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1.
Res Pharm Sci ; 9(6): 431-43, 2014.
Article in English | MEDLINE | ID: mdl-26339258

ABSTRACT

Amyloid pathology is associated with fibril aggregation of different proteins which results in the progressive damage of affected organs. It is strongly believed that specific small molecules interfere with fibrillation by interacting with the amyloidogenic proteins. We had previously reported the strong and long-term inhibition of fibrillation of hen egg white lysozyme (HEWL) by Cuminum cyminum oil. Herein, it was intended to rationally identify the active anti-amyloidogenic compounds of the oil. After fractionation, the highest inhibitory effect was observed in the toluene-ethyl acetate part of the oil. Gas chromatography-mass spectrometry (GC-MS) analysis of this fraction indicated that eight compounds were predominantly present in the fraction. Unexpectedly, two compounds including terpinolene and limonene, having very similar chemical structures, inhibited and induced fibrillation, respectively. PC12 cells (derived from a transplantable rat pheochromocytoma) were affected by HEWL fibrils, whereas the inhibited forms of fibrils in the presence of terpinolene led to higher levels of viability, as shown by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT), lactate dehydrogenase (LDH) and flow cytometry assays. Molecular local docking analysis suggested a site of interaction for terpinolene in the flexible cleft of the protein. This interaction site is close to tryptophan -62 and -63 and two other hydrophobic residues in the hot spot regions of the protein. Seemingly, these interactions interrupt protein self-assembly and therefore, fibril formation. Despite previously reported small anti-amyloid molecules which have aromatic flat rings, terpinolene ring is not flat. This functionally durable small molecule may aid us toward developing new anti-amyloidogenic compounds with extended activity.

2.
Clin Vaccine Immunol ; 20(8): 1274-82, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23761659

ABSTRACT

CD40 and CD40 ligand (CD40L) have costimulatory effects as part of a complex series of events in host immunity. In this study, the expression of CD40 and CD40L on peripheral blood mononuclear cells (PBMCs) isolated from cattle with Johne's disease were measured on freshly isolated PBMCs and on cells cultured for 8, 24, and 72 h in the presence or absence of live Mycobacterium avium subsp. paratuberculosis and exogenous gamma interferon, interleukin 10, and transforming growth factor ß. Results demonstrated greater CD40 and CD40L expression on fresh PBMCs obtained from animals in the clinical stage of disease (symptomatic) than those from healthy control animals or cows in the subclinical stage of disease (asymptomatic). A similar expression profile with greater magnitude was noted for cultured PBMCs, with increased CD40 expression after 8 and 24 h of culture and increased CD40L expression between 24 and 72 h on PBMCs obtained from clinically infected animals. The addition of live M. avium subsp. paratuberculosis to cell cultures resulted in downregulation of CD40L expression in naturally infected cows, regardless of the disease stage. In contrast, the addition of live M. avium subsp. paratuberculosis to cultures resulted in upregulation of CD40 expression on cells obtained from clinically infected animals, while a decrease in expression was noted for healthy and subclinically infected cows. No effects of exogenous cytokines on CD40 or CD40L expression were observed. These results clearly point for the first time to a disparity in the expression of these costimulatory molecules on immune cells from cattle in different stages of Johne's disease and suggest further investigation into their roles in paratuberculosis pathogenesis.


Subject(s)
CD40 Antigens/analysis , CD40 Ligand/analysis , Leukocytes, Mononuclear/immunology , Mycobacterium avium subsp. paratuberculosis/immunology , Paratuberculosis/immunology , Animals , Cattle , Cells, Cultured , Leukocytes, Mononuclear/chemistry , Up-Regulation
3.
J Dairy Sci ; 96(1): 9-15, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23182355

ABSTRACT

Probiotic bacteria and phytosterols are natural hypocholesterolemic agents with potential cardiovascular benefits. Accordingly, the present study was conducted to evaluate the effect of supplementation of probiotics and phytosterols alone or in combination on serum and hepatic lipid profiles and thyroid hormones of hypercholesterolemic rats. Mixed probiotics treatment consisted of 8 probiotic strains: 2 strains of each of Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus gasseri, and Lactobacillus reuteri. The rats were fed for 8 wk with the given treatments in addition to a high-fat-high-cholesterol basal diet to induce hypercholesterolemia. Results showed that supplementation significantly reduced serum total cholesterol, low-density-lipoprotein cholesterol (LDL-C), high-density-lipoprotein cholesterol, and triglycerides compared with the controls. The symbiotic treatment was more effective in lowering LDL-C, whereas mixed probiotics treatment more effectively lowered serum total cholesterol and LDL-C than the phytosterol-containing treatment. The phytosterol-containing treatments induced the increased activity of thyroid glands, as evident by elevated levels of serum total thyroxine, total triiodothyronine, and free triiodothyronine. In conclusion, the lipid profile can effectively be reduced to lower the incidence of cardiovascular disease using combinations of Lactobacillus-based probiotics and phytosterols in functional foods.


Subject(s)
Hypercholesterolemia/drug therapy , Lipids/analysis , Liver/chemistry , Phytosterols/pharmacology , Probiotics/pharmacology , Thyroid Hormones/blood , Animals , Cholesterol/analysis , Cholesterol/blood , Cholesterol, Dietary/pharmacology , Dietary Supplements , Drug Therapy, Combination , Hypercholesterolemia/blood , Lactobacillus , Lipids/blood , Lipoproteins, HDL/analysis , Lipoproteins, HDL/blood , Lipoproteins, LDL/analysis , Lipoproteins, LDL/blood , Liver/drug effects , Male , Phytosterols/administration & dosage , Probiotics/administration & dosage , Rats , Rats, Sprague-Dawley , Thyroxine/blood , Triglycerides/analysis , Triglycerides/blood , Triiodothyronine/blood
4.
Int J Dent Hyg ; 9(1): 9-16, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21226845

ABSTRACT

OBJECTIVES: Topically applied chlorhexidine and hyaluronan have many studies supporting their use to enhance oral wound healing. Allantoin is widely used topically to promote epithelial proliferation and wound healing, with very little scientific evidence to support such uses. This study investigated and compared the influence of these agents on the healing of intra-oral excisional wounds with large epithelial and connective tissue defects. METHODS: Excisional wounds, 3 mm in diameter, were made at the centre of the palate of 125 Wistar male albino rats. Five animals constituted the baseline group at time 0. The remaining animals were divided into four experimental and one control groups, in which chlorhexidine digluconate gel 0.2% (Perio.Kin®), hyaluronan gel (Gengigel®), allantoin 0.5% in vehicle gel, vehicle gel alone and nothing were applied daily to the wounds. The wound areas were measured photographically and the epithelialization rates were determined histologically at 0, 3, 7, 14 and 21 days post-surgery. RESULTS: The mean wound area and mean distance between the epithelial margins decreased significantly with time in all experimental and control groups (P < 0.05). A significant rate of wound area reduction was observed following the use of Perio.Kin® and Gengigel® at 7 and 14 days. Perio.Kin® showed a significant rate of wound epithelialization at 7 days. Allantoin did not positively or negatively affect wound healing. CONCLUSIONS: None of the tested agents had a negative effect on the rate of wound healing when applied on an excisional wound with epithelial and connective tissue defect. Positive results were achieved with Perio.Kin® and Gengigel®.


Subject(s)
Allantoin/administration & dosage , Chlorhexidine/administration & dosage , Hyaluronic Acid/administration & dosage , Palate/surgery , Periodontal Dressings , Wound Healing/drug effects , Administration, Topical , Animals , Anti-Infective Agents, Local/administration & dosage , Bandages, Hydrocolloid , Dermatologic Agents/administration & dosage , Follow-Up Studies , Gels , Male , Random Allocation , Rats , Rats, Wistar
6.
Lab Anim ; 44(2): 143-9, 2010 Apr.
Article in English | MEDLINE | ID: mdl-19858163

ABSTRACT

UNLABELLED: Collagen-induced arthritis (CIA) in rats is a widely used preclinical animal model of rheumatoid arthritis (RA). However, CIA development in Sprague-Dawley (SD) rats is less severe in terms of inflammatory response compared with other strains. Therefore, a modified CIA model called MCIA, using N-acetylmuramyl dipeptide (MDP), has been developed in the less sensitive SD rat strains. This work was conducted to better understand the immunopathological role and contributions of the pro-inflammatory T-helper type 1 (Th-1) cytokines and inflammatory mediators, interleukin-1 (IL-1beta), tumour necrosis factor-alpha (TNF-alpha) and nitric oxide (NO); the anti-inflammatory T-helper type 2 (Th-2) cytokine, IL-10 and autoantibodies such as rheumatoid factor (RF)-immunoglobulin M (IgM) in this newly developed RA model. TNF-alpha, NO and RF-IgM levels were significantly increased, while IL-1beta levels were not affected in this MCIA rat model. The levels of IL-10 were lower than the baseline when compared with controls. IN CONCLUSION: (1) the immunological features represented in the MCIA rat model favour the Th-1 cytokine profile over Th-2 and (2) RF-IgM can be used as a diagnostic test in preclinical RA models.


Subject(s)
Arthritis, Rheumatoid/immunology , Disease Models, Animal , Immunoglobulin M/metabolism , Interleukin-10/metabolism , Interleukin-1beta/metabolism , Nitric Oxide/metabolism , Rheumatoid Factor/metabolism , Tumor Necrosis Factor-alpha/metabolism , Animals , Immunoglobulin M/immunology , Interleukin-10/immunology , Interleukin-1beta/immunology , Male , Nitric Oxide/immunology , Rats , Rats, Sprague-Dawley , Rheumatoid Factor/immunology , Th1 Cells/immunology , Th1 Cells/metabolism , Tumor Necrosis Factor-alpha/immunology
7.
Poult Sci ; 88(10): 2118-24, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19762865

ABSTRACT

The effect of tilmicosin, florfenicol, or enrofloxacin on humoral and cell-mediated immune response induced by Newcastle disease (ND) vaccination was evaluated in 20-wk-old specific-pathogen-free layer chickens. Humoral immunity was measured by detection of ND virus (NDV) antibody titer and anti-NDV IgG response using the hemagglutination inhibition (HI) test and ELISA, respectively, whereas cell-mediated immunity was evaluated by measurement of chicken interferon gamma (ChIFN-gamma) produced in splenocytes cell culture stimulated with concanavalin A, inactivated NDV antigen, or live attenuated La Sota strain using ELISA. Florfenicol hampered the ND antibody production measured by both HI and ELISA. Tilmicosin and enrofloxacin reduced the production of ND antibody in the first 3 wk after the last ND vaccination measured by HI test, which suggests that these antibiotics exert their effect mainly on the IgM isotype. The ND-vaccinated, but not treated group, showed an increase in ChIFN-gamma production after NDV antigen-specific stimulation above the nonstimulated cell culture, whereas this effect was masked in all the antibiotic-treated groups due to the stronger ChIFN-gamma production background value reported in the nonstimulated cell culture. In conclusion, our results showed, for the first time, that tilmicosin, florfenicol, or enrofloxacin reduced the humoral immune response and had beneficial effects on the cell-mediated immune response. In addition, we demonstrated that the combination of both inactivated and attenuated ND vaccine gave a strong immune response at both the humoral and cellular level.


Subject(s)
Anti-Bacterial Agents/pharmacology , Antibody Formation/immunology , Chickens , Immunity, Cellular/immunology , Newcastle Disease/immunology , Newcastle disease virus/immunology , Animals , Antibodies, Viral/blood , Antibody Formation/drug effects , Enrofloxacin , Enzyme-Linked Immunosorbent Assay/veterinary , Female , Fluoroquinolones/pharmacology , Hemagglutination Inhibition Tests/veterinary , Immunity, Cellular/drug effects , Interferon-gamma/blood , Newcastle Disease/virology , Specific Pathogen-Free Organisms , Thiamphenicol/analogs & derivatives , Thiamphenicol/pharmacology , Tylosin/analogs & derivatives , Tylosin/pharmacology
8.
Vet Immunol Immunopathol ; 131(1-2): 97-104, 2009 Sep 15.
Article in English | MEDLINE | ID: mdl-19409621

ABSTRACT

Nitric oxide (NO) is a crucial mediator in host defense and is one of the major killing mechanisms within macrophages. Its induction is highly affected by the types of cytokines and the infectious agents present. In the current study, NO production was evaluated after in vitro infection of unfractionated peripheral blood mononuclear cells (PBMCs) with Mycobacterium avium subsp. paratuberculosis (MAP) after 8h, 3 and 6 days of culture for cows in different stages of disease. In addition, the effects of in vitro exposure to inhibitory cytokines such as interleukin-10 (IL-10) and transforming growth factor beta (TGF-beta) as well as the pro-inflammatory cytokine IFN-gamma were correlated with the level of NO production. Nitric oxide production was consistently higher in cell cultures from subclinically infected animals at all time points. An upregulation of NO production was demonstrated in unfractionated cell cultures from healthy control cows after exposure to MAP infection as compared to noninfected cell cultures. A similar increase in NO due to the addition of MAP to cell cultures was also noted for clinically infected cows. NO level among subclinically infected cattle was greater at all time points tested and was further boosted with the combination of both in vitro MAP infection and IFN-gamma stimulation. Alternatively, nonspecific stimulation with LPS from Escherichia coli O111:B4-W resulted in an upregulation of NO production in all infected groups at 3 and 6 days after in vitro infection. Finally, the in vitro exposure to inhibitory cytokines such as IL-10 and TGF-beta prior to MAP infection or LPS stimulation resulted in the downregulation of this inflammatory mediator (NO) in all experimental groups at all time points. In summary, a higher level of NO production was associated with cows in the subclinical stage of MAP infection. As well, the results demonstrated an increase in NO production upon infection with MAP and in the presence of exogenous IFN-gamma. Finally, the results suggest an important role of IL-10 and TGF-beta on the profile of NO production which may explain the low NO production in MAP clinically infected cows.


Subject(s)
Cattle Diseases/immunology , Nitric Oxide/biosynthesis , Paratuberculosis/immunology , Animals , Cattle , Escherichia coli/pathogenicity , Female , Interferon-gamma/pharmacology , Interleukin-10/pharmacology , Lipopolysaccharides/pharmacology , Transforming Growth Factor beta/pharmacology
9.
Vet Immunol Immunopathol ; 126(3-4): 211-9, 2008 Dec 15.
Article in English | MEDLINE | ID: mdl-18692906

ABSTRACT

CD5 is a cell surface molecule involved in antigen recognition and is present on all T lymphocytes and a subset of B lymphocytes. The purpose of this study was to examine CD5+ expression on peripheral blood B cells from healthy, noninfected cattle and cattle with subclinical and clinical paratuberculosis. Peripheral blood mononuclear cells (PBMC) were freshly isolated or cultured for 7 days in the presence or absence of live Mycobacterium avium subsp. paratuberculosis (M. avium subsp. paratuberculosis), and then analyzed by flow cytometry for CD5 expression within the B cell subpopulation. Analysis demonstrated a significant increase (P<0.01) in B cells in clinical animals as compared to healthy control cows and subclinically infected cows. In addition, three subpopulations within the CD5+ B cell population were identified: CD5dim, CD5bright, and a minor population that was characterized as CD5extra bright. A decrease in the CD5dim B cell population along with a concomitant increase in CD5bright B cells was observed in infected cows, an effect that was highly significant (P<0.01) for subclinically infected cows in cultured PBMC. In vitro infection with live M. avium subsp. paratuberculosis did not affect CD5+ expression patterns on B cells, regardless of animal infection status. Addition of exogenous IL-10 to PBMC cultures resulted in decreased numbers of CD5(bright) B cells for healthy control cows, whereas, a synergistic effect of IL-10 and infection with live M. avium subsp. paratuberculosis resulted in increased CD5bright B cells for subclinically infected cows. These results suggest that differential expression of CD5bright and CD5dim subpopulations on B cells in animals with paratuberculosis may reflect a shift in host immunity during the disease process.


Subject(s)
B-Lymphocytes/immunology , CD5 Antigens/immunology , Cattle Diseases/immunology , Cattle Diseases/microbiology , Mycobacterium avium subsp. paratuberculosis/immunology , Paratuberculosis/immunology , Animals , Cattle , Flow Cytometry/veterinary
10.
Eur J Pediatr Surg ; 16(5): 358-61, 2006 Oct.
Article in English | MEDLINE | ID: mdl-17160784

ABSTRACT

Solid pseudopapillary neoplasms of the pancreas (SPNP) are rare pancreatic tumors that occur predominantly in young women, with very few cases reported in men. While the origin of the tumor may be unclear, it is characterized by a distinct histological appearance and a clinical course highlighting its low malignant potential. SPNP have an excellent prognosis and are potentially curable provided they are managed appropriately by complete surgical resection. In the rare instances where metastatic disease is encountered, surgical debulking has been shown to prolong survival. The role of chemotherapy and radiation therapy in the management of SPNP is still controversial. We report here on an unusual occurrence of SPNP in the area of the head of the pancreas in a 12-year-old female treated by pancreatico-duodenectomy, together with a review of the literature.


Subject(s)
Pancreatic Neoplasms/surgery , Child , Female , Humans , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy , Prognosis , Tomography, X-Ray Computed
11.
Int J Gynecol Cancer ; 16(5): 1933-5, 2006.
Article in English | MEDLINE | ID: mdl-17009994

ABSTRACT

Metastatic carcinoma of the spleen occurs in a setting of widespread malignant disease. Solitary parenchymal splenic metastasis of ovarian carcinoma is rare. We report a case of a 59-year-old woman who presented with an elevated serum CA125 level due to a solitary splenic metastasis after a long disease-free period. She was treated with laparoscopic splenectomy followed by chemotherapy. The literature contains 16 cases of solitary parenchymal splenic metastasis of ovarian carcinoma. Our case is the third case that was treated with laparoscopic splenectomy. We review the literature, and we focus on the laparoscopic approach in managing these cases.


Subject(s)
Cystadenocarcinoma, Serous/secondary , Ovarian Neoplasms/pathology , Splenic Neoplasms/secondary , CA-125 Antigen/blood , Cystadenocarcinoma, Serous/surgery , Female , Humans , Laparoscopy/methods , Middle Aged , Ovarian Neoplasms/therapy , Spleen/pathology , Spleen/surgery , Splenic Neoplasms/surgery
13.
Dig Liver Dis ; 38(11): 851-3, 2006 Nov.
Article in English | MEDLINE | ID: mdl-16621745

ABSTRACT

Anorectal varices are identified endoscopically in up to 40% of patients with liver cirrhosis [Misra SP, Dwivedi M, Misra V. Prevalence and factors influencing haemorrhoids, anorectal varices, and colopathy in patients with portal hypertension. Endoscopy 1996;28:340-5] but are an infrequent cause of bleeding and their management remains controversial. We present a patient with chronic hepatitis C virus infection who developed recurrent haemorrhage from an isolated, endoscopically inevident rectal varix in the absence of clinical or endoscopic evidence of portal hypertension. The difficulties in diagnosis and management of anorectal varices are highlighted.


Subject(s)
Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/etiology , Rectum/blood supply , Varicose Veins/diagnosis , Aged , Embolization, Therapeutic , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/therapy , Hepatitis C, Chronic/complications , Humans , Male , Mesenteric Veins , Recurrence , Varicose Veins/complications , Varicose Veins/therapy
15.
Vet Immunol Immunopathol ; 99(1-2): 39-46, 2004 May.
Article in English | MEDLINE | ID: mdl-15113652

ABSTRACT

Johne's disease progresses through distinct stages including a protracted subclinical stage in which the infection appears to be controlled; followed by a more acute stage in which the host animal demonstrates clinical signs such as diarrhea and weight loss. Little is known about the dynamics of the host immune response during these two phases of disease, however, it is possible that immune modulation in the early stages of disease may play an important role in disease progression. We hypothesized that the clinical stage of Johne's disease is mediated by the expression of cytokines such as transforming growth factor-beta (TGF-beta) and interleukin-10 (IL-10) that may be accompanied by the downregulation of IFN-gamma gene expression. In the present study, tissue samples were collected from the ileum, ileocecal junction, ileocecal lymph node, and mesenteric lymph nodes of healthy, subclinically or clinically infected cows. The expression of TGF-beta, IL-10, and IFN-gamma genes in these tissues was determined by quantitative competitive RT-PCR. The results demonstrate that TGF-beta and IL-10 mRNA levels are higher in cows that have progressed to the clinical stage of disease compared to subclinically infected or healthy cows. In contrast, IFN-gamma gene expression was significantly higher in subclinically infected cows. These results suggest that a change in the balance of cytokines at the site of infection may contribute to the ability of the host to control Mycobacterium avium subsp. paratuberculosis infection.


Subject(s)
Cattle Diseases/microbiology , Mycobacterium avium subsp. paratuberculosis/metabolism , Paratuberculosis/metabolism , Transforming Growth Factor beta/biosynthesis , Animals , Cattle , Cattle Diseases/genetics , Cattle Diseases/immunology , Cattle Diseases/metabolism , Female , Ileum/microbiology , Immunohistochemistry/veterinary , Interferon-gamma/genetics , Interferon-gamma/immunology , Interleukin-10/genetics , Interleukin-10/immunology , Mycobacterium avium subsp. paratuberculosis/genetics , Mycobacterium avium subsp. paratuberculosis/immunology , Paratuberculosis/immunology , Paratuberculosis/microbiology , RNA/chemistry , RNA/genetics , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction/veterinary , Transforming Growth Factor beta/genetics , Transforming Growth Factor beta/immunology
16.
Infect Immun ; 72(4): 1974-82, 2004 Apr.
Article in English | MEDLINE | ID: mdl-15039317

ABSTRACT

Gamma interferon (IFN-gamma) plays a significant role in the control of mycobacterial infections, including Mycobacterium avium subsp. paratuberculosis. However, the contribution of other immunoregulatory cytokines, such as interleukin-10 (IL-10) and transforming growth factor beta (TGF-beta), in Johne's disease has not been investigated as yet. In this study, we examined the effects of in vivo and in vitro infection with M. avium subsp. paratuberculosis on the production of IFN-gamma, IL-10, and TGF-beta by peripheral blood mononuclear cells (PBMC). We also examined the effects of exogenous IFN-gamma, IL-10, and TGF-beta on M. avium subsp. paratuberculosis survival in the cell cultures. PBMC obtained from naturally infected cows, regardless of their disease status, specifically upregulated IL-10 and TGF-beta in culture supernatants in response to stimulation with live M. avium subsp. paratuberculosis. Nonstimulated PBMC recovered from subclinically infected animals secreted the lowest levels of TGF-beta, but after stimulation with live M. avium subsp. paratuberculosis, TGF-beta levels in the culture supernatants increased to levels similar to that produced by PBMC from healthy animals. The numbers of viable M. avium subsp. paratuberculosis recovered from cultures from naturally infected animals were higher than those from healthy cows after in vitro infection with M. avium subsp. paratuberculosis. The addition of exogenous IL-10 and TGF-beta to PBMC isolated from healthy cows inhibited the bactericidal activity of these cells as evidenced by the increased number of viable M. avium subsp. paratuberculosis recovered from these cultures compared to cell cultures containing medium alone. These data suggest important immune regulatory roles for IL-10 and TGF-beta during infection with M. avium subsp. paratuberculosis that may be directly related to their effects on macrophage activation and killing of M. avium subsp. paratuberculosis.


Subject(s)
Cattle Diseases/immunology , Cytokines/metabolism , Macrophages/immunology , Monocytes/immunology , Mycobacterium avium subsp. paratuberculosis/pathogenicity , Paratuberculosis/immunology , Animals , Cattle , Cattle Diseases/microbiology , Cells, Cultured , Culture Media, Conditioned/metabolism , Interferon-gamma/metabolism , Interleukin-10/metabolism , Macrophage Activation , Macrophages/microbiology , Monocytes/microbiology , Mycobacterium avium subsp. paratuberculosis/growth & development , Paratuberculosis/microbiology , Transforming Growth Factor beta/metabolism
18.
Eur J Gastroenterol Hepatol ; 13(3): 275-7, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11293448

ABSTRACT

Surgical decompression by a portosystemic shunt in Budd-Chiari syndrome depends on the caval state. Obstruction of the inferior vena cava (IVC) precludes such an operation due to the risk of reduced blood flow across the shunt and subsequent thrombosis. Similar risks are encountered in more complicated operations such as mesoatrial shunt. We report a patient with Budd-Chiari syndrome in whom obstruction of the intrahepatic IVC by a hypertrophied caudate lobe of the liver precluded the construction of a standard portocaval shunt. A two-step procedure with preoperative radiological stenting of the narrowed IVC followed by a portocaval shunt was successfully performed. This is the fifth case reported in the literature of such an approach.


Subject(s)
Budd-Chiari Syndrome/complications , Budd-Chiari Syndrome/therapy , Portasystemic Shunt, Surgical , Stents , Vena Cava, Inferior , Adult , Constriction, Pathologic , Humans , Male , Vena Cava, Inferior/pathology
20.
Surg Endosc ; 14(5): 500-1, 2000 May.
Article in English | MEDLINE | ID: mdl-11287991

ABSTRACT

Laparoscopic instrumentation of the common bile duct (CBD) via the transcystic route or through direct choledochotomy seems to be safe, but in rare cases, complications such as pancreatitis, bile duct damage, and hemorrhage from cystic artery may occur. We report an unusual complication with this approach. A 62-year-old man with gallbladder stones presented with obstructive jaundice, mild pancreatitis, and a dilated CBD. He underwent laparoscopic cholecystectomy with an intraoperative cholangiogram through the cystic duct. A small stone seen in the CBD was removed using a 6-Fr vascular Fogarty catheter. Two days later, he became jaundiced again with a rising bilirubin. An endoscopic retrograde cholangiogram showed a 1.5-cm round filling defect floating in a dilated CBD. A sphincterotomy was performed, and a balloon catheter was inflated proximally and pulled down. To our surprise, the filling defect was a crystal clear object, which we finally realized was a fully inflated Fogarty catheter balloon. The balloon spontaneously deflated while being caught with a basket. Surgeons should be aware of this possible complication, and every effort should be made to verify that the balloon still is in place after removal of the embolectomy catheter. Whether vascular embolectomy catheter balloons are appropriate for stone removal or more rigid balloons should be used needs further evaluation.


Subject(s)
Catheterization/adverse effects , Cholecystectomy, Laparoscopic/methods , Cholestasis/etiology , Common Bile Duct Diseases/etiology , Catheterization/instrumentation , Cholecystectomy, Laparoscopic/adverse effects , Cholelithiasis/surgery , Cholestasis/surgery , Common Bile Duct Diseases/surgery , Equipment Failure , Humans , Male , Middle Aged
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