[How do intraoperative complications effect adhesion formation after laparoscopic cholecystectomy: a comparative animal study]

BACKGROUND

The aim of this study was to evaluate the extent of postoperative formation of adhesions following laparoscopic and open cholecystectomy.

MATERIAL AND METHODS

60 experimental laparoscopic cholecystectomies (LC) were performed in dogs by qualified surgeons to learn laparoscopic technique. To assess the relationship between complications occurred during the operation (bleeding, laceration of the liver bed or gallbladder perforation) and the formation of adhesions surviving animals were divided into 4 groups according to the type of complication. We assessed the results during second-look laparoscopy 4 weeks following LC using the adhesion index (AI: 0-4 score). Animals were then sacrificed to measure the extent of adhesions. As a control group open cholecystectomy was performed in 15 dogs without intraoperative complications. Mann-Whitney Rank Sum test and Dunn's Method were used for statistical analysis.

RESULTS

No adhesions were observed in the laparoscopic group without intraoperative complications. In all dogs with bleeding or laceration of the liver bed maintained by electrocoagulation, adhesions developed. Formation of adhesion in these groups was significantly higher than in "ideal LC" or in case of gallbladder perforation (P < 0.01). All animals in the control group developed significantly more adhesions compared to the experimental group (p < 0.05).

CONCLUSION

LC produces less adhesion compared to conventional open technique. Complications such as bleeding or laceration of the liver bed during LC can increase the formation of adhesions. No formation of adhesions can be related to gallbladder perforation during LC.

[Effect of pentoxifylline on the healing of experimental anastomosis of the left colon in rats]

The healing of colonic anastomoses is determined by several factors such as microcirculation, the strength of the inflammatory response, and the time required for regeneration. We investigated the effects of pentoxifylline--a drug which improves microcirculation and modulates leukocyte functions--on the healing of experimental anastomosis on the left colon of rats. As a result of drug treatment (0.25 mg/100 g, i.p.) in Group I anastomosis bursting pressure (ABP) was by 56 +/- 17% higher at day 2 than in controls with no pentoxifylline treatment. On the 5th postoperative day in Group I, ABP reached 80 +/- 8% the value for the intact colon (218 +/- 21 mmHg), whereas respective value in the control (untreated) group was only 47 +/- 7%. In Group II (pentoxifylline: 2 mg/100 g, i.p.) ABP was by 55 +/- 10% and by 73 +/- 8% higher than control values at postoperative days 1 and 2, respectively. At day 2, in Group I colonic blood flow measured at the anastomosis line by 86Rb uptake technique was significantly higher than in the untreated controls (0.18 +/- 0.01 ml/min vs. 0.14 +/- 0.01 ml/min, (p < 0.02). Blood flow measured in colon tissue above and below the anastomosis changed differently. Pentoxifylline treatment also suppressed the peritoneal inflammatory response assessed with peritoneal reaction index (2.0 +/- 0.3 vs. 1.1 +/- 0.2, p < 0.01). The results of the present study show that pentoxifylline treatment shortens the time needed for the healing of colonic anastomosis. These observations suggest that pentoxifylline medication can prevent failure of colonic anastomoses.

[Esophageal anastomosis--based on the experience with 1460 operations]

The authors reviewed the clinical records of 1460 patients with esophageal anastomoses, the operations performed in their institute between 1973 and 2000. Surgical outcome was assessed with incidence of anastomotic leaks and overall mortality. Hand-sewn anastomoses were performed by inserting single layer interrupted monofil steel wire (507), PDS (232) or Vicryl (65) sutures and circular stapler (EEA, Ethicon) was used in 656 patients. 453 (65 cervical, 293 thoracic, and 95 abdominal) anastomoses performed between 1995 and 2000 were analyzed separately. During this 6-year period, the majority of operations (88%) were performed because of esophageal malignancy (squamous cell carcinoma of the esophagus or adenocarcinoma of the cardia). Surgery was performed for benign disease (e.g. stricture, perforation, and stage IV achalasia) in 12%. The incidence of anastomotic leak was the highest (20%) after cervical anastomosis, compared to a 4.4% or 1% associated with thoracic or abdominal anastomoses. These differences are statistically significant (p < 0.001). The rate of anastomotic leakage was strongly connected to surgical technique: it was 15% in hand-sewn anastomoses and only 4.4% with stapled anastomosis. During the 6-year period overall mortality was 6.6%t.

[Rare late complication after subtotal esophagectomy]

We report a case of a peptic ulcer developed in the stomach tube used for the replacement of the esophagus. The patient was a 60 years old female who had undergone subtotal esophagectomy for mid esophageal malignancy, with intrapleural stomach replacement. Urgent endoscopy revealed an excavated, bleeding ulcer in the thoracic part of the stomach. After unsuccessful medical treatment urgent operation was performed via right thoracotomy. Opening the stomach an ulcer was found on the posterior wall of the stomach, it was penetrating to the right atrium of the heart. The bleeding was controlled by suturing the atrium wall. The patient treated with i.v. Omeprazol in the postoperative period. On the 21st postoperative day a rebleeding occurred causing shock. After reoperation the patient died. This complication is very rare. We emphasise the importance of postoperative pH measurement investigations showing the presence of duodenogastric reflux disease.

Response to the sexual pheromone and wounding in the green alga volvox: induction of an extracellular glycoprotein consisting almost exclusively of hydroxyproline

The extracellular matrix (ECM) of Volvox is modified during development or in response to external stimuli, like the sex-inducing pheromone. It has recently been demonstrated that a number of genes triggered by the sex-inducing pheromone are also inducible by wounding. By differential screening of a cDNA library, a novel gene was identified that is transcribed in response to the pheromone. Its gene product was characterized as an ECM glycoprotein with a striking feature: it exhibits a hydroxyproline content of 68% and therefore is an extreme member of the family of hydroxyproline-rich glycoproteins (HRGPs). HRGPs are known as constituents of higher plant ECMs and seem to function as structural barriers in defense responses. The Volvox HRGP is also found to be inducible by wounding. This indicates that the wound response scenarios of higher plants and multicellular green algae may be evolutionary related.

Therapeutic results with Cerebrolysin in the treatment of dementia

BACKGROUND

In the present study patients suffering from dementia were treated with an infusion therapy using the neurotrophic drug Cerebrolysin. The effectiveness of the therapy was examined under conditions of daily clinical practice.

METHODS

645 Patients were treated with 30 ml Cerebrolysin daily. The average period of treatment was 17.8 days. Prior to treatment patients were diagnosed according to DSM-III-R. In addition a differential diagnostic examination using the Hachinski Ischemic Score was performed. Clinical symptoms and the Clinical Global Impression (CGI) were determined before and after therapy.

RESULTS

Cerebrolysin therapy led to a significant (p < 0.001) improvement in memory for 62% of the patients. 65% showed improvement in concentration, 50% in mood and fatigue, and 47% improved in vertigo. An improvement in the Clinical Global impression was observed in approximately 80% of the patients. The improvement of symptoms was significantly larger (p < 0.05) in younger, less afflicted patients than in the older, more seriously ill patients. The unusual good tolerance of Cerebrolysin was especially noteworthy.

CONCLUSIONS

The present study confirms the results of earlier clinical studies with Cerebrolysin in the treatment of Alzheimer patients and patients with vascular dementia in which similar responder rates were observed. The significant dependence of therapeutic success on the length and severity of illness confirms that timely pharmacological intervention leads to best therapeutic results.

The trental treatment prevents the reduction of superoxide dismutase enzyme (SOD) activity in rats after colon surgery

The authors tested the effects of the pentoxiphyllin (px, Trental) pre-treatment upon the superoxide dismutase activity of the left colonpart anastomosis of rats. It has been found that the SOD activity of the proximal (4.9 U/g), the anastomical area (1.9 U/g) and the distal (3.1 U/g) intestinal segments considerably decreased, compared to the control (9.16 U/g). In the operated and pre-treated animals with Trental, the SOD activity of all the three intestinal segments increased (proximal 15.5-anastomosis 5.7-distal 8.9 U/g) compared to the non treated group.

Effects of streptozotocin-induced diabetes on neurogenic inflammation of gingivomucosal tissue in rat

It has been suggested that the unmyelinated small diameter afferent nociceptive C-fibres are impaired in diabetes mellitus. We have recently demonstrated that these fibres are the prerequisite for neurogenic inflammation induced by mechanical or chemical irritations. These experiments were designed to characterize the neurogenic inflammatory responses of gingivomucosal tissue in the early phase of experimental induced diabetes mellitus in rat. Effect of dental ligature on the gingivomucosal (GM) vascular permeability was studied in control rats and in rats pretreated with streptozotocin at d 7 and 14 following streptozotocin administration. In separate groups of control and streptozotocin diabetic rats studies were also performed to investigate the effect of local capsaicin application on GM vascular permeability on d 14. Vascular permeability was assessed by means of Evans blue extravasation. The ligature placed around the mandibular left first molar caused a significant increase vascular permeability of GM tissue on the ipsilateral side on both d 7 and 14 after the ligation in control rats. In streptozotocin diabetic rats on d 7, there was also a significant elevation of Evans blue extravasation in the tissue tested on the ligature side. However, on d 14 the ligation failed to produce any changes in Evans blue extravasation on the ipsilateral side, i.e. no difference in GM vascular permeability could be recorded between the two sides in streptozotocin diabetic rats. Topical capsaicin administration produced significant Evans blue extravasation in GM tissue of control rats compared to that observed in diabetic rats on d 14 after streptozotocin treatment. Electron microscopic and light microscopic studies demonstrated fibre degeneration of the C neurones and less inflammatory cells in streptozotocin-induced diabetes in the gingivomucosal tissue. These findings appear to indicate that the inflammatory responses induced by mechanical (dental ligature) and/or chemical irritants (topical application of capsaicin) in the gingivomucosal tissue are altered in streptozotocin diabetic rats and this alteration is due to the diabetes-induced damage to the unmyelinated C fibres.

Neurogenic component in ligature-induced periodontitis in the rat

Effect of ligation on the vascular permeability in the gingiva and alveolar mucosa encircling the mandibular left 1st molar was studied in rats with and without capsaicin pretreatment. Vascular permeability was assessed by the Evans blue extravasation. Ligation caused a significant augmentation in vascular permeability of the gingivomucosal tissue at day 8 (right: 18.14 +/- 1.68 micrograms g-1; left (ligature): 38.21 +/- 2.43 micrograms g-1, n = 8, p < 0.001) and at day 14 (right: 20.31 +/- 1.71 micrograms g-1: left (ligature): 36.98 +/- 2.73 micrograms g-1, n = 8, p < 0.001). 4 days after ligation, no difference could be observed in vascular permeability in the oral mucosa of the ligated side (left: 23.14 +/- 1.21 micrograms g-1) as compared to the side without ligature (right: 23.5 +/- 1.45 micrograms g-1, n = 8, NS). There was no elevation of vascular permeability of gingivomuscosal tissue around the ligation in rats pretreated with capsaicin either in newborn age (right: 23.92 +/- 1.76 micrograms g-1; left (ligature): 23.51 +/- 2.16 micrograms g-1, n = 8, NS) or in adult age (right: 20.61 +/- 1.62 micrograms g-1; left (ligature): 20.85 +/- 1.07 micrograms g-1, n = 8, NS). Light microscopical studies of oral mucosa revealed, that 8 and 14 days after the ligature placed around the mandibular left 1st molar of the rat, there resulted an accumulation of inflammatory cells in the connective tissue.(ABSTRACT TRUNCATED AT 250 WORDS)