Fate of transgenic soybean DNA and immune response of broilers fed genetically modified DP-3Ø5423-1 soybean

Increased use of genetically modified (GM) plants in the food and feed industry has raised several concerns about the presence of unwanted genes in the food chain and potential associated health risks. In recent years, several studies have compared the nutrient contents of GM crops to conventional counterparts, and some have also tracked the fate of novel DNA fragments and proteins in the gastrointestinal (GIT) and their presence in several tissues. This study was conducted to investigate the fate of transgenic PHP19340A DNA fragment containing gm-fad2-1 (Soybean Event DP-3Ø5423-1) gene in digestive tract contents, blood, internal organs, and muscle tissues. The effects of feeding DP-3Ø5423-1 full-fat soybean meal (FFSBM) to broiler chickens on immune response and blood profiles were also evaluated on d 35. Day-old Ross 308 birds (n = 480) were randomly allocated to 24 floor pens in a 2 × 2 factorial arrangement with diet and gender as main factors. Birds were fed diets containing 20% of either DP-3Ø5423-1 or non-GM FFSBM for 35 d. Data were subjected to a 2-way ANOVA using the GLM procedure of JMP (Pro13). Based on PCR analysis, transgenic PHP19340A DNA fragment containing gm-fad2-1 gene was degraded throughout the digestive system to reach undetectable level in the cecal digesta. Moreover, there was no transgenic gene translocation to blood, organs, or muscle tissue. Feeding DP-3Ø5423-1 FFSBM to broilers had no effect on mRNA abundance of IL-1β, IL-2, IL-6, IL-12B, IL-17A, IFNγ, TNFα, and NF-κB in the spleen or on blood profile. In conclusion, these findings indicate that the examined transgenic fragment in DP-3Ø5423-1 FFSBM progressively degraded in the GIT and did not translocate into blood or tissues. Along with the immune response and blood profile findings, it can be assumed that DP-3Ø5423-1 soybean is safe and unlikely to pose any health risks to broilers or consumers.

Performance, fatty acid composition, and liver fatty acid metabolism markers of broilers fed genetically modified soybean DP-3Ø5423-1

Several genetically modified (GM) plants have been produced and approved by regulatory agencies worldwide for cultivation and commercialization. Soybean and its by-products are major components of poultry diets and approximately 74% of world production is obtained from GM soybean events. The aim of this study was to evaluate the nutrient composition of DP-3Ø5423-1 extruded full-fat soybean meal (FFSBM) and near isoline non-GM control FFSBM included in broiler diets. Also assessed were their effects on bird performance, body composition, intestinal morphology, tissue fatty acid profile, and mRNA abundance of fatty acid metabolism markers. A total of 480 Ross 308 d of hatch birds were randomly allocated to 24 floor pens in a 2 × 2 factorial arrangement with diet and gender as main factors. Birds were fed diets containing 20% of either DP-3Ø5423-1 or control FFSBM for 35 d. Data were subjected to a 2-way ANOVA using the GLM procedure of JMP (Pro13). No significant interaction (P > 0.05) was observed between treatment groups in terms of performance and carcass composition. Morphological measurements of the jejunum and ileum were not influenced by the SBM treatments. Dietary addition of the DP-3Ø5423-1 FFSBM resulted in higher monounsaturated fatty acid composition of the thigh muscle and abdominal fat. Moreover, dietary treatment had no significant impact on the mRNA abundance of metabolic markers ACCα, FAS, MTTP, SREBP1, PPARα, PPARγ, AMPK-α1, SOD, CAT, and GPx in the liver. In conclusion, our results showed that DP-3Ø5423-1 extruded FFSBM is nutritionally equivalent to non-GM near-isoline counterpart with a comparable genetic background as evidenced by feed analyses except for fatty acid composition. Furthermore, the findings of this study clearly indicate that the examined DP-3Ø5423-1 FFSBM yields similar bird performance as conventional FFSBM.

Performance and gut health status of broilers fed diets supplemented with two graded levels of a monoglyceride blend

The present study was undertaken to evaluate the efficacy of 2 graded levels (0.03 and 0.05% of diet) of a monoglyceride blend containing butyric, caprylic, and capric acids in broilers' diet for optimizing gut structure and animal growth performance. For this purpose, a total of 210, one-day-old male Ross 308 broiler chicks were randomly allocated to 3 experimental treatments using 7 replicates each and 10 birds/replicate. The treatment groups involved supplementation of blend of short and medium chain fatty acids at the level of 0, 0.03, and 0.05% of the diet for 42 d. The incorporation of mixes of monoglycerides into broilers' diet linearly improved BWG between d 0 and 21 (P = 0.034). At the end of trial, however, no significant changes were observed in performance indexes (BWG, FI, FCR). Jejunal morphometric parameters (villus height, crypt depth, and their ratio) remained unaltered with the monoglyceride supplementation on d 21. The results further showed that monoglycerides supplementation increased the goblet cell counts along the jejunal villi (P = 0.034) and crypt regions (P = 0.022), as well as it effectively modulated the mRNA abundances of tight junction protein (ZO-1, P = 0.033) and nutrient transporters (SGLT, PePT1; P = 0.005, 0.023, respectively) in the jejunum. Moreover, the downregulation in mRNA abundance of TNFα (P = 0.030) was observed with the monoglyceride supplementation. The SCFAs analysis of cecal contents showed no notable differences with monoglyceride blend supplementation when compared to the unsupplemented group. Collectively, high goblet cell numbers in the jejunum along with downregulation of the mRNA abundances of pro-inflammatory cytokines, upregulation of tight junction proteins, and nutrient transporters showed favorable responses of low doses of monoglycerides blend in broiler feeding. Further studies should be conducted in different rearing conditions to examine the effectiveness of such low levels of a monoglyceride blend in the modulation of gut structure, its functionality and animal performance.

Influence of dietary vitamin E and selenium supplementation on broilers subjected to heat stress, Part II: Oxidative stress, immune response, gut integrity, and intestinal microbiota

This study evaluated the effects of vitamin E (Vit E) and selenium (Se) supplementation on mRNA abundance of antioxidant, immune response, and tight junction genes, as well as taxonomic and functional profiles of ileal microbiota of broilers exposed to daily 4-h elevated temperature during d 28 to 35. A total of 640-day-old Cobb male broiler chicks were randomly allocated to 32 floor pens in a 2 × 2 factorial arrangement that included ambient temperature (thermoneutral [TN] or heat stress [HS]) and dietary treatments (basal diet or Vit E + Se). Vit E and organic Se were added to the basal diet at the rate of 250 mg/kg and 1 mg/kg, respectively. Liver and jejunum tissue samples were taken on d 27 (1 bird/pen), d 28 and d 35 (2 birds/pen) from birds for qPCR analysis. Data were subjected to a 2-way ANOVA using the GLM procedure of JMP. Ileal contents were taken on d 27 and d 35 for microbial profiling. Microbiota data were analyzed in QIIME 2 and significance between treatments identified linear discriminant analysis effect size (LEfSe, P < 0.05). Dietary Vit E/Se significantly downregulated the mRNA levels of HSPs in liver and jejunal tissues of the HS-challenged birds both on d 28 and d 35. Moreover, mRNA abundance of TLR2, TNFα, IFNγ, IL-1β, IL-10, and iNOS in the liver were significantly downregulated in birds fed the Vit E/Se diet on d 35. However, dietary treatment had no significant impact on oxidative stress, immunity, and gut integrity related genes analyzed in jejunal tissues on d 28 and d 35, except downregulation of IFNγ on d 35 (P = 0.052). LEfSe analysis revealed that Lachnospiraceae FE2018 and Ruminococcaceae NK4A214 groups was enriched in the Vit E/Se birds on d 35. Moreover, PICRUSt analysis predicted significant functional differences among the treatment groups. In conclusion, dietary supplementation of Vit E/Se mitigated the negative effects of HS potentially via improving antioxidant status, regulating cytokine responses and modifying ileal microbiota and its function.

Relation between CRP-Albumin ratio and left atrial volume index for prediction of new onset atrial fibrillation in patients with STEMI treated with percutaneous coronary interventions

New onset atrial fibrillation (NOAF) in the case of acute myocardial infarction appears to be associated with inflammation. However, its influence alongside other risk factors is currently unknown. In this study, the effect of inflammation in predicting NOAF independent of left atrial volume index (LAVi) was investigated with a new marker, the C-reactive protein/Albumin ratio (CAR). We included 945 ST-elevation myocardial infarction (STEMI) patients who underwent pPCI. Two groups were defined according to the presence of NOAF and the groups were compared for demographic, clinical and angiographic findings. Predictors of the NOAF were assessed by multivariable regression analysis. Fifty-five (5.8%) patients had NOAF after the procedures. CAR was substantially higher in patients with NOAF (5.9 [4.9] vs 0.46 [1] p<0.01). CAR was shown as an independent marker for NOAF (OR:1.19 95% CI: 1.11-1.27 p<0.01) development in multivariable regression analysis. In receiver operating curve characteristics, the sensitivity and the specificity of the value CAR>4.2 were 64% and 81% (AUC: 0.86) respectively. In subgroup analysis, OR of CAR in LAVi ≥26.7 ml/m² was 19.5 and 22.1 in LAVi<26.7 ml/m² (p for interaction=0.02). A novel inflammatory marker, CAR has the potential to predict the development of NOAF regardless of LAVi in patients with STEMI treated by PPCI.

Managing broilers gut health with antibiotic-free diets during subclinical necrotic enteritis

Necrotic enteritis (NE) caused by Clostridium perfringens is among the most important enteric diseases in poultry production. This study examined the effects of 2 probiotics (Prob) and a synbiotic (Synb) during a naturally occurring NE challenge. On the day of hatch, 1200 Cobb male broilers were randomly allocated to 5 groups (8 pens/treatment, 30 birds/pen) including 1) negative control (NC): corn-soybean meal diet; 2) positive control (PC): NC + 453 g Stafac20/907 kg feed; 3) Prob 1: NC + 453 g Prob 1/907 kg feed; 4) Prob 2: NC + 453 g Prob 2/907 kg feed; and 5) Synb: NC + 453 g Synb/907 kg feed. One day after placement, birds were challenged by a coccidia vaccine to induce NE. Feed intake and body weights were measured on day 8 (NE onset) and end of starter (day 14) and grower (28) periods. On day 8, the small intestines of 3 birds/pen were examined for NE lesions. Ileal mucosal scrapings from one bird/pen were collected on day 8 and day 28 to profile the microbiota using 16S rRNA sequencing. Data were analyzed in JMP or QIIME 2 and significance between treatments identified by LSD or linear discriminant analysis effect size (P < 0.05). The Synb group significantly lowered NE lesion scores on day 8 and reduced day 0-14 mortality by 50% compared with NC. FCR was significantly better in all the groups, whereas ADG was higher in PC, Synb, and Prob 2 groups compared with NC from day 0 to day 28. Lower lesion scores in the Synb group were accompanied by lower relative abundance of Alistipes, ASF356, Faecalibaculum, Lachnospiraceae UCG-001, Muribaculum, Oscillibacter, Parabacteroides, Rikenellaceae RC9 gut group, Ruminococcaceae UCG-014, and Ruminiclostridium 9 compared with NC on day 8. On day 28, relative abundance of Lactobacillus was lower, whereas abundance of Bacteroides, Barnesiella, Butyricicoccus, CHKCI001, Eisenbergiella, Eubacterium hallii group, Helicobacter, Ruminococcaceae UCG-005, Ruminococcus torques group, and Sellimonas was significantly higher in the NC birds than in the Synb and Prob 2 groups. Collectively, these data indicate that during a subclinical naturally occurring NE, supplementation of specific additives could be effective in reducing intestinal lesions and mortality, and improving performance potentially through developing a signature microbial profile in the intestinal mucosal layer.

Effect of Probiotics and Multi-Component Feed Additives on Microbiota, Gut Barrier and Immune Responses in Broiler Chickens During Subclinical Necrotic Enteritis

The withdrawal of antibiotic growth promoters from poultry feed has increased the risk of necrotic enteritis (NE) outbreaks. This study examined the effects of a probiotic (PROB) or probiotic/prebiotic/essential oil supplement (PPEO) during a subclinical NE challenge. On day (d) of hatch, 960 male broilers were randomized to four groups (8 pens/treatment, 30 birds/pen) including (1) negative control (NC): corn-soybean meal diet; (2) positive control (PC): NC + 20 g Virginiamycin/ton diet; (3) NC + 227 g PROB/ton diet; and (4) NC + 453 g PPEO/ton diet. One d after placement, birds were challenged by a coccidia vaccine to induce NE. Feed intake and body weights were measured on d 8 (NE onset) and end of each feeding period. On d 8, the small intestines of three birds/pen were examined for NE lesions. Jejunum samples and ileal mucosal scrapings from one bird/pen were respectively collected to measure mRNA abundance (d 8 and d 14) and profile the microbiota (d 8 and d 42). Data were analyzed in JMP or QIIME 2 and significance between treatments identified by LSD (P < 0.05). PROB and PPEO had significantly lower mortality (d 0–14) and NE lesion scores compared to NC. Feed conversion ratio was significantly lower in PC, PROB, and PPEO, while average daily gain was higher in PPEO and PC groups compared to NC from d 0–42. On d 8 and d 14, mRNA abundance of claudin-3 was higher in PPEO compared to NC. On d 14, compared to NC, mRNA abundance of sIgA and PGC-1α in PROB and PPEO were lower and higher, respectively. Compared to NC, PPEO increased mTOR abundance on d 14. On d 8, relative abundance of Clostridium sensu stricto 1, Ruminiclostridium9, Prevotellaceae, Prevotellaceae UCG-014, ASF356, and Muribaculaceae was higher in NC compared to PPEO and PROB, while Lactobacillus was lower in NC. Escherichia-Shigella had higher abundance in PC compared to PPEO and PROB. Collectively, these data indicate that during a subclinical naturally occurring NE, supplementation of PROB or PPEO supports performance and reduces intestinal lesions, potentially through modifying tight junction proteins, gut microbiota, immune responses, and cell metabolism.

Effects of Paenibacillus xylanexedens on growth performance, intestinal histomorphology, intestinal microflora, and immune response in broiler chickens challenged with Escherichia coli K88

This study investigated the effects of dietary Paenibacillus xylanexedens ysm1 supplementation on growth performance, intestinal morphology, immune response, and cecal microbiota of broiler chickens challenged with Escherichia coli K88. A total of 320 one-day-old male broiler chicks were randomly allocated to 4 treatments (8 floor pens, 10 birds/pen) including 1) negative control (NC) birds fed a basal diet and not challenged with E. coli K88; 2) positive control (PC) birds fed a basal diet and challenged with of E. coli K88; 3) P. xylanexedens ysm1 treatment (PRO) birds fed a basal diet supplemented with 1 × 109P. xylanexedens ysm1 cfu/kg feed and challenged with E. coli K88; and 4) antibiotic treatment (ANT) birds fed a basal diet supplemented with 20 mg of colistin sulphate/kg of feed and challenged with E. coli K88. The E. coli challenge decreased (P < 0.05) BWG in PC birds compared with the ANT birds on days 21 and 28. The FCR was higher (P < 0.01) in PC birds compared with the NC, PRO, and ANT birds on days 14, 21, and 28. Compared with the NC, PRO, and ANT birds on day 28, PC birds had shorter villi and higher number of goblet cells in both jejunum and ileum (P < 0.001). Irrespective of the dietary treatments, the E. coli challenge reduced the number of PCNA-positive cells in both the jejunum and ileum on day 28. Paenibacillus xylanexedens ysm1 treatment resulted in higher concentration of mucosal sIgA in the jejunum as compared to the other treatment groups on days 14 and 28. The numbers of cecal E. coli were reduced (P = 0.017) in broilers treated with P. xylanexedens ysm1 or antibiotic in comparison with the PC group on day 28. In conclusion, the present study demonstrated that dietary supplementation of this new probiotic bacteria P. xylanexedens ysm1 improved broiler performance by modulating intestinal morphology, enhancing immune response, and reducing the number of E. coli in the cecum.

Effects of Dietary Direct Fed Microbial Supplementation on Performance, Intestinal Morphology and Immune Response of Broiler Chickens Challenged With Coccidiosis

Poultry coccidiosis is a costly intestinal disease that leads to considerable tissue damage, inefficient nutrient absorption, increased mortality, and predisposition to secondary infections. This study evaluated the effects of a direct feed microbial (DFM) dietary additive on performance, intestinal morphology, and immune response of broilers during a mixed coccidiosis challenge. In total, 840 Cobb500 male broilers were randomly allocated to 3 treatments (7 replicates, 40 birds/pen) including negative control (NC) fed basal diet; positive control (PC) fed basal diet with coccidiosis challenge; and DFM supplemented diet, with coccidiosis challenge. At 15 days of age, all birds except for the NC treatment were orally gavaged with live oocysts of a commercial vaccine. On d 21 (6 days post challenge), 4 birds/pen were randomly selected and euthanized for scoring of coccidia-caused lesions in the duodenum, jejunum, and ceca. Body weight gain (BWG), feed intake (FI), and feed conversion ratio (FCR) were recorded on d 7, 14, 28, and 42. Jejunal and ileal tissue samples were taken for histomorphological assessment from 2 birds/pen on d 21. Ileal samples were also taken for mRNA expression analysis on d 14 and d 21. The DFM birds had significantly greater BWG than PC birds during d 0–21 (P < 0.05). No differences were observed among the treatment groups in terms of FI and FCR. Dietary DFM supplementation significantly reduced lesion scores in the duodenum and jejunum when compared with PC group (P < 0.05). The coccidia challenge significantly reduced (P < 0.05) ileal villus height when compared to the non-challenged group on d 21. Conversely, dietary DFM supplementation alleviated the negative effects of coccidiosis by increasing ileal villus area on d 21 (P < 0.05). The challenged birds had significantly greater expression of IFN-γ and IL-1β in the ileum on d 21. Based on these findings, dietary DFM supplementation may help restore broiler performance during the starter and early grower periods during coccidiosis, likely by maintaining gut integrity via improving intestinal morphology and also by reducing disease severity as manifested by lower lesion scores.

Necrotic Enteritis in Broiler Chickens: The Role of Tight Junctions and Mucosal Immune Responses in Alleviating the Effect of the Disease

Necrotic enteritis (NE) continues to present major challenges to the poultry industry, and the etiologic agent Clostridium perfringens is the fourth leading cause of bacterially-induced food- borne illnesses in the US. This study was designed to evaluate the effects of a probiotic during naturally occurring NE. On day of hatch, 1080 Cobb 500 male broilers were randomly allocated to three groups (12 replicate pens/treatment, 30 birds/pen) including 1) negative control (NC): corn-soybean meal diet; 2) positive control (PC): NC + 20 mg virginiamycin/kg diet (0.450 kg Stafac®20/ton); and 3) NC + PrimaLac (1.36 and 0.91 kg/ton from 1-21 and 22-42 days, respectively). One day (d) post placement, all birds were challenged by a commercial live oocyst coccidia vaccine as a predisposing factor to NE. Body weight and feed intake were measured at the onset of NE (d 8) and end of each feeding phase. On d 8, small intestines of two birds/pen were examined for NE lesions, and jejunum samples from one bird were collected for mRNA gene expression analysis of tight junction proteins, cytokines, and nutrient transporters. Data were analyzed using the Jump (JMP) software and significance between treatments identified by LSD (P < 0.05). Compared to NC, supplementation of probiotic reduced d 1-42 mortality; however, PC was the only group with significantly lower mortality. Despite significantly improved feed conversion ratio (FCR) in PC and probiotic groups during d 1-42, average daily gain was only higher in PC (77.69 g/bird) compared with NC (74.99 g/bird). Furthermore, probiotic and PC groups had significantly reduced lesion scores in the duodenum and jejunum compared to NC. Expression of claudin-3 was higher, while expression of zonula occluden-2 tended (P = 0.06) to be higher in probiotic-supplemented birds compared to NC. Moreover, birds fed the probiotic diet had significantly higher expression of IL-10, IL-17, AMPK-α1, and SGLT1 mRNA compared to NC birds. The expression of PepT1 was higher for the probiotic-supplemented group compared to PC. IFN-γ expression was lower in PC compared to NC, while there was no difference between probiotic and NC. There were no differences in gene expression of sIgA, TNF-α, IL-1β, and IL-22 among treatments. Collectively, these data indicate that in a naturally occurring NE model, supplementation of a probiotic helps to improve FCR and reduce lesions, potentially due to the improvements in mRNA expression of tight junctions, cytokines, and nutrient transporters.

Effect of lactulose supplementation on growth performance, intestinal histomorphology, cecal microbial population, and short-chain fatty acid composition of broiler chickens

This study investigated the effects of dietary lactulose supplementation on broiler growth performance, intestinal histomorphology, cecal microflora, and cecal short-chain fatty acid (SCFA) concentrations. A total of 245 one-day-old male broiler chickens were randomly assigned to 5 different treatments, with 7 replicates including 7 birds each. The birds received the same basal diet based on corn--soybean meal, and lactulose was included in the diet at 0, 0.2, 0.4, 0.6, or 0.8% at the expense of corn and/or soybean meal. The body weight gain (linear, P=0.027) and feed conversion (linear, P=0.003) from 0 to 21 d showed significant improvement as dietary lactulose was increased from 0.2 to 0.8%. However, dietary lactulose did not affect broiler performance at the end of the experiment (42 d). Furthermore, intestinal measurements and the goblet cell count of broilers fed a lactulose-containing diet differed from those of birds fed a diet that did not contain lactulose. In addition, a significant quadratic response in the Lactobacillus count (P≤0.001) was observed at 42 d on increasing the level of lactulose. The cecal coliform bacterial population was not affected by the dietary treatments. Supplementation with lactulose significantly increased the concentrations of acetate, propionate, butyrate, and total SCFA measured on d 7 and d 42. In conclusion, inclusion of lactulose in the diet can enhance broiler performance and intestinal morphology by selectively stimulating intestinal microflora and increasing cecal SCFA concentrations.

Intensive pulmonary care after liver surgery: a retrospective survey from a single center

BACKGROUND

Prevention from postoperative pulmonary complications (PPCs) has been an important topic. The aims of this study were to determine the risk factors for PPC after liver surgery and to analyze the efficacy of postoperative pulmonary care on PPC prevention.

MATERIALS AND METHODS

We retrospectively analyzed variables of 81 patients who underwent hepatectomy and 4 transplantations between January 2007 and March 2012.

RESULTS

Nineteen patients suffered PPCs (22.4%). Bivariate analysis identified four risk factors: preoperative anemia (odds ratio [OR] = 5.69), the American Society of Anesthesiologists (ASA) score of 3 or 4 (OR = 5.36), blood transfusion (OR = 2.81), and prolonged operative time (OR = 1.01). Upon multivariate analysis, only prolonged operative time was an independent risk factor for PPC (OR = 1.01). Pulmonary function test (PFT) was performed for 22 of 41 patients with an ASA score ≥ 2 (53.7%); there was no significant relationship between abnormal PFTs (n = 13) and the development of PPCs (P = .12).

CONCLUSIONS

The elimination of risk factors may reduce the incidence of PPCs. Postoperative intensive pulmonary care should be given to all patients after liver surgery but particularly to patients with high ASA scores and those with abnormal PFTs irrespective of age.

Hepatic microcirculation in inflow and inflow-outflow occlusion of the liver

BACKGROUND

Total vascular exclusion (TVE) causes warm liver ischemia. The aim of this study was to investigate the patterns of injury caused by inflow-outflow obstruction in the rat liver.

MATERIALS AND METHODS

Twenty-four Wistar-Albino rats were divided into three groups: liver inflow occlusion (Group A), inflow-outflow occlusion (Group B) and intermittent inflow-outflow occlusion applied for 15 minutes. Microcirculation was measured with laser Doppler flowmetry during the procedure. Samples for biochemical and histopathological analyses were collected at the end of the ischemia period.

RESULTS

Significant alterations in microcirculation were determined by application of vascular control maneuvers. Microcirculation in the central and dome segments were affected adversely compared with the dome segments in all experimental groups. TVE induced severe disturbances in hepatic microcirculation with more prominent hepatocellular damage. Damage to central segments of the rat liver was more prominent with inflow occlusion; whereas inflow-outflow occlusion produced more prominent damage to dome segments. Intermittent application of TVE clamping was associated with more hepatocellular damage compared with continuous TVE.

CONCLUSION

Our mapping methodology within the liver parenchyma suggested that hepatovenous back-perfusion is a principle source of continuity of microcirculation in the rat liver during inflow occlusion. Inflow-outflow occlusion caused more tissue damage compared with inflow occlusion. Ischemic preconditioning during TVE did not increase the tolerance of the liver against ischemia.

Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy

BACKGROUND

Technical modifications and methods for gallbladder dissection to minimize the risk of gallbladder perforation during laparoscopic cholecystectomy (LC) are described. The authors aimed to investigate the effects of gallbladder aspiration during LC on the operative and postoperative course of patients.

METHODS

For this study, 200 patients undergoing LC for symptomatic cholelithiasis were randomly divided into two groups. Gallbladders were aspirated before dissection in group A (n = 100), and they were not aspirated in group B (n = 100). Operative and postoperative data on the patients were collected.

RESULTS

The rate of gallbladder perforation was significantly lower in group A than in group B (p = 0.0003). The operative time was significantly shorter in group A (46.70 +/- 15.93 min) than in group B (60.75 +/- 22.09 min) (p = 0.047). Postoperative complications were more numerous in group B. The hospital stay was significantly longer in group B (1.55 +/- 0.81 days) than in group A (1.3 +/- 0.5 days; p = 0.004).

CONCLUSION

The findings demonstrate the advantages of gallbladder aspiration in elective cases.

Pheochromocytoma combined with pre-clinical Cushing's syndrome in the same adrenal gland

Pheochromocytoma (PHEO) occasionally associates with pathological lesions of the adrenal cortex. In most of them, ectopic adrenocorticotropic hormone (ACTH) produced by PHEO resulted in bilateral adrenocortical hyperplasia. The coexistence of PHEO and pre-clinical Cushing's syndrome (PCS) of the same adrenal gland has rarely been reported. We report on a patient and discuss the peculiar diagnostic aspects of this entity. A 52-yr-old Turkish woman was hospitalized at Farabi Hospital for further examinations of a right adrenal mass that was incidentally discovered by abdominal ultrasonography during examinations for abdominal bloating and "gas" in other hospital. The patient had a history of palpitations, nervousness, sweating and heat intolerance. On admission, her blood pressure was 140/90 mmHg. A physical examination revealed no signs of an excessive production of adrenocortical steroids such as in CS. Tension Holter monitoring revealed paroximal hypertension attacks (183/105 mmHg). Urinary catecholamines were markedly increased. Her serum cortisol concentrations ranged from 5 to 17 microg/dl, whereas ACTH levels were undetectable. Cortisol was not suppressed on the overnight 1 mg oral dexamethasone suppression test (DST), 2-day low-dose dexamethasone suppression test (DST). Abdominal computed tomography and magnetic resonance imaging studies revealed a solid round tumor approximately 4 cm in diameter, located in the right adrenal gland. A 131 lodine-metaiodobenzylguanidine (131 I-MIBG) scan revealed uptake within tumor in the right adrenal gland. Right adrenalectomy was performed; the surgical specimen revealed PHEO and adrenocortical hyperplasia. To our knowledge, the present report is a rare case of PHEO combined with PCS in the same adrenal gland.

Effects of octreotide on acute pancreatitis of varying severity in rats

OBJECTIVE

To find out the effects of the octreotide on the course of acute pancreatitis in rats.

DESIGN

Prospective laboratory study.

SETTING

Medical school, Turkey

ANIMALS

184 Sprague-Dawley rats, 120 of which were randomly allocated into 8 groups of 15 each for the survival study, and the remainder of which were randomly allocated into 8 groups of 8 rats each for assessment of biochemical variables and histological score.

INTERVENTIONS

The same 8 groups were used for the two parts of the study: saline alone (control), octreotide alone (control), oedematous pancreatitis induced by cerulein with and without octreotide, moderate pancreatitis induced by low-dose glycodeoxycholic acid and cerulein with and without octreotide, and severe pancreatitis induced by high-dose glycodeoxycholic acid and cerulein with and without octreotide.

MAIN OUTCOME MEASURES

Mortality, results of biochemical tests, and histological score.

RESULTS

No rats in the control groups died. Of those with oedematous pancreatitis 1 died that had not been given octreotide (7%) and 2 that had (13%). In the moderate pancreatitis groups 4 that had not been given octreotide died (27%) compared with one that had (7%). In the severe pancreatitis group 7 that had not had octreotide died (46%) compared with 6 that had (40%). Octreotide caused a reduction in serum amylase and lactate dehydrogenase activity in all groups, but reduced aspartate aminotransferase only in those rats with moderate pancreatitis. It prevented hypocalcaemia in rats with severe pancreatitis, but had no effect on serum electrolyte concentrations, alkaline phosphatase activity, or blood gas analyses. Rats with moderate pancreatitis that had been given octreotide had less tissue oedema, acinar necrosis, and inflammatory cell infiltration. In those with severe pancreatitis there was less tissue oedema but more acinar necrosis.

CONCLUSION

If octreotide is given early in the course of the disease it may result in improved outcome, but it seems to be ineffective in severe pancreatitis in which acinar necrosis is already established.

Laparoscopic abdominal observation method without anesthesia for preventing unnecessary second-look procedures: short report

Second-look operations after massive intestinal resections secondary to mesenterovascular occlusion are a frequent practice. In about one half of patients who undergo second-look procedures, no intraabdominal intervention is necessary. We present a laparoscopic abdominal observation method to prevent unnecessary laparotomies. In the first operation, two laparoscopic trocars, 5 and 10 mm in diameter, were left in the abdominal wall. After an appropriate time interval, the abdomen was explored laparoscopically through these trocars without anesthesia. If obvious intestinal gangrene and anastomotic leaks were observed laparoscopically, the patients were reoperated on while under general anesthesia; otherwise, the procedure was terminated with removal of the trocars. This method was performed on six patients. Unnecessary relaparotomies were prevented in four patients; intestinal gangrene and anastomotic leaks were not missed in the remaining two patients. A larger patient sample is needed to assess the advantages of this method in preventing unnecessary laparotomies.

Effects of total parenteral nutrition using a solution enriched with branched-chain amino acids on experimental pancreatitis in rats

The main purpose of this study was to investigate the influence of total parenteral nutrition enriched with branched-chain amino acids (BCAA) on acute pancreatitis (AP) induced by sodium taurocholate in rats. Total parenteral nutrition (TPN) increased the survival rate and serum calcium, and reduced serum urea, liver transaminase, acid phosphatase and lactate dehydrogenase levels, but it did not change the degree of pancreatic damage or serum amylase. Total plasma amino acid concentration and the concentrations of glutamate, glycine, alanine, taurine, valine, leucine, isoleucine, phenylalarine increased significantly after the induction of AP, but there was no difference between the control and therapy groups. Hyperglycemia occurred during the use of TPN. BCAA-enriched TPN can be used in the treatment of AP with few side effects.

Intestinal obstruction caused by splenic volvulus: report of a case

Torsion of a wandering spleen is rare, usually presenting as acute abdomen, and is commonly misdiagnosed. In special cases, ultrasonography, arteriography, and additional scintigraphy are extremely valuable in the preoperative diagnostic management. We herein present an unusual case of torsion of a wandering spleen in a 19-year-old female. The presenting symptom was acute gastrointestinal obstruction due to pressure of the enlarged and ptotic spleen in the pelvis. The intestinal obstruction with signs of peritonitis made a laparatomy with removal of the infarcted spleen imperative. After the operation, the patient made a complete recovery.

Complications of 867 thyroidectomies performed in a region of endemic goiter in Turkey

This article aims to define the incidence of complications in 867 thyroidectomies performed by residents with attending surgeons' supervision as part of a training programme, in a region of endemic goiter. Seven hundred and nine patients were female and 158 were male. The age of the patients ranged between 6 and 76 and mean age was 32.5. Cases were divided into two groups according to their disease nature. Group 1 included 805 patients with nodular colloidal goiter (NCG) and adenomas. The remaining 62 cases, 25 with recurrence of goiter (RG), 21 with thyroid malignancy (TM) and 16 with thyroiditis formed group 2. While the overall complication rate was 11.3% (93 cases) in group 1, it was 20.9% (13 cases) in group 2. The mortality rate was zero in both groups. The incidence of complications of 867 thyroidectomies performed by residents with the attending surgeons' supervision was within acceptable limits especially as far as group 1 was concerned. However we suggested that attending surgeons themselves, disregarding residents training, should perform the operation in special cases such as recurrent goiters, thyroid carcinomas with positive regional lymph nodes and thyroiditis with regional adhesions.

Influence of thyrotropin-releasing hormone on experimental pancreatitis in rats

The main purpose of this study was to investigate the influence of thyroid releasing hormone on acute sodium-taurocholate-induced pancreatitis in rats. Thyroid-releasing hormone did not change the survival rate, serum amylase, glucose calcium, liver transaminases levels or the degree of pancreatic damage, but reduced lactate dehydrogenase. Our findings suggest that the use of thyroid-releasing hormone has no beneficial effect on the course of acute experimental pancreatitis.

Solitary extramedullary plasmocytoma of the breast with kappa monoclonal gammopathy

We report a case of solitary extramedullary plasmocytoma of the breast in a 85 year old woman. This is the third case of solitary breast plasmocytoma in the world's literature. This disorder is very rare and it was associated with a serum monoclonal protein. A similar case is presented and its clinical presentation and pathology discussed.

The effects of variously performed vagotomies on gastric secretion and gastric emptying in rats

The main purpose of this study was to investigate the effects of (i) truncal vagotomy + pyloroplasty, (ii) proximal cell vagotomy and (iii) anterior proximal cell vagotomy + posterior truncal vagotomy on the gastric secretion and gastric emptying in rats. After vagotomy basal and 2-deoxy-glucose stimulated gastric secretion decreased significantly in all three vagotomy groups. Gastric secretion on the other hand was significantly higher in the proximal cell vagotomy group than on the other vagotomy groups. The rate of gastric emptying in proximal cell vagotomy and anterior proximal cell vagotomy + posterior truncal vagotomy groups was delayed. The best results were found in the truncal vagotomy + pyloroplasty group when the gastric secretion and the rats of gastric emptying are concerned.

A modified technique for performing anterior gastropexy in Stamm gastrostomies

We describe herein a new modified technique for performing the anterior gastropexy step of the Stamm gastrostomy procedure. In this method, anterior gastropexy was carried out with four 2-0 silk or propylene sutures. These sutures were secured through the whole layer of the abdominal wall from out to within. Then, after passing the seromuscular layer of stomach, they return to skin through the abdominal wall from within to out and tied over the skin surface. This modified technique which provided better exposure and an excellent seal of the stomach and parietal peritoneum, was successfully performed on 23 patients, none of whom developed any peritoneal leakage and peritonitis. The only complications that arose were wound infection in one case and skin excoriation in two others, and these were easily managed.

The intrabiliary rupture of hydatid cyst of the liver

The intrabiliary rupture of hydatid cyst of the liver is a severe and relatively frequent complication. In this study six similar cases are presented. 4 of the cases had hydatid cyst surgery before the admission. The obstructive jaundice, cholangitis and unclosed bile fistula are the most frequent clinical findings. Ultrasound is very useful for the diagnosis. In the cases of space occupying lesions of the liver with wide choledochus (1.1 cm >) the intrabiliary rupture of hydatid cyst can be suspected by ultrasonographic examinations. Surgical therapy as the capitonnage combined with the resection of the projecting dome of the cyst and T tube application remains a method which gives good results and has low mortality and morbidity.

The management of enterocutaneous fistulas with parenteral hyperalimentation

During a period of nine years, all patients with enterocutaneous fistula who received parenteral nutrition as part of therapy were evaluated retrospectively. Twenty-three patients were studied. Peptic ulcer was the most common primary disease, with the fistula arising in 78 percent of the cases from the breakdown of an anastomosis and in the remainder from a direct trauma to the bowel. The most common site of the fistulas was the ileum followed by the duodenum. All the patients were treated conservatively with total bowel rest and parenteral nutrition, and in 56.5 percent of the cases spontaneous closure occurred within an average of 29.6 days. In five patients, the fistula failed to close, and surgery was performed. The mean surgical closure time overall 36.4 days, but this varied from 20.8 days for the duodenum to 39 days for the jejunum and ileum, and 19.7 days for the large intestine. Five patients (22.7%) died, four from sepsis, the fifth from systemic malignancy. Mortality was related to the location and output of the fistula, with jejuno-ileal high-output fistulas in particular figuring prominently in the mortality.

A comparison of the simple ligation and ligation inversion of the appendiceal stump after appendectomy

In this article, we present 80 noncomplicated acute appendicitis that we operated. The patients was separated into two groups. The first group, appendiceal stump was tied and dropped in abdominal cavity in 40 cases and second group, it was tied and inverted into the cecum in the other 40 cases. The cases were observed in the postoperative period concerning intraabdominal abscess, brid ileus, incisional wound infection and hospitalization duration. No significant difference has been found between these two groups.

Volvulus of the sigmoid colon

Between 1983 and 1986, 18 patients with colonic volvulus (94.4% sigmoid, 5.6% caecal) were seen at Karadeniz Medical Faculty. There were 11 male and 7 female patients, with a mean age of 68 years. In 66.6% and 22.2% of patients respectively a palliative procedure or a Hartmann operation were performed. The recurrence rate in the palliative group was 30%. The mortality rate for all patients with volvulus was 16.8%. The palliative procedures were successful in patients in good general condition and without bowel necrosis, whereas the Hartmann operation gave successful results in patients with bowel necrosis.

Rupture of a choledochal cyst during postpartum period

A 25 year old female was operated on three times due to a choledochal cyst rupture occurring on the 6th postpartum day. In the last operation, a hepaticojejunostomy with Braun's anastomosis was performed and a temporary internal stent was applied. The internal stent was removed on the 70th postoperative day. The patient is still living with the risk of secondary biliary cirrhosis and cholangitis.

[Prevention of wound infection in elective colon surgery by the use of systemic ceftriaxone and ornidazole]

In this study prophylactic effects of ceftriaxone and ornidazole on the patients undergoing elective colon surgery was studied in the surgical clinics, Medical Faculty of Karadeniz Technical University. Colon cleaning with Nichol's method was performed in all cases. But kanamycin and metronidazole were given instead of erythromycin and metronidazole. One hour before the operation ceftriaxone 1 gr. and ornidazole 500 mg. (IV, IM) were administered. Those antibiotics were followed by ceftriaxone 2 gr. daily and ornidazole 1 gr. daily (IV, IM) three days after operation. The wound infection were observed in the postoperative period (5%). The average hospitalization time of the cases were 12 days. This period was 18 days and 21 days in the cases having infection. Side effects related the drugs were not observed and there were no significant laboratory changes.