Evaluating the influence of simultaneous inoculation of SiO2-alginate encapsulated bacteria and yeasts on volatiles, amino acids, biogenic amines and sensory profile of red wine with lysozyme addition

The influence of the timing of inoculation (sequential and simultaneous alcoholic fermentation (AF)/malolactic fermentation (MLF)) on the chemical and sensory properties of red wines was studied. The impact of the encapsulation of Oenococcus oeni into SiO₂-alginate hydrogel (Si-ALG) and the addition of lysozyme in wines inoculated with encapsulated bacteria were also analysed. There was a significant influence of the timing of inoculation on the volatile composition of the wines just as on the amino acid and biogenic amine content. The wines produced by simultaneous AF/MLF showed the highest contents of some volatile compounds, such as ethyl esters and terpenes, as well as amino acids and tyramine. Bacterial encapsulation affected the volatile and amino acid profile of the wines, while the biogenic amine composition was not modified. The chemical composition of the wines was not altered by the presence of lysozyme. A trained panel did not perceive substantial differences between treatments.

Highly Efficient Malolactic Fermentation of Red Wine Using Encapsulated Bacteria in a Robust Biocomposite of Silica-Alginate

Bacteria encapsulation to develop malolactic fermentation emerges as a biotechnological strategy that provides significant advantages over the use of free cells. Two encapsulation methods have been proposed embedding Oenococcus oeni, (i) interpenetrated polymer networks of silica and Ca-alginate and (ii) Ca-alginate capsules coated with hydrolyzed 3-aminopropyltriethoxysilane (hAPTES). On the basis of our results, only the first method was suitable for bacteria encapsulation. The optimized silica-alginate capsules exhibited a negligible bacteria release and an increase of 328% and 65% in L-malic acid consumption and mechanical robustness, respectively, compared to untreated alginate capsules. Moreover, studies of capsule stability at different pH and ethanol concentrations in water solutions and in wine indicated a better behavior of silica-alginate capsules than untreated ones. The inclusion of silicates and colloidal silica in alginate capsules containing O. oeni improved markedly their capacity to deplete the levels of L-malic acid in red wines and their mechanical robustness and stability.

Traumatic rupture of horseshoe kidney

We present the case of a 25-year-old male who came to the emergency room for pain and abdominal distension following trauma to the mesogastrium. A CT scan was performed, revealing a voluminous retroperitoneal hematoma with laceration of both inferior renal poles with regard to rupture of the isthmus of a horseshoe kidney. The patient presented anemization and increased pain, requiring selective embolization by means of arteriography of a branch of the right renal artery and placement of a double J stent due to urinary extravasation in the lower left kidney pole. Following 1 year of monitoring, the patient has maintained normal renal function. Renal affection in blunt abdominal trauma is frequent, occurring in 7% of previously pathological kidneys. The traumatic rupture of horseshoe kidney is facilitated by its particular anatomical characteristics, constituting an infrequent entity, knowledge of which is necessary to achieve conservative management that renders it possible to preserve renal function.

Randomized controlled trial of aspiration needle versus automated biopsy device for transjugular liver biopsy

PURPOSE

The efficacy and safety of transjugular liver biopsy used to obtain liver specimens in patients with coagulation disorders have been widely proven. However, histopathologic examination is not always possible because of fragmented samples provided by the aspiration technique. Recently, an automated device with a Tru-Cut-type needle was designed. In this randomized controlled trial, the use of this new device is compared with the traditional method in terms of efficacy and safety.

METHOD

Fifty-six patients were included in the study; 28 were randomized to undergo the aspiration technique and 28 were randomized to undergo the automated biopsy technique.

RESULTS

Correct positioning of the device was achieved in 93% of patients undergoing the aspiration technique and 96% of patients undergoing the automated biopsy technique (P = NS). Mean duration of the procedure and total number of passes were significantly higher in the aspiration needle group than in the automated device group (22.6 min +/- 12.6 vs 15.5 min +/- 9.4; P = .03, and 3.3 min +/- 1.9 vs 1.5 min +/- 0.63; P < .001, respectively). The number of portal tracts was significantly higher in the automated device group (4.7 +/- 2.5 vs. 2.7 +/- 3.4; P < .05). Adequate specimens for histopathologic evaluation were obtained in 26 patients in the automated device group and 24 patients in the aspiration needle group (92.8% vs 85.7%; P = NS), but a definite histopathologic diagnosis was more frequently obtained with the automated biopsy device (68% vs 43%; P = .05). No significant differences were observed in complication rates (7.14% vs. 10.7%; P = NS).

CONCLUSION

The automated biopsy device for transjugular liver biopsy is more effective than an aspiration needle in obtaining good samples for a definite histologic diagnosis.

Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliation

PURPOSE

To determine the effectiveness and safety of metallic stents in the treatment of malignant colorectal obstruction before surgery and for palliation.

MATERIALS AND METHODS

Eighty patients with acute malignant colorectal obstruction presumed to be malignant were treated by means of implanting self-expanding metallic stents.

RESULTS

Stent placement was successful in 70 of the 80 patients and resolved bowel obstruction in 67 patients (96%). Two patients had colonic perforation and developed peritonitis 18 and 24 hours after stent placement; one patient died as a consequence. Thirty-three patients underwent elective surgery after 7 days +/- 3 (SD; range, 4-10 days), and adequate tumoral coverage and cleansing of the colon were observed in all patients. Stent placement was used as final palliative treatment in another 35 patients. Patient follow-up lasted a mean of 138 days +/- 93 (range, 36-334 days). The survival rate for the palliative group was 55% at 3 months, 44% at 6 months, and 25% at 9 months. The estimated primary stent patency rate was 91% at 3 and 6 months.

CONCLUSION

Management of colorectal obstruction by using metallic stents was effective and safe, although colonic perforation is a potential complication. In cases of palliation, the method may obviate palliative colostomy.

[Prognostic factors for survival following transarterial chemoembolization in advanced hepatocellular carcinoma]

The efficacy of transarterial chemoembolization in the palliative treatment of non-resectable hepatocellular carcinoma is controversial. To determine the possible existence of clinical and analytical variables with independent predictive value for survival related to the tumor and the treatment given, a multivariate analysis in a series of 111 patients who underwent transarterial chemoembolization was carried out. Overall actuarial survival was 54%, 31% and 24% at 1, 2 and 3 years respectively. Child-Pugh score (p < 0.05), tumor size (p < 0.05) and arterial occlusion after intraarterial chemotherapy (p < 0.05) reached independent predictive value. The group of patients in whom two or three of these factors were simultaneously present had a very poor prognosis with a survival of 20% and 0% at 1 and 2 years respectively, compared with 60%, 50% and 37% at 1, 2 and 3 years respectively in the group with one or none of these factors (p < 0.01). Grouping on the basis of these variables may be useful in the design of future controlled prospective studies that aim to determine the efficacy of transarterial chemoembolization.

[Percutaneous intrahepatic portosystemic shunting in the treatment of veno-occlusive disease of the liver after bone marrow transplantation]

Veno-occlusive disease of the liver is a frequent cause of morbidity and mortality after bone-marrow transplantation. Its clinical manifestations are primarily related to the development of portal hypertension and sinusoidal congestion. The efficacy of the different therapeutic options used is controversial. We present a 22-year-old woman with veno-occlusive liver disease histologically confirmed after autologous bone-marrow transplantation, with progressive alteration in liver biochemistry and ascites. She was treated by percutaneous intrahepatic portosystemic shunting. After the procedure there was a marked improvement in ascites and an increase in diuresis with liver function progressively returning to normal. The safety and efficacy of this approach in the treatment of patients with veno-occlusive liver disease should be evaluated in controlled studies.

Urgent transjugular intrahepatic portosystemic shunt for control of acute variceal bleeding

OBJECTIVE

Endoscopic sclerotherapy and pharmacological therapy are widely used in the treatment of acute variceal hemorrhage. However, they fail at arresting acute bleeding in 20-30% of bleeding episodes. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the prevention of recurrent variceal bleeding has been proved recently, but the effectiveness and safety of urgent TIPS in the treatment of acute variceal bleeding refractory to conventional therapy are still under evaluation.

METHODS

Over 4.5 yr, 358 variceal hemorrhage episodes were treated in our hospital. Pharmacological and endoscopic therapy failed to control hemorrhage in 93 episodes. Thirty-two patients died because of uncontrolled massive bleeding. In 56 patients, TIPS (Strecker stent) was performed after temporary control of the episode with balloon tamponade.

RESULTS

Eleven of 56 patients with urgent TIPS belonged to Child-Pugh class A, 22 to class B, and 23 to class C. The mean time between indication and insertion was 17 +/- 10 h (range 4-24 h). Control of bleeding was achieved in 53 patients (95 %). Eight patients had recurrent bleeding at 1 month after TIPS, seven of them during the first week after the procedure. The 1-month actuarial probability of rebleeding was 22%. The main complications of the procedure were massive hemoperitoneum (n = 1), cardiorespiratory arrest (n = 2), cardiac failure (n = 1), acute renal failure (n = 2), and bacteremia (n = 7). Operative mortality (30 days) was 28%. The actuarial probability of survival at 30 days was significantly lower in Child-Pugh class C than in class A or B (48% vs 90%; p < 0.001). The presence of ascites, hepatic encephalopathy, and serum albumin level before TIPS were independent prognostic factors associated with the risk of operative mortality.

CONCLUSIONS

Urgent TIPS is an effective alternative for the treatment of acute variceal bleeding refractory to endoscopic and pharmacological therapy, but sometimes is associated with major complications. Because of the high operative mortality rate in patients with severe liver failure, careful selection of patients is required before TIPS.

Superior mesenteric arterial embolism: local fibrinolytic treatment with urokinase

PURPOSE

To evaluate the efficacy of intraarterial urokinase in the treatment of superior mesenteric arterial (SMA) embolism.

MATERIALS AND METHODS

Within 3 years, 10 patients (six men, four women; aged 62-82 years) with angiographically proved SMA emboli were selected on the basis of absence of peritoneal signs of intestinal necrosis at physical examination and normal abdominal plain radiographs to undergo local lysis with urokinase.

RESULTS

The procedure was performed without complications in all 10 patients. The embolus was successfully lysed in nine patients (90%). Clinical success was achieved in seven patients (70%); however, in one patient laparotomy was required to confirm the clinical finding. None of these patients had recurrent embolism or postischemic intestinal stenosis during follow-up (mean, 11.2 months). The three remaining patients (30%) underwent laparotomy subsequent to failure of intraarterial treatment with urokinase.

CONCLUSION

Fibrinolytic treatment with urokinase may be an effective alternative to surgical embolectomy in patients with SMA embolism without clinical or radiologic signs of intestinal infarction. In this small series, abatement of abdominal pain in the 1st hour of fibrinolytic treatment was the best indicator of clinical success. Pain persisted in patients with intestinal infarction.

Stenosis of the inferior vena cava after liver transplantation: treatment with Gianturco expandable metallic stents

PURPOSE

Evaluate the efficacy of double Gianturco expandable metallic stents for stenosis of the inferior vena cava (IVC) after orthotopic liver transplantation (OLT).

METHODS

Three patients developed severe Budd-Chiari syndrome secondary to suprahepatic caval stenosis after OLT. Percutaneous angioplasty (PTA) of the stenoses was unsuccessful. Therefore double Gianturco expandable metallic stents, connected in tandem, were deployed at the site of the stenoses.

RESULTS

One double stent was successfully and definitively deployed in patient 1. Partial dislocation of the upper and lower stents comprising the double stent occurred in patient 2. The double stent initially implanted across the stenosis became displaced in patient 3. The Budd-Chiari syndrome resolved in all three patients who remained asymptomatic during follow-up from 3 to 32 months.

CONCLUSIONS

Double Gianturco stent deployment is a viable option in patients with anastomotic stenosis of the IVC secondary to OLT when initial treatment with PTA fails. Certain modifications of the stents employed are suggested for the purpose of avoiding technical complications.

Variceal hemorrhage: efficacy of transjugular intrahepatic portosystemic shunts created with Strecker stents

PURPOSE

To evaluate the efficacy of transjugular intrahepatic portosystemic shunts (TIPS) in treatment of variceal hemorrhage.

MATERIALS AND METHODS

Forty-five patients with cirrhosis underwent TIPS placement for treatment of acute (n = 12) or recurrent (n = 33) variceal hemorrhage. Shunts were created with Strecker stents.

RESULTS

Shunts were established by deployment of stents in 42 patients. The portosystemic pressure gradient decreased from an average of 20.4 mm Hg +/- 5.4 to 9.2 mm Hg +/- 4.1. Complications included hepatic failure (n = 1), acute shunt thrombosis (n = 2), right jugular vein thrombosis (n = 1), bacteremia (n = 1), and stent misplacement (n = 1). Acute bleeding was controlled in 12 patients. The 30-day mortality rate was 2%; four other patients have since died. During follow-up (mean, 8.9 months), variceal bleeding recurred in six patients. Hepatic encephalopathy developed in six patients. Shunt stenosis or occlusion requiring further intervention occurred in 20 patients.

CONCLUSION

TIPS are safe and effective in treatment of variceal hemorrhage; however, secondary interventions are often required to preserve shunt function.