Attaching and effacing (A/E) lesion formation by enteropathogenic E. coli on human intestinal mucosa is dependent on non-LEE effectors.

Enteropathogenic E. coli (EPEC) is a human pathogen that causes acute and chronic pediatric diarrhea. The hallmark of EPEC infection is the formation of attaching and effacing (A/E) lesions in the intestinal epithelium.

The impact of ultra-radical surgery in the management of patients with stage IIIC and IV epithelial ovarian, fallopian tube, and peritoneal cancer.

Objective: The aim of this study is to estimate the percentage of patients with metastatic ovarian, fallopian tube, and primary peritoneal cancer requiring ultra-radical surgery to achieve cytoreduction to less than 1 cm (optimal) or no macroscopic residual disease (complete).

Methods: Perioperative data were collected prospectively on consecutive patients undergoing elective cytoreductive surgery for metastatic epithelial ovarian, fallopian tube, or primary peritoneal cancer at the Norfolk and Norwich University Hospital, a tertiary referral cancer centre in the United Kingdom from November 2012 to June 2016.

Results: Over a 42-month period, 135 consecutive patients underwent cytoreductive surgery for stage IIIC and IV ovarian, fallopian tube, or primary peritoneal cancer.

Lactobacillus reuteri Inhibition of Enteropathogenic Escherichia coli Adherence to Human Intestinal Epithelium.

Enteropathogenic Escherichia coli (EPEC) is a major cause of diarrheal infant death in developing countries, and probiotic bacteria have been shown to provide health benefits in gastrointestinal infections. In this study, we have investigated the influence of the gut symbiont Lactobacillus reuteri on EPEC adherence to the human intestinal epithelium. Different host cell model systems including non-mucus-producing HT-29 and mucus-producing LS174T intestinal epithelial cell lines as well as human small intestinal biopsies were used.

Recurrent chest wall abscesses overlying a pneumonectomy scar: an unusual presentation of a cholecystocutaneous fistula.

We report a case of recurrent chest wall abscesses overlying a right thoracotomy scar four years after a pneumonectomy for a right middle lobe bronchus squamous cell carcinoma. Exploration of the abscess cavities revealed no intra-thoracic or intra-abdominal communication. The patient developed sinuses in his thoracotomy scar and two years later, two gallstones were expelled from these sinuses.

Bimodal electric tissue ablation: positive electrode studies.

Background: Bimodal electric tissue ablation is a novel variation to standard radiofrequency ablation that produces significantly larger ablations by the addition of a direct electrical current. The negative electrode is attached to the radiofrequency current and the positive electrode is placed nearby. It has been identified that an electrolytic injury can occur at the positive electrode site.

Bimodal electric tissue ablation-long term studies of morbidity and pathological change.

Background: Radiofrequency ablation is a popular method of treating unresectable liver tumors but tumors greater than 3 cm in diameter have a much greater risk of local recurrence after treatment. Bimodal electric tissue ablation is a modified form of radiofrequency ablation that creates significantly larger ablations by the addition of extra direct current circuitry. This may help to reduce the risk of local recurrence in these larger tumors.

Bimodal electric tissue ablation-modified radiofrequency ablation with a le veen electrode in a pig model.

Radiofrequency ablation (RFA) is a method of treating non-resectable liver tumors by use of a high-frequency alternating electrical current. Concerns have been raised as the local recurrence rates following treatment have been reported to be as high as 47%. The size of the ablation is limited by charring of adjacent tissues.

Laparoscopic distal pancreatectomy for lymphoepithelial cyst of the pancreas.

Lymphoepithelial cysts are rare pancreatic lesions. This case report describes the first excision of such a lesion by laparoscopic distal pancreatectomy which is a recognized procedure for treatment of cystic pancreatic neoplasms. Our patient underwent complete excision of the lesion and has enjoyed complete resolution of his symptoms.

Local ablation for unresectable liver tumors: is thermal best?

Hepatic resection remains the "gold standard" for patients with resectable disease. Nevertheless, for a variety of reasons this is not feasible for the majority of patients. A wide range of locally ablative techniques has been developed for use in these patients with the aim of improving survival.

Is laparoscopic intraoperative cholangiogram a matter of routine?

Background: Intraoperative cholangiography during laparoscopic cholecystectomy reveals the anatomy of the biliary tree and any stones contained within it. The use of intraoperative cholangiography may be routine for all laparoscopic cholecystectomy. An alternative approach is a selective policy, performing intraoperative cholangiography only for those cases in which choledocholithiasis is suspected on clinical grounds, or those for which the anatomy appears unclear at operation.

Subtotal hepatectomy: a porcine model for the study of liver regeneration.

Background: This study aimed to devise a simple, reproducible method of subtotal hepatectomy in a large animal model. Such an experimental model could be useful in the investigation of liver regeneration and liver insufficiency after partial hepatectomy. Equally, this technique could be used for assessing the effect of artificial liver support systems on both liver function and regeneration.

The lack of a systemic inflammatory response syndrome supports the safety of pancreatic electrolysis: experimental studies.

Background: Per-ductal pancreatic electrolysis is a new minimally invasive ablation treatment. Possible applications include tumor debulking and treatment of chronic pancreatitis. Both solid organ ablation and pancreatitis are associated with the risk of an overwhelming systemic inflammatory response syndrome (SIRS) and multiorgan failure.

Unusual case of Morgagni hernia associated with malrotation.

Morgagni herniae are rare congenital diaphragmatic hernia, which normally present late in adult life with minimal symptoms. They are always associated with a peritoneal hernial sac, and often contain transverse colon or stomach. We present an unusual case of a Morgagni hernia containing caecum in an 81-year-old woman, post ruptured aortic aneurysm repair.

Bioartificial liver support devices: historical perspectives.

Fulminant hepatic failure (FHF) is an important cause of death worldwide. Despite significant improvements in critical care therapy there has been little impact on survival with mortality rates approaching 80%. In many patients the cause of the liver failure is reversible and if short-term hepatic support is provided, the liver may regenerate.

The value of laparoscopic staging for patients with colorectal metastases.

Background: Resection offers the only chance of cure for hepatic colorectal metastases. However, preoperative staging does not always reliably detect unresectable disease. The aim of this study was to investigate the role that laparoscopy with ultrasound may have in detecting unresectable disease, thus sparing patients from unnecessary laparotomy with the associated morbidity and cost.

Postoperative colonic perforation in a right-sided congenital diaphragmatic hernia in an adult.

Congenital posterolateral hernias rarely present in the adult. We describe an unusual case that presented after a routine total abdominal hysterectomy. The patient developed acute respiratory symptoms caused by a perforated colon and hypoplastic right hemi-liver contained within a right-sided hernia.

Surgical management of intractable pain in chronic pancreatitis: past and present.

The surgical management of pain in patients with chronic pancreatitis continues to provide a formidable challenge. Despite recent advances in the area of the pathophysiolgical cause of the symptoms of chronic pancreatitis there is still controversy as to the exact mechanisms that result in pain in both large and small duct disease. In addition, the surgical community has very polarized views as to the correct management of these patients.

Management dilemmas with choledochal cysts.

Context: Choledochal cysts are rare and of unknown cause. Their presentation is protean, with the classical triad of pain, jaundice, and mass rarely seen. The potential complications are serious, including pancreatitis, cholangitis, and cholangiocarcinoma.

Experimental studies of serum cytokine concentration following pancreatic electrolytic ablation.

Background: Pancreatic cancer has a poor prognosis, with symptomatic palliation being the priority in the majority of cases. Alternative palliative techniques, such as local ablation, are under investigation. Palliative per-ductal electrolytic ablation of the pancreas has been reported, in an experimental series.

Electrolytic ablation as an adjunct to liver resection: Safety and efficacy in patients.

Background: Electrolytic ablation is a relatively new method for the local destruction of colorectal liver metastases. Experimental work in animal models has shown this method to be safe and efficacious. However, before proceeding to clinical trials it was necessary to confirm these findings in a pilot study of five patients.

Management of liver trauma with implications for the rural surgeon.

Background: The majority of patients with liver trauma can be managed conservatively. However, the unstable patient requires emergency laparotomy to control bleeding. Controversy exists regarding the primary surgical management of these injuries.

Color coding of sutures in laparoscopic perforated duodenal ulcer: a new concept.

A simple modification for securing the omental patch during laparoscopic oversewing of perforated duodenal ulcers is presented. This new concept uses color coding of sutures to prevent confusion and suture "cut-out" during the tie-over of the omental patch. The concept of suture color-coding may be applicable to other laparoscopic procedures where identification of "suture pairs" is difficult.

Electrolysis and other local ablative treatments for non-resectable colorectal liver metastases.

The present paper is a review of the current ablative treatment options for the treatment of colorectal liver metastases. Cryotherapy, microwave coagulation therapy, radiofrequency ablation and laser-induced thermotherapy are discussed. Electrolysis, a novel non-thermal ablative treatment, is described.

Islet yield remains a problem in islet autotransplantation.

For patients with chronic pancreatitis whose pain is inadequately controlled with opiate analgesia, surgical resection offers a good chance of symptomatic relief. However, the inevitable sequela is type 1 diabetes mellitus and its attendant long-term complications. Islet cell autotransplantation offers a theoretical "cure" for this iatrogenic diabetes but this end point has not been produced consistently in clinical practice.