Primary pancreatic hydatid disease: A rare presentation of echinococcosis

Hydatid disease is a zoonotic parasitic disease which rarely involves pancreas primarily. Diagnosis of pancreatic hydatid cyst is a challenge and operative skills are important to avoid spillage of cyst's content. A 19-year-old male patient was admitted to hospital with recurrent abdominal pain which was on epigastrium and left upper quadrant of abdomen. Pain was not associated with nausea, vomiting or fever. An abdominal computed tomography (CT) scan was ordered. As a result of abdominal CT scan, there was a cystic area in tail of pancreas with a diameter of 5.6 cm which includes septa and there was calcification on borders of the cyst. Possible diagnosis were either pancreatic hydatid disease, pancreatic cyst adenoma or cystadenocarcinoma or pseudocyst of autoimmune pancreatitis. Whole body positron emission tomography (PET-CT) scan showed no other cyst or lesion other than pancreatic cyst. Hydatid disease indirect hemagglutination test has been studied and it was positive. Imaging studies and laboratory results were suggested hydatid disease and laparoscopic distal pancreatectomy has been applied. Primary pancreatic hydatid disease should be in differential diagnosis when newly appearing pancreatic cyst has been diagnosed, especially in endemic areas. Appropriate surgical technique has to be applied to avoid dissemination of cyst's content.

The Impact of Metabolic 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Parameters on the Prognosis of Resectable Pancreatic Adenocarcinoma

Objectives

¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) is a useful staging method in pancreatic cancer. The prognosis of pancreatic adenocarcinoma is affected by the tumor stage and resectable state. Maximum standardized uptake value (SUV_max), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of primary tumors are related to prognostic parameters in pancreatic cancer. This study compared ¹⁸F-FDG PET/CT findings with prognostic factors and overall survival of patients with pancreatic cancer.

Methods

Patients with pancreatic adenocarcinoma, referred to our department between 2015 and 2022 for staging, were retrospectively evaluated. Head-to mid-thigh PET/CT images were obtained 1 h after ¹⁸F-FDG injection. Demographic data, survival, and clinical and pathological findings of 39 patients, who underwent surgery after PET/CT imaging, were collected. All primary tumor MTV, SUV_max, background SUV_max, and TLG data have were measured.

Results

The images of 39 patients (24 women and 15 men) with a mean age of 66.62±9.60 years were evaluated. The mean SUV_max, MTV 40%, and TLG of the primary tumors in the pancreatic tissue were 6.28±2.33, 19.33±9.77, and 66.56±45.99, respectively. The average survival after disease diagnosis was 18.97±11.47 (2-55) months. MTV and TLG were significantly higher in patients who died during our study. SUV_max has a significant effect on mortality.

Conclusion

¹⁸F-FDG PET/CT metabolic parameters of SUV_max, MTV, and TLG could help predicting the prognosis of pancreatic cancer preoperatively and follow-up in patients with resectable tumors. Additionally, in our study group tumor grade and perineural invasion significantly affected overall survival.

Delayed diagnosis and successful management of completely transected common hepatic duct in a blunt multitrauma patient

Extrahepatic bile duct injuries are very uncommon and easily be missed in multitrauma patients. Patients suffer from bile duct injuries need special approach to this situation. In this report, a case with total transection of common hepatic duct and treatment approach was presented. In unstable patients, damage control surgery can be applied. A 32-year-old male patient was brought to the emergency department after a beating that includes multiple blunt trauma. Radiological screening showed cranial, nasal, lumbar vertebral, and costal bone fractures, decreased blood flow to the right kidney and free perihepatic and perisplenic fluid. Neurosurgeons operated this patient at the day of admission and no plan for laparotomy was made for this patient at that time. Second day postoperatively patient was transferred to the department of surgery and exploratory laparotomy has been made. Common hepatic duct was fully transected and because of the patient's hemodynamic instability, an external fistula has been made. The patient discharged 10th day postoperatively. The patient was operated after follow-up and a Roux-en-y hepaticojejunostomy has been made. Extrahepatic bile duct injuries are rare and high suspicion is important in complex multitrauma patients. Extent of the injury is unique for every patient and technical aspect of repair can be challenging.

Xanthogranulomatous Cholecystitis: Is Surgery Difficult? Is Laparoscopic Surgery Recommended?

Introduction: Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder (GB). XGC surgery is a difficult process due to its clinical, radiological, and intraoperative findings. In this study, our aim is to show the difficulties of XGC surgery and to find out if laparoscopic surgery is a sufficient procedure. Materials and Methods: Histological findings of 3339 cholecystectomy patients, who were operated between January 2015 and January 2020, were retrospectively reviewed. Age, gender, radiological results, clinical features, intraoperative findings, and surgical management of the patients with XGC were recorded. Results: XGC was observed in 70 patients (2.09%). The average age was 53.75. M:F ratio was 1.2. In radiological examinations, gallstones were found in 94.2% of the patients and GB wall thickness (≥3 mm) was increased in 58.5% of the patients. Around 45.7% of the patients came to the clinic with chronic cholecystitis and 32.9% with acute cholecystitis. In the intraoperative period, adhesions were observed in 80% and increase in GB wall thickness was observed in 77.1% of the patients. The operation started laparoscopically in 66 patients. In 14 patients (21.2%), it was converted to open surgery usually due to insufficient dissection of Calot's triangle. Gallbladder carcinoma (GBC) was suspected in 6 patients, but none of them had malignancy in frozen sections or histology. Conclusions: XGC surgery is difficult due to its radiological, clinical, and intraoperative features and mimicking GBC. It can be converted to open cholecystectomy due to difficulties in laparoscopic dissection. However, since conversion cholecystectomy rates are reasonable, laparoscopic surgery is recommended in patients with suspected XGC.

Early Surgical Repair of Bile Duct Injuries following Laparoscopic Cholecystectomy: The Sooner the Better

Background  We aimed to investigate the outcomes of the immediate surgical repair of bile duct injuries (BDIs) following laparoscopic cholecystectomy. Materials and Methods  Between January 2012 and May 2017, patients, who underwent immediate surgical repair (within 72 hours) for postcholecystectomy BDI, by the same surgical team expert in hepatobiliary surgery, were enrolled into the study. Data collection included demographics, type of BDI according to the Strasberg classification, time to diagnosis, surgical procedures, and outcome. Results  There were 13 patients with a mean age of 43 ± 12 years. Classification of BDIs were as follows: type E in six patients (46%), type D in three patients (23%), type C in two (15%), and types B and A in one patient each (7.6%). Mean time to diagnosis was 22 ± 15 hours. Surgical procedures included Roux-en-Y hepaticojejunostomy for all six patients with type-E injury, primary repair of common bile duct for three patients with type-D injury, and primary suturing of the fistula orifice was performed in two cases with type-C injury. Other two patients with type-B and -A injury underwent removal of clips which were placed on common bile duct during index operation and replacing of clips on cystic duct where stump bile leakage was observed probably due to dislodging of clips, respectively. Mean hospital stay was 6.6 ± 3 days. Morbidity with a rate of 30% ( n  = 4) was observed during a median follow-up period of 35 months (range: 6-56 months). Mortality was nil. Conclusion  Immediate surgical repair of postcholecystectomy BDIs in selected patients leads to promising outcome.

Emergency computed tomography for the diagnosis of acute appendicitis: How effectively we use it?

BACKGROUND

Technological developments support using ultrasonography (US) in all patients, if available, and advanced diagnostic methods such as abdominal computed tomography (CT) in case of clinical suspicion during diagnostic process of acute appendicitis. We aimed to investigate whether CT was appropriately and efficiently used in the diagnosis of acute appendicitis.

METHODS

Between May 2013 and February 2016, 811 patients who underwent appendectomy were retrospectively reviewed from an IRB-approved database, and those who underwent a preoperative CT were enrolled into the study. Results of Alvarado scores and US were recorded in addition to which clinic requested the CT (general surgery or emergency department).

RESULTS

The frequency of CT use in the diagnostic process was 25% (n=208/811). Ultrasound was negative for appendicitis in 53% of these patients. The mean Alvarado score was 5±1.5 (range: 3-8). General surgeons requested 57% of CTs. Alvarado scores were significantly higher in patients whose CT was requested by general surgery than in those whose CT was requested by the emergency clinic (5.6 vs. 4.7, p=0.013). Regarding histopathological results, age and Alvarado scores were significantly lower (p=0.015 and 0.037, respectively), whereas the frequency of negative CT was significantly higher (p=0.042) in those with negative appendectomy (n=29, 14%).

CONCLUSION

Most patients who underwent CT in the diagnostic process had an Alvarado score between 5 and 8 and negative ultrasound for appendicitis preoperatively. These findings may provide efficient use of CT in the diagnosis of appendicitis with an acceptable rate of 25% compared with the findings in current literature. However, further research is needed to ensure more efficient use of CT because negative appendectomy has been a concern in our series despite promising results of this study.

Management of iatrogenic injuries due to endoscopic sphincterotomy: Surgical or conservative approaches

OBJECTIVE

The best therapeutic approach for endoscopic retrograde cholangiopancreatography-related perforations remains controversial; while some authors suggest routine conservative management, others advocate mandatory surgical exploration. We aimed to evaluate our clinical experience of perforations during endoscopic sphincterotomy.

MATERIAL AND METHODS

A retrospective chart review from January 2010 to October 2015 identified 20 patients with endoscopic retrograde cholangiopancreatography-related perforations. Data collection included demographics, time to diagnosis, type of perforation, treatment strategy, surgical procedure, complications, hospital stay, and outcome. All patients were classified into two groups on the basis of radiological and operative findings.

RESULTS

Only five patients underwent surgical treatment, whereas 15 patients were managed conservatively. The mean time to diagnosis was 7.8 hrs (range: 1 to 36 hrs). In patients who underwent surgical treatment, the types of perforations included type I and III in one patient each and type II in three patients. Surgical procedures included laparoscopic and open cholecystectomy with t-tube drainage in two patients each and primary repair of duodenal injury with hepaticojejunostomy in one patient. Among conservatively managed patients, eight, four, and three had type II, type III, and type IV injuries, respectively. Of these 15 patients, 60% (n=9) underwent percutaneous procedures. The mean length of hospital stay was similar for conservatively and surgically treated patients (12 vs. 12.4 days, respectively, p=0.790). One patient (5%) with type I injury died of multiorgan deficiency.

CONCLUSION

With close close clinical follow-up, medical treatment can be beneficial for most patients, and surgical procedures should be reserved for patients with type I (definite) and type II/III injuries; in patients with these clinical parameters, conservative management will likely be unsuccessful.

Synchronous Solid Pseudopapillary Tumor and Insulinoma in an Adolescent MEN1 Patient Presenting with Diagnostic Dilemmas

Multiple endocrine neoplasia (MEN1) is a rare autosomal dominant disorder characterized by primary hyperparathyroidism, enteropancreatic neuroendocrine tumors, and anterior pituitary adenomas. A 16-year-old male presented to the emergency outpatient clinic with tonic convulsions. Physical examination in the postconvulsive period was unremarkable and revealed a muscular, postpubertal adolescent. Biochemical tests at admission were consistent with hyperinsulinemic hypoglycemia and remarkable for elevated levels of liver transaminases and creatine kinase. Work-up for a potential inborn error of metabolism and Doppler ultrasound for congenital portal-hepatic shunt were negative. When the patient was questioned, he reported using the anabolic steroid stanozolol to strengthen his muscles. His enzyme levels normalized after cessation of stanozolol. Hypoglycemia did not recur on diazoxide therapy. Magnetic resonance imaging showed two discrete lesions in the pancreas. Distal pancreatectomy revealed two masses 1.1 and 1.4 cm in diameter: a solid pseudopapillary tumor and an insulinoma. The patient also had asymptomatic primary hyperparathyroidism. DNA sequence analysis of the MEN1 gene in the index patient and his father and brother revealed a previously reported "pW183S" heterozygous mutation. This case further adds to the "pancreatic tumor" phenotype of MEN1 with the presence of a solid pseudopapillary tumor. This case report also confirms the need to meticulously question drug abuse in adolescents presenting to clinics with diagnostic challenges.

Case of an intrahepatic sewing needle and review of the literature

An intrahepatic foreign body (FB) is rarely observed. In most cases, object passes from the gastrointestinal tract to the liver via migration. Uncomplicated intrahepatic FB can be followed without surgical intervention; however, complicated intrahepatic FB requires laparoscopy or laparotomy. Presently described is laparoscopic operation on 22-year-old female patient who had incidental sewing needle in the right liver lobe. As there were initially no complications, follow-up monitoring was recommended. However, the patient subsequently complained of stomach pain and developed fever. Laparoscopic exploration located sewing needle in the right liver lobe lateral to the gall bladder with end of needle protruding from the liver. Needle was removed with laparoscopic grasper. Review of the literature regarding 23 other intrahepatic sewing needle cases is also presented.

Inflammatory myofibroblastic pancreas tumor: a case report

Inflammatory myofibroblastic tumor (IMT) histologically characterized by fibroblastic and myofibroblastic proliferation with inflammatory infiltrate. The therapy adopted was Whipple's pancreaticoduodenectomy with a histological diagnosis of the inflammatory myofibroblastic tumor. The disease that should be considered as the differential diagnosis is pancreatic cancer. The diagnosis and treatment of IMT is surgical resection.

The difficulties encountered in conversion from classic pancreaticoduodenectomy to total laparoscopic pancreaticoduodenectomy

BACKGROUND:

Recently, total laparoscopic pancreatectomy has been performed at many centres as an alternative to open surgery. In this study, we aimed to present the difficulties that we have encountered in converting from classic open pancreaticoduodenectomy to total laparoscopic pancreatectomy.

MATERIALS AND METHODS:

Between December 2012 and January 2014, we had 100 open pancreaticoduodenectomies. Subsequently, we tried to perform total laparoscopic pancreaticoduodenectomy (TLPD) in 22 patients. In 17 of these 22 patients, we carried out the total laparoscopic procedure. We analysed the difficulties that we encountered converting to TLPD in three parts: Preoperative, operative and postoperative. Preoperative difficulties involved patient selection, preparation of operative instruments, and planning the operation. Operative difficulties involved the position of the trocars, dissection, and reconstruction problems. The postoperative difficulty involved follow-up of the patient.

RESULTS:

According to our experiences, the most important problem is the proper selection of patients. Contrary to our previous thoughts, older patients who were in better condition were comparatively more appropriate candidates than younger patients. This is because the younger patients have generally soft pancreatic texture, which complicates the reconstruction. The main operative problems are trocar positions and maintaining the appropriate position of the camera, which requires continuous changes in its angles during the operation. However, postoperative follow-up is not very different from the classic procedure.

CONCLUSION:

TLPD is a suitable procedure under appropriate conditions.

Laparoscopic versus open surgery for hydatid disease of the liver. A single center experience

BACKGROUND

Cystic Echinococcosis is a chronic parasitic infection, which is still an important problem in rural areas. Due to the development in technology, laparoscopic surgery has been introduced for the surgical treatment of hydatid disease of the liver (HD-L). The present study aimed to evaluate the clinical outcomes of laparoscopic versus open surgery for HD-L in a comparative analysis.

METHODS

Between January 2010 and March 2014, medical records of 83 patients who underwent surgery for HD-L were retrospectively analyzed. Patients' demographic data, cystic features, operative details and postoperative outcomes were reviewed from the database. All patients were divided in two groups regarding the surgical approach; Group A (open surgery, n= 69) and Group B (laparoscopic surgery, n= 14) RESULTS: Both groups were similar regarding demographic variables and cystic features. In group B, mean operative time was significantly lower when compared to Group A (89±28 minutes vs. 144±19 minutes, respectively p<0,01). Hospital stay was also lower in laparoscopic group (3.38±0.7 vs 8.81±5.4 p<0,01). Overall postoperative complication was 19% and it was similar between groups. incidence of biliary fistula was 15% (n=13).

CONCLUSION

Laparoscopic approach in the treatment of HD-L is safe and feasible. Additionally, it has some advantages including shorter operative time and hospital length of stay.

KEY WORDS

Conventional surgery, Hydatid disease of the liver, Laparoscopic approach, Surgical treatment.

Clinical Significance of Intraoperative Frozen Section Analysis of Pancreatic Cancer Surgical Margin at the Time of Pancreaticoduodenectomy

BACKGROUND

Today, in the management of pancreas cancers, achieving an R0 resection is one of the most powerful independent predictors of long-term survival. The aim of this study is to assess the clinical significance of intraoperative frozen section analysis of the pancreatic surgical margin for pancreatic cancer during pancreaticoduodemectomy.

MATERIAL AND METHODS

We conducted a retrospective analysis of prospectively collected data of 37 patients who were operated for pancreatic head cancer and who were evaluated for surgical margin by frozen section analysis intraoperatively, between September 2013 and August 2014 in our center. The intraoperative biopsy reports were compared with final pathological reports.

RESULTS

The mean age of the patients was 64.55(19-82) years (range), the mean tumor size was 3.96(1.16-6.25) cm (range) and the mean harvested lymph node number was 18.52(9-45) (range). In the intraoperative frozen section, one patient was positive for surgical margin (%2.7) who underwent total or complementary pancreatectomy.

CONCLUSION

To secure a tumor-free margin by frozen section, intraoperatively, may increase R0 resection rate in pancreas cancers. The preoperative estimation of tumor margin by endoscopic ultrasonography, computerized tomography or magnetic resonance imaging mostly correlate with intraoperative findings, however in suspected cases intraoperative frozen section for margin determination should be performed.

Prediction of the grade of acute cholecystitis by plasma level of C-reactive protein

Background:

Acute cholecystitis is the most common complication of gallbladder stones. Today, Tokyo guidelines criteria are recommended for diagnosis, grading, and management of acute cholecystitis.

Objectives:

We aimed to evaluate the levels of C-reactive protein (CRP) at different cut-off values to predict the severity of the disease and its possible role in grading the disease with regard to the guideline.

Patients and Methods:

This is a retrospective study, analyzing 682 cases out of consecutive 892 patients with acute cholecystitis admitted to two different general surgery clinics in Istanbul, Turkey. Records of patients diagnosed with acute cholecystitis were screened retrospectively from the hospital computer database between January 2011 and July 2014. A total of 210 patients with concomitant diseases causing high CRP levels were excluded from the study. The criteria of Tokyo guidelines were used in grading the severity of acute cholecystitis, and patients were divided into 3 groups. CRP values at the time of admission were analyzed and compared among the groups.

Results:

Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P < 0.001). Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P < 0.0001). After evaluating CRP levels according to the grade of the disease, group 2 was distinguished from group 1 with a cut-off CRP level of 70.65 mg/L, and from group 3 with a value of 198.95 mg/L. Those results were found to be statistically significant (P < 0.001).

Conclusions:

CRP, a well-known acute phase reactant that increases rapidly in various inflammatory processes, can be accepted as a strong predictor in classifying different grades of the disease, and treatment can be reliably planned according to this classification.

Impact of GLP-1 analogue on oxidative damage and hepatic regeneration in experimental 70% hepatectomy model

BACKGROUND/AIMS

The purpose of our study is researching into impact of glucagon like peptide 1 (GLP 1) analogue on liver regeneration after major hepatectomy.

METHODOLOGY

24 wistar albino rats were consecutively divided into 3 groups. Group 1: Control (sham) group day 14 (n = 8), Group 2: Liver resection group day 14 (n = 8); 70% Liver resection was performed, Group 3: Study group day 14 (n = 8); Subsequent to performing 70% liver resection, GLP-1 analogue was administered 2 times a day. (10 μgr/70 kg x 2 times). After 14 day, rats were sacrificed. Oxi- dative stress and antioxidant enzymes and mitochon- drial permeability transition, cytochrome-c, Bax, Bcl- 2, caspase-3, caspase-8 and caspase-3 activity were examined.

RESULTS

70% Liver resection induced oxi- dative stress of liver tissue was ameliorated by GLP-1 induction. Administration of GLP increased Bcl-2 ex- pression. Decreased expression of cytochrome-c was accompanied by a decrease caspase-3, caspase-8, and Bax expression and caspase-3 activity.

CONCLUSIONS

Glp 1 induction plays a regenerative role in the major hepatectomy. This effect is dependent on modulation of the antiapoptotic and antioxidative pathways by GLP 1 expression.

Impact of allyl disulfide on oxidative damage and liver regeneration in an experimental hepatectomy model

BACKGROUND

We investigated the effects of allyl disulfide (agarlic extract) on tissue damage, regeneration, proliferation and oxidative damage in an experimental liver resection model.

MATERIALS AND METHODS

In the study, 24 female Wistar albinorats weighing approximately 200-250 g were used. Group 1:The rats in the experimental group all received a 70%hepatectomy and were fed an Allyl disulfide (30 μg kg day,Allyl disulfide, Sigma-Aldrich, formula: C6H10S2, CASNumber: 2179-57-9, formula weight: 146.27 g mol) in supplement to a regular diet for 1 week both preoperatively and postoperatively. Group 2: The rats in the control group also underwent a 70% hepatectomy and were given regular food and water for 1 week both preop and postop. Group 3: In the sham group, all rats were sacrificed 7 days after surgery. Forbiochemical evaluation, SGOT, SGPT, bilirubin, CRP and MDA were studied. In a histopathological examination, the fattening of the liver tissue, existence of (macro-micro vesicular),fibrosis, pleomorphism at hepatocyte nuclei, portal inflammation, existence of intralobular inflammatory cells,dilation at sinusoids, congestion, congestion at the central vein, regeneration, existence of Kupffer cells in the sinu soidallumen and ki-67 proliferation index at hepatocytes were examined.

RESULTS

A significant difference between group 1 and group2 was observed regarding the existence of regeneration,(p:0.06), the occurrence of nuclear pleomorphisms (p:0,001)and the fibroblast activity status (p:0.001). Significant differences were found between the experimental groups in regard to Kupffer cell increase and dilation and the hyperemiastatus in the sinusoid lumens (p:0.013 and p:0.001,respectively). In the Allyl disulfide group, the proliferation index was significantly higher than that of the other groups(p:0,001), while the average plasma MDA value was lower than that of the other groups (p: 0,042). No significant differences were found among the groups with respect to tissue MDA values (p:0,720). No significant difference was found for SGPT (ALT) and SGOT (AST) levels between Group 1 and the other groups (p:0.247 and p:0.539, respectively).The average total bilirubin (T. Bili) values were 0,12,0,08 and 0,04 in the allyl disulfide group, control group andSham group, respectively. This difference among the groups is statistically significant (p:0.001). The average direct bilirubin (D. Bili) values were 0,06, 0,02 and 0,02 in the allyl disulfide group, control group and Sham group, respectively.This variation among the groups is also statistically significant (0.001).

CONCLUSION

We observed that the use of Allyl disulfide supplementation after major hepatectomy has a positive impact on liver regeneration, proliferation and oxidative damage.

ABBREVIATIONS

Postop: post-operative, Preop: pre-operative,SGOT(AST): serum glutamic oxaloacetic transaminase,SGPT(ALT): serum glutamate-pyruvate transaminase, CRP:C- Reactive protein, MDA: Malondialdehyde, DAS: Garlicextract diallyl sulfide, AGE: aged garlic extract.

A novel screening test for colon cancer: Talin-1

OBJECTIVE

Cell adhesion and angiogenesis within the extracellular matrix involve special signaling molecules, such as integrins and the actin binding protein Talin-1. The aim of this study was to investigate and describe the expression of Talin-1 for the early detection of colon cancer.

PATIENTS AND METHODS

Blood serum samples were collected from 50 healthy volunteers and from 90 patients with colon cancer. Using an enzyme-linked immunosorbent assay (ELISA), all 140 samples were analyzed.

RESULTS

Preoperative levels of Talin-1 in the serum were significantly higher in patients with colon cancer (p < 0.001). No significant correlation was found between preoperative levels of Talin-1 in the serum and the age and gender of the patients (p < 0.05). However, a significant correlation was found between Talin-1 levels and the tumor grade, TNM stage, and lymph node metastasis (p < 0.001).

CONCLUSIONS

Talin-1 may play a role in the reinforcement of cell proliferation, cell adhesion, and angiogenesis in colon cancer. Thus, the Talin-1 protein activity may be a novel biomarker to detect colon cancer in humans.

The effect of progesterone in the prevention of the chemically induced experimental colitis in rats

PURPOSE

To study the effects of progesterone on an experimental colitis model.

METHODS

Wistar albino rats were treated subcutaneously with 2mg/kg once a day during seven days Colitis was induced by intrarectal administration of 5mg trinitrobenzene sulfonic acid (TNBS). Disease activities, macroscopic and microscopic scores were evaluated. To determine the response provoked by progesterone we measured Colonic malondialdehyde (MDA), TNF alfa, IL-6 and Nitric oxide (NO) levels in addition to the MPO (Myeloperoxidase) and caspase-3 activities.

RESULTS

Progesterone ameliorated significantly the macroscopic and microscopic scores. TNBS-induced colitis significantly increased the colonic MDA levels and caspase-3 activities in group 2 in comparison to the control group. The results of the study revealed a decline in MDA, NO, IL6 and TNF-α levels in the colon tissue and in blood due to progesterone therapy in group 3 when compared to the group 2, a significant improvement. Progesterone treatment was associated with decreased MDA, MPO, TNF alfa and caspase-3 activity.

CONCLUSION

Progesterone therapy decreased oxidative damage in the colonic mucosa.

Feasibility and safety of laparoscopic hydatid surgery: a systematic review

BACKGROUND/AIMS

Eccinococal disease is an important problem in regions such as Turkey, where tapeworms are endemic. Surgery is the main key to successful treatment. Among the various techniques, laparoscopy has recently come to be preferred over the commonly used open technique. The aim of this review was to evaluate the feasibility, safety and potential benefits of laparoscopic hydatid surgery.

METHODOLOGY

Three independent investigators conducted comprehensive research using PubMed, MEDLINE, Embase and the Cochrane library. Language was restricted to English; reference lists were searched manually.

RESULTS

Tweny-two retrospective studies were selected for review, none of which were randomized controlled trials. It was found that the laparocopic approach was attempted in 666 patients. The overall conversion rate to laparotomy was 4% (27/666) with a recurrence rate of hydatid disease of 1.6% (11/666). Average length of hospital stay was 4.7 (1-30) days.

CONCLUSIONS

Based on this meta-analsysis, evidence confirms that the laparoscopic surgical technique is feasable and safe. Good randomized controlled trials are lacking.

Multiple gunshot carotico-jugular fistulas

The development of post-traumatic fistula between the carotid artery and jugular vein is an extremely rare clinical condition. The authors present a 28-year-old patient, who sustained a gunshot injury to the right side of the neck 6 years ago, with undiagnosed contralateral carotico-jugular fistula.

Iloprost reduces colonic injury in ischemic colitis in rats

PURPOSE

Evaluate the effects of iloprost administration in the early period of ischemic colitis and the mechanism that how these effects develop.

METHODS

Thirty two Wistar albino female rats with an average weight of 220g were divided into four groups of eight rats. In group 1 the rats were given iloprost and sacrificed after 24 hours and in group 2 they were sacrificed after 24 hours without any iloprost. The rats in group 3 were administrated iloprost and sacrificed after 72 hours and in group 4 they were sacrificed at 72th hour without iloprost. The differences between the groups as tissue damage, vascularization or apoptosis were assessed statistically.

RESULTS

Oxidative damage and apoptosis were less pronounced and vascularization was better developed in rats that were given iloprost and sacrificed at 24th hour later in contrast to the rats that were not treated with iloprost. But there was no statistical difference among the groups at 72th hour.

CONCLUSION

Iloprost inhibited leucocyte infiltration, decreased proinflammatory cytokines and enhanced angiogenesis so that the oxidative stress and inflammatory response decreased resulting in lesser tissue damage.

Single incision thoracoscopic sympathectomy for hyperhidrosis

Thoracal sympatectomy for hyperhidrosis and vasospastic vascular diseases is a rare method of surgical treatment. Three patients (1 male, 2 female; mean age 27.6; between 25 and 30) with palmar hyperhidrosis and/or axillary and dorsal hyperhidrosis who underwent single port thoracoscopic sympatectomy were analysed for age, sex, time of operation room, intraoperative and postoperative complications and length of hospital stay. Mean operating room time was 70 min (between 30 and 120 min). Mean length of hospital stay was 1 day. No postoperative complications were noted. Single incision laparoscopic surgery for hyperhidrosis is a safe method of treatment and an alternative to laparoscopy.

Adrenomedulline improves ischemic left colonic anastomotic healing in an experimental rodent model

BACKGROUND

Leakage from colonic anastomosis is a major complication causing increased mortality and morbidity. Ischemia is a well-known cause of this event. This study was designed to investigate the effects of adrenomedullin on the healing of ischemic colon anastomosis in a rat model.

METHODS

Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats that were divided into four groups. To mimic ischemia, the mesocolon was ligated 2 cm from either side of the anastomosis in all of the groups. The control groups (1 and 2) received no further treatment. The experimental groups (3 and 4) received adrenomedullin treatment. Adrenomedullin therapy was started in the perioperative period in group 3 and 4 rats (the therapeutic groups). Group 1 and group 3 rats were sacrificed on postoperative day 3. Group 2 and group 4 rats were sacrificed on postoperative day 7. After careful relaparotomy, bursting pressure, hydroxyproline, malondialdehyde, interleukin 6, nitric oxide, vascular endothelial growth factor, and tumor necrosis factor alpha levels were measured. Histopathological characteristics of the anastomosis were analyzed.

RESULTS

The group 3 animals had a significantly higher bursting pressure than group 1 (p<0.05). Hydroxyproline levels in group 1 were significantly lower than in group 3 (p<0.05). The mean bursting pressure was significantly different between group 2 and group 4 (p<0.05). Hydroxyproline levels in groups 3 and 4 were significantly increased by adrenomedullin therapy relative to the control groups (p<0.05). When all groups were compared, malondialdehyde and nitric oxide were significantly lower in the control groups (p<0.05). When vascular endothelial growth factor levels were compared, no statistically significant difference between groups was observed. Interleukin 6 and tumor necrosis factor alpha were significantly decreased by adrenomedullin therapy (p<0.05). The healing parameters and inflammatory changes (e.g., granulocytic cell infiltration, necrosis, and exudate) were significantly different among all groups (p<0.05).

CONCLUSION

Adrenomedullin had positive effects on histopathologic anastomotic healing in this experimental model of ischemic colon anastomosis.

Effects of glutamine and curcumin on bacterial translocation in jaundiced rats

AIM: To investigate the effect of curcumin on bacterial translocation and oxidative damage in an obstructive jaundice model and compare the results to glutamine, an agent known to be effective and clinically used.

METHODS: Twenty-four female Wistar-Albino rats, weighing 200-250 g, were randomly divided into three groups (8 in each group). After ligation of the common bile duct in all animals, Group I received oral normal saline, Group II received oral glutamine and Group III received oral curcumin for seven days. Blood samples via cardiac puncture, tissue samples (terminal ileum, liver and mesenteric lymph node) and peritoneal fluid were obtained from the animals at the time of death to investigate bacterial translocation and oxidative damage.

RESULTS: We observed that both glutamine and curcumin reduced bacterial translocation in blood, hepatocellular damage, plasma cytokine levels, oxidative tissue damage and apoptosis significantly compared to the control group. Additionally, glutamine showed protective effects on ileal epithelium and reduced villus atrophy.

CONCLUSION: On the basis of these findings, both curcumin and glutamine are thought to be effective in preventing or reducing bacterial translocation and oxidative damage in obstructive jaundice.

Parasitic infestation as cause of acute appendicitis

AIM

The role of parasitic infestation in the cause of acute appendicitis has been long time discussed. The aim of this study is to evaluate the role of parasitic infestation in the etiology of acute appendicitis.

PATIENTS AND METHODS

This retrospective study includes 5.100 patients undergoing surgical therapy for acute appendicitis between 1996 and 2005. Patients were divided into two groups according to the presence of the parasites in the appendix lumen: in Group 1 (n=24) we observed parasitic infestation, whereas in patients of the Group 2 (n=5.076) no parasitic infestation was present.

RESULTS

Parasitic infestation was detected in 24 (0.5%). Of 24 parasitic infestation, 12 (50%) were enterobiasis, 6 (25%) were schistosomiasis, 4 (17%) were Ascaris lumbricoides, and 2 (8%) were Taenia saginata. The ratios of the patients with suppurative, gangrenous or perforative appendicitis were similar in both groups. The ratio of the normal histological findings in the Group 1 patients (25%) was significantly higher than that in the Group 2 patients (4.8%, p=0.001).

CONCLUSION

Although parasitic infestation may result in symptoms resembling acute appendicitis, parasitic infestation can't be considered in the etiology of acute appendicitis.

Esophageal stent migration can lead to intestinal obstruction

BACKGROUND

Self-expanding metallic stents are the devices of choice in the treatment of malign or benign strictures of the esophagus. Stent migration is a well-known complication of this procedure.

AIMS

We report a case of intestinal obstruction caused by esophageal stent migration, in which surgical intervention was used.

METHODS

A 65-year-old woman, who had a medical history of gastric cancer operations and esophageal stent applications, was admitted to our emergency department with a 48-hour history of abdominal pain, nausea and vomiting. An emergency laparotomy was performed and the migrated stent causing intestinal obstruction was removed.

RESULTS

The patient recovered without incident and was discharged on postoperative day 3.

CONCLUSION

This case illustrates that esophageal stent migration has to be considered as a potential life-threatening complication.

Diagnostic problems with parasitic and non-parasitic splenic cysts

BACKGROUND

The splenic cysts constitute a very rare clinical entity. They may occur secondary to trauma or even being more seldom due to parasitic infestations, mainly caused by ecchinocccus granulosus. Literature lacks a defined concencus including the treatment plans and follow up strategies, nor long term results of the patients. In the current study, we aimed to evaluate the diagnosis, management of patients with parasitic and non-parasitic splenic cysts together with their long term follow up progresses.

METHODS

Twenty-four patients with splenic cysts have undergone surgery in our department over the last 9 years. Data from eighteen of the twenty-four patients were collected prospectively, while data from six were retrospectively collected. All patients were assessed in terms of age, gender, hospital stay, preoperative diagnosis, additional disease, serology, ultrasonography, computed tomography (CT), cyst recurrences and treatment.

RESULTS

In this study, the majority of patients presented with abdominal discomfort and palpable swelling in the left hypochondrium. All patients were operated on electively. The patients included 14 female and 10 male patients, with a mean age of 44.77 years (range 20-62). Splenic hydatid cysts were present in 16 patients, one of whom also had liver hydatid cysts (6.25%). Four other patients were operated on for a simple cyst (16%) two patients for an epithelial cyst, and the last two for splenic lymphangioma. Of the 16 patients diagnosed as having splenic hydatit cysts, 11 (68.7%) were correctly diagnosed. Only two of these patients were administered benzimidazole therapy pre-operatively because of the risk of multicystic disease The mean follow-up period was 64 months (6-108). There were no recurrences of splenic cysts.

CONCLUSION

Surgeons should keep in mind the possibility of a parasitic cyst when no definitive alternative diagnosis can be made. In the treatment of splenic hydatidosis, benzimidazole therapy is not necessary, although it is crucial to perform splenectomy without rupturing and spilling the cysts.

The effect of hyaluronic acid carboxymethyl cellulose on the healing of colonic anastomosis in rats

BACKGROUND

This study demonstrates the effect of hyaluronic acid-carboxymethylcellulose on the healing of colonic anastomosis.

METHOD

30 female Wistar-Albino rats were divided into three groups; control group 1 (n=10), treated with hyaluronic acid-carboxymethylcellulose, group 2 (n=8) treated with HBO and group 3 with hyaluronic acid-carboxymethylcellulose and HBO.

RESULT

Bursting pressure and rupture strength were significantly higher in the group 3 compared to other two groups (p<0.05). The severity of necrosis, granulation, neovascularisation and epithelization among groups did not show any significant difference (p>0.05). But the evaluation of inflammation showed a statistical significance (p<0.001) such as as granulation (p<0.05).

CONCLUSION

This study did not detect the negative affect of seprafilm on wound healing. Combined treatment with seprafilm and HBO has a favorable therapeutic effect on the healing of ischemic colonic anastomosis (Tab. 4, Fig. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Ascaris as a leading point for small-bowel intussusception in an adult: a rare cause of intussusception

Adult intussusception represents 1% of patients with bowel obstructions and requires a surgical approach. Malignancy is associated with 31% of small bowel intussusception and 70% of large bowel intussusception. Intestinal intussusception caused by ascaris, however, is very uncommon. This report describes our experience of this rare cause of intussusception and its clinical findings.

Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases

Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum.

Coughing may lead to spontaneous chylothorax and chylous ascites

Chylous ascites is a rare form of ascites resulting from the accumulation of lymph in the abdominal cavity. It is due to an interruption in the lymphatic system. Surgical management is indicated in cases of recurrence or failure after conservative treatment. We report a case of spontaneous chylous peritonitis after chylothorax, which is a rare clinical event. The primary reason was unclear and the outcome of medical and surgical treatment was successful.