Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

Impact of morphine dependency on secondary intention wound healing in rat

Wound healing has always been among important and crucial subjects in medicine. Morphine dependency has also been a social and health problem in the Middle East. This study was aimed to investigate the effects of morphine dependency on pro-inflammatory and fibroblast cell recruitment, as well as reepithelialization and the revascularization processes involved in secondary intention wound healing in rats. A full-thickness wound [2×2 cm in diameters] was created on the dorsum of two groups of rats, a control group and a second group consisted of morphine dependent rats. During the first 14 days of post wounding the wound was excised consecutively at priorly planned days with peripheral margins of normal skin. The specimens were evaluated by two pathologists, who were blind to the study design, and the cellular population, re-epithelialization and revascularization were reported by them. Histological examination of the wound tissue showed evidence of increased population of fibroblasts and a plateau or decreased recruitment of macrophage and neutrophile cells. In the dependent group re-epithelialization was observed to be enhanced significantly in comparison to the control group while having an inhibitory effect on revascularization. The present study demonstrates that morphine dependency enhances re-epithelialization as well as tissue recruitment of fibroblasts; thereby probably enhancing secondary intention wound healing

Soft tissue distraction using pentagonal frame for long-standing traumatic flexion deformity of interphalangeal joints / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Interphalangeal joint contracture is a challenging complication of hand trauma, which reduces the functional capacity of the entire hand. In this study we evaluated the results of soft tissue distraction with no collateral ligament transection or volar plate removal in comparison with traditional operation of contracture release and partial ligament transection and volar plate removal.</p><p><b>METHODS</b>In this prospective study, a total of 40 patients in two equal groups (A and B) were studied. Patients suffering from chronic flexion contracture of abrasive traumatic nature were included. Group A were treated by soft tissue distraction using pentagonal frame technique and in Group B the contracture release was followed by finger splinting.</p><p><b>RESULTS</b>Analyzed data revealed a significant difference between the two groups for range of motion in the proximal interphalangeal joints (P less than 0.05), while it was not meaningful in the distal interphalangeal joints (P larger than 0.05). There was not a significant difference in the degrees of flexion contracture between groups (P larger than 0.05). Regression analysis showed that using pentagonal frame technique significantly increased the mean improvement in range of motion of proximal interphalangeal joints (P less than 0.001), while the higher the preoperative flexion contracture was observed in proximal interphalangeal joints, the lower improvement was achieved in range of motion of proximal interphalangeal joints after intervention (P less than 0.001).</p><p><b>CONCLUSION</b>Soft tissue distraction using pentagonal frame technique with gradual and continuous collateral ligament and surrounding joint tissues distraction combined with skin Z-plasty significantly improves the range of motion in patients with chronic traumatic flexion deformity of proximal and/or distal interphalangeal joints.</p>

Persistent sciatic artery presenting as blue toe: diagnostic dilemma

A persistent sciatic artery [PSA] results from lack of regression of the fetal arterial blood supply of the leg and is often combined with an abnormally developed superficial femoral artery. Here in we would like to present a 63 year old woman presenting for the first time with blue toe and on further evaluation diagnosis of PSA was made. Our case illustrates that a complete physical examination and comprehensive evaluation of the peripheral arterial system of the lower limb including possible persistence of sciatic artery is essential in patients presenting as blue toe before embarking on a surgical or other type of interventional procedure

Lead exposure changes gastric acid secretion in rat: role of nitric oxide [No]

Sub chronic exposure to lead in rats slows gastric emptying, but little is known about the effects of lead on gastric secretion. This study was designed to investigate the effects of lead on gastric acid secretion and its possible mechanisms in rats. Lead acetate was dissolved in drinking water in a concentration of 1%. Sodium acetate-containing water with a molar concentration similar to lead was also prepared. We had nine groups of animals [n=8]; four of them were exposed to lead for 1, 2, 3, and 4 weeks [Pbl, Pb2, Pb3 and Pb4 groups, respectively]. Sodium acetate solution was given to another four groups for 1, 2, 3, and 4 weeks [Nal, Na2, Na3 and Na4 groups, respectively]. Gastric secretion was collected by washout technique and its acid output was measured in the basal [Basal Acid Output, BAO], vogotomy [Vagotomized Acid Output, VAO], and vagally stimulated [Vagally Stimulated Acid Output, VSAO] states using titrator instrument. Nitric oxide [NO] metabolite of gastric tissue was determined by Griess micro assay method to evaluate the possible mechanism of lead effect on gastric secretion. VSAO was significantly less in Pbl and Pb2 groups than Nal and Na2 ones respectively [1.75 +/- 0.17, 2.10 +/- 0.30 vs. 5.79 +/- 0.20, 6.18 +/- 0.27 micromol/15min] [P=0.001, P=0.001] BAO was significantly more in Pb3 and Pb4 groups than Na3 and Na4 ones respectively [2.77 +/- 0.37, 2.80 +/- 0.31 vs. 1.73 +/- 0.16, 1.79 +/- 0.34 micromol/15min] [P=0.01, P=0.02], but it was the same after vagotomy. VSAO was more in Pb3 and Pb4 groups than their Na counterparts [P=0.001, P=0.0001] NO metabolite of gastric tissue was more in all Pb groups in comparison to their Na counterparts [P=0.0001]. In this study, it seems that lead exposure, via NO mechanism, has different effects on acid secretion. Nitric oxide in small and large amounts decrease and increase gastric acid secretion, respectively

Lead exposure changes gastric motility in rats: role of nitric oxide [no]

Abdominal colic, constipation and delay in gastric emptying are symptoms of lead poisoning, but there is scant information about the effect of lead on gastric motility. In the present study, we investigated the effect of lead acetate on gastric motility in rats. Animals were divided into nine groups [n=8]; four groups were exposed to lead acetate solution [1%] for 1, 2, 3, and 4 weeks [Pb1, Pb2, Pb3, and Pb4 groups, respectively]. Sodium acetate solution was given to another four groups for 1, 2, 3, and 4 weeks [Na1, Na2, Na3, and Na4 groups, respectively] and the control group had free access to tap water. Gastric motility was measured in the basal and acetylcholine [Ach]-stimulated states using a physiograph instrument. Nitric oxide metabolite of gastric tissue was determined by Griess micro-assay. There were no significant differences between basal and Ach-stimulated gastric motility in Pb1, Pb2, Na1, and Na2 groups. However, it was significantly greater in Pb3 and Pb4 groups when compared with Na3 and Na4 groups in both basal and Ach-stimulated states [P<0.05]. In addition, nitric oxide metabolite of gastric tissue was more in all Pb groups in comparison with their Na counterparts [P<0.05]. We found that lead exposure could affect gastric motility via the nitric oxide pathway

effect of acute consumption of paraoxon on basal and Pentagastrin-Stimulated Gastric acid and pepsin secretion in rats

Paraoxon is an organophosphate. Organophosphate inhibit acetylcholinestrase enzyme and cause nicotinic and muscarinic sings. There is no study on our knowledge regarding the effect of these substances on gastric acid and pepsin secretion. In the present study, the effect of acute consumption of paraoxon on gastric acid and pepsin secretion has been investigated. In the present study 30 female N-mari rats weighing 200-250gr were used. The first group [paraoxon] received 0.5mg/kg paraoxon intraperitonealy. The second group [alcohol] received the dozes of ethyl alcohol [96%] and the third group [control] received no drug. Animals were anesthetized by intraperitoneal injection of 50mg/kg Sodium thiopental. After trachesotomy and laparatomy gastric secretions were collected with a tube via duodenum. Pentagastrin [25 micro g/kg. ip] was used as gastric stimulator. Acid and pepsin secretions were measured by titration and Anson methods respectively. Stages of measurement were basal, stimulated. and re-basal. The basal acid secretion in control, alcohol and paraoxon groups was 7.6 +/- 0.26, 7.46 +/- 0.4 and 7.03 +/- 0.28 micro mol/15min respectively that shows no significant difference among three groups. Although following pentagastrin-stimulation acid secretion was significantly more than basal stage in all groups, but there was significantly more secretion in control than alcohol subjects. But there was no difference between control and paraoxon or alcohol and paraoxon groups in this regard. Regarding pepsin secretion, there was significantly more secretion in alcohol subjects than others in all measured stages. In comparison to control group, acute paraoxon has no effect on basal acid pepsin secretion, while acute alcohol caused a significant increase in basal acid/pepsin secretion

Garlic effects on gastric acid and pepsin secretions in rat

Garlic [Allium Satiyum] is a plant widely used in traditional medicine. Its anti-hypertensive, lipid lowering, oxidative activities, anti-viral, anti-bacterial, anti-fungal properties have been proven. It has a tonic effects on stomach but its effects on gastric secretion is not known. To investigate the effect of garlic extract on basal and pentagastrin stimulated gastric acid and secretions in rats. Garlic extract stimulates gastric gland causing increased production/release of basal acid and pepsin level. Garlic acid mask pentagastrin stimulatory response and causes decrease in acid and pepsin secretary level. Two group of wistar rats [12 in each group] weighing 200-250gm were used. The first group was considered as study group and received garlic extract, the second group was considered as control. Animal were anesthetized with an intraperitoneal injection of sodium thiopental [50 mg/kg] and after tracheotomy and ligation of cervical esophagus, laparotomy was done. A cannula was placed in stomach through duodenum and 1ml of normal saline was injected in to stomach in each group. After 30 minutes their stomach were emptied. Next in study group 1ml garlic extract [100 mg/kg] and in control group 1ml normal saline were introduced into stomach. After 15 min 1ml normal saline was injected in both groups and immediately all gastric contents were collected in both groups by wash out technique and basal secretions of acid and pepsin were measured. In order to measure pentagastrin effect on gastric secretions, 25 micro gram/kg pentagastrin was used in both groups. Basal acid secretion in study group showed a significant increase in comparison to control group with P value <0.001 [15.6 +/- 1.63 micro mol/15 min in case group vs 4.1 +/- 0.36 micro mol/15min]. Basal pepsin secretion in study group showed a significant increase in comparison to control group with P value <0.001 [7.27 +/- 0.15 micro gm/15min in case group vs 5.62 +/- 0.12 micro gm/15min]. On pentagastrin stimulation, acid secretion in control group showed a significant increase in comparison to its basal value with P value <0.001 [10.14 +/- 1.34 micro mol/15min in vs 4.1 +/- 0.36 micro mol/15 min] but its value decreases in study group [10.5 +/- 1.89 micro mol/15min basal value]. In control group following pentagastrin stimulation, pepsin secretion showed a significant increase in comparison to its basal value with P value <0.001 [6.9 +/- 0.12 micro gm/15min in case group vs 5.62 +/- 0.12 micro gm/15min], while in study group there is no significant difference from its basal value [7.03 +/- 0.03 micro gm/15 min vs 7.27 +/- 0.15 micro gm/15 min basal value]. Garlic extract have a stimulatory effect on acid and pepsin secretion. The possible mechanism cloud be: a] Increase in parietal or chief cell activities due to Ach release. b] Due to its stimulatory effect on histamine release. However, on pentagastrin stimulation acid secretion decline and pepsin level remain same in study group and this effect may be due to rapid emptying of gastric acid stock or due to inhibition of gastric activity because of attachment of some components in garlic extracts to gastrin receptors on parietal cells

Arterial homograft and medical therapy in pseudoaneurysm of infrarenal aorta concomitant with recurrent right ventricular thrombus in Behcet's disease

Pseudoaneurysm of the infrarenal aorta due to Behcet s disease is very rare. We report a case of pseudoaneurysm associated with Behcet s disease in a 17-year-old boy with a recurrent right ventricular thrombus successfully treated with revascularization using arterial homograft patch. Echocardiography examination revealed a right ventricular mass, thought to be a thrombus in an unusual location. Postoperatively, the findings of the pathologic examination confirmed the mass as a thrombus. When the patient was subsequently re-admitted to the emergency unit with complaints of severe abdominal pain, fever, fatigue, sinus tachycardia, and a pulsating and tender abdominal mass, a right ventricular thrombus and a large pseudoaneurysm of the abdominal aorta were found on echocardiography and angiography. The patient underwent resection of the aortic aneurysm and aortoplasty, using arterial homograft patch, and received immunosuppressive and anticoagulation therapy. The thrombus of the right ventricle disappeared 4 months later. This case indicates that a right ventricular thrombosis in Behcet s disease may be managed by medical therapy

effects of chronic consumption of heroin on basal and vagal electrical-stimulated gastric acid and pepsin secretion in rat

Addiction to opium and heroin is not only an important social and individual problem in the world but it also affects the human physiology and multiple systems. The aim of this study is to determine the effects of chronic heroin consumption on basal and vagus electrical-stimulated total gastric acid and pepsin secretion in rats. The study was carried out in the Department of Physiology, Kerman University of Medical Sciences, Iran from August 2002 to June 2003. Both male and female rats weighing 200-250g were used. Rats received daily doses of heroin intraperitoneally starting from 0.2 mg/kg to 0.1mg/kg/day up to the maintenance level of 0.7mg/kg and continued until day 12. After anesthesia, tracheotomy and laparotomy, gastric effluents were collected by washout technique with a 15 minutes interval. The total titrable acid was measured by manual titrator, and the total pepsin content was measured by Anson's method. Vagal electrical stimulation was used to stimulate the secretion of acid and pepsin. Heroin results in a significant decrease in total basal acid and pepsin secretions [4.10 +/- 0.18mmol/15 minutes versus 2.40 +/- 0.16mmol/15 minutes for acid, p<0.01, and 3.63 +/- 0.18 mg/15 minutes versus 3.11 +/- 0.18 mg/15 minutes for pepsin, p<0.05]. But, it does not produce any significant changes in acid and pepsin secretions in vagotomized condition. Heroin also causes a significant decrease in vagal-electrically stimulated acid and pepsin secretions [14.70 +/- 0.54 mmol/15 minutes versus 4.30 +/- 0.21mmol/15 minutes for acid, p<0.01, and 3.92 +/- 0.16 mg/15 minutes versus 3.37 +/- 0.16 mg/15 minutes for pepsin, p less than 0.05]. Heroin consumption decreases the total gastric basal and vagus stimulation of acid and pepsin secretion, but not in vagotomized condition. Heroin may decrease acid secretion by inhibiting vagal release of acetylcholine within the gastric wall. Other probable mechanisms include: presynaptic inhibition of acetylcholine release or depressing the vagal center, inhibition of pentagastrin induced acid secretion, inhibitory effects via central mechanisms, probably mediated by the opiate receptors. Further studies are needed to recognize the actual mechanism

Effect of thyriod hormones on basal and stimulated gastric acid secretion due to histamine, carbachol and pentagastrin in rats

Thyroid hormones affect gastric acid secretion. As the mechanism of this effect has not been fully known, in this experimental study the isolated gastric acid secretion of hypothyroid and hyperthyroid rats were compared with control group by the administration of different doses of pentagastrin, histamine and carbachol as gastric acid secretion stimulators. This study was carried out in Ahwaz University of Medical Sciences, Ahwaz, Iran in the year 2000. Each group were consisted of 8 rats [N-mari] of both sexes with a mean weight of 246 +/- 5 grams. Hypothyroid and hyperthyroid states were induced respectively by adding methimazole [500 mg/liter] for 20 days and thyroxin [500 ug/liter] for 35 days in animals drinking water. After general anesthesia, by intraperitoneal injection of sodium thiopental [50 mg/kg body weight], celiotomy was carried out quickly. The end of esophagus was tied and a silicon tube [2-2.5 mm] was entered into the stomach via duodenum and fasted in pylor region. The stomach was isolated by cutting the esophagus proximal to the tied region and the proximal part of duodenum and put into cold serous solution. After washing the serous and mucus surfaces by serous and mucus solutions, the stomach was transferred immediately to a tissue bath containing warm serous solution [V= 40 ml, T= 370C]. Gastric acid secretion in isolated stomach stimulated by pentagastrin, carbachol and histamine was measured by wash out technique and automatic titrator. Moreover, to study the effect of thyroid hormones on gastric acid secretion a number of dose-dependent experiments after the administration of different doses of histamine [50, 100, 150, 200 umol], carbachol [50, 100, 150, 200 umol], and pentagastrin [30, 60, 90, 120 ug/kg body weight] were performed. Both basal and histamine, carbachol, pentagastrin stimulated-acid secretion decreased and increased in hypothyroid and hyperthyroid groups compared with control group. It seems that thyroid hormones have not exert their effects by changing the cholinergic, gastrin and histamine receptors but probably by alerting the number or size of the secretory cells in stomach