Significant association between MDM2 T309G polymorphism and colorectal cancer.

PURPOSE: The Murine double minute 2 (MDM2) gene plays a crucial role in regulating and suppressing the function of apoptotic pathway. We investigated the relationship between MDM2 gene SNP309 (T309G) (rs2279744) polymorphism and colorectal cancer (CRC) in a Turkish population. METHODS: The polymorphism T309G (rs2279744) in the MDM2 gene was studied in patients with colorectal cancer (n=135) and healthy control subjects (n=145) using the polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method. The findings were evaluated using logistic regression and x2 tests. RESULTS: When CRC cases and controls were evaluated based on different habits and family cancer histories, a statistically significant relationship was found between CRC and alcohol consumption (x2=4.07, p=0.044). Cancer cases and controls had statistically significant different family histories of cancer (x2=6.82, p=0.009). There was also significant difference in TG genotype distribution in the MDM2 T309G polymorphism between those with and without cancer (OR=1.98, 95% CI=1.98-3.91, x2=4.00, p=0.045). CONCLUSIONS: The SNP309 polymorphism of the MDM2 gene is associated with increased CRC risk in the Turkish population.

Fall of another myth for colon cancer: Duration of symptoms does not differ between right- or left-sided colon cancers.

BACKGROUND/AIMS: Patients with colorectal cancer continue to present with relatively advanced tumors that are associated with poor oncological outcomes. The aim of the present study was to assess the association between localization, symptom duration, and tumor stage. MATERIALS AND METHODS: A prospective, multicenter cohort study was conducted on patients newly diagnosed with a histologically proven colorectal adenocarcinoma. Standardized questionnaire-interviews were performed. Data were collected on principal presenting symptoms, duration of symptoms (time to first presentation to a doctor and time to diagnosis) and treatment, diagnostic procedures, tumor site, and stage of the tumor (tumor, node, and metastasis (TNM)). RESULTS: A total of 1795 patients with colorectal cancer were interviewed (mean age: 60.76±13.50 years, male patients: 1057, patients aged >50 years: 1444, colon/rectal cancer: 899/850, right side/left side: 383/1250, stage 0-1-2/stage 3-4: 746/923). No statistically significant correlations were found between duration of symptoms and either tumor site or stage. Principal presenting symptoms were significantly associated with left colon cancer. Patients who had "anemia," "change in bowel habits," "anal pruritus or discharge," "weight loss," and "tumor in right colon" had a significantly longer symptom time. CONCLUSION: Symptom duration is not associated with localization, nor is the tumor stage. Diagnosis of colorectal cancer at an earlier stage may be best achieved by screening of the population.

Investigation of the association between the MDM2 T309G polymorphism and gastric cancer.

Murine double minute clone 2 oncoprotein (MDM2) is a key component in the regulation of the tumour suppressor p53. The association between the MDM2 polymorphism and gastric cancer (GC) has been investigated in Turkish population. In the present case-control study, the aim was to investigate the association between genetic polymorphisms of the MDM2 gene (a major regulator of p53 function) and primary GC risk in a Turkish population. The polymorphism, T309G (rs2279744) in the MDM2 gene was determined in patients with GC (n=65) and in healthy control subjects (n=67) using the polymerase chain reaction-restriction fragment length polymorphism method. The findings were evaluated using logistic regression and χ2 tests. No statistically significant differences were observed between the control subjects and patients with GC regarding smoking status. A comparison between GC cases and control subjects indicated a statistically significant difference for family history of cancer [odds ratio (OR)=0.17; 95% confidence interval (CI), 0.05-0.56; χ2=0.19; P=0.01]. A significant difference was identified in the GG genotype distribution between GC patients and control subjects (OR=4.58; 95% CI, 1.18-17.79; P=0.022). Thus, the results of the present study indicate that the MDM2 gene T309G intron (GG) genotype may be an important risk factor for GC development in the Turkish population.

Oxidative stress markers in laparoscopic vs. open appendectomy for acute appendicitis: A double-blind randomized study.

BACKGROUND: Oxidative stress is a complicated process, which was defined as an increase in prooxidants and decrease in antioxidants caused by various mechanisms, including inflammation and surgical trauma. The association between acute appendicitis and oxidative stress has been showed in previous studies. However, comparison of oxidative stress in laparoscopic or open appendectomy (OA) has not been established. PATIENTS AND METHODS: Patients who were diagnosed as acute appendicitis between October 2012 and January 2013 were randomized to open (OA, n = 50) and laparoscopic appendectomy (LA, n = 50). Blood samples for oxidative stress markers (total oxidant status [TOS] and total antioxidant status [TAS]), C-reactive protein (CRP) and white blood cells (WBC's) were collected just before the surgery and 24 h after surgery. RESULTS: There were no differences in preoperative values of WBC and CRP between LA and OA groups (P = 0.523 and 0.424), however, in postoperative 24(th) h, CRP was reduced in LA group (P = 0.031). There were no differences in preoperative levels of TOS, TAS, and oxidative stress index (OSI) between LA and OA groups. In the postoperative 24(th) h, TOS and OSI were found to be significantly higher in OA group when compared to LA group (P = 0.017 and 0.002) whereas no difference was detected in TAS level in the postoperative 24(th) h (P = 0.172). CONCLUSIONS: This double-blind, randomized clinical trial provides evidence that LA for uncomplicated appendicitis is associated with significantly lower oxidative stress compared with OA. Some of the advantages of LA may be attributed to the significant reduction of oxidative stress in these patients.

Expression of FHIT, p16, p53 and EGFR as prognostic markers in thyroid tumors of uncertain malignant potential.

PURPOSE: Thyroid tumors of uncertain malignant potential (TT-UMP) constitute a relatively new diagnosis. The purpose of this study was to analyze the relationship between immunohistochemical panels, prognostic parameters and TT-UMP. METHODS: Group I was composed of patients diagnosed as differentiated thyroid carcinoma (DTC) and Group II of patients diagnosed as TT-UMP. The prognostic scores of patients were calculated using data according to the well-known prognostic scoring systems MACIS, AMES, AGES. Evaluations of antibodies were based on the presence of nuclear staining for p16 and p53, membranous and cytoplasmic staining for epidermal growth factor receptor (EGFR) and cytoplasmic staining for fragile histidine triad (FHIT). RESULTS: Statistically significant difference was noted (p< 0.05) between Group I and Group II according to MACIS and AMES. No statistical difference was found in terms of immunostaining between groups when stained with p16, p53 and FHIT. On the other hand, in Group II a moderate positive correlation was detected between MACIS and EGFR. CONCLUSION: According to our findings p53 was not important in tumor genesis at early stages in well-differentiated thyroid carcinomas and p16 loss of expression could be used as a finding to help in difficult microscopic diagnosis. TT-UMP is a gray zone of lesions requiring specific therapeutic procedures and postoperative follow-up. A positive correlation was detected between EGFR and TT-UMP, leading to assume that this situation could be used as a new tool in the follow-up of these patients in the future.

The effects of sildenafil in liver and kidney injury in a rat model of severe scald burn: a biochemical and histopathological study.

BACKGROUND: Severe burn induces systemic inflammation and reactive oxygen species leading to lipid peroxidation which may play role in remote organs injury. Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5. Sildenafil reduces oxidative stress and inflammation in distant organs. The aim of the present study was to evaluate the effects of different dosages of sildenafil in remote organs injury. METHODS: A total of thirty-two rats were randomly divided into four equal groups. The groups were designated as follows: Sham, Control, 10, and T20 mg/kg sildenafil treatment groups. Levels of malondialdehyde (MDA), vascular endothelial growth factor (VEGF), VEGF receptor (Flt-1), activities of glutathione peroxidase (Gpx), levels of total antioxidative capacity (TAC), and total oxidant status (TOS) were measured in both tissues and serum, and a semi-quantitative scoring system was used for the evaluation of histopathological findings. RESULTS: Sildenafil increased levels of Gpx, and Flt-1, and decreased MDA and VEGF levels in tissues. Sildenafil also increased serum levels of TAC and Flt-1 and decreased TOS, OSI, and VEGF. CONCLUSION: Sildenafil decreased inflammation scores in remote organs in histopathological evaluation. It has protective effects in severe burn-related remote organ injuries by decreasing oxidative stress and inflammation.

The protective effects of sildenafil in acute lung injury in a rat model of severe scald burn: A biochemical and histopathological study.

Severe burn induces biochemical mediators such as reactive oxygen species that leads to lipid peroxidation which may have a key role in formation of acute lung injury (ALI). Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5. Sildenafil preserves alveolar growth, angiogenesis, reduces inflammation and airway reactivity. The purpose of the present study was to evaluate the effects of different dosages of sildenafil in ALI due to severe scald burn in rats. Twenty-four rats were subjected to 30% total body surface area severe scald injury and were randomly divided into three equal groups as follow: control, 10 and 20mg/kg sildenafil groups. Levels of malondialdehyde (MDA), activities of glutathione peroxidase (Gpx), catalase (Cat), total oxidative stress (TOS), and total antioxidative capacity (TAC) were measured in both tissues and serums. Oxidative stress index (OSI) was calculated. A semi-quantitative scoring system was used for the evaluation of histopatological findings. Sildenafil increased Gpx, Cat, TAC and decreased MDA, TOS and OSI. Sildenafil decreased inflammation scores in lungs. Our results reveal that sildenafil is protective against scald burn related ALI by decreasing oxidative stress and inflammation and the dosage of 10mg/kg could be apparently better than 20mg/kg.

The impact of Ramadan on peptic ulcer perforation.

BACKGROUND: Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP. METHODS: A retrospective analysis of 229 patients who were operated due to PUP between 1999-2009 was made. Patients were divided into two groups. Group I (n=188) included the patients who were operated in other periods of the year, while Group II (n=41) included the patients who were operated during Ramadan, the Muslim period of fasting. Patients in Group II were analyzed in terms of duration of fasting. RESULTS: The increase in surgeries per group was higher in Group II than Group I (p<0.05). Predisposing factors, anti-ulcer drug usage and demographic variables were seen to have no role in this difference. Duration of fasting may have a minimal effect on the perforation. CONCLUSION: The results of this study demonstrate that PUP is detected as relatively higher during Ramadan among those who are fasting for more than 12 hours daily. We suggest that people with predisposing factors should be informed before making a decision to fast.

Effects of Ramadan fasting on peptic ulcer disease as diagnosed by upper gastrointestinal endoscopy.

BACKGROUND AND STUDY AIMS: The diagnostic methods such as upper gastrointestinal endoscopy (UGE) have played an important role in the evaluation of peptic ulcer (PU). Every year, millions of Muslims fast in Ramadan month. The aim of this study was to evaluate the effect of fasting on PU via UGE. PATIENTS AND METHODS: A total of 321 patients in the period from 2009 to 2011, who underwent UGE as a diagnostic work-up mainly for epigastric pain, were analysed. Patients were divided into three groups: Patients who have been evaluated by UGE, in the month just before Ramadan (group I, n=69), in Ramadan month (group II, n=132) and in the month just after Ramadan (group III, n=120). Continuous data were expressed as the mean±SD, and were compared with one-way analysis of variance (ANOVA) test amongst groups. Categorical data were given as percentages and were compared with the chi-squared test. RESULTS: Epigastric pain was the most common indication for referral in each group. Interestingly, the indication 'bleeding' was found to be the least in group II, but was far from statistical significance. The highest prevalence of duodenal ulcers and duodenitis was found in group II; the differences to the other groups were statistically significant. CONCLUSION: Duodenal ulcers and duodenitis were found more during Ramadan month. We recommend that, the patients with epigastric pain may fast by taking their medications.

Effects of proton pump inhibitors and h(2) receptor antagonists on the ileum motility.

Objectives. To investigate the effects of proton pump inhibitors (PPIs) and H(2) receptor antagonists on ileum motility in rats with peritonitis and compare changes with control group rats. Methods. Peritonitis was induced by cecal ligation and puncture in 8 rats. Another of 8 rats underwent a sham operation and were accepted as controls. Twenty-four hours later after the operation, the rats were killed, and their ileum smooth muscle was excised and placed in circular muscle direction in a 10 mL organ bath. Changes in amplitude and frequency of contractions were analyzed before and after PPIs and H(2) receptor blockers. Results. PPI agents decreased the motility in a dose-dependent manner in ileum in both control and intraabdominal sepsis groups. While famotidine had no significant effect on ileum motility, ranitidine and nizatidine enhanced motility in ileum in both control and intraabdominal sepsis groups. This excitatory effect of H(2) receptor antagonists and inhibitor effects of PPIs were significantly high in control group when compared to the peritonitis group. The inhibitor effect of pantoprazole on ileum motility was significantly higher than the other two PPI agents. Conclusions. It was concluded that H(2) receptor antagonists may be more effective than PPIs for recovering the bowel motility in the intraabdominal sepsis situation.

A new variant of bile duct duplication with coexistence of distal cholangiocarcinoma.

BACKGROUND: A 72-year-old hypertensive woman presented with a 2-month history of right upper quadrant abdominal pain. She had a 15-day history of jaundice, fever with chills and shivering, nausea, vomiting, weight loss and generalized pruritus. INVESTIGATIONS: Physical examination, laboratory evaluation, transabdominal ultrasonography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, brush cytology, laparotomy and histopathology. DIAGNOSIS: Bile duct duplication with coexistence of distal cholangiocarcinoma. MANAGEMENT: En bloc resection (including the duodenum, pancreatic head and adjacent lymph nodes), hepaticojejunostomy and pylorus-saving Whipple operation.

Could total thyroidectomy become the standard treatment for Graves' disease?

PURPOSE: Graves' disease is the most frequent cause of hyperthyroidism. Although treatment with antithyroid drugs or radioactive iodine is effective, surgery remains the preferred treatment for many patients. We analyzed the results of 55 prospectively followed patients who underwent total thyroidectomy for Graves' disease. METHODS: Total thyroidectomy was performed by experienced endocrine surgeons in all 55 patients. We monitored the patients postoperatively for early and late complications. RESULTS: There were 19 men, with a mean age of 42 years (range, 34-68 years) and 36 women, with a mean age of 38 years (range, 19-78 years). One patient suffered postoperative hemorrhage and subsequent wound infection, two patients had transient recurrent laryngeal nerve palsy, and 24 patients had transient hypocalcemia. The mean follow-up time was 4 years (range, 10 months to 6 years). Recurrence of hyperthyroidism was not reported in this period. CONCLUSION: Removal of all thyroid tissue offers the best chance of preventing recurrent hyperthyroidism. Total thyroidectomy is the most effective surgery for achieving the goal of treatment of Graves' disease to ensure that hyperthyroidism will not recur.

Effects of contrast media on the hepato-pancreato-biliary system.

AIM: To determine the effects of high osmolarity contrast media (HOCM) and iso-osmolar contrast media (CM) application, with or without pressure, on hepato-pancreato-biliary (HPB) system. METHODS: Sixty rats were divided into six equal groups as follows: Group 1: (0.9% NaCl, control), Group 2: (diatrizoate meglumine Na, ionic HOCM, Urographin), Group 3: (iodixanol, iso-osmolar non-ionic CM, Visipaque); each of which was applied without pressure, whereas the animals of the remaining three groups (1p, 2p, 3p) were subjected to the same CM with pressure. We performed a duodenal puncture and introduced a catheter into the ampulla. After the catheterization, 0.2 mL CM or 0.9% NaCl was injected with or without pressure. Blood samples were taken for biochemical evaluations. The histopathological examinations of liver, common bile duct, and pancreas were performed. RESULTS: There were no significant differences between the six groups for blood amylase, alanine aminotransferases, aspartate aminotransferases, bilirubin levels (P > 0.05). Alkaline phosphatase and gamma glutamyl transaminase levels were higher (P < 0.05) in the Urographin groups (2, 2p) than the Visipaque groups (3, 3p), or control groups (1, 1p). Hepatocyte necrosis, portal area inflammation, and Kupffer's cell hyperplasia were higher (P < 0.05) in the study groups than the control group. However, there were no significant differences (P > 0.05) between HOCM (2, 2p) and iso-osmolar CM (3, 3p) groups. Bile duct proliferation and regeneration in the Urographin groups (2, 2p) were significantly higher (P < 0.05) than the Visipaque groups (3, 3p) or the control groups (1, 1p). Although CM caused minor damage to the pancreas, there were no statistically significant differences (P > 0.05) between the groups. Application of the CM with pressure did not cause additional damage to the HPB system. CONCLUSION: Iso-osmolar, non-ionic CM could be more reliable than the ionic HOCM, whereas the application of pressure during the CM application had no effect on the HPB system.

Altered spontaneous contractions of the ileum by anesthetic agents in rats exposed to peritonitis.

AIM: To investigate in vitro effects of propofol, midazolam and dexmedetomidine, which are commonly used anaesthesic or sedatives, on spontaneous contractions of the ileum both in normal rats and those exposed to hyperdynamic peritonitis. METHODS: Spontaneous contractions of isolated ileum muscle segments from sham operated rats and those exposed to peritonitis, were studied in vitro. The amplitude and the frequency of spontaneous contractions of ileum muscle segments were studied after adding dexmedetomidine, propofol, and midazolam to the organ bath in a cumulative manner. RESULTS: Both amplitude (85.2 +/- 6.6 vs 47.4 +/- 7.1) and frequency (32.8 +/- 4.6 vs 20.2 +/- 3.9) of spontaneous contractions in ileum smooth muscle segments were decreased significantly in the peritonitis group compared to the control group (P < 0.05). Dexmedetomidine significantly increased the amplitude of spontaneous contractions (85.2 +/- 6.6 vs 152.0 +/- 5.4, P < 0.05) whereas, propofol (85.2 +/- 6.6 vs 49.6 +/- 4.8, P < 0.05) and midazolam (85.2 +/- 6.6 vs 39.2 +/- 4.5, P < 0.05) decreased it in both control and peritonitis groups. The frequency of spontaneous contractions were significantly decreased by propofol in both control (32.8 +/- 4.6 vs 18.2 +/- 3.4, P < 0.05) and peritonitis groups 20.2 +/- 3.9 vs 11.6 +/- 3.2, P < 0.05). Dexmedetomidine and midazolam did not cause significant changes in the number of spontaneous contractions in both control and the peritonitis groups (P > 0.05). CONCLUSION: Propofol, midazolam and dexmedetomidine have various in vitro effects on spontaneous contractions of the rat ileum. While dexmedetomidine augments the spontaneous contraction of the rat ileum, propofol attenuates it. However, the effects of these compounds were parallel in both control and peritonitis groups.

Effects of NO/L-arginine pathway on gallbladder contractility in bile duct ligated guinea pigs.

BACKGROUND: Common bile duct ligation (CBDL) produces gallbladder distension and acute inflammation similar to that seen in human acute acalculous cholecystitis. CBDL in the guinea pig affects smooth muscle contractility. The aim of this study was to determine whether the nitric oxide-L-arginine pathway plays a role in the inflammatory process and abnormal gallbladder contractility that occur after CBDL. MATERIALS AND METHODS: Contractility of gallbladder muscle from CBDL and sham-operated guinea pigs was studied in vitro. Animals were treated with saline, aminoguanidine (AG), or an aminoguanidine + L-arginine combination (AG + L-Arg) in vivo. Potassium chloride, carbachol, and electric field stimulation (EFS) were used for contracting the gallbladder muscle strips or activating intrinsic nerves. Hematoxylin and eosin-stained slides of muscle strips were scored for inflammation. RESULTS: Contraction responses to carbachol and EFS were decreased significantly in CBDL guinea pigs compared with those in the sham-operated group. AG partly reversed the smooth muscle contractile response to carbachol and EFS, but did not reduce the inflammation score. Treatment with AG + L-arg did not reverse either the contraction response or the inflammation score. CONCLUSIONS: These findings suggest that AG and AG + L-Arg treatments have no beneficial effect on inflammation in guinea pigs after CBDL, although AG significantly reversed the effect on muscle contractility (P < 0.05). This improvement was independent of inflammation and may be due to a decreased level of NO and its diminished relaxant effect.

Efficacy of chlorhexidine gluconate during surgery for hydatid cyst.

BACKGROUND: Dissemination of protoscolices-rich fluid during surgery for hydatid cyst disease is a major cause of recurrence. Instillation of a scolicidal agent into a hepatic hydatid cyst before opening is the most commonly employed measure to prevent this serious complication. In this clinical study, the efficacy of 0.04% chlorhexidine gluconate (Chx-Glu) during hydatid cyst surgery was tested, and early-term results were evaluated. METHODS: A total of 30 consecutive patients with 45 liver cysts were studied. Only type I and type II cysts were included. Cysts were punctured, and fluid was aspirated. The viability of protoscolices in this fluid was determined. Chx-Glu 0.04% was instilled into the cyst cavity. After 5 minutes of exposure, the cyst fluid was reaspirated and evaluated for the viability of protoscolices. Imprints of the germinative membranes were determined for protoscolices viability. RESULTS: All protoscolices in 45 cysts evaluated were killed by 5 minutes of exposure to 0.04% Chx-Glu. The whole of the germinative membrane imprints contained dead protoscolices. Chx-Glu 0.04% did not cause any adverse effect on biliary tracts in communication with cysts. There was no recurrence during the 2-year follow-up period. There were also no mortality and no cavity-related complications. CONCLUSIONS: This study shows that intracystic injection of 0.04% Chx-Glu is an effective measure against the dissemination of viable protoscolices. In addition, Chx-Glu is the most convenient scolicidal agent as per the criteria defined by the World Health Organization. Therefore, it can be used safely during hydatid cyst surgery. However, there remains the need to perform advanced comparative clinical studies on the efficacy of Chx-Glu and other scolicidal agents.

Effects of peritoneal lavage with scolicidal agents on survival and adhesion formation in rats.

Intraoperative irrigation of the peritoneal cavity with scolicidal agents is frequently recommended when dealing with traumatic or spontaneous rupture of hydatid cysts. The present experimental study was designed to examine the influence of various scolicidal agents on adhesion formation and survival. A total of 149 rats were randomly allocated to nine groups. Peritoneal lavage through a median laparotomy was performed with the following scolicidal agents. Group 1 (0.9% saline: controls), group 2 (20% hypertonic saline), group 3 (0.04% chlorhexidine gluconate), group 4 (3% hydrogen peroxide), group 5 (0.5% silver nitrate), group 6 (1% polyvinylpyrrolidone-iodine, or PVP-I ), group 7 (5% PVP-I), group 8 (0.5% cetrimide/0.05% chlorhexidine), and group 9 (10% PVP-I). The surviving animals were sacrificed on postoperative day 15. Adhesion formation was macroscopically graded by the Nair criteria. The severity of adhesion formation was evaluated microscopically using the fibrosing scoring criteria and the strain test. Group 9 (10% PVP-I) was excluded from the adhesion evaluation because all of the rats died in this group. The mortality rate was significantly higher in groups 5 and 7 than in groups 1, 2, 3, 4, 6, and 8. Adhesion scores were significantly lower in groups 1, 2, 3, and 4 than in groups 5, 6, 7, and 8. The lowest adhesion score was found in group 3 and the highest in the group 7. These results indicate that 0.04% chlorhexidine gluconate, the most potent scolicidal agent in vitro and in vivo, was associated with the lowest adhesion formation and mortality among various scolicidal agents in this experimental study.

The effects of cetrimide-chlorhexidine combination on the hepato-pancreatico-biliary system.

Sclerosing cholangitis is a rare but dreadful complication of liver hydatid surgery. Almost all scolocidal agents are associated clinically or experimentally with this complication. Cetrimide-chlorhexidine combination is the most potent scolocidal agent, and this study was designed to examine its effect on the hepato-pancreatico-biliary system. Forty Wistar-albino rats were divided into two groups. 0.5% cetrimide-0.05% chlorhexidine was injected into the biliary tract of study group animals and 0.9% saline ( NaCl ) into the control group through a 3-mm duodenotomy. The animals were sacrificed after 90 days and histopathological examination of the liver, biliary tract, and pancreas was performed 90 days after the biliary injection. The histopathological examination showed that the lesions ranged from focal necrosis to sclerosing cholangitis to liver cirrhosis. Focal necrosis and eosinophilic inflammation were observed in all rats in the study group. The changes in the liver, biliary tract, and pancreas of the study group animals were significantly more severe than those in the control group (p < 0.05). This experimental study confirms the deleterious effect of another scolocidal agents on the hepato-pancreatico-biliary system. Although it is a very effective scolocidal agent, it should not be used in the presence of a duct biliary-cyst communication.

Chlorhexidine gluconate: an ideal scolicidal agent in the treatment of intraperitoneal hydatidosis?

Hydatid disease is a parasitic disease that is treated primarily by surgery. The most important complication of surgical treatment is spillage of the contents of the cyst, leading to secondary dissemination. In this study, the effect of chlorhexidine gluconate (Chx-Glu) was investigated in the treatment of experimental intraperitoneal hydatidosis (IPH). IPH was reproduced in 100 Wistar albino rats by inoculation with 1 ml of a suspension contained approximately 1500 viable protoscolices of Echinococcus granulosus following determination of scolicidal activity of chlorhexidine gluconate in vitro. Five minutes after protoscolex inoculation, 5 ml of the scolicidal solution was instilled into the peritoneal cavity: 0.9% NaCl (control group), 4.0% Chx-Glu, 0.4% Chx-Glu, and 0.04% Chx-Glu. After 6 months of follow-up, the rats were sacrificed, and the number of isolated cysts, peroperative and postoperative deaths, and toxicity were evaluated. Cyst formation did not occur in any of the Chx-Glu groups compared to the control group (p < 0.05), whereas it was detected in all of the control rats. In addition, to 4.0% Chx-Glu was found to be more toxic and to cause a high mortality rate compared to the 0.4% and 0.04% Chx-Glu groups and the control group (p < 0.05). Chx-Glu 0.04% was found to be the most potent, nontoxic agent; it is easily available, inexpensive, and highly potent in a short period of time at the low concentration. Chx-Glu 0.04% can be used safely in the treatment of intraperitoneal hydatidosis and hydatid cyst.