Effect of intraperitoneal cetuximab administration on colonic anastomosis and early postoperative adhesion formation in a rat model.

OBJECTIVE: We aimed to evaluate the effect of intraperitoneal cetuximab administration on the healing of anastomosis and development of early adhesion formation in a rat model. MATERIALS AND METHODS: Twenty-four female rats were used. A colon segment was resected and end-to-end anastomosis was performed. The rats were randomized into three groups after the performance of colonic anastomosis and received 10 mL of intraperitoneal solution including study drugs after closure of abdominal cavity: normal saline was administered to the normal saline group (n=8), cetuximab (400 mg/m(2)) was administered to the postoperative 1 group (n=8) 1 day after surgery, and cetuximab (400 mg/m(2)) was administered to the peroperative group (n=8) during surgery. RESULTS: The mean adhesion grade was 2.63±0.92, and 0.50±0.76 and 0.63±0.74 for control and test groups, respectively. Cetuximab reduced adhesion formation in test groups (p<0.05). When all groups were compared, it was found that vascular endothelial growth factor levels decreased significantly only in the abdomen (p<0.05). Hydroxyproline levels and anastomosis bursting pressure were examined, and a statistical difference was found between groups (hydroxyproline p<0.05, bursting pressure p<0.05). However, when postoperative 1 day group was compared with the control group, it was found that there was no difference between groups according to these parameters (p>0.05), but when peroperative group was compared with the control group a significant decrease was observed in both parameters. Histopathological healing score was also evaluated. No statistical difference between groups was found. CONCLUSION: Twenty-four hours later from the operation, intraperitoneal cetuximab therapy may be a safe and feasible treatment for metastatic colorectal patients.

Well-differentiated abdominal liposarcoma: experience of a tertiary care center.

BACKGROUND: We presented abdominal liposarcoma cases diagnosed and managed in a tertiary care center and also conducted a literature review on main features of this tumor. METHODS: Chart reviews of eight cases were conducted, and clinical, surgical, histopathological, and follow-up data were recorded. RESULTS: Overall, complete surgical resection was performed with adjacent organ resection in 25% of cases, and radiotherapy was not administered. Recurrence was developed in only one case and died after 2 years and 3 months, and other cases are under follow-up without recurrence. Histopatological examinations revealed findings of well-differentiated liposarcoma. CONCLUSIONS: According to our surgical experience, the surgical margin positivity may not be a determining factor for the survival of patients with well-differentiated liposarcoma, and in the absence of macroscopic invasion, adjacent organ resection may not be required. Radiotherapy may not be preferred when complete resection of abdominal mass was achieved.

Guidelines for extended lymphadenectomy in gastric cancer: a prospective comparative study.

AIMS: To assess the efficacy of extended lymph node dissection in gastric cancer and to identify factors affecting lymph node detection. METHODS: A prospective study of 126 gastric cancer patients was conducted. Patients eligible for curative resection received total gastrectomy and extended lymphadenectomy (D2) and paraaortic lymph node sampling as the standard of care (study group). Supramesocolic total lymphadenectomy of the upper gastrointestinal tract was performed on 23 autopsy cases as a control group. RESULTS: Fifty-five gastric carcinoma patients were included in the study group. Median age was 58 years (range 31-80 years); 14 patients were female (25%), and 41 were male (75%). The median number of lymph nodes harvested from the specimen was 47 (24-95), and the median number of metastatic lymph nodes was 15 (1-71). In contrast, in the autopsy comparative group, the median number of harvested lymph nodes was 72 (50-91). The median number of stational lymph nodes excised (lymph nodes excised from stations 4, 5, 10, 11, 12, and 16) was significantly higher in the control group than in the study group (P<0.05). Lymph node detection was adversely affected by body mass index (BMI) (P<0.03). In the study group, stations 5, 12, 11, and 10 had the highest lymph node absence (LNA) (noncompliance) ratio with percentages of 53, 36, 33, and 22%, respectively. In the autopsy group, LNA (noncompliance) was not detected. CONCLUSIONS: Lymph nodes should be dissected by surgeons with sufficient technical and anatomical experience, and then examined and counted by experienced pathologists to reduce the occurrence of LNA. The results of this anatomical study can serve as a guideline to assess the success of lymph node dissection during gastric cancer surgery. Similar studies should be conducted in every country to establish national guidelines.

Effects of intraperitoneal bevacizumab administration on colonic anastomosis and early postoperative adhesion formation.

AIM: The purpose of this study is to investigate the effect of intraperitoneal (IP) bevacizumab on colonic anastomosis and evaluate the effects on early postoperative adhesion formation. MATERIALS AND METHODS: A total of 24 mature female Sprague-Dawley rats were used for this study. Rats were randomly assigned to a control group that received saline (n = 8) or to experimental groups (n = 8 each) that received bevacizumab at a dose of 2.5 mg/kg (group 1) or 5 mg/kg (group 2). Animals were killed humanely on the seventh day after operation, and measurements of anastomotic strength and biochemical variables were performed. RESULTS: The mean adhesion grade was 2.63 ± 0.92, and 1 ± 0.93 and 0.75 ± 0.71 for the control and test groups, respectively. Bevacizumab significantly reduced adhesion formation in both low-dose and high-dose IP applications (P < .05). When all groups were compared, it was found that VEGF levels decreased significantly only in the tissue (P = .001), whereas there was no significant difference in the blood and the IP fluid (P = .73 and .08, respectively). We evaluated hydroxyproline levels, anastomosis bursting pressure, and histopathological healing scores. When each of these parameters were examined, there was statistical difference between groups (P = .01, .004, and .01, respectively). It was found that these parameters significantly decreased depending on increasing drug dose. CONCLUSION: IP administration of bevacizumab effectively reduced the formation of adhesions and caused significant impairment of anastomotic wound healing when standard doses were administered (5 mg/kg), but the 2.5-mg/kg dosage did not affect the anastomotic wound healing and also effectively reduced the formation of adhesions.

Low Mmp 9 and VEGF levels predict good oncologic outcome in mid and low rectal cancer patients with neoadjuvant chemoradiation.

BACKGROUND: The aim of this study was to evaluate apoptotic (Bcl-2, Bax expression, caspase-3 activity, and cytochrome-c) and angiogenic (MMP-9 levels and VEGF expression) markers in operable rectal cancer patients who were treated with preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME). Understanding these factors will facilitate the identification of potential pathological responders before treatment, leading to better local control and survival rates. METHODS: Between March 2006 and March 2008, 29 patients withTNM Stage III (cT3 N+) mid or low rectal cancer were included in this study. Our sample consisted of 17 males (58.6%) and 12 females (41.4%). The median age was 60 years (range 24-88 years). Biopsy samples were taken from different portions of the tumors using flexible endoscopy before neoadjuvant CRT. Preoperatively, all patients received radiation (45-50.4 gray (Gy) in 25 cycles with concurrent 5-florouracil (5-FU) chemotherapy. RESULTS: A complete response was observed in 7 of 29 patients (24%). Bax staining was negative in 1 of the 7 patients (14%) in the pathological complete response (PCR) group and in 18 of the 22 patients (82%) in the no pathological complete response (noPCR) group (p = 0.001). MMP-9 and VEGF levels were higher in the noPCR group than the PCR group (p = 0.04, p = 0.05 respectively). No statistically significant differences were found between VEGF and MMP-9 levels in nodal downstaging. No statistically significant relationships were found between the other apoptotic factors (Bcl 2, cytochrome-c, and caspase-3 activity) and pathological response rate (p > 0.05). CONCLUSION: In neoadjuvant CRT patients, high levels of Bax expression and low levels of VEGF and MMP-9 expression on preoperative biopsies indicate that the patient will potentially be a good pathological responder.

Role of pentoxifylline and iloprost in the prevention of ischemia-reperfusion injury in an experimental model of intestine ischemia-reperfusion in rats.

BACKGROUND: Intestinal ischemia-reperfusion (I/R) injury can lead to multiple organ failure and death. The aim of this study was to investigate the effects of pentoxifylline and iloprost administered before reperfusion in intestinal ischemia. METHODS: In total, 25 male Wistar Albino rats weighing 250-300 g were divided into five groups each comprising five subjects: control group (n=5), sham group (n=5, no I/R), I/R group (n=5, 45 min ischemia, and 120 min reperfusion), I/R + pentoxifylline group (n=5, 45 min ischemia following intraperitoneal 50 mg/kg pentoxifylline and 120 min reperfusion), and I/R + iloprast group (n=5, 45 min ischemia followed by intraperitoneal 2 mcg /kg iloprost and 120 min reperfusion). At the end of the experiment, ileum specimens were stained using hematoxylin-eosin and histopathologically evaluated using the Chiu score. Isometric contraction-relaxation responses were recorded using organ baths for contraction-relaxation responses. RESULTS: Pentoxifylline provided a significant improvement in response to histopathological and contraction-relaxation responses. Although iloprost provided recovery in reperfusion injury, it was not statistically significant. CONCLUSION: Our findings demonstrate that pentoxifylline may be promising in preventing small bowel ischemia-reperfusion injury. We concluded that further clinical and experimental studies for iloprost are needed.

An incidence study on thyroglossal duct cysts in adults.

OBJECTIVE: To investigate the incidence of the asymptomatic thyroglossal duct anomalies and to review the literature and make comments on the significance of this condition. METHODS: A total of 80 cadavers were dissected in the present study. This study was carried out during 2005, where the cadavers were randomly included from the criminal laboratories of the Ministry of Justice, Republic of Turkey in Istanbul. None of the cadavers had laryngeal and cervical injuries resulting from a trauma or the cause of their death. The examined cadavers included 59 men and 21 females, and their age were ranged from 35-80 years old. The larynges were removed and fixed in 10% formalin and then dissected. The sections were examined using surgical SMZ 10 Nikon stereomicroscope. We evaluated the presence, localization, and diameter of the cysts with regard to age and sex of the cadavers. RESULTS: We observed a total of 12 different localization of thyroglossal ducts and cysts among the dissected 80 cadavers. Ten of these ducts cysts were found in males with an age range of 35-68 years and 2 in female cadavers aged 46-65 years. In 6 cases, the thyroglossal ducts and cysts were located in the left of the midline of the neck, while 3 cases were from the right of the midline, and the remaining was located on the midline of the neck. In all cases, thyroglossal ducts and cysts were complete and restricted to the infrahyoid region; all of them had connection with the hyoid bone, but not with the perichondrium of the cartilage. In addition, the thyroglossal ducts had connection with the left lobe of the thyroid glands in 3 cases, one case in the right lobe, and 2 cases with the isthmus of the thyroid gland. Finally, in 5 cases thyroglossal ducts were complete and had well-developed cysts. CONCLUSION: Thyroglossal duct remnants are one of the most often seen congenital asymptomatic masses of the neck region (7%). The presence of these duct remnants may lead to abnormal phonation and epithelial carcinomas. Therefore, correlation of the rate of thyroglossal duct remnants in a population together with the related clinical symptoms can lead to an early diagnosis and better treatment chances for these problems.

The protective effects of sildenafil in acute lung injury in a rat model of severe scald burn: A biochemical and histopathological study.

Severe burn induces biochemical mediators such as reactive oxygen species that leads to lipid peroxidation which may have a key role in formation of acute lung injury (ALI). Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5. Sildenafil preserves alveolar growth, angiogenesis, reduces inflammation and airway reactivity. The purpose of the present study was to evaluate the effects of different dosages of sildenafil in ALI due to severe scald burn in rats. Twenty-four rats were subjected to 30% total body surface area severe scald injury and were randomly divided into three equal groups as follow: control, 10 and 20mg/kg sildenafil groups. Levels of malondialdehyde (MDA), activities of glutathione peroxidase (Gpx), catalase (Cat), total oxidative stress (TOS), and total antioxidative capacity (TAC) were measured in both tissues and serums. Oxidative stress index (OSI) was calculated. A semi-quantitative scoring system was used for the evaluation of histopatological findings. Sildenafil increased Gpx, Cat, TAC and decreased MDA, TOS and OSI. Sildenafil decreased inflammation scores in lungs. Our results reveal that sildenafil is protective against scald burn related ALI by decreasing oxidative stress and inflammation and the dosage of 10mg/kg could be apparently better than 20mg/kg.

Effects of Ramadan fasting on peptic ulcer disease as diagnosed by upper gastrointestinal endoscopy.

BACKGROUND AND STUDY AIMS: The diagnostic methods such as upper gastrointestinal endoscopy (UGE) have played an important role in the evaluation of peptic ulcer (PU). Every year, millions of Muslims fast in Ramadan month. The aim of this study was to evaluate the effect of fasting on PU via UGE. PATIENTS AND METHODS: A total of 321 patients in the period from 2009 to 2011, who underwent UGE as a diagnostic work-up mainly for epigastric pain, were analysed. Patients were divided into three groups: Patients who have been evaluated by UGE, in the month just before Ramadan (group I, n=69), in Ramadan month (group II, n=132) and in the month just after Ramadan (group III, n=120). Continuous data were expressed as the mean±SD, and were compared with one-way analysis of variance (ANOVA) test amongst groups. Categorical data were given as percentages and were compared with the chi-squared test. RESULTS: Epigastric pain was the most common indication for referral in each group. Interestingly, the indication 'bleeding' was found to be the least in group II, but was far from statistical significance. The highest prevalence of duodenal ulcers and duodenitis was found in group II; the differences to the other groups were statistically significant. CONCLUSION: Duodenal ulcers and duodenitis were found more during Ramadan month. We recommend that, the patients with epigastric pain may fast by taking their medications.

The impact of Ramadan on peptic ulcer perforation.

BACKGROUND: Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP. METHODS: A retrospective analysis of 229 patients who were operated due to PUP between 1999-2009 was made. Patients were divided into two groups. Group I (n=188) included the patients who were operated in other periods of the year, while Group II (n=41) included the patients who were operated during Ramadan, the Muslim period of fasting. Patients in Group II were analyzed in terms of duration of fasting. RESULTS: The increase in surgeries per group was higher in Group II than Group I (p<0.05). Predisposing factors, anti-ulcer drug usage and demographic variables were seen to have no role in this difference. Duration of fasting may have a minimal effect on the perforation. CONCLUSION: The results of this study demonstrate that PUP is detected as relatively higher during Ramadan among those who are fasting for more than 12 hours daily. We suggest that people with predisposing factors should be informed before making a decision to fast.

Effects of proton pump inhibitors and h(2) receptor antagonists on the ileum motility.

Objectives. To investigate the effects of proton pump inhibitors (PPIs) and H(2) receptor antagonists on ileum motility in rats with peritonitis and compare changes with control group rats. Methods. Peritonitis was induced by cecal ligation and puncture in 8 rats. Another of 8 rats underwent a sham operation and were accepted as controls. Twenty-four hours later after the operation, the rats were killed, and their ileum smooth muscle was excised and placed in circular muscle direction in a 10 mL organ bath. Changes in amplitude and frequency of contractions were analyzed before and after PPIs and H(2) receptor blockers. Results. PPI agents decreased the motility in a dose-dependent manner in ileum in both control and intraabdominal sepsis groups. While famotidine had no significant effect on ileum motility, ranitidine and nizatidine enhanced motility in ileum in both control and intraabdominal sepsis groups. This excitatory effect of H(2) receptor antagonists and inhibitor effects of PPIs were significantly high in control group when compared to the peritonitis group. The inhibitor effect of pantoprazole on ileum motility was significantly higher than the other two PPI agents. Conclusions. It was concluded that H(2) receptor antagonists may be more effective than PPIs for recovering the bowel motility in the intraabdominal sepsis situation.

Effects of contrast media on the hepato-pancreato-biliary system.

AIM: To determine the effects of high osmolarity contrast media (HOCM) and iso-osmolar contrast media (CM) application, with or without pressure, on hepato-pancreato-biliary (HPB) system. METHODS: Sixty rats were divided into six equal groups as follows: Group 1: (0.9% NaCl, control), Group 2: (diatrizoate meglumine Na, ionic HOCM, Urographin), Group 3: (iodixanol, iso-osmolar non-ionic CM, Visipaque); each of which was applied without pressure, whereas the animals of the remaining three groups (1p, 2p, 3p) were subjected to the same CM with pressure. We performed a duodenal puncture and introduced a catheter into the ampulla. After the catheterization, 0.2 mL CM or 0.9% NaCl was injected with or without pressure. Blood samples were taken for biochemical evaluations. The histopathological examinations of liver, common bile duct, and pancreas were performed. RESULTS: There were no significant differences between the six groups for blood amylase, alanine aminotransferases, aspartate aminotransferases, bilirubin levels (P > 0.05). Alkaline phosphatase and gamma glutamyl transaminase levels were higher (P < 0.05) in the Urographin groups (2, 2p) than the Visipaque groups (3, 3p), or control groups (1, 1p). Hepatocyte necrosis, portal area inflammation, and Kupffer's cell hyperplasia were higher (P < 0.05) in the study groups than the control group. However, there were no significant differences (P > 0.05) between HOCM (2, 2p) and iso-osmolar CM (3, 3p) groups. Bile duct proliferation and regeneration in the Urographin groups (2, 2p) were significantly higher (P < 0.05) than the Visipaque groups (3, 3p) or the control groups (1, 1p). Although CM caused minor damage to the pancreas, there were no statistically significant differences (P > 0.05) between the groups. Application of the CM with pressure did not cause additional damage to the HPB system. CONCLUSION: Iso-osmolar, non-ionic CM could be more reliable than the ionic HOCM, whereas the application of pressure during the CM application had no effect on the HPB system.