Coloseminal vesicle fistula after low anterior resection: Report of a case and review of the literature

INTRODUCTION

A rectoseminal vesicle fistula after a low anterior resection for rectal cancer is a rare complication despite their anatomic proximity. From a Medline search from 1966 to date, a total of twenty-one previous cases of coloseminal vesicle fistula have been reported. From these cases, eleven were a complication of laparoscopic low anterior resection for rectal cancer.

DESCRIPTION OF THE CASE

This report presents the case of a 63-year-old patient who was readmitted to the hospital on the fifteenth postoperative day after his surgical intervention for fever, abdominal pain, dysuria and pneumaturia. A sinography with water-soluble contrast revealed a tract between the rectum and the seminal vesicle. The condition was treated conservatively with antibiotics, urinary catheter and a transanastomotic Malecot probe for abscess drainage. The fistula had completely recovered on postoperative day 71 and the patient is still symptoms free, six months after the complication developed.

DISCUSSION

This case reinforces the presumed link between anastomotic leakage and rectoseminal vesicle fistula in cases of low anterior resection while reviewing and summarizing similar previously reported cases on the course of the disease, diagnostic procedures and treatment options.

CONCLUSION

Seminal vesicle are susceptible to fistula in oncological resection of rectum. Both CT scan with water-soluble contrast or sinography are effective diagnostic examinations. Depending on the characteristics of the fistula, conservative approach may be adequate and benefits much less morbidities than the surgical options.

The glue-clot technique: a new technique description for small calyceal stone fragments removal

During the last 20 years, the technology advancement of small flexible ureterorenoscopes has dramatically changed the management of renal calculi. Retrograde intrarenal surgery (RIRS) has currently a high impact on active stone treatment, and it is increasingly used worldwide. Nevertheless, kidney stone fragmentation and direct removal of fragments require many passages of the ureteroscope, is often time-consuming, and may be very difficult through anatomical and technical factors. We describe a simple, feasible and efficient technique for small stone fragments retrieval, which are often difficult to remove during RIRS.

Person perception and autonomic nervous system response: the costs and benefits of possessing a high social status

This research was designed to investigate the relationship between sympathetic and parasympathetic autonomic nervous system (ANS) responses to the perception of social targets varying in social status. Participants varying in subjective financial status were presented with faces assigned with either a low, average, or high financial status. Electrocardiographic and impedance cardiography signals were recorded and measures of sympathetic (pre-ejection period; PEP) and parasympathetic (high frequency heart rate variability; HF HRV) cardiac control were derived. These measures associated with the presentation of each face condition were examined in relation to the subjective status of the perceivers. Participants with high subjective financial status showed reduced sympathetic activity when viewing low- and medium-status targets as compared to high-status targets, and lower parasympathetic response when viewing high- and medium-status targets relative to low-status targets.

The neural substrates of person perception: spontaneous use of financial and moral status knowledge

The current study examines the effect of status information on the neural substrates of person perception. In an event-related fMRI experiment, participants were presented with photographs of faces preceded with information denoting either: low or high financial status (e.g., "earns $25,000" or "earns $350,000"), or low or high moral status (e.g., "is a tobacco executive" or "does cancer research"). Participants were asked to form an impression of the targets, but were not instructed to explicitly evaluate their social status. Building on previous brain-imaging investigations, regions of interest analyses were performed for brain regions expected to support either cognitive (i.e., intraparietal sulcus) or emotional (i.e., ventromedial prefrontal cortex) components of social status perception. Activation of the intraparietal sulcus was found to be sensitive to the financial status of individuals while activation of the ventromedial prefrontal cortex was sensitive to the moral status of individuals. The implications of these results towards uncovering the neural substrates of status perception and, more broadly, the extended network of brain regions involved in person perception are discussed.

An fMRI study of violations of social expectations: when people are not who we expect them to be

The current study examines the effect of violations of social expectancies on the neural substrates of person perception. In an event-related fMRI experiment, participants were presented with the photographs of either Republican or Democrat politicians paired with either typical Republican or Democrat political views (e.g., "wants a smaller government" or "wants liberal supreme court judges"). Subjects were asked to form an impression of the targets using information about both their political affiliation and their political views. Of interest was the contrast between stereotypically congruent trials and stereotypically incongruent trials. The results reveal that brain regions previously involved in mentalizing (i.e., temporoparietal junction and medial prefrontal cortex) are preferentially recruited when viewing incongruent social targets.

Unusual methyl-branched alpha,beta-unsaturated acyl chain substitutions in the Nod Factors of an arctic rhizobium, Mesorhizobium sp. strain N33 (Oxytropis arctobia)

Mesorhizobium sp. strain N33 (Oxytropis arctobia), a rhizobial strain isolated in arctic Canada, is able to fix nitrogen at very low temperatures in association with a few arctic legume species belonging to the genera Astragalus, Onobrychis, and Oxytropis. Using mass spectrometry and nuclear magnetic resonance spectroscopy, we have determined the structure of N33 Nod factors, which are major determinants of nodulation. They are pentameric lipochito-oligosaccharides 6-O sulfated at the reducing end and exhibit other original substitutions: 6-O acetylation of the glucosamine residue next to the nonreducing terminal glucosamine and N acylation of the nonreducing terminal glucosamine by methyl-branched acyl chains of the iso series, some of which are alpha,beta unsaturated. These unusual substitutions may contribute to the peculiar host range of N33. Analysis of N33 whole-cell fatty acids indicated that synthesis of the methyl-branched fatty acids depended on the induction of bacteria by plant flavonoids, suggesting a specific role for these fatty acids in the signaling process between the plant and the bacteria. Synthesis of the methyl-branched alpha,beta-unsaturated fatty acids required a functional nodE gene.

[Conceptual difficulties in personality disorders.]

This article examines the debate surrounding the concepts of personality disorders through a review of the Medline literature on personality disorders definitions, psychometric studies, etiologies, categorical versus dimensional as well as trait-state issues and stability of diagnosis. It is suggested that clinicians will gain better diagnosis accuracy and more refined treatment planning if they understand the conceptual difficulties belonging to personality disorders. Beyond the knowledge of DSM diagnostic criteria, they should familiarise themselves with notions of traits, dimensions and temperament as these paradigms help to follow current developments in personality etiology research.

Sequence and mutational analysis of the 6.7-kb region containing nodAFEG genes of Rhizobium sp. strain N33: evidence of DNA rearrangements

A 6.7-kb region upstream of nodBC genes in Rhizobium sp. strain N33 was shown to contain the nodAFEG genes and an open reading frame designated orfZ. The open reading frames for these genes contain 591, 282, 1209, 738, and 1,338 nucleotides respectively. Homologues of these genes were found in other rhizobia with the exception of orfZ, for which there was no counterpart found in the Genbank/EMBL database. Tn5 mutagenesis in nodEG and in the intergenic nodG-B region has shown a Nod+ phenotype on their temperate hosts Onobrychis viciifolia and Astragalus cicer. The nodules formed on O. viciifolia plants by these mutants were altered in shape and size. However, on A. cicer there was only a reduction in the number of nodules formed, compared with the wild-type strain. Sequence analysis of the orfZ-nodA and nodG-B intergenic regions indicates the presence of truncated nodD genes.

Sequence and mutational analysis of the common nodBCIJ region of Rhizobium sp. (Oxytropis arctobia) strain N33, a nitrogen-fixing microsymbiont of both arctic and temperate legumes

By heterologous hybridization, we have identified the common nodulation genes nodBCIJ of Rhizobium sp. strain N33 within a 8.2-kb PstI fragment. The nodBCIJ genes are located within a 4,620-bp region which also included a consensus nod box promoter. The four open reading frames coding for the nodBCIJ genes contain 657, 1,353, 915, and 789 nucleotides, respectively. We found that the nodA gene was not adjacent to the nodB gene, unlike the situation in many rhizobia. The DNA of the nodBCIJ genes of Rhizobium sp. strain N33 were found to be homologous to the corresponding genes of other rhizobia except for the 3'-coding region of the nodC gene. The deduced NodC protein was the longest of the rhizobia except Bradyrhizobium japonicum. Tn5 mutagenesis of the common nod region of strain N33 revealed that the nodBC genes were essential for nodulation on their temperate hosts Onobrychis viciifolia and Astragalus cicer. By contrast, mutations in the nodI and nodJ genes produced a Nod+ phenotype with a reduced number of nodules on the temperate hosts. Nodules formed on Onobrychis viciifolia by either nodI or nodJ mutants were approximately 10 times smaller than nodules formed by the wild type strain: this reduction in nodule size was not observed on Astragalus cicer.

Heat and cold shock protein synthesis in arctic and temperate strains of rhizobia

We compared heat shock proteins (HSPs) and cold shock proteins (CSPs) produced by different species of Rhizobium having different growth temperature ranges. Several HSPs and CSPs were induced when cells of three arctic (psychrotrophic) and three temperate (mesophilic) strains of rhizobia were shifted from their optimal growth temperatures (arctic, 25 degrees C; temperate, 30 degrees C) to shock temperatures outside their growth temperature ranges. At heat shock temperatures, three major HSPs of high molecular weight (106,900, 83,100, and 59,500) were present in all strains for all shock treatments (29, 32, 36.4, 38.4, 40.7, 41.4, and 46.4 degrees C), with the exception of temperate strains exposed to 46.4 degrees C, in which no protein synthesis was detected. Cell survival of arctic and temperate strains decreased markedly with the increase of shock temperature and was only 1% at 46.4 degrees C. Under cold shock conditions, five proteins (52.0, 38.0, 23.4, 22.7, and 11.1 kDa) were always present for all treatments (-2, -5, and -10 degrees C) in arctic strains. Among temperate strains, five CSPs (56.1, 37.1, 34.4, 17.3, and 11.1 kDa) were present at temperatures down to 0 degrees C. The 34.4- and the 11.1-kDa components were present in all temperate strains at -5 degrees C and in one strain at -10 degrees C. Survival of all strains decreased with cold shock temperatures but was always higher than 50%. These results show that rhizobia can synthesize proteins at temperatures not permissive for growth. In all shock treatments, no correspondence between the number of HSPs or CSPs produced and rhizobial survival was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis of partial rupture of tendo Achillis with magnetic resonance imaging

This manuscript presents a case with diagnosis of a partial rupture of the Achilles tendon performed with magnetic resonance imaging (MRI) at 1.5 T. Diagnosis of partial rupture of Achilles tendon is rarely reported with the use of MRI. While other means do exist, MRI can be the most useful noninvasive technique of diagnosing a partial rupture. A 62-year-old male runner with chronic Achilles tendon pain is reported, for which MRI tests were performed. Normal MRI of a volunteer patient is included for comparison. The authors suggest, where applicable, the MRI test should be performed to evaluate Achilles tendon credibility, both as a diagnostic tool and an evaluator of treatment during follow-up visits.