Oncologic outcomes and trends in each colon cancer location and stages over the last two decades: insights from the SEER registry.

BACKGROUND: The main purpose of the study is to comprehensively evaluate population-level survival disparities stage-by-stage, according to specific anatomical colon segments, and based on prognosis as defined by lymph nodes among patients who have undergone curative resection for non-metastatic colon cancer. METHODS: The study was conducted from the Surveillance Epidemiology and End Result (SEER) program from the USA. Patients who underwent surgery for colon adenocarcinoma between 2000 and 2019 were identified. Demographics and clinical and pathologic factors were compared amongst each other according to different colon segments, stages, and time periods. RESULTS: A total of 482,672 patients were identified and 195,105 of them met the inclusion criteria. Patients with proximal cancers were significantly older, more likely to be female, had a higher number of lymph nodes, and node positivity (p < 0.001). During the study period, an almost 10% improvement in overall survival rate was observed at 3 and 5 years for each colon site and stage (p < 0.05). CONCLUSIONS: The study's findings revealed a notable improvement in overall and cancer-specific survival rates across all colon segments and stages in patients who underwent curative treatment for non-metastatic primary colon cancer from a nationwide database.

Comprehensive anatomy of the superior hypogastric plexus and its relationship with pelvic surgery landmarks: defining the safe zone around the promontory.

BACKGROUND: Pelvic surgery carries an inherent risk of autonomic nerve injury leading to genitourinary and bowel dysfunction due to the close proximity of the superior hypogastric plexus (SHP). The aim of this study was to define the detailed anatomy of SHP and identify its relationship with the vascular landmarks and ureters for pelvic autonomic nerve-preserving surgery. METHODS: A cadaveric study on the detailed anatomy of the SHP was conducted in our surgical anatomy research unit. Between 02/2019 and 10/2019, macroscopic anatomical dissections were performed on 45 fresh adult cadavers (39 male, 6 female). Distances between the SHP, major vascular structures, and other anatomical landmarks were measured. RESULTS: Three types of SHP morphology were observed: mesh (64.8%), single nerve (24.4%), and fiber (10.8%). SHP bifurcation was located inferior to the aortic bifurcation in all cases; however, it was observed cranial to the promontory in 80% of the cases, whereas 18% were caudally and 2% were over the promontory. The closest vessels to the left and right of the SHP bifurcation were the left common iliac vein (LCIV) (86.2%, the mean distance was 8.49 ± 7.97 mm) and the right internal iliac artery (RIIA) (48.2%, mean distance was 13.4 ± 9.79 mm), respectively. At SHP bifurcation level, the lateral edge of the SHP was detected on the LCIV in 22 cases and on the RIIA in 10 cases for the left and right side of the plexus, respectively. The distance between the SHP bifurcation and the ureter was 27.9 mm on the right and 24.2 mm on the left. The width of the left (LHN) and right hypogastric nerves (RHN) were 4.35 mm and 4.62 mm at 2 cm below the SHP bifurcation, respectively. LHN was on the vascular structures in 13 cases, whereas RHN in only 1 case, 2 cm below the SHP bifurcation. CONCLUSIONS: Understanding the location of the SHP, including its relationship with important anatomical landmarks, might prevent iatrogenic injury and reduce postoperative morbidity in the pelvic surgery setting.

Three-step standardized approach for complete mobilization of the splenic flexure during robotic rectal cancer surgery.

AIM: The aim of this technical note is to describe a three-step technique for expeditious and complete mobilization of the splenic flexure (CMSF) during single docking totally robotic rectal cancer surgery. METHOD: A prospectively maintained database was searched for all patients who underwent single docking totally robotic rectal cancer surgery with CMSF through a stepwise technique. RESULTS: We studied 89 patients underwent CMSF during single docking totally robotic lower anterior resection for rectal cancer. CONCLUSION: The technique demonstrates that CMSF can be performed with a standardized approach using the natural embryological planes of surgery. Moreover, this technique does not involve any change in patient's position on the operating table or undocking the robotic system. We have included an intra-operative video recording to demonstrate the technique.

Comparison between the intraoperative use of polyvinyl chloride cover and surgical compresses for preventing postoperative adhesions.

BACKGROUND/PURPOSE: Surgical compresses used for retraction during major abdominal and pelvic procedures lead to postoperative adhesion formation resulting from damage to the visceral peritoneum. This study investigates whether polyvinyl chloride (PVC) covers cause less postsurgical adhesion and inflammation than surgical compresses in an animal model. METHODS: Female Wistar albino rats (n = 160) were divided into three groups (compress, PVC cover and control), which were then divided into 16 subgroups (n = 10/group). All animals underwent midline laparotomy and cecal abrasion. A metal retractor, which applies a constant force, was then placed on the small intestine for 2 h. In the control group, no material was placed under the retractor, whereas a surgical compress or PVC cover was placed in the experimental animals. Full-thickness small intestinal biopsies were obtained and examined by light and electron microscopy. The following parameters were evaluated: congestion, mesothelial proliferation, leukocyte migration and collagenization. Adhesions were scored according to the Nair, Knightly and Mazuji scoring systems. RESULTS: All inflammation scores were significantly higher in the compress group than in the other two groups. However, no significant difference was observed between the PVC cover and control groups. Adhesions were more frequent in the compress group than in the other two groups, regardless of the scoring system used. CONCLUSIONS: Surgical compresses used in abdominal and pelvic surgeries cause inflammation and adhesion. Contrary to surgical compresses, PVC covers do not cause inflammation and adhesion, which may considerably reduce adhesion-related complications in abdominopelvic surgeries.

No effect of perianal application of topical anaesthetic on patient comfort during nonsedated flexible sigmoidoscopy: a randomized, placebo-controlled clinical trial.

AIM: A literature review revealed no data on the effects of topical anaesthetic on patient comfort during flexible sigmoidoscopy. We therefore aimed to evaluate this in a randomized manner. METHOD: One hundred and forty-six patients who underwent flexible sigmoidoscopy were randomly allocated to one of three groups. Vaseline (n = 49), 2% lidocaine gel (n = 51) or a cream of 2.5% lidocaine plus 2.5% prilocaine (n = 46) were applied to the patients 30 min before the procedure. Demographic data and haemodynamic monitoring during procedures were recorded. Pain was assessed by visual analogue scale (VAS) and anxiety levels by the State-Trait Anxiety Inventory (STAI-I and STA-II). RESULTS: Median pre-procedural STAI-I scores were 45, 46 and 40.5 and median post-procedural STAI-I scores were 35, 34 and 33.5 for the vaseline, lidocaine, and lidocaine/prilocaine treatments, respectively. There was no statistical difference among the groups in terms of STAI-I and II scores. However, post-procedural STAI-I scores were significantly lower than pre-procedural values in each group (P < 0.001). There was no significant difference in VAS scores among the groups. In all groups there were statistically higher VAS scores during the procedure compared with the pre- and post-procedural scores (P < 0.001). CONCLUSION: Perianal application of topical anaesthetic does not influence patient comfort during sigmoidoscopy.

Quality of life measures in Islamic rectal carcinoma patients receiving counselling.

AIM: This prospective study was conducted to compare changes in the health-related quality of life (HRQoL) and religious practices of patients who underwent surgery for rectal cancer. METHOD: We prospectively followed 93 Muslim patients after surgery for colorectal carcinoma: abdominoperineal excision (APE, n = 50), sphincter-saving resection (LAR, n = 22) or anterior resection including sigmoid colectomy (AR, n = 1). The HRQoL was measured pre- and postoperatively at 15-18 months with the Medical Outcomes Study Short Form 36 Health Survey (SF-36) and a modified version of the American Society of Colorectal Surgeons (ASCRS) Fecal Incontinence questionnaire. Life standards, including religious practice, were measured using the Ankara University Life Standard Questionnaire. RESULTS: No difference was detected in any SF-36 Health Survey HRQoL domain among the groups, although there were differences within groups before and after surgery. The ASCRS Fecal Incontinence questionnaire scales of lifestyle, coping/behaviour and depression/self-perception were similar in the APE and AR groups and were significantly worse than in the AR group (P ≤ 0.004). The embarrassment scale was worse in the APE than in the LAR and AR groups (P < 0.001). Religious worship (praying alone, praying in mosques, fasting during Ramadan and purifying alms) was not significantly different among the groups. CONCLUSION: HRQoL measured by the SF-36 questionnaire and religious practices were not significantly different after APE compared with AR. Ostomy support and pre- and postoperative health-related and religious counselling may have had beneficial effects.

Thromboxane synthase inhibitor, UK 38485, prevents renal injury in the rabbit isolated perfused kidney exposed to cold ischemia.

Recent studies have indicated that, the administration of thromboxane A2 (TxA2) inhibitors improved renal functions in experimental renal allograft transplantation. Thus TxA2, a vasoconstrictor metabolite of arachidonic acid, may play a role in renal function and blood flow during hypothermic storage. The aim of the present study was to evaluate the cytoprotective effect of TxA2 synthase inhibitor, UK 38485, on altered renal function due to cold ischemia for 24 and 72 h. Experiments were performed in isolated perfused kidney from adult rabbits. Kidneys were perfused with Euro-Collins (EC) containing UK 38485 and incubated with the same solution in a beaker exposed to cold ischemia for 24 and 72 h. The same procedure was applied to the control kidneys in EC solution alone. Vascular responses and urinary output to noradrenaline, angiotensin II, endothelin-1, acetylcholine, and sympathetic stimulation were assessed as the functional activity of kidney. The addition of UK 38485 to EC solution increased the preservation time of kidney and protects the vascular endothelial regulatory functions and urine excretion when compared to EC alone. The results of the present study can be taken as an evidence of the cytoprotective effect of the UK 38485 and might be useful for kidney preservation.

Acalculous cholecystitis: ascariasis as an unusual cause.

Migration of roundworms into the biliary tree is a well-known complication of Ascaris lumbricoides infestation of the intestine. Massive infestation of the hepato-biliary tract is uncommon but can lead to complications if not treated. Here, we report two cases of acalculous cholecystitis caused by ascariasis.

Porta choledochal fistula: an unusual complication of a cholangiocarcinoma arising from a type I choledochal cyst.

A vena porta choledochal fistula caused by an adenocarcinoma arising from a type I choledochal cyst was detected in a 42-year-old woman. The diagnostic and therapeutic aspects of this malignancy are discussed.

Reperfusion injury delays healing of intestinal anastomosis in a rat.

BACKGROUND: Revascularization of ischemic bowel may induce further local tissue damage due to reperfusion injury. Therefore, we aimed to investigate the effect of ischemia-reperfusion injury on the healing of intestinal anastomosis in experimental models. METHODS: One hundred and two male Wistar rats were divided into three groups: a control group (group I, n = 23); an ischemia group (group II, n = 32), in which only the superior mesenteric artery (SMA) was occluded for 30 minutes; and a profound ischemia group (group III, n = 47), in which SMA was occluded as well as collateral vessels for 30 minutes. The pulsations were seen to return to marginal vessels and the bowels began to appear pinker and healthier in all groups following the restoration of arterial flow. Then, all animals underwent a 3-cm ileal resection and primary anastomosis, 10 cm proximal to the ileocecal valve. Within each group, animals were anesthetized either on the third or seventh postoperative days. Abdominal wound healing, intraabdominal adhesions, anastomotic complications, anastomotic bursting pressure measurements, and bursting site were recorded. RESULTS: Statistically significant differences were detected in intraperitoneal adhesion scores in group II and III (P <0.001). Anastomotic dehiscence was found in 2 of 23 (9%) in group I, 5 of 32 (16%) in group II, and 16 of 47 (34%) in group III (P <0.001). On the third and seventh days, the median bursting pressures of the anastomosis were determined to be 42 mm Hg and 250 mm Hg in group I, 46 and 253 in group II, and finally 19 and 90 mm Hg in group III (P <0.01). The burst occurred at the anastomoses in all animals tested on the third postoperative day, none in group I, 4 (28%) in group II, and 8 (67%) in group III on the seventh postoperative day (P <0.005). CONCLUSION: The present study demonstrated that ischemia-reperfusion impairs anastomotic healing. Despite the fact that the intestines are well perfused and viable after revascularization, one must bear in mind that intestinal reperfusion may compromise anastomotic healing.

Comparison of long-term quality of life after laparoscopic and open cholecystectomy.

BACKGROUND: Although many studies have compared open and laparoscopic procedures, showing many advantages in favor of the laparoscopic technique during the early postoperative period, only a limited number of reports in the literature compare the two techniques during the later follow-up period with regard to quality of life. This study aimed to compare the effects of these two cholecystectomy techniques on the quality of life and clinical outcome of the patients during long-term follow-up evaluation. METHODS: This study evaluated 200 patients who underwent cholecystectomy operations with either technique between 1993 and 1999 in our department. There were 100 patients in each group. Both groups were similar with respect to age, gender, body mass indexes, American Society of Anesthesiology (ASA) scores, and indications for surgery. The Medical Outcome Study Short Form 36 Health survey (SF-36), which includes 36 items, was used for evaluating the quality-of-life index. In addition to this, a system-specific instrument for gastrointestinal diseases was used to investigate clinical outcome. RESULTS: The mean administration time for the questionnaire was 46.8 +/- 18.7 months in the laparoscopic cholecystectomy (LC) group and 41.5 +/- 16 months in the open cholecystectomy (OC) group. Statistically significant differences were noted in the scores for all eight SF = 36 health status domains in favor of laparospopic surgery. No statistically significant difference was found for abdominal pain, location of the pain, referral to a doctor for the pain, accompanying symptoms, relieving factors for the pain, distention, and dyspeptic complaints, usage of antacid therapy, weight changes, changes in bowel habit, need for a special diet, or sexual functions between the two groups. CONCLUSIONS: The gastrointestinal clinical symptoms were similar in the two groups during the long-term follow-up evaluation, but laparoscopic cholecystectomy was found to be significantly superior to the open technique with respect to the quality of life over the long term.

Effects of intestinal ischemia-reperfusion on major conduit arteries.

Intestinal ischemia-reperfusion (I-R) is a common and serious clinical condition associated with simultaneous remote organ dysfunction. The purpose of this study was to investigate the effects of intestinal I-R on the vasomotor functions of major conduit arteries. Anesthetized rabbits were randomly assigned to one of three groups: sham-operated controls (Group I), and one-hour intestinal ischemia with two-hour reperfusion (Group II) or four-hour reperfusion (Group III). The following mechanisms of vasomotor functions were studied in abdominal aorta, superior mesenteric, renal, pulmonary, and carotid arterial rings: (1) endothelial-dependent vasodilation response to acetylcholine, (2) endothelial-independent vasodilation response to nitroprusside, (3) beta-adrenergic vasodilation response to isoproterenol, and (4) phenylephrine-induced vasoconstriction. Intestinal injury was quantified using malondialdehyde (MDA) concentration and wet-to-dry intestine weight ratio. Intestinal I-R did not affect the maximal responsiveness or the sensitivity to acetylcholine, nitroprusside, and isoproterenol in all the vessels studied. The maximal contractile response to phenylephrine increased significantly in mesenteric artery in Group II, (227.1+/-15.1% vs. 152.8+/-11.7% in controls) (p<0.05). Intestinal MDA concentration, a marker of oxidant injury, increased from 39.87+/-9.41 nmol/g to 67.8+/-8.8 nmol/g in group II (p<0.01), and to 94.8+/-7.56 nmol/g in Group III (p<0.001). Wet-to-dry intestine weight ratio increased from 3.62+/-0.12 to 4.28+/-0.17 in Group II (p<0.01), to 4.62+/-0.14 in Group III (p<0.001). These data indicate that although the intestines of the animals subjected to intestinal I-R are seriously injured, the smooth muscle relaxation of major conduit arteries was not affected.

Obstructive jaundice promotes bacterial translocation in humans.

BACKGROUND/AIMS: Significant bacterial translocation was demonstrated following experimental biliary obstruction, however very little is known about the importance and the prevalence of gut-origin sepsis in obstructive jaundice patients. Therefore, the aim of this study was to investigate the concept of gut-origin sepsis in obstructive jaundiced patients and its clinical importance. METHODOLOGY: Twenty-one patients requiring laparotomy for obstructive jaundice (group I) and thirty patients operated on electively mainly for chronic cholecystitis (group II) were studied. Peritoneal swab, mesenteric lymph node, portal venous blood, liver wedge biopsy and bile were sampled for culture immediately after opening the peritoneum. Additionally, peripheral blood samples were taken pre- and post-operatively from all patients. Post-operatively, patients were monitored for infectious complications. RESULTS: The mean serum bilirubin concentration, gamma glutamyl transferase and alkaline phosphatase levels in jaundiced patients before therapeutic intervention were significantly higher than in control patients. Five patients demonstrated bacterial translocation in group I (24%), whereas only one did so in group II (3.5%, p < 0.05). Septic complications were detected in three patients, but only in two with bacterial translocation in group I. There was one patient with bacterial translocation who had septic complication in group II. CONCLUSIONS: The present study demonstrated that obstructive jaundice significantly promotes bacterial translocation in humans, however, its clinical importance has yet to be defined.

Colonic anastomotic healing after preoperative chemo-radiotherapy in rat.

PURPOSE: To prevent micrometastasis at an earlier stage and to increase the lateral or circumferential tumor free margins, there is a rationale for neo-adjuvant chemo-radiotherapy in patients with colorectal cancer. In order to investigate the effects of such a protocol on colonic anastomotic healing, an experimental study resembling the clinical use of neo-adjuvant concomitant 5-FU+ irradiation treatment of colorectal cancer was conducted. MATERIALS AND METHODS: Seventy-one male Wistar rats were divided into three groups: a control group (I) underwent left colon resection and primary anastomosis (n = 20); a sham-treated group (II, n = 20); and a study group (III) which received fractionated irradiation to the whole pelvis to a total dose of 22 Gy, 5.5 Gy per fraction, in four consecutive days with linear accelerator and concomitant intra-peritoneal 5-FU (20 mg/kg/day) for five consecutive days. The last fraction of irradiation and the last injection were given four and three days before colonic resection and anastomosis, respectively. Within each group one-half of the animals were anesthetized on the third postoperative day and one-half on the seventh postoperative day. Abdominal wound healing, intraperitoneal adhesions, anastomotic complications, and anastomotic bursting pressure measurements were recorded. Following these measurements the anastomotic segment was resected for hydroxyproline content, myeloperoxidase activity, and histopathological evaluation. RESULTS: There were no differences in the abdominal wound healing, intraperitoneal adhesions, and anastomotic complications between groups. At three and seven days, the mean bursting pressures of the anastomoses were 36.5 mm Hg and 208 mm Hg in group I, 34.5 and 228 in group II, and 27 and 167 in group III, respectively (p < 0.01, group III vs both groups I and II on day seven). The burst occurred at the anastomosis in all animals tested on the third postoperative day, and one in group I (10%), none in group II, and four in group III (40%) on the seventh postoperative day. CONCLUSION: Preoperative pelvic fractionated irradiation and concomitant 5-FU delays anastomotic healing.

In vitro and in vivo inhibition of myeloperoxidase with 5-fluorouracil.

OBJECTIVE: Myeloperoxidase (MPO) exists in neutrophils and has an important bactericidal role. During phagocytosis, MPO catalyzes a peroxidative reaction using chloride ion and hydrogen peroxide (H2O2) as substrate. The aim of the present study was to investigate whether 5-fluorouracil (5-FU), a chemotherapeutic agent, has a direct inhibitory effect on MPO and to evaluate some properties of this inhibition. METHODS: The inhibitory effect of 5-FU on MPO was studied in rat tissue, human leukocytes, and leukocytes from cancer patients under 5-FU therapy. MPO was solubilized in a detergent-containing buffer. MPO activity was measured spectrophotometrically through the oxidation of a synthetic substrate tetramethyl benzidine in the presence of H2O2. RESULTS: 5-FU inhibited tissue-associated MPO activity in a dose-dependent but not time-dependent manner with an IC50 value of 0.6 mg/ml. 5-FU also inhibited MPO activity in isolated human leukocytes in a dose-dependent manner, and the IC50 value was 0.75 mg/ml. Using this 5-FU concentration, the inhibitory effect was monitored at different substrate concentrations. Leukocyte MPO activities of patients receiving 5-FU therapy were compared before treatment and after the first, second, and third administration cycles. 5-FU treatment resulted in a significant decrease in leukocyte MPO activity, and repeated 5-FU treatment caused additional decrease. CONCLUSION: Our data showed that 5-FU directly inhibited the MPO activity of human leukocytes in vitro and in vivo. We concluded that, the patients treated with 5-FU should be intensively followed for the risk of infections.

Intestinal ischemia and reperfusion impairs vasomotor functions of pulmonary vascular bed.

OBJECTIVE: To investigate the effects of intestinal ischemia and reperfusion (I/R) on the pulmonary vascular endothelium and smooth muscle. SUMMARY BACKGROUND DATA: Respiratory failure is an important cause of death and complications after intestinal I/R. Although the mechanism of respiratory failure in this setting is complex and poorly understood, recent studies of lung injury suggest that endothelial dysfunction may play a significant role. METHODS: A rat model of acute lung injury was studied after 60 minutes of superior mesenteric arterial occlusion followed by either 120 or 240 minutes of reperfusion. The pulmonary vasomotor function was examined in isolated lungs perfused at a constant flow rate. RESULTS: Sixty minutes of intestinal ischemia followed by 120 or 240 minutes of reperfusion led to a significant reduction in the ability of the pulmonary vasculature to respond to angiotensin II, acetylcholine, and calcium ionophore but not to nitroglycerin. The vasoconstriction response to N(G)-nitro-L-arginine methyl ester, which is a measure of basal nitric oxide release, was diminished in the 240-minute reperfusion group. Intestinal I/R was also associated with pulmonary leukosequestration and increased pulmonary microvascular leakage. CONCLUSIONS: Basal and agonist-stimulated release of nitric oxide from the pulmonary vascular endothelium and the ability of pulmonary smooth muscle to contract in response to angiotensin II were impaired by intestinal I/R. Such functional impairment in both pulmonary vascular endothelium and smooth muscle may contribute to the alveolocapillary dysfunction and pulmonary hypertension found in acute lung injury after intestinal I/R.

The effect of nicardipine on renal functions following 72-hour cold ischemia.

The aim of the study was to investigate the cytoprotective effect of a calcium channel blocker, nicardipine, on altered renal function due to cold ischemia for 72 h. The experiments were performed on isolated perfused kidneys from adult rabbits. Kidneys were perfused with either standard Euro-Collins (EC) solution (n = 7) or EC containing nicardipine (n = 6) and then incubated with the same preservation solutions in a beaker exposed to cold ischemia for 72 h at +4 degrees C. In the control group the same procedure was applied to untreated kidneys (n = 6) which were exposed to cold ischemia for 30 min. Vascular responses and urinary output to noradrenaline, angiotensin II, endothelin-1, acetylcholine and sympathetic stimulation were assessed as the functional activities of the kidney. The responses of the preserved kidneys were compared following cold ischemic conditions. The results indicate that the addition of nicardipine to EC solution protects the vascular endothelial regulatory function and urine excretion; therefore, dihydropyridine calcium channel blockers might be useful for kidney preservation.

The presence of hemorrhagic shock increases the rate of bacterial translocation in blunt abdominal trauma.

BACKGROUND: Sepsis and multisystem organ failure are common after hemorrhagic shock. The aims of this study were to determine whether hemorrhagic shock would promote the translocation of bacteria and if it correlates with clinical outcome in patients with blunt abdominal trauma. METHODS: Twenty-six patients requiring laparotomy for blunt abdominal trauma (group I) and 30 patients operated electively (group II) were studied. Injury Severity Score, Trauma Score, and Acute Physiology and Health Evaluation (APACHE) II score were recorded before the operation. Peritoneal swab, mesenteric lymph node, portal venous blood, liver wedge biopsy, and spleen biopsy (in splenectomized patients) were sampled for culture after surgical hemostasis. Additionally, peripheral blood samples were taken preoperatively and postoperatively in group I patients for culture. The same samples were taken in group II patients except for the spleen biopsy. Moreover, patients in group I were further subdivided into subgroups A and B, indicating the presence or absence, respectively, of hemorrhagic shock (defined as systolic blood pressure < 90 mm Hg with identifiable blood loss). Postoperatively, patients were checked for infectious and septic complications. RESULTS: Mean Injury Severity Score, Trauma Score, and APACHE II score were 32.0, 12.1, and 10.9 in group I and 2.1 (APACHE II,p < 0.01) in group II, respectively. Two patients in group IA, eight patients in group IB, and one patient in group II demonstrated bacterial translocation (BT) (p < 0.01). Five patients with blunt abdominal trauma had major infectious complications, but only one had BT, and the same microorganism grew in the intra-abdominal abscess. There were two infectious complications in the control group. One of these patients had BT, and the same microorganism grew in the wound infection. CONCLUSION: We conclude that BT occurs after blunt abdominal trauma in humans and correlates with the presence of hemorrhagic shock, but the clinical significance of BT in trauma patients remains unclear.

Role of tumour necrosis factor in lung injury caused by intestinal ischaemia-reperfusion.

BACKGROUND: Despite the well known inflammatory effects of tumour necrosis factor alpha (TNF), the mechanism of TNF-mediated lung injury following ischaemia-reperfusion (I/R) is still unclear. In this study, the role of TNF in the development of acute lung injury following intestinal I/R was investigated. METHODS: Male Wistar rats underwent either sham operation (n = 10), 1 h of superior mesenteric artery occlusion and 2 h of reperfusion (I/R, n = 10), or pretreatment with anti-TNF polyclonal antibody 2 mg/kg and I/R (n = 6). Lung injury was evaluated by Evans blue dye concentration, immunohistochemical staining and morphometric analysis. Intestinal injury was assessed by Evans blue dye concentration and histological examination. RESULTS: Intestinal I/R resulted in lung injury characterized by an increase in Evans blue dye concentration, neutrophil sequestration, and obvious staining for expression of pulmonary CD11b and CD18. Pretreatment of animals with anti-TNF antibody led to a reduction in the sequestration of neutrophils, and a decrease in expression of pulmonary intracellular adhesion molecule 1 and CD18. Anti-TNF antibody pretreatment also reduced the intestinal microvascular injury but not histological grade after intestinal I/R. CONCLUSION: Treatment with an anti-TNF antibody resulted in a significant attenuation of lung injury following intestinal I/R. The data indicate that TNF is an important trigger for upregulation of pulmonary endothelial and neutrophil adhesion molecules after intestinal I/R.