Cecum perforation due to biliary stent migration.

The endoscopic placement of biliary stents for benign and malignant biliary disease has been performed for over a decade. Several complications of stent placement have been described such as pancreatitis, hemorrhage, cholangitis, and perforation. Migration of biliary stents is a rare event, which can cause severe complications such as gastrointestinal tract perforation. We report the case of a 26-year-old woman with a cecum perforation due to biliary stent migration. We present the second case of cecal perforation related to the migration of a biliary stent.

Effect of bencyclane fumarate on intestinal ischaemia reperfusion injury.

BACKGROUND: Post-ischaemic intestinal tissue damage appears to be due to the formation of oxygen radicals. Free radical-initiated lipid peroxidation following intestinal ischaemia/reperfusion (I/R) may disrupt mucosal integrity. Indirectly, the radicals trigger the accumulation of neutrophils within the affected tissue, initiating inflammatory processes that lead to severe mucosal lesions. We have investigated the protective effect of bencyclane fumarate, a vasodilating Ca(2+) channel blocker, which has been used for the treatment of peripheral arterial occlusive diseases, on intestinal ischaemia reperfusion (IR) injury in rats. METHODS: Forty-eight Wistar albino rats were divided into three groups: a sham-operated group (no IR injury, n = 16), an ischaemic control group (IR, n = 16), and BF-treated group (pretreatment 5 mg/kg bencyclane fumarate + IR, n = 16). A marker for lipid peroxidation, namely malondialdehyde; free radical scavengers, glutathione peroxidase, catalase and superoxide dismutase levels; an index of polymorphonuclear neutrophils, myeloperoxidase activity and mucosal damage were investigated. RESULTS: Malondialdehyde levels, myeloperoxidase activity and the severity of mucosal damage were decreased in the BF group. In addition, in the BF group, glutathione peroxidase, catalase and superoxide dismutase levels were higher compared with the IR group. CONCLUSION: The pretreatment of rats with bencyclane fumarate before intestinal ischaemia attenuates the mucosal damage in intestinal IR injury, probably by altering lipid peroxidation, neutrophil accumulation and antioxidant activity.

Prognostic factors of peptic ulcer perforation.

OBJECTIVES: Today a perforated peptic ulcer (PPU) is a rare condition. However, emergency surgery for perforated ulcer presently carries a mortality risk of up to 30%. The aim of this study is to analyze and define factors influencing surgical prognosis in patients operated upon for PPU. METHODS: We performed a retrospective analysis of 62 patients treated for PPU in Suleyman Demirel University, Surgical Department between January 1995 to January 2004. Univariate analysis was performed to determine risk factors for mortality in PPU by chi-square test, Pearson and Spearman correlation tests using SPSS for Windows statistical software. We accepted statistical significance for p values <0.05. RESULTS: The overall mortality rate was 17.7%. The present study confirms the age, sex, American Society of Anesthesiology (ASA) classification, coexisting medical disease, elapsed time from symptoms to operation, blood pressure, pulse, serum albumin and creatinine levels, hemoglobin level and diameter of perforation as valid prognostic factors in whole series, whereas a previous history of peptic ulcer disease, chronic ingestion history of nonsteroidal anti-inflammatory drugs, alcohol ingestion, smoking habits, site of perforation, type of surgical treatment (simple suture or resection), postoperative complications did not appear to be related to prognosis. CONCLUSION: Age, gender, ASA classification, coexisting medical disease, elapsed time from symptoms to operation, blood pressure, pulse, serum albumin and creatinine levels, hemoglobin level and diameter of perforation are factors significantly associated with fatal outcomes in patients undergoing emergency surgery for PPU. Thus, such factors need to be carefully taken into account during the general workup of patients admitted for PPU.

Hypercalcemia syndrome. Coexisting hyperthyroidism, primary hyperparathyroidism and cancer of the gallbladder.

Hypercalcemia is a frequent finding in clinical practice. All possible causes must be considered in a patient with hypercalcemia. The association between both benign or malignant thyroid disease and primary hyperparathyroidism is well recognized. Up to 65% with primary hyperparathyroidism have associated thyroid abnormality. Hypercalcemia has also been associated with many malignant conditions. But, it is rarely seen in digestive tract cancer, such as carcinoma of gallbladder. Hypercalcemia syndrome is an absolutely rare entity. It is coexisting with hyperthyroidism, primary hyperparathyroidism and cancer of the gallbladder.