Oil Content, Fatty Acid and Phenolic Profiles of Some Olive Varieties Growing in Lebanon

Olive growing in Lebanon plays an important role at both a social and economic level. Nevertheless, the quality of olive oil produced in the country is rarely addressed. In this study, oil content, fatty acid, and phenolic profiles were studied along four different ripening stages for 11 varieties of olives, including two clones of the local variety “Baladi,” in addition to nine foreign varieties (“Ascolana Tenera,” “Bella di Cerignola,” “Itrana,” “Jabaa,” “Kalamata,” “Nabali,” “Salonenque,” “Sigoise,” and “Tanche”). Oil content was determined using the Soxhlet method and Abencor system. Fatty acid composition was determined using a GC-FID, total phenols using spectrophotometry, and the phenolic profile using HPLC-DAD. Results showed that variety, fruit ripening and their interaction have a significant effect on the overall studied oil parameters. Among the studied varieties, “Kalamata” presented the higher oil content on dry matter (OCDM = 48.24%), “Baladi 1” the highest oil content on humid matter (OCHM = 27.86%), and “Tanche” the highest oil industrial yield (OIY = 19.44%). While “Tanche” recorded the highest C18:1 (71.75%), “Ascolana Tenera” showed the highest total phenols (TP = 539 mg GAE/Kg of oil), “Salonenque” the highest oleacein (121.57 mg/Kg), and “Itrana” the highest oleocanthal contents (317.68 mg/Kg). On the other hand, oil content together with C18:2 and C18:0 increased along ripening while C18:1, total phenols and the main individual phenols decreased. Although preliminary, this study highlights the good quality of olive oil produced from both local and foreign varieties growing in Lebanon and encourages further investigations on the characterization and authentication of Lebanese olive oil.

A case report on a left sided gallbladder: A rare finding during cholecystectomy

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Cholecystectomy is a common procedure increasingly performed in the day surgery setting.

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A true left sided gallbladder is a rare finding. Retrospective studies suggest a prevalence of 0.1–0.7%.

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Exact aetiology and pathway for its anatomical variation is has yet to be determined.

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It can be associated with number of other structural variation affect the biliary system the knowledge of which is paramount in hepatobiliary surgery.

Introduction

Cholecystectomy is the surgical removal of gallbladder for symptomatic gallstones disease or where exist the risk of gallbladder malignancy. Its performed routinely across the globe often as day surgery. In this case report, we describe an incidental intra operative finding of a left sided gallbladder creating a technical challenge for the surgeon.

Case

We describe the case of 35 year old female who presented with RUQ pain. Ultrasound examination revealed gallstones. Intraoperative findings during routine cholecystectomy were of a left sided gallbladder. The surgical procedure in performing laparoscopic surgery required an extra port placement for safe and effective dissection.

Discussion

The finding of left sided gallbladder is a rare congenital anomaly and has a prevalence of 0.1–0.7%. A true left sided gallbladder is one that is found to the left of the ligamentum teres and falciform ligament and the cystic artery always crosses in front of the CBD from right to left. There are various abnormalities associated this anatomical variant from abnormality of the biliary tree to the porto-venous anatomy. Failure to recognise these variations can lead to serious complications especially in hepatobiliary surgery.

Conclusion

The finding of left sided gallbladder is an abnormality which is often discovered intraoperatively. It may provide the surgeon with operative challenges in performing the surgery safely and increase the incidence of morbidity. If there is any clinical suspicion of the presence of a left sided gallbladder, pre-operative CT angiography and/or intraoperative cholangiography should be performed to minimise the risk of intraoperative complications.

Pheochromocytoma: A Cause of Anemia

Patients with a Pheochromocytoma usually present with intractable hypertension, postural hypotension, headaches and palpitations, with intractable hypertension being the predominant symptom. When the tumor is located in the urinary bladder, symptoms may be induced by micturition. Herein, we report a young patient with a urinary bladder Pheochromocytoma without hypertension or symptoms induced by micturition. Instead, she presented with anemia.

Patient and graft outcome in current era of immunosuppression: a single centre pilot study

OBJECTIVES

The present single centre study aims at analyzing the impact on renal allograft outcome of the important changes which occurred in the transplant population and immunosuppressive therapy during the last two decades.

METHODS

From 2000 to 2013, 779 single kidney transplantations were performed on 635 patients who all received on an intent-to-treat basis steroids, a calcineurin inhibitor, mycophenolate mofetil and an induction therapy with either antithymocyte globulin or an antagonist directed to the interleukin (IL)-2 receptor. Uni- and multivariate analyses of patient and immunologic graft survival were conducted.

RESULTS

The sole factor predicting patient survival is recipient's age: 10-year survival rates are 94·7, 81·6 and 57·9% for the <45, 45-60 and >60 years age groups, respectively (P<0·001). Peak (>50% panel reactive antibodies) anti-human leucocyte antigens (HLA) sensitization, cold ischaemia time and HLA-B and -DR mismatches (MM) influence graft outcome: at 10 years, the difference in 10-year survival rates is 5·9% between grafts from sensitized and not sensitized patients (90·9 vs 96·8%, P = 0·002), 3·8% between grafts with <18 and ≧18 hours cold ischaemia (96·6 vs 92·8%, P = 0·003), 7·3% between grafts with no MM and either B or DR MM versus those with B and DR MM (96·8 vs 89·5%, P = 0·002).

CONCLUSION

In our single centre experience, graft survival was most strongly determined by HLA matching, offering excellent long term graft outcome to most patients.

Mucin lakes or perforation?

We are reporting two cases with similar appearances on post chemo radiotherapy MRI scan of the mucinous adenocarcinoma. There was high signal on T2-weighted sequences of the mucin pools within and beyond the rectal wall. Does this imply that wall tissues become less resistant to cancer pools intrusion after chemo radiation? Does the high intramural pressure have an impact on the protrusion of the cancer pools beyond the muscularis propria?

Final histology reports differ from predicted MRI staging. It highlights the difficulty of the final MRI staging and outcome for mucinous adenocarcinomas. The presence of acellular mesothelial reaction, acellular mucin pools and inflammation extending to the serosal surface causes considerable confusion and may result in over staging or under staging of mucinous adenocarcinoma.

Pathogenesis and prediction of the mucin lakes behaviour prior and post chemoradiotherapy is unclear and requires future study but may impact surgical management.

Infiltration of Wounds and Extraperitoneal Space with Local Anesthetic in Patients Undergoing Laparoscopic Totally Extraperitoneal Repair of Unilateral Inguinal Hernias: A Randomized Double-Blind Placebo-Controlled Trial

Background:

The potential analgesic benefit of infiltration of the wounds and extraperitoneal space with local anesthetic in patients undergoing laparoscopic totally extraperitoneal (TEP) repair of inguinal hernias remains unclear.

Methods:

Consenting adults scheduled to undergo laparoscopic TEP repair of unilateral inguinal hernias were recruited to this randomized double-blind placebo-controlled clinical trial of 0.25% bupivacaine (group I) versus saline (group II) infiltration of abdominal wounds and the extraperitoneal space. Pain scores were assessed at 4 and 24 hours postoperatively using the short-form MCGill pain questionnaire (SF-MPQ), the Present Pain Index (PPI) score and the visual analogue scale (VAS). The intravenous and oral analgesic requirements were recorded. Each patient completed questionnaire to assess their satisfaction with the postoperative analgesia.

Results:

40 patients were randomized (group I, n = 20; group II, n = 20). The two groups were comparable for age, gender, body mass index, and operating time. Minor complications occurred in one patient in each group. There were no significant differences in the postoperative SF-MPQ scores, PPI and VAS at 4 hours (p = 0.413, p = 0.631, p = 0.615 respectively) and 24 hours (p = 0.116, p = 0.310, p = 0.100 respectively) post-operatively. The parenteral and oral analgesics consumed post-surgery were comparable (p = 0.605, p = 0.235). No difference was observed in the patient satisfaction scores.

Conclusions:

Infiltration of abdominal wounds and extraperitoneal space with bupivacaine in patients undergoing laparoscopic TEP repair of unilateral inguinal hernias does not appear to offer analgesic benefits.

[Why screening for a renal artery stenosis?]

Diagnosis of renal artery stenosis (RAS) should be discussed in numerous clinical situations including refractory high blood pressure (HBP), HBP in a polyvascular patient, degradation of renal function following renin angiotensin inhibitor or flash pulmonary edema. Ultrasound-doppler coupled with gadolinium-enhanced MR or CT angiography has proven adequate for most patients with RAS. Digital subtraction angiography should be limited to revascularisation procedures. Functional testing are not sensitive or specific enough because the degree of renin activation differs widely among patients with RAS. Renal percutaneous angioplasty induces a light to moderate decrease in blood pressure, has no effect on renal function but allows to reduce the number of anti-hypertensive drugs. Stenting completed angioplasty is worthwhile in most patients with atherosclerotic RAS. ACE inhibitors decrease mortality and increase renal function in patients with RAS.

Why wait for a colonoscopy? An easy cure

OBJECTIVE

Three thousand five hundred and forty-nine patients are waiting for a colonoscopy in the Kent and Medway cancer network. New guidelines identify those who require surveillance for polyp, cancer, IBD and family history. Our hypothesis was that most of the patients on the waiting list would no longer need a colonoscopy if the new guidelines were applied.

PATIENTS AND METHODS

We compared the ACPGBI guidelines for screening/surveillance colonoscopy with the indications in 411 notes of one hospital's waiting list and removed patients as appropriate. In the second part of study we analysed 192 patients attending colonoscopy in seven hospitals in the region and calculated the potential impact of the guidelines on our waiting lists.

RESULTS

Of 411 patients on the waiting list in one hospital, only 98 (24%) needed to remain on the list. 142 (34%) were cancelled completely. One hundred and seventy-one (42%) were taken off the 'waiting' list and rebooked for a later date since according to the new guidelines the colonoscopy was not due yet. Of 192 colonoscopies actually performed during the study period in 7 hospitals of Kent and Medway cancer network, 72 (38%) were for surveillance. Two thirds of those were not in line with the guidelines. As a result of implementing the guidelines, waiting times for diagnostic colonoscopy fell from 12 to 4 weeks for urgent, and from 40 to 15 weeks for routine referrals.

CONCLUSION

A quarter of the 8000 colonoscopies performed annually in our region are unnecessary when compared to the guidelines. More than three quarters of our waiting list could be removed by reviewing the notes. Implementing the guidelines in one cancer network would save pounds 1 million per year even on conservative estimates of pounds 500 per colonoscopy. It would also reduce the waiting times for diagnostic colonoscopy.