Combined duplication of the colon and vermiform appendix in an adult patient.

Combined duplication of the colon and vermiform appendix is one of the rare congenital anomalities of the alimentary tract. Only a few cases have been reported in the adult population. A 28-year-old man presented to the clinic with a mass in the right flank. Imaging showed only a hydronephrotic atrophic kidney. The final diagnosis was only available at exploration. Combined duplication of the tubular colon and vermiform appendix was confirmed histopathologically. The patient was treated with nephrectomy and complete resection of the duplicated colon and vermiform appendix. The patient recovered uneventfully, and has done well for the past year. This is believed to be one of the first reports of combined duplication of the tubular colon and vermiform appendix as a cause of hydronephrotic atrophic kidney in an adult patient.

The role of erythropoietin in hemorrhagic shock-induced liver and renal injury in rats.

INTRODUCTION: The aim of the present study was to evaluate the role of erythropoietin (EPO) in liver and renal injury following hemorrhagic shock (HS) after inhibition of tyrosine kinase activity in rats.. METHODS: Forty-eight Sprague-Dawley rats were assigned to six groups: (I) HS alone; (II) HS followed by retransfusion; (III) EPO and genistein followed by HS; (IV) EPO and genistein followed by HS, followed by retransfusion; (V) HS followed by EPO and genistein; and (VI) HS followed by EPO and genistein, followed by retransfusion. HS was induced for 60 minutes after withdrawal of 30% of the calculated total blood volume of each rat from the left femoral artery. Blood and tissue samples (from the kidney and liver) were obtained 60 minutes after HS in Group I, III, and V; blood and tissue samples were obtained 60 minutes after retransfusion in Group II, IV, and VI. In Group III and IV, EPO was given 60 minutes before HS, and genistein 30 minutes before HS. In Group V and VI, EPO and genistein were given 30 minutes after HS. RESULTS: Liver and renal injury were significantly attenuated with EPO and genistein administration. CONCLUSION: These results suggest that EPO is effective in attenuating liver and renal injury in HS, even with inhibition of tyrosine kinase activity with genistein.

The clinical features of Fournier's gangrene and the predictivity of the Fournier's Gangrene Severity Index on the outcomes.

Fournier's gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions. Several factors have been reported to contribute to the clinical outcomes. The primary aims of this study were to examine the clinical features of patients with FG and evaluate the predictivity of the Fournier's Gangrene Severity Index (FGSI) score on the outcomes. We carried out a collective retrospective chart review of patients diagnosed and treated for FG in three reference centers between January 1995 and July 2007. Seventy-two patients with FG with were included to the study. Data were collected on medical history, symptoms, physical examination findings, admission and final laboratory tests, timing and extent of surgical debridement and antibiotic therapy. Perianal and perirectal abscess, scrotal abscess and urethral stenosis were the leading etiological factors. Diabetes mellitus was the predominant risk factor. Etiological factors and risk factors did not significantly contribute to survival or mortality, and duration of the symptoms was significantly longer in the non-survivor's group (P < 0.05). The FGSI scores were higher in the non-survivor's group. Regression analysis showed a FGSIS score of 10.5 as the cut-off to the outcome. Based on these results, we conclude that a patient's metabolic status and the extent of disease at presentation are the most important factors determining the prognosis of FG. The FGSI score may be considered as an objective and simple tool to predict the outcome in the patient with FG and should be used in further studies of FG patient series for comparison purposes.

Protective effect of leptin against ischemia-reperfusion injury in the rat small intestine.

BACKGROUND: The small intestine is extremely sensitive to ischemia-reperfusion (I/R) injury and a range of microcirculatory disturbances which contribute to tissue damage. Previous studies have shown that leptin plays an important physiological role in the microvasculature. The aim of this study was to evaluate the protective effects of leptin in I/R--induced mucosal injury in the small intestine. METHODS: Forty rats were divided into 5 groups (n = 8). Group I was subjected to a sham operation. Following mesenteric ischemia in group II (control); physiologic saline 1 cm3, in group III; leptin 100 microg/kg, and physiologic saline 1 cm3, in group IV; NG-L-arginine methyl ester (L-NAME) 20 mg/kg, and physiologic saline 1 cm3, in group V; leptin 100 microg/kg, L-NAME 20 mg/kg, and physiologic saline 1 cm3 were given intra-peritoneally. In these groups, an I/R procedure was performed by occlusion of the superior mesenteric artery for 45 min followed by 120 min reperfusion. After reperfusion, the small intestines were resected for malondialdehyde (MDA) and nitric oxide (NO) concentration and histopathologic properties. Mucosal lesions were scored between 0 and 5. Tissue MDA and NO concentration and histopathologic grades were compared statistically. RESULTS: Tissue MDA level significantly increased (P < 0.05), tissue NO level significantly decreased in group V animals, compared to group III animals respectively (P < 0.001). Histopathologically, intestinal injury significantly decreased in the leptin treated ischemic group. CONCLUSION: Leptin can be used safely in mesenteric occlusive diseases, since it induces NO formation and release in mesenteric vessels.

Do not mask the mask: use it as a premedicant.

BACKGROUND: Preoperative anxiety frequently causes resistance to mask application and prolongs induction. Anesthesia masks resembling popular heroes or toys was used to deal with this problem. An anesthesia mask given on a preoperative visit to play with at home, may aid to establish a familiarity with the mask and alleviate mask fear, possibly making a gaseous induction more acceptable. METHODS: After approval of the ethical committee, 50 children were randomly assigned into two groups. Both groups received conventional verbal information about the anesthetists, materials and equipment to be used for the procedure, description of gaseous induction via mask and transportation to the operating room. Additionally transparent anesthesia masks were given to children in the mask group after conventional verbal information. Both groups were premedicated with 0.3 mg.kg(-1) midazolam. Anxiety was assessed during separation from parents and induction of anesthesia by a modified Yale Preoperative Anxiety Scale. Mask acceptance quality and total mask time (TMT; time between the introduction of mask anesthesia and the loss of lid reflex) were also determined. RESULTS: Anxiety levels in the informed group were statistically higher than in the mask group during induction of anesthesia (26 +/- 1.8 vs 30 +/- 2.9, P < 0.05). Mask acceptance quality was better in the mask group than in the informed group (IG). TMTs were 5.1 +/- 1.3 and 7 +/- 0.9 min in the mask group and in the IG, respectively. CONCLUSIONS: Playing with an anesthesia mask given during a preanesthesia visit relieved anxiety, improved mask acceptance quality and shortened the induction period. We believe that this type of premedication would be feasible in gaseous induction of anesthesia in children.

Esophagectomy in esophageal lipoma: report of a case.

Lipoma is an uncommon benign tumor of the alimentary tract and its overall incidence is 4.1%, but that of the esophagus is extremely rare, with an incidence of only 0.4%. We present a case of esophageal lipoma. A 55-year-old man had a two-year history of dysphagia and odynophagia. Upper gastrointestinal system endoscopy showed a mass in the wall of the esophagus, occupying the lumen, and causing obstruction. Computed tomography and abdominal ultrasonography were performed because of endoscopic suspicion of submucosal tumor, and the mass was confirmed to be a lipoma in the wall of the esophagus. It was removed surgically by a thoracic approach. His symptoms resolved after the operation. Surgical excision by enucleation of the tumor is the preferred treatment of esophageal lipoma, but opening of the esophageal mucosa during this procedure is a rare cause for esophageal resection.