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Background and Objectives: Robotic bariatric surgery is increasingly adopted by surgeons. We present the surgical results of 527 consecutive patients who underwent robotic Roux-en-Y gastric bypass (RYGB) using the standard technique. Methods: A retrospective analysis of a prospectively maintained database was performed including 527 consecutive patients who underwent robotic RYGB between January 1, 2018 and December 31, 2021. Results: The mean age of the patients was 41 years, with a male/female sex distribution of 143/384 (27.1%/72.9%). Type 2 diabetes in the pre-operative period was diagnosed in 31% of patients. The median pre-operative body mass index (BMI) was 44.6 kg/m2 (range, 35-64). The mean operation time was 134 min for robotic RYGB, including the docking process. Early (< 30 days) complications included ileus (0.2%), atelectasis (0.2%), thromboembolic (0.2%) events, and surgical-site infection (0.2%). No leakage or bleeding of the gastrojejunal and jejunojejunal anastomoses were recorded. Oral food intake was begun at 1.8 days on average. The average hospital stay was 2 days. Despite a range of BMI values, operation times and gastrojejunal anastomosis times did not show significant differences. There were no significant differences in mean operation time or mean gastrojejunal anastomosis time over the years. Conclusions: The robotic approach is effective and safe for patients undergoing RYGB. This technique provides satisfactory results with short-term surgical outcomes. However, the real benefits of robotic RYGB should be further evaluated by well-conducted randomized trials. Even in difficult cases with higher BMI values, optimal operation times and similar operative efficiency can be obtained if a standard operation technique is applied.
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Diabetes Mellitus Tipo 2 , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Procedimentos Cirúrgicos Robóticos , Cirurgiões , Adulto , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Derivação Gástrica/métodos , Humanos , Laparoscopia/métodos , Masculino , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do TratamentoRESUMO
Objective We compared the effects of sevoflurane and isoflurane on systemic inflammation, sepsis-associated encephalopathy, and memory impairment in a rat sepsis model of cecal ligation and puncture (CLP)-induced polymicrobial peritonitis. Methods Twenty-four rats were assigned to sham, CLP, CLP + sevoflurane, and CLP + isoflurane groups. At 72 hours after CLP, the rats underwent behavior tests. Serum cytokines were evaluated. Brain tissue samples were collected for determination of glutathione peroxidase (GPX), superoxide dismutase (SOD), and catalase; the wet/dry weight ratio; myeloperoxidase (MPO) and malondialdehyde (MDA); apoptotic gene release; and histologic examinations. Results The MPO level, wet/dry weight ratio, and histopathology scores were lower and the Bcl2a1 and Bcl2l2 expressions were upregulated in both the CLP + sevoflurane and CLP + isoflurane groups compared with the CLP group. The interleukin-6, interleukin-1ß, MDA, and caspase 3, 8, and 9 levels were lower; the GPX, SOD, Bax, Bcl2, and Bclx levels were higher; and non-associative and aversive memory were improved in the CLP + sevoflurane group compared with the CLP + isoflurane group. Conclusion Sevoflurane decreased apoptosis and oxidative injury and improved memory in this experimental rat model of CLP. Sevoflurane sedation may protect against brain injury and memory impairment in septic patients.
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Anestésicos Inalatórios/farmacologia , Encéfalo/efeitos dos fármacos , Transtornos da Memória/prevenção & controle , Fármacos Neuroprotetores/farmacologia , Peritonite/metabolismo , Encefalopatia Associada a Sepse/prevenção & controle , Sepse/metabolismo , Sevoflurano/farmacologia , Animais , Antibacterianos/uso terapêutico , Apoptose , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/fisiopatologia , Química Encefálica , Caspases/metabolismo , Modelos Animais de Doenças , Isoflurano/farmacologia , Peroxidação de Lipídeos , Masculino , Transtornos da Memória/etiologia , Transtornos da Memória/metabolismo , Estresse Oxidativo , Peritonite/complicações , Peritonite/fisiopatologia , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos , Ratos Wistar , Sepse/complicações , Sepse/fisiopatologia , Encefalopatia Associada a Sepse/etiologia , Encefalopatia Associada a Sepse/metabolismo , Transdução de Sinais , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle , Proteína X Associada a bcl-2/metabolismoRESUMO
BACKGROUND AND OBJECTIVES: Benign duodenal neoplasm is a rare occurrence. Minimally invasive tumor resection and anastomosis formation with an OrVil catheter is a novel approach to treating this disease. In this article, we present a new technique for duodenojejunal anastomosis. This technique was applied in 4 patients with benign distal duodenal tumors who were treated with minimally invasive surgery with robotic assistance. METHODS: In 4 patients, after the removal of distal duodenal masses with a robotic technique, an orifice in the duodenum was opened to allow for the passage of a guidewire. The guidewire was removed from the orifice by holding it with forceps during an upper endoscopy. An OrVil catheter was sutured to the guidewire outside to allow 2 catheters to proceed consecutively. After the removal of the anvil, an end-lateral duodenojejunostomy was performed with a circular stapler. RESULTS: The patients included 3 men and 1 woman (average age, 56). The durations of the operations were 215, 175, 180, and 185 minutes. No complications were observed in any of the patients during the postoperative period. The patients began oral intake on the fifth day of the postoperative period, and they were discharged on the sixth postoperative day. Histopathologic analyses indicated that the removed tumors were adenomas in 2 patients and gastrointestinal stromal tumors (GISTs) in 2 patients. Clear surgical margins were observed in all of the patients. CONCLUSION: The placement of an OrVil catheter for anastomosis in benign neoplasms with distal duodenum localization and the subsequent achievement of duodenojejunal anastomosis with a circular stapler constitute a novel treatment approach.
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Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Catéteres , Neoplasias Duodenais/cirurgia , Procedimentos Cirúrgicos Robóticos , Adenoma/cirurgia , Adulto , Idoso , Duodeno/cirurgia , Feminino , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Jejunostomia , Masculino , Pessoa de Meia-Idade , Grampeamento CirúrgicoRESUMO
BACKGROUND AND OBJECTIVES: The current study was conducted to determine whether robotic low anterior resection (RLAR) has real benefit over laparoscopic low anterior resection (LLAR) in terms of surgical and early oncologic outcomes. METHODS: We retrospectively analyzed data from 35 RLARs and 28 LLARs, performed for mid and low rectal cancers, from January 2013 through June 2015. RESULTS: A total of 63 patients were included in the study. All surgeries were performed successfully. The clinicopathologic characteristics were similar between the 2 groups. Compared with the laparoscopic group, the robotic group had less intraoperative blood loss (165 vs. 120 mL; P < .05) and higher mean operative time (252 vs. 208 min; P < .05). No significant differences were observed in the time to flatus passage, length of hospital stay, and postoperative morbidity. Pathological examination of total mesorectal excision (TME) specimens showed that both circumferential resection margin and transverse (proximal and distal) margins were negative in the RLAR group. However, 1 patient each had positive circumferential resection margin and positive distal transverse margin in the LLAR group. The mean number of harvested lymph nodes was 27 in the RLAR group and 23 in the LLAR group. CONCLUSIONS: In our study, short-term outcomes of robotic surgery for mid and low rectal cancers were similar to those of laparoscopic surgery. The quality of TME specimens was better in the patients who underwent robotic surgery. However, the longer operative time was a limitation of robotic surgery.
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Laparoscopia/métodos , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Neoplasias Retais/diagnóstico , Estudos RetrospectivosRESUMO
Isolated ovarian metastases from colorectal cancer (CRC) are rare disease presenting in approximately 3% of all patients undergoing colorectal resection. Most reports describe an open approach to the disease, but we report a case isolated ovarian metastases from CRC managed completely by robotic technique. A 54-year-old female, with a family history of CRC, was admitted for rectosigmoid junction cancer. Computed tomography scan demonstrated in rectosigmoid tumor and pelvic mass, presumed as teratoma. Robotic surgery discovered a 10-cm encapsulated tumor, attached to the left ovary, with no macroscopic peritoneal involvement. The pathologic diagnosis of the resected pelvic mass, ovarian metastases from CRC. Robotic anterior resection was performed. Operative time was lasted 165 min, considering 25 min for robotic system set up. This is the first report to describe robot-assisted anterior resection and oophorectomy in patient with isolated ovarian metastases from rectosigmoid junction cancer.
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Background. The present study aimed to compare the clinical outcomes of laparoscopic versus open surgery for colorectal cancers. Materials and Methods. The medical records from a total of 163 patients who underwent surgery for colorectal cancers were retrospectively analyzed. Patient's demographic data, operative details and postoperative early outcomes, outpatient follow-up, pathologic results, and stages of the cancer were reviewed from the database. Results. The patients who underwent laparoscopic surgery showed significant advantages due to the minimally invasive nature of the surgery compared with those who underwent open surgery, namely, less blood loss, faster postoperative recovery, and shorter postoperative hospital stay (P < 0.05). However, laparoscopic surgery for colorectal cancer resulted in a longer operative time compared with open surgery (P < 0.05). There were no statistically significant differences between groups for medical complications (P > 0.05). Open surgery resulted in more incisional infections and postoperative ileus compared with laparoscopic surgery (P < 0.05). There were no differences in the pathologic parameters between two groups (P < 0.05). Conclusions. These findings indicated that laparoscopic surgery for colorectal cancer had the clear advantages of a minimally invasive surgery and relative disadvantage with longer surgery time and exhibited similar pathologic parameters compared with open surgery.
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BACKGROUND AND OBJECTIVES: Bowel anastomosis after anterior resection is one of the most difficult tasks to perform during laparoscopic colorectal surgery. This study aims to evaluate a new feasible and safe intracorporeal anastomosis technique after laparoscopic left-sided colon or rectum resection in a pig model. METHODS: The technique was evaluated in 5 pigs. The OrVil device (Covidien, Mansfield, Massachusetts) was inserted into the anus and advanced proximally to the rectum. A 0.5-cm incision was made in the sigmoid colon, and the 2 sutures attached to its delivery tube were cut. After the delivery tube was evacuated through the anus, the tip of the anvil was removed through the perforation. The sigmoid colon was transected just distal to the perforation with an endoscopic linear stapler. The rectosigmoid segment to be resected was removed through the anus with a grasper, and distal transection was performed. A 25-mm circular stapler was inserted and combined with the anvil, and end-to-side intracorporeal anastomosis was then performed. RESULTS: We performed the technique in 5 pigs. Anastomosis required an average of 12 minutes. We observed that the proximal and distal donuts were completely removed in all pigs. No anastomotic air leakage was observed in any of the animals. CONCLUSION: This study shows the efficacy and safety of intracorporeal anastomosis with the OrVil device after laparoscopic anterior resection.
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Colectomia/métodos , Colo Sigmoide/cirurgia , Reto/cirurgia , Anastomose Cirúrgica/métodos , Animais , Colo/cirurgia , Modelos Animais de Doenças , Feminino , Laparoscopia/métodos , Técnicas de Sutura , SuínosAssuntos
Carcinoma de Células em Anel de Sinete , Neoplasias Gástricas , Biópsia , Carcinoma de Células em Anel de Sinete/patologia , Carcinoma de Células em Anel de Sinete/cirurgia , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Estômago/patologia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
BACKGROUND: This study aimed to evaluate the differential protective effects of isoflurane or sevoflurane on lung inflammation in a rat model of cecal ligation and puncture (CLP) induced sepsis. METHODS: Seventy-two rats were assigned to control, sevoflurane, or isoflurane groups. At 2 and 4 h, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1ß (IL-1ß), nitrate/nitrate levels (NO), total antioxidant capacity (TAC), and intercellular cell adhesion molecule-1 (ICAM-1) were determined. At 12 and 24 h, malondialdehyde (MDA), myeloperoxidase (MPO), and histologic changes were evaluated. Survival was monitored for 7 d after CLP. RESULTS: Sevoflurane (75%) and isoflurane (63%) significantly improved survival rate compared with control rats (38%). When sevoflurane and isoflurane groups were compared, sevoflurane pretreatment showed significant decrease in NO at 2 h [1045 (803-1274)/1570 (1174-2239) and 4 h [817 (499-1171)/1493 (794-2080)]; increase in TAC at 4 h [580.0 (387-751)/320 (239-512)]; decrease in MDA at 12 h [2.5 (1.1-4.2)/5.4 (4-73)] and 24 h [10.8 (6.0-14.0)/15.9 (9-28)]; and decrease in MPO at 24 h [145.8 (81-260)/232 (148-346)]. The difference in the ICAM-1 expression of the isoflurane and sevoflurane groups was not significant at both measurement times. The architectural integrity of the alveoli was preserved in all the groups. The injury scores of the three groups at 12 and 24 h did not show any significant difference. CONCLUSIONS: Both sevoflurane and isoflurane attenuated inflammatory response, lipid peroxidation, and oxidative stress. Furthermore, sevoflurane was more effective in modulating sepsis induced inflammatory response at the chosen concentration in sepsis model.
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Anestésicos Inalatórios/farmacologia , Precondicionamento Isquêmico/métodos , Isoflurano/farmacologia , Éteres Metílicos/farmacologia , Pneumonia/tratamento farmacológico , Sepse/tratamento farmacológico , Animais , Ceco/lesões , Modelos Animais de Doenças , Molécula 1 de Adesão Intercelular/sangue , Interleucina-1beta/sangue , Interleucina-6/sangue , Masculino , Malondialdeído/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Peroxidase/metabolismo , Pneumonia/metabolismo , Pneumonia/mortalidade , Ratos , Ratos Wistar , Sepse/metabolismo , Sepse/mortalidade , Sevoflurano , Taxa de Sobrevida , Fator de Necrose Tumoral alfa/sangue , Ferimentos PerfurantesRESUMO
Achalasia is a relatively rare condition with a prevalence estimated at less than 0.001 %. Laparoscopic or robotic Heller myotomy is an effective surgical treatment for achalasia. We present the first published case of a morbidly obese achalasia patient treated with robotic Heller myotomy and Dor fundoplication. The operative time was 175 min, with an estimated blood loss of 110 ml. The patient had a normal bowel transit on postoperative day 2, and he was discharged on postoperative day 4 on a liquid diet. A follow-up at 2 months showed significant resolved symptoms of achalasia.
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BACKGROUND: Nuclear factor (NF)-κB plays an essential role in inflammation. We tested this role by administering NF-κB-inhibitors into rats undergoing a well-established model of colonic anastomotic healing. METHODS: Wistar rats underwent laparotomy, descending colonic transection, and handsewn reanastomosis. The animals were randomized to receive either a selective NF-κB inhibitor (parthenolide 0.5 mg/kg or resveratrol 0.5 mg/kg) or an equal volume of water by gavages before operation and then daily after surgery. Animals were sacrificed either immediately after anastomotic construction (d 0) or at the third, fifth, or seventh postoperative day. RESULTS: Both parthenolide and resveratrol treatment led to early significant increases in plasma levels of IL-6. On d 7, hydroxyproline levels were significantly higher in the parthenolide and resveratrol groups. A similar pattern was observed with the bursting pressure. In contrast, gelatinase activity (MMP-2 and MMP-9 expression) was significantly higher in the control group on postoperative d 3. On d 3, expression of NF-κB activity was up-regulated in the anastomotic area. Both parthenolide and resveratrol completely attenuated NF-κB activity. Study groups also developed more marked inflammatory cell infiltration and collagen deposition on histology analysis. CONCLUSIONS: Parthenolide and resveratrol significantly improved healing and mechanical stability of colonic anastomoses in rats during the early postoperative period. Both agents may be acting to accelerate the host reparative process as well as to enhance protection of the anastomotic wound bed.
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Colo/fisiologia , Colo/cirurgia , NF-kappa B/antagonistas & inibidores , Sesquiterpenos/farmacologia , Estilbenos/farmacologia , Cicatrização/efeitos dos fármacos , Anastomose Cirúrgica , Animais , Anti-Inflamatórios não Esteroides/farmacologia , Enterite/tratamento farmacológico , Enterite/imunologia , Hidroxiprolina/metabolismo , Interleucina-6/sangue , Laparotomia , Masculino , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Modelos Animais , NF-kappa B/metabolismo , Ratos , Ratos Wistar , Resveratrol , Cicatrização/imunologiaRESUMO
BACKGROUND: An accepted treatment strategy for cholelithiasis with secondary choledocholithiasis is the laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreaticography (ERCP). Although early cholecystectomy is advised, there is no consensus about the time interval between LC and ERCP. The aim of this study is to evaluate the effects of the time interval between ERCP and ERCP on operation outcomes. METHODS: Patients with cholelithiasis and a risk of choledocholithiasis underwent ERCP. Patients were grouped as those operated on between 24 and 72 h after ERCP (group 1) and those operated on more than 72 h after ERCP (group 2). Patients' age, gender, body mass index, American Society of Anesthesiologists Physical Status, abdominal ultrasonography findings, white blood cell count, total serum bilirubin, ALP, amylase, ALT, AST, GGT levels, ERCP findings, time interval between ERCP and LC, conversion rate, median postoperative hospital stay, median operation time, intraoperative complication and postoperative complication rates were collected. RESULTS: There was no significant difference between the demographics of the patients in both groups. The median operation time, median postoperative hospital stay and conversion rate in group 2 were significantly higher than those of group 1. More postoperative complications were seen in group 2. CONCLUSION: Early cholecystectomy after ERCP, within 72 h, has better outcomes, probably due to the inflammatory processes.
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Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/métodos , Coledocolitíase/cirurgia , Colelitíase/cirurgia , Adulto , Distribuição de Qui-Quadrado , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Coledocolitíase/complicações , Coledocolitíase/diagnóstico por imagem , Colelitíase/complicações , Colelitíase/diagnóstico por imagem , Feminino , Humanos , Masculino , Estudos Prospectivos , Estatísticas não Paramétricas , Fatores de TempoRESUMO
AIM: Ghrelin, the most important modulator of endocrine and exocrine pancreatic functions, has a role in the development of islets of Langerhans during embryogenesis. The aim of this study was to evaluate the effects of ghrelin on pancreatic regeneration in rats with 90% pancreatectomy. MATERIALS AND METHODS: Two- to 3-week-old Wistar rats were used in the study. After anesthesia, 90% pancreatectomy was performed. In the ghrelin group, 90% pancreatectomy was performed. Ten nanomoles per kilogram per day of ghrelin was administered intraperitoneally from the first postoperative day. In the antagonist group, 90% pancreatectomy was performed. From the first postoperative day, rats received the ghrelin receptor antagonists and substance P intraperitoneally at 1 mumol/kg. In the control group, 90% pancreatectomy was performed, and intraperitoneal saline was administered. The sham group did not receive pancreatectomy. Eight rats from each group were randomly selected and sacrificed on the second, third, and 30th days. RESULTS: Blood glucose levels in pacreatectomized rats were significantly higher than in rats in the sham group. The number of beta islet cells, serum insulin levels, and PDX-1 and cytokeratin staining scores decreased in rats with pancreatectomy when compared to the sham-group rats. In the ghrelin-receiving rats, blood glucose levels tended to decrease from the 15th postoperative day. Ghrelin treatment increased insulin levels, insulin-positive islet cell number, and 5-bromo-2-deoxyuridine and PDX-1 staining, whereas ghrelin antagonist administration resulted in significant decreases in these parameters. Ghrelin treatment significantly improved glucose tolerance test results. CONCLUSION: Exogenous ghrelin administration decreased blood glucose levels after 90% pancreatectomy by increasing islet cell numbers and enhancing endocrine and exocrine regeneration.
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Diabetes Mellitus Experimental/fisiopatologia , Grelina/farmacologia , Regeneração/efeitos dos fármacos , Animais , Glicemia/análise , Contagem de Células , Ilhotas Pancreáticas/citologia , Ilhotas Pancreáticas/efeitos dos fármacos , Pancreatectomia , Ratos , Ratos WistarRESUMO
AIM: To investigate the roles of the adipocytokines, ghrelin and leptin in gastric cancer cachexia. METHODS: Resistin, ghrelin, leptin, adiponectin, insulin and insulin-like growth factor (IGF-I), were measured in 30 healthy subjects, and 60 gastric cancer patients of which 30 suffered from cancer-induced cachexia and 30 served as a control group. The relationships between hormones, body mass index (BMI) loss ratio, age, gender, and Glasgow Prognostic Score (GPS) were investigated. RESULTS: Cachexia patients had higher tumor stage and GPS when compared with non-cachexia patients (P < 0.05). Ghrelin, resistin, leptin, adiponectin and IGF-I, showed a significant correlation with BMI loss ratio and GPS (P < 0.05). A strong correlation was seen between GPS and BMI loss (R = -0.570, P < 0.0001). Multivariate analysis indicated that BMI loss was significantly independent as a predictor of ghrelin, resistin, leptin and IGF-I (P < 0.05). Existence of an important significant relationship between resistin and insulin resistance was also noted. CONCLUSION: These results showed that serum ghrelin, leptin, adiponectin, and IGF-I play important roles in cachexia-related gastric cancers. No relationship was found between resistin and cancer cachexia. Also, because of the correlation between these parameters and GPS, these parameters might be used as a predictor factor.
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Adipocinas/sangue , Caquexia/metabolismo , Grelina/sangue , Neoplasias Gástricas/complicações , Adiponectina/sangue , Adulto , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Caquexia/etiologia , Caquexia/patologia , Estudos de Casos e Controles , Feminino , Humanos , Insulina/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Pré-Albumina/metabolismo , Estudos Prospectivos , Resistina/sangue , Albumina Sérica/metabolismo , Índice de Gravidade de Doença , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia , Fatores de TempoRESUMO
AIMS: Adrenomedullin (AM) is a multifunctional peptide with a putative beneficial role after an ischaemic insult. The aim of this study was to evaluate the effect of AM on partial hepatic ischaemia reperfusion (I/R) injury. METHODS: Rats were subjected to 1 h of 70% hepatic ischaemia, followed by reperfusion or sham. At the end of ischaemia, vehicle (phosphate-buffered saline solution), N-nitro-L-arginine methyl ester (L-NAME) and AM with or without L-NAME were infused via the portal vein. Analysis was performed at pre-ischaemia, ischaemia onset and 1, 2 and 4 h after reperfusion. Hepatic tissue blood flow (HTBF) was evaluated by laser Doppler. RESULTS: Plasma AM levels in the I/R groups were significantly lower than the levels in the sham group. AM treatment significantly reduced levels of aspartate transaminase and tissue arginase (P<0.05). Significant decreases of tumour necrosis factor-alpha, interleukin-1beta and endothelin-1 levels were also found in the serum. Endothelin-1, malondialdehyde and necrosis were observed more frequently in liver tissue in the AM group than the control (P<0.05). Tissue nitric oxide, energy charge and HTBF were significantly increased in AM treatment experiments (P<0.05). CONCLUSION: The improved HTBF, energy charge and nitric oxide and the reduction of hepatic necrosis, oxidative stress, liver enzymes, endotelin-1 and pro-inflammatory cytokines demonstrate that treatment with AM attenuates liver I/R injury.
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Adrenomedulina/uso terapêutico , Hepatopatias/tratamento farmacológico , Traumatismo por Reperfusão/tratamento farmacológico , Vasodilatadores/uso terapêutico , Adrenomedulina/sangue , Animais , Arginase/metabolismo , Aspartato Aminotransferases/sangue , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Modelos Animais de Doenças , Quimioterapia Combinada , Endotelina-1/sangue , Inibidores Enzimáticos/farmacologia , Interleucina-1beta/sangue , Hepatopatias/patologia , Hepatopatias/fisiopatologia , Masculino , Malondialdeído/metabolismo , NG-Nitroarginina Metil Éster/farmacologia , Óxido Nítrico/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Wistar , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/fisiopatologia , Fator de Necrose Tumoral alfa/sangue , Vasodilatadores/sangueRESUMO
BACKGROUND: We investigated the effects of isoflurane and sevoflurane in a warm liver ischemia-reperfusion (IR) model on cytokines, hepatic tissue blood flow (HTBF), energy content, and liver structure. METHODS: Seventy-two Wistar rats were randomly assigned into 1 of 3 groups: Control group, no volatile anesthetics; sevoflurane group, 2% sevoflurane; isoflurane group, 1.5% isoflurane. Thirty minutes after the start of volatile anesthetics, rats were subjected to 45 min hepatic ischemia and 2 and 4 h of reperfusion. Rats were killed at the end of ischemia, 2 and 4 h of reperfusion. Aspartate aminotransferase and alanine aminotransferase, HTBF, malondialdehyde, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, energy charge, and histologic examination were used to evaluate the extent of liver injury. RESULTS: Serum alanine aminotransferase and aspartate aminotransferase levels were similar in control and isoflurane groups while there was a significant decrease in the sevoflurane group in the postischemic period (P < 0.01). HTBF was remarkably better in the sevoflurane group than in the isoflurane group and worse in the control group. Tissue malondialdehyde levels were significantly low in the sevoflurane group compared with the isoflurane group at 2 h of reperfusion (P < 0.05) and reached its maximum value in the postischemic period in the control group. After ischemia, 2 and 4 h of reperfusion, tumor necrosis factor-alpha and interleukin-1beta values were lowest in the sevoflurane group and highest in the control group but it was not statistically significant (P > 0.05). In the sevoflurane group, hepatic adenosine triphosphate and energy charge were significantly high at all measurement times. At the postischemic period, energy charge was lower compared with the sevoflurane and isoflurane groups. The degree of hepatocyte injury was small in the sevoflurane group. CONCLUSIONS: Clinically relevant concentrations of sevoflurane given before, during, and after hepatic ischemia protected the liver against IR injury, whereas the effects of isoflurane on hepatic IR injury were not notable.
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Anestésicos Inalatórios/farmacologia , Citocinas/sangue , Metabolismo Energético/efeitos dos fármacos , Isoflurano/farmacologia , Circulação Hepática/efeitos dos fármacos , Fígado/efeitos dos fármacos , Éteres Metílicos/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Trifosfato de Adenosina/metabolismo , Alanina Transaminase/sangue , Anestésicos Inalatórios/uso terapêutico , Animais , Aspartato Aminotransferases/sangue , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Modelos Animais de Doenças , Interleucina-1beta/sangue , Isoflurano/uso terapêutico , Peroxidação de Lipídeos/efeitos dos fármacos , Fígado/irrigação sanguínea , Fígado/metabolismo , Fígado/patologia , Masculino , Malondialdeído/metabolismo , Éteres Metílicos/uso terapêutico , Fragmentos de Peptídeos/sangue , Ratos , Ratos Wistar , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/fisiopatologia , Sevoflurano , Fatores de Tempo , Fator de Necrose Tumoral alfa/sangueRESUMO
BACKGROUND AND AIM: Ergothioneine (EGT) is a natural compound that is synthesized by soil bacteria in fungal substrates and exhibits antioxidant functions in many cell models. The purpose of this study was to investigate the effect of EGT on mesenteric ischemia and reperfusion injury. MATERIALS AND METHODS: Rats were supplemented with or without l-ergothioneine (10 mg/kg/d) for 15 days prior to intestinal ischemia. Animals were subjected to ischemia induced by clamping the superior mesenteric artery for 60 min followed by reperfusion. Serum tumor necrosis factor (TNF)-alpha and interleukin-1beta (IL-1beta) levels, tissue malondialdehide (MDA), myleoperoxidase (MPO), and heat shock protein (HSP) 70 levels, as well as histological findings, were evaluated after 1, 2, and 4 h of reperfusion. RESULTS: Serum TNF-alpha and IL-1beta levels, and tissue MDA and MPO activities at 1, 2 and 4 h after reperfusion in the EGT group, were significantly lower than the control group (P < 0.05). Tissue HSP-70 levels of the study group were significantly greater than the control group at any time point of reperfusion. No significant differences in tissue damage including morphological changes ranging from villous denudation to focal necrosis, ulceration, hemorrhage, and architectural disintegration at 1 and 2 h after reperfusion exist between the two groups; however, after 4 h of reperfusion, the tissue damage based on histopathologic scores by Chiu was considerably lower in the study group (P < 0.05). After 4 h of reperfusion, focal epithelial lifting and occasional areas of denuded villi could be seen in the samples of the treated animals, thus preserving villous height and mucosal architecture. CONCLUSION: EGT attenuates mesenteric ischemia reperfusion injury in rat intestine by increasing tissue HSP-70 and decreasing TNF-alpha, IL-1beta, MDA, and MPO levels. EGT also improves morphological alterations, which occurred after IR injury after prolonged periods of reperfusion.
Assuntos
Antioxidantes/farmacologia , Ergotioneína/farmacologia , Proteínas de Choque Térmico HSP70/metabolismo , Interleucina-1beta/metabolismo , Traumatismo por Reperfusão/tratamento farmacológico , Fator de Necrose Tumoral alfa/metabolismo , Animais , Mucosa Intestinal/metabolismo , Intestinos/irrigação sanguínea , Intestinos/patologia , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Peroxidase/metabolismo , Ratos , Ratos Wistar , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/prevenção & controle , Circulação EsplâncnicaRESUMO
BACKGROUND: Mirizzi syndrome is a rare complication of cholelithiasis. Adenomyomatosis is a common tumor-like lesion of the gallbladder. METHODS: A 52-year-old man was admitted to our hospital complaining of right hypochondriac pain and jaundice. Ultrasonography and computed tomography revealed stones in the gallbladder and dilation of the intrahepatic bile ducts. Magnetic resonance cholangiopancreatography revealed narrowing of the common bile duct caused by compression of the gallbladder. Laparotomy revealed type II Mirizzi syndrome. RESULTS: Partial cholecystectomy with a Roux-en-Y hepaticojejunostomy reconstruction was performed. Histologically, Rokitansky-Aschoff sinus proliferation, hypertrophy of smooth muscles, and fibrosis were seen in the gallbladder. A segmental type of adenomyomatosis of the gallbladder was diagnosed. CONCLUSIONS: The pathogenic link between the two peculiar entities is unclear. A possible explanation is considered that the pathogenesis of Mirizzi syndrome is resulted from chronic inflammation due to adenomyomatosis.
Assuntos
Colestase Extra-Hepática/complicações , Colestase Extra-Hepática/diagnóstico , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/diagnóstico , Anastomose em-Y de Roux , Colecistectomia , Colelitíase/complicações , Ducto Colédoco/patologia , Fibrose , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Síndrome , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodosRESUMO
Sepsis is one of the most important risk factors in acute respiratory distress syndrome (ARDS). beta-Glucan is a potent reticuloendothelial modulating agent, the immunobiological activity of which is mediated in part by an increase in the number and function of macrophages. In this study, we investigated the putative protective role of beta-glucan against sepsis-induced lung injury. Sepsis was induced by cecal ligation and puncture (CLP) in Wistar rats. The control group received saline, and the treatment groups received beta-glucan or beta-glucan + beta-1,3-D-glucanase. Five hours thereafter, plasma tumor necrosis factor (TNF) alpha, interleukin (IL) 1beta, and IL-6 levels were determined. Presence of lung injury was determined via lung tissue myeloperoxidase (MPO) activity, intercellular adhesion molecule (ICAM) 1 levels, and histopathological examination at 18 h after CLP. In a separate set of experiments, survival was monitored for 7 days after CLP. beta-Glucan treatment led to a significant increase in survival rate (63% in glucan-treated rats vs 38% in saline-treated rats). Administration of the beta-glucan inhibitor abrogated beta-glucan's survival benefit (50%). After CLP, plasma TNF-alpha, IL-1beta, and IL-6 concentrations were increased in control animals. When beta-glucan was administered, it completely blocked the elevation of TNF-alpha, IL-1beta, and IL-6. Administration of beta-1,3-D-glucanase suppressed glucan-induced decrease in cytokines. Animals treated with beta-glucan showed a significant reduction in lung injury score, a marked decrease in ICAM-1 expression, and a significant decrease in MPO levels. In contrast, beta-1,3-D-glucanase caused a significantly increased MPO and ICAM-1 levels in the lung. These data reveal that beta-glucan treatment improved the course of CLP-induced peritonitis and attenuated the lung injury. Administration of beta-glucanase inhibited the beta-glucan activity and resulted in enhanced lung injury.