Intraperitoneal administration of bevacizumab intraoperatively does not affect abdominal wound healing in rats.

BACKGROUND: Bevacizumab is a monoclonal antibody targeted at vascular endothelial growth factor (VEGF) to treat advanced colorectal cancer as well as other malignancies, but the ideal time point for its administration in patients scheduled for surgery is not well defined due to serious concerns regarding possible side effects on wound healing. Therefore, we conducted an experimental study in rats to clarify this issue. METHODS: Four groups of 10 Wistar rats each underwent a 4-cm midline laparotomy and closure of the wound in 2 layers. In the treatment groups (A and B), bevacizumab (Avastin(®)) received a single dose of 5 mg/kg i.p., and an equal amount of saline was given to the control groups (C and D). Groups A and C were sacrificed on the 7th postoperative day, and groups B and D on the 14th postoperative day. Wounds were inspected by two independent observers upon sacrifice and results were recorded; wound tissues were sent for histology to assess the degree of fibrosis and measurement of tissue hydroxyproline levels. Serum levels of endothelin-1, C-reactive protein, pro-oxidant/antioxidant balance and carbonylated proteins were also determined. For statistical analysis, the Mann-Whitney U test was used. RESULTS: Wound healing did not differ among groups both on the 7th and the 14th postoperative days, and there was also no significant difference regarding the degree of inflammation, fibroblast proliferation and collagen synthesis, as well as hydroxyproline and biochemical marker levels among the groups. CONCLUSIONS: Intraperitoneal bevacizumab administered intraoperatively does not significantly affect abdominal wound healing in rats.

Tension-free by mesh-plug technique for inguinal hernia repair in elderly patients.

BACKGROUND: elderly patients are steadily becoming a growing part of the population. The aim of this study is to evaluate the outcome of open inguinal hernia repair in patients aged over 65 years. METHODS: from January 1999 to December 2008, a total of 719 patients underwent open tension-free inguinal hernia repair with mesh-plug; 301 among them were ≥ 65 years old. RESULTS: elderly patients had a mean age of 72.4 years (women 3.3%), while the mean age of younger patients was 48.7 years (women 5.7%). According to the ASA score, patients aged ≥ 65 years were at significantly higher risk than the younger patients. Spinal anesthesia was used most frequently in both groups. No significant differences were found in postoperative pain, mortality and recurrence. Morbidity and hospital stay were significantly higher in patients aged ≥ 65 years. CONCLUSIONS: open hernia repair in the elderly is safe and well tolerated, but it is associated with higher morbidity and longer hospitalization.

Retractile mesenteritis appearing as a sigmoid colon tumor.

Retractile mesenteritis is a rare, fibrosing, inflammatory disease affecting the adipose tissue of the intestinal and colonic mesentery. So far, about 300 cases have been reported in the literature. We present a case of retractile mesenteritis.

Acute afferent loop syndrome: a true emergency. A case report.

Afferent loop syndrome is a relatively rare complication after subtotal gastrectomy. We present a late onset of afferent loop obstruction, in a patient who underwent Billroth II gastrectomy with Roux-Y reconstruction for a gastric ulcer 27 years ago. A 60-year-old male was admitted to the hospital with an 8-hour history of acute epigastric pain, associated with vomiting, fever and signs of sepsis. Laboratory tests revealed leukocytosis, elevated liver function tests and high serum amylase. An obstructed afferent loop appeared on CT as a fluid filled tubular mass, crossing the middle line between the aorta and the mesenteric vessels. Advanced sepsis was also seen in the peripancreatic and retroperitoneal region. Although the patient was operated on immediately after diagnosis with reconstruction of Roux-Y anastomosis, he died 12 hours later. Afferent loop syndrome is quite uncommon, and must be suspected in patients who have undergone subtotal gastrectomy. Clinical manifestations of the syndrome are usually non-specific. CT is the examination of choice and surgery the first choice treatment.

Pelvic malakoplakia simulating recurrence of rectal adenocarcinoma: report of a case.

Malakoplakia represents a chronic inflammatory disease associated with a broad spectrum of bacterial infections. On histopathology, Michaelis-Gutmann bodies are considered as pathognomonic histopathological findings. Rarity of the disease and wide variety of clinical presentation makes its diagnosis very challenging. We report herein the case of a 66-year-old woman who, having undergone lower anterior resection for rectal adenocarcinoma 3 and a half years ago, presented with urinary frequency and dull abdominal pain. CT scan revealed a soft tissue tumour infiltrating the preperitoneal fat over the urinary bladder, which was considered as recurrence of the rectal carcinoma. On laparotomy, a tumour invading the bladder, small intestine and the anterior abdominal wall was resected and the patient recovered uneventfully. On histopathology, malakoplakia of urinary bladder was revealed. Overstaging of patients' malignancy due to malakoplakia is not uncommon, so its early identification can help avoid incorrect treatment.

Early propranolol administration does not prevent development of esophageal varices in cirrhotic rats.

BACKGROUND AND AIMS: Variceal bleeding is the most serious complication of portal hypertension associated with high mortality. This study was conducted to investigate any protective effect of early propranolol administration in the development and degree of esophageal varices in cirrhotic rats with portal hypertension. This topic is controversial in the literature. METHODS: For the development of liver cirrhosis and esophageal varices, 60 rats underwent ligation of the left adrenal vein and complete devascularization of the left renal vein, followed by phenobarbital and carbon tetrachloride (CCl(4)) administration. This operation enhances the development of cephalad collaterals, responsible for the induction of esophageal varices. After 2 weeks of CCl(4) administration, the rats were randomly separated into 2 groups. In group I, propranolol was continuously administered intragastrically throughout the study, whereas in group II normal saline (placebo) was administered instead. Cirrhosis was detected clinically by ascites development. Hemodynamic studies and morphometric analysis of the lower esophagus were performed after complete induction of cirrhosis, measuring the following parameters: portal pressure, total number of submucosal veins, total submucosal vessel area, mean cross-sectional submucosal vessel area, relative submucosal area (percentage) occupied by vessels and area of the single most dilated submucosal vein. RESULTS: The statistical analysis revealed no statistically important difference between the 2 groups for the morphometrically studied parameters. However, portal venous pressure was lower in group I. CONCLUSION: Early propranolol administration did not protect rats from developing esophageal varices, despite the fact that a significant decrease in portal pressure was detected.

Effect of experimentally induced liver cirrhosis on wound healing of the post-extraction tooth socket in rats.

BACKGROUND: Wound healing in liver cirrhosis is known to be impaired possibly due to liver insufficiency and subsequent malnutrition status; however, there is no study to examine healing effectiveness of the tooth socket following an extraction in such patients. MATERIALS AND METHODS: Irreversible cirrhosis was induced in 30 Wistar rats by repetitive weekly doses of CCl(4) and continuous administration of phenobarbital in a 12-week course was monitored by body weight measurement and ascites development, and was proved histologically. One week later, cirrhotic and control rats were subjected to extractions of two maxillary grinders on each side, one side by simple method, the other by surgical method. Half of the animals of each subgroup were sacrificed on the 10th post-extraction day, whereas the other half on the 30th post-extraction day, and histological sections were examined from all tooth sockets for wound-healing activity. RESULTS: A malnutrition status was detected in cirrhotic rats with significant difference in their body weight. Several histological parameters of socket healing were not statistically different between cirrhotic and control animals. However, a significant delay on epithelialization and cancellous bone formation was detected on the 10th post-extraction day for either simple or surgical extractions in cirrhotic animals. CONCLUSIONS: Liver cirrhosis in rats provokes a significant delay on epithelialization and mature cancellous bone formation and consecutively on early socket wound healing after a tooth extraction.

Major complications during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy may lead to serious complications, some of which can be disastrous if they are not recognized and managed immediately. Over the past 12-year period, 1225 laparoscopic cholecystectomies were performed. Totally, major complications occurred in 19 cases (1.5%). The conversion rate was 7.4%. Complications included common bile duct injury in 2 cases (0.16%), vessel injury by trocar or Veress needle in 4 cases (0.32%) including 1 case of aorta injury (0.08%), bleeding from the gallbladder bed or the cystic artery in 10 cases (0.8%), bile leak in 1 case (0.08%), duodenum injury in 1 case (0.08%), and transient liver ischemia in 1 thalassanemic patient (0.08%). The complication was recognized during the operation in 11 cases. Reoperation was necessary in five cases (0.4%), and conservative management was applied in three cases. Although infrequent, major complications may occur during laparoscopic cholecystectomy. Immediate recognition and management is critical and may lead to a safe outcome.

Epidermoid splenic cyst presented as huge splenic abscess: a case report.

Epidermoid splenic cysts are very rare. Symptoms emerge because of enlargement, infection, haemorrhage or rupture. Although splenectomy is indicated for large cysts, minimally invasive and preservation procedures, such as partial splenectomy or total cystectomy with splenorrhaphy, have been increasingly used during the last decade. We report herein the case of a 16-year old female presented with left upper abdominal quadrant pain, fever and abdominal distention treated in our department.

Intraperitoneal ePTFE mesh repair of parastomal hernias.

Parastomal hernia represents a common complication of colostomy formation. Surgical techniques such as facial repair and stoma relocation have almost been abandoned because of high recurrence rates. Extraperitoneal prosthetic mesh repair had better results but was accompanied by high rates of mesh contamination. A new technique, with intraperitoneal onlay position of expanded polytetrafluoroethylene (ePTFE) was therefore established. We report herein two cases of symptomatic large parastomal hernias treated in our department.