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Background: The date palm cultivation has a long history in Bushehr province. Throughout the recent decade; the dusts, in addition to direct harmful effects on humans, have adverse effects on health of the population living in this area. The infestation of pests in the southern province of Bushehr has groves. Due to the importance of dates in this area, the total ash and acid insoluble ash as indexes for assessing of chemical pollution and also, mold and yeast as indicators for microbial contamination were evaluated. Recently in a number of dates packaging industries, washing the products after the harvest is done. In current study, the effects of rinsing to decrease the dust pollution on date palm along with, the time effect on the quality and durability of washed and un-washed dates were investigated. Materials and Methods: Overall, 48 washed and un-washed dates were sampled from traditional and technologically advanced packaging industries, equally, and were confirmed according to ISIRI methods. Results: The Averages of total and acid insoluble ashes in washed date samples were:1.05±0.14 and 3.32±0.32%, and for un-washed samples were 1.36±0.27 and 4.59±1.64 percent, respectively. In all date samples were presented the yeast, however, their means were lower than the maximum limit (1 x 104 CFU). Also, all date samples were moldy. The Mean percentage of total ash samples in un-rinsed and rinsed dates were approximately, 1.84 and 1.33 times more than the maximum permissible limit, respectively. The mean of acid insoluble ash in all samples (100%), and 98% of total ash were higher than acceptable levels (p<0.05). The results revealed that the average percentage difference between the two groups were transpicuous, while this difference was not significant (p=0.13). Under the similar conditions, the average amount of yeast in washed date samples, were significantly different (p<0.05) and more than un-wash samples. The Mold levels in un-rinsed and rinsed samples; were 83.3 and 75% higher than the maximum permissible limit. According to the results, regardless of a decrease in amount of molds in washed samples than un-wash samples, the rinsing, was unable to eliminate the pollution, or even decreased it to acceptable levels. Conclusion: According to the findings, present rinsing is not an appropriate method for long storage. Observations, after one year upkeep in the same conditions, expressed that all un-washed date samples were apparently healthy, without any pests and insects. While 91.6% of the washed samples were insectivores, also their textured appearances were very unpleasant. [ABSTRACT FROM AUTHOR]

Background: Evidence on the value of minimally invasive pancreatic surgery (MIPS) has been increasing but it is unclear how this has influenced the view of pancreatic surgeons on MIPS., Methods: An anonymous survey was sent to members of eight international Hepato-Pancreato-Biliary Associations. Outcomes were compared with the 2016 international survey., Results: Overall, 315 surgeons from 47 countries participated. The median volume of pancreatic resections per center was 70 (IQR 40-120). Most surgeons considered minimally invasive distal pancreatectomy (MIDP) superior to open (ODP) (94.6%) and open pancreatoduodenectomy (OPD) superior to minimally invasive (MIPD) (67.9%). Since 2016, there has been an increase in the number of surgeons performing both MIDP (79%-85.7%, p = 0.024) and MIPD (29%-45.7%, p < 0.001), and an increase in the use of the robot-assisted approach for both MIDP (16%-45.6%, p < 0.001) and MIPD (23%-47.9%, p < 0.001). The use of laparoscopy remained stable for MIDP (91% vs. 88.1%, p = 0.245) and decreased for MIPD (51%-36.8%, p = 0.024)., Conclusion: This survey showed considerable changes of MIPS since 2016 with most surgeons considering MIDP superior to ODP and an increased use of robot-assisted MIPS. Surgeons prefer OPD and therefore the value of MIPD remains to be determined in randomized trials., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

In Argentina there are no multicenter studies evaluating the management of patients with acute pancreatitis (AP) nationwide., Objectives: The main objective of this study is to know how the patients with AP are treated in Argentina. The secondary objective is to assess whether the results comply with the recommendation of the American College of Gastroenterology Guide., Material and Methods: Twenty three center participated in the study. They include in a database hosted online consecutive patients with acute pancreatitis from june 2010 to june 2013., Results: 854 patients entered the study. The average age was 46.6 years and 495 (58%) belonged to the female sex. The most common cause (88.2%) of AP was biliary. Some prognostic system was used in 99 % of patients and the most used was Ranson (74.5%). Were classified as mild 714 (83.6%) patients and severe 140 (16.4%). Systemic complications occurred in 43 patients and local complications in 21. 86 patients underwent dynamic CT scans and 73 patients had pancreatic and / or peripancreatic necrosis. Mortality was 1.5%. There was no difference in mortality in relation to the size, complexity or affiliation of the center. The comply of key recommendations of the American College of Gastroenterology Guide was over 80%., Conclusions: The diagnosis and treatment of patients with AP in 23 health centers located throughout the country was optimal. The management complied with most of the recommendations of the American College of Gastroenterology Guide.

Introduction: Approximately 80% of patients with pancreatic cancer are not candidates for curative resection at the time of diagnosis. The objective of this study is to show that although endoscopic treatment is the standard palliation, surgical laparoscopic treatment is both feasible and effective for these patients., Materials and Methods: Preoperative resectability was evaluated by dynamic contrast-enhanced computed tomography scans. Endoscopic palliation was the first choice for patients with metastatic disease and for patients with locally advanced pancreatic cancer with bad performance status. Laparoscopic surgical palliation was indicated for patients with jaundice and locally advanced pancreatic cancer (elective palliation) and for patients with jaundice with metastatic disease and failure in the endoscopic/percutaneous treatment (necessary palliation). Elective palliation consisted of Roux-en-Y hepaticojejunostomy and gastrojejunostomy and necessary palliation consisted of laparoscopic hepaticojejunostomy alone., Results: A total of 48 patients received laparoscopic surgical palliation. Morbidity rate was 33.3% and mortality was 2.08%. There was no need for late surgeries in any of the patients., Conclusion: Surgical laparoscopic palliation is a feasible treatment option for locally advanced pancreatic cancer. Even though metallic stents are still the best palliation method for patients with systemic disease, if stents fail, the laparoscopic approach is a viable treatment.

A 34-year-old female patient presented with fever and right flank pain ten days after uncomplicated vaginal delivery. CT examination revealed right ovarian vein thrombosis and methicillin-resistant Staphylococcus aureus (MRSA) was isolated from blood cultures. No other source of bacteremia was found. Antibiotic therapy and anticoagulation with enoxaparin were instituted. Fourteen days after admission, she was discharged in good condition. Although a very uncommon complication after spontaneous vaginal delivery, septic ovarian vein thrombophlebitis should be suspected in cases of persistent puerperal fever when other diagnostic possibilities have been excluded.

Introduction: Distal pancreatectomy with spleen preservation and splenic vessel excision is a commonly used technique. However, it produces significant gastrosplenic circulation and splenic function changes., Purpose: The aim of this work was to determine the immediate consequences on gastrosplenic circulation, late consequences on splenic function, and development of varicose veins., Methods: Thirty-five patients with pancreatic tumors and anatomical feasibility were included. Preoperative splenic circulation was evaluated by dynamic contrast-enhanced computed tomography (CT) scans. Early splenic perfusion was assessed by CT 7 days after surgery and late changes in gastrosplenic circulation 6 months after surgery. Varicose veins were evaluated by CT and endoscopy 6 months after surgery. Pitted cells and Howell-Jolly bodies were used as markers of splenic function. Postoperatory findings included changes in splenic perfusion 7 days and 6 months after surgery, development of varicose veins on CT scans and endoscopy, and detection of markers of splenic hypofunction on blood smears., Results and Conclusion: Seven days after surgery, 63% of patients had some degree of splenic hypoperfusion, and 6 months after surgery, 83% of patients had normal perfusion. CT scans showed varices in 26 patients, and endoscopy revealed varicose veins in 11. Two patients experienced bleeding; markers of splenic hypofunction were found in 59% of cases.

A contained open abdomen is commonly used during damage control laparotomy and consists of the temporary coverage of the abdomen for protection of the viscera and reduction of intra-abdominal pressure. Definitive closure of a contained open abdomen is technically difficult due to the inability to obtain primary fascial suture. The insertion of a prosthetic mesh can be complicated with enterocutaneous fistula, and other definitive closure techniques need several surgical procedures. We describe a low cost technique that allows definitive closure of large abdominal wall defects avoiding the risk of intestinal fistula., ((c) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Unlabelled: This prospective study aimed at evaluating dynamic computed tomography (CT) as a prognostic indicator of local complications in patients with pancreatic necrosis., Methods: We analyze the relationship between the anatomic pattern of pancreatic necrosis at dynamic CT (pancreatic necrosis, peripancreatic necrosis, and transparenchymal necrosis) and the development of local complications (infected pancreatic necrosis and pseudocyst)., Results: One hundred thirty-eight patients were included in the study. Nine patients were excluded, and 86 required surgery. Average time from the onset of symptoms to dynamic CT was 8.3 days. Multivariate analysis identified the following prognostic factors for local complications: (1) extent of pancreatic necrosis (odds ratio [OR], 7.32; 95% confidence interval [CI], 1.32-23.76; P = 0.015) and presence of peripancreatic necrosis (OR, 37.32; 95% CI, 3.77-369.38; P = 0.002) were useful to predict the development of infected pancreatic necrosis; and (2) transparenchymal necrosis with upstream viable (enhancing) pancreas (OR, 36.22; 95% CI, 3.18-412.36; P = 0.004) and no peripancreatic necrosis (OR, 0.016; 95% CI, 0.004-0.62; P < 0.001) were associated with pseudocyst development., Conclusions: Dynamic CT prognostic factors useful to predict local complications in patients with pancreatic necrosis were the extent of pancreatic necrosis, presence of peripancreatic necrosis, and the finding of transparenchymal necrosis with upstream viable (enhancing) pancreas.

Background: Laparoscopic sleeve gastrectomy and its indications are currently being evaluated. The objective of this study was to show the preliminary results obtained with this technique indicated as an alternative to gastric bypass in patients with multiple intraabdominal adhesions, therefore preserving the benefits of the laparoscopic approach., Methods: An analysis of all patients who underwent a laparoscopic sleeve gastrectomy for the above indication was done. Data included demographics, number of previous surgeries, operative time, morbidity, mortality, and %EWL at 3 and 6 months., Results: Fifteen patients underwent laparoscopic sleeve gastrectomy as an alternative to gastric bypass because of multiple intraabdominal adhesions. No patient required conversion to an open procedure; morbidity was 6% with no mortality. %EWL at 3 months was 41% and at 6 months was 44%. Mean follow-up was 6 months., Conclusion: In our initial experience, laparoscopic sleeve gastrectomy proved to be a safe and effective alternative to gastric bypass for patients with multiple intraabdominal adhesions.

Introduction: there are many studies about prognostic scores in acute pancreatitis but the best one has yet to be determined., Objective: to analyze the pleural effusion (diagnosed by ultrasound) as a prognostic factor and to compare it with three multiple criteria scores (RANSON, APACHE II, APACHE II O)., Patients and Methods: all patients with acute gallstone pancreatitis were included in the study during the period 2002-2006. Patients treated with ERCP at admission and those in whom ultrasonography was not done were excluded. The severity of the attack was set according to the Atlanta Classification criteria. The prognostic scores used were analyzed to predict separately systemic complications, local complications and total complications (local and systemic). The likelihood positive ratio was used as the most accurate index to compare the prognostic accuracy of the 4 prognostic scores., Results: 178 patients were included. 35 patients were excluded (ERCP at admission=32, ultrasonography not done at admission=3). 29 patients of 143 patients developed severe acute pancreatitis. The pleural effusion evaluated by ultrasonography showed the great accuracy at predicting the development of systemic complications (likelihood positive ratio=6.3), local complications (likelihood positive ratio=11) and total complications (likelihood positive ratio=16.1)., Conclusion: the pleural effusion evaluated by ultrasonography can predict with great levels of accuracy a severe acute attack. When it was compared with 3 multiple criteria scores (RANSON, APACHE II, APACHE II O) showed to be more accurate at predicting disease severity.

Treatment of acute pancreatic pseudocysts (APP) after an episode of severe acute pancreatitis (SAP) remains controversial. Both population heterogeneity and limited numbers of patients in most series prevent a proper analysis of therapeutic results. The study design is a case series of a large, tertiary referral hospital in the surgical treatment of patients with APP after SAP. An institutional treatment algorithm was used to triage patients with complicated APP and organ failure based on Sequential Organ Failure Assessment scores to temporizing percutaneous or endoscopic drainage to control sepsis and improve their clinical condition before definitive surgical management. Over a 10-year period of study (December 1995 to 2005), 73 patients with APP after an episode of SAP were treated, 43 patients (59%) developed complications (infection 74.4%, perforation 21%, and bleeding 4.6%) and qualified for our treatment algorithm. Percutaneous/endoscopic drainage was successful in controlling sepsis in 11 of 13 patients (85%) with severe organ failure and allowed all patients to undergo definitive surgical management. The morbidity (7 vs 44.1%, P = 0.005) and mortality rates (0 vs 19%, P = 0.04) were significantly higher in complicated vs uncomplicated APP. Acute pancreatic pseudocysts after SAP are unpredictable and have a high incidence of complications. Once complications develop, there is a significantly higher morbidity and mortality rate. In complicated APP with severe organ failure, percutaneous/endoscopic drainage is useful in controlling sepsis and allowing definitive surgical management.

Objective: To test the hypothesis that early endoscopic intervention, performed on patients with acute gallstone pancreatitis and biliopancreatic obstruction, reduces systemic and local inflammation., Summary Background Data: The role of early endoscopic intervention, in the treatment of acute gallstone pancreatitis, remains controversial. Previous randomized trials have not focused on the subgroup of patients with clinical evidence of biliopancreatic obstruction., Methods: This single-center randomized clinical trial was performed between May 2000 and September 2005. Of 238 patients, admitted within 48 hours after the onset of acute gallstone pancreatitis, 103 with a distal bile duct measuring > or =8 mm combined with a total serum bilirubin > or =1.20 mg/dL, were randomized to receive either endoscopic retrograde cholangiopancreatography followed by endoscopic papillotomy for bile duct stones (EEI, n = 51) or early conservative management (ECM, n = 52). Patients with clinical evidence of coexisting acute cholangitis were excluded. Outcome measures included changes in organ failure score and computed tomography (CT) severity index during the first week after admission, incidence of local complications, and overall morbidity and mortality., Results: The incidence of bile duct stones at EEI was 72% and 40% of patients in the ECM group had persisting bile duct stones at elective biliary surgery. No significant differences were found between the EEI and ECM groups regarding changes in mean organ failure score (P = 0.87), mean CT severity index (P = 0.88), incidence of local complications (6% vs. 6%, P = 0.99), overall morbidity (21% vs. 18%, P = 0.80), and mortality (6% vs. 2%, P = 1)., Conclusions: The present study failed to provide evidence that early endoscopic intervention reduces systemic and local inflammation in patients with acute gallstone pancreatitis and biliopancreatic obstruction. If acute cholangitis can be safely excluded, early endoscopic intervention is not mandatory and should not be considered a standard indication.

A 3-year-old child with a spinal cord direct arteriovenous fistula successfully treated by endovascular occlusion is presented. Intradural direct arteriovenous fistulae are the most infrequent variety of spinal arteriovenous malformations, although they are not properly identified as such in many published series. Whereas the exact mechanism by which they produce symptoms remains an unresolved issue--steal through fistula or compression by giant venous varices--the evolution of our case, with amelioration after partial occlusion, favors the former. Surgical resection of the thrombosed venous varix was not necessary. Endovascular occlusion proved to be a safe and effective form of treatment in this case of spinal intradural direct arteriovenous fistula, no additional treatment being necessary thereafter.

A family, carrying a balanced 3q;22p translocation, was detected through a propositus who showed multiple congenital malformations. As there are no previous references of similar cases where identification techniques were performed, the authors present this material for consideration in the delineation of clinical syndromes associated with specific chromosomal anomalies.