Diagnostic value of preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 in colorectal cancer.

BACKGROUND: Since the first introduction of tumour markers, their usefulness for diagnosis has been a challenging question. The aim of the present prospective study was to investigate, in colorectal cancer patients, the relationship between preoperative tumour marker concentrations and various clinical variables. METHODS: The study prospectively enrolled 131 consecutive patients with a confirmed diagnosis of colorectal carcinoma and 131 age- and sex-matched control subjects with no malignancy. The relationships of the tumour markers carcinoembryonic antigen (cea) and carbohydrate antigen (ca) 19-9 with disease stage, tumour differentiation (grade), mucus production, liver function tests, T stage, N stage, M stage were investigated. RESULTS: Serum concentrations of cea were significantly higher in the patient group than in the control group (p = 0.001); they were also significantly higher in stage iii (p = 0.018) and iv disease (p = 0.001) than in stage i. Serum concentrations of cea were significantly elevated in the presence of spread to lymph nodes (p = 0.005) in the patient group. Levels of both tumour markers were significantly elevated in the presence of distant metastasis in the patient group (p = 0.005 for cea; p = 0.004 for ca 19-9). CONCLUSIONS: Preoperative levels of cea and ca 19-9 might provide an estimate of lymph node invasion and distant metastasis in colorectal cancer patients.

Hydatid cyst of the pulmonary artery secondary to hepatic hydatid cyst embolism.

A cystic lesion of the liver extending into the inferior vena cava was discovered in a 33-year old female patient suffering from dyspnea, pain and swelling in the legs. Plain chest X-ray was normal. CT and MRI of the thorax showed a cystic lesion within the right pulmonary artery. The liver lesion was treated by a partial cystectomy and omentoplasty, inferior vena cava and bile ducts repair. Through a right thoracotomy, a hydatid cyst was found in the pulmonary artery and enucleated. Although very rare, pulmonary artery hydatidosis may be the cause of an unexplained dyspnea in patients with hydatidosis of the liver.

Giant aneurysm of the splenic artery adherent to the pancreas with splenic infarct: report of a case.

Giant aneurysms of the splenic artery are extremely rare clinical entities. The size of splenic aneurysms rarely exceeds 3 cm. The treatment includes surgical procedures that sometimes require pancreatectomy. We present a case of a 9 cm giant splenic artery aneurysm tightly adherent to the pancreas which was treated surgically.

Effect of carbon dioxide pneumoperitoneum on the severity of acute pancreatitis: an experimental study in rats.

BACKGROUND: In the management of mild acute biliary pancreatitis, it is generally recommended to perform laparoscopic cholecystectomy after the subsidence of the attack during the same hospital admission. The effect of laparoscopy on abdominal organs has been widely investigated but not in acute pancreatitis. This study used an animal model of mild acute pancreatitis to examine the effects of CO(2) pneumoperitoneum on acute pancreatitis in rats. METHODS: Mild acute pancreatitis was induced in 30 male Sprague-Dawley rats by surgical ligation of the biliopancreatic duct. After 2 days, animals were assigned to three groups: sham operation (animals were anesthetized for 30 min without undergoing laparotomy), CO(2) pneumoperitoneum (applied for 30 min at a pressure of 12 mmHg), and laparotomy (performed for 30 min, and then the abdomen was closed). Two hours after the surgical procedures, animals were killed and levels of lactate dehydrogenase, aspartate aminotransferase, glucose, urea, hematocrit, and leukocyte count among Ranson's criteria and levels of amylase, lipase, and total bilirubin were measured to determine the severity of acute pancreatitis. Histopathologic examination of the pancreas was done, and malondialdehyde and glutathione levels of the pancreas and lung were determined. RESULTS: The only significant differences between the groups were in lactate dehydrogenase and aspartate aminotransferase levels, which were significantly higher in the pneumoperitoneum group compared to the sham operation group. CONCLUSION: CO(2) pneumoperitoneum for 30 min at a pressure of 12 mmHg did not affect the severity of acute pancreatitis induced by ligation of the biliopancreatic duct in rats.

Endoscopic clipping versus band ligation in the management of bleeding esophageal varices.

BACKGROUND: The effectiveness of endoscopic clipping in the hemostasis of bleeding esophageal varices and the eventual variceal eradication was compared with that of band ligation. METHODS: Forty patients were enrolled in the study in a prospective manner, 19 of whom received endoscopic clipping (group I) and the remaining (n = 21 patients) received endoscopic band ligation (group II). All patients in this study presented with bleeding from esophageal varices. The patient characteristics (age, sex, Child-Pugh score, variceal grade) were comparable in the two groups. After initial hemostasis, the patients were assigned one of the two forms of endoscopic therapy which was continued in the follow-up sessions until varices were eradicated. Early and late results were compared. RESULTS: Initial hemostasis was achieved in all patients in group I but two patients in group II required clip ligation for initial hemostasis because of the failure in band ligation. Those two were treated with band ligation in the follow-up sessions. A total of 224 clips in 53 treatment sessions and 296 bands in 82 treatment sessions were placed in group I and group II, respectively. The rates of complete variceal eradication were 89% and 76% in group I and group II, respectively (p > 0.05). The median number of required treatment sessions for complete eradication of the varices was significantly lower in group I than group II (3 versus 4, p = 0.013). Three patients from group I (15%) and seven patients from group II (33%) were readmitted for variceal bleeding during the follow-up period (p > 0.05). CONCLUSIONS: With the advantages of high initial hemostasis rate, decreased risk of rebleeding, and fewer treatment sessions needed for variceal eradication, endoscopic clipping is as effective as band ligation, or perhaps more effective in the treatment of bleeding esophageal varices.

A comparison of the hemodynamic and metabolic effects of extraperitoneal carbon dioxide and nitrous oxide insufflation.

BACKGROUND: The aim of the present study was to compare the hemodynamic and metabolic effects of extraperitoneal carbon dioxide (CO(2)) and nitrous oxide (N(2)O) insufflation. MATERIAL AND METHODS: Fourteen dogs were used in the experiment. All the animals were intubated under general anesthesia. A catheter was placed into the right jugular vein for central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), and heart rate (HR) monitorization. End-tidal CO(2) pressure was measured by a capnometer connected to the endotracheal tube. Another catheter was inserted into the left femoral artery for arterial blood gas analysis and blood pressure monitorization. The preperitoneal dissection was made from a 1.5 cm subumbilical incision by using a preperitoneal dissection balloon. A laparoscope was placed in the preperitoneal space and the gas insufflation was kept at a constant pressure of 12 mm Hg throughout the experiment. All the study parameters were measured at the beginning of the insufflation and at every 15 minutes for 1 hour. RESULTS: Mean artery pressure increased with time in both groups, but the increase was only significant in the CO(2) group. PWP, CVP, PAP, and HR increased slightly in both groups, but there was no significant difference between the groups. The end-tidal CO(2) increased in the CO(2) group but decreased from the baseline in the N(2)O group. A significant acidosis was observed in only the CO(2) group. PaCO(2) significantly increased in the CO(2) group; hence, PaCO(2) slightly decreased in N(2)O group. The difference between the groups was significant. CONCLUSIONS: N(2)O insufflation of the extraperitoneal space in dogs avoided the unwanted metabolic and hemodynamic side effects of CO(2) insufflation. Thus, N(2)O insufflation in the extraperitoneal space is a safer alternative to CO(2) insufflation experimentally, and can be preferred especially in patients with cardiac and pulmonary diseases.

Whole gut washout ameliorates the progression of acute experimental pancreatitis.

BACKGROUND: Septic complications are mainly responsible for deterioration of a patient with acute pancreatitis. Intestinal tract is accepted as the main source of pancreatic or peripancreatic infection. MATERIAL AND METHODS: Acute pancreatitis was induced in 40 Sprague-Dawley rats by ligation of the main biliopancreatic duct. Animals were divided into two groups. The first group of animals (n = 20) received high volume polyethylene glycol-3500 (GoLYTELY) for 6 hours through a silastic catheter introduced into the proximal part of the jejunum from a puncture gastrostomy during the initial laparotomy. The second group animals (n = 20) did not receive any treatment. Half of the animals from each group were sacrificed 72 hours later and tissue samples were taken from mesenteric lymph nodes, pancreas, spleen, and liver for bacteriologic cultures. Cecum cultures were also prepared. Blood samples at 72 hours were obtained for the measurement of amylase, lactic dehydrogenase (LDH), lactic acid, alanine aminotransferase (ALT), glucose, calcium, arterial pH, base excess, partial oxygen pressure, bicarbonate, leucocyte count, and hematocrit levels. The pancreas was examined histopathologically. The remaining half of the animals from each group were allowed to survive until death. RESULTS: The levels of amylase, LDH, ALT, lactic acid, pH, pO(2), bicarbonate and base excess for the rats in group I were significantly lower when compared with the rats in group II (P<0.05). Positive mesenteric lymph node cultures were detected in 30% of group I animals whereas they were positive in 90% of group II animals (P = 0.0198). Distant organ cultures were positive in 8 animals (liver 5, spleen 2, pancreas 1) in group II, whereas only one positive distant organ culture (liver) was established in group I (P>0.05). Histopathological scoring observed in the pancreas were less severe for the rats in group I when compared with the rats in group II (P = 0.012). The rats in group I survived longer than the rats in group II (median survival 6.8 days versus 17.3 days, P<0.001). CONCLUSIONS: Whole gut washout with high-volume polyethylene glycol in pancreatitis reduced the blood levels of enzymes and increased the survival. Whole gut washout for acute pancreatitis appears effective to ameliorate the prognostic factors in blood and this modality may be a promising treatment method in acute pancreatitis.

Effect of pedunculated seromuscular flap on bursting strength of intestinal anastomosis after corticosteroid treatment.

PURPOSE: This study was designed to investigate the protective effect of a pedunculated seromuscular flap on intestinal anastomosis after corticosteroid treatment. METHODS: Forty male Sprague-Dawley rats were divided into four groups, and all animals underwent intestinal anastomosis. Two groups, with or without seromuscular flap wrapping, received 5 mg cortisone acetate, and two groups received placebo (saline) preoperatively for 16 days. Anastomotic strength was defined as bursting pressure (in millimeters of mercury). The pedunculated seromuscular flap was prepared from a segment of intestine next to the anastomosis. Intestinal bursting strength at the anastomotic site was measured at Postoperative Day 8. RESULTS: The anastomotic bursting strength was significantly lower in the steroid groups at Postoperative Day 8 (P < 0.01). The pedunculated seromuscular flap increased the strength of the anastomosis both in the steroid and control groups (P < 0.05). CONCLUSION: The adverse effect of corticosteroids on intestinal anastomoses may be prevented by a pedunculated seromuscular flap.

Effect of laparoscopic cholecystectomy on platelet aggregation.

The purpose of this study was to investigate the effect of laparoscopic cholecystectomy on platelet function. We operated on 40 women with symptomatic gallbladder stone, 20 of whom (study group) underwent laparoscopic cholecystectomy and 20 of whom (control group) open cholecystectomy. Patients with a history of bleeding, abnormal platelet count, or systemic disorders and those who were on salicylates, heparin, or oral anticoagulants were excluded. Blood parameters were checked at the beginning and the end of the operation, including platelet aggregation using adenosine 5'-diphosphate (ADP), collagen, and ristocetin in a whole-blood aggregometer. Platelet aggregation was evaluated by percent aggregation. Platelet aggregation due to collagen and ristocetin increased significantly at the end of the operation in the study group (p < 0.001). Aggregation due to ADP did not differ significantly from the start to the end of the operation. Control group results did not show any differences. Although the clinical findings of aggregated platelet are not frequently observed in practice, we suggest that laparoscopy increases platelet aggregation.

Transanal electrovaporisation of rectal tumours.

OBJECTIVE: To present our early results with endoscopic transanal electrovaporization of rectal tumours. DESIGN: Retrospective study. SETTING: Department of Surgery, Faculty of Medicine, University of Selçuk. SUBJECTS: 10 patients, 4 with malignant and 6 with benign lesions. INTERVENTIONS: Vaporization of the tumour using a new ridged roller electrode, the VaporTrode, and a standard 24F urological resectoscope. MAIN OUTCOME MEASURES: Morbidity and recurrence. RESULTS: There were no complications and all adenomas were vaporized completely. 2 patients with obstruction required a further treatment 3 and 5 months later because of recurrence. Median duration of operation was 22.5 minutes (range 10-38) and median duration of hospital stay was 3 days (range 1-4). CONCLUSION: The VaporTrode is a safe and potentially useful tool for transanal excision of rectal tumours, the long term efficacy of which should be tested in larger series of patients.

Open drainage versus overlapping method in the treatment of hepatic hydatid cyst cavities.

In order to compare the results of open drainage and overlapping methods, 58 consecutive patients with uncomplicated hepatic hydatid disease were investigated between January 1990 and January 1997. The cavities were obliterated by overlapping method in 26 patients and were left open into the peritoneal cavity following partial pericystectomy in 32 patients. Postoperative complications and follow-up results of ultrasonography (US) and computed tomography (CT) were compared between the two groups. In total, there were 56 cysts in the obliterated group and 83 cysts in the open drainage group. There was no significant difference in age, sex, mean diameter of the cysts, US features of the cysts according to the Gharbi classification, and median follow-up. Mean hospital stay was 10 days in the overlapping group and 7.5 days in the open drainage group (P = 0.033). No postoperative complication was observed in the obliterated group and nearly half of the cyst cavities could not be detected in the early postoperative period by US and CT. Pleural effusion (n = 1) and biliary fistula (n = 1) were detected in the open drainage group which disappeared spontaneously. In the open drainage group, US and CT surveillance revealed that the cyst cavities were reduced in size and the echo pattern was changed in the early postoperative period, whereas the appearance changed into pseudotumor view in the late postoperative period. In conclusion, the cyst cavities disappear perfectly in the overlapping group. Treating the cyst cavity by open drainage is an easy, effective and safe technique. Open drainage can be a 'method of choice' for patients with multiple hydatid cysts and for cysts where management is difficult or unamenable to other methods, but the residual cyst cavities may be misinterpreted as a new cyst by an inexperienced radiologist.

Effect of octreotide (Sandostatin 201-995) on bile flow and bile components.

Octreotide (Sandostatin 201-995) has an inhibitory effect on gastric, intestinal, and pancreatic secretions and hepatic and splachnic blood flow. We examined the effects of octreotide on bile flow and bile components in 10 patients with T-tube choledochostomy. A Fogarty balloon catheter was inserted distal to the T-tube of these patients for measurement of bile flow and bile components. Bile samples were obtained to analyze bile acid, phospholipid, lipoprotein, and cholesterol, and bile flow measurements were performed every 15 min for a period of 90 min before study and after normal saline and octreotide administrations. While octreotide had an inhibitory effect on bile flow, the concentrations of bile acid, phospholipid, and lipoprotein in bile were increased with octreotide.

Does large-bowel enema reduce septic complications in acute pancreatitis?

BACKGROUND: The source of septic complications in acute pancreatitis was unknown until recent years. The pathogenesis of bacterial translocation from the gut has been accepted as the main source of pancreatic or peripancreatic infection. This study was designed to investigate the role of large bowel enema during acute pancreatitis in preventing bacterial translocation. MATERIALS AND METHODS: Twenty-four Spraque-Dawley rats were used in this study. The rats were divided into two groups. Group I animals received biliopancreatic duct ligation plus colon cleansing by rectal enemas; group II animals received only biliopancreatic duct ligation. Rectal enemas were applied to the first group of animals three times, at 6, 24, and 48 hours after the operation using 10 cc sodium hydrogen phosphate solutions. All animals were sacrificed 72 hours later, and tissue samples were taken from mesenteric lymph nodes, pancreas, spleen, and liver for bacteriologic cultures via a midline laparatomy. Blood and cecum cultures were also prepared. RESULTS: Positive mesenteric lymph node cultures were found in all 12 animals in group II but in only 3 of 11 animals of group I (P <0.05). Distant organ cultures were positive in 9 of group II, but the only infected distant organ culture found in group I was the positive liver culture (P <0.05). CONCLUSION: As a result of this study, we believe that large bowel enema can reduce the frequency of septic complications in acute pancreatitis by reducing bacterial translocation.

Retroperitoneal and scrotal giant liposarcoma: report of a case.

The case of a 63 year-old man with a giant scrotal and retroperitoneal tumor is herein reported. The initial symptoms began in the scrotum and subsequent abdominal distention resulted in discomfort 2 years later. The intraabdominal organs were under pressure because of the bulky mass, and the patient had dyspnea. Ultrasonograpy, computed tomography, and fine needle aspiration biopsy investigations all revealed a retroperitoneal tumor suspected to be liposarcoma. At operation, a tumor weighing 42 kg was excised. Respiratory support was provided in the early postoperative period. The histopathological diagnosis was myxoid liposarcoma. The patient was discharged from the hospital 14 days after the operation and was scheduled to undergo radiotherapy.

Is urinary bladder pressure a sensitive indicator of intra-abdominal pressure?

BACKGROUND AND STUDY AIMS: The accuracy of transurethral bladder catheter pressure in reflecting intra-abdominal pressure is well defined in experimental studies and case reports but not in controlled clinical trials. PATIENTS AND METHODS: We compared bladder pressure with insufflator pressure during laparoscopic cholecystectomy in 40 patients. Measurements were made at four pressure levels of the insufflator: 0, 5, 10 and 15 mmHg. RESULTS: When the insufflator displayed 0, 5, 10, and 15 mmHg (0, 6.8, 13.6 and 20.4 cmH2O), and the mean bladder pressures measured 2.5 +/- 1.4, 7.3 +/- 1.5, 12.9 +/- 1.6 and 19.7 +/- 1.5 cmH2O, respectively. The two measurements correlated well with each other (r = 0.973, P < 0.0001). CONCLUSION: We concluded that bladder pressure measured by transurethral catheter was equal to insufflator pressure during laparoscopy, and that this was a valid indicator of intra-abdominal pressure.