Can Simple Tests Prior to Endoscopy Predict the OLGA Stage of Gastritis?

Gastritis is a progressive disease that evolves from a non-atrophic to atrophic state and progresses through intestinal metaplasia, with some cases leading eventually to gastric cancer. Since gastritis by definition is an inflammatory process of the mucosal lining of the stomach and is usually associated with pain, we aimed to identify any association between the severity of gastritis and pain and a simple inflammatory marker derived from a complete blood count (CBC). This was a prospective cross-sectional study which enrolled 155 consecutive adult patients who underwent an upper endoscopy. Prior to the endoscopy, all patients were given a questionnaire, numerical rating scale (NRS) and complete blood count evaluation. The biopsy was obtained from the gastric mucosa according to the modified Sydney classification and scored with the Operative Link for Gastritis Assessment (OLGA) scoring system. The results showed a significant correlation between NRS and intestinal metaplasia (p < 0.01); moreover, a correlation was also found between the NRS and OLGA stage (r = 0.469, p < 0.001). A nonlinear curve was constructed for OLGA stage estimation according to NRS scores (r2 was found to be 0.442, with p < 0.001). The results also showed a correlation between the neutrophil to the lymphocyte ratio (NLR) and OLGA stage (p < 0.01). No correlation was found between the other gastric parameters and NLR (p > 0.05). Helicobacter pylori positivity did not correlate with NRS and NLR. As a conclusion, pain measured by NRS and NLR, which are simply calculated from the CBC prior to endoscopy, may be used to predict OLGA stages and estimate the severity of gastritis in endoscopy patients.

Protective effects of laparoscopic sleeve gastrectomy on atherosclerotic and hemocytic parameters in obese patients.

OBJECTIVES: The aim of this study was to evaluate the effects of the change in the body mass index following laparoscopic sleeve gastrectomy on the vascular morphology structure and biochemical and hemocytic parameters. MATERIAL AND METHODS: A prospective evaluation of 60 patients who underwent sleeve gastrectomy was conducted. The relationship was evaluated between the vascular morphological parameters and biochemical and hemocytic inflammatory variables of the patients preoperatively and at 6, 12, and 18 months postoperatively. RESULTS: Compared to the baseline values, a significant decrease was determined in the carotid intima media thickness at 6, 12, and 18 months (p<0.001, p<0.001, p<0.001, respectively). The compliance and distensibility values were observed to increase over time (p<0.05, p<0.001, p<0.001, respectively). A statistically significant difference was determined in the carotid intima media thickness values according to gender, with males (n:7) measuring 0.618±0.123 mm and females (n:53) measuring 0.506±0.113 mm (p<0.01). When patients were grouped as neutrophil-to-lymphocyte ratio ≤2.54 (n:41) and neutrophil-to-lymphocyte ratio>2.55 (n:19), the increasing neutrophil-to-lymphocyte ratio values were observed to be in proportion to the carotid intima media thickness, and the difference was statistically significant (p<0.001). When factors affecting the vascular morphology parameters measured at baseline and throughout the study were evaluated with the correlation analysis, there was observed to be a positive correlation between the baseline carotid intima media thickness thickness and neutrophil percentage (r=0.736, p<0.001) and neutrophil-to-lymphocyte ratio (r=0.676, p<0.001), and between the negative correlation and lymphocyte percentage (r=-0.628, p<0.001). CONCLUSION: Laparoscopic sleeve gastrectomy is not only a cosmetic procedure reducing the body mass index values, but it also has a beneficiary effect on vascular morphology, biochemical, and hemocytic parameters.

Self-expandable metallic stent application for the management of upper gastrointestinal tract disease.

OBJECTIVE: The aim of the present study was to share our experiences of the use of self-expandable metallic stent for the upper gastrointestinal tract disease. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 18 patients who underwent self-expandable metallic stent implantation procedure for anastomosis stricture, anastomosis leak, or spontaneous fistula of the upper gastrointestinal tract at two different surgery clinics. Self-expandable metallic stent implantation procedures were performed while keeping the patient under sedation and the correct stent localization was verified using fluoroscopy. The stent localization and possible stent migration were checked using X-ray films taken a few days after the stenting procedure. RESULTS: Overall, 25 self-expandable metallic stents were implanted in 18 patients (malignant, 13; benign, 5) aged between 19 and 89 years. The indications for self-expandable metallic stent implantation were as follows: malignant gastric stricture (inoperable; n=6), malignant esophageal stricture (inoperable; n=4), staple line leak (laparoscopic sleeve gastrectomy; n=4), esophagojejunostomy anastomotic leak (total gastrectomy+Roux-en-Yesophagojejunostomy; n=2), and stricture (total gastrectomy+Roux-en-Yesophagojejunostomy; n=1), and esophagopleural fistula (pulmonary tuberculosis; n=1). A favorable outcome was achieved in a single session in 15 patients, whereas more than two sessions of stenting were necessary in the remaining three patients. Among the patients who underwent esophagojejunal anastomosis (n=3), self-expandable metallic stents were successfully deployed in a single session in two patients to relieve anastomosis leak (n=1) and anastomosis stricture (n=1); the remaining patients underwent four self-expandable metallic stent implantation procedures to relieve anastomosis leak and subsequent recurrent strictures. No complications developed during the stenting procedure. Three of the four patients who developed mortality had advanced stage esophageal cancer, whereas one patient had morbid obesity and developed staple line leakage. CONCLUSION: Endoscopic self-expandable metallic stent implantation under fluoroscopic guidance is a low-morbidity and effective procedure for the management of advanced stage tumors of the gastrointestinal tract and the elimination of postoperative complications.

Assessment of risk factors affecting mortality in patients with colorectal cancer.

INTRODUCTION: The most important risk factors for colorectal cancer are age, high ASA score, anemia, low albumin, tumor stage, histopathological properties, tumor's relationship with adjacent tissues, positivity of surgical borders and timing of the surgical procedure. AIM: To determine possible risk factors for mortality in patients undergoing colorectal cancer surgery. MATERIAL AND METHODS: The medical records of 101 consecutive patients who underwent colorectal cancer surgery at the Department of Surgery, Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey between January 2008 and November 2015 were retrospectively reviewed. The patients were divided into two groups: surviving (n = 76) and deceased (n = 25) groups. The groups were compared in terms of several demographic, clinical, biochemical, and histopathological parameters. In addition, risk factors for mortality were analyzed with multivariate analysis. SPSS 22.2, PAST 3, and MedCalc 14 software packages were used for statistical analyses. RESULTS: The surviving and deceased groups significantly differed with respect to age (p = 0.001), hemoglobin (p = 0.001), lymph node positivity (p = 0.009), positive lymph node/total lymph node ratio (p = 0.012), thrombocyte count (p = 0.047), lymphovascular invasion (p = 0.028), urgency of admission (emergency/elective) (p = 0.036), and postoperative carcinoembryonic antigen (CEA) level (p = 0.002). A receiver operating characteristics curve was drawn to determine the cut-off values of various parameters including age (63), hemoglobin (12.8), node positivity (3), positive/total lymph node ratio (0.435) and thrombocyte count (308), with age (p < 0.001), hemoglobin (p < 0.001), node positivity (p = 0.025) and positive/total lymph node ratio (p = 0.024) being significantly different. A multivariate analysis revealed that age (p = 0.049), hemoglobin (p = 0.045), and positive/total lymph node ratio (p = 0.025) were independent risk factors for mortality. CONCLUSIONS: This study shows that older age, lower hemoglobin level, and high positive/total lymph node ratio were independent risk factors for mortality among colorectal cancer patients.

Efficacy of the Evaluation of Inflammatory Markers for the Reduction of Negative Appendectomy Rates.

Unnecessary appendectomy can cause complications; ways of reducing negative appendectomy rates (NAR) using biochemical and imaging methods are desirable. We retrospectively examined 640 patients who underwent appendectomy for suspected AA. Patients with histologically confirmed appendicitis were designated the positive appendectomy group (n = 565), whereas those with unconfirmed appendicitis were designated the negative appendectomy group (n = 75). The positive appendectomy group was subdivided into the non-perforated (n = 511) and perforated (n = 54) appendectomy groups according to pathology reports. We compared the age, sex, lymphocyte count, neutrophil percentage, pathologic positivity or negativity for appendicitis, C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) of the patients. When the perforated, non-perforated, and negative appendectomy groups were compared, the highest CRP level, NLR, and PLR were evident in the perforated appendectomy group (p = 0.001), whereas the lowest neutrophil percentage was found in the non-perforated appendectomy group (p = 0.001). Multiple logistic regression analysis identified neutrophil percentage, CRP value, and NLR as independent variables and demonstrated that AA could be diagnosed with 88.9 % accuracy using the cutoff values determined. In patients with suspected AA, particularly in rural areas with limited access to advanced imaging modalities, the evaluation of neutrophil percentage, CRP level, and NLR, in combination with the findings of a physical examination, may aid diagnosis and reduce NAR.

Assessment of clinical and pathological features of patients who underwent thyroid surgery: A retrospective clinical study.

AIM: To evaluate whether there was any correlation between the clinical parameters and final pathological results among patients who underwent thyroid surgery. METHODS: We retrospectively analyzed parameters, including age, sex, complete blood cell count parameters, nodule diameter, nodule localization, thyroid function testing, and pathology reports, in patients who underwent thyroid surgery. The patients were divided into malignant (n = 92) and benign (n = 413) groups depending on the final pathological results. Both groups were compared for demographic and clinical parameters. The Kolmogorov-Smirnov normality test was used to determine if the quantitative variables had a normal distribution. The nonparametric Mann-Whitney U test was used to compare quantitative data that were not normally distributed, and Pearson's chi-squared test was used to compare the qualitative data. The correlation between the final pathological results and fine-needle aspiration biopsy findings was calculated using the cross-tabulation method. RESULTS: This study included 406 women and 99 men aged between 15 and 85 years. No significant differences were found between the groups with respect to age, sex, white blood cell count, neutrophil count, lymphocyte count, thrombocyte count, red cell distribution width, platelet distribution width, mean platelet volume, platecrit, nodule localization, and thyroid function testing. On the other hand, there were significant differences between the groups with respect to nodule size (P = 0.001), cervical lymphadenopathy (P = 0.0001) and nodular calcification (P = 0.0001). Compared with the malignant group, the benign group had a significantly greater nodule size (35.4 mm vs 27.6 mm). The best cut-off point (≤ 28 mm) for nodule size, as determined by the receiver operating characteristic curve, had a sensitivity and specificity of 67.7% and 64.4%, respectively. The correlation between fine-needle aspiration biopsy and the final pathological results was assessed using the cross-table method. The sensitivity and specificity of fine-needle aspiration biopsy were 60% and 98%, respectively. CONCLUSION: This study showed that significant differences existed between the malignant and benign groups with regard to nodule size, cervical lymphadenopathy, and nodular calcification.

An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma.

OBJECTIVE: To evaluate the clinical characteristics of a patient operated for water-clear cell adenoma and to discuss these in the light of relevant literature. MATERIAL AND METHODS: PubMed and Google Scholar were searched to identify articles related to water-clear cell adenoma using the following keywords: parathyroid tissue, parathyroid gland, parathyroid cells, parathyroid adenoma, parathyroid hyperplasia, water-clear-cell, and water clear cell. The search included case reports, review articles, and original articles that had been published between January 1990 and November 2014 without any restrictions on language. All articles that contained information on the study population and treatment related data were identified and retrieved. In addition, an evaluation was of a case of a 47-year-old male patient with PHC who was treated at our clinic was conducted. RESULTS: A total of 19 patients, including our new case, (age range: 18 to 81 years, mean±SD: 57.47±16.31 years) were included in the analysis. Eleven patients were female. Information about adenoma location was available from studies involving 17 patients and they indicated the following distribution of locations: left inferior (n=10), right superior (n=4). When preoperative imaging methods were examined, a false negative result was given by ultrasonography in 28.5% of patients and only 57.1% were positive on scintigraphy. Concomitant thyroid papillary carcinoma was determined in 1 patient. The mean tissue dimensions were 3.47±1.73 cm (range, 0.8-6.8 cm). CONCLUSION: Water-clear cell adenoma, which shows similar clinical characteristics to other parathyroid adenomas, is an uncommon cause of hyperparathyroidism.

Evaluation of silybum marinaum efficacy on University of Wisconsin and histidine-tryptophan-ketoglutarate solutions latter the damage of the perfused liver.

PURPOSE:: To investigate the hepatoprotective and antioxidant effeicacies of Silybum marianum's (silymarin, S) on University of Wisconsin (UW) and histidinetryptophan-ketoglutarate (HTK) preservation solutions. METHODS:: Thirty two Wistar albino adult male rats were used. Group 1: UW group, Group 2: UW + Silymarin group(S), Group 3: HTK group, Group 4: HTK + silymarin group (S), respectively. Silymarin was enforced intraperitoneally before the surgery. Biopsies were enforced in 0, 6 and 12.hours to investigate. RESULTS:: Biochemical parameters examined in alanine aminotransferase (ALT), furthermore superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) in rats were also evaluated. Detected histopathological changings were substantially declining in the groups that received silymarin, cellular damage was decreased significantly in HTK + Silymarin group, according to other groups. It has been identified as the most effective group was HTK + silymarin group in evaluation of ALT, electron microscopic results, also decreased MDA and elevated in SOD, and CAT activity. Caspase 3 analysis showed a substantial lower apoptosis ratio in the silymarin groups than in the non-performed groups (p<0.05). CONCLUSION:: Histidinetryptophan-ketoglutarate+silymarin group provides better hepatoprotection than other groups, by decreasing the hepatic pathologic damage, delayed changes that arise under cold ischemic terms.

Can We Predict the Perioperative Pulmonary Complications Before Laparoscopic Sleeve Gastrectomy: Original Research.

BACKGROUND: The increasing prevalence of obesity in worldwide is one of the most serious chronic public health problems and is considered to be a global epidemic. Bariatric surgical procedures have also been applied more often with increased prevalence of obesity. As a result, the incidence of surgical complications has increased. Preoperative evaluation is quite important for these patients. AIMS: The aim of our study is to determine the predictors of perioperative pulmonary complications of laparoscopic sleeve gastrectomy. STUDY DESIGN: The study is a cross-sectional study. METHODS: One hundred eighty-three consecutive patients who received laparoscopic bariatric surgery were followed up during 3 months. Patients were divided into two groups A and B. Group A being the patients who had perioperative pulmonary complications (n = 28) and group B being patients who had not (n = 155). Pulmonary function test (PFT), body mass index (BMI), preoperative oxygen saturation, age, gender, comorbid diseases, and smoking history were compared between these groups. RESULTS: Mean age, size, weight, BMI, PFT parameters of groups A and B were close to each other. The strongest predictors of perioperative pulmonary complications were duration of smoking in current smokers and low baseline oxygen saturation. CONCLUSIONS: Preoperative oxygen saturation and smoking history may help to predict perioperative complications of laparoscopic sleeve gastrectomy.

A rare disease mimics postoperative bile leakage: Invasive aspergillosis.

Aspergillus fungi can cause serious infections, including intra-abdominal infection, particularly in patients with compromised immune system. Described in the present report is case of 46-year-old female patient who had undergone laparoscopic cholecystectomy (LC) at another healthcare facility. In early postoperative period, she had increasing complaints of swelling, nausea, and vomiting. On postoperative 19th day, she was referred to our clinic with diagnosis of acute abdomen. Surgery was performed with suspected possibility of bile leakage. However, pathological examination of soft, yellow-green mass found in subhepatic space determined it was fungus ball caused by fungi of the genus Aspergillus. Patient was diagnosed postoperative intra-abdominal aspergillosis (IAA).

Diagnosis and management of early gastric band slip after laparoscopic adjustable gastric banding.

Laparoscopic adjustable gastric banding (LAGB) used to be a very popular bariatric procedure at a certain time for the treatment of obesity as it has many advantages and is associated with low morbidity and mortality rates. Complications are often late and are rarely seen by general surgeons due to the limited number of patients, and physicians should be aware of the symptoms. We present a case of a 40-year-old female patient who underwent LAGB and was admitted for a huge gastric pouch dilatation on postoperative day 5. She had a history of food consumption on the fourth day after surgery. She was diagnosed with early gastric band slippage (EGBS). The band was repositioned and gastrogastric sutures were placed to prevent reprolapse of the band. The EGBS is an immediate postoperative complication. Diagnosis of EGBS can be made with oral contrast X-ray studies, and surgical intervention is necessary.

Laparoscopic Sleeve Gastrectomy in Situs Inversus Totalis: a Case Report and Comprehensive Literature Review.

The aim of this study is to review the reliability of laparoscopic obesity operations in patients with situs inversus totalis(SIT). A new case of SIT was presented together with a literature review of published English language studies on laparoscopic gastric banding (LAGB), laparoscopic gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic obesity surgery (LOS), and SIT, accessed via PubMed and Google Scholar databases. The case is presented of a 21-year-old female patient who underwent LSG due to SIT. A total of 12 publications in literature matched the search criteria for LAGB, LRYGB, LSG, LOS, and SIT, which reported LAGB in five cases, LRYGB in four cases, and LSG in four cases. In the rare event of SIT, LOS can be safely used following good evaluation.

The Role of Conventional Ultrasonography in the Evaluation of Antrum Wall Thickness in Obese Patients.

BACKGROUND: The objective of this study is to evaluate the utility of conventional ultrasonography (USG) in the evaluation of the stomach antrum and distal corpus lesions. METHODS: A prospective evaluation was made of 69 patients who underwent sleeve gastrectomy. Preoperative USG was applied to the patients and measurements were taken and recorded of the stomach antrum full layer wall thickness (USGFT) and of mucosal thickness (USGMT). Postoperatively, same parameters were again measured histopathologically and the pathological full thickness (PFT) and pathological mucosal thickness (PMT) values were compared. RESULTS: When evaluation was made in respect of USG and pathological measurements, the USGFT was 8.51 ± 3.07 (range 4.5-15.8) and USGMT was 5.80 ± 2.15 (range 2.36-10.5). The PFT was determined as 8.13 ± 2.24 (range 4-14) and PMT as 5.53 ± 1.86 (range 2-10.5). In the histopathological examination, gastritis was seen in 53 (76.8 %) patients and Helicobacter pylori (HP) positivity was determined in 32 (46.4 %) patients. When the patients were grouped as obese (BMI ≤ 49.9 kg/m2) (group 1, n = 50) and super obese (BMI ≥ 50 kg/m2) (group 2, n = 19), no difference was determined between the groups ultrasonographically or histopathologically (p > 0.05). The antrum wall thickness was seen to be significantly greater in the patients with gastritis and HP positivity compared to the patients who were negative. In ROC analysis, cutoff values were calculated for USGFT (5.86 mm) and USGMT (4.49 mm). In gastritis diagnosis, the USGFT cutoff value was found to have 796 % sensitivity and 68.7 % specificity. CONCLUSION: USG was seen to be an extremely effective method in visualising the antrum wall and gastritis diagnosis can be made comfortably from the wall thickness measurement.

Predictive role of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for diagnosis of acute appendicitis during pregnancy.

Acute appendicitis (AA) is not uncommon during pregnancy but can be difficult to diagnose. This study evaluated the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in addition to conventional diagnostic indicators of the disease to diagnose AA during pregnancy. Age, gestational age, white blood cell (WBC) count, Alvarado scores, C-reactive protein (CRP), lymphocyte count, NLR and PLR were compared among 28 pregnant women who underwent surgery for AA, 35 pregnant women wrongly suspected as having AA, 29 healthy pregnant women, and 30 nonpregnant healthy women. Mean WBC counts and CRP levels were higher in women with proven AA than in those of control groups (all p < 0.05). Among all the groups, the median NLR and PLR were significantly different in women with proven AA (all p < 0.05). Receiver operating characteristic analysis was used to determine cut-off values for WBC count, CRP, lymphocyte count, NLR and PLR, and multiple logistic regression analysis showed that NLR and PLR used with routine methods could diagnose AA with 90.5% accuracy. Used in addition to routine diagnostic methods, NLR and PLR increased the accuracy of the diagnosis of AA in pregnant women.

Comparison of efficacy of topical phenytoin with hypericin in second-degree burn wound healing: an experimental study in rats.

BACKGROUND: This experiment was performed to compare the effects of Phenytoin (PHT) and Hypericin (HP) cream on healing of burn wounds in rats. MATERIAL AND METHODS: Twenty rats were divided into 3 groups and second-degree burn wounds were created. The burn wounds in the first, second, and third groups were covered twice daily with PHT cream, HP cream, and saline (control), respectively. At the end of days 3, 7, 14, and 21, full-thickness skin biopsies were done for histopathologic and immunohistochemical analyses. RESULTS: Histopathologic evaluations at the 14th day showed that re-epithelialization scores were greater in the HP group than the PHT group, but on day 21, re-epithelialization scores were higher in the PHT group than the HP group. Collagen content on days 3 and 14 in the PHT group was found to be higher than in the HP group. Well-vascularized granulation tissue on day 7 in the PHT group was higher than in other groups. HP and PHT groups had a significant increase in VEGF and TGF-b expression in burn wound healing area compared to the control group on all days. CONCLUSIONS: Topical application of HP can promote re-epithelialization in burn wounds to shorten the wound healing time for superficial burns. Phenytoin, on the other hand, contributes to healing by increasing vascularized granulation tissue and collagen synthesis through re-epithelialization. The increased VEGF and TGF-b expression following PHT and HP treatment strongly indicate that PHT and HP treatment promotes VEGF and TGF-b production and action in the burn wound area.

Protective effects of intravenous anesthetics on kidney tissue in obstructive jaundice.

AIM: To evaluate the protective effects on kidney tissue of frequently used intravenous anesthetics (ketamine, propofol, thiopental, and fentanyl) in rats with obstructive jaundice. METHODS: There is an increased incidence of postoperative acute renal failure in patients with obstructive jaundice. Thirty-two Wistar-albino rats were randomly divided into four equal groups. Laparatomy was performed on each animal in the four groups and common bile ducts were ligated and severed on day 0. After 7 d, laparotomy was again performed using ketamine, propofol, thiopental, or fentanyl anesthesia whose antioxidative properties are well known in oxidative stress in a rat liver model of obstructive jaundice. After 2 h, the rats were sacrificed. Renal tissue specimens were analyzed for catalase, superoxide dismutase and malondialdehyde enzymes activities. All values are expressed as the mean ± SD. P values less than 0.05 were considered statistically significant. RESULTS: All animals survived without complications until the end of the study. Enlargement in the bile duct and obstructive jaundice were observed in all rats. Catalase was found to be significantly lower in the fentanyl group than in the ketamine (P = 0.039), propofol (P = 0.012), and thiopental (P = 0.001) groups. Superoxide dismutase activities were similar in all groups (P > 0.05). Malondialdehyde was found to be significantly lower in the ketamine group than in the propofol (P = 0.028), thiopental (P = 0.002) and fentanyl (P = 0.005) groups. Malondialdehyde was also lower in the fentanyl group than in the thiopental group (P = 0.001). The results showed that obstructive jaundice sensitizes renal tissue to damage under the different anesthetics. CONCLUSION: Among the agents tested, ketamine and propofol generated the least amount of oxidative stres on renal tissues in this rat model of obstructive jaundice created by common bile duct ligation. The importance of free radical injury in renal tissue in obstructive jaundice under different intravenous anesthetics during hepatobiliary and liver transplant surgery should be considered for prevention of postoperative acute renal failure.

Protective effects of zinc, pentoxifylline, and N-acetylcysteine in an animal model of laparoscopy-induced ischemia/reperfusion injury of the small intestine.

BACKGROUND: Pneumoperitoneum induced to facilitate laparoscopy is associated with splanchnic hypoperfusion, ischemia/reperfusion (I/R) injury, and oxidative stress. AIM: This study investigated the effects of pre- and postlaparoscopic conditioning, zinc, pentoxifylline, and N-acetylcysteine on markers of I/R injury of the small intestine in an animal model. METHODS: Male Sprague-Dawley rats (n=56) were randomized to 1 of 7 treatment groups. Except for group 7 (control group that underwent sham surgery without pneumoperitoneum), pneumoperitoneum was induced in all by use of carbondioxide insufflation under a pressure of 15 mmHg. Group 1 (laparoscopic I/R) was subjected to 60 minutes of pneumoperitoneum. Group 2 (laparoscopic preconditioning plus laparoscopy) was subjected to 5 minutes of insufflation and 5 minutes of desufflation followed by 60 minutes of pneumoperitoneum. Group 3 (laparoscopy plus laparoscopic postconditioning) was subjected to 60 minutes of pneumoperitoneum and 60 minutes of desufflation followed by 5 minutes of insufflation and 5 minutes of desufflation. Group 4 (zinc), group 5 (pentoxifylline), and group 6 (N-acetylcysteine) received a single intraperitoneal injection of zinc (50 mg/kg), pentoxifylline (50 mg/kg), or N-acetylcysteine (150 mg/kg), respectively, 5 minutes before the desufflation period. Animals were killed at the end of the experiments, and small intestine samples were tested for malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPX), and superoxide dismutase (SOD). RESULTS: There was no significant difference for MDA levels between each other in the groups 1, 2, and 3. But MDA levels were higher significantly in groups 1, 2, and 3 than those of groups 4, 5, 6, and 7. SOD and GPX levels of group 3 were significantly higher than those of groups 1, 2, 4 through 7. According to the SOD levels, there was no significant difference between each other in those of groups 1, 2, 4 through 7. GPX levels of group 3 were significantly higher than those of groups 1, 2, 4 through 7. GPX levels of group 1 were significantly lower than those of groups 5 and 7. The mean CAT level of groups 1 and 2 was significantly lower than that of groups 3, 6, and 7. The mean CAT level of group 3 was significantly higher than that of groups 1, 2, 4 through 7. CONCLUSIONS: In this animal model of small intestine I/R injury, laparoscopy caused small intestine ischemia as evidenced by elevated markers of tissue I/R injury. This effect was significantly attenuated by zinc, pentoxifylline, and N-acetylcysteine, but not by prelaparoscopy conditioning and postlaparoscopy conditioning.

Splenic hydatic cyst as a cause of sinistral portal hypertension and isolated gastric variceal bleeding.

A 60-year-old male, living in a rural area, presented with recurrent upper gastrointestinal bleeding. Isolated fundal varices were seen on endoscopy. A lesion similar to cyst hydatid was seen in the spleen on abdominal ultrasonography and computerized tomography scanning. Also, sinistral (left-sided) portal hypertension and collaterals were seen due to the compression of the splenic vein by the cyst. Indirect hemagglutination antibody test for Echinococcus granulosus was positive. By screening, no other cyst was found in any other site of the body. The patient underwent open abdominal surgery, and the anterior wall of the cyst was resected partially; within it were multiple daughter cysts and hydatid fluid. After decontamination of the daughter cysts and hydatid fluid, germinative membrane omentoplasty was performed with a part of the omentum. However, the patient suffered from recurrent gastrointestinal bleeding postoperatively and he was re-evaluated. Later, splenectomy was performed in order to relieve left-sided portal hypertension. The patient did not experience further bleeding and gastric varices disappeared following splenectomy.

Yersinia pseudotuberculosis colitis presented with severe gastrointestinal bleeding.

We report an adult case of Yersinia pseudotuberculosis colitis who presented with severe gastrointestinal bleeding. A 25-year-old male had admitted with fever, vomiting, body aches, and massive lower gastrointestinal bleeding. Since diagnostic tests were unremarkable and the patient's hemodynamic condition was unstable, emergency explorative laparotomy was performed. During the operation, localized wall thickening and ulcers were seen in the cecum. Right hemicolectomy was performed. Histological examination showed non-caseation granulomas in mesenteric lymph nodes and transmural inflammation in the cecum. Y. pseudotuberculosis serology, based on histological suspicion, was positive. The patient was discharged with cure 12 days after the operation following gentamicin treatment. To our knowledge, there are only two reports about massive lower gastrointestinal bleeding due to Y. pseudotuberculosis. Although this is a rare entity, lower gastrointestinal bleeding due to Y. pseudotuberculosis should be taken into consideration in the differential diagnosis of patients presenting with massive lower gastrointestinal bleeding, as a possible cause.