Ethyl pyruvate protects colonic anastomosis from ischemia-reperfusion injury.

Ethyl pyruvate is a simple derivative in Ca(+2)- and K(+)-containing balanced salt solution of pyruvate to avoid the problems associated with the instability of pyruvate in solution. It has been shown to ameliorate the effects of ischemia-reperfusion (I/R) injury in many organs. It has also been shown that I/R injury delays the healing of colonic anastomosis. In this study, the effect of ethyl pyruvate on the healing of colon anastomosis and anastomotic strength after I/R injury was investigated. Anastomosis of the colon was performed in 32 adult male Wistar albino rats divided into 4 groups of 8 individuals: (1) sham-operated control group (group 1); (2) 30 minutes of intestinal I/R by superior mesenteric artery occlusion (group 2); (3) I/R+ ethyl pyruvate (group 3), ethyl pyruvate was administered as a 50-mg/kg/d single dose; and (4) I/R+ ethyl pyruvate (group 4), ethyl pyruvate administration was repeatedly (every 6 hours) at the same dose (50 mg/kg). On the fifth postoperative day, animals were killed. Perianastomotic tissue hydroxyproline contents and anastomotic bursting pressures were measured in all groups. When the anastomotic bursting pressures and tissue hydroxyproline contents were compared, it was found that they were decreased in group 2 when compared with groups 1, 3, and 4 (P < .05). Both anastomotic bursting pressure (P = .005) and hydroxyproline content (P < .001) levels were found to be significantly increased with ethyl pyruvate administration when compared with group 2. When ethyl pyruvate administration doses were compared, a significant difference was not observed (P > .05). Ethyl pyruvate significantly prevents the delaying effect of I/R injury on anastomotic strength and healing independent from doses of administration.

Primary rectal lymphoma: an unusual treatment for a rare case.

Lymphomas may be localised throughout the whole gastrointestinal tract, from oral cavity to rectum. The rectum is a fairly uncommon site for lymphoma compared to other gastrointestinal sites. Primary rectal lymphoma is the rarest disorder accounting for 0.1-0.6% of all colonic malignancies, and 0.05% of all primary rectal tumours. It is unclear whether surgery, chemotherapy, radiotherapy or combinations of these treatments improve the prognosis and survival rate in such patients. The role of surgery in primary rectal lymphoma of the rectum is still controversial. A case of primary rectal lymphoma treated by a combination of chemotherapy and radiotherapy is described.

Liability and validity of the Appropriateness Evaluation Protocol in Turkey.

OBJECTIVE: To assess the inter-rater reliability between nurses and the convergent validity of the Appropriateness Evaluation Protocol (AEP) in the Turkish context. METHODS: Two nurses applied the original AEP concurrently to a random subsample of 335 patient-days in internal medicine, general surgery, and gynaecology departments at a university hospital and a government teaching hospital, as a part of a larger study. Inter-rater reliability was tested by calculating overall agreement and specific agreements between nurse reviewers' AEP assessments. Validity was tested by comparing the assessments of the nurses based on the AEP with the implicit judgements of five expert physicians on a random subsample of 818 patient-days. Sensitivity, specificity, positive and negative predictive values of the AEP were calculated. Reliability and validity were also evaluated by the K statistic. RESULTS: In the reliability test, there was a high level of agreement between the two independent raters applying the AEP in the three departments studied: overall agreement = 90.7-97.6%; specific inappropriate agreement = 69.1-92.3%; specific appropriate agreement = 88.3-96.6%. In validity testing, the AEP had a sensitivity of 0.83-0.97, specificity of 0.62-0.80, and positive and negative predictive values of 0.84-0.88 and 0.73-0.95 respectively. Kappa coefficients in internal medicine and gynaecology indicated almost perfect agreement in reliability testing and moderate agreement in validity testing. In general surgery, the K coefficients showed substantial agreement in both tests. CONCLUSION: These results indicate that the AEP is a reliable and valid instrument to assess appropriateness of patient-days in Turkey.