Surgical treatment of hydatid disease of the liver.

The records of 100 consecutive cases of hydatid disease of the liver that were treated surgically were reviewed to determine the complications and the results of different surgical procedures applied. Of those, 74% had single cyst and in 70% the disease was confined to the right lobe of the liver. Marsupialization and omentoplasty were the most commonly used techniques, followed by cystectomy, tube drainage, and cystojejunostomy. Infection in the remaining cavity was the most common postoperative complication. The complication rates were higher in marsupialization and tube drainage when compared with omentoplasty and cystectomy. Omentoplasty and cystectomy led to a shorter hospitalization period. All of the patients who underwent omentoplasty or cystectomy had good results whereas only 28.1% of those on whom marsupialization was done and 27.3% of the patients who underwent tube drainage had good results. The overall mortality was 3%.

Captopril prevents the oxidative damage to proteins after renal ischemia reperfusion injury: role of endothelin-1.

Ischemia reperfusion (I/R) injury is one of the leading cause of the transplanted organ loss. In this experimental study, we investigated the effect of captopril on endothelin and eicosanoid release in I/R injury of the kidney. Rats were subjected to 60 min ischemia and 60 min of reperfusion of the left kidney in control and captopril groups. Tissue protein oxidation products, PGE2 and LTB4 levels and plasma endothelin-1 (ET-1) like activity were determined in sham operated, control and captopril groups. There were no differences in the LTB4 levels among the groups. ET-1 and PGE2 levels and protein oxidation products increased in the control group when compared with the sham. Captopril further increased both PGE2 and ET-1 concentrations and prevented protein oxidation. The increased ET-1 concentrations in the captopril treated group may imply the protective role of endothelin as the significant increase in protein oxidation products was reversed by captopril infusion. This has led us to believe that captopril might be useful in preventing I/R injury of the kidney. Also the release of endothelin from the vascular endothelium is increased by captopril and may be mediated by PGE2.

The effect of iloprost and NDGA in ischemia reperfusion injury in rat liver.

In this study, the effects of iloprost (ZK 36374) and NDGA on warm ischemia and reperfusion injury in rat liver were investigated. Rats were given isotonic saline (control group), iloprost 25 micrograms/kg i.v. (group II) just before warm ischemia or NDGA 10 micrograms/kg i.v. (group III) 5 min before reperfusion or the same drugs were given together (group IV). Serum SGOT, SGPT, and LDH values and tissue malondialdehyde (MDA), glutathione (GSH), prostaglandin (PG)E2, and leukotriene (LT)C4 levels were determined after ischemia-reperfusion injury. Histopathologic examination of the liver was carried out under the light microscope. The serum SGOT, SGPT and LDH levels improved significantly in groups II, III, and IV when compared with the control group (p < 0.05). There was a significant decrease (p < 0.05) in tissue MDA levels and significant increase (p < 0.05) in tissue GSH levels in group I, when compared with group IV and the control groups. The values did not differ significantly in group IV when compared to controls. The LTC4/PGE2 ratio was low and histologic findings were worse in group III. In conclusion, iloprost was found to be beneficial in preventing the ischemia-reperfusion injury in the rat livers. NDGA, either by direct toxic effect or by shifting the arachidonic acid metabolism to the cyclooxygenase route, was not found to be as effective. Iloprost and NDGA did not exert a synergist effect.

Does PGE2 act as a mediator for endothelin release?

To investigate the effect of iloprost (ZK 36374) and thromboxane synthetase inhibitor UK 38485 on endothelin release by the intestinal vascular endothelium after ischemia/reperfusion (IR) injury, five experimental groups were formed. The groups consisted of sham, control, iloprost treated (ILO), UK 38485 treated (TSI), and iloprost + UK 38485 treated (ILO + TSI) groups. The last three groups received the corresponding agents and then the superior mesenteric artery was clamped for 30 min followed by 90 min reperfusion. Endothelin levels in the portal blood and malondialdehyde (MDA), prostaglandin E2 (PGE2) and leukotriene C4 (LTC4) levels in the intestinal tissue were determined. The MDA levels increased significantly in the control group and this increase was reversed in ILO, TSI, and ILO + TSI groups, the two drugs together showing a synergistic effect in preventing lipid peroxidation. The changes in the LTC4 levels were not significant among the groups. The increased endothelin levels in the control group were reversed in ILO and TSI groups but these two agents did not have a synergistic effect. Increased PGE2 levels were reversed with iloprost but neither UK 38485 nor the combination of the two agents was effective in decreasing PGE2 levels. It is concluded that endothelin release after mesenteric IR injury is relatively unrelated to lipid peroxidation and the lipoxygenase pathway. The cylooxygenase pathway has a direct effect on endothelin release and PGE2 may act as a mediator.

The effect of Iloprost (ZK 36374) on isolated and transplanted pancreatic islet cells.

Several methods have been described for the prolongation of survival of isolated and transplanted islet cells. To investigate the effect of a stable prostacyclin analogue, ZK 36374 (Iloprost) on isolated and allotransplanted islet cell function, we studied 6 groups of rats: Group 1 (n = 7) animals underwent pancreatectomy and their islets were isolated and cultured by standard techniques. Group 2 (n = 8) animals were treated the same, except for the addition of Iloprost to the culture solutions. Group 3 (n = 7) animals were treated as group 1, but the isolated islets were transplanted to the subcapsular space of the left kidney of group 5 (n = 7) animals. Group 4 (n = 8) animals were treated as group 2, and the isolated islets were transplanted to group 6 (n = 8) animals. The insulin levels in the culture media obtained in group 1 and 2 were measured. In groups 5 and 6 blood glucose levels were measured and intraperitoneal glucose loading tests were performed. Histological examination was performed for both isolated and transplanted islets. The results showed that both insulin levels and histologic evaluation were better for group 2 than group 1. Animals in group 6 reached normoglycemia on the fifth day following transplantation while it was the ninth day for group 5. The intraperitoneal glucose loading test was tolerated better by group 6 animals. We conclude that Iloprost may be responsible for the improved results which seem to be due to its cytoprotective effect.

Median neuralgia caused by brachial pseudoaneurysm.

A rare neurovascular complication of a antebrachial arteriovenous fistula in a chronic hemodialysis patient is reported. A large brachial venous pseudoaneurysm caused median neuralgia by direct compression of the nerve. Surgical resection of the pseudoaneurysm resulted in complete relief of neuralgia.

Preoperative albendazole treatment for liver hydatid disease decreases the viability of the cyst.

OBJECTIVE: Although in experimental models the efficacy of albendazole has been demonstrated, more clinical data are required. In this study, the effect of preoperative albendazole treatment was investigated in patients with liver hydatid cysts. DESIGN: This is a prospective non-randomized study. METHODS: In this study, the viability was assessed by the gross appearance of the cyst and intracystic pressure (ICP). The study consisted of 70 patients with 89 liver hydatid cysts in two groups. The patients in the first group (n = 29) received 10 mg/kg albendazole orally for 3 weeks before surgery. Thirty-five cysts were evaluated in this group. The second group (n = 41) with 54 liver hydatid cysts received no preoperative treatment. RESULTS: In the first group receiving preoperative albendazole, 20 cysts were viable and 15 non-viable. The median ICP was 21 (range 8-56) cm H2O in viable and 0 (range 0-8) cm H2O in non-viable cysts. In the second group, 43 cysts were viable and 11 non-viable. The median ICP was 35 (range 8-75) cm H2O in viable and 0 (range 0-2) cm H2O in non-viable cysts. The ICP values of viable cysts in the first group receiving preoperative albendazole were significantly lower (P < 0.05). The number of non-viable cysts was also significantly higher in the group treated with preoperative albendazole (P < 0.05). CONCLUSION: Albendazole in this study has proved to be effective in decreasing the viability of liver hydatid cysts when given for 3 weeks preoperatively.

The effect of thermal injury on gastric emptying in rats.

Gastric distension and gastrointestinal discomfort are common complications of burn injuries. This study was designed to examine the effect of thermal injury on the emptying rate of liquids in conscious rats fitted with stainless steel cannulae in the body of the stomach. In rats with partial-thickness burns emptying of the hyperosmolal saline was found to be delayed (P < 0.5) with respect to control only during the chronic phase of injury. However, full-thickness burns delayed hyperosmolal saline emptying in both acute and chronic phases, together with delayed saline emptying in the acute state. Thermal injury did not influence the gastric emptying of peptone and acid solutions, which activate different pathways to delay gastric emptying. Delayed gastric emptying of hyperosmolal solutions may be explained by increased sympathetic and opiatergic nervous activities, resulting in reflex relaxation of gastric smooth muscle.

Surgical treatment of hepatic hydatid cysts.

Ninety-two surgical procedures were carried out in 82 patients with 92 hepatic hydatid cysts. The most common complication of the hydatid cyst was biliary rupture (17.3%) followed by infection of the cyst cavity (5.4%). Omentoplasty was carried out for uncomplicated cysts (38.0%) with a low morbidity (14.2%) and short hospital stay (mean 12.8 days). External tube drainage was carried out in 30.5% of patients. The morbidity rate was 67.8% and the mean hospital stay was 19.8 days. No single method can be recommended for the treatment of hepatic hydatid cysts but the choice of the surgical method must be made according to the complications of the cyst. Omentoplasty is the procedure of choice for uncomplicated cysts with a low complication rate and relatively short hospital stay. External tube drainage is recommended for infected cysts and a biliary drainage procedure must be added to external tube drainage for cysts with intrabiliary rupture.

Renal transplantation with multiple arteries.

Out of a total of 184 transplant operations there were 27 kidneys with 2 or more renal arteries. Five of these were in 23 related transplants. Ischaemic times were increased compared with those of kidneys with single arteries, but the incidence and duration of acute tubular necrosis and also the length of time spent in hospital were similar in both groups. Excessive bleeding and other complications were no more common than following single arterial anastomosis. Kidneys with multiple arteries can be used safely if careful interrupted suturing is performed, the kidneys are perfused before and kept cool during the procedure and polar arteries are not tied.

Preoperative prediction of postoperative complications.

The value of history taking, physical examination and routine laboratory tests as predictors of postoperative complications was investigated in 100 patients undergoing major surgery. Major and minor risk markers were identified and compared with major and minor postoperative complications. The results proved this approach to be a simple, inexpensive and reliable method for the prediction of postoperative complications.

Splenic abscesses due to Salmonella (report of two cases).

Two cases with splenic abscesses due to salmonella infection have been presented and the relevant literature has been reviewed. Diagnostic and therapeutic modalities have been discussed.

Treatment of experimental peritonitis with intraperitoneal povidone-iodine solution.

Intraperitoneal lavage with povidone-iodine solution has been reported by some to be beneficial in the treatment of peritonitis and by others to cause local and toxic side effects. In this study, 200 white mice, divided into four groups of 50, were subjected to bacterial peritonitis. The first group had no treatment; peritoneal lavage was carried out using povidone-iodine solution in the second group and a 0.9% sodium chloride solution in the third. In the fourth group, antibiotics (clindamycin and gentamicin) were instilled intraperitoneally without peritoneal lavage. The povidone-iodine solution had no beneficial effect, the death rate after 1 week (76%) being similar to that in the control group (78%) and much higher than that in mice treated with sodium chloride lavage (38%) and antibiotics without lavage (16%). A second series of experiments was, therefore, carried out to investigate the toxic effect of povidone-iodine solution intraperitoneally on mice without peritonitis; the solution was found to be toxic.

How minimally invasive is laparoscopic cholecystectomy?

To determine the extent of surgical stress induced by open (n = 20) and laparoscopic (n = 20) cholecystectomy, postoperative serum cortisol, growth hormone, and insulin responses were determined for each group. The groups were similar regarding age, sex distribution, and duration of the surgical procedures. The open cholecystectomy group had significant elevations of serum cortisol, growth hormone, and insulin levels 8 h after surgery (p < 0.05). The increased cortisol and growth hormone levels returned to preoperative control values 48 h after surgery. In the laparoscopically operated group, although all hormones increased after surgery, only the increase in growth hormone was statistically significant (p < 0.05). Serum cortisol and growth hormone levels gradually returned to control values 48 h after surgery, but the increased serum insulin levels remained significantly high in both groups 24 and 48 h after surgery (p < 0.05). It is concluded that acute surgical stress induced by open cholecystectomy is more severe than that induced by laparoscopic surgery as reflected by serum hormone determinations. However, the hormonal convalescence rate was similar for both groups. It appears that laparoscopic cholecystectomy is "minimally invasive" concerning the hormonal responses.

Primary torsion of the omentum mimicking acute appendicitis: report of a case.

A case of primary omental torsion seen in a 26-year-old man is discussed. All signs and symptoms mimicked acute appendicitis. The patient underwent emergency laparotomy in which a normal appendix and serohemorrhagic fluid in the pelvis were observed. The pathological diagnosis was a primary torsioned omentum which was thus excised. This case helps to emphasize the importance of a routine exploration of the abdomen when serohemorrhagic fluid is found at the time of laparotomy in the absence of any pathological condition in the pelvis.

Importance of testing stapled rectal anastomoses with air.

OBJECTIVE: To compare the air test (insufflation of air through the anus after the peritoneal cavity has been filled with saline) and the completeness of doughnuts as indicators of the integrity of stapled rectal anastomoses. DESIGN: Prospective open study. SETTING: Marmara University Hospital, Istanbul, Turkey. SUBJECTS: 23 patients with sigmoid and rectal carcinoma. MAIN OUTCOME MEASURES: Correlation between positive air test, completeness of doughnuts, and clinical anastomotic breakdown. RESULTS: Two patients were withdrawn (one had a handsewn anastomosis and in one the air test was omitted). Five patients had positive air tests, and in four of these the doughnuts were complete. The leaks were repaired with additional sutures in three patients, and two were given covering colostomies. There was only one clinical anastomotic breakdown. CONCLUSION: The air test enabled the surgeon to repair or protect five anastomoses (24%). The completeness of the doughnuts was an reliable test of anastomotic integrity.