Red cell distribution width, gamma glutamyl transpeptidase and anticoagulant use affect mortality in acute arterial mesenteric ischemia.

BACKGROUND: Despite advances in surgery and intensive care, mortality in acute mesenteric ischemia remains between 50% and 90%. In this study, we evaluated factors affecting mortality in acute arterial mesenteric ischemia. METHODS: This is a retrospective cohort study involving 73 patients with an initial diagnosis of arterial acute mesenteric ischemia admitted to Ankara Numune Teaching Hospital between January 2008 and December 2013. We retrospectively collected data about demographic variables, co-morbidities, medications, extent of surgical resection, laboratory values, pathology results and outcome. RESULTS: The mean age of the patients was 69.3±12.6. Thirty one patients were female (42.46%) and 42 (57.53%) were male. We divided the patients into two groups: Group 1 (n=40); those who died and Group 2 (n=33); those who were discharged. In multivariate analysis of high gamma glutamyl transpeptidase and red cell distribution width levels, the presence of anticoagulant use was statistically significant (p<0.05) in favor of Group 1. CONCLUSION: High red cell distribution width and gamma glutamyl transpeptidase levels and anti-coagulant use are factors affecting mortality in arterial acute mesenteric ischemia. The assessment of these variables could help predict the extent of arterial acute mesenteric ischemia and the mortality associated with it.

Comparison of meshes for the repair of experimental abdominal wall defects.

The aim of this experimental study was to compare the effects of polytetrafluoroethylene patch, polypropylene mesh, and porcine dermal collagen implant in rats for the repair of abdominal wall defects. We created experimental abdominal wall defects in 45 rats (three groups of fifteen) and repaired them with polytetrafluoroethylene, polypropylene mesh, and porcine dermal collagen implant by onlay technique. We sacrificed 4 rats from each group at 4, 8, 10, and 12 weeks after implantation and observed if hernia, adhesion, effusion, or infection occurred. We measured the tensile strengths of meshes by a digital tensometer. We made histological and electron microscopic evaluations of the meshes. Postoperative infection and effusion occurred in one rat in each group. Hernia was not found throughout the trial. The tensile strength of polytetrafluoroethylene patch and polypropylene mesh increased more than porcine dermal collagen implant until the end of week 12. Adhesion formation was minimal in the porcine dermal collagen group and moderate in the polytetrafluoroethylene patch and polypropylene mesh groups. Polytetrafluoroethylene patch showed minimum absorption and maximum foreign body reaction. Our results show that although none of the material reached the criteria of ideal mesh, polypropylene mesh is the better mesh for the repair of abdominal defects. Polytetrafluoroethylene patch though expensive, can also be used as a reliable mesh. We do not advise porcine dermal collagen implant as a mesh for abdominal defects due to its weak structure.

The effect of short-term octreotide administration on the histologic structure of stomach, duodenum, jejunum, colon, liver and gallbladder in an experimental pancreatitis model.

It is known that long-term administration of octreotide leads to changes in the histology of intraabdominal organs and plasma biochemical values. The purpose of the present study was to evaluate the histological effect of short-term octreotide administration on digestive organs in the experimentally induced pancreatitis by ligating pancreatic duct. The sham operation was performed on 20 rabbits in Groups 1 and 2. Acute pancreatitis was induced by pancreatic duct ligation in 20 rabbits in Groups 3 and 4. Octreotide was administered subcutaneously to the rabbits in Groups 2 and 4 at a dosage of 10 microg/kg/day for 7 days. The animals were sacrificed at the end of day 7, blood and tissue samples were collected. There was no histological changes in the stomach, duodenum, gallbladder, or small and large intestines of those group which received octreotide, while hepatic bile duct proliferation, bile duct epithelium proliferation, periportal inflammation and venous stasis were observed in liver histology. In conclusion, one-week octreotide administration in this experimental acute pancreatitis model was not associated with pathologic changes in digestive organs except liver.

Aggressive bowel preparation does not enhance bacterial translocation, provided the mucosal barrier is not disrupted: a prospective, randomized study.

PURPOSE: Prospective, randomized studies have shown that bowel preparation may adversely affect infectious complications following colonic resections. However, very little is known about the effects of bacterial translocation on these infectious complications. The aim of this prospective, randomized study was to assess the effects of bowel preparation on bacterial translocation. METHODS: A total of 82 consecutive patients undergoing elective abdominal operations were randomly assigned to four groups: control (I; n = 20), mechanical (II; n = 21), mechanical plus oral metronidazole (III; n = 20), and polyethylene glycol preparation (IV; n = 21). Patients with intra-abdominal infection, those receiving preoperative antibiotics for any reason, and those having lower gastrointestinal tract disease were excluded from the study. Peritoneal swab, ileocecal and pericolic mesenteric lymph nodes, liver wedge biopsy, portal venous blood, and peripheral blood samples were taken for culture. Patients were followed up for postoperative infectious complications. Groups were matched according to age, gender, body surface area, and Acute Physiology and Chronic Health Evaluation II scores. RESULTS: Bacterial translocation was identified by a positive culture in one patient in Group I, two in Group II, one in Group III, and three in Group IV, respectively. Differences in number of positive cultures among the groups were not statistically significant. Nine patients had major infectious complications. Only two had bacterial translocation, and the same micro-organisms grew in both patients, in one at the wound site and in the other at the cyst abscess. CONCLUSION: This study demonstrated that mechanical bowel preparation does not enhance the spontaneous occurrence of bacterial translocation in patients without any clinical signs of lower gastrointestinal tract disease.

Re-evaluation of the role of impedance plethysmography in the diagnosis of deep vein thrombosis in surgical patients.

The clinical diagnosis of deep-vein thrombosis (DVT) is nonspecific and nonsensitive. As a result invasive and non-invasive laboratory tests are needed. In order to detect the diagnostic value of impedance plethysmography (IPG), a widely used non-invasive laboratory test, a prospective clinical trial was performed to compare IPG with color Doppler-ultrasonography (CDUS) and venography. Seventy-six (41 female, 35 male) high-risk abdominal surgery patients were included in the study. IPG and CDUS were performed preoperatively. During the postoperative period IPG, CDUS and venography were carried out. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of IPG were all determined. The preoperative IPG was positive in 32 patients, being (+) in 29 patients postoperatively. On the other hand, two of the 29 postoperative IPG (+) patients had DVT diagnosed postoperatively by CDUS and venography. One of 47 IPG (-) patients had DVT diagnosed postoperatively. According to these findings, the sensitivity of IPG was 67%, specificity 63%, and PPV, NPV and accuracy were 7%, 98% and 63%, respectively. Our study showed that IPG was not a reliable non-invasive laboratory method in the diagnosis and screening of DVT of the lower extremity.