Might simple peripheral blood parameters be an early indicator in the prediction of severity and morbidity of cholecystitis?

Purpose: The aim of this study is to examine the effectiveness of the neutrophil-lymphocyte ratio (NLR) and CRP/albumin ratio (CAR) in evaluating disease severity and predicting clinical outcomes in patients diagnosed with acute cholecystitis (AC). Methods: A total of 186 patients with AC were evaluated retrospectively. NLR, CAR, Mannheim Peritonitis Index (MPI), and P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) scores were compared with AC severity grade. Results: The rates of the grade 1 patients (group 1) and the grade 2-3 patients (group 2) were 57.5% (n = 107) and 42.5% (n = 79) according to the disease severity according to Tokyo Guidelines criteria (TG) 18/TG13, respectively. The morbidity rates determined in groups 1 and 2 were 26.7% (n = 28) and 51.9% (n = 41), respectively. No mortality was found in group 1, whereas the mortality rate in group 2 was 6.3% (n = 5). According to multivariate analysis, CAR (odds ratio [OR], 1.234; P < 0.001) and MPI (OR, 1.175; P = 0.001) were found to be associated with moderate-severe disease while CAR (OR, 1.109; P = 0.035) and P-POSSUM morbidity (OR, 1.063; P = 0.007) variables were found to be associated with the presence of morbidity. Conclusion: We have demonstrated that CAR can be used in predicting severity of AC and that CAR is an alternative simple parameter of P-POSSUM morbidity score in prediction of morbidity in these cases. In addition to other assessment methods, these scores can provide valuable and complementary information in assessment of disease severity and prognosis in AC.

Effects of Tempol on Experimental Acute Necrotizing Pancreatitis Model in Rats.

AIM: We aimed to investigate the effects of Tempol on local organ damage in an experimental acute pancreatitis model. METHODS: This experimental study was conducted on 40 male Wistar- albino rats. The animals were randomly allocated into four groups: (i) Sham-operated group, laparotomies and cannulations of the pancreatic duct without acute necrotizing pancreatitis (ANP) (n=10); (ii) Sham + Tempol group, identical to group 1 except for intravenous tempol treatment for 4 hours (n = 10); (iii) ANP group, glycodeoxycholic acid was infused into the pancreatic duct and cerulein was infused intravenously for 6 hours for development of ANP (n=10); and (iv) ANP + Tempol treated group, in addition to the procedure in group 3, rats were administered tempol intravenously for 4 hours (n = 10). Injury of the pancreas was evaluated histopathologically. Malondialdehyde and myeloperoxidase levels of the pancreatic tissue, blood gas analysis, leukocyte and hematocrit levels were measured. Wet/dry weight of pancreatic tissue was also measured. RESULTS: Serum amylase levels, pancreatic tissue malondialdehyde and myeloperoxidase levels, wet/dry weight ratio, pancreatic edema, acinar necrosis, fat necrosis and hemorrhage, inflammation and perivascular infiltration were significantly lower in the ANP + Tempol group compared with the ANP group. CONCLUSION: Tempol infusion reduced local organ damage due to acute necrotizing pancreatitis in this experimental study. These findings demonstrate that tempol has protective effects on local organ damage due to acute necrotizing pancreatitis in rats.

The analysis of scoring systems predicting mortality in geriatric emergency abdominal surgery.

BACKGROUND: Accurate measurement of surgical outcomes, proper evaluation of hospitals and surgeons regardless of case can be performed by mortality prediction models. The aim of this study was to analyze factors affecting mortality, present our clinical experience and patient profile and evaluate different scoring systems in use of these patients. METHODS: A retrospective review of one hundred and twelve geriatric patients who underwent major abdominal emergency surgery between 2004 and 2008 was performed. APACHE II, ODIN, SAPS II expanded, P-POSSUM, Manheim peritonitis and Charlson comorbidity index, Goldman and ASA scores were calculated using patient data. Sensitivity, positive predictive value and Odd's ratio were calculated to predict the mortality for these scoring systems. RESULTS: The overall mortality rate for our patients was found 33.9%. The factors affecting mortality in this study were found to be the duration of initial complaint, requirement of intensive care unit, requirement of mechanical ventilation and its duration, the presence of coexisting disease and peritonitis. CONCLUSION: According to our study, in this particular group of patients, APACHE II scoring system is more valid and accurate in estimating the mortality risk when compared to other scoring systems.

Effects of oriental sweet gum storax on porcine wound healing.

PURPOSE: The objective of the present study was to assess the effects of oriental sweet gum (Liquidambar orientalis Mill.) storax on partial-thickness and full-thickness wounds compared to conventional wound dressings in a porcine model. METHODS: Six young Yorkshire pigs were used. Sixteen square excisional wounds measuring 3 × 3 cm were performed per animal. The wounds were allocated to one of the four treatment modalities: storax, hydrocolloid dressing, silver sulfadiazine, and control groups. Partial-thickness wounds were created in two pigs, and tissue samples were harvested on days 4 and 8, respectively. Full-thickness wounds were created in four pigs, and tissue samples were taken on days 4, 8, 14, and 21, respectively. Histologically, all wounds were examined for re-epithelialization and granulation tissue formation. Tissue hydroxyproline content and wound contraction areas were measured. RESULTS: In storax-applied group, there was a greater depth of granulation tissue at 4 and 8 days compared to all other groups (p < .0125), and there was a faster re-epithelialization at 21 days compared to both hydrocolloid dressing and control groups in full-thickness wounds (p < .0125). Tissue hydroxyproline content and wound contraction did not differ significantly between the groups. CONCLUSION: The results of this study indicate that topical application of storax enhanced both re-epithelialization and granulation tissue formation in full-thickness wounds. Further studies are indicated in this important area of wound healing research to evaluate the clinical efficacy of this storax and search for the mechanisms that explain its effects.

A trial of midazolam vs diphenhydramine in prophylaxis of metoclopramide-induced akathisia.

STUDY OBJECTIVE: The study aimed to evaluate the effects of midazolam and diphenhydramine for the prevention of metoclopramide-induced akathisia. METHODS: This randomized, double-blind, and controlled trial aimed to investigate coadministered midazolam vs diphenhydramine in the prophylaxis of metoclopramide-induced akathisia. Patients 18 to 65 years of age who presented to the emergency department with primary or secondary complaints of nausea and/or moderate to severe vascular-type headache were eligible for this study. Patients were randomized to one of the fallowing 3 groups: (1) metoclopramide 10 mg + midazolam 1.5 mg; (2) metoclopramide 10 mg + diphenhydramine 20 mg; (3) metoclopramide 10 mg + placebo. Metoclopramide was administered as a 2-minute bolus infusion. Midazolam, diphenhydramine, and normal saline solution were administered as a 15-minute slow infusion. The whole procedure was observed; and akathisia and sedation scores and vital changes were recorded. RESULTS: There were significant differences among groups with respect to akathisia (P = .016) and sedation (P < .001). The midazolam group showed the lowest mean akathisia score but the highest mean sedation score. Akathisia scores of the diphenhydramine group were not different from placebo. There were significant differences among groups in terms of changes in mean vital findings such as respiration rates, pulse rates, and systolic blood pressures (P < .05). There were no significant difference among groups in terms of changes in mean diastolic blood pressures (P = .09). CONCLUSION: Coadministered midazolam reduced the incidence of akathisia induced by metoclopramide compared to placebo but increased the rate of sedation. No difference was detected from diphenhydramine. Routine coadministered 20 mg diphenhydramine did not prevent metoclopramide-induced akathisia.

What would be left behind if subtotal thyroidectomy were preferred instead of total thyroidectomy?

BACKGROUND: The choice between subtotal thyroidectomy (STT) and total thyroidectomy (TT) for multinodular goiter (MNG) remains controversial. METHODS: Thyroid tissue samples of 34 patients who underwent TT for multinodular disease between October 2005 and June 2007 in Pamukkale University Hospital, Department of General Surgery were evaluated. Thyroid tissues weighing 2 g each from either side were separated from the main specimen to simulate the tissues that would be left behind if a subtotal resection were performed instead of a total resection. Ki-67 staining was performed. RESULTS: The mean age of subjects was 49.3 +/- 12 years and 25 (73.5%) were females. Papillary microcarcinomas were found in 4 patients, 1 of which was in a residual thyroid specimen (RTS). Micronodule formations were found in 73.5% of specimens simulating residual thyroid. While Ki-67 indexes of residual thyroid tissues were 4.65% in nodules and 1.91% in normal areas (P < .05), they were 5.42% and 2.84%, respectively, for nodular and normal areas in the main specimens (P < .05). CONCLUSION: Remnant thyroid tissues, following STT, have a high percentage of micronodule formation with a remarkable cellular proliferative activity.

Appendicolithiasis causing diagnostic dilemma: a rare cause of acute appendicitis (report of a case).

Appendicolithiasis is a condition characterized by a concretion in the vermiform appendix. Appendicoliths are found in 10% of patients with acute appendicitis, but they are seen more frequently in perforated appendicitis and in abscess formation. We herein report a case of acute appendicitis due to appendicolithiasis, which mimics acute disorders of the genitourinary tract and causes diagnostic confusion. A38- year-old man presented to our emergency department with a history of intense, acute, recurrent, crampy right lower quadrant pain radiating to the right groin region, accompanied by nausea. Physical examination revealed muscular defense and rebound tenderness in the right lower quadrant, tenderness in the line of the right ureter and right costovertebral angle tenderness. On X-ray examination, a right kidney stone was identified as was an incidental 3-cm density in the right lower quadrant. The patient underwent appendectomy. The diagnosis was made by operation and also X-ray examination of the appendectomy material showing appendicolithiasis. Acute appendicitis may manifest as a variety of genitourinary disorders. The possibility of an appendicolith with or without acute appendicitis must always be considered in the differential diagnosis of acute lower abdominal and pelvic disorders, and in the consideration of common acute urological disorders.

Primary infiltrating ductal carcinoma arising in aberrant breast tissue of the axilla: a rare entity. Report of a case.

A 52-year-old woman presented with a palpable nodule in the right axilla. Physical examination revealed a 2.5 x 2.5 cm, nontender, firm, brownish, and peripherally hyperemic mass with overlying skin retraction on the right anterior axillary fold. Bilateral mammogram was negative. Ultrasonography of the right axillary region showed a 1.8 x 1.1 cm, poorly defined hypoechoic mass with irregular margins and posterior acoustic shadowing. Fine-needle aspiration biopsy of the mass revealed malignant epithelial cells. The patient underwent a wide local excision of the right axillary lesion with en bloc axillary lymph node dissection. Histopathological examination revealed an infiltrating ductal carcinoma. Here we report this case of carcinoma originating from aberrant breast tissue in the axilla. It is suggested that subcutaneous lesions of uncertain origin around the periphery of the breast should be suspected for breast carcinoma and treated appropriately.

Effects of tempol, a membrane-permeable radical scavenger, on local and remote organ injuries caused by intestinal ischemia/reperfusion in rats.

BACKGROUND: Tempol is a stable piperidine nitroxide of low molecular weight that permeates biological membranes and scavenges superoxide anions in vitro. In a variety of animal models, deleterious effects of reperfusion injury on both local and remote organs have been demonstrated. In this study, we aimed to investigate the effects of a membrane-permeable radical scavenger, Tempol, on local and remote organ injuries caused by intestinal ischemia/reperfusion (I/R) in rats. MATERIALS AND METHODS: Male Wistar-albino rats were randomized into three groups: (I) Sham-operated control group, laparotomy without I/R injury (n = 12); (II) Intestinal I/R group, 60 min of ischemia by superior mesenteric artery occlusion followed by 2-h of reperfusion (n = 12); and (III) I/R + Tempol-treated group, identical to I/R group except for Tempol administration, 30 mg/kg bolus injection 5 min before reperfusion, followed by an infusion of 30 mg/kg/h intravenously (n = 12). Histopathologically, intestinal mucosal lesions were assessed by Chiu's classification, and pulmonary parenchymal damage was appraised by pulmonary neutrophil infiltration and acute lung injury scaling. Biochemically, myeloperoxidase activity, malondialdehyde, glutathione, and nitrite/nitrate (NO(x)) levels were determined in both intestinal mucosa and lung parenchyma. Evans blue dye concentration and organ wet/dry weight ratios were used as a marker of organ edema. Animal survival was observed up to 1 week. RESULTS: Intestinal mucosal lesions and pulmonary parenchymal damage were significantly attenuated with Tempol treatment, histopathologically (P < 0.05). Tempol administration significantly reduced myeloperoxidase activity and malondialdehyde levels, and also significantly increased glutathione and NO(x) levels of both intestinal and lung tissues, biochemically (P < 0.05). Evans blue dye extravasation and wet/dry weight ratios of organs were significantly reduced with Tempol injection (P < 0.05). The survival rates of rats in Tempol-treated group were significantly higher than that of I/R-treated group (P < 0.05). CONCLUSIONS: The present study suggests that Tempol administration significantly reduces both local and remote organ injuries caused by intestinal I/R before and throughout the reperfusion period. Further clinical studies are needed to clarify whether Tempol may be a useful therapeutic agent to use in particular operations where the reperfusion injury occurs.

The clinical features of Fournier's gangrene and the predictivity of the Fournier's Gangrene Severity Index on the outcomes.

Fournier's gangrene (FG) is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions. Several factors have been reported to contribute to the clinical outcomes. The primary aims of this study were to examine the clinical features of patients with FG and evaluate the predictivity of the Fournier's Gangrene Severity Index (FGSI) score on the outcomes. We carried out a collective retrospective chart review of patients diagnosed and treated for FG in three reference centers between January 1995 and July 2007. Seventy-two patients with FG with were included to the study. Data were collected on medical history, symptoms, physical examination findings, admission and final laboratory tests, timing and extent of surgical debridement and antibiotic therapy. Perianal and perirectal abscess, scrotal abscess and urethral stenosis were the leading etiological factors. Diabetes mellitus was the predominant risk factor. Etiological factors and risk factors did not significantly contribute to survival or mortality, and duration of the symptoms was significantly longer in the non-survivor's group (P < 0.05). The FGSI scores were higher in the non-survivor's group. Regression analysis showed a FGSIS score of 10.5 as the cut-off to the outcome. Based on these results, we conclude that a patient's metabolic status and the extent of disease at presentation are the most important factors determining the prognosis of FG. The FGSI score may be considered as an objective and simple tool to predict the outcome in the patient with FG and should be used in further studies of FG patient series for comparison purposes.

Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma.

BACKGROUND: A number of large series' have attempted to examine the management of blunt solid organ injuries; however, only a few studies regarding multiple injuries exist. The aim of this study is to analyze whether multiple solid organ injury affects nonoperative management (NOM) and to look for predictive factors of NOM. METHODS: All patients admitted with a diagnosis of blunt solid organ injury between January 1, 1999 and January 1, 2005 were included in this prospective observational study. Of the 468 patients who had solid organ injury, 46 patients met the inclusion criteria of multiple solid organ injuries. Presentation, mechanism of injury, injury grade, Abbreviated Injury Scale score, management, and outcomes were analyzed. Independent predictive factors of NOM failure were identified. Patients managed nonoperatively were compared with patients who had had emergent laparotomy and patients for whom NOM failed. RESULTS: Fifteen patients (33%) underwent emergency laparotomy because of hypovolemic shock that was unresponsive to aggressive resuscitation, and 31 (66%) were selected for NOM. Among the 31 patients, NOM was successful in 23 (75%). No specific organ injury combination was found to affect NOM failure. Admission lactate level [odds ratio(OR), 1.44; 95% confidence interval (CI), 1.05-1.98; p = 0.025], a drop in the hematocrit greater than 20% in the first hour after admission (OR, 1.13; 95% confidence interval CI, 1.04-1.24; p = 0.007), and solid viscus score (OR, 1.67; 95% CI, 1.03-2.80; p = 0.04) were significant independent risk factors in those patients for whom NOM failed. In logistic regression analysis, hypotension at admission (OR, 0.96; 95% CI, 0.92-0.99; p = 0.014) and transfusion in the first 6 hours after admission (OR, 1.03; 95% CI, 1.00-1.05; p = 0.015) were found to significantly affect the success rate of nonoperative management. CONCLUSION: Lactate levels at admission, solid viscus score, necessity of transfusion, crystalloid resuscitation, and a drop in the hematocrit in the first hour after admission are useful parameters for judging the failure of NOM. Although there is a higher failure rate of NOM in multiple solid organ injury, NOM can still be considered in these cases with extra caution.

The effect of different temporary abdominal closure techniques on fascial wound healing and postoperative adhesions in experimental secondary peritonitis.

BACKGROUND: Secondary peritonitis causes considerable mortality and morbidity. New strategies have been introduced like relaparotomy and temporary abdominal closure in the management of such persistent intra-abdominal infections. MATERIALS AND METHODS: Rats were divided into five groups each having ten animals. After induction of peritonitis, relaparotomies were done, and the abdomen was closed by different temporary abdominal closure techniques. After performing two relaparotomies during a 48-h period, all fascias closed primarily and incisional tensile strengths, hydroxyproline contents, and adhesions were measured on the following seventh day. RESULTS: The median values of tensile strength and hydroxyproline concentrations were lowest in skin-only closure rats. Intraperitoneal adhesion scores were highest in Bogota bag closure group. CONCLUSION: Primary, Bogota bag, and polyprolene mesh closures seem to be safe in terms of early fascial wound healing. Although it is easy to perform, skin-only closure technique has deleterious effects on fascial wound healing probably due to fascial retraction. Interestingly, Bogota bag has caused increased intraperitoneal adhesion formation.

Pyrrolidine dithiocarbamate prevents 60 minutes of warm mesenteric ischemia/reperfusion injury in rats.

BACKGROUND: Pyrrolidine dithiocarbamate (PDTC) is a low-molecular-weight thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. It has been shown to attenuate harmful effects of ischemia/reperfusion (I/R) injury in many organs. In recent animal studies, destructive effects of reperfusion injury has been demonstrated. In this study, we aimed to investigate whether PDTC prevents harmful effects of superior mesenteric I/R injury in rats. METHODS: Wistar-albino rats were randomly allocated into the following 4 groups: (1) sham-operated group--these animals underwent laparotomy without I/R injury (group I, n = 12); (2) sham+PDTC group--identical to sham-operated rats except for the administration of PDTC (100 mg/kg intravenous bolus) 30 minutes prior to the commencement of the experimental period (group II, n = 12); (3) I/R group--these animals underwent laparotomy and 60 minutes of ischemia followed by 120 minutes of reperfusion (group III, n = 12); (4) PDTC-treated group (100 mg/kg, intravenously, before the I/R, group IV, n = 12). All animals were killed, and intestinal tissue samples were obtained for investigation of intestinal mucosal injury, myeloperoxidase (MPO) activity, malondialdehyde (MDA) levels, glutathione (GSH) levels, and intestinal edema. RESULTS: There was a statistically significant decrease in GSH levels, along with an increase in intestinal mucosal injury scores, MPO activity, MDA levels, and intestinal tissue wet-to-dry weight ratios in group III when compared to groups I, II, and IV (P < .05). However, PDTC treatment led to a statistically significant increase in GSH levels, along with a decrease in intestinal mucosal injury scores, MPO activity, MDA levels, and intestinal tissue wet-to-dry weight ratios in group IV (P < .05). CONCLUSIONS: This study showed that PDTC treatment significantly prevented the reperfusion injury caused by superior mesenteric I/R. Further clinical studies are needed to clarify whether PDTC may be a useful therapeutic agent to use in particular operations where the reperfusion injury occurs.

Pyrrolidine dithiocarbamate prevents deleterious effects of remote ischemia/reperfusion injury on healing of colonic anastomoses in rats.

BACKGROUND: Pyrrolidine dithiocarbamate (PDTC) is a low-molecular-weight thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. It has been shown to attenuate local harmful effects of ischemia/reperfusion (I/R) injury in many organs. In recent animal studies, a delaying effect of remote organ I/R injury on the healing of colonic anastomoses has been demonstrated. In this study we investigated whether PDTC prevents harmful systemic effects of superior mesenteric I/R on left colonic anastomosis in rats. METHODS: Anastomosis of the left colon was performed in 40 rats randomly allocated into the following four groups: (1) Sham-operated group (group I, n = 10)-simultaneously with colonic anastomosis, the superior mesenteric artery and collateral branches divided from the celiac axis and the inferior mesenteric artery were isolated but not occluded. (2) Sham+PDTC group (group II, n = 10)-identical to sham-operated rats except for the administration of PDTC (100 mg/kg IV bolus) 30 minutes prior to commencing the experimental period. (3) I/R group (group III, n = 10)-60 minutes of intestinal I/R by superior mesenteric artery occlusion. (4) PDTC-treated group (group IV, n = 10)-PDTC 100 mg/kg before and after the I/R. On postoperative day 6, all animals were sacrificed, and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for investigation of anastomotic hydroxyproline (HP) contents, perianastomotic malondialdehyde (MDA) levels, myeloperoxidase activity (MPO), and glutathione (GSH) level. RESULTS: There was a statistically significant decrease in anastomotic bursting pressure values, tissue HP content and GSH level, along with an increase in MDA level and MPO activity in group III, when compared to groups I, II, and IV (p < 0.05). However, PDTC treatment led to a statistically significant increase in anastomotic bursting pressure values, tissue HP content and GSH level, along with a decrease in MDA level and MPO activity in group IV (p < 0.05). CONCLUSIONS: This study showed that PDTC treatment significantly prevented the delaying effect of remote organ I/R injury on anastomotic healing in the colon. Further clinical studies are needed to clarify whether PDTC may be a useful therapeutic agent for increasing the safety of the anastomosis during particular operations where remote organ I/R injury occurs.

Pyrrolidine dithiocarbamate reduces lung injury caused by mesenteric ischemia/reperfusion in a rat model.

BACKGROUND: Pyrrolidine dithiocarbamate (PDTC) is a low-molecular thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. It has been shown to attenuate local harmful effects of ischemia/reperfusion (I/R) injury in many organs. In this study, we aimed to study the effect of PDTC on lung reperfusion injury induced by superior mesenteric occlusion. METHODS: Male Wistar-albino rats randomized into three groups: (1) sham-operated control group (n = 12), laparotomy without I/R injury; (2) intestinal ischemia/reperfusion (I/R) group (n = 12), 60 min of ischemia by superior mesenteric occlusion followed by 2 h of reperfusion; and (3) I/R+PDTC-treated group (n = 12), 100 mg/kg injection of PDTC intravenously, 30 min after the commencement of reperfusion. Evans blue dye was injected to half of rats in all groups before the induction of I/R. We assessed the degree of pulmonary tissue injury biochemically by measuring malondialdehyde (MDA), glutathione (GSH), and nitric oxide (NO) levels, and histopathologically by establishing pulmonary neutrophil sequestration and acute lung injury scoring. Pulmonary edema was evaluated by Evans blue dye extravasation, as well as lung tissue wet/dry weight ratios. RESULTS: Pyrrolidine dithiocarbamate treatment significantly reduced the MDA and NO levels, and increased the GSH levels in the lung parenchyma, biochemically (p < 0.05), and atteneuated the pulmonary parenchymal damage, histopathologically (p < 0.05). However, pulmonary neutrophil sequestration was not affected by postischemic treatment with PDTC (p > 0.05). Pyrrolidine dithiocarbamate administration also significantly alleviated the formation of pulmonary edema, as evidenced by the decreased Evans blue dye extravasation and organ wet/dry weight ratios (p < 0.05). CONCLUSIONS: This study showed that postischemic treatment with PDTC significantly attenuated the lung reperfusion injury. Further clinical studies are needed for better understanding of the specific mechanisms of PDTC protection against I/R-related organ injury and to clarify whether PDTC may be a useful therapeutic agent during particular operations where remote organ I/R injury occurs.

Effects of a membrane-permeable radical scavenger, Tempol, on healing of colonic anastomoses in the cecal ligation and puncture model of polymicrobial sepsis in rats.

BACKGROUND: Tempol (Sigma-Aldrich, Steinheim, Germany) is a stable piperidine nitroxide of low molecular weight that permeates biologic membranes and scavenges superoxide anions in vitro. In recent animal studies, the delaying effect of intraperitoneal sepsis on the healing of colonic anastomoses has been shown. In this study we aimed to investigate the effects of Tempol on the healing of colonic anastomoses in the presence of polymicrobial sepsis. METHODS: Anastomosis of the left colon was performed on the day after cecal ligation and puncture (CLP) in 30 rats that were divided into 3 groups: sham-operated control (laparotomy and cecal mobilization, group I, n = 10), CLP (group II, n = 10), Tempol-treated group (30 mg/kg intravenously before the construction of colonic anastomosis, group III, n = 10). On postoperative day 6, all animals were killed and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for further investigation of anastomotic hydroxyproline (HP) contents, perianastomotic myeloperoxidase (MPO) activity, malondialdehyde (MDA), and glutathione (GSH) levels. RESULTS: There was a statistically significant increase in MPO activity and MDA levels in the CLP group (group II), along with a decrease in GSH levels, anastomotic HP contents, and bursting pressure values when compared with controls (group I). However, Tempol treatment led to a statistically significant increase in anastomotic bursting pressure values, tissue HP contents, and GSH levels, along with a decrease in MPO activity and MDA levels in group III (P < .05). CONCLUSIONS: This study showed that Tempol treatment significantly prevented the delaying effect of CLP-induced polymicrobial sepsis on anastomotic healing in the left colon. Further clinical studies are needed to clarify whether Tempol may be a useful therapeutic agent to increase the safety of the anastomosis during particular surgeries in which sepsis-induced organ injury occurs.

Ectopic pancreas of the gastric antrum contiguous to a gastrointestinal stromal tumor manifesting as upper gastrointestinal bleeding: report of a case.

A 54-year-old woman was referred to us for investigation of recurrent episodes of melena. Gastroduodenal endoscopic examination revealed a hemorrhagic, polypoid tumor, about 3 cm in diameter, in the posterior wall of the gastric antrum, near the greater curvature. The lesion had a smooth surface with ulceration, and was fixed to the sublying planes. The source of the bleeding was the mucosa overlying the tumor. We performed a distal subtotal gastrectomy with Roux-en-Y anastomosis. Histopathological examination of the resected specimen revealed an ectopic pancreas and a gastrointestinal stromal tumor contiguous to the ectopic pancreatic tissue in the gastric antrum. The patient was discharged after an uneventful postoperative course and has not experienced any recurrence of symptoms since.

Interleukin-10 gene transfer: prevention of multiple organ injury in a murine cecal ligation and puncture model of sepsis.

INTRODUCTION: The aim of this study was to determine the effect of immunoregulatory cytokine interleukin-10 (IL-10) gene therapy on multiple organ injury (MOI) induced by a cecal ligation and puncture (CLP) model of sepsis in mice. METHODS: Male Balb/c mice subjected to CLP were treated with either an hIL-10-carrying vector or an empty control vector. We assessed the degree of lung, liver, and kidney tissue destruction biochemically by measuring myeloperoxidase (MPO) and malondialdehyde (MDA) activity. Histologic assessments were based on neutrophil infiltration in lung and liver tissue. IL-10 protein expression was examined immunohistochemically, and ultrastructural changes in the liver were studied by transmission electron microscopy. We analyzed the expression of tumor necrosis factor-alpha (TNFalpha) mRNA by reverse transcription polymerase chain reaction 3, 8, and 24 hours after CLP in all organs. RESULTS: Organ damage was significantly reduced by hIL-10 gene transfer, which was associated at the tissue level with reduced MPO activity in the liver, lung, and kidney and decreased leukocyte sequestration and MDA formation in the lung. The liver MDA was not significantly higher in the hIL-10 gene therapy group than in the controls and seemed not to be affected by hIL-10 gene transfer. The reduced portal tract neutrophilic infiltration and preserved ultrastructure of the hepatocytes also showed that tissue function was not impaired. The lung and kidney TNFalpha mRNA expression was suppressed markedly in the hIL-10 gene therapy group, but liver TNFalpha mRNA expression varied over time. CONCLUSIONS: These findings showed that IL-10 gene therapy significantly attenuated sepsis-induced MOI.

Tempol prevents harmful effects of remote ischemia reperfusion injury on healing of experimental colonic anastomoses.

BACKGROUND AND AIMS: Tempol (4-hydroxy-2,2,6,6-tetramethylpiperidine-N-oxyl) is a water-soluble analogue of the spin label TEMPO. As an antioxidative agent, it is a member of nitroxides, which detoxifies superoxide and possibly other toxic radicals in vivo. In this study, we aimed to investigate whether tempol prevents harmful systemic effects of superior mesenteric ischemia-reperfusion on left colonic anastomosis in rats. MATERIALS AND METHODS: Anastomosis of the left colon was performed in 30 rats that were divided into three groups each having ten animals: sham-operated control (group I), 60 min of intestinal ischemia-reperfusion by superior mesenteric artery occlusion (group II), and tempol-treated group (30 mg/kg before and after the ischemia-reperfusion (group III). On postoperative day 5, all animals were killed and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for further investigation of anastomotic hydroxyproline content, perianastomotic malondialdehyde, and glutathione levels. RESULTS: There was a statistically significant increase in the quantity of myeloperoxidase activity and malondialdehyde levels in group II, along with a decrease in glutathione levels, anastomotic hydroxyproline content, and bursting pressure values when compared to controls. However, all of the investigated parameters were normalized in tempol-treated animals (group III). CONCLUSION: We conclude that tempol significantly prevents harmful systemic effects of reperfusion injury on colonic anastomoses in a rat model of superior mesenteric artery occlusion.

Effects of pyrrolidine dithiocarbamate on healing of colonic anastomoses in the cecal ligation and puncture model of intraperitoneal sepsis in rats.

INTRODUCTION: Pyrrolidine dithiocarbamate (PDTC) is a low-molecular thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. In recent animal studies, the delaying effect of intraperitoneal sepsis on healing of colonic anastomoses has been demonstrated. In this study, we aimed to investigate the effects of PDTC on healing of colonic anastomoses in the presence of intraperitoneal sepsis induced by a rodent model of cecal ligation and puncture (CLP). METHODS: Anastomosis of the left colon was performed on the day following CLP in 30 rats that were divided into three groups: sham-operated control (laparotomy and cecal mobilization, group I, n =10), cecal ligation and puncture (CLP) (group II, n = 10), PDTC-treated group (100 mg/kg IV before construction of the colonic anastomosis) (group III, n = 10). On postoperative day 6, all animals were sacrificed, and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for further investigation of colonic anastomotic hydroxyproline (HP) contents, perianastomotic myeloperoxidase (MPO) activity, and malondialdehyde (MDA) and glutathione (GSH) levels. RESULTS: There was a statistically significant increase in the activity of MPO and MDA levels in the CLP group (group II) along with a decrease in GSH levels, colonic anastomotic HP contents, and bursting pressure values when compared to controls (group I). However, PDTC treatment led to a statistically significant increase in the tissue HP contents, GSH levels, and colonic anastomotic bursting pressure values, along with a decrease in MPO activity and MDA levels in group III (p < 0.05). CONCLUSIONS: This study showed that PDTC treatment significantly prevented the delaying effect of CLP-induced intraperitoneal sepsis on anastomotic healing in the colon. Further clinical studies are needed to clarify whether PDTC may be a useful therapeutic agent to increase the safety of the anastomosis during particular operations where sepsis-induced injury occurs.