Dietary whey supplementation in experimental models of wound healing.

Whey is a dairy product containing milk serum proteins with diverse biological effects. In this study, the effect of dietary whey supplementation on wound healing was investigated. Rats were fed a standard or whey-supplemented diet for three weeks. Wound healing parameters, glutathione, and lipid peroxide levels were determined three days after the application of two different models of wound healing, i.e. laparotomy and colonic anastomosis. Dietary whey supplementation significantly increased glutathione levels and suppressed lipid peroxidation after experimental laparotomy and colonic anastomosis. Bursting pressures, hydroxyproline, and cytokine levels were not changed. Our results show that dietary whey supplementation increases glutathione synthesis and cellular antioxidant defense. Long-term effects of whey feeding on wound healing remains to be investigated.

Enterostomy closure site hernias: a clinical and ultrasonographic evaluation.

BACKGROUND: Parastomal hernia with a reported incidence of up to 50% is a major problem after ostomy formation. Hernias at the closure site may be a problem after the closure of the enterostomy. In this study, in addition to physical examination, we used ultrasonography (USG) in order to find the true incidence of ostomy closure site and laparotomy incisional hernias. METHODS: We examined patients with closed enterostomy sites by both physical examination and USG for the detection of hernias. Risk factors for hernia formation, such as age, gender, body mass index (BMI), ostomy type, and surgical site infections, were determined. RESULTS: The evaluation of 31 patients with ostomies resulted in a 32% incidence of closed ostomy site hernias when patient medical history, physical examination, and ultrasonographic examination were used together. With physical examination and USG, incisional hernias at the laparotomy incision were found in 58% of cases. USG was able to detect hernias which were not clinically evident at the ostomy closure site and the laparotomy wound. BMI, age, gender, ostomy type, and surgical site infection did not have a significant effect on hernia formation. CONCLUSION: Ostomy closure site and laparotomy incisional hernias are important clinical problems with a high incidence after ostomies are closed. Closure of the enterostomy site should be regarded as a hernia repair rather than a simple fascial closure. USG is a valuable clinical tool in combination with physical examination for the detection of minor defects.

Outpatient follow-up'' or ''Active clinical observation'' in patients with nonspecific abdominal pain in the Emergency Department. A randomized clinical trial.

AIM: The aim of this study was to determine whether it is safe and cost-effective to discharge nonspecific abdominal pain (NSAP) patients from the Emergency Department (ED) and re-evaluate diagnosis later. METHODS: Patients aged between 18 and 65 years were enrolled into the study. They had been admitted to the ED for acute abdominal pain with an indefinitive diagnosis after clinical examination and base-line investigations. The patients were randomly assigned into two groups: 1) active clinical observation (ACO), comprising those admitted to the ED observation room; 2) outpatient group (OG), comprising those discharged and asked to return for re-evaluation at 8-12 hours intervals over the following three days. Each patient was examined by an ED physician and a consultant general surgeon. Demographics, blood tests, morbidity and mortality, number of operations, together with 6-month follow-up results were noted. Finally, a patient satisfaction questionnaire was administered. RESULTS: A total of 105 patients were enrolled into the study; 50 were randomized to the ACO group and 55 to the OG. There were no statistically significant differences in demographics and blood parameters between the two groups. Overall agreement of ED diagnosis with final diagnosis was 91.4%. Total morbidity was 10% in the ACO group and 7.2% in the OG. There were no statistically differences in morbidities and usage of diagnostic imaging modalities between the two groups (P>0.05). No deaths occurred in either group during the study period. The patients in the ACO group were more keen on returning for re-evaluation and willing to recommend our hospital services to other people (P< or =0.05). CONCLUSION: Outpatient evaluation of patients with an ED diagnosis of NSAP may be an option, seems to be safe, is not accompanied by an increased incidence of complications and is efficient if patients are selected properly.

Biliary decompression reduces the susceptibility to ethanol-induced ulcer in jaundiced rats.

We investigated the gastric response to an ulcerogenic irritant and the change in gastric functions in an experimental rat model of obstructive jaundice, with or without biliary drainage. After biliary obstruction for 14 days, rats with ligated bile duct (BDL) were randomly divided into three groups: BDL group without biliary drainage, BDL followed by choledochoduodenostomy (CD) or a choledochovesical fistula (CVF). The gastric functions were evaluated 2 weeks after the surgery. Gastric damage, induced by orogastric administration of ethanol, was evaluated 30 min later using a lesion index and microscopic scoring was then performed on fixed stomachs. Basal gastric acid secretion was measured by the pyloric ligation method. The lesion index and maximum lesion depth did not differ in the BDL and sham groups, while they were significantly reduced in the CD group. Gastric acid output and secretory volume were reduced in the BDL group compared to the sham group, while these reductions were abolished in the CD group. Afferent denervation with capsaicin further reduced the ulcer index in the later group. Our data suggest that gastric mucosal susceptibility to injury is dependent on the normal flow of bile into the duodenal lumen, which appears to be a requirement for adaptive gastric cytoprotection.

Beneficial effects of glycocholic acid (GCA) on gut mucosal damage in bile duct ligated rats.

In order to investigate the effect of bile acids on gastrointestinal inflammations, bile duct ligated rats (BDL) were treated with GCA (25 mM/ml, oral or colonic) or saline I h before ethanol challenge and twice daily for 3 days in the ileitis group, while GCA was given twice daily for 3 days in the colitis group. BDL reduced the macroscopic and microscopic damage scores in the ileitis group compared to sham operated group, while it had no significant effect on ulcer or colitis groups. However, GCA given in BDL group reduced the ulcer index and microscopic damage in colitis group compared to saline-treated groups, but had no effect in ileitis group. Both BDL and GCA administration in BDL group reduced ileitis- or colitis-induced elevations in MPO levels. GCA administration in BDL group inhibited gastric acid output and volume. Our results suggest that oral or colonic administration of primary bile acids may be useful for the treatment of gastrointestinal inflammations.

The effect of hyperthermic preconditioning on the immune system in rat peritonitis.

OBJECTIVE: To assess whether hyperthermic (HT) preconditioning prevents the lethal effects of peritonitis by acting on the immune system. DESIGN: Prospective, controlled, experimental study. SETTING: Laboratory and animal facility of the university. MATERIALS: Adult male Sprague-Dawley rats. INTERVENTIONS: In the HT groups animals were subjected to hyperthermia (42 degrees C, 15 min) and 8 h later peritonitis (P) (n = 14) was induced. In the normothermic (NT) groups, animals were subjected to normothermia (38 degrees C, 15 min) and 8 h later peritonitis (n = 14) was induced. Each group had a corresponding sham laparotomy group (n = 14). Six rats from each group were allowed to live 7 days for survival. In the control group (n = 4), rats were not anesthetized or heat treated. MEASUREMENTS AND RESULTS: Sixteen hours after peritonitis and laparotomy, rats were killed. Blood was taken to measure the percentage of CD(4)(+), CD(8)(+), CD(4)(+)CD(56)(+), CD(8)(+) CD(11 b)(+), NK(+), B cells and the level of tumor necrosis factor. Grading of peritonitis and the measurement of free oxygen radicals in the peritoneal fluid were undertaken. All rats in the HT + P and sham laparotomy groups survived for 7 days, while in the NT + P group two rats died in 7 days. HT decreased the severity of peritonitis and increased the free oxygen radicals in the peritoneal fluid; however, the difference did not reach statistical significance. HT prevented the decrease in CD(4)(+) and B cells and the increase in CD(11 b)(+). CONCLUSIONS: HT may have a protective role in sepsis by reducing the severity of peritonitis. A causal relation between hyperthermia and an improved immune system seems possible.

Prospective multicentre trials in developing countries: willingness of surgeons to participate.

OBJECTIVE: To assess the feasibility of conducting a multicentre study among surgeons in Turkey. DESIGN: Prospective open multicentre study. SETTING: Teaching hospitals in Turkey. SUBJECTS: Surgeons working in 23 university and 15 state hospitals. INTERVENTIONS: Surgeons willing to participate were asked to look for the presence of Meckel's diverticulum in all patients undergoing laparotomy. MAIN OUTCOME MEASURES: To find out the number of surgeons willing to participate in the study and once they agreed to see how they fulfilled the requirements. RESULTS: 14 agreed to participate (12 from universities and 2 from state hospitals) and completed the study. A total of 2781 patient records were collected. University hospitals were more willing to participate than state hospitals (52% compared with 13%) but state hospitals contributed 20% of the patients. The number of patients contributed in the first and second halves of the study did not differ, reflecting no diminution of the enthusiasm. CONCLUSION: This study, with no financial support, showed that it is possible to conduct multicentre studies among surgeons in developing countries such as Turkey. Increased awareness of the importance of publication may have helped to obtain this result.