepsis. Therefore, the aim of this study was to evaluate the cytokine/chemokine levels in different vessels and the BBB integrity after pneumococcal meningitis induction. Wistar rats were infected with Streptococcus pneumoniae, and the BBB integrity was investigated using Evan's blue dye. Also, blood from the carotid artery and jugular vein was collected in order to perform tumour necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-6 (IL-60 and cytokine-induced neutrophil chemoattractant-1 (CINC-1) analyses by enzyme-linked immunosorbent assay (ELISA). CINC-1 levels were increased at 6 h in the arterial plasma and at 3 and 6 h in the jugular plasma. We observed BBB breakdown between 12 and 24 h in the hippocampus and at 12 and 18 h in the cortex after pneumococcal meningitis induction. The increase of CINC-1 occurred prior to the BBB breakdown. CINC-1 is a neutrophil chemoattractant and it may be related to early events in the pneumococcal meningitis pathophysiology.

CaPrx, a Coffea arabica gene encoding a putative class III peroxidase induced by root-knot nematode infection

Class III peroxidases (Prxs) are enzymes involved in a multitude of physiological and stress-related processes in plants. Here, we report on the characterization of a putative peroxidase-encoding gene from Coffea arabica (CaPrx) that is expressed in early stages of root-knot nematode (RKN) infection. CaPrx showed enhanced expression in coffee roots inoculated with RKN (at 12 h post-inoculation), but no significant difference in expression was observed between susceptible and resistant plants. Assays using transgenic tobacco plants harboring a promoter-β-glucuronidase (GUS) fusion revealed that the CaPrx promoter was exclusively active in the galls induced by RKN. In cross sections of galls, GUS staining was predominantly localized in giant cells. Up-regulation of GUS expression in roots of transgenic plants following RKN inoculation was observed within 16 h. Moreover, no increase in GUS expression after treatment with jasmonic acid was detected. Altogether, these results point to a putative role of this peroxidase in the general coffee response to RKN infection.

P2-13-11: Follow Up of BRCA1/2 Carriers: The Spectrum of Cancer Diagnoses in Healthy at Risk Individuals (HTR), and in Cancer Survivors (CS)

Introduction and Objective: Data from long term follow up of BRCA1/2 carriers is scarce and is mainly related to BRCA1 women. Our multidisciplinary program targets both women and men for counselling towards BRCA1/2 screening and inclusion in clinical follow up. In here we review all cancer diagnoses observed in our BRCA1/2 cohort during follow up.

Methods: Review of individual records of BRCA1/2 carriers registered from January 2000 to December 2010. Follow up was calculated since BRCA1/2 post-test counselling until the last visit to the Clinic. All new cancer diagnoses and preventive surgeries were registered.

Results: Two-hundred and fifty nine BRCA1/2 carriers (206 females and 53 males) were diagnosed with BRCA1/2 mutations (42 BRCA1 and 217 BRCA2). Medium follow up for all population is 25 months (1-98). At the date of initial BRCA1/2 diagnosis 99 women and 14 men were CS.

Female population: Eighty-eight female CS had been previously diagnosed with breast cancer (18 bilateral cases), 18 with ovarian cancer, and 1 with biliary tract cancer. Preventive surgeries in the CS female population were: bilateral adnexectomy (33 pts) and prophylactic contralateral mastectomy (10 pts). In this CS female population, new cancers, during follow up were: Contralateral breast cancer (4 cases), peritoneal cancer (2 cases in pts with previous prophylactic surgery) and skin non-melanoma cancers (2 cases). In female HTR, 23 preventive bilateral adnexectomies and 20 bilateral mastectomies were performed. Cancer diagnoses during follow up were: breast (11), peritoneum (1 in a pt with previous prophylactic surgery), gastric (1) and M3 leukemia (1). Global failure of prophylactic adnexectomy, so far (CS+HTR): 3/56 (5%).

Male population: The medium age for male CS is 73 yrs and for male HTR is 52 yrs. Male CS had mostly been previously diagnosed with BC (12; 4 bilateral) and prostate cancer (4). Other previous cancers: gastric (2), skin (2: 1Melanoma, 1 non-Melanoma), colorectal (1). One BRCA2 man with gynecomastia and prostate cancer was submitted to reduction mastectomy, as a preventive surgery. During follow up, we diagnosed second and third cancers in male CS: breast (2), prostate (6) and gastric (1). Only 1 male HTR was diagnosed with cancer: skin non-melanoma.

Conclusion: The proportion of second and third cancer diagnoses in the male BRCA2 CS population is higher than in the female BRCA1/2 CS population. Small numbers and the availability of preventive surgery for women influence this observation. No data from preventive mastectomy exists for males (we have one case). The low frequency of cancer in male HTR may be due to younger age and other unknown modifier factors. Longer follow is needed.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-13-11.

Role of the ftsA1p promoter in the resistance of mucoid mutants of Salmonella enterica to mecillinam: characterization of a new type of mucoid mutant

Mucoid mutants of Salmonella enterica serovar Typhimurium isolated by resistance to mecillinam include lon (27%) and rcsC (8%) mutants but the most frequent class (65%) is affected in a new gene (mucM) located at centisome 76. mucM cells are shorter than mucM+ cells and rcsB mutations normalize size and response to mecillinam. Expression of ftsA1p, the ftsA-ftsZ promoter submitted to RcsB stimulation, is greatly increased in mucM mutants, and this expression is dependent on RcsB and ftsA1p. It is proposed that the mucM product interferes with RcsB activation. Mucoidy results from the activation of cps genes and mecillinam resistance from ftsA-ftsZ overexpression, both traits caused by the increased activity of the RcsB effector. The same mechanism seems to be responsible for the resistance of mucoid rcsC mutants to mecillinam but the resistance of lon mutants is not dependent on RcsB and so responds to a different cause.

Surgical treatment of lung metastases: prognostic factors for long-term survival

BACKGROUND AND OBJECTIVES

Surgical resection of lung metastases is an established therapy for a large number of primary tumors, but there is some controversy about prognostic factors for long-term survival.

METHODS

From 1968 to 1996, we performed a retrospective review of a series of 85 patients (100 operations) that have been operated for resection of lung metastases. The Kaplan-Meier method was used to estimate the probabilities of survival, the log-rank test for the univariate analysis of prognostic factors for survival, and the Cox model in the subsequent multivariate analysis.

RESULTS

The operative mortality was 4% and the morbidity 18%. The mean follow-up after lung resection was 22.13 months (1-146). The actuarial 5-year survival rate was 29.2%. By univariate analysis, the following factors were associated with survival after resection: location and histology of the primary tumor, greatest dimension of the largest metastasis, radicality of the resection, involvement of the resection margins, and use of adjuvant therapy (P < 0.05). After multivariate analysis, only the dimension of the metastases and involvement of surgical margins have been found to be independently associated with survival.

CONCLUSIONS

Surgical excision is a safe and effective therapy for lung metastases from a large number of primary tumors, provided a complete resection is feasible.

Conditional lethality of cell shape mutations of Salmonella typhimurium: rodA and mre mutants are lethal on solid but not in liquid medium

Round-cell (rodA, mre, divD) derivatives of a conditional alaS mutant of Salmonella typhimurium were studied under conditions allowing expression of tolerance to lethal cell shape mutations (41 degrees C), and under nontolerant conditions (30 degrees C). The rodA22::Tn10d(Kan) derivative grew normally (OD650 nm) in LB-broth at 30 degrees C; however, doubling of total cell count took much longer (130 min) than at 41 degrees C (57 min). Although the cells were able to divide in LB-broth at 30 degrees C, viable count on LB-agar at 30 degrees C was 10(3)-fold lower than on LB-agar at 41 degrees C. Phase-contrast microscopy of rodA cells incubated under different conditions showed that their size increased on LB-soft agar at 30 degrees C, but they failed to divide and finally lysed. In contrast, division occurred in LB-broth at 30 degrees C and also in LB-broth and LB-soft agar at 41 degrees C. The mre-17::Tn10d(Kan) derivative acted like the rodA strain whereas the divD135::Tn10d(Kan) mutant behaved normally both at 30 degrees C and 41 degrees C. It is concluded that rodA and mre mutations delay cell division, but are lethal only on solid medium. Mutations conferring tolerance to "lethal" rodA and mre mutations improve division performance both in liquid and solid media.

Deficiency of alpha-actinin-3 (ACTN3) occurs in different forms of muscular dystrophy

The alpha-actinins belong to a superfamily of cytoskeletal proteins, and their role in human genetic diseases is still unclear. Therefore, they could be good candidates for muscular dystrophies of unknown etiology. We have analyzed alpha-actinin-3 (ACTN3) in muscle biopsies from a total of 54 patients. A complete deficiency was found in 9 patients: 2/12 with classical merosin-positive congenital MD (CMD), 1/12 with Severe Childhood Autosomal Recessive MD (DLMD), but with a positive IF pattern for the proteins of the sarcoglycan complex: 3/14 with mild limb-girdie MD (1LGMD2A and 2 yet unclassified), 1/10 with sarcoglycanopathies (LGMD2C), and 2/6 with Xp21 Duchenne MD (DMD). Patients within the same family, and with the same disease (DMD, LGMD2A, LGMD2C), were discordant for ACTN3 deficiency. Additionally, no correlation was found with the degree of muscle degeneration, nor with the clinical course. One ACTN3-deficient CMD patient showed no mRNA expression for the muscle ACTN3 gene, but the other ACTN3-deficient patients with different forms of muscular dystrophy showed very low or no mRNA expression as well. These results show that the deficiency of ACTN3 is a secondary effect in these dystrophies.

[The curative surgery of periampullary tumors. The results of 48 resections]

Periampullary tumors form a clinical entity with common symptoms, similar therapeutic options, unsatisfactory resectability rates and unfavorable prognosis. From April 1970 until March 1994, one hundred and twenty-seven patients with periampullary carcinoma were operated by our surgical team. In 48 of these patients, a resection for cure was performed (38%). Resectability rates varied according to the origin of these tumors, i.e., pancreas-20%, ampulla-76%; distal bile duct-71%, periampullary duodenum-88%. Pancreatic tumors showed a different resectability rate from the other periampullary carcinomas (p = 0.04). Forty-two of these patients had a pancreatoduodenectomy and in the remaining 6 cases a total pancreatectomy was performed. Fifteen patients had major post-operative morbidity (31%) and 8 of these cases died in-hospital (17%). Follow-up data was available in 81% of the patients, survival estimates were calculated according to the Kaplan-Meier method and survival comparisons were made with the Log-rank test. Median survival for resected pancreatic carcinoma was 6 months and for resected tumors of the ampulla 37 months. In this group of patients, pancreatic tumors showed a different survival rate from the remaining periampullary tumors (Log-rank-p = 0.002). This work evidences the need to improve management of periampullary tumors, particularly in-hospital mortality and long-term survival. To achieve these goals, patients with periampullary tumors should be treated in specialized centers and research to improve local and systemic control of this disease should be pursued.

Curative surgery for gastric cancer: study of 166 consecutive patients

From January 1980 to December 1991 we operated on 295 patients with a gastric carcinoma. In 166 cases (56.3%) surgery was performed with curative intent. In 93 patients (56%) a subtotal gastrectomy was performed, and in 73 cases (44%) a total gastrectomy. In all the cases a D-2 type lymphadenectomy was used. The global morbidity rate was 23%, and in-hospital mortality was 3.6%. The morbidity and mortality rates of these two operations were statistically different. Global 5-year survival estimate for the whole series is 61.3%. Univariate and multivariate analysis according to T and N (TNM classification), the number of positive nodes resected, and the relation of positive per resected nodes, revealed statistically different outcomes. This kind of quantitative classification allowed identification of high risk groups irrespective of site of nodal involvement. Tumors classified as intestinal or diffuse type by the Lauren classification had similar survival curves and 5-year survival estimates (p = 0.834). By univariate and multivariate analysis this classification did not reveal a prognostic value in this group of patients. In our opinion, tumor penetration and lymph node involvement are at present the most reliable prognostic factors available.

[Palliative surgery in carcinoma of the stomach. Retrospective study of 112 consecutive cases]

From January 1980 until October 1991 we operated 112 patients with Gastric cancer in which Surgery was considered palliative by intra-operative criteria or by pathological analysis of the resected specimen. Locally irresectable tumour was found in 24.1% of the cases, peritoneal metastases (mets.) in 21.4%, liver mets. in 17%, lymphatic mets. in 16.1%, and other mets. in 21.4%. Resections were possible in 57 patients (50.8%), with a mortality rate of 10.5%, which was similar to the mortality in the non-resection group (7%) p = 0.2. Median survival for the entire group was 7 months, the non-resection group had a median survival of 4 months, and the resection group of 18 months (p = 6.480 e-0.7). Locally advanced tumors had a better outcome than the metastatic group (p = 0.05), but no difference was observed between patients with liver or peritoneal mets. Patients in stage 3 and 4 of the disease had a different prognosis (p = 0.03), and the resection group within each stage fared better.

Round-cell mutants of Salmonella typhimurium produced by transposition mutagenesis: lethality of rodA and mre mutations

Thirty-three insertions of transposon Tn10 delta 16 delta 17 into genes involved in the control of rod cell shape were isolated in Salmonella typhimurium by the characteristic glossy appearance of colonies composed of spherical cells. Genetic tests demonstrated that 25 (76%) were insertions in the rodA gene, 7 (21%) were mre mutants, and 1 (3%) was a divD mutant. No insertion in the pbpA gene were found. Insertions in cell shape genes only appeared when strains displaying resistance to mecillinam (not caused by beta-lactamase production) were employed. Neither rodA nor mre insertions could be transduced to wild-type strains but they were normally accepted by mecillinam-resistant derivatives and by cya and crp mutants, which, unlike the corresponding Escherichia coli strains, did not display resistance to mecillinam. On the other hand, the divD insertion could be efficiently transduced to any strain. It is concluded that the rodA, mre, and divD genes are involved in the control of rod cell shape but, in addition, the RodA and Mre products perform some function(s) that is essential for wild-type cells but dispensable for some mecillinam-resistant strains, and for cya and crp mutants.