Decreased preoperative serum fibulin-3 levels in colon cancer patients.

OBJECTIVE: Fibulin-3 is known to play a role in tumor cell malignancy, invasion and metastasis, as well as in the clinical progression of tumors. This study aimed to assess serum fibulin-3 levels in patients with colon cancer compared with healthy controls and its relationship to demographics and tumor pathology. PATIENTS AND METHODS: A total of 80 patients (mean age, 58.99 years; 42% males) with colon cancer and 50 controls (mean age, 57.75; 55% males) were included. Serum levels of fibulin-3 were determined using a commercially available sandwich ELISA (Enzyme-Linked ImmunoSorbent Assay). RESULTS: Preoperative serum fibulin-3 levels were significantly lower in the group of patients with colon cancer (mean, 35.91 ng/mL; range, 10-73 ng/mL) compared with the control group (mean, 96.68 ng/mL; range, 57-168 ng/mL). CONCLUSIONS: It was concluded that fibulin-3 is expressed at a lower level in colon cancer, and it can serve as a marker for advanced colon cancer.

An alternative sutureless repair technique with amelogenin for duodenal perforation.

BACKGROUND: Among the various sutureless techniques, fibrin glue has proved to be effective in the treatment of peptic ulcer perforation as an alternative to classical suture repair. Albeit rare, a potential disadvantage of fibrin glue use is viral transmission or anaphylaxis. The aim of this study is to introduce a new technique for the closure of duodenal perforation using a novel recombinant enamel protein called amelogenin. METHODS: In this case-control experimental study, 32 adult male Wistar Albino rats weighing 250-300 g were randomly divided into four groups, each containing 8 rats. Duodenal perforation of 0.2 cm were performed in the postpyloric region in all rats. Each group received primary repair, primary repair with omentoplasty, fibrin glue, and amelogenin, respectively. All animals were killed on the postoperative day five and the bursting pressure measurements, hydroxyproline levels and histopathologic values of the wound site were evaluated. RESULTS: Bursting pressure levels of the fibrin glue and amelogenin groups were significantly lower than the primary repair and primary repair with omentoplasty groups (P < 0.05) However, no significant difference existed between the fibrin glue and amelogenin groups in this respect (P > 0.05). There was also no statistically significant difference among all groups regarding tissue hydroxyproline levels and histopathologic values (P > 0.05). CONCLUSION: Application of amelogenin as an alternative sutureless repair technique did not improve wound healing in this animal model of duodenal perforation.

A new technique: prolene mesh sphincteroplasty for the treatment of fecal incontinence.

Although successful short-term results have been achieved with the use of overlapping sphincteroplasty and primary end-to- end repairs to treat fecal incontinence due to sphincteric injury, long-term failure rates may reach as high as 50%. This disadvantage associated with tension repairs may be overcome by utilizing a tension-free technique. Here the authors describe a new tension-free technique involving the use of prolene mesh.

Is it possible to resterilize disposable laparoscopy trocars in a hospital setting?

Nosocomial infections associated with interventional procedures have been attributed to improper decontamination of instruments. Disinfection of solid laparoscopic instruments, such as telescopes, by 2% glutaraldehyde and ethylene oxide was shown to be effective in preventing infection transmission. However, instrument design in more complex surgical instruments may hamper the quality of disinfection. The aim of this study is to investigate the safety of hospital disinfection of disposable laparoscopic instruments with a relatively more complex design. A total of 40 laparoscopic trocars were divided into two equal groups: group 1 was contaminated with bacteria and yeast, and group 2 was contaminated with the hepatitis B virus. Each group was then divided to two equal subgroups. After disinfecting subgroup A with 2% glutaraldehyde and B with ethylene oxide, samples were obtained for bacterial cultures and for virus detection using polymerase chain reaction (PCR). Bacterial and yeast cultures were positive in three instruments in group 1A and in two instruments in group 1B. Tests results for the hepatitis B virus were negative in group 2A, but positive in group 2B. Results of this study indicate that disinfection for multiple use of disposable laparoscopic instruments with a relatively complex structure is not effective and may result in nosocomial disease transmission by bacteria, fungi, and viruses.

Bronchobiliary fistula due to alveolar hydatid disease: report of three cases.

Bronchobiliary fistula is a serious complication of echinococcosis of the liver. Surgical and endoscopic treatments have been used successfully in the management of bronchobiliary fistula due to hepatic hydatid cysts. However, very little information exists on the management of bronchobiliary fistula due to alveolar hydatid disease. We report here the efficacy of various potential therapies in three cases.

Human colonic smooth muscle electrical activity during and after recovery from postoperative ileus.

Colon smooth muscle electrical control (ECA) and response activities (ERA) were recorded for up to 4 wk postoperatively for 48 patients after major abdominal operations. Bipolar electrodes were implanted into right and left colon circular muscle and exteriorized through the flanks, and signals were tape recorded for 2-24 h daily beginning on the 1st postoperative day. A computer program was used for data reduction and analysis. Recorded signals were digitized and filtered. The ECA frequency components were identified by fast Fourier transformation, and their relative tenancy in low, mid, and high frequency ranges was determined. Short and long ERA burst duration and frequency and number and velocity of propagating long ERA bursts were determined. ECA was omnipresent and exhibited a downshift of the dominant frequency from the mid to the low range as recovery from postoperative ileus progressed. Concurrently, first in the right and then in the left colon, the frequency of long ERA bursts increased, followed by the appearance of propagating long ERA. After the 6th postoperative day, no further significant changes in parameters of colon electrical activity occurred with time.

Management of intrabiliary rupture of hydatid cyst of the liver.

Thirty-six patients with intrabiliary rupture of hepatic echinococcal cysts were managed between 1974 and 1993. Clinical findings, skin tests, serologic tests, and imaging techniques were used to establish the diagnosis. Twenty-five (69.4%) patients had pain, 24 (66.6%) jaundice, 22 (61.1%) fever, 20 (55.5%) chills, 10 (27.7%) malaise, and 7 (19.4%) other symptoms as the major causes of admission. All patients underwent choledochotomy and T-tube drainage. Treatment directed to the cyst was cystectomy and capittonage, cystectomy and drainage, and partial hepatectomy in 22, 12, and 2 patients, respectively. Omentoplasty was added to the treatment in 10 patients. Seven (19.4%) patients had complications. The period of hospitalization for patients with and without complications was 34.6 +/- 18.1 and 15.1 +/- 2.7, days, respectively. This study indicates that better results are obtained in patients with cystic lesions of the liver by avoiding percutaneous puncture or biopsy, the early use of ultrasonography and computed tomography, evacuation of the cyst together with its germinative membrane and the involved biliary tract under adequate care to avoid spillage into the peritoneal cavity, treating the remaining cavity according to its location, size, and the presence of infection, and decreasing the pressure in the biliary tract by T-tube drainage.

An alternative technique for treatment of choledocholithiasis found at laparoscopic cholecystectomy.

OBJECTIVE: To introduce a new strategy for dealing with abnormal cholangiograms at laparoscopic cholecystectomy that makes postoperative cholangiograms possible and facilitates stone extraction by assuring access to the duct for a guide-wire-assisted endoscopic retrograde sphincterotomy. DESIGN: Retrospective review of a prospectively maintained database. PATIENTS: Twenty-four patients with abnormal cholangiograms had a percutaneously placed double-lumen catheter threaded through the cystic duct and advanced into the duodenum. RESULTS: Ten successful guide-wire-assisted endoscopic retrograde sphincterotomies were performed without complications. Eleven normal postoperative cholangiograms suggested spontaneous stone passage or false-positive intraoperative cholangiograms. There were three technical failures in the early part of the series. CONCLUSIONS: This strategy is a reasonable alternative to laparoscopic common bile duct exploration (1) when the cholangiogram is questionably positive, (2) when prolonged anesthesia (poor-risk patient) should be avoided, (3) when the equipment for laparoscopic common bile duct exploration is not available, and (4) when spontaneous stone passage seems likely. Postoperative endoscopic retrograde sphincterotomy with stone extraction is facilitated when it becomes necessary because a guide wire can be introduced through the catheter.

Preliminary experience with a double-illumination technique for laparoscopic left colectomy.

This report describes our technique and initial experience with total intraabdominal laparoscopic left colectomy on 3 patients. Three consecutive patients, 2 females and 1 male, underwent laparoscopic left colectomy due to sigmoid volvulus and villous adenoma, respectively. The technique described herein helps to locate the intracolonic lesion, enables en bloc resection, shortens the operation time, and reduces the cost. Because the procedure is minimally invasive, patient recovery is remarkable compared with the conventional technique. All of the patients in this report were discharged on postoperative day 4 without any morbidity.

Early wound excision and skin grafting restores cellular immunity after severe burn trauma.

Suppression of cellular immunity following thermal injury may contribute to the high incidence of postburn sepsis. Early excision and skin grafting may remove deleterious local wound factors and prevent immunosuppression. The effect on cellular immunity of early burn wound excision and skin grafting was investigated in an animal model using female Wistar rats. The development of immunosuppression shortly after burn injury was shown by popliteal lymph node assay and a 2,4-dinitrofluorobenzene skin reaction test. Excision and skin grafting 2 days after burn trauma restored parameters to normal. Burned tissue suppresses cellular immunity; this effect is preventable by early excision and skin grafting.

Single session ligation treatment of bleeding hemorrhoids.

Rubber band ligation (RBL) was prospectively used in 49 consecutive patients with bleeding internal hemorrhoids between 1987 and 1990. All patients underwent a two year follow-up period. Ten patients experienced complications consisting of pain, bleeding, mild discomfort and dissatisfaction. Hemorrhoidectomy was required in three patients. Long term results were satisfactory in 93.9 percent of the patients. The results of this study confirm that single session RBL is a valuable alternative to hemorrhoidectomy in selected patients.

Antibiotic prophylaxis for scheduled operative procedures.

As a result of numerous trials during the past two decades addressing antibiotic prophylaxis for surgical procedures, it has been established that appropriately administered antibiotic prophylaxis reduces the risk of postoperative infection by about 50% when compared with comparable untreated patients. Antibiotics cannot completely eliminate all risk of infection, however, and will never be a substitute for good surgical practices.