Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence:A case report

BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.     

Research on the Release of Dangerous Compounds from the BTEX and PAHs Groups in Industrial Casting Conditions

The assessment of the harmfulness of moulding and core sands is mainly based on investigations of compositions of gases emitted by liquid casting alloys during the mould pouring. The results of investigations of moulding sands obtained under industrial conditions are presented in this paper. A unique research stand was designed and built for this aim. It allowed us to determine emissions of gases at individual stages of casting a mass up to 50 kg. This approach enables simulation of foundry conditions. Moulding sands bound by organic binders (phenol-formaldehyde; furan), inorganic binders and green sand, were subjected to investigations. The composition of gases that evolved during the individual stages, pouring, cooling and knocking out, was tested each time, and the contents of Polycyclic Aromatic Hydrocarbons (PAHs) and benzene, toluene, ethylbenzene, and xylenes (BETX) were analysed. Investigations indicated that the emission of gases from sands with inorganic binders is negligible when compared with the emission of gases from sands with organic binders. The emission of gases from green sand is placed in the middle of the scale. As an example: the sand with furan resin emitted 84 mg of BTEX (in recalculation for 1 kg of sand) while from sands with inorganic binders there was a maximum of 2.2 mg (for 1 kg of sand). In the case of sands with inorganic binders, MI and MC sands indicated comparable and very low emissions of gases from the PAHs group, at the level of 0.018 mg and 0.019 mg for 1 kg of sand, respectively. The higher emission of PAHs from MG sand is the result of its different way of hardening (a binder was of an organic character) than of sands MI and MC.     

Ocena zależności między stosowaniem inhibitorów pompy protonowej a występowaniem uczulenia na wybrane alergeny pokarmowe

Proton pump inhibitors are considered to be highly selective and effective drugs, which have few side effects. They are used in both adults and children (including infants) as well as in pregnant women. By increasing the gastric fluid pH, they impair the activation process and reduce the secretion of pepsin, secretin and pancreatic proteases, thereby impairing protein degradation. The remaining peptides are immunoreactive and lead to the development of an allergic response, while the increased permeability of the gastrointestinal tract mucosa may also induce sensitization. Observational studies conducted in patients with gastroenterological disorders, children with allergy diseases and experimental studies in animals have demonstrated that the use of anti-ulcer drugs favours sensitization to selected food allergens.     

Visfatin serum concentration is associated with cardiac allograft vasculopathy in heart transplant recipients

Cardiac allograft vasculopathy (CAV) still is one of the most important limiting factors of long‐term survival following heart transplant (HT). This study aimed to investigate the association between proinflammatory adipokine‐visfatin and the incidence of CAV in HT recipients. After HT, 182 patients who had a follow‐up visit at the Transplantation Clinic between 2016 and 2017 were analyzed. The median age was 60.5 years, and 76.4% were men. The incidence of CAV was 54.9%. According to the multivariable proportional hazard regression analysis, visfatin level (1.795 [1.539‐2.094]; P < .001) was significantly associated with CAV, and statin use was protective against CAV (0.504 [0.32‐0.793]; P = .003). The area under the receiver operating characteristic curve indicated an excellent discriminatory power of visfatin (0.9548 [0.9281‐0.9816]) for CAV detection. The cutoff value of 5.42 ng/mL for visfatin yielded a sensitivity of 89% and specificity of 91%. This is the first study to demonstrate that visfatin serum concentrations are independently associated with the incidence of CAV in HT recipients. Visfatin allows for simple and cheap detection of CAV given its excellent discriminatory ability and high sensitivity and specificity. In addition, we have found an independent association between the statin use and a lower risk of CAV.     

Influence of Different Stages of Experimental Chronic Kidney Disease on Rats Locomotor and Postural Skeletal Muscles Microcirculation

Background. Chronic kidney disease (CKD) is associated with muscle excess fatigue and diminished maximal whole body oxygen consumption, which in part could be depended on poor muscle microcirculatory network. The aim of this study was to assume the influence of different stages of CKD on microcirculation vessels in functionally different skeletal muscles—locomotor, the gastrocnemius muscle, and postural, the longissimus thoracis muscle. Methods. Male Wistar rats underwent sham operation (CON), uninephrectomy (CKD 1/2) and subtotal nephrectomy (CKD 5/6). Muscle samples were stained for an alkaline phosphatase to differentiate capillaries. The number of capillaries was estimated by a single observer in 10 μm transverse sections by point counting at a magnification of ×125 using an Image Analysis System Q 500 MC of Leica. Blood pressure and serum creatinine, haptoglobin, MCP-1, VEGF, and PDGF were measured. Results. There were significant differences (p < 0.05) in CD (number of capillaries per 1 mm² of muscle tissue), C:F (capillary to fiber ratio), and CC/F (capillary contact per fiber). The CKD 1/2 group in gastrocnemius and longissimus muscle had 53% and 33% lower C:F; 56% and 33% lower CD; and 44% and 20% less CC/F than CON, respectively. The CKD 5/6 group in gastrocnemius and longissimus muscle had 46% and 20% lower C:F; 47% and 11% lower CD; and 48% and 25% less CC/F versus control, respectively. Blood pressure was higher in CKD 5/6 vs. CKD 1/2 and CON (145/95 vs. 107/87 and 119/77 mmHg, p < 0.05, respectively). CKD 5/6 had higher creatinine than CKD 1/2 and CON (1.22 vs. 0.83 and 0.74 mg/dL, p < 0.05, respectively). Haptoglobin was higher in CKD 1/2 and CKD 5/6 versus CON (1.68 and 1.63 vs. 0.70 mg/mL, p < 0.05, respectively). MCP-1 was higher in CKD 5/6 and CKD 1/2 versus CON (609 and 489 vs. 292 pg/mL, p < 0.05, respectively). There were no significant differences in serum growth factors concentration between groups. Conclusion. Capillary rarefaction is present in early stages of CKD. These changes are independent of blood pressure and progression of CKD. We suspected that muscle function has a big impact on microvasculature as capillaries rarefaction has been reduced more in locomotor than postural skeletal muscle.