Effects of various drugs (flunixin, pentoxifylline, enoxaparin) modulating micro-rheological changes in cerulein-induced acute pancreatitis in the rat.

Previously we have investigated the cerulein-induced acute pancreatitis and provided data on its micro-rheological impact in the rat. We hypothesized that non-steroid anti-inflammatory agent flunixin, the xanthine-derivate pentoxifylline and the low molecular weight heparin enoxaparin may have various beneficial effects improving microcirculatory and rheological parameters. In female rats, under general anesthesia, 10 µg/kg cerulein s.c. was administered and 2 hours afterwards microcirculation was tested by laser Doppler flowmetry on the tongue and after performing laparotomy on the small intestine, liver and pancreas prior to terminal blood sampling. From blood samples hematological parameters, blood pH, lactate concentration, erythrocyte deformability, osmoscan parameters and erythrocyte aggregation were tested. Compared to normal control in acute pancreatitis group we found severe deterioration in tissue microcirculation together with impaired erythrocyte deformability and enhanced aggregation, accompanied by acidic pH and increasing lactate concentration. Improvement was found when using flunixin (s.c.), pentoxifylline (i.p.) or enoxaparin (s.c.). These drugs could partly improve the blood flux on the surface of the investigated organs, and the flunixin had the most expressed improving effects on micro-rheological parameters. Surprisingly, the improving effect of pentoxifylline on micro-rheological parameters was not obvious (red blood cell deformability did not improved better than in the other treated groups), however, microcirculatory parameters improved.

Occurrence of bladder metastasis 10 years after surgical removal of a primary gastric cancer: a case report and review of the literature.

INTRODUCTION: Secondary bladder neoplasms are uncommon and they represent only 2% of all malignant bladder tumors. CASE PRESENTATION: The authors present a case of a 59-year-old Caucasian man with a primary gastric adenocarcinoma that had been surgically removed 10 years before he developed bladder metastasis. He presented with low abdominal pain after 10 years without any symptoms. Cystoscopy and an abdominal computed tomography scan showed a bladder tumor. A transurethral resection of the bladder tumor was performed. A histological examination revealed an adenocarcinoma, which turned out to be a metastasis of the primary gastric tumor. One year later, abdominal surgery revealed peritoneal metastases. CONCLUSION: This is the first known case in Europe where bladder metastasis occurred 10 years after surgical removal of a primary gastric neoplasm. There are only four cases in the literature where metastases of the peritoneum developed 11 years after surgical removal of a primary gastric tumor.

Correlations between clinicopathological parameters and molecular signatures of primary tumors for patients with stage T3n0 colorectal adenocarcinomas: a single center retrospective study on 100 cases.

BACKGROUND/AIMS: To examine the clinical and protein expression characteristics of tumor tissues for prediction of prognosis in colorectal cancer (CRC). METHODOLOGY: We retrospectively analyzed the clinicopathological data of patients with stage T3N0 CRC, operated between 1997-2003 and the surgical materials for the relation between disease prognosis and p53, p21, p16, ß-catenin, E-cadherin, EGFR, hMLH1, hMSH2 and TS protein expressions. RESULTS: A significantly shorter 3-year disease free survival was observed in patients under the age of 50. The worst 5-year overall survival (OS) observed for patients over 70. Tumor localization and number of processed lymph nodes significantly affected prognosis. The EGFR, hMSH2 and TS expressions and the 5-fluorouracyl treatment were not found to be of prognostic value; p53 and p21 positivity had significantly worse survival. When ß-catenin membrane expression disappeared on tumor cells, the 5-year OS rate decreased and time to metastasis shortened significantly. Membrane ß-catenin expression, processed lymph nodes number and age were detected as independent prognostic markers. CONCLUSIONS: These results suggest that the evaluation of a clinicopathological profile, based on age, tumor localization, number of examined lymph nodes, p53, p21 and E-cadherin ß-catenin expression appears to be useful in identifying high risk patients.

Micro-rheological changes during experimental acute pancreatitis in the rat.

Although microcirculatory disturbances play pivotal role in the pathomechanism of acute pancreatitis (AP), very few papers can be found which had been tested any of hemorheological parameters. The aim of our study was to analyze the hemorheological changes in cerulein-induced experimental acute pancreatitis in rat in two doses (5 and 10 µg/kg, s.c.). Male and female rats were subjected to Control group, or AP with 5 or 10 µg/kg cerulein groups. Blood samplings (lateral caudal vein) were completed before cerulein administration, and 1, 2 and 24 hours later. Hematological parameters, amylase activity, erythrocyte deformability (ektacytometry) and aggregation (light-transmission method) were tested. The presence of AP could be confirmed by amylase testing and histological examination. The earliest impairment of the red blood cell deformability could be observed 1 hour after cerulein administration in 10 µg/kg dosage. Female animals had the worst rheological results with high mortality. In conclusion, subcutaneously administrated cerulein in dosage of 5 and 10 µg/kg resulted in AP in rats, with significant changes in red blood cell deformability and alterations in erythrocyte aggregation. This model seems to be suitable for further comparative studies.

[Analysis of clinical course of severe acute biliary and non biliary pancreatitis: a comparative study]. / Biliaris és nem biliaris eredetu súlyos akut pancreatitises betegek kórlefolyásának összehasonlító elemzése.

UNLABELLED: The acute pancreatitis is a relative common disease with incidence of 5-80 per 100000 people of the population. The number of new cases has steadily increased in recent years. The two main etiological factors are alcohol and cholelithiasis. The incidence of alcoholic pancreatitis is higher in male, and the incidence of gallstone pancreatitis is higher in female. AIM: To summarize the difference between the clinical course of biliary and not biliary type of severe acute pancreatitis by analyzing the data of these patients. METHODS: 139 patients treated with severe acute pancreatitis were divided in two groups: biliary (A group) and non biliary (B group) of origin. The two groups were compared on the basis of sex and age, mortality, morbidity, number of surgery and hospital stay. chi 2 probe was used for the statistical analysis. RESULTS: The complications in biliary group were more serious. The average mortality rate was 15.1%, 17.8% in group A and 13.8% in group B. The mortality rate of female patients in group A was significantly higher. CONCLUSION: Female patients suffering from severe biliary acute pancreatitis have higher morbidity and mortality rate. Therefore an elective cholecystectomy is suggested in old female patients with serious co-morbidity and gallstones, before any complications.

Therapeutic tactics in the treatment of acute necrotizing pancreatitis.

BACKGROUND/AIMS: The authors analyze the possibilities for the delay of surgery with special consideration regarding percutaneous peripancreatic drainage in the treatment of acute necrotizing pancreatitis. METHODOLOGY: In addition to intensive care therapy, 61 patients were also given antibiotic prophylaxis, and early nasojejunal enteral feeding was commenced. In a total of 22 cases where peripancreatic fluid was found, percutaneous drainage was performed. Septic necrosis, sepsis, multi-organ failure not resolving with conservative treatment, gastrointestinal perforation, and bleeding were the indications for operation. Only 9 patients underwent surgery within one week and in 40 patients delayed (more than 7 days) necrectomy was performed. Following surgery, closed omental bursa rinsing was performed. RESULTS: Five patients were cured with only conservative therapy and 7 others were cured under the influence of percutaneous drainage. In 15 patients it was possible to delay surgery using percutaneous drainage with combination of conservative treatment. A total of 39 reoperations occurred due to septic focus, bleeding, colonic necrosis and gastric perforation. The average days of nursing care was 43.3 (3-120). Mortality was 16.4% (10/61 patients). CONCLUSIONS: The number of early operations can be reduced with the use of antibiotic prophylaxis, nasojejunal feeding and percutaneous drainage.

[Current issues in the diagnosis and treatment of penetrating chest trauma]. / Athatoló mellkassérülések diagnózisának és kezelésének idoszeru kérdései.

INTRODUCTION: Successful treatment of penetrating chest trauma largely depends on the accurate and rapid diagnostic work-up, as well as the adequate surgical management. The authors discuss current issues in the diagnosis and the treatment of penetrating chest injuries based on the analysis of 109 cases. PATIENTS AND METHODS: 82 men and 27 women with penetrating chest trauma were studied. The average age of the patients was 37.8 years. The injury was caused by stabbing in 104 cases (95.4%), gunshot in 4 patients (3.7%) and explosion in one case (0.9%). 41 patients had cardiac and pericardial injuries. In those, 19 (46.3%) patients had a chest X-ray, echocardiography was done in nine cases (22%), while CT scan and diagnostic VATS were performed in two patients, respectively. All patients underwent surgery except one, who was treated conservatively.In all of the 68 patients, who had no cardiac injuries, a chest X-ray was performed. Echocardiography was done in six (8.8%) cases, diagnostic VATS in four (5.9%) patients, and abdominal ultrasound scan in 3 (4.4%) cases. Chest tube was inserted in 13 patients (19.1%), an open surgery was performed in 51 cases, while in 4 cases VATS was carried out. RESULTS: In the group of patients with cardiac and pericardial injuries, the sensitivity of the chest X-ray, echocardiography and VATS were 57.9%, 88.9% and 100%, respectively. Further, specificity of the above were 26.3%, 88.9% and 100%, respectively. However, in patients with non-cardiac injuries, the sensitivity of the chest X-ray was 100%, and both the specificity and sensitivity of VATS was 100%. Postoperative complication rate was 12.6% overall (15% in cases with cardiac injury and 10.9% in the non-cardiac subgroup). Mortality rate was 7.3% among the patients with cardiac injury, while there was no mortality detected in the non-cardiac subgroup. The average mortality rate was 2.8%. CONCLUSION: Patients with penetrating chest trauma should undergo a rapid and accurate diagnostic work-up followed by an adequate surgical management in order to keep their prognosis relatively good.

[Surgical management of sternoclavicular joint infections]. / Sternoclavicularis ízület fertözésének sebészi kezelése.

AIMS: The pyogenic infection of the sternoclavicular joint is a rare disease. The treatment can be conservative (antibiotics) or surgical (exposure and drainage of the joint or its resection). The authors analyze the causative and predisposing factors, the symptoms, the diagnosis, the questions of the therapy and its efficiency. PATIENTS AND METHODS: In the 6 cases (5 male, 1 female, average age: 56.8 years) the cause of the disease were trauma or metastatic septic focus in 2-2 cases and intraarticular injection or preceding radiotherapy in 1-1 case. Predisposing diseases (diabetes mellitus, gout, chronic alcoholism, liver cirrhosis) could be proved in two cases. The most frequent symptoms were the swelling and erythema of the joint, fever, pain and limitation of motion. In all cases the CT scan proved the destruction of the joint. In one case after unsuccessful conservative therapy and in 1-1 case after debridement and drainage because of concomitant multiple septic focuses and mediastinitis resection of the sternoclavicular joint was applied in a later second step. In the other three patients primary resection of the joint was performed. RESULTS: Both the conservative and drainage managements were insufficient. On the other hand the radical joint resection caused complete recovery in all cases. No intra and postoperative complications were observed. On an average 28.2 months after the radical operation the functional results were excellent. CONCLUSIONS: Relying upon the results, radical resection is supposed to be the most effective method. Conservative treatment or drainage are recommended only for cases associated with severe complications. Resection is worthy performing after the recovery of the concomitant illnesses.

[Anterior approach for liver resection in the cases of the treatment of large liver tumors]. / Anterior májreszekció, mint a nagyméretu májtumorok ellátácsára alkalmas mutéti módszer.

The authors compare the results of the patients who underwent right hemihepatectomy through anterior approach with those by conventional hemihepatectomy. In 119 patients hemihepatectomy was done, 52 of them were anterior approaches. We used this technique when the tumor was large, or it seemed to be fragile and its mobilisation could be dangerous or infiltrated the diaphragm or the the hepatic vein's preparation was difficult or impossible. We started the operation with dissecting parenchyma from the anterior surface toward hilus without preparation and ligation of the affected vessels and bile duct. No patient died following anterior technique. Death and reoperation occurred in two cases following conventional hemihepatectomy. The operation time and the average nursing days was not significantly different. The blood transfusion was significantly less during anterior approach. However, between the two groups, in those cases when the operations were performed because of liver malignancies, there were no differences regarding to survival rate after 62 months follow up in contrast with the literature. The anterior technique used and modified by authors can be performed safely. The blood consumption is significantly less in the cases of anterior technique. There was no significant difference between the groups regarding to the operation-time and the average nursing days. The median survival rate was similar in both groups. Our team suggest this method of the anterior approach for liver resection in the above mentioned cases.

[Surgical treatment for primary and secondary tumors of the liver]. / A primer és szekunder májdaganatok sebészi kezelése.

We performed liver resection for focal liver disease in 266 patients between January 1, 1992 and December 31, 2001 at the University of Debrecen Medical and Health Science Center, Medical School of Medicine, 2nd Department of Surgery in Debrecen, Hungary. The indication was primary liver cancer in 35 cases, liver metastasis in 97 cases. The primary tumour and its liver metastases were removed synchronously in 28 patients (29.9%). Comparing the results of different operating methods we found the need of transfusion significantly less in "anterior" liver resections. Regarding operating time, complications and survival time there were no significant differences between the different operations. One patient died in the perioperative period because of cardiac failure and one because of DIC (1.5%). There were 4 complications which needed reoperation in the early postoperative period. Eighty of the patients were treated with systemic adjuvant chemotherapy (Mayo protocol), with added chemoembolisation in another 26 patients. This has not increased life expectancy significantly. Thirty-two patients are still alive, their average survival time is 21.2 (5 to 59) months. The average survival time of the 78 patients' who died is 16.5 (3 to 58) months. Twenty-two patients were lost out of our follow-up.