Effects of melatonin and phospholipid on adhesion formation and correlation with vascular endothelial growth factor expression in rats.

BACKGROUND: The aim of this experimental study was to investigate the effects of melatonin and phospholipid on adhesion formation and the correlation with vascular endothelial growth factor (VEGF) expression in rats. METHODS: Sixty Wistar-Albino rats were divided into four groups as sham, control and two study groups, each including 15 rats. In the sham group, laparotomy was the only procedure. Left lower parietal peritoneum was abraded after laparotomy and serosal defects formed on the cecum, ileum and right uterine horn in the study and control groups. Ringer lactate was then applied to the control group, while melatonin and phospholipid suspension were applied separately in the two study groups. Relaparotomy was performed in all groups on the 15th day to score and evaluate the adhesion formation. RESULTS: Adhesion formation was significantly lower in the sham, melatonin and phospholipid groups than in the control group (p<0.05). VEGF staining was significantly higher in the control group with adhesion areas compared to the other groups (p<0.05). When VEGF staining was compared, there was no significant difference between VEGF- stained and normal areas in the melatonin and phospholipid groups. CONCLUSION: Melatonin and phospholipid decreased the adhesion formation in an experimental adhesion model in rats. There is a correlation between adhesion severity and VEGF expression.

Melatonin reduces bacterial translocation and apoptosis in trinitrobenzene sulphonic acid-induced colitis of rats.

AIM: To investigate the effects of exogenous melatonin on bacterial translocation and apoptosis in a rat ulcerative colitis model. METHODS: Rats were randomly assigned to three groups: group I: control, group II: experimental colitis, group III: colitis plus melatonin treatment. On d 11 after colitis, plasma tumor necrosis factor-alpha, portal blood endotoxin levels, colon tissue myeloperoxidase and caspase-3 activity were measured. Bacterial translocation was quantified by blood, lymph node, liver and spleen culture. RESULTS: We observed a significantly reduced incidence of bacterial translocation to the liver, spleen, mesenteric lymph nodes, portal and systemic blood in animals treated with melatonin. Treatment with melatonin significantly decreased the caspase-3 activity in colonic tissues compared to that in trinitrobenzene sulphonic acid- treated rats (16.11 +/- 2.46 vs 32.97 +/- 3.91, P < 0.01). CONCLUSION: Melatonin has a protective effect on bacterial translocation and apoptosis.

Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem.

BACKGROUND: Granulomatous lobular mastitis is a rare chronic inflammatory disease of the breast. Clinical and radiological features may mimic breast carcinoma. Since this entity was first described, several clinical and pathologic features of the disease have been reported, but diagnostic features and treatment alternatives are still unclear. The purpose of this study is to evaluate diagnostic difficulties and discuss the outcome of surgical treatment in a series of 21 patients with granulomatous lobular mastitis. METHODS: A retrospective review of 21 patients with histologically confirmed granulomatous lobular mastitis treated in our center between January 1995 and May 2005 was analyzed to identify issues in the diagnosis and treatment of this rare condition. RESULTS: The most common presenting symptoms were a mass in the breast and pain. Four patients had no significant mammographic findings (MMG), but on ultrasound (US), 2 had irregular hypoechoic mass, and 2 hypoechoic nodular structures had abnormalities-one parenchymal distortion and 1 mass formation in 2 of these 4 patients' magnetic resonance imaging (MRI). In recurrent cases, limited excision under local anesthesia was performed, as the clinical examination suggested carcinoma. CONCLUSIONS: Although some findings on MMG and US are suggestive of benign breast disease, these modalities do not rule out malignancy. MRI may be helpful in patients who do not have significant pathology at MMG or US. Fine-needle aspiration cytology may be useful in some cases but diagnosis is potentially difficult because of its cytologic characteristics. Wide excision, particularly under general anesthesia, can be therapeutic as well as useful in providing an exact diagnosis.

Portal vein resection for a portal vein thrombus caused by nonfunctioning islet cell carcinoma: report of a case.

We report a case of nonfunctioning islet cell carcinoma of the pancreas causing a tumor thrombus in the portal vein. The patient was a 60-year-old woman whose presenting symptoms were abdominal pain, vomiting, and weight loss. We performed a subtotal pancreatectomy and splenectomy combined with partial resection of the portal vein. Histopathological studies confirmed the diagnosis of nonfunctioning islet cell carcinoma of the pancreas with a tumor thrombus in the portal vein. The patient's postoperative course was uneventful and she is doing well 25 months after the operation.

Short and long-term effects of bacterial translocation due to obstructive jaundice on liver damage.

BACKGROUND/AIMS: The present study was conducted to determine if obstructive jaundice promotes bacterial translocation and to evaluate the changes in hepatic histopathology in patients with benign biliary obstruction. METHODOLOGY: Between January 1996 and January 1998, 19 patients treated for benign biliary obstruction were studied. Fourteen patients with symptomatic cholelithiasis were taken as the control group. Patient characteristics, preoperative and post-operative laboratory tests with an interval of 7 days were recorded. In all patients, bile and mesenteric lymph nodes samples were taken for bacterial growth and histopathologic changes were studied on the liver excised during surgery. RESULTS: In the control group, bacterial growth was observed in the bile and mesenteric lymph nodes cultures in one (7.1%) and two patients (14.3%), respectively. In the study group, 8 patients (42%) had positive bile cultures and 12 patients (63.2%) had positive mesenteric lymph nodes cultures, respectively. Histopathologic examination of the liver revealed significant increase in the rate of periductal and portal fibrosis in the jaundiced patients, compared with control group (p < 0.001). Postoperative complications in the study group were wound infection (3 cases), renal failure (2 cases), ARDS (1 cases) and intraabdominal abscess (1 cases). In the control group, one patient had wound infection and one had atelectasis. Two patients with jaundice died of multiple organ failure and respiratory failure. In long-term follow-up (mean 17 months), when sclerosing cholangitis and secondary biliary cirrhosis developed in one patient each in the study group, no long-term complication occurred in the control group. CONCLUSIONS: Our clinical results demonstrate that extrahepatic biliary obstruction promotes bacterial translocation and this process is an important cause of morbidity and mortality in patients with jaundice. Also, obstructive jaundice subsequently leads to significant functional and morphological damage in the liver.

[Surgical alternatives in complex pancreatic injuries]. / Kompleks pankreas yaralanmalarinda cerrahi yaklasimlar.

BACKGROUND: Objective of this study is to analyze the treatment outcomes of patients undergoing surgery for complex pancreatic injuries in our center over a 20-year period. METHODS: Between January 1980 and December 2001, medical records of 11 patients who underwent surgical intervention for complex pancreatic trauma were investigated retrospectively. RESULTS: The study group consisted of nine males and two female patients with a mean age of 36 years. Six patients had stab wounds, three had motor vehicle accidents and two had gunshot wounds. The mean value of Injury Severity Score (ISS) was 32. Among six patients with Grade III injury, five were managed by distal pancreatectomy and one by external drainage. In three patients with Grade IV injury each underwent distal pancreatectomy, subtotal pancreatectomy and pancreaticoduodenectomy. The remaining two patients with Grade V injury were managed by pancreaticoduodenectomy. In the postoperative course, pancreatic fistula was observed in two patients and peripancreatic abscess and pancreatitis in one patient each. Endocrine insufficiency occurred in one patient who underwent subtotal pancreatectomy. Operative mortality was 18.2%. CONCLUSION: Owing to the retroperitoneal location of the pancreas and its proximity to major vascular structures, associated organ injuries play a significant role in morbidity and mortality.

Grasper-assisted versus traditional laparoscopic splenectomy in the management of hematologic disorders.

OBJECTIVE: To compare the technical benefits of grasper-assisted laparoscopic splenectomy (LS) with traditional LS. METHODS: The study comprised 27 consecutive patients who were admitted to our hospital from 1998 to 2002 and underwent LS: 13 patients underwent traditional LS (group 1), and 14 had grasper-assisted LS (group 2). RESULTS: In both groups, the most common indication for LS was idiopathic thrombocytopenic purpura. There was no difference between the groups in the demographic characteristics of patients. All splenectomies were performed in the right semidecubitus position, using four or five trocars. Conversion to open surgery was required in one patient (7.7%) in group 1 and in one patient (7.1%) in group 2. Both conversions occurred during the initial 16 operations and no conversion occurred during the subsequent 11 operations. The mean operating time was significantly shorter for group 2 (132 minutes) than for group 1 (154 minutes) (P <.005). Mean estimated blood loss (201 vs. 282 mL) was also lower in group 2 than in group 1 (P <.05). The mean length of hospital stay was 3.3 days in group 1 and 2.4 days in group 2 (P >.05). CONCLUSION: Grasper-assisted LS is both safe and feasible in patients with hematologic diseases. This technique can be preferred in order to grasp and position the spleen during the surgery.