Free Fluids Research Articles

From granulite fluids to quartz-carbonate megashear zones: The gold rush

At peak granulite-facies metamorphic conditions, lower continental crust is arguably fluxed by large amounts of two key low water activity fluids: (i) high-density CO2 and/or (ii) concentrated saline solutions. These fluids are either internally-derived, generated by mineral reactions or dehydration melting or, notably for CO2, externally-derived, issued from the underlying mantle. Postmetamorphic evolution results in complete disappearance of these fluids, except for minute remnants preserved in minerals as fluid inclusions. Two major processes are involved: (i) at peak conditions, granitoid magmas form, migrate upward, and crystallize as shallow intrusions in the upper crust (mineralized porphyry types or reduced intrusions); (ii) during the rapid decompression which almost systematically follows a period of post-peak isobaric cooling, especially for ultrahigh-temperature granulites (anticlockwise P-T paths), quartz-carbonate megashear zones are formed by repeated periods of seismic activity. Seismic activity may continue until all free fluids have disappeared, resulting in the ultramylonites and pseudotachylites that are found in many granulite domes. A great majority of vein-type Au deposits worldwide occur in the above-mentioned settings or nearby. We suggest that the Au has been scavenged by the granulite fluids, then redistributed and concentrated during the formation of veins and related phenomena.

English

Malathion degrading bacteria were isolated from a soil sample. Growth of mono and co-cultured strains of Pseudomonas in media containing the organophosphate insecticide, malathion as sole source of carbon was employed to assess degradability of the bacteria. On the seventh day of inoculation, bacteria free culture fluids as well as un-inoculated fluids were analyzed by gas chromatography and mass spectrometry (GC-MS). Malathion was not detected in the cell free culture fluids, instead four degradation products namely phoratoxon sulfone, malaoxon, butanedioic acid and ethyl methyl-methyl phosphonate made their appearance in the cultivation culture. All of the three strains used in this study, appeared efficient in degrading the insecticide especially in co-culturing conditions. These bacteria are promising for detoxifying the insecticide contaminated soils. Key words: Pseudomonas, detoxification, malathion.

How good is fine needle aspiration? What results should you expect?

Tissue acquisition plays a key role before treatment decision in most of oncological pathologies but also in several benign diseases. By offering tissue sampling, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become an essential tool in the diagnostic processes. One of the reasons for the success of the technique is related to its excellent diagnostic performance. The diagnostic accuracy of EUS-FNA is above 80% for most of the usual indications. These performances are however dependent on some factors related to both the disease and patient's medical history but also related to medical staff expertise. Endoscopist needs to know how to reach a lesion but also how to efficiently acquire good tissue samples. This review aims to report general recommendations available in the literature for high quality EUS-FNA. Sample processing and sample interpretation also influence diagnostic accuracy of FNA. This paper includes a discussion on sample processing and benefits of the on-site pathology examination. It also provides the results reported in the literature of sample adequacy and diagnostic performance of EUS-FNA for most common indications: Pancreatic diseases, sub-mucosal lesion, mucosal thickenings, lymph nodes, cystic lesion and free fluids.

Intravenous fluids for reducing the duration of labour in low risk nulliparous women

Intravenous fluids for reducing the duration of labour in low risk nulliparous women

P-0274 - Short-Term Outcomes of Single-Port Low Anterior Resection for Colorectal Cancers: a Comparative Study

Background: Single-port laparoscopic surgery was designed to maximize the advantages of minimal invasive surgery. However, no comparative study has been reported on this concept. Methods: Prospectively collected data of patients who had undergone either conventional laparoscopic lower anterior resection (LAR) (n = 49) or single-port LAR (n = 31) for colorectal cancers between March 2006 and June 2011, were analyzed retrospectively. Results: In single-port LAR, comparable lymph nodes could be attained (23.9 ± 14.9), and sufficient proximal and distal cut margins were secured (proximal cut margin: 10.9 ± 5.5 cm, distal cut margin: 5.1 ± 2.6 cm). Clinically, single-port LAR resulted in shortening of operation time (256 min versus 310 min; P = 0.015), lesser requirement of intra-operative PRC transfusion (6.5 per cent versus 44.9 per cent, P = 0.000), shortened duration to first flatus (2.0 days versus 3.2 days; P = 0.001), earlier initiation of free oral fluids (2.8 days versus 5.1 days) and soft diet (4.6 days versus 7.1 day), and shorted hospital stay (10.7 days versus 15.4 days). Conclusion: This study shows that single-port LAR is both safe and feasible in colorectal cancers, if performed by a surgeon who is good at conventional laparoscopic surgery, with a requirement of a short-term learning period. Furthermore, if single-port is subsequently supported by favorable, at least not inferior, long-term oncologic results, it could be one of the standard procedures for colorectal cancers.

Appendix Not Seen

Acute appendicitis is the most prevalent emergency surgical diagnosis in children. Although traditionally a clinical diagnosis, the diagnosis of acute appendicitis is uncertain in approximately 30% of pediatric patients. In attempts to avoid a misdiagnosis and facilitate earlier definitive care, imaging modalities such as ultrasonography have become important tools. In many pediatric studies, the absence of a visualized appendix with no secondary sonographic features has been reported as a negative study result, and a study where the appendix is not seen but demonstrates secondary features is often deemed equivocal. With ultrasound appendiceal detection rates reported at 60% to 89%, the dilemma of the nonvisualized appendix or equivocal study is frequently faced by clinicians. This study aimed to assess the value of the nonvisualized appendix on ultrasound and the association of secondary sonographic findings in pediatric patients with acute right lower quadrant pain undergoing ultrasound, in whom acute appendicitis was a diagnostic consideration. Retrospective case review of 662 consecutive children (age < 18 years) presenting to a pediatric emergency department with clinically suspected appendicitis, who had graded compression sonographic studies during the 24-month study period, was performed. The appendix could not be visualized in 241 studies (37.7%). An alternate diagnosis was identified via sonography in 47 patients (19.5%). Twenty-five patients (12.9%) were taken for surgery where 17 (8.8%) had acute appendicitis confirmed via pathology. The specificity of moderate-to-large amounts of free fluid is 98%, phlegmon at 100%, pericecal inflammatory fat changes at 98%, and any free fluids with prominent lymph nodes at 81%. The odds ratio of appendicitis increases from 0.56 to 0.64 to 2.3 and 17.5, respectively, when there were 2 and 3 ultrasonographic inflammatory markers identified. Although uncommonly seen, large amounts of free fluid, phlegmon, and pericecal inflammatory fat changes were very specific signs of acute appendicitis. In the absence of a distinctly visualized appendix, the presence of multiple secondary inflammatory changes provides increasing support of a diagnosis of acute appendicitis.

Characterizing the Main Himalayan Thrust in the Garhwal Himalaya, India with receiver function CCP stacking

We use common conversion point (CCP) stacking of Ps receiver functions to image the crustal structure and Moho of the Garhwal Himalaya of India. Our seismic array of 21 broadband seismometers spanned the Himalayan thrust wedge at 79–80°E, between the Main Frontal Thrust and the South Tibet Detachment, in 2005–2006. Our CCP image shows the Main Himalayan Thrust (MHT), the detachment at the base of the Himalayan thrust wedge, with a flat-ramp-flat geometry. Seismic impedance contrasts inferred from geologic cross-sections in Garhwal imply a negative impedance contrast (velocity decreasing downward) for the upper flat, located beneath the Lower Himalaya, and a positive impedance contrast (velocity increasing downward) for the ramp, located beneath the surface trace of the Munsiari Thrust (or MCT-I). At the lower flat, located beneath the Higher Himalaya, spatially coincident measurements of very high electrical conductivities require the presence of free fluids, and we infer a negative impedance contrast on the MHT caused by ponding of these fluids beneath the detachment. Our seismic image indicates that the upper flat of the MHT is ∼10km below sea level and dips north at ∼2°, connecting to a mid-crustal ramp which is ∼10km high and dips at ∼16°. The lower flat is 20–25km below sea level and dips at ∼4°. The Main Central Thrust (MCT) appears as a negative impedance contrast, dipping at ∼16°. The Moho is nearly horizontal at 35–45km depth beneath the Sub-Himalaya and Lower Himalaya, deepening to 50km or more beneath the Higher Himalaya. This depth is 10–25km shallower than in the NW Indian Himalaya and 5–10km shallower than in central Nepal, requiring significant along-strike variations in crustal thickness. The observed thickness of subducted Indian crust in Garwhal is 20–28km.

Fe(II)-Mediated Reduction and Repartitioning of Structurally Incorporated Cu, Co, and Mn in Iron Oxides

The reduction of trace elements and contaminants by Fe(II) at Fe(III) oxide surfaces is well documented. However, the effect of aqueous Fe(II) on the fate of redox-active trace elements structurally incorporated into iron oxides is unknown. Here, we investigate the fate of redox-active elements during Fe(II)-activated recrystallization of Cu-, Co-, and Mn-substituted goethite and hematite. Enhanced release of Cu, Co, and Mn to solution occurs upon exposure of all materials to aqueous Fe(II) relative to reactions in Fe(II)-free fluids. The quantity of trace element release increases with pH when Fe(II) is present but decreases with increasing pH in the absence of Fe(II). Co and Mn release from goethite is predicted well using a second-order kinetic model, consistent with the release of redox-inactive elements such as Ni and Zn. However, Cu release and Co and Mn release from hematite require the sum of two rates to adequately model the kinetic data. Greater uptake of Fe(II) by Cu-, Co-, and Mn-substituted iron oxides relative to analogues containing only redox-inactive elements suggests that net Fe(II) oxidation occurs. Reduction of Cu, Co, and Mn in all materials following reaction with Fe(II) at pHs 7.0-7.5 is confirmed by X-ray absorption near-edge structure spectroscopy. This work shows that redox-sensitive elements structurally incorporated within iron oxides are reduced and repartitioned into fluids during Fe(II)-mediated recrystallization. Such abiotic reactions likely operate in tandem with partial microbial and abiotic iron reduction or during the migration of Fe(II)-containing fluids, mobilizing structurally bound contaminants and micronutrients in aquatic systems.

The Moho in subduction zones

Abstract The Moho in subduction zones exists in two distinct forms, one associated with the subducting oceanic plate and second with the overriding plate. The seismic expression of both forms is linked to the nature of a landward dipping, low-velocity zone (LVZ) that has been detected in a majority of subduction zones about the globe and that approximately coincides with Wadati–Benioff seismicity. We review seismic studies that constrain the properties of the LVZ in Cascadia where it has been extensively studied for over a quarter century. A model in which the LVZ is identified with hydrated pillow basalts and sheeted dikes of oceanic crustal Layer 2, is consistent with available geological and geophysical data, and reconciles previously conflicting interpretations. In this model, the upper oceanic crust is hydrated through intense circulation at the ridge and becomes overpressured upon subduction as a result of metamorphic dehydration reactions combined with an impermeable plate boundary above and a low porosity gabbroic Layer 3 below. The resulting seismic velocity contrast (approaching 50% for S-waves) significantly overwhelms that of a weaker, underlying oceanic Moho. At greater depths, oceanic crust undergoes eclogitization in a top-down sense leading to gradual disappearance of the LVZ. The large volume change accompanying eclogitization is postulated to rupture the plate boundary allowing fluids to penetrate the cooled, forearc mantle wedge. Pervasive serpentinization and free fluids reduce velocities within the wedge, thereby diminishing, erasing or even inverting the seismic contrast associated with the Moho of the overriding plate. This model is tested against observations of LVZs and forearc mantle structure worldwide.

New geoelectrical characterisation of a continental collision zone in the West-Central Pyrenees: Constraints from long period and broadband magnetotellurics

Continental collision dominates the development of a large number of mountain ranges on Earth. Although the geological evolution of these regions is highly studied, lithospheric-scale physical processes are less well characterised and their interpretations frequently differ. A new magnetotelluric profile crossing the West-Central Pyrenees with broadband and long period magnetotelluric data constrains the geoelectrical features of this continental collision zone confining the geological and physical processes that take place at a lithospheric scale. Three geoelectrical structures associated with partial melting and its melt migration are imaged for the first time in the West-Central Pyrenees suggesting an Iberian subducted lower crust reaching the depth of 70km. This result, supported by an analysis of the thermal evolution of the Iberian subducted lower crust, reinforces the hypothesis of partial melting in this region. From the long period magnetotelluric data, the asthenosphere has been imaged as a geoelectrical structure with electrical resistivity values between 20Ωm and 70Ωm. The lithosphere–asthenosphere boundary close to the collision zone has been constrained between 90km and 110km depth below the Iberian plate and between 120km and 160km depth below the transition zone between plates and the European plate, in agreement with the previous geophysical data. Additionally, other geoelectrical anomalies imaged have been associated with an unexpected major Variscan boundary located below the Ebro basin, Silurian sediments and free fluids in the Gavarnie thrust, and with a thick sequence of Jurassic and Early Cretaceous sediments situated below the North Pyrenean Thrust Sheet.

Components for improved lithium battery systems: pressure regulation and fluid control

An essential characteristic of battery systems used in automotive and industrial applications is their long-term durability. One thing that has to be prevented is the occurrence of free fluids inside the battery system. This can be caused by leakage and by the “breathing interaction” between the battery housing and its surrounding environment – leading to condensation of air humidity forming inside the battery housing. This article describes approaches to pressure regulation of battery systems and to reducing and/or preventing fluids from occurring inside them.

The Short-term Outcomes of Conventional and Single-port Laparoscopic Surgery for Colorectal Cancer

The aim of this study was to show the safety and feasibility of single-port laparoscopic surgery (SPLS) by comparing its short-term outcomes with those following conventional laparoscopic surgery. Single-port laparoscopic surgery maximizes the advantages of laparoscopic surgery, and therefore it can be an ultimate attainment of laparoscopic surgery. However, no comparative study has addressed its role in colorectal cancer. Prospectively collected data of patients who had undergone either conventional laparoscopic surgery (n = 106) or SPLS (n = 73) for colorectal cancer between March 2006 and May 2010 were analyzed retrospectively. The short-term outcomes of these 2 operative modalities were compared. Of the 179 study subjects, 103 (57.5%) had colon cancer and 76 (42.5%) had rectal cancer. Various operative methods, from right hemicolectomy to abdominoperineal resection, were used according to location through either conventional laparoscopic or SPLS approach. In its comparison, mean surgical time was greater in the SPLS group (255 vs 276 minutes, P < 0.008). Acquired length of sufficient surgical margins and the number of harvested lymph nodes were comparable. Postoperative recovery was faster in the SPLS group, in terms of shorter time duration before first flatus (SPLS vs conventional laparoscopic surgery; 2.5 ± 1.2 vs 3.2 ± 1.8 days, P = 0.004), earlier initiation of free oral fluids (1.8 ± 2.2 vs 2.6 ± 1.7 days, P = 0.000) and of a solid diet (4.2 ± 2.9 vs 6.5 ± 2.7 days, P = 0.000), less frequent usage of parenteral narcotics (2.2 ± 3.2 vs 3.5 ± 4.0 times, P = 0.029), and shorter hospital stay (9.6 ± 9.6 vs 15.5 ± 9.8 days, P = 0.000). This study shows that SPLS is both safe and feasible in colorectal cancer, and that it has equivalent or better short-term outcomes than conventional laparoscopic surgery. Accordingly, the authors conclude that SPLS can be an alternative to conventional laparoscopic surgery for colorectal cancer.

Shear driven two-phase flows in vertical cylindrical duct

Experiments and numerical simulations were carried out for shear-driven two-phase flows in a confined volume of liquid under conditions of normal gravity. The geometry corresponds to a cylindrical liquid bridge surrounded by a concentric annular gas channel with external solid walls. The internal part consists of solid supports at the bottom and top, while the central part is a liquid zone filled with a viscous liquid and kept in its position by surface tension. Gas enters into the annular duct, flows between solid walls and upon reaching the liquid zone entrains initially quiescent liquid. The flow dynamics is governed by the Navier–Stokes equations in both fluids, which are numerically solved in the exact experimental geometry taking into account interface deformation by gravity. In the experiments 5 cSt silicone oil and air were used as test fluids and the flow was monitored by means of particle tracking velocimetry. The experiments were performed for unit aspect ratio (the ratio of liquid zone length to its radius), while the simulations of shear-driven flow were carried out for a wide range of parameters. A particular attention is focused on the effect of free surface shape and fluids viscosity contrast on the interfacial flow dynamics. The current study suggests a linear dependence between velocities of gas and liquid when the viscosity of the liquid is larger by two orders of magnitude than that of gas. Another relation is proposed when the fluids viscosity ratio, μ l / μ g , is less than 50.

D-foam-induced flavor condensates and breaking of supersymmetry in free Wess-Zumino fluids

Recently we argued that a particular model of string-inspired quantum space-time foam (D-foam) may induce oscillations and mixing among flavoured particles. As a result, rather than the mass-eigenstate vacuum, the correct ground state to describe the underlying dynamics is the flavour vacuum, proposed some time ago by Blasone and Vitiello as a description of quantum field theories with mixing. At the microscopic level, the breaking of target-space supersymmetry is induced in our space-time foam model by the relative transverse motion of brane defects. Motivated by these results, we show that the flavour vacuum, introduced through an inequivalent representation of the canonical (anti-) commutation relations, provides a vehicle for the breaking of supersymmetry (SUSY) at a low-energy effective field theory level; on considering the flavour-vacuum expectation value of the energy-momentum tensor and comparing with the form of a perfect relativistic fluid, it is found that the bosonic sector contributes as dark energy while the fermion contribution is like dust. This indicates a strong and novel breaking of SUSY, of a non-perturbative nature, which may characterize the low energy field theory of certain quantum gravity models.

Correlation of Histology and Dynamic Tissue Perfusion Measurement (DTPM) of the Colonic Wall in Ulcerative Colitis (UC)

Purpose: At present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn’s disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard. Material & Methods: We recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts’ score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids). Results: B-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT . 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (. 2.5 mm) was the only B-US characteristic significantly (P , 0.0001) and independently (OR 5 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR. Conclusion: B-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy.

Ultrasonographic Detection of Early Post-Surgical Recurrence in Crohn's Disease

PurposeAt present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn's disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard.Material & MethodsWe recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts' score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids).ResultsB-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT > 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (> 2.5 mm) was the only B-US characteristic significantly (P < 0.0001) and independently (OR = 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR.ConclusionB-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy. PurposeAt present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn's disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard. At present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn's disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard. Material & MethodsWe recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts' score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids). We recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts' score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids). ResultsB-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT > 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (> 2.5 mm) was the only B-US characteristic significantly (P < 0.0001) and independently (OR = 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR. B-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT > 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (> 2.5 mm) was the only B-US characteristic significantly (P < 0.0001) and independently (OR = 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR. ConclusionB-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy. B-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy.

Zweizeitige traumatische Ruptur der Ovarialarterie nach Hochrasanztrauma

Rupture of the Arteria ovarica is a rare but life-threatening injury and occurs primarily in pregnancy. Most previously described ruptures of the Arteria ovarica were in the early postpartum period and in women who were older than 45 years. We report on a two-stage rupture of the Arteria ovarica after a high energy trauma, which has not previously been described in the literature. A 66-year-old female patient was admitted to the emergency room after a car accident. Initial treatment was performed in a regional hospital. Initial clinical and radiological examinations were without any pathologies and the patient was discharged home after ambulatory treatment. Six days later, the patient was referred to our hospital because of increasing headache. A computed tomography of the head showed a subdural haematoma. A follow-up CT scan after three days showed no further progression of the haematoma. During the hospital stay, the patient developed abdominal pain, nausea and cardiovascular decompensation. An ultrasound of the abdomen showed free fluids, while a performed CT scan of the abdomen confirmed an arterial bleeding from a pseudoaneurysm of the left ovarian artery. An emergency operation was performed. Postoperative management included ICU monitoring, diuresis control and blood transfusion. The patient was discharged home after 19 days in a good condition. The indication for performing a CT scan and primary hospitalisation after a high energy trauma should be applied generously.

P.1.90: THE ACCURACY OF THE BIOSCANNER TRIMPROB, A NON-INVASIVE TOOL, FOR THE DIAGNOSIS OF COLON CANCER. A DOUBLE-BLIND PROSPECTIVE STUDY

4.4 years, surgical recurrence was observed in 10 cases (9%). US recurrence occurred in 77 cases (75%) after 1.3 years (95%CI 1.1-1.6) and was associated to clinical recurrence (p=0.0004). Median bowel wall thickness was 4.5 mm (95%CI 4.1-5). The best cut-off to predict clinical recurrence was >4.6 mm (AUC 0.655, sensitivity 59%, specificity 63%). US characteristics of the population are listed in the Table. Clinical recurrence was associated to increased wall thickness (p=0.0284), mesenteric hypertrophy (p=0.0461), PowerDoppler signal (p=0.0284), but not to echopattern (p=0.228), presence of stenoses (p=0.9719), fistulae (p=0.4928), abscesses (p=0.6371), enlarged lymphnodes (p=0.2155) or free fluids (p=0.6891). At logistic regression the only US characteristic (p=0.01) associated to clinical recurrence was bowel wall thickness (p=0.0178, OR=2.66, 95%CI 1.18-5.97).

Enhanced recovery is feasible in bariatic patients: Early outcomes of enhanced recovery following laparoscopic roux-en-y gastric bypass

Enhanced recovery is feasible in bariatic patients: Early outcomes of enhanced recovery following laparoscopic roux-en-y gastric bypass

Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution

IntroductionAs even small concentrations of acetate in the plasma result in pro-inflammatory and cardiotoxic effects, it has been removed from renal replacement fluids. However, Plasma-Lyte 148 (Plasma-Lyte), an electrolyte replacement solution containing acetate plus gluconate is a common circuit prime for cardio-pulmonary bypass (CPB). No published data exist on the peak plasma acetate and gluconate concentrations resulting from the use of Plasma-Lyte 148 during CPB.MethodsThirty adult patients were systematically allocated 1:1 to CPB prime with either bicarbonate-balanced fluid (24 mmol/L bicarbonate) or Plasma-Lyte 148. Arterial blood acetate, gluconate and interleukin-6 (IL-6) levels were measured immediately before CPB (T1), three minutes after CPB commencement (T2), immediately before CPB separation (T3), and four hours post separation (T4).ResultsAcetate concentrations (normal 0.04 to 0.07 mmol/L) became markedly elevated at T2, where the Plasma-Lyte group (median 3.69, range (2.46 to 8.55)) exceeded the bicarbonate group (0.16 (0.02 to 3.49), P < 0.0005). At T3, levels had declined but the differential pattern remained apparent (Plasma-Lyte 0.35 (0.00 to 1.84) versus bicarbonate 0.17 (0.00 to 0.81)). Normal circulating acetate concentrations were not restored until T4. Similar gluconate concentration profiles and inter-group differences were seen, with a slower T3 decay. IL-6 increased across CPB, peaking at T4, with no clear difference between groups.ConclusionsUse of acetate containing prime solutions result in supraphysiological plasma concentrations of acetate. The use of acetate-free prime fluid in CPB significantly reduced but did not eliminate large acetate surges in cardiac surgical patients. Complete elimination of acetate surges would require the use of acetate free bolus fluids and cardioplegia solutions.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000267055