Flavonoids protect colon against radiation induced colitis.

Radiation induced colitis is one the most common clinical issue for patients receiving radiotherapy. For this reason, we aimed to investigate the effect of antioxidant-effective flavonoids hesperidin and quercetin on the intestinal damage induced by radiation in this study. TNF-alpha, interleukin-10 (IL-10), heat shock protein 70 (HSP 70) and caspase 3, 8, 9 markers of apoptotic pathways were measured in the colon tissues of irradiated acute intestinal damage by enzyme-linked immunosorbent assay (ELISA). Irradiation of rats caused a significance increase of TNF-alpha, caspase 3/8/9 and decrease of IL-10 concentrations. Hesperidin and quercetin treatment resulted in decreased levels of TNF-alpha and increased levels of IL-10. Quercetin significantly decreased caspase 3/8/9 levels. Hesperidin produced a decreased of caspase 3/8/9 levels compared with irradiation group but this was statistically not significant. Only significant alteration of HSP 70 were seen in hesperidin treated rats. Further studies are needed to elucidate the mechanism by which flavonoids induced signaling provides protection against apoptosis and inflammation.

The effects of tadalafil and pentoxifylline on apoptosis and nitric oxide synthase in liver ischemia/reperfusion injury.

The aim of this study was to investigate the effects of tadalafil (TDF) and pentoxifylline (PTX) on hepatic apoptosis and the expressions of endothelial and inducible nitric oxide synthases (eNOS and iNOS) after liver ischemia/reperfusion (IR). Forty Wistar albino rats were randomly divided into five groups (n=8) as follows: sham group; IR group with ischemia/reperfusion alone; low-dose and high-dose TDF groups received 2.5 mg/kg and 10 mg/kg TDF, respectively; and PTX group received 40 mg/kg PTX. Blood was collected for the analysis of serum alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, uric acid, malondialdehyde (MDA), and total antioxidant capacity (TAC). MDA and TAC also were measured in liver tissue. Histopathological examination was performed to assess the severity of hepatic injury. Apoptosis was evaluated using the apoptosis protease-activating factor 1 (APAF-1) antibody; the expressions of eNOS and iNOS were also assessed by immunohistochemistry in all groups. Serum alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, uric acid, MDA, and TAC, tissue MDA and TAC levels, hepatic injury, and score for extent and for intensity of eNOS, iNOS, and apoptosis protease-activating factor 1 were significantly different in TDF and PTX groups compared to the IR group. High dose-TDF and PTX have the best protective effect on IR-induced liver tissue damage. This study showed that TDF and PTX supplementation may be helpful in preventing free oxygen radical damage, lipid peroxidation, hepatocyte necrosis, and apoptosis in liver IR injury and minimizing liver damage.

Rectal dexmedetomidine in rats: evaluation of sedative and mucosal effects / Dexmedetomidina retal em ratos: avaliação dos efeitos sedativos e sobre a mucosa / La dexmedetomidina rectal en ratones: evaluación de los efectos sedativos y sobre la mucosa

BACKGROUND AND OBJECTIVES: In this study, we investigated the anesthetic and mucosal effects of the rectal application of dexmedetomidine to rats. METHODS: Male Wistar albino rats weighing 250-300 g were divided into four groups: Group S (n = 8) was a sham group that served as a baseline for the normal basal values; Group C (n = 8) consisted of rats that received the rectal application of saline alone; Group IPDex (n = 8) included rats that received the intraperitoneal application of dexmedetomidine (100 µg kg-1); and Group RecDex (n = 8) included rats that received the rectal application of dexmedetomidine (100 µg kg-1). For the rectal drug administration, we used 22 G intravenous cannulas with the stylets removed. We administered the drugs by advancing the cannula 1 cm into the rectum, and the rectal administration volume was 1 mL for all the rats. The latency and anesthesia time (min) were measured. Two hours after rectal administration, 75 mg kg-1 ketamine was administered for intraperitoneal anesthesia in all the groups, followed by the removal of the rats' rectums to a distal distance of 3 cm via an abdominoperineal surgical procedure. We histopathologically examined and scored the rectums. RESULTS: Anesthesia was achieved in all the rats in the Group RecDex following the administration of dexmedetomidine. The onset of anesthesia in the Group RecDex was significantly later and of a shorter duration than in the Group IPDEx (p < 0.05). In the Group RecDex, the administration of dexmedetomidine induced mild-moderate losses of mucosal architecture in the colon and rectum, 2 h after rectal inoculation. CONCLUSION: Although 100 µg kg-1 dexmedetomidine administered rectally to rats achieved a significantly longer duration of anesthesia compared with the rectal administration of saline, our histopathological evaluations showed that the rectal administration of 100 µg kg-1 dexmedetomidine led to mild-moderate damage to the mucosal structure ...

JUSTIFICATIVA E OBJETIVOS: Neste estudo pesquisamos os efeitos anestésicos e sobre a mucosa da aplicação retal de dexmedetomidina em ratos. MÉTODOS: Ratos machos albinos Wistar, com 250-300 g, foram divididos em quatro grupos: Grupo S (n = 8) foi um grupo sham que serviu de parâmetro para os valores basais normais; Grupo C (n = 8) consistiu em ratos que receberam a aplicação retal apenas de soro fisiológico; Grupo IPDex (n = 8) consistiu em ratos que receberam aplicação intraperitoneal de dexmedetomidina (100 µg kg-1) e Grupo RecDex (n = 8) consistiu em ratos que receberam a aplicação retal de dexmedetomidina (100 µg kg-1). Para a administração dos fármacos por via retal, usamos cânulas intravenosas de calibre 22, com os estiletes removidos. A administração consistiu em avançar a cânula 1 cm no reto e o volume de administração retal foi de 1 mL para todos os ratos. Os tempos (min) de latência e de anestesia foram registrados. Duas horas após a administração por via retal, 75 mg kg-1 de cetamina foram administrados a todos os grupos para anestesia intraperitoneal, seguido por remoção dos retos dos ratos a uma distância 3 cm distal por meio de procedimento cirúrgico abdominoperineal. Os retos foram histopatologicamente examinados e classificados. RESULTADOS: A anestesia foi feita em todos os ratos do grupo RecDex após a administração de dexmedetomidina. O tempo de início da anestesia no Grupo RecDex foi significativamente mais longo e com uma duração mais curta do que no Grupo IPDEx (p < 0,05). No Grupo RecDex, a administração de dexmedetomidina induziu perdas leves a moderadas da arquitetura da mucosa do cólon e reto duas horas após a inoculação retal. CONCLUSÃO: Embora a administração de 100 µg kg-1 de dexmedetomidina por via retal em ratos tenha resultado em uma duração significativamente maior da anestesia, em comparação com a administração retal de soro fisiológico, nossas avaliações histopatológicas mostraram que a administração ...

JUSTIFICACIÓN Y OBJETIVOS: En este estudio investigamos los efectos anestésicos y sobre la mucosa de la aplicación rectal de la dexmedetomidina en los ratones. MÉTODOS: Ratones machos albinos Wistar, con un peso de 250-300 g, fueron divididos en 4 grupos: el grupo S (n = 8) fue un grupo simulado que sirvió de base para los valores basales normales; el grupo C(n = 8) consistió en ratones que recibieron aplicación rectal solamente de suero fisiológico; el grupo IPDex (n = 8) estaba formado por en ratones que recibieron aplicación intraperitoneal de dexmedetomidina (100 µg/kg-1); y el grupo RecDex (n = 8) consistió en ratones que recibieron la aplicación rectal de dexmedetomidina (100 µg/kg-1). Para la administración de los fármacos por vía rectal usamos cánulas intravenosas de calibre 22 sin estiletes. La administración consistió en avanzar la cánula 1 cm en el recto y el volumen de administración rectal fue de 1 mL para todos los ratones. Los tiempos (min) de latencia y de anestesia fueron registrados. Dos horas después de la administración por vía rectal, fueron administrados 75 mg/kg-1 de ketamina a todos los grupos para la anestesia intraperitoneal, seguido de la retirada de los rectos de los ratones a una distancia 3 cm distal por medio de un procedimiento quirúrgico abdominoperineal. Los rectos fueron histopatológicamente examinados y clasificados. RESULTADOS: La anestesia fue realizada en todos los ratones del grupo RecDex después de la administración de dexmedetomidina. El inicio de la anestesia en el grupo RecDex fue significativamente más tarde y con una duración más corta que en el grupo IPDEx (p < 0,05). En el grupo RecDex, la administración de dexmedetomidina indujo pérdidas leves a moderadas de la arquitectura de la mucosa del colon y del recto 2 h después de la inoculación rectal. CONCLUSIÓN: Aunque la administración de 100 µg/kg-1 de dexmedetomidina por vía rectal en ratones logra una duración significativamente más ...

[Rectal dexmedetomidine in rats: evaluation of sedative and mucosal effects]. / Dexmedetomidina retal em ratos: avaliação dos efeitos sedativos e sobre a mucosa.

BACKGROUND AND OBJECTIVES: In this study, we investigated the anesthetic and mucosal effects of the rectal application of dexmedetomidine to rats. METHODS: Male Wistar albino rats weighing 250-300g were divided into four groups: Group S (n=8) was a sham group that served as a baseline for the normal basal values; Group C (n=8) consisted of rats that received the rectal application of saline alone; Group IPDex (n=8) included rats that received the intraperitoneal application of dexmedetomidine (100µgkg(-1)); and Group RecDex (n=8) included rats that received the rectal application of dexmedetomidine (100µgkg(-1)). For the rectal drug administration, we used 22G intravenous cannulas with the stylets removed. We administered the drugs by advancing the cannula 1cm into the rectum, and the rectal administration volume was 1mL for all the rats. The latency and anesthesia time (min) were measured. Two hours after rectal administration, 75mgkg(-1) ketamine was administered for intraperitoneal anesthesia in all the groups, followed by the removal of the rats' rectums to a distal distance of 3cm via an abdominoperineal surgical procedure. We histopathologically examined and scored the rectums. RESULTS: Anesthesia was achieved in all the rats in the Group RecDex following the administration of dexmedetomidine. The onset of anesthesia in the Group RecDex was significantly later and of a shorter duration than in the Group IPDEx (p<0.05). In the Group RecDex, the administration of dexmedetomidine induced mild-moderate losses of mucosal architecture in the colon and rectum, 2h after rectal inoculation. CONCLUSION: Although 100µgkg(-1) dexmedetomidine administered rectally to rats achieved a significantly longer duration of anesthesia compared with the rectal administration of saline, our histopathological evaluations showed that the rectal administration of 100µgkg(-1) dexmedetomidine led to mild-moderate damage to the mucosal structure of the rectum.

Our long-term results of Tenckhoff peritoneal dialysis catheters placement via laparoscopic preperitoneal tunneling technique.

Previously we described the technique to lessen complications of continuous ambulatory peritoneal dialysis (CAPD) and to achieve immediate use of the catheter. In this study we evaluated our long-term results of the technique. A total of 61 procedures were carried out in 58 patients from September 2003 to February 2009. All patients were followed in our hospital CAPD clinic. Demographic, medical, operative, postoperative, and other information regarding complications and continued patient management was obtained retrospectively from the patients' medical records and entered into a computerized database. There were 33 men and 25 women. The mean age was 58 years. In 29 of the 58 patients indication of catheter placement was end stage renal failure combined with diabetes mellitus. Mean follow-up time was 33.31 ± 20.11 months. Catheter related complications were outflow obstruction (n=3, 5.2%) and peritonitis (n=2, 3.4%). Etiologies of catheter removal were out flow obstruction (n=2), recovery from renal disease (n=2), peritonitis (n=1), and pregnancy (n=1). The mean catheter survival time was found 5.57 ± 0.17 years. Our long-term results showed that the method ensured accurate placement, preperitoneal fixation, and immediate use of the catheter for routine peritoneal dialysis. Preperitoneal fixation of the catheter decreased outflow obstruction over long-term follow-up.

Postoperative adhesions after application of topical hemostatic agents: outcomes in a rat partial nephrectomy model.

OBJECTIVE: To compare 3 kinds of topical hemostatic agents in terms of adhesive strength, control of hemorrhage, and postoperative intra-abdominal adhesions in an experimental partial nephrectomy (PN) model. METHODS: A total of 27 Wistar rats were divided into 5 groups. PN was performed in 6 rats (control group) with the conventional technique, in which the lower pole of the kidney was excised and sutured after hilar control. In 5 rats, oxidized cellulose was placed over the excised part of the kidney following conventional technique. In 6 rats, the hemostatic plant extract was used without hilar control. In 5 rats, the hemostatic agent chitosan was used without hilar control. As a sham group, 5 rats underwent a laparotomy and handling of the renal pedicle without the removal of renal pole. On the tenth day after the operation, the degree of adhesions to the operated kidney were evaluated. Histopathological evaluation was also performed by a blinded pathologist. RESULTS: Mean warm ischemia times for control and oxidized cellulose groups were 4.85 ± 0.75 and 4.28 ± 1.28 minutes, respectively (P = .662). Wound healing was excellent in all groups except in 1 rat in the chitosan group. Chitosan was associated with significantly higher intestinal and peritoneal adhesion scores, although histopathologically comparable scores were revealed. CONCLUSION: In our rat model, chitosan and the hemostatic plant extract were as effective as conventional suturing in achieving hemostasis even without hilar control. Warm ischemia was eliminated and PN time was significantly decreased. The use of oxidized cellulose was not associated with higher scores of adhesion, suppuration, or hematoma.

Primary intestinal diffuse large B-cell lymphoma forming multiple lymphomatous polyposis.

Multifocal and skip involvement is quite a rare developmental pattern for primary gastrointestinal lymphomas. A 25-year-old male patient with diffuse large B-cell lymphoma of the small intestine, with macroscopic features and clinical aspects imitating Crohn's disease and attracting attention with cobblestone-like appearance, is presented herein together with the clinical and pathological features.Multiple ulcerated lesions were also observed infiltrating the serosa with polypoid appearance, 2.5 cm in largest diameter, within the resected jejunoileal specimen, which displayed patchy, healthy-appearing mucosal areas. In microscopic examination, a tumoral infiltration was observed comprised of pleomorphic, atypical lymphoid cells with abundant eosinophilic cytoplasm, marked nucleoli and vesicular nuclei. A B-cell phenotype immunoreaction was observed by vimentin, LCA, CD20, and CD79a in those atypical cells. The diagnosis of the case was diffuse large B-cell lymphoma.The possibility of the presence of this disorder, although rare, is emphasized here for patients applying to the hospital with the signs and symptoms of Crohn's disease.

Does intraabdominal use of Ankaferd Blood Stopper cause increased intraperitoneal adhesions?

BACKGROUND: The aim of this study was to investigate whether intraabdominal Ankaferd Blood Stopper (ABS) causes increased intraabdominal adhesion formation and to determine any side effects of ABS in vivo. METHODS: The present experimental study was designed to examine the effects of Ankaferd solution on peritoneal adhesion formation in a rat model of cecal abrasion. Intraperitoneal adhesions were assessed macroscopically and histopathologically on the 10th postoperative day. The possible adverse affects of ABS on liver and lung tissues were analyzed histopathologically, and blood chemistry was also evaluated. RESULTS: Our study revealed that ABS reduced intraperitoneal adhesion formation in an experimental rat model. The blood chemistry was not disturbed due to ABS administration. Intraperitoneal administration of ABS led to some minor changes in the lungs and serosal surfaces of the intestines, with minor architectural changes in the liver that were not considered as toxic. Further studies with various application doses and routes with more detailed cellular analysis are thus warranted to clarify the possible pleiotropic and adverse effects of this new agent away from hemostasis. CONCLUSION: There was less intraperitoneal adhesion formation in the ABS group than in the control group and saline group. Intraperitoneal administration of ABS has no toxic effects on blood chemistry or the lungs, kidneys and the liver, but it has some minor adverse effects.

Protective value of a folkloric medicinal plant extract against mortality and hemorrhage in a life-threatening renal trauma model.

OBJECTIVES: To compare the efficacy of a folkloric medicinal plant extract (Ankaferd Blood Stopper [ABS]) with that of oxidized cellulose (Surgicel) in a life-threatening renal injury model. ABS is a mixture of 5 plants that has historically been used in Turkish traditional medicine. It has been approved by the Ministry of Health to manage external hemorrhage and dental surgery bleeding in Turkey. METHODS: Twenty-two Wistar albino rats underwent partial nephrectomy after intravenous heparin anticoagulation (2000 U/kg). The cut surface received 1 of 3 therapies, namely no treatment, Surgicel (Johnson & Johnson, New Brunswick, NJ) or ABS (Trend Teknoloji Iaç AS, Istanbul, Turkey). Blood pressure was continually monitored. Survival time, total blood loss, and mean arterial pressure were recorded for 60 minute or until death. Rats that were alive (mean arterial pressure>or=20 mm Hg) at the end of 60 minutes were sacrificed with blood withdrawal with the help of catheters. RESULTS: All animals that received no treatment died within 60 minutes of follow-up. One of 7 in the Surgicel group, and 5 of 7 animals in the ABS group, survived. Mean survival times for the Surgicel and ABS groups were 42.7 and 53.4 minutes, respectively. Rats in the ABS and Surgicel groups survived significantly longer than rats in the control group (P<.05). There were no significant differences between the ABS and the Surgicel groups in survival (P=.128). CONCLUSIONS: ABS is as effective as Surgicel in achieving hemostasis and lengthening survival time following partial nephrectomy in an experimental rat model.

Effects of dexmedetomidine pretreatment on bupivacaine cardiotoxicity in rats.

BACKGROUND AND OBJECTIVE: We evaluated the effects of dexmedetomidine pretreatment on bupivacaine cardiotoxicity in anesthetized rats. METHODS: Sixteen Wistar-Albino male rats (300-400 g) were anesthetized with ketamine. Electrocardiographic and invasive blood pressure monitoring were performed, and the results were continuously recorded. The rats were randomized into 2 groups. In group D, rats were pretreated with intravenous dexmedetomidine at a dose of 10 Kg/kg (n = 8), whereas in group S, rats were pretreated with intravenous saline (n = 8). Fifteen minutes later, bupivacaine was infused at a rate of 3 mg/kg per minute until cardiac asystole occurred. The timing of specific cardiotoxic events (a 25%, 50%, and 75% reductions of mean arterial pressure and heart rate as well as occurrence of the first arrhythmia and asystole) was recorded. RESULTS: Dexmedetomidine pretreatment reduced the heart rates and mean arterial pressures of the rats who received it (P G 0.05). Dexmedetomidine pretreatment before bupivacaine administration also significantly increased the time to the 25%, 50%, and 75% reductions in mean arterial pressure and the time to the 25% and 50% reductions in heart rate (P G 0.05). In addition, dexmedetomidine significantly increased the time to first arrhythmia and time to asystole (P G 0.05) in the rats who received it before receiving bupivacaine. CONCLUSIONS: Dexmedetomidine pretreatment delays the effects of bupivacaine cardiotoxicity.

Mitigation of indomethacin-induced gastric mucosal lesions by a potent specific type V phosphodiesterase inhibitor.

AIM: To investigate the gastroprotective effect of vardenafil against indomethacin-induced gastric damage. METHODS: Forty-eight female Wistar albino rats were randomly divided into 6 groups. Group 1 received saline only. Group 2 (indomethacin) received indomethacin. Rats in group 3 and 4 were pretreated with different doses of famotidine. Group 5 and 6 were pretreated with different doses of vardenafil. Rats in groups 3 to 6 received 25 mg/kg indomethacin 30 min after pretreatment. The animals were sacrificed 6 h later and their stomachs were opened. Gastric lesions were counted and measured. The stomach of each animal was divided in two parts for histopathological examinations and nitric oxide (NO) and malondialdehyde (MDA) assays, respectively. RESULTS: There were no gastric mucosal lesion in the saline group but all rats in the indomethacin group had gastric mucosal ulcerations (ulcer count; 6.25 +/- 3.49, and mean ulcer area; 21.00 +/- 12.35). Ulcer counts were diminished with famotidine 5 mg/kg (4.12 +/- 2.47, P > 0.05), 20 mg/kg (2.37 +/- 4.43, P < 0.05), vardenafil 2 mg/kg (4.37 +/- 3.06), and vardenafil 10 mg/kg (1.25 +/- 1.38, P < 0.05) compared to the indomethacin group. Gastric mucosal lesion areas were diminished with famotidine 5 mg/kg (8.62 +/- 2.97, P < 0.001) , famotidine 20 mg/kg (0.94 +/- 2.06, P < 0.001), vardenafil 2 mg/kg (6.62 +/- 5.87, P < 0.001), and vardenafil 10 mg/kg (0.75 +/- 0.88, P < 0.001) compared to the indomethacin group. MDA levels were significantly higher in indomethacin group (28.48 +/- 14.51), compared to the famotidine 5 mg/kg (6,21 +/- 1.88, P < 0.05), famotidine 20 mg/kg (5.88 +/- 1.60. P < 0.05), vardenafil 2 mg/kg (15.87 +/- 3.93, P < 0.05), and vardenafil 10 mg/kg (10.97 +/- 4.50, P < 0.05). NO concentration in gastric tissues of the famotidine groups were significantly increased (P < 0.05), but the NO increases in the vardenafil groups were not statistically significant. Histopathology revealed diminished gastric damage for pretreatment groups compared to the indomethacin group (P < 0.05). CONCLUSION: Vardenafil affords a significant dose-dependent protection against indomethacin induced gastric mucosal lesions in rats.

Effect of 2-octyl-cyanoacrylate on ischemic anastomosis of the left colon.

INTRODUCTION: 2-octyl-cyanoacrylate may be a good alternative in ischemic colon anastomosis without impairment of tissue perfusion. METHODS: Forty male Wistar albino rats were randomized into four experimental groups (n = 10 in each group). In group 1 (control), a well-perfused left colonic segment was transected, and free ends were anastomosed by propylene sutures. In groups 2, 3, and 4, the animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. In group 2, an end-to-end anastomosis was created using six interrupted 6-0 polypropylene sutures between ischemic edges. In group 3, after approximating the mesenteric and antimesenteric edges of the anastomosis with two 6-0 polypropylene sutures, 2-octyl-cyanoacrylate was applied between the edges. In group 4, anastomosis was created by the same technique as described in group 2, and additionally 2-octyl-cyanoacrylate was applied on suture line. Rats were killed on day 4 following operation. Anastomotic integrity, intraperitoneal adhesion scores, anastomotic bursting pressures, and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed. RESULTS: There were no statistically significant differences among groups with respect to anastomotic integrity (p =.142). The mean bursting pressure values were 81.1 +/- 23.83, 43.3 +/- 26.06, 15.8 +/- 11.3, and 17.6 +/- 18.02 in groups 1, 2, 3, and 4, respectively. There were no statistically significant differences among groups 2, 3, and 4 with respect to tissue hydroxyproline levels and bursting pressure levels. The highest adhesion scores were observed in groups 3 and 4. DISCUSSION: 2-octyl cyanoacrylate does not have additional advantages in the healing of experimental ischemic colon anastomosis.

Evaluation of a new hemostatic agent Ankaferd Blood Stopper in experimental liver laceration.

INTRODUCTION: Hemorrhage is a leading cause of death after trauma. It is also the major cause of operating room deaths among patients who undergo liver surgery. Various techniques and materials have been attempted to manage bleeding, but a standard method has not been defined yet. We studied the hemostatic effects of Ankaferd Blood Stopper on liver injury in comparison with regenerated oxidized cellulose. MATERIALS AND METHODS: Thirty Wistar albino rats underwent partial hepatic laceration by scissors. The animals were randomized to the treatment of resected surface with either Ankaferd Blood Stopper (ABS, n = 11) or regenerated oxidized cellulose (Surgicel, n = 9), or were left untreated (controls, n = 10). All the animals were resuscitated with lactated Ringer's solution at 3.3 ml/min/kg to a mean arterial pressure (MAP) of 100 mmHg. Survival time, total blood loss, resuscitation volume, and MAP were recorded for 30 min or until death. The rats that were alive at the end of 30 min were sacrificed with blood withdrawal from catheters. RESULTS: Rats in the ABS and Surgicel groups survived significantly longer than rats in the control group (p =.0001). There were no significant differences between the ABS and the Surgicel groups in survival (p =.91). Application of ABS and Surgicel was associated with a significant reduction in blood loss compared to controls (p =.008), with no significant differences between active treatment groups (p =.74). The resuscitation volume was not different. CONCLUSIONS: ABS is as effective as Surgicel in achieving hemostasis following partial liver excision in an experimental rat model.

Does sildenafil reverse the adverse effects of ischemia on ischemic colon anastomosis: yes, 'no'.

INTRODUCTION: Sildenafil may lead an improvement in anastomotic healing of ischemic left colon anastomosis. METHODS: Thirty-six male Wistar albino rats were randomized into four experimental groups (n=9 in each group). In group 1, a well-perfused left colonic segment was transected, and free ends were anatomosed. In groups 2, 3 and 4 animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. Group 2 animals received only tap water. In groups 3 and 4 animals received 10mg/kg/body-weight and 20mg/kg/body-weight sildenafil, single dose a day during 4 days, respectively. Rats were sacrificed on day 4 following operation. Anastomotic integrity, intra-peritoneal adhesion scores, anastomotic bursting pressures and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed. RESULTS: There was no statistically significant difference among groups with respect to anastomotic integrity (p=0.142) but ischemia decreased the anastomotic bursting pressure. The mean bursting pressure values were 78.8+/-24.1, 43.3+/-26, 55.1+/-32.4, and 43.3+/-20.4 in groups 1, 2, 3, and 4, respectively. Group 1 had the highest values whereas; there was no statistically significant difference between groups 1 and 3. There was no statistically significant difference among groups 2, 3, and 4 with respect to tissue hydroxyproline levels, adhesion scores and the Chiu scores. The highest inflammatory cell presence in the granulation tissue was detected in group 2, whereas the lowest was detected in group 4 (p=0.0001). The highest fibroblast infiltration in the granulation tissue was detected in group 1 (p=0.045). DISCUSSION: Our results showed that 10mg/kg sildenafil decreased the adverse effects of ischemia on the healing of ischemic left colon anastomosis. Additional investigations are needed to confirm the effects of phosphodiesterase-5 inhibitors in ischemic colon anastomosis models.

Biliary cannulation facilitated by endoscopic clip assistance in the setting of intra-diverticular papilla.

Endoscopic cannulation of the biliary tract may be challenging in cases with juxtapapillary, duodenal diverticula. A 70-year old woman admitted to the hospital with the diagnosis of choledocholithiasis and acute cholangitis. She was placed on antibiotic treatment and parenteral fluid resuscitation. On endoscopic retrograde cholangiopancreatography, the papilla could not be cannulated because of the duodenal diverticulum. Various attempts at biliary cannulation failed. Endoscopic clips were used for evertion and fixation of a partially everted papilla from the diverticulum and for securing it in an orientation that allowed direct cannulation of the biliary tree. Cholangiography demonstrated multiple calculi within the choledochus. She was discharged from the hospital on the 9th day following endoscopic retrograde cholangiopancreatography in good condition. With this report, we aimed to remind physicians that the clip assisted method is a safe and effective technique for pancreatic and/or biliary cannulation, and should be preferred in patients in whom cannulation is extremely difficult due to large periampullary diverticula..

Fournier's Gangrene after Open Hemorrhoidectomy without a Predisposing Factor: Report of a Case and Review of the Literature.

Fournier's gangrene (FG) is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and vulva in women. An unpredictable case of FG two weeks after open hemorrhoidectomy in a previously healthy 55-year-old male is described. Full-thickness patchy skin necrosis of the perianal, perineal and scrotal region associated with rectal perforation was detected on admission. Prompt radical debridement together with aggressive fluid resuscitation and broad-spectrum antibiotic administration was initiated. Because of rectal involvement, diverting sigmoid colostomy was fashioned. The patient survived after two additional local debridements. Nevertheless, loss of sphincter function due to massive muscle destruction led to permanent colostomy. Our case together with others reported in the literature illustrates that, although rare, FG after open hemorrhoidectomy represents a life-threatening complication to otherwise healthy patients. The development of fever and urinary retention should draw the attention of the surgeon, even if the presentation is delayed. The current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than anticipated. This disastrous complication without predisposing factor is discussed along with a literature review.

Complications of total thyroidectomy performed by surgical residents versus specialist surgeons.

PURPOSE: Surgeon inexperience has been defined as a significant predictor of deleterious outcome in thyroid surgery; however, the safety of training programs in which residents are the primary surgeons is controversial. The objective of this prospective study was to compare the complication rates of total thyroidectomy (TT) performed by residents with those of TT performed by specialist surgeons in similar patient groups. METHODS: Between April 2001 and May 2007, 144 patients underwent TT at our hospital. For 75 operations, the primary surgeon was a resident under the direct supervision of the attending surgeon, and for 69 operations, the primary surgeon was the experienced attending surgeon. Pre-and postoperative vocal cord examinations and serum calcium level evaluations were carried out in all patients. RESULTS: The rates of temporary (unilateral) recurrent laryngeal nerve (RLN) palsy were 2.66% vs 2.17% after TT performed by the residents vs the attending surgeon, respectively. There were no significant differences in the incidences of temporary hypoparathyroidism (20% vs 20.28%), permanent (unilateral) RLN palsy, hematoma, infection, seroma, and incidental parathyroidectomy between the two groups. CONCLUSION: The complication rates of TT performed by residents and attending surgeons were similar. Thus, residents can perform TT safely and effectively under the direct supervision of a senior surgeon. Ultimately, strict adherence to the contemporary principles of thyroid surgery is of paramount importance.