The Nutritional Risk Screening 2002 tool for detecting malnutrition risk in hospitalised patients: perspective from a developing country.

BACKGROUND/AIMS: To verify the validity of the Nutritional Risk Screening (NRS) 2002 test in a Turkish population. MATERIALS AND METHODS: We prospectively investigated 2566 patients at a tertiary referral hospital. Nutritional status was screened using NRS 2002, and the length of the stay (LOS) was the main outcome measure. Hospital stays >10 days were accepted as prolonged LOS. NRS scores ≥3 were accepted as indicating risk for malnutrition. Statistical analyses were performed to determine the independent risk factors for malnutrition risk and prolonged LOS. RESULTS: The mean age of patients was 56.6±16.9 years. According to the NRS 2002, 964 patients (37.6%) were without risk, 1320 (51.4%) warranted surveillance and 282 (11%) were at high risk for malnutrition. Malnutrition rate was the highest in the intensive care unit (22.01%). Prolonged LOS was seen in 24.4% of patients. Intensive care unit stay [odds ratio (OR): 0.585; confidence interval (CI): 1.45-2.22; p<0.001] and an NRS score ≥3 (OR: 0.88; CI: 1.87-3.13; p<0.001) were independent risk factors for prolonged LOS. CONCLUSION: Improving healthcare outcomes while avoiding preventable healthcare costs is an important goal of healthcare provision in developing countries. NRS 2002 was predictive of LOS, and thus, of patient prognosis. Further community-based studies are warranted to assess the impact of NRS 2002 on reducing healthcare costs.

Assessment of the effectiveness of silver-coated dressing, chlorhexidine acetate (0.5%), citric acid (3%), and silver sulfadiazine (1%) for topical antibacterial effects against the multi-drug resistant Pseudomonas aeruginosa infecting full-skin thickness burn wounds on rats.

The aim of this study was to compare the effects of four different topical antimicrobial dressings on a multi-drug resistant Pseudomonas aeruginosa contaminated full-thickness burn wound rat model. A total of 40 adult male Wistar albino rats were used. The control group (group 1), silver sulfadiazine (1%) group 2, chlorhexidine acetate (0.5%) group 3, citric acid (3%) group 4, and silver-coated dressing group 5 were compared to assess the antibacterial effects of a daily application to a 30% full-skin thickness burn wound seeded 10 minutes earlier with 10(8) CFU (colony forming unit)/0.5 mL of a multi-drug resistant Pseudomonas aeruginosa strain. Five groups (1 control group and 4 treatment groups) were compared. The administration of third-degree burns to all rats was confirmed based on histopathologic data. The tissue cultures from groups 2 and 5 exhibited significant differences compared to those of the other 3 groups, whereas no significant differences were observed between groups 1, 3, and 4. The effectiveness of the treatments was as follows: 1% silver sulfadiazine > silver-coated dressing > 3% citric acid > 0.5% chlorhexidine acetate > control group. Our results supported the efficacy of topical therapy by silver sulfadiazine and silver-coated dressing on infections caused by multi-drug resistant Pseudomonas spp.

Protective role of simvastatin on lung damage caused by burn and cotton smoke inhalation in rats.

BACKGROUND: Smoke inhalation injury is a major comorbid factor in patients with thermal injury and occurs in about 30% of patients with major burns. In addition, inhalation injury reportedly accounts for 20%-84% of the mortality in burned individuals and is associated with higher mortality rates for every age and burn size category. The aim of the present study was to investigate the effects of simvastatin on lung damage with burn and cotton smoke inhalation. METHODS: Wistar rats were randomly assigned to three groups: saline treated control group, via an orogastric route (group 1, n = 6), burn (30%) and cotton smoke inhalated group (group 2, n = 6), and simvastatin treated (25 mg/kg/d, via an orogastric route) burn (30%) and cotton smoke inhalated group (group 3, n = 6). Rats were sacrificed at 48 h of the treatments and the trachea and lungs were removed completely. Tissue samples were taken for histopathologic, immunohistopathologic, and biochemical analyses. Univariate analysis of variance coupled with Duncan's post-hoc test was performed for statistical evaluation. RESULTS: Lung parenchymal and tracheoepithelial damage was confirmed in group 2 by histopathologic examination. Lung malonedialdehyde (MDA) levels were significantly decreased (P < 0.001), while glutathione (GSH) concentration did not alter in group 2 compared with group 1. Also, immunopathologic data revealed that epithelial iNOS level was elevated, while no modulation was detected in the level of myeloperoxidase (MPO). Simvastatin administration resulted in decreasing the lung parenchymal and tracheoepithelial damage. Tissue MDA levels were decreased significantly (P < 0.001), whereas GSH concentrations were elevated in group 3 compared with group 1 and group 2 (P < 0.001). Simvastatin treatment caused a decrease in epithelial iNOS levels, while MPO levels were not modulated. In addition, simvastatin significantly reduced pulmonary apoptosis in lung injury. CONCLUSIONS: Our results have indicated that simvastatin administration seems to play beneficial role in lung injury of rats promoted by combined burn and smoke inhalation. Thus, simvastatin may represent a potential approach to prevent smoke inhalation-associated lung dysfunction. However, the significant decrease in basal oxidant production may cause impairment in cellular signalling processes.

Perforated ileal diverticulitis: CT findings.

Diverticulosis of the ileum is very uncommon. The differential diagnosis for any inflammatory process in the right lower quadrant of the abdomen includes appendicitis, Crohn's disease, and other infectious and inflammatory conditions of the terminal ileum and cecum. Diagnosis of small bowel diverticulitis is based on radiological findings, and computed tomography is the method of choice to demonstrate mural changes and the mesenteric extent of the inflammation. Preoperative knowledge of this condition may influence surgical and medical management.

Evaluation of neointimal hyperplasia on tranilast-coated synthetic vascular grafts: an experimental study.

Tranilast is an antiallergic drug that interferes with proliferation and migration of vascular smooth muscle cell induced by platelet-derived growth factor (PDGF) and transforming growth factor-beta1 (TGF-beta1). We investigated the local effect of tranilast on neointimal hyperplasia using tranilast-coated prosthetic grafts. The inner sides of the thin-walled polytetrafluoroethylene (PTFE) grafts were coated with chitosan and tranilast containing chitosan solution. Wistar albino rats (32) were used in the study. Patches (1 x 2 mm) for vascular grafts were prepared. Three groups were tested: group 1 (n = 12; tranilast coated), group 2 (n = 10; adhesive-only film-layer-coated), and group 3 (n = 10; normal ePTFE patch grafts sutured to the carotid arteries of the rats). Recipient sites of the carotid arteries were excised 4 weeks after surgery. All sections were examined histologically for graft patency, thrombus formation, and neointimal thickness. Expression of PDGF, fibroblast growth factor, and TGF-beta1 on cross-sections of the neointima were evaluated by immunohistochemistry. No significant differences were found regarding mean neointimal thicknesses. PDGF and TGF-beta-1 expressions were significantly lower in group 1. Although a decrease in local effect of tranilast was observed for growth factor expressions at a drug concentration of 0.05 mg/cm(2), a significant reduction in neointimal hyperplasia was not achieved. The coating concentration of 0.05 mg/cm(2) may have been too low to produce an antiproliferative effect. Given our promising results, further studies are recommended and planned using different drug concentrations and time intervals.

Endothelial nitric oxide synthase gene intron 4 (VNTR) polymorphism and vascular access graft thrombosis.

Vascular access thrombosis is a leading cause of vascular access failure in hemodialysis patients. Thrombosis is a multifactorial condition and genetic makeup can affect thrombosis risk. We conducted a study to investigate for possible associations between ecNOS gene intron 4 variable-number tandem repeat (VNTR) polymorphism and thrombosis of polytetrafluoroethylene hemodialysis arteriovenous access grafts (AVG) in Turkish patients. Fifty-five patients with end-stage renal disease who had AVGs implanted between 2000 and 2002 and 167 healthy individuals representing our healthy population were enrolled in this prospective study. Each subject provided a venous blood sample from which DNA was isolated, and polymerase chain reaction analysis was done to identify genotypes (aa, bb, ab) for ecNOS gene intron 4 VNTR polymorphism. All grafts were placed in brachioaxillary position. The subjects were divided into two groups based on duration of graft patency. The thrombosis group (Group I) comprised 26 patients who developed AVG thrombosis in the first 12 months after placement. The no-thrombosis group (Group II) comprised 29 patients whose grafts remained patient for at least 12 months. The frequency of the aa genotype in Group I was significantly higher than that in Group II (p = .005). At 6, 12, and 24 months, the primary patency rates for the AVGs in patients with the aa genotype were significantly lower than the corresponding rates for the bb and ab genotype groupings (p = .01, p = .01 and p = .04 for the three respective time points; Kaplan-Meier). ecNOS gene intron 4 VNTR polymorphism is linked with the pathogenesis of vascular access thrombosis in Turkish patients undergoing hemodialysis.

Ultrastructural study of severe testicular damage following acute scrotal thermal injury.

AIM: The scrotum provides an appropriate environment for the testicles that is essential for spermatogenesis. The aim of this study was to investigate the severity of ultrastructural damage to the testicles after acute thermal injury. MATERIALS AND METHODS: Twenty male Sprague-Dawley rats weighing 250+/-20g were randomly divided into four groups of five rats each (10 testicles in each group). In the sham group, animals were anesthetized, and both testicles were removed through a lower transverse abdominal incision. For animals in the burn induction group, a container filled with boiling water was used. For the T30 group, the scrota were in contact with steam from the boiling water for 30s. This procedure was the same for the other two groups: the T60 group (60s of steam contact) and the T90 group (90s of steam contact). Skin biopsies of scrota and excisional biopsies of both testicles were taken 1h after burn. Specimens were prepared for immunohistochemical and transmission electron microscopic examinations. Apoptotic and proliferative activity in the testicles and epidermal and dermal damage to the skin were measured. RESULTS: Histopathological examination indicated increasing epidermal and dermal damage to the skin in parallel with the length of contact between the scrota and the steam. Increased apoptotic activity was observed in animals after 30s, testicular degeneration began at 60s, and a diffuse degeneration was observed at 90s with a high rate of apoptosis (P<.005). CONCLUSION: Our findings demonstrate that thermal trauma to scrotal skin directly affects proliferation, the occurrence of apoptotic and necrotic cell death of spermatogenic seria, Sertolli and Leydig cells in testicles. Attempts to protect the testicles from severe thermal damage are essential, when the scrotal skin is affected by the burn.

Influence of synthetic mesh on ilioinguinal nerve motor conduction and chronic groin pain after inguinal herniorrhaphy: a prospective randomized clinical study.

Chronic postherniorrhaphy pain is a significant complication that can ruin a patient's quality of life. Our study aimed to assess the mesh-nerve interactions and the possible effects of this interaction on nerve morphology and function. Ilioinguinal nerve motor transmission studies using electromyelogram (EMG) were performed before the herniorrhaphy procedure, and Lichtenstein (n=50) or Shouldice (n=50) herniorrhaphies were used for repair. At the end of the first year after surgery, we found no significant differences on ilioinguinal nerve motor conduction studies between the mesh and Shouldice groups. We found a significant correlation between EMG results and inguinal pain. Our results indicates that nerve graft contact does not influence nerve motor conduction. The etiology of postherniorrhaphy chronic pain may be caused by nerve injury resulting in dissection or compression of the nerves.

Delayed spinal cord injury after high-voltage electrical injury.

Delayed spinal cord injury is a rare complication of high-voltage injury. The diagnosis of this scenario is difficult because radiologic imaging techniques lack sensitivity. Frequent neurologic assessments, although difficult to perform in the early stages of such multisystem traumas, are required for accurate diagnosis.

Local and systemic interactions related to serum transforming growth factor-beta levels in burn wounds of various depths.

OBJECTIVES: This study aimed to investigate the interaction between serum levels of TGF-beta and active-immune cell infiltration in burn wounds of various depths. MATERIALS AND METHODS: Thirty female Sprague-Dawley rats were divided into three groups: full-thickness burns (F), partial-thickness burns (P), and no burns (S). After burn-induction, blood samples were obtained only once from shams and at postburn 1, 48 h, and 7 days in burn groups. Serum levels of TGF-beta were measured by means of the ELISA. The proportions of neutrophils, fibroblasts, vascular proliferation, CD68-macrophages, and CD3-lymphocytes were studied immunohistochemically and graded semiquantitatively. RESULTS: Serum TGF-beta levels in the F and P groups were lower than those in sham at 1h after burn (p<.05). No significant differences in TGF-beta were observed between groups F and P on days 2 and 7 after injury. No local accumulation of macrophages and fibroblasts was noted in either burn group, but the proportion of lymphocytes was higher in the P group at 1h after burn. Neutrophils were higher in the F group than the P on day 7 after burn. CONCLUSIONS: Prolonged neutrophil infiltration in full-thickness burn wounds and suppressed lymphocyte proliferation in partial-thickness burn wounds seem to be related to an increase in serum TGF-beta levels.

Successful treatment of burn and visceral injury combined with full-thickness loss of the abdominal wall after blast injury.

A 29-year-old man was admitted to our institution 10 days after he had undergone an urgent exploratory laparotomy at a local army hospital after a terrorist bombing attack. On admission, deep second-degree and third-degree burns involving 25% of the upper and lower extremities were present, together with a 25 x 10-cm abdominal full-thickness blast injury defect on the left side, an infected eviscerated midline incision, and a colostomy on the right side of the abdomen. The patient underwent a second laparotomy, at which time the intraabdominal abscess was drained, and the abdominal cavity was irrigated with saline. A jejunal perforation was found and sutured. The abdominal cavity was left open and covered with a Bogota bag for temporary closure. On postburn day 18, the patient underwent débridment and grafting of the third-degree burns to the left and right arm and right lower extremities. After several débridment sessions (postburn days 16, 18, 20, 22, and 24), an abdominal skin release and reapproximation were performed (postburn day 26). On postburn day 36, split-thickness skin grafts were placed directly on the granulated tissue of the intestines and on a defect in the left flank and iliac regions. Postoperatively, the patient did well. He was discharged on postburn day 78 with all wounds well healed. In our opinion, temporary closure followed by direct application of meshed split-thickness skin grafts to exposed abdominal viscera represents a simple method of reconstruction that can be safely performed, with minimal risk, on critically ill patients.

Interactions of systemic immune response and local wound healing in different burn depths: an experimental study on rats.

This study aimed to clarify the local and systemic immune responses at different burn depths. Thirty female Sprague-Dawley rats were divided into three groups: full-thickness (F), partial-thickness (P), and Sham (S). Burns were induced on three separate areas on the dorsums of rats. Serum levels of interferon (IFN)-gamma; tumor necrosis factor-alpha; interleukin (IL)-1, IL-6, and IL-10 were measured once in controls and 1 hour after burn, 48 hours after burn, and 7 days after burn in F and P groups. Neutrophils, CD68-positive macrophages, HLA-DR-positive cells, and CD3-positive lymphocytes were graded semiquantitatively, and the wounds were examined once in shams and at 1 hour after burn, 48 hours after burn, and 7 days after burn in F and P groups. IL-6 levels were highest in F group, followed by P group 1 hour after burn. IFN-gamma levels were higher in the F group; IL-1 levels were higher in F and P groups at 1 hour after burn. Local accumulation of macrophages was similar in F and P groups. Lymphocytes were denser in P group at 1 hour after burn, and neutrophils were denser in F group at 7 days after burn. We suggest that early elevations of IL-6 and IFN-gamma prolong inflammation in full-thickness burns. Modulation of proinflammatory cytokines may improve burn wound treatment.

Effects of different preservation solutions on skin graft epidermal cell viability and graft performance in a rat model.

This study sought to evaluate the viable epidermal cell count of skin stored at 4 degrees C in different media, and to determine the longest time that grafts could be stored and still be used for clinical application of skin grafts. Harvested rat skin grafts were divided into four groups: saline (group 1), Roswell Park Memorial Institute-1,640 solution (RPMI) (group 2), University of Wisconsin solution (UW) (group 3), and Histidine-tryptophan-ketoglutarate solution (HTK) (group 4). After the designated storage time (7, 14, 21, 28, or 35 days), grafts were divided into two parts. Skin grafts (3 cm x 3 cm) were then autotransplanted onto full-thickness circular wound beds. Percentages of viable keratinocytes (PVK) declined significantly for skin grafts stored in UW, HTK, and saline solutions (Kruskal-Wallis, P<0.05), while there was an insignificant decline in the PVK of skin grafts stored in RPMI until the 28th day of storage (Kruskal-Wallis, P>0.05). Compared with UW, HTK, and saline, grafts stored in RPMI had significantly higher percentages of PCNA at the 14th and 21st days of storage (Mann-Whitney U-test, P<0.05). Grafts stored in RPMI had significantly lower apoptosis rates than did grafts stored in UW or HTK (P<0.05). Based on these results, we conclude that RPMI-1640 provides a better environment for skin grafts by increased quality and survival time of skin grafts, as assessed by both microscopic and macroscopic investigations.

Scalding in Turkish children: comparison of burns caused by hot water and hot milk.

INTRODUCTION: Our aim in this study was to compare the clinical differences and etiologic risk factors for hot water and hot milk scald burns in Turkish children. METHODS: The retrospective study examined the cases of 140 children aged 0.1-7 years who had scald burns treated in three burn units of a Turkish hospital network between March 2000 and December 2004. The patients were categorized in two groups: hot water burns or hot milk burns. RESULTS: Ninety-five (67.9%) patients had hot water burns and 45 (47.1%) had hot milk burns. The proportion of patients with hot milk burns who lived in rural areas was significantly higher than the corresponding proportion for the hot water cases (75.6% versus 52.6%, respectively; p<0.01). In 20 (44%) of the hot milk cases, the burn was caused by milk being boiled in large pots outdoors for cheese production. The other 25 hot milk cases were caused by milk being boiled in the kitchen. The mean (+/-S.D.) percentage total body surface area burned in the hot milk cases was higher than that in the hot water cases (33.6+/-2.24% versus 21.42+/-1.43%, respectively; p<0.001), and the corresponding mean percentages of TBSA with full-thickness burns were 9.2+/-2.52% versus 3.13+/-0.83%, respectively; (p=0.083). The mean percentages of TBSA with second-degree burns showed the same trend (29.0+/-12.39% versus 18.8+/-1.47%, respectively; p<0.001) higher percentage of the children with hot milk burns required antibiotics (78% versus 52.8%, respectively; p<0.006). Seven (7.4%) of the hot water burn patients and 15 (33.3%) of the hot milk burn patients died during the study period (p=0.025; overall mortality rate 15.7%). CONCLUSION: Children scalded with hot milk tend to have more extensive burns, and thus have higher mortality, than those scalded with hot water. To create effective programs for preventing scald injuries in Turkey and elsewhere, it is essential to consider ethnic and cultural issues based on these characteristics. Simple precautions should be explained and methods of using liquids such as hot milk should be researched in different geographic locations in order to formulate good prevention strategies.

Acquired-transient factor X deficiency associated with anticardiolipin antibodies in a child with extensive burns.

The article presents the case of an 18-month-old boy with major scald burns complicated by acquired F-X deficiency. On the 15th day of hospitalization, the patient developed sepsis and fever. He also exhibited bruxism, especially during the febrile episodes, which his permanent teeth to luxate and become mobile. Pedodontists decided that all the child's teeth should be extracted to ensure proper development of the jaw with growth. Twelve hours later, he developed a leukemoid reaction, which was attributed to infection with another aerobic organism or development of anaerobic bacteremia after teeth extraction. Twenty-four hours after the extractions, the burn wounds began oozing and there was extensive gingival bleeding and epistaxis. Coagulation parameters were assessed immediately. Disseminated intravascular coagulation was detected initially and was successfully treated with fresh-frozen plasma transfusions, but bleeding from the burn wounds and nasal/oral mucous membranes continued. Further testing revealed the diagnosis of acquired isolated F-X deficiency linked with antiphospholipid antibodies. Treatment with plasmapheresis, steroids, and intravenous immunoglobulin was successful. Hypertrophic scar formation was the only issue during 7 months of follow-up.

Epidemiologic analysis of patients with burns presenting to the burn units of a University Hospital Network in Turkey.

This retrospective study analyzed risk factors in addition to the demographic and epidemiological features of 813 burn patients who were admitted to the burn units of a University Hospital Network in Turkey during a 6-year period. The study consisted of 436 men (53.6%) and 377 women (46.4%; mean age, 31; range, 0-87 years). The age distribution of the patients peaked at 1 to 6 years and at 35 to 44 years. The most common types of burns were scalds (63.8%) and flame burns (22.1%). The mean TBSA burned was 9.4 +/- 15.3% in adults and 19.8 +/- 18.6% in children. The median and mean hospital stays were 16 and 22.8 days, respectively (range, 1-114 days). A total of 813 patients were evaluated, leaving only 255 hospitalized patients. Of the hospitalized patients, 100 (74.6%) underwent autografting, 8 (6.0%) underwent amputation, 113 (84.3%) underwent débridment, and 76 (56.7%) underwent escharotomy. The mortality rate among hospitalized patients was 14.1%. Although this study provides information about the population within close proximity to our burn units, there remains a need for a countrywide database of burn incidents.

Ultrasound-guided percutaneous cholecystostomy for acute cholecystitis in critically ill patients: one center's experience.

BACKGROUND/AIMS: The standard treatment for acute cholecystitis is cholecystectomy; however, cholecystectomy is not an option in some patients who are too high-risk for emergency surgery. Ultrasound-guided percutaneous cholecystostomy is an alternative for such patients. This study presents one center's five-year clinical experience with ultrasound-guided percutaneous cholecystostomy for treatment of acute cholecystitis. METHODS: In this study the records of all patients (18 total; mean age, 68.2+/-15.4 years; range, 42-91 years) who underwent ultrasound-guided percutaneous cholecystostomy for acute cholecystitis between June 1998 and October 2003 were reviewed. Duration of hospitalization, duration of tube placement, mortality and morbidity after tube placement, complication rates, culture results for aspirated bile, and clinical outcomes were analyzed. RESULTS: Fourteen patients were diagnosed with acute calculous cholecystitis and four were diagnosed with acalculous cholecystitis. The average hospital stay was 19+/-12.6 days (range, 5-52 days), and the average duration of catheter drainage was 20.5+/-19.1 days (range, 1-75 days). Six patients underwent open cholecystectomy between days 16 and 26 of catheter drainage, and none had postoperative complications. CONCLUSIONS: Ultrasound-guided percutaneous cholecystostomy is a relatively safe and easy method for treating acute cholecystitis in critically ill patients. The risk of complications is low and the likelihood of success is high.

Knowledge, attitudes, and behavior of occupational physicians related to burn cases: a cross-sectional survey in Turkey.

The primary care of victims of burns at the workplace is provided by occupational physicians. In Turkey, the routine practice is to certify physicians for work in occupational medicine. The aim was to evaluate the knowledge, attitudes, and behavior of occupational physicians regarding burn cases. A total of 510 occupational physicians working in Ankara were surveyed by mail, and 101 (19.8%) physicians responded. Most of these physicians (n=67, 66.3%) had encountered burn cases within the prior year. The most frequent type of burn was scalds (n=55, 54.5%) followed by thermal burns (n=37, 36.6%). Of the respondents, 22 (21.8%) knew the most appropriate classification of burns. Regarding first-aid treatments prior to triage, only 4% chose the valid items. The mean rate of favourable attitudes of the participants toward first aid of different types of burn injuries was 70.8%. Only 31.7% of the physicians surveyed used up-to-date first-aid modalities. We conclude that Turkish occupational physicians have inadequate knowledge and inappropriate attitudes toward the first aid and primary care of burn victims. With the vital support of the Burn and Fire Disaster Institute at Baskent University, nationwide educational policies could be improved and assessed.

The efficacy of 99mTc-HIG for sentinel lymph node mapping in breast cancer patients.

OBJECTIVE: To evaluate the efficacy of Tc-HIG on SLN identification in patients with early-stage breast cancer. MATERIALS AND METHODS: Seventeen women (18 tumours) with early-stage breast cancer were included. On the day of the operation, 111 MBq Tc-HIG was injected around the tumour or biopsy scar in all patients. Subsequently, dynamic lymphoscintigraphic images were taken for 30 min. After this, static images were recorded at 15-20 min intervals until the SLN was visualized. Patients were taken to the operating room 2-4 h after radiopharmaceutical injection. Before the incision, 5 ml of isosulfan blue dye solution was injected peritumourally in all subjects. Aided by blue dye and gamma probe SLN detection was done during the operation. RESULTS: In 17/18 tumours, SLN was detected with Tc-HIG lymphoscintigraphy. The mean visualization time for axillary SLNs was 49.94+/-11.25 min and for internal mammary SLNs was 52.50+/-10.60 min. In 15 of the tumours, only one SLN was detected in the axillary region. However, in two tumours, SLNs were found in both axillary and internal mammary regions. With blue dye mapping, axillary SLNs were found in 17/18 tumours. With the application of intraoperative gamma probe, all axillary and internal mammary SLNs were detected in 18 tumours. CONCLUSION: We conclude that Tc-HIG may be a suitable agent for SLN detection by lymphoscintigraphy and intraoperative gamma probe application in early-stage breast cancer patients.

The impact of transient elevation of intra-abdominal pressure on liver regeneration in the rat.

Transient increased intra-abdominal pressure (IIAP) due to carbon dioxide insufflation is suspected to cause a form of ischemia-reperfusion injury. Considering this, a study was designed to assess the effect of transient IIAP on liver regeneration in a rat model. Six groups of animals (each n = 6) were studied. While experiments in Group 1 (IIAP+PHR) were subjected to IIAP, following partial hepatic resection (PHR), those in Group 2 (IIAP) experiments were subjected to IIAP. Animals in Group 3 (IR+PHR) were subjected to liver ischemia-reperfusion (IR) following PHR, and those in Group 4 (IR) underwent only IR. Group 5 (PHR) and Group 6 (healthy) served as controls. Blood was taken for assessment of tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 with enzyme-linked immunosorbent assay (ELISA) at day 5 postoperatively. Each rat was then given a lethal injection of pentobarbital. Gravimetric analysis and immunohistochemistry staining for proliferating cell nuclear antigen (PCNA) were used for assessments of liver regeneration. Apoptosis was assessed by immunohistochemical TUNEL index, expressed as the number of positive cells/per total number of cells at the same time. Although mean liver regeneration rates of Group 1 and Group 3 were the same, that of Group 5 was the highest (p = .04). Serum TNF-alpha levels of Group 1 versus Group 3 were 340 pg/ml versus 352 pg/ml. Serum IL-l levels of Group 1 versus Group 3 were 124 pg/ml versus 135 pg/ml. Serum TNl-alpha and IL-6 levels of Group 1 and Group 3 were the same at the first day of surgical procedure (p > .05). Mean serum TNF-alpha levels of Group 5 (387 pg/ml) were significantly higher than those of both Group 1 and Group 3 at 24 h of operation. Serum IL-6 levels of Group 5 (174 pg/ml) at the same time was higher than those of Group 1 and Group 3 at the same time (p = .01). Proliferating cell nuclear antigen indices of Group 1, Group 2, Group 3, Group 4, and Group 6 were the same; however, the mean PCNA-labeling index of Group 5 was higher than those of the others. There were no significant differences between the groups (p > .05). Liver regeneration is suppressed by transient IIAP. However, the effect of IIAP on liver apoptosis needs to be clarified.