Morphological investigation of protective effects of CDP-choline on liver and small intestine in an experimental sepsis model in rats / Investigación morfológica de los efectos protectores de la CDP-colina en el hígado y el intestino delgado en un modelo experimental de sepsis en ratas

SUMMARY: Fifty male Wistar albino rats were divided into 5 groups; Group 1 as a sham group. Group 2 as a control group, Group 3 as 100 mg/kg CDP-choline administered group, Group as 200 mg/kg CDP-choline administered group, and Group 5 as sepsis group. The sepsis model was performed by ligating and perforating the caecum of rats. Liver and small intestine tissues were assessed either histologically or quantitatively and qualitatively. There was a significant difference between the sepsis and CDP-choline groups for liver and intestinal damage evaluated in tissue samples. (p <0.001). CDP-choline treatment partially improved dose-dependent the clinical parameters of sepsis and septic shock, reversed micro-anatomical damage caused by sepsis.

Cincuenta ratas albinas Wistar macho se dividieron en 5 grupos; Grupo 1 como grupo control simulador, el grupo 2 como grupo de control, el grupo 3 como grupo al que se administró 100 mg/kg de CDP-colina, el grupo 4 como grupo al que se administró 200 mg/kg de CDP-colina y el grupo 5 como grupo con sepsis. El modelo de sepsis se realizó ligando y perforando el intestino ciego de las ratas. Los tejidos del hígado y del intestino delgado se evaluaron histológicamente o cuantitativa y cualitativamente. Hubo una diferencia significativa entre los grupos de sepsis y CDP-colina para el daño hepático e intestinal evaluado en muestras de tejido (p<0,001). El tratamiento con CDP-colina mejoró parcialmente, según la dosis, los parámetros clínicos de sepsis y shock séptico y revirtió el daño micro anatómico causado por la sepsis.

Comparative Analysis of Preoperative Ratio Based Markers in Predicting Postoperative Infectious Complications After Gastrectomy.

AIM: Postoperative infections (POIs) are associated with prolonged postoperative recovery, delayed adjuvant therapy, psychological problems, and poor long-term outcomes. The study aims to cross-compare the ratio-based preoperative parameters to predict POIs in patients with D2 gastrectomy for gastric cancer. MATERIALS AND METHODS: A retrospective cohort and single-center study evaluated the data of 293 patients who underwent curative gastrectomy between January 2007 and November 2019 in a tertiary hospital in Istanbul. A receiver operating characteristic (ROC) curve was used to assess the ability of laboratory values to predict clinically relevant POIs. The predictive capacity of the neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and CRP-albumin ratio (CAR) was calculated by the area under the curve. Then, the cutoff points were determined for all 4 indexes. RESULTS: POIs developed in 77 (26.2%) patients. Patients with POI had higher Charlson comorbidity index (CCI) scores and a longer length of hospital stay. ROC curve analysis revealed that NLR, LMR, and CAR were significantly effective in predicting POI, while PLR was ineffective. LMR was the best ability to predict the POI. According to multivariate analysis, CCI score 3, NLR> 3.8, and LMR 2.34 were independent risk factors influencing the POI. CONCLUSION: Preoperative LMR was most predictive for POI. Although CAR predicted the development of the POI, it was not superior to LMR and NLR. PLR did not have any prediction for POI. In addition, increased comorbidity (CCI 3) was an independent risk factor for POI.

Hepatic bridge and round ligament of the liver during cytoreductive surgery: a retrospective cohort.

PURPOSE: The hepatic bridge as an anatomical variation may lead to recurrence and treatment failure in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by constituting an obscure region during surgery. This report aimed to highlight the relationship between the hepatic bridge and various prognostic factors in peritoneal carcinomatosis. METHODS: Data of 101 patients who underwent CRS/HIPEC for peritoneal carcinomatosis in a single centre were retrospectively reviewed. Demographic characteristics, primary origin of peritoneal carcinomatosis, classification of hepatic bridge, Peritoneal Cancer Index (PCI) score, and completeness of cytoreduction (CC) score were analysed. RESULTS: The tumour was proven histopathologically in 18 (28.6%) of 63 patients who underwent distal round ligament (DRL) resection. The PCI score was found to be significantly higher in patients with tumour in DRL compared to the ones without tumour (p < 0.001). The median PCI score of patients with implant positive DRL was 18 (12-20) and this score was 3 (2-6) for patients with implant negative DRL (p < 0.001). The ROC curve concerning the risk of an implant penetrating the round ligament revealed the optimal cut-off value of PCI at 10 with 88.9% sensitivity and 79.3% specificity. CONCLUSION: The round ligament should be removed, regardless of the PCI score, as a standard in mucinous adenocarcinoma of the appendix and malignant peritoneal mesothelioma. DRL should be removed when PCI is equal or higher than 10 for PC due to colorectal and ovarian cancers.

Low Educational Status and Childhood Obesity Associated with Insufficient Mid-Term Weight Loss After Sleeve Gastrectomy: a Retrospective Observational Cohort Study.

PURPOSE: Successful weight loss after bariatric surgery has been associated with a variety of factors. The aim of this study was to determine the effects of educational status on surgical weight loss for patients undergoing sleeve gastrectomy (SG). MATERIALS AND METHODS: This retrospective cohort study was carried out on patients undergoing SG between September 2013 and July 2015. Six months after surgery, the patients were classified into two groups according to their success in the percentage of excess weight loss (%EWL). Group 1: <%50EWL (insufficient WL) and group 2: ≥%50EWL (successful WL) in the sixth month. The independent predictors for insufficient weight loss six months after SG were analyzed. RESULTS: In the sixth post-operative month, their mean %EWL and percentage of excess body mass index loss (%EBMIL) were 50 ± 15.4 and 58.2 ± 19.3, respectively. In univariate analysis, group 1 patients were found to be significantly older when compared to group 2 patients while the education level of group 2 patients was significantly higher when compared to group 1. A tertiary educational level at a university or higher was associated with a nearly fourfold increased success in weight loss (AOR 3.772, p = 0.03) 6 months after SG. Multivariate analysis showed that patients with a history of childhood obesity were more likely to have insufficient weight loss (AOR 0.390, p = 0.045). CONCLUSION: Childhood obesity and a lower level of education are associated with insufficient weight loss 6 months after SG. However, prospective external validation is warranted, with a long-term follow-up of a large bariatric surgery population.

Cholecystectomy and duodenogastric reflux: interacting effects over the gastric mucosa.

AIMS: To evaluate association between duodenogastric reflux and early gastric mucosal changes before and after the cholecystectomy procedure. MATERIALS AND METHODS: Patients were evaluated with preoperative and postoperative endoscopy and endoscopic biopsy. Demographic and clinical characteristics, histological parameters, presence of duodenogastric reflux, and Updated Sydney scores were noted. RESULTS: A total of fifty patients who obeyed the follow-up were enrolled into the study. Median age of the patients was 43 years (range 25-84). Male-female ratio was 0.51 (17/33). Duodenogastric reflux % and Updated Sydney scores before and after cholecystectomy were 24 (48%) versus 39 (78%) and 2.38 ± 2.21 versus 3.46 ± 3.05, respectively (p = 0.001, p < 0.000). Mucosal inflammation degree showed significant increase in 15 (30%) patients, decrease in 7 (14%) patients and equality in 28 (56%) patients (p = 0.037). Neutrophil activation degree was significantly higher in 21 (42%) patients, lower in 5 (10%) patients after the surgery (p = 0.005). Postoperative glandular atrophy degree was also higher in 13 (26%) patients and equal in 37 (74%) patients (p = 0.001). Pre- and postoperative degree of intestinal metaplasia and H. pylori density did not any show significant difference (p = 0.157, p = 0.248, respectively).There were significant positive correlation between postoperative H. pylori infection and mucosal activity, inflammation, atrophy and intestinal metaplasia. CONCLUSION: Cholecystectomy is a potent inducer of pathologic duodenogastric reflux. Early onset of duodenogastric reflux and underlying H. pylori gastritis cause early gastric mucosal injury following cholecystectomy procedure by interacting collectively.

Challenging management of obturator hernia: a report of three cases and literature review.

Obturator hernia (OH) is a rare condition with high rates of morbidity and mortality. While diagnosis is difficult, surgery is the definitive treatment. Intestinal obstruction is the most common symptom upon admission. In addition, small-bowel obstruction is documented in more than half of OH patients. Advanced age, intestinal obstruction, bowel perforation, comorbid diseases, and clinical deterioration are risk factors for higher rates of mortality. The aim of the present report was to document clinical and surgical management of 3 female patients, each over 80 years of age, admitted to the emergency surgery department with intestinal obstruction and OH.

Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in "difficult cholecystectomies".

OBJECTIVE: Laparoscopic cholecystectomy has become the "gold standard" for benign gallbladder diseases due to its advantages. In the presence of inflammation or fibrosis, the risk of bleeding and bile duct injury is increased during dissection. Laparoscopic partial cholecystectomy (LPC) is a feasible and safe method to prevent bile duct injuries and decrease the conversion (to open cholecystectomy) rates in difficult cholecystectomies where anatomical structures could not be demonstrated clearly. MATERIAL AND METHODS: The feasibility, efficiency, and safety of LPC were investigated. The data of 80 patients with cholelithiasis who underwent LPC (n=40) and conversion cholecystectomy (CC) (n=40) were retrospectively examined. Demographic characteristics, ASA scores, operating time, drain usage, requirement for intensive care, postoperative length of hospital stay, surgical site infection, antibiotic requirement and complication rates were compared. RESULTS: The median ASA value was 1 in the CC group and 2 in the LPC group. Mean operation time was 123 minutes in the CC group, and 87.50 minutes in the LPC group. Surgical drains were used in 16 CC patients and 4 LPC patients. There was no significant difference between groups in postoperative length of intensive care unit stay (p=0.241). When surgical site infections were compared, the difference was at the limit of statistical significance (p=0.055). Early complication rates were not different (p=0.608) but none of the patients in the LPC group suffered from late complications. CONCLUSION: LPC is an efficient and safe way to decrease the conversion rate. LPC seems to be an alternative procedure to CC with advantages of shorter operating time, lower rates of surgical site infection, shorter postoperative hospitalization and fewer complications in high-risk patients.

The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis.

BACKGROUND/AIMS: Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by attacks of fever and diffuse abdominal pain. The primary concern with this presentation is to distinguish it from acute appendicitis promptly. Thus, we aimed to evaluate the role of neutrophil lymphocyte ratio (NLR) to leverage the differential diagnosis of acute FMF attack with histologically proven appendicitis. METHODS: Twenty-three patients with histologically confirmed acute appendicitis and 88 patients with acute attack of FMF were included in the study. NLR, C-reactive protein and other hematologic parameters were compared between the groups. RESULTS: Neutrophil to lymphocyte ratio was significantly higher in patients with acute appendicitis compared to the FMF attack group (8.24 ± 6.31 vs. 4.16 ± 2.44, p = 0.007). The performance of NLR in diagnosing acute appendicitis with receiver operating characteristic analysis with a cut-off value of 4.03 were; 78% sensitivity, 62% specificity, and area under the curve 0.760 (95% confidence interval, 0.655 to 0.8655; p < 0.001). CONCLUSIONS: This study showed that NLR, the simple and readily available inflammatory marker may have a useful role in distinguishing acute FMF attack from acute appendicitis.

The impact of PET/CT on the management of hepatic and extra hepatic metastases from gastrointestinal cancers.

PURPOSE: To investigate the efficacy of positron emission tomography/computed tomography (PET/CT) in detection and management of hepatic and extrahepatic metastases from gastrointestinal cancers. MATERIALS AND METHODS: Between February 2008 and July 2010, patients histopathologically diagnosed with gastrointestinal cancer and showing suspected metastasis on CT screening were subsequently evaluated with PET/CT. All patients were subgrouped according to histopathological origin and localization of the primary tumor. Localization of gastrointestinal cancers was further specified as lower gastrointestinal system (GIS), upper GIS, or hepato-pancreato-biliary (HPB). Both accuracy and impact of CT and PET/CT on patient management were retrospectively evaluated. RESULTS: One hundred and thirteen patients diagnosed histopathologically with gastrointestinal cancers were retrospectively evaluated. Seventy-nine patients had adenocarcinoma and 34 patients other gastrointestinal tumors. Forty-one patients were in the upper GIS group, 30 patients in the HPB group, and 42 patients in the lower GIS group. Evaluation the diagnostic performance of PET/CT for suspected metastasis according to histopathological origin of the tumor, revealed that the sensitivity of PET/CT - although statistically not different - was higher in adenocarcinomas than in non-adenocarcinomas (90% (95% CI, 0.78-0.96) vs. 71.4% (95% CI, 0.45-0.88), P=0.86). The specificity was not significantly different (85.7% (95% CI, 0.70-0.93) vs. 85% (95% CI, 0.63-0.94), P=1.00). In the overall patient group; CT was significantly more sensitive than PET/CT for detection of hepatic metastases (94.7% vs. 78.9%, P=0.042), whereas PET/CT was significantly more specific than CT (48% vs. 98.7%, P<0.001). In subgroup analysis, sensitivity was not significantly different (P>0.05) but specificity was significantly higher in PET/CT than CT (P<0.05). The specificity of PET/CT was highest in upper GIS (100%) and HPB (100%) subgroups. In the overall patient group; for detection of extrahepatic metastasis, the sensitivity of CT (75%) and PET/CT (87.5%) showed no significant difference (P=0.437). However, PET/CT was significantly more specific than CT (88.7% vs. 70.4%, P=0.007). In subgroup analysis, no significant difference was found between CT and PET/CT either in sensitivity or in specificity (P>0.05). The specificity of PET/CT was highest in the lower GIS subgroup (93%). The management of 45 patients (39.8%) was revised after PET/CT evaluation. CONCLUSIONS: PET/CT has a higher specificity than CT in detecting suspected hepatic and extrahepatic metastases of gastrointestinal cancers, and has an impact of nearly 40% on changing patient management strategies.

Effects of combined epidural analgesia with total intravenous anesthesia on risky patients underwent major abdominal surgery.

OBJECTIVES: The aim of this study is to investigate the effects of combined epidural analgesia with total intravenous anaesthesia and only total intravenous anaesthesia on the different clinical parameters. METHODS: Sixty high risk patients undergoing a major abdominal surgical procedure were included in this prospective, double blind, randomized study. Induction of anaesthesia was performed with IV remifentanil 0.5µg/kg and propofol titrated to achieve bispectral index score between 40 and 50. after intubation; in Group E, 0.1% bupivacaine and 2 µg/mL fentanyl were administered by an infusion rate at 0.15 ml/kg/h via the epidural catheter and Group C received epidural normal saline as same infusion rate. RESULTS: In group E, intraoperative MAP values were significantly lower than those in group C (p<0.05). Time of extubation, time of eye opening with audible warning and time of verbal response was significantly lower in group E than those in group C. Total anaesthetic drug consumption was significantly higher in group C than those in group E (p<0.05). CONCLUSION: Based on lower requirements for propofol and remifentanil as well as the favourable effects on clinical parameters; we conclude that bispectral index score guided combined epidural with total intravenous anaesthesia is superior to solely total intravenous anaesthesia in this type of surgery.

Preoperative serum tumor marker levels in gastric cancer.

OBJECTIVE: Tumor markers have shown little benefit as a method for screening. However, they can be used clinically for the monitoring of tumor recurrence and used as prognostic factors because higher levels have been observed in advanced disease. This study aimed to investigate the relationship between the preoperative tumor marker levels and different clinical aspects of gastric cancer. METHODS: One hundred and six consecutive patients with confirmed diagnosis of gastric cancer and 106 subjects (age and sex matched) with no malignancy as control group were included prospectively in this study in 3 years. The relationships between tumor markers CEA, CA 19-9 and stage of disease, tumor differentiation, presence of ringlet cell type, presence of peritoneal carcinomatozis were investigated. RESULTS: The serum CEA and CA 125 levels were found to be significantly elevated in gastric cancer patients than in controls. The serum level of CEA had showed a significant elevation with the presence of distant metastasis. The CA 19-9 and CA 125 levels had showed significant elevations with the presence of peritoneal carcinomatozis. Conclusions : This study showed that there is a limited clinical benefit of preoperative tumor marker measurements in gastric cancer such as estimation of peritoneal dissemination.

Comparison of propofol-based sedation regimens administered during colonoscopy.

BACKGROUND: The ideal sedative agent for endoscopic procedures should allow a rapid modification of the sedation level and should not have any adverse effects. AIM: To evaluate and compare the efficacy, safety, cost and patient satisfaction of some propofol-based sedation regimens administered during colonoscopy. MATERIAL AND METHODS: One hundred twenty one patients scheduled for elective outpatient colonoscopy with conscious sedation were randomized to four groups to evaluate the administration of dexmedetomidine, sufentanil, meperidine and midazolam in combination with propofol to maintain sedation during the procedure. Evaluated outcomes were efficacy, safety, cost and patient satisfaction of sedation procedures. RESULTS: Patients receiving dexmedetomidine achieved a higher degree of sedation when compared with the other groups (p < 0.05). The lapse to recover protective reflexes and motor function, was significantly shorter in groups receiving dexmedetomidine or sufentanil than in groups receiving meperidine or midazolam (p < 0.05). There were no differences between groups in pre-sedation and post-sedation neurophysiologic performance, measured by the Trail Making A and B tests. CONCLUSIONS: Sedation for endoscopy can be safely and effectively accomplished with low doses of propofol combined with dexmedetomidine, intranasal sufentanil, IV meperidine and IV meperidine with midazolam.

Comparison of propofol-based sedation regimens administered during colonoscopy / Comparación de protocolos de sedación basados en propofol para obtener sedación durante endoscopias

Background: The ideal sedative agent for endoscopic procedures should allow a rapid modification ofthe sedation level and should not have any adverse effects. Aim: To evaluate and compare the efficacy, safety, cost and patient satisfaction of some propofol-based sedation regimens administered during colonoscopy. Material and Methods: One hundred twenty one patients scheduled for elective outpatient colonoscopy with conscious sedation were randomized to four groups to evaluate the administration of dexmedetomidine, sufentanil, meperidine and midazolam in combination with propofol to maintain sedation during the procedure. Evaluated outcomes were efficacy, safety, cost and patient satisfaction of sedation procedures. Results: Patients receiving dexmedetomidine achieved a higher degree of sedation when compared with the other groups (p < 0.05). The lapse to recoverprotective reflexes and motor function, was significantly shorter in groups receiving dexmedetomidine or sufentanil than in groups receiving meperidine or midazolam (p < 0.05). Therewere no differences between groups in pre-sedation and post-sedation neurophysiologic performance, measured by the Trail MakingA and B tests. Conclusions: Sedation for endoscopy can be safely and effectively accomplished with low doses of propofol combined with dexmedetomidine, intranasal sufentanil, IV meperidine and IV meperidine with midazolam.

Antecedentes: El protocolo de sedación ideal para procedimientos endoscópi-cos es aquel que permita efectuar modificaciones rápidas del nivel de sedación y no tenga efectos secundarios. Objetivo: Comparar la eficacia, seguridad, costos y satisfacción del paciente con protocolos de sedación basados en propofol, durante colonoscopias. Material y Métodos: Ciento veinte pacientes programados para una colonoscopia fueron aleatorizados en cuatro grupos en que se evaluó la administración de dexmedetomidina, sufentanil, meperidina y midazolam en combinación con propofol, para mantener la sedación durante el procedimiento. Se evaluó la eficacia, seguridad, costo y satisfacción del paciente con los diferentes protocolos de sedación. Resultados: Los pacientes que recibieron dexmedetomidina, alcanzaron un mayor nivel de sedación que el resto de los grupos. El lapso necesario para recuperar reflejos y funciones motoras protectoras, fue significativamente menor en los grupos que recibieron dexmedetomidina o sufentanil comparado con los grupos que recibieron meperidina o midazolam (p < 0,05). No hubo diferencias entre los grupos en la capacidad neuro-cognitiva, medida con los Tests de Reitan A y B, antes o después de la sedación. Conclusiones: Se puede obtener una buena sedación para endoscopia combinando dosis bajas de propofol con dexmedetomidina, sufentanil intranasal, meperidina endovenosa con o sin midazolam.

Comparison of surgical Limberg flap technique and crystallized phenol application in the treatment of pilonidal sinus disease: a retrospective study.

OBJECTIVE: This study was designed to compare the efficacy of crystallized phenol method with Limberg flap in pilonidal sinus treatment. MATERIAL AND METHODS: Patients with a diagnosis of pilonidal sinus disease treated with surgical excision + Limberg rhomboid flap technique and crystallized phenol method between 2010-2011 in the Sevket Yilmaz Training and Research Hospital, Department of General Surgery were evaluated retrospectively. Patients' age, sex, length of hospital stay, complications and recurrence rates were evaluated. RESULTS: Eighty eight percent of patients were male and mean age was 26.84±6.41 in the Limberg group, and 24.72±5.00 in the crystallized phenol group. Sinus orifice locations and nature, and duration of symptoms before surgery were similar in the two groups. Length of hospital stay in the Limberg group was 1.46±0.61 days; whereas all patients in the crystallized phenol group were discharged on the same day. Infection, hematoma, wound dehiscence, and cosmetic problems were significantly higher in the Limberg group. There was no difference between the two groups in terms of recurrence and seroma formation. CONCLUSION: The less invasive method of crystallized phenol application may be an alternative approach to rhomboid excision and Limberg flap in patients with non-complicated pilonidal sinus disease, yielding acceptable recurrence rates.

Mesenteric panniculitis patients requiring emergency surgery: report of three cases.

Mesenteric panniculitis is a rare, benign disease characterized by a chronic non-specific inflammatory process of mesenteric fat tissue with unknown etiology. The small bowel mesentery is affected mostly. This process rarely involves the large intestine mesentery. Mesenteric panniculitis includes symptoms as abdominal pain, nausea and vomiting, diarrhea, constipation, and fever. In our cases, we had difficulty in the preoperative diagnosis as the clinical changes imitated an obstruction or ischemia of the small bowel. All the cases required emergency abdominal surgery and partial jejunal resection. The aim of this article was to present three cases of mesenteric panniculitis of the small bowel mesentery requiring emergency surgery together with a short review of the literature.

Preoperative local staging of colorectal cancer patients with MDCT.

BACKGROUND/AIMS: To evaluate tumor invasion (T staging) and lymph node metastasis (N staging) of colorectal cancer preoperatively by using multi-detector computerized tomography (MDCT) and to compare with the histopathological findings. METHODOLOGY: MDCT scan was performed for 73 patients with pathological proven colorectal carcinoma. One radiologist prospectively evaluated the depth of tumor invasion (T staging) and regional lymph node involvement (N staging). The MDCT assessment was then compared with the histopathological findings for accuracy, sensitivity and specificity. RESULTS: In this study, the best accuracy results had been acquired for T1 and T2 tumors as 90.4% and 73.9%, respectively. For both histopathologically staged N0 and N1 patients, the accuracy results were 61.6%. The distant metastases were not detected in this study. CONCLUSIONS: Our study results showed that the MDCT may be useful in the preoperative assessment for the T and N staging in colorectal carcinoma.

Anti-inflammatory efficiency of levobupivacaine in an experimental colitis model.

AIM: To investigate the efficiency of levobupivacaine in treating experimentally induced colitis in rats. METHODS: Colitis was induced by trinitrobenzene sulfonic acid and ethanol in 30 rats under general anesthesia, and 10 rats were used as a sham group. Subsequent to induction of colitis, rats were divided into three groups; budesonide group received 0.1 mg/kg budesonide, levobupivacaine group received 10 mg/kg levobupivacaine and saline group received 1 mL saline solution via rectal route for 7 d. In the sham group, only routine rectal catheterization was performed without use of any material. At the end of 7 d, laparotomy and total colectomy were performed for histopathological examination in all rats and blood samples were drawn for measurement of tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 following cardiac puncture. Macroscopic and microscopic evaluations of the specimens were performed by a pathologist blinded to group assignment of the rats. RESULTS: Weight loss (P = 0.016) and macroscopic examination scores (P = 0.001) were significantly higher in saline group than others. Histopathological scoring was comparable between all colitis groups (P = 0.350). There was no significant difference in TNF-alpha levels and IL-6 levels (P = 0.150). CONCLUSION: The significant improvement in macroscopic scores suggests that levobupivacaine may have topical anti-inflammatory effects in an experimental colitis model; however, this finding was not supported by microscopic findings.

[Diagnostic accuracy of symptoms, signs and one-year prognosis of patients with acute non-specific abdominal pain: prospective survey]. / Akut nonspesifik karin agrili olgularin bir yillik prognozlari, semptom ve bulgularinin tanisal dogrulugu.

BACKGROUND: The aims of this study were to determine the diagnostic value of elements of the disease history, the clinical findings and basic laboratory examinations in differential diagnosis of the patients with nonspecific abdominal pain and to analyze the long-term survey of these patients. METHODS: A prospective observational study was performed at the Department of General Surgery Medicine Faculty of Uludag University between November 2001 to November 2002. Based on the diagnosis reasons for abdominal pain, 610 patients were classified as being of specific abdominal pain (n=501) versus nonspecific abdominal pain (n=109). Patients with nonspecific abdominal pain were invited to a follow-up examination 24 hours later and 4 follow-up interviews were conducted on days 8, 15, 30 and at the end of 1 year. Statistical analyses were performed between findings of two groups. RESULTS: In logistic regression analysis, presence of a history of similar pain (odds ratio 1.88; p=0.009), nausea (odds ratio 0.46; p=0.001), rigidity (odds ratio 0.24; p=0.024), fever < or = 36.6 degrees C (odds ratio 1.66; p=0.037), leukocyte count < or = 8700 (odds ratio 1.85; p=0.011), age < or = 39 years (odds ratio 1.85; p=0.018), respiratory rate < or = 15 (odds ratio 3.19; p=0.00..) were significantly independent diagnostic factors. There was no malignancy during one-year follow-up period. CONCLUSION: The possibility of a specific cause is higher in patients with history of a similar pain, nausea, rigidity, fever >36.6 degrees C, leukocyte count >8700, age >39 years, respiratory rate >15 in admission and persistent pain 24 hours after discharge.

Morphological study of the perireticular nucleus in human fetal brains.

Abstract The perireticular nucleus consists of scattered neurons that are located in the internal capsule. The presence of perireticular neurons in the rat, ferret, cat and human has been described previously. Evidence suggests that the perireticular neurons in various species decrease in number with increasing gestation, but in humans this finding has not been supported by quantitative data. This study aimed to investigate (1) the morphology of the human fetal perireticular neurons, (2) the average number of perireticular neurons within the anterior and posterior crus of the internal capsule per unit area, and (3) the magnitude and the stage of neuronal loss in the human perireticular nucleus subsequent to maturation. Nissl-stained sections of the internal capsule of human fetal brains of 24, 26.5, 32, 35, 37 and 39 weeks of gestation showed a number of clearly distinguishable large perireticular and small microglia cells. A regular increase of both perireticular and microglial cells was observed up to 32 weeks of gestation, after which a dramatic reduction in the number of both perireticular and microglia cells was observed. The average number of perireticular and the microglia cells per unit area, located within the posterior crus, was more than in the anterior crus of the internal capsule. In the adult, no perireticular neurons were detected within the internal capsule. The results show that perireticular neurons are not restricted to the region lateral to the thalamus and medial to the globus pallidus (posterior crus) but are also present at the region lateral to the caudate nucleus and medial to the globus pallidus (anterior crus).