Epithelial splenic cysts and life-threatening splenic rupture.

BACKGROUND/AIM: Primary splenic cysts are relatively uncommon and in the majority of cases are classified as epithelial cysts which are more frequent in young patients. Most of them are asymptomatic, and they are found incidentally during imaging techniques or laparotomy. We report two rare cases of patients with epithelial splenic cysts as an incidental finding during emergency laparotomy for splenic rupture. MATERIALS AND METHOD: The first patient was a 70-year-old man who presented with symptoms of acute abdomen after intensive cough during an episode of asthma. Emergency laparotomy findings were splenic rupture and intraperitoneal haemorrhage. A splenectomy was performed and the histological examination showed a ruptured spleen with an epithelial cyst. The second patient was a 19-year-old man who was transferred to the Emergency Department in hypovolemic shock due to intraperitoneal bleeding after a blunt abdominal injury. During laparotomy a splenic rupture was found, and an epithelial cyst. CONCLUSION: Epithelial splenic cysts are a rare entity and they can be an incidental finding during the surgical treatment of a spleen rupture and haemoperitoneum. These cysts may be a predisposing factor to splenic rupture in cases of increased intraabdominal pressure or blunt abdominal trauma.

Buflomedil: potential new indications for an old agent.

Our understanding of vascular pathophysiology has significantly improved during the past two decades. Patients with type 2 diabetes mellitus have an increased vascular risk and a series of modifiable risk factors play a crucial role in the atherosclerotic process. The microvascular dysfunction in diabetes results in increased vascular permeability and impaired regulation of blood flow and vascular tone. These changes culminate in nephropathy, retinopathy and neuropathy and probably contribute to the increase vascular morbidity and mortality in this population. Moreover, studies in the skin microvasculature suggest that this microvascular dysfunction contributes significantly to the pathogenesis of diabetic foot. Several studies showed a beneficial effect of vasoactive drugs, including buflomedil, in non-diabetic patients. However, it remains to be established whether these drugs could also be beneficial in the diabetic population, especially in the early stages of diabetes.

Severe total hepatic ischemia and reperfusion: relationship between very high alpha-tocopherol uptake and lipid peroxidation.

Reperfusion injury of the liver occurs in liver transplantation and in major hepatectomies. It triggers a severe oxidative stress that leads to increased lipid peroxidation. In our study we examined the effect of parenteral supranutritional administration of alpha-tocopherol, a vitamin that plays a key role in the endogenous antioxidant system, to rats subjected to severe ischemia/reperfusion (I/R) injury of the liver. alpha-Tocopherol was administered to the animals at doses of 30 and 300 mg/kg bw, whereas total hepatic ischemia was induced for 60 min followed by 120 min reperfusion. Tissue and blood samples were collected for malonyldialdehyde (MDA) and serum alpha-tocopherol assay, respectively. In the sham operation group, mean MDA level in liver was 1.14 nmole/g wet tissue in the control subgroup, and 1.01 or 0.74 nmole/g wet tissue in the subgroups given 30 or 300 mg/kg alpha-tocopherol. In the I/R group, mean MDA level was 1.57 nmole/g wet tissue in the control subgroup, and 0.97 and 0.77 nmole/g wet tissue in the subgroups given 30 or 300 mg/kg alpha-tocopherol. Mean levels of alpha-tocopherol in serum (mumole/l) were 10.20 and 1.80 in the control subgroups, 25.28 and 11.25 in the subgroups treated with 30 and 300 mg/kg bw of alpha-tocopherol, and 31.00 and 13.02 in the subgroups treated with 30 and 300 mg/kg bw of alpha-tocopherol, within the sham-operation and I/R groups, respectively. A significant decrease of MDA accompanied by a significant increase of serum alpha-tocopherol was documented in the alpha-tocopherol-treated rats within both groups. Ischemia/reperfusion triggered a significant increase of the MDA level in the liver of the rats not treated with alpha-tocopherol as compares with the treated animals.

Blockade of Kupffer cells by gadolinium chloride reduces lipid peroxidation and protects liver from ischemia/reperfusion injury.

BACKGROUND/AIMS: The implication of lipid peroxidation in the inhibitory effect of GdCl3 (gadolinium chloride) on Kupffer cells activation has not been extensively investigated. The aim of this study was to examine the effect of GdCl3 inhibition of Kupffer cells activation on lipid peroxidation after severe total hepatic ischemia/reperfusion. METHODOLOGY: Male Wistar rats (n = 40) were randomly divided into a sham-operation group, a control ischemia/reperfusion group, and two ischemia/reperfusion groups pretreated with GdCl3 (10 mg and 20 mg/kg bw intravenously, 48 and 24 h prior to operation). Following 60 min of total hepatic ischemia and 120 min of reperfusion, the rats were sacrificed, and liver samples were taken for determination of malondialdehyde and light microscopy examination. Blood samples were also taken for assay of aspartate and alanine transaminase. Additional animals (n = 60) were followed up for a 7-day survival rate determination. RESULTS: Ischemia/reperfusion decreased the survival rate to 13.3%, increased (p < 0.001) the levels of aspartate and alanine transaminase in serum to 2387 +/- 75 and 2157 +/- 87 IU/L, respectively, and increased (p < 0.001) malondialdehyde levels in liver to 1.609 +/- 0.096 nmoles/g compared with 1.164 +/- 0.060 in the sham operation group. Pretreatment with GdCl3 increased the survival rate to 60%, and decreased (p < 0.001) the levels of aspartate transaminase in serum to 1549 +/- 66 and 1496 +/- 55 IU/L, the levels of alanine transaminase in serum to 1302 +/- 48 and 1305 +/- 63 IU/L, and the levels of malondialdehyde in liver to 1.132 +/- 0.034 and 1.149 +/- 0.57 nmoles/g for the lower and the higher doses of GdCl3, respectively. Histological examination showed protection of liver parenchyma in the animals treated with GdCl3. CONCLUSIONS: Experimental data suggest that GdCl3 inhibition of Kupffer cells activation protects liver from ischemia/reperfusion injury by a mechanism that reduces lipid peroxidation.

Effects of buflomedil on skin blood flow in patients with type 2 diabetes mellitus without overt micro- or macroangiopathy.

AIM: The aim of this study was to assess the effects of buflomedil on the peripheral microcirculation in patients with type 2 diabetes mellitus (T2DM) without overt micro- or macroangiopathy. METHODS: Twenty-three patients with T2DM were randomly assigned to receive buflomedil 600 mg/day for six months (N.=12) or no medication (N.=11). Skin blood flow in the lower limbs was assessed at baseline and after 3 and 6 months using Laser Doppler. We measured the following laser Doppler parameters: volume, flow and velocity. RESULTS: In patients treated with buflomedil, there was a significant increase in volume (P=0.039) and a trend for an increase in both flow and velocity (P=0.097 for both parameters). In contrast, significant decreases in volume and flow were observed in the control group (P=0.045 and P=0.027, respectively) whereas velocity did not change (P=0.150). CONCLUSION: In conclusion, buflomedil appears to have a beneficial effect on the peripheral microcirculation in patients with T2DM.

Metachronous colorectal adenocarcinomas.

BACKGROUND: The purpose of our study is to emphasise the diagnostic and therapeutic problems of metachronous colorectal cancer. MATERIALS AND METHODS: Between 1990 and February 2004, amongst 185 patients that were treated for colorectal cancer, in four of them a metachronous carcinoma was diagnosed. RESULTS: 1st patient: male 41 years, underwent colectomy of the descending colon for adenocarcinoma. Four years later, a rectosigmoidal cancer was found infiltrating urinary bladder. 2nd patient: male 62 years, underwent right hemicolectomy. Eight years later two synchronous cancers were diagnosed, in the left colic flexure and in the sigmoid colon. 3rd patient: female 73 years, underwent low anterior resection for rectal cancer. Eight years later, caecal and ascending colon cancers were diagnosed with hepatic metastases. 4th patient: female 60 years underwent transversectomy. Six years later caecal cancer was diagnosed with pulmonary metastases. Amongst the four patients, only the fourth had an adequate postoperative follow up. CONCLUSIONS: Extended radical colectomies in young patients and in those where adenomatous polyps coexist will reduce the incidence of metachronous carcinoma. Effective and persistent postoperative surveillance in patients with colorectal cancer will greatly contribute in the detection and treatment of metachronous carcinomas.

Postoperative follow-up of patients with colorectal cancer: a combined evaluation of CT scan, colonoscopy and tumour markers.

BACKGROUND: The purpose of this study is to present the experience of our department regarding the importance of the systematic postoperative follow-up of patients with colorectal cancer, early diagnosis and treatment of the recurrence of the disease or a metachronous cancer. METHODS: In a study that took place between October 2001 and February 2004 amongst 67 patients that were operated upon for colorectal cancer, 41 were systematically being followed up through CT scan, colonoscopy and tumour markers. RESULTS: In the 14th and 18th months postoperatively for 2 of the patients the CT scan showed hepatic metastasis, while the colonoscopy was negative. Regarding the tumour markers, one (CEA) was elevated in one patient while three were elevated in the others. For 2 out of the 41 patients the colonoscopy showed recurrence of the disease within one and two years respectively. The CT scan proved to be free of metastasis and the tumour markers were falling within the normal range for one of the patients while for the other CEA was elevated. Both patients underwent additional colectomy. Postoperative increase of the tumour markers was observed in 9 patients. The above patients had normal markers in the immediate postoperative period. For 4 out of the 9 patients recurrence or spread of the disease was observed while the rest of them are still being followed up. CONCLUSIONS: In conclusion, we believe that the systematic postoperative follow-up of the patients with colorectal cancer through CT, colonoscopy and the use of tumour markers contributes decisively to the early diagnosis and treatment of any possible recurrence of the cancer or a metachronous cancer or misdiagnosed concomitant cancer.