The protective effect of infliximab on cisplatin-induced intestinal tissue toxicity.

OBJECTIVE: Cisplatin (CP) is a popular chemotherapeutic agent. However, high doses of CP may lead to severe side effects to the gastrointestinal system. The aim of this study was to investigate the protective effects of infliximab on small intestine injury induced by high doses of CP. MATERIALS AND METHODS: The A total of 30 rats were equally divided into three groups, including sham (C), cisplatin (CP), and cisplatin + infliximab (CPI). The CP group was treated with 7 mg/kg intraperitoneal cisplatin, and a laparotomy was performed 5 days later. The CPI group received 7 mg/kg infliximab intraperitoneally, were administered 7 mg/kg cisplatin 4 days later, and a laparotomy was performed 5 days after receiving cisplatin. Histopathological and immunohistochemical analysis of small intestine tissue sections were performed, and superoxide dismutase, malondialdehyde, and TNF-α levels were measured. RESULTS: Histopathological evaluation revealed that the CP group had damage in the epithelium and connective tissue, but this damage was significantly improved in the CPI group (p < 0.05). In addition, these histopathological findings were confirmed by biochemical analyses. CONCLUSIONS: These results suggest that infliximab is protective against the adverse effects of CP.

A safety-based comparison of pure LigaSure use and LigaSure-tie technique in total thyroidectomy.

BACKGROUND AND AIM: Sutureless total thyroidectomy by using vessel sealing devices has been shown to be safe in some recent clinical studies. However, some surgeons are still concerned about the use of these energy devices in the vicinity of there current laryngeal nerve and parathyroid glands. The objective of this study was to investigate the effects of the use of pure LigaSure on postoperative complications and to discuss the pertinent literature. METHODS: A total of 456 patients having undergone a total thyroidectomy operation between June 2009 and March 2011 were included in the study. Data were prospectively collected and retrospectively evaluated. Patients were separated into 2 groups. Group L comprised of 182 patients where onlyLigaSure was used, and group LT consisted of 274 patients where ligation was used in the vicinity of the recurrent laryngeal nerve and parathyroid glands, and LigaSure was used in all other parts of the surgery. Patient's blood calcium values were checked preoperatively and at postoperative 24, 48, and 72 hours. Groups were assessed in terms of demographic properties, thyroid pathology, duration of operation, and postoperative complications. RESULTS: Groups were similar in respect of demographic properties, operation duration, thyroid gland pathology. No mortality rate was recorded. Laboratory hypocalcemia rate was higher in group L (P 0.003), but no significant difference was identified between groups in terms of symptomatic hypocalcemia.No permanent hypocalcemia or recurrent laryngeal nerve injury developed in any of the patients in the two groups. CONCLUSIONS: Pure LigaSure for total thyroidectomy may increase laboratory hypocalcemia rate, but not symptomatic hypocalcemia. Hemorrhage related complications were similar and low in the two groups. Ligations in the places close to delicate anatomic structures did not cause longer operative times and may be a safer option in total thyroidectomy.

Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material.

AIM: To evaluate the effects of sonographic characteristics of thyroid nodules, the diameter of needle used for sampling, and sampling technique on obtaining sufficient cytological material (SCM). MATERIALS AND METHODS: We performed sonography-guided fine-needle biopsy (FNB) in 232 solid thyroid nodules. Size-, echogenicity, vascularity, and localization of all nodules were evaluated by Doppler sonography before the biopsy. Needles of size 20, 22, and 24 G were used for biopsy. The biopsy specimen was acquired using two different methods after localisation. In first method, the needle tip was advanced into the nodule in various positions using a to-and-fro motion whilst in the nodule, along with concurrent aspiration. In the second method, the needle was advanced vigorously using a to-and-fro motion within the nodule whilst being rotated on its axis (capillary-action technique). RESULTS: The mean nodule size was 2.1+/-1.3 cm (range 0.4-7.2 cm). SCM was acquired from 154 (66.4%) nodules by sonography-guided FNB. In 78 (33.6%) nodules, SCM could not be collected. There was no significant difference between nodules with different echogenicity and vascularity for SCM. Regarding the needle size, the lowest rate of SCM was obtained using 20 G needles (56.6%) and the highest rate of adequate material was obtained using 24 G needles (82.5%; p=0.001). The SCM rate was 76.9% with the capillary-action technique versus 49.4% with the aspiration technique (p<0.001). CONCLUSION: Selecting finer needles (24-25 G) for sonography-guided FNB of thyroid nodules and using the capillary-action technique decreased the rate of inadequate material in cytological examination.

Giant intraosseous lipoma of the rib.

Lipoma is defined as a benign tumor consisting of a circumscribed mass of adipose tissue. Intraosseous lipomas represent fewer than 0.08% of all primary bone tumors. We present an unusual case of intraosseous lipoma arising from the left 10th and 11th ribs and extending to the subdiaphragmatic area and abdomen. Lipoma of the rib is an extremely rare disorder presenting diagnostic challenges.

Histopathological effects of bipolar vessel sealing devices on liver parenchyma and comparison with suture method: an experimental study.

BACKGROUND: LigaSureand SurgRx are bipolar vessel sealing devices providing hemostasis by denaturating collagen and elastin from the vessel wall and surrounding connective tissue. We aimed to histopathologically evaluate the lateral injury during rat liver resection with LigaSure and SurgRx. METHODS: Suture technique was used in group A, LigaSure was used in group B and SurgRx was used in group C to resect one lobe of liver from midline. One of the resected pieces was histopathologically examined the same day and the other piece was left in the animal to be examined at the 7th day. Relaparotomy was performed at the 7th day. RESULTS: Necrosis, exudate formation, chronic inflammation, histiocytes and fibroblasts scores were significantly lower in SurgRx group compared to the other groups. CONCLUSION: Our findings suggest that LigaSure and SurgRx can be safely used in liver resection as compared to suture technique while SurgRx was superior than LigaSure in inflammatory response as it causes lower lateral thermal injury and inflammatory scores probably due to its different technical properties.

Blunt and penetrating traumatic ruptures of the diaphragm.

BACKGROUND: The difficulties in diagnosing traumatic diaphragmatic rupture (TDR) at the first admission are the most common causes of morbidity and mortality. The purpose of this study was to review our experience with the management of TDR in order to identify the factors contributing to diagnostic delay and associated morbidity and mortality. METHODS: Fourteen patients with TDR were treated in our hospital between January 2000 and June 2005. They have been investigated retrospectively. RESULTS: The study identified 9 men (64 %) and 5 women (36 %), with ages ranging from 19 to 65 years (mean 35.3 years). Rupture of the diaphragm was left-sided in 10 (71 %) and right-sided in 4 (29 %) of the patients. Blunt trauma accounted for the injuries of 11 patients (79 %). Early diagnosis was obtained in 9 patients (64 %). The diagnosis was established preoperatively in 8 patients (57 %), and intraoperatively in 4 (29 %). The diagnosis was missed in 2 (14 %) patients in the first operation. Multiple associated injuries were observed in 12 patients (85 %). Postoperative complications were encountered in five patients (35 %), and the overall mortality was 7 %. CONCLUSIONS: Diaphragmatic rupture should be suspected in all blunt or penetrating traumas of the thorax and abdomen, and the presence of such an injury should be excluded before terminating the exploratory procedure.

Influence of pentoxifylline and interferon-alpha on prevention of stricture due to corrosive esophagitis. An experimental study in the rat.

The effects of pentoxifylline (PTX) and interferon alpha (IFN-alpha) in the prevention of strictures due to corrosive esophagitis in rats were investigated. Forty rats were randomly divided into four equal groups. Corrosive esophagitis was induced in all groups by application of 37.5% NaOH to the distal esophagus for a period of 90 s followed by saline rinse. Histopathologic damage was significantly lower in the PTX and IFN-alpha-treated groups than in the untreated group. During the study period, PTX and INF-alpha-treated animals showed a significant increase in body weight when compared to controls. However, PTX provided more significant prevention of stricture formation than IFN-alpha. In the PTX-treated group, the wall thickness and quantity of hydroxyprolin were significantly lower than in the untreated and IFN-alpha-treated groups. Stenosis index in the PTX group was significantly reduced compared to the control group. PTX prevents the stricture formation due to corrosive esophagitis in this experimental model. IFN-alpha was also shown to prevent stricture formation when considering amelioration of histopathologic damage and increase in body weight.

Is it possible to resterilize disposable laparoscopy trocars in a hospital setting?

Nosocomial infections associated with interventional procedures have been attributed to improper decontamination of instruments. Disinfection of solid laparoscopic instruments, such as telescopes, by 2% glutaraldehyde and ethylene oxide was shown to be effective in preventing infection transmission. However, instrument design in more complex surgical instruments may hamper the quality of disinfection. The aim of this study is to investigate the safety of hospital disinfection of disposable laparoscopic instruments with a relatively more complex design. A total of 40 laparoscopic trocars were divided into two equal groups: group 1 was contaminated with bacteria and yeast, and group 2 was contaminated with the hepatitis B virus. Each group was then divided to two equal subgroups. After disinfecting subgroup A with 2% glutaraldehyde and B with ethylene oxide, samples were obtained for bacterial cultures and for virus detection using polymerase chain reaction (PCR). Bacterial and yeast cultures were positive in three instruments in group 1A and in two instruments in group 1B. Tests results for the hepatitis B virus were negative in group 2A, but positive in group 2B. Results of this study indicate that disinfection for multiple use of disposable laparoscopic instruments with a relatively complex structure is not effective and may result in nosocomial disease transmission by bacteria, fungi, and viruses.

The effects of hyperbaric oxygen on normal and ischemic colon anastomoses.

BACKGROUND: Leakage from colonic anastomoses is a major complication causing increased mortality and morbidity, and ischemia is a well-known cause of this event. Inadequate tissue oxygenation could be reversed by using hyperbaric oxygen. This study was designed to investigate the effects of hyperbaric oxygen on the healing of ischemic and normal colon anastomoses in the rat model. METHODS: Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats divided into four groups. The control group (I) received no further treatment. To mimic ischemia, 2 cm mesocolon was ligated on either site of the anastomosis in group II and IV rats. Hyperbaric oxygen therapy was started immediately after surgery in group III and IV rats (therapeutic groups). All animals were sacrificed on the fourth postoperative day. After careful relaparotomy, in situ bursting pressure was measured. The hydroxyproline contents of the anastomotic segments in equal length were determined. RESULTS: The hydroxyproline assay revealed that rats in group II with ischemic colonic anastomosis have significantly lower levels (P <0.05). The highest levels are in the group III rats with normal colonic anastomosis treated by hyperbaric oxygen (P <0.05). There was no significant difference in hydroxyproline levels between group II and group IV animals (P >0.05). Group III animals had significantly higher bursting pressures than any other group (P <0.05). Group II rats had lowest bursting pressures (P <0.05). Group IV animals had significantly higher levels than group II (P <0.05). Mean bursting pressure values both in groups III and IV and hydroxyproline levels in group III were significantly increased by hyperbaric oxygen therapy (P <0.05). CONCLUSIONS: Ischemia impairs anastomotic healing. Hyperbaric oxygen increases anastomotic healing of both normal and ischemic colonic anastomosis and reverses ischemic damage. This study demonstrated that hyperbaric oxygen improves anastomotic healing.