Role of alkaline phosphatase intestine-isomerase in acute mesenteric ischemia diagnosis.

BACKGROUND: The aim of the present study was to investigate the diagnostic value of alkaline phosphatase (ALP) intestine-isomerase, plasma lactate dehydrogenase (LDH), and D-dimer levels in acute mesenteric ischemia. METHODS: Thirty Wistar rats were divided into 5 groups of 6 rats each. In Group 1, blood samples were obtained to determine normal parameter levels. In the sham group, Group 2, blood samples were obtained following laparotomy. In Group 3, blood samples were obtained 2 hours after ligation. In Groups 4 and 5, blood samples were obtained at 4 and 6 hours after ligation, respectively. Ischemic damage was assessed using a pathological scoring system. Blood samples were analyzed for hourly changes in parameters. RESULTS: No statistically significant difference in D-dimer levels was found between ischemia groups (p=0.337). A statistically significant difference in LDH levels was found between the control group, Group 1, and Group 4 (p=0.018). ALP intestine-isomerase enzyme levels were not statistically significant in other groups (p=0.077). CONCLUSION: Findings indicate that plasma LDH levels higher than 1900 IU/L may be a useful marker in the early diagnosis of acute mesenteric obstruction. However, ALP intestine-isomerase enzyme and D-dimer plasma levels were not found to contribute to the diagnosis.

Is cetrimide-chlorhexidine risky for secondary sclerosing cholangitis?

BACKGROUND: The liver is the most frequent organ for placement of hydatid cyst disease. All known protoscolicidals that are used for echinococcus degeneration have a risk of caustic secondary sclerosing cholangitis. The cetrimide-chlorhexidine combination is an effective protoscolicidal agent for treatment of hydatid liver cysts. OBJECTIVES: The aim of this experimental study was to examine this combination for potential risks of caustic secondary sclerosing cholangitis. MATERIAL AND METHODS: Thirty rats were enrolled and divided into two groups. In the study group, 0.15 mL of a cetrimide (0.5%) and chlorhexidine (0.05%) combination was injected into the bile ducts for five minutes. The control group included the same amount of normal saline and waiting period. The rats were followed for 120 days and the living rats were examined for biliary injury by biochemical analysis and histopathology. RESULTS: No specific histopathological findings for caustic sclerosing cholangitis such as bile duct stricture or periductal fibrosis were present in any groups. Other pathological criteria demonstrating inflammation including portal inflammation, bile duct proliferation and necrosis were similar in both groups. Biochemical analysis including a liver function test (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyltranspeptidase) appeared similar to the control group. CONCLUSIONS: A cetrimide 0.5% and chlorhexidine 0.05% combination has similar liver function results and histopathological effects to normal saline on bile ducts and it appears to be safe for bile ducts.

Is neopterin a diagnostic marker of acute appendicitis?

BACKGROUND: The diagnosis of acute appendicitis, even for experienced surgeons, can sometimes be complex. A delay in diagnosis increases the complication rate. This experimental study aimed to investigate the suitability and significance of neopterin as a marker for acute appendicitis. METHODS: The levels of neopterin were measured using an acute appendicitis animal model in 35 New Zealand male rabbits. They were divided into 5 groups as Group 1= control; Group 2= sham; and Groups 3 (12-hour); 4 (24-hour); and 5 (48-hour) (based on the elapsed time period before their appendectomies). The neopterin levels of each group were measured by neopterin enzyme immunoassay kit in blood samples (taken before the appendectomies in Groups 3, 4 and 5). RESULTS: For the diagnosis of acute appendicitis, the optimal cut-off point was 34.475 nmol/L. The probability of acute appendicitis was found to be 4.667 times higher when the neopterin level was greater than 34.475 nmol/L. CONCLUSION: This study was an experimental animal study; however, it provides valuable clues useful in clinical assessment. Neopterin seems to have great potential as a new diagnostic marker for the diagnosis of acute appendicitis.

Predicting the likelihood of nonsentinel lymph node metastases in triple negative breast cancer patients with a positive sentinel lymph node: Turkish Federation of Breast Disease Associations protocol MF09-01.

BACKGROUND: Triple negative (TN) tumor has a relatively high rate of recurrence and distant metastasis, but results of studies revealed that triple positive tumor is an independent predictor of axillary lymph node involvement. Our aim was to evaluate the frequency of nonsentinel lymph node metastasis (NSLNM) involvement in operable TN breast cancer with positive sentinel lymph node (SLN) and predicting the likelihood of NSLNM in this cohort of patients by using 4 different nomograms. METHODS: A total of 128 patients with TN and SLN(+) underwent complete axillary lymph node dissection in 14 different centers in Turkey. For comparison, we used our previous multicenter MF08-01 Protocol, which identified 441 patients with estrogen receptor (ER(+)) who had a positive SLN biopsy and underwent subsequent complete axillary lymph node dissection. Turkish, Cambridge, and Stanford nomograms and the Tenon Score system were used to calculate the probability of NSLNM. RESULTS: Patients with TN tumor had a larger tumor size. The actual percentage of NSLN positivity was 41% in the TN group and 47.1% in patient with ER(+). The Tenon Score was ≤3.5 in 12% of patients with TN and ER(+); the area under the curve in the receiver operating characteristics curve were 0.53 and 0.59, respectively. Based on the Turkish, Cambridge, and Stanford nomograms, areas under the curve were 0.54, 0.53, and 0.61, respectively in patients with TN, and were 0.79, 0.72, and 0.70, respectively, in patients with ER(+). CONCLUSION: Using the Tenon Score system underestimates NSLN positivity, and tested nomograms are not good discriminators of NSLNM in patients with TN and positive SLN.

Can D-dimer become a new diagnostic parameter for acute appendicitis?

INTRODUCTION: In this study, we investigated D-dimer serum level as a diagnostic parameter for acute appendicitis. MATERIALS AND METHODS: Forty-nine patients were enrolled in the study. Patients were classified according to age; sex; duration between the beginning of pain and referral to a hospital or clinic; Alvarado scores; and in physical examination, presence of muscular defense, the number of leukocytes, preoperative ultrasonography, and D-dimer levels of histopathologic study groups were analyzed. RESULTS: Of the patients enrolled in the study, 26.5% were females and 73.5% males. The average age was 21 years (range, 16-38 years) and 81.7% acute appendicitis (AA). According the duration of pain, 63.2% of the patients were referred to the hospital within the first 24 hours, 26.5% of the patients were referred to the hospital within 24 to 48 hours, and 10.3% were referred to the hospital within a period of more than 48 hours. No statistically significant difference was determined regarding D-dimer levels between the histopathologic study groups (P > .05). Alvarado scores lower than 7 were found in 36.7% and 7 or higher in 63.3% of the patients. There was no statistically significant difference related with D-dimer levels between histopathologic study groups (P > .05). The ratio of cases with a number of leukocytes below the upper limit were determined respectively as 32.7% and 67.3%, and no statistically significant difference was found regarding d-dimer levels between histopathologic study groups (P > .05). CONCLUSION: Increased D-dimer levels should not be considered as a diagnostic parameter in diagnosis of acute appendicitis.

The importance of urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis.

PURPOSE: Acute appendicitis is one of the most common surgical emergencies. Diagnosis is usually made depending on the presenting history, clinical evaluation, and laboratory tests. The aim of this study was to investigate the role of urinary 5-hydroxyindoleacetic acid (U-5-HIAA) in the early diagnosis of acute appendicitis. METHODS: Thirty-five pigmented male rabbits were divided into 5 groups. Group 1 is the control (n = 7); group 2 is the sham (n = 10). The appendix was ligated from its base, and an appendectomy was performed after 12, 24, 36 hours in group 3 (n = 7), group 4 (n = 7), and group 5 (n = 7), respectively. Spot urine samples were obtained for U-5-HIAA determination, and appendectomy tissues were examined histopathologically. RESULTS: Acute appendicitis was diagnosed in all animals in group 3, group 4, and group 5, and the mean levels of U-5-HIAA in group 3 were higher than in the other groups. The mean of U-5-HIAA levels between animals with appendicitis and those without showed a significant difference (P = .003). The U-5-HIAA cutoff point of 4.15 mg/g creatinine had a sensitivity of 85%, a specificity of 64.29%, and an accuracy of 76% (area under curve = 0.805) for acute appendicitis. The probability of acute appendicitis is found to be 10, 2 times more when the U-5-HIAA level is greater than 4.15 mg/g creatinine. CONCLUSION: We have concluded that spot U-5-HIAA level increases significantly in the early stages of acute appendicitis.

[A rare cause of bleeding intestinal intussusception in adult: jejunal lipoma]. / Eriskinde nadir bir intestinal intussusepsiyon ve kanama nedeni: Jejunal lipom.

Small bowel neoplasms are usually diagnosed when patients are referred with complications such as hemorrhage or obstruction. Intestinal lipomas are the third most frequent benign tumors among all intestinal neoplasms and their definite diagnosis is usually obtained after histopathological examination of the resected specimen. A 76 year-old male patient with partial intestinal obstruction and rectal bleeding at admittance was found to have an abdominal mass on ultrasound. The density pattern of the mass at abdominal CT was supporting a jejunal lipoma leading an intussusception. Then an enteroclysis localized and reduced the jejunojejunal intussusception. The diagnosis of lipoma was confirmed with histopathological examination of the mass removed by an elective intestinal resection. This case was reported as the intestinal lipoma leading a jejunojejunal intussusception associated with bleeding, could be diagnosed preoperatively.

Placement technique and the early complications of balloon breast brachytherapy: Magee-Womens Hospital experience.

BACKGROUNDS AND OBJECTIVES: Open (OT) and percutaneous closed (PCT) techniques have been described for placement of the MammoSite catheter to deliver accelerated partial breast brachytherapy. We report early complications of both techniques. METHODS: A total of 125 patients underwent catheter placement for MammoSite high-dose rate brachytherapy, with 108 patients successfully completing treatment. The OT was used in 85 patients and PCT in 40 patients. The mean distance between the balloon surface and breast skin was 1.44 cm and 1.31 cm, respectively. Average skin dose was 278 cGy in the OT group and 295 cGy in the PCT group (P > 0.05). Average gross specimen size was 43.16 cm3 in the OT group and 62.19 cm3 in the PCT group. Median follow-up was 11 months for the OT group and 5 months for the PCT group. RESULTS: In 17 cases, the catheter was subsequently removed without the patient completing treatment. Two of the patients in the OT group (3%) developed a delayed abscess. The overall incidence of persistent seroma (>6 months) was 20% with all occurring in the OT group, 30% of those patients. There were no acute skin toxicities higher than grade 2. The overall cosmesis is excellent or good in 95% of patients. CONCLUSION: Despite short follow-up and a small sample size in this study, it seems that the MammoSite brachytherapy was well tolerated by patients with early stage breast cancer when using either the OT or PCT.

Stump resections resulting from incomplete operations.

Stump viscera caused by an incomplete operation can present the same symptoms as before the first operation. Furthermore, as an acute clinical event, these incomplete resections may sometimes cause acute abdomen and may need emergency surgical intervention. A 34-year-old woman with a history of laparoscopic cholecystectomy 5 days before was admitted with acute abdominal symptoms. Abdominal exploration revealed that she had undergone incomplete resection of the gallbladder. Another patient, a 21-year-old man, was admitted with complaints of fluid drainage from his appendectomy incision scar. He was diagnosed as having enterocutaneous fistula. Abdominal exploration revealed a stump appendix fistulizing to the abdominal wall. The third patient was a 32-year-old man with an appendectomy scar who was admitted with complaints of acute appendicitis. The patient was diagnosed as having acute appendicitis and underwent an appendectomy. A stump appendix was removed during the operation. Surgeons should be aware of stump pathologies and keep in mind a possible incomplete operation to prevent delayed diagnosis and treatment.

Beneficial effects of N-acetylcysteine on sodium taurocholate-induced pancreatitis in rats.

BACKGROUND: Acute pancreatitis (AP) is a complex disease associated with significant complications and a high rate of mortality. Although several mechanisms are put forward, oxidative stress seems the most important early event in the pathophysiology of AP. Therefore, we evaluated the beneficial effects of N-acetylcysteine (NAC), a strong antioxidant, in experimental AP. METHODS: Forty-nine Sprague-Dawley rats were used. Acute pancreatitis (AP) was induced by the intraductal infusion of sodium taurocholate. Rats were divided into seven groups (each containing seven rats): control, sham-operated (saline-treated, 3.5 and 12 h), non-treated AP (3.5 and 12 h) and NAC-treated AP (3.5 and 12 h). Treated rats received intraperitoneal (i.p.) NAC 1000 mg/kg 24 h before and just before the induction of pancreatitis. RESULTS: Rats with AP had extensive parenchymal and fat necrosis and NAC treatment at 12 h reduced tissue necrosis significantly (P < 0.05). NAC treatment at 12 h reduced leukocytic infiltration significantly (P < 0.05). Edema and hemorrhage were significantly increased in the AP groups when compared to controls (P < 0.001). NAC treatment reduced edema and hemorrhage at both 3.5 and 12 h slightly but not significantly. The total pathological mean score was significantly increased in the AP groups (P < 0.05) and it was reduced by NAC treatment (P < 0.05). NAC treatment decreased plasma amylase and lipase levels significantly (P < 0.05). While glutathione peroxidase (GPx) activity of pancreatic tissue was similar in the NAC-treated and AP groups, hepatic tissue GPx activity was lower in the AP groups, and NAC treatment restored it (P < 0.05). NAC had no effect on pancreatic superoxide dismutase level. In the NAC-treated rats, the serum NO(2)/NO(3) (nitrite/nitrate) level was significantly increased in the 3.5-h group when compared to the respective AP group (P < 0.05). NAC treatment also significantly reduced the serum concentration of the lipid peroxidation product, malondialdehyde, at 12 h (P < 0.05). CONCLUSIONS: NAC treatment had beneficial effects in sodium taurocholate-induced AP in rats. It reduced pancreatic tissue necrosis and lipid peroxidation. In our study, the mechanism underlying the beneficial effects of NAC seemed to be its antioxidant activity, either by increasing hepatic GPx activity, or by a direct scavenging effect on free radicals, thus enhancing the production of and/or inhibiting the degradation of nitric oxide.

[Comparison of primary colonic anastomosis and colostomy in experimental localized fecal peritonitis]. / Deneysel lokalize fekal peritonitte primer kolon anastomozu ile kolostominin karsilastirilmasi.

BACKGROUND: To investigate the appropriate surgical method that should be selected in the localized fecal peritonitis due to colonic injuries with 24 hours delay. METHODS: Colonic injuries were performed in 35 rats and the repairs were carried out after 24 hours. Seven rats (%20) died of generalized peritonitis in this period. The remaining 28 rats in which fecal peritonitis were localized by surrounding organs, were randomized in two groups: colostomy (n=14) and primary anastomosis (n=14). Intraabdominal complications and 15 days mortality were assessed. RESULTS: The groups had similar results according to intraabdominal complications. The 15 days survival was 71.4 % for the colostomy group and 78.5 % for the anastomosis group (p=0.31) CONCLUSION: If the injured or perforated colon is surrounded by the organs and so the generalized peritonitis is avoided, primary anastomosis would have similar results with colostomy despite fecal contamination and prolonged intervention time.

Pharmacologic characterization of contractile serotonergic receptors in human isolated mesenteric artery.

The 5-hydroxytryptamine (5-HT) receptors mediating contraction in human isolated mesenteric arteries were characterized. Endothelium-denuded human isolated mesenteric arteries were used. 5-HT induced concentration-dependent contractions in mesenteric arteries (Emax, 127.37 +/- 7.61% of 80 mM KCl maximal contraction; pD2, 6.73 +/- 0.09 [-logEC50]). Sumatriptan, a selective 5-HT1B/1D receptor agonist, induced concentration-dependent contractions in some of the arteries (Emax, 61.82 +/- 10.04%; pD2, 6.56 +/- 0.21, n = 9) but not in the others (Emax < 5%, n = 13), suggesting that functional 5-HT1B/1D receptors exist in some but not in all mesenteric arteries. GR127935 (a selective 5-HT1B/1D receptor antagonist, 3 nM) inhibited sumatriptan-induced contractions in arteries in which sumatriptan responses were strong in an insurmountable manner. GR127935 (10 nM) also inhibited 5-HT responses and shifted the concentration-response curve of 5-HT to the right significantly (p < 0.05; pD2s were 6.54 +/- 0.18 and 5.93 +/- 0.11 in the presence of vehicle and GR127935, respectively). Ketanserin (0.01-1 microM) competitively antagonized 5-HT responses in human mesenteric arteries: pA2 value was 8.40 +/- 0.25 (slope of Schild regression, 1.43 +/- 0.18; r2, 0.98). Tropisetron (5-HT3 receptor antagonist) and prazosin (alpha1-adrenoceptor antagonist) did not affect the contractions induced by 5-HT. These results suggest that 5-HT2A and 5-HT1B/1D receptors, but not 5-HT3 and alpha1-adrenoceptors, are involved in the 5-HT-induced contractions in human isolated mesenteric arteries. Sumatriptan-induced and 5-HT1B/1D receptor-mediated responses vary greatly among patients.