Exogenous pulmonary surfactant prevents the development of intra-abdominal adhesions in rats.

Intra-abdominal adhesions are major post-operative complications for which no effective means of prevention is available. We aimed to evaluate the efficacy of exogenous pulmonary surfactant administration in the prevention of post-operative abdominal adhesions. Rats were randomly assigned to undergo laparotomy (L) or gastroenterostomy (GE) and then treated with surfactant (groups L-S and GE-S, respectively). Intra-abdominal adhesions, collagen fibre content, metalloproteinase (MMP)-9, expression of growth factors (TGF-ß, KGF and VEGF), type III procollagen (PCIII) and pro-caspase 3, as well as isolectin B4 and ED1-positive cells expressing MMP-9, were evaluated. Groups treated with surfactant (GE-S and L-S) exhibited fewer adhesions. A significant reduction in collagen fibre content was observed in GE-S compared to GE animals (P < 0.001). In situ and gelatin zymography analysis showed higher MMP-9 expression and activity in the GE-S group compared to the GE group (P < 0.05). ED1-positive cell counts were significantly higher in the GE-S group (P < 0.001) than in the GE group. Virtually all cells positive for ED1 were MMP-9+. Double-labelling of MMP-9 with IB4 showed no significant differences between GE-S and GE groups. TGF-ß, KGF, PCIII and pro-caspase-3 mRNA expression decreased significantly in GE-S compared to GE animals (P < 0.05). Surfactant administration also reduced apoptosis in the GE-S group. These findings suggest that surfactant reduces the intra-abdominal adhesions triggered by laparotomy and gastrointestinal anastomosis, thus preventing fibrosis formation at the peritoneal surfaces. This preclinical study suggests an innovative treatment strategy for intra-abdominal adhesions with surfactant and to endorse its putative mechanism of action.

Rupture of a hepatic adenoma in a young woman after an abdominal trauma: a case report.

Unlike hepatic haemorrhage following blunt abdominal trauma, spontaneous abdomen bleeding is rare, even in the presence of a hepatocellular adenoma (HA) or carcinoma. However, the diagnosis of a tumour underlying a haematoma after liver trauma is unusual, especially when it occurs more after two years after the accident. Here, we report a case of a ruptured HA due to blunt abdominal trauma. A 36-year-old woman was admitted to our hospital with sudden onset of upper abdominal pain. Her medical history revealed a blunt abdominal trauma two years prior. Initial abdominal computed tomography scan revealed a large haematoma measuring more than 16 cm in diameter in the right lobe of the liver. Magnetic resonance imaging showed haemorrhagic areas and some regions with hepatocyte hyperplasia, suggesting HA. The patient underwent right hepatic lobectomy, and a histopathological examination confirmed a diagnosis of HA. In conclusion, it is important to consider that abdominal trauma may hide old, asymptomatic and not previously detected injuries, as in the case reported.

Primary spleen lymphoma associated with hepatitis C virus infection.

Lymphoproliferative disorders associated with hepatitis C virus (HCV) make up a heterogeneous group of diseases, including lymphomas. It was only recently that HCV was recognised as being a potential cause for the development of non-Hodgkin's lymphoma. The authors report a case of an older woman with chronic hepatitis C who developed primary spleen lymphoma. This case report points out the pathophysiological mechanisms of this disease and the importance of considering this disease in the differential diagnosis of patients with chronic HCV infection.

Multivisceral radical en bloc resection with spleen preservation in T4 gastric cancer.

Gastric cancers are the second most common cause of cancer death worldwide. In the majority of countries, gastric tumours are diagnosed at advanced stages. The authors present the case of a patient with a T4 gastric tumour who underwent a multivisceral en bloc resection (liver segmentectomy, total gastrectomy, partial pancreatectomy) and D2 lymphadenectomy with spleen preservation. The aim of this report was to confirm that, for T4 gastric tumours, radical resection can be performed without splenectomy with minimal morbidity, and this procedure can improve long-term survival.