Role of high mobility group box-1 and protection of growth hormone and somatostatin in severe acute pancreatitis

In this study, we investigated the potential role of high-mobility group box 1 (HMGB1) in severe acute pancreatitis (SAP) and the effects of growth hormone (G) and somatostatin (S) in SAP rats. The rats were randomly divided into 6 groups of 20 each: sham-operated, SAP, SAP+saline, SAP+G, SAP+S and SAP+G+S. Ileum and pancreas tissues of rats in each group were evaluated histologically. HMGB1 mRNA expression was measured by reverse transcription-PCR. Levels of circulating TNF-α, IL-1, IL-6, and endotoxin were also measured. In the SAP group, interstitial congestion and edema, inflammatory cell infiltration, and interstitial hemorrhage occurred in ileum and pancreas tissues. The levels of HMGB1, TNF-α, IL-1, IL-6 and endotoxin were significantly up-regulated in the SAP group compared with those in the sham-operated group, and the 7-day survival rate was 0%. In the SAP+G and SAP+S groups, the inflammatory response of the morphological structures was alleviated, the levels of HMGB1, TNF-α, IL-1, IL-6, and endotoxin were significantly decreased compared with those in the SAP group, and the survival rate was increased. Moreover, in the SAP+G+S group, all histological scores were significantly improved and the survival rate was significantly higher compared with the SAP group. In conclusion, HMGB1 might participate in pancreas and ileum injury in SAP. Growth hormone and somatostatin might play a therapeutic role in the inflammatory response of SAP.

Jejunum and ileum blunt trauma: what has changed with the implementation of multislice computed tomography? / Trauma contuso de jejuno e íleo: o que mudou com a implementação da tomografia computadorizada multislice?

OBJECTIVE: to evaluate the impact of the new technology of multidetector computed tomography (MDCT) in improving the accuracy and early diagnosis of BSBI. METHODS: patients with blunt small bowel injuries (BSBI) grade> I were identified retrospectively and their CT scans reviewed by an experienced radiologist. Clinical and tomographic findings were analyzed and patients grouped as "pre-MDCT" and "post-MDCT", according to the time of implementation of a 64-slice MDCT. RESULTS: of the 26 patients with BSBI 16 had CT scans. Motor vehicle collision (62.5%) was the most frequent mechanism of injury. In the pre-MDCT period, five of the 13 patients (38.5%) had abdominal CT, and in the post-MDCT, 11 of 13 patients (84.6%) had the exam. During pre-MDCT, all CT scans were abnormal with findings of pneumoperitoneum (60%), free fluid (40%) and bowel wall enhancement (20%). In the post-MDCT group, all exams but one were abnormal and the most frequent findings were free fluid (90.9%), bowel wall enhancement (72.7%), and pneumoperitoneum (54.5%). However, the rate of delayed laparotomy did not change. The mortality rate in both groups were similar, with 20% during pre-MDCT and 18.2% during post-MDCT. CONCLUSION: the use of MDCT in abdominal trauma in our service has increased the sensibility of the diagnosis, but has had no impact on outcome so far. .

OBJETIVO: avaliar se o avanço tecnológico dos aparelhos de tomografia computadorizada (TC) melhorou a acurácia e rapidez no diagnóstico dessas lesões. MÉTODOS: pacientes com lesão de intestino delgado grau>I (AAST-OIS) por trauma contuso foram identificados e suas imagens de TC analisadas por especialista. Foram analisados achados clínicos e tomográficos agrupando os pacientes em antes e após o uso da TC multislice 64 canais, incorporada em nosso Serviço em abril de 2009. RESULTADOS: Dentre os 26 pacientes identificados entre 2005 e 2012, 16 realizaram TC. Acidente automobilístico (62,5%) foi o principal mecanismo de trauma. No período pré-multislice, cinco dentre 13 pacientes (38,5%) realizaram TC e no pós-multislice 11 de 13 (84,6%). No grupo pré-multislice todos os exames foram alterados, sendo os principais achados pneumoperitônio (60%), liquido livre (40%) e espessamento da parede intestinal (20%). No grupo pós-multislice apenas um exame foi considerado normal e os achados mais frequentes nos outros 10 casos foram: líquido livre (90,9%), espessamento da gordura do mesentério (72,7%) e pneumoperitônio (54,5%). Não foi observada mudança no intervalo de tempo entre a realização de TC e a laparotomia. A mortalidade em ambos os grupos foi semelhante (20% no pré-multislice e 18,2% no pós-multislice). CONCLUSÃO: O uso de tomografia multislice aumentou a sensibilidade do diagnóstico, porém sem alteração na evolução dos pacientes. .

Terminal ileal perforation due to various etiologies and their treatment modalities

Terminal ileum perforation is quite common in developing countries carrying high morbidity and mortality. Retrospective case study. This study was carried out at the Department of General Surgery, Allama Iqbal Memorial Hospital, Sialkot from March 2007 to March 2013. The study was aimed to find aetiological factors of Terminal ileum perforation and different treatment modalities for such perforation. There were 34 typhoid, 6 tuberculous, 14 non-specific and 2 others of foreign body and ascariasis. Various surgical procedures like Covering ileostomy, Closure with exteriorization, Ileostomy alone, Resection of perforation with covering ileostomy and Right hemicolectomy were done depending upon the severity of disease and clinical status of the patient. Treatment of Terminal ileal perforation is always surgical regardless of the techniques. Operation must be done as soon as possible and should be associated with aggressive resuscitation before operation. This results in remarkable decrease in morbidity and mortality of the patients. Response of treatment modalities varies from patient to patient depending upon the aetiological factors. The outcome is very encouraging in those who present earlier

Técnica quirúrgica para facilitar lacolocación de tornillos sacroilíacospercutáneos / Percutaneous iliosacral screw fixation

Percutaneous iliosacral screw fixation is a useful technique for fixation of posterior pelvis ring injuries but it has potential complications. We describe a surgical technique modification of the original technique described by Routt etal. Using the surface of the C-arm as a guide in the inlet and outlet views, exact positioning of the guide wire is easier and surgical time as radiation exposure are decreased. We hope that this modification, in addition to a better understanding of sacral anatomical variations and risk factors for misplacement of iliosacral screws would reduce complications related to this procedure.

La fijación percutánea con tornillos sacroilíacos es una técnica de utilidad demostrada para la fijación de las fracturas de la pelvis posterior, sin embargo, no está exenta de riesgos. Describimos una modificación de la técnica quirúrgica original descrita por Routt et al. Utilizando las superficies del fluoroscopio como referencia en las vistas inlet y outlet, se facilita la orientación de la aguja guía disminuyendo el tiempo operatorio y el tiempo de radiación necesaria para la colocación de este tipo de osteosíntesis. Esperamos que esta modificación, asociado a un mejor conocimiento de la anatomía del sacro y los factores asociados a mal posición de los tornillos sacroilíacos permita disminuir los riesgos asociados a este procedimiento.

Distal illeal perforation secondary to ingested foreign bodies

A 22-year-old man was admitted with abdominal pain, nausea and vomiting secondary to ingestion of multiple foreign bodies. He was found to be in increasing distress with an increase in abdominal pain and distention and no passage of foreign bodies. Patient underwent a laparotomy. Foreign bodies removed from perforated distal ileum included 8 big size [10 cm] plastic clothes pegs, a 10 cm pencil, couple of stones, a 10 cm wood nail, nail scissors and a small size battery. In case of foreign body ingestion, especially in mentally-ill patients, the patient should be carefully examined because of the potential risk of obstruction and bowel perforation, more so, if the foreign body is a battery which can puncture causing corrosive injury as well

Alterations in the intestinal wall due to protein malnutrition in rats: Evaluation of the rupture strength and the tissue's collagen / Alterações da parede intestinal na carência de proteína no rato: Avaliação da força de ruptura e do colágeno tecidual

PURPOSE: To study the effect of protein malnutrition on the intestinal wall of rats by evaluating alterations in the rupture force and dosing tissue collagen in the ileum and distal colon. METHODS: One hundred and twenty rats, that had an average weight of 100g, were used. They received water and a standard diet with 20 percent protein during 7 days for adaptation to the diet itself and to environmental conditions. After that period, the animals were randomly distributed in two groups of 60 rats each: Group 1 - the animals received a control diet with 20 percent casein for 21 days; Group 2 - hypoprotein diet with 2 percent casein for 21 days. After the adaptation period, 12 animals of each group were sacrificed at 5 moments: the beginning of experimental period (M0), 4° day (M1), 7° day (M2), 14° day (M3) and 21° day (M4). The diet to the other rats was maintained until the last sacrifice. The following variables were evaluated: body weight, blood albumin rate, tissue's hydroxyproline, hydroxyproline/total protein ratio and rupture strength in the intestinal wall of the ileum and the distal colon. RESULTS: It was observed that the rupture strength in the ileum segment and distal colon was lower in malnourished animals (Group 2); the loss of mechanical resistance was higher in the distal colon segment than in the ileum probably due to the smaller concentration of tissue collagen in the distal colon. CONCLUSION: Protein malnutrition induces the loss of mechanical resistance of the ileum and distal colon and may be associated with a smaller percentage of collagenous tissue formation in the intestinal wall.

OBJETIVO: Avaliar o efeito da desnutrição protéica na parede intestinal do rato através da medida de força de ruptura e dosagem do colágeno tecidual no íleo e cólon distal. MÉTODOS: Foram utilizados 120 ratos, pesando em média 100g, que receberam durante 07 dias uma dieta padrão, contendo 20 por cento de caseína para adaptação dos animais as condições do biotério. Após esse período os animais foram divididos em dois grupos de 60, o controle denominado grupo um que recebeu a dieta padrão, e o grupo teste denominado grupo dois, que recebeu dieta hipoprotéica contendo 2 por cento de caseína. Os dois grupos receberam suas respectivas dietas por um período de 21 dias. Após esse período iniciou-se o sacrifício seqüencial dos animais em ambos os grupos, em número de 12 animais em cada momento, correspondendo ao dia Zero (MO), 4º dia (M1), 7º dia (M2), 14º dia (M3), e 21º dia (M4) sendo mantida a mesma dieta até o final do sacrifício. Em cada momento foram avaliados o peso corpóreo, albumina sanguínea, hidroxiprolina tecidual, relação hidroxiprolina/proteína tecidual e a força de ruptura no segmento ileal e cólico dos animais. RESULTADOS: Observou-se que a força de ruptura do segmento ileal e do cólon distal foi menor nos animais desnutridos (Grupo 2). A perda da resistência mecânica foi maior no segmento do cólon distal do que no segmento ileal, provavelmente pela menor concentração do colágeno tecidual no cólon distal. CONCLUSÃO: A desnutrição protéica induz a diminuição da resistência mecânica no íleo e no cólon distal associado a diminuição do colágeno tecidual na parede intestinal.

Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions?

PURPOSE: The objective of this study was to compare patients with "isolated" blunt small bowel injury (SBI) to patients with multiple intra-abdominal injuries and analyze whether delayed laparotomy affected outcome. METHODS: Medical records of patients that suffered a blunt SBI between 1994 and 2005 were reviewed. The patients were divided into two groups: those with isolated SBI and those with other associated intra-abdominal injuries ("non-isolated"). The method of diagnosis, time to operation, small bowel Organ Injury Scale (OIS) assessment (grade > 2), injury severity score (ISS), morbidity, and mortality were analyzed. RESULTS: A total of 90 patients met the inclusion criteria, including 62 (68.9 percent) isolated cases and 28 (31.1 percent) non-isolated cases. Isolated cases required more supplementary diagnostic methods than the non-isolated cases. Non-isolated cases had a shorter diagnosis to treatment period (p < .01) and a higher ISS (mean 22.5 vs. 17.2 in "isolated" group). Morbidity (51.6 percent and 53.6 percent) and mortality (16.1 percent and 28.6 percent) did not differ significantly between the isolated and non-isolated groups. Delays in diagnosis were common in the isolated group, but this did not affect outcome. Patients with associated injuries, and higher ISS, had higher mortality. CONCLUSIONS: The presence of associated intra-abdominal injuries significantly affected the presentation and time to diagnosis of patients with SBI, but not morbidity or mortality. Delayed surgical treatment in the isolated cases was not associated with an increased incidence of complications. Patients inflicted with more severe associated injuries were less likely to survive the trauma.

OBJETIVO: Comparar pacientes com lesão "isolada" de intestino delgado com pacientes com lesões abdominais "associadas" e analisar o quanto o retardo para indicação de laparotomia influenciou na evolução dos pacientes. MÉTODOS: Foram revisados os prontuários de pacientes com trauma abdominal fechado e lesão de intestino delgado no período de 1994 a 2005, sendo os pacientes divididos em dois grupos: lesão "isolada" e lesões abdominais "associadas". Foram analisados os métodos diagnósticos, intervalo de tempo para a cirurgia, gravidade da lesão de delgado (grau > 2), ISS e morbimortalidade dos pacientes. RESULTADOS: Noventa pacientes preencheram os critérios de inclusão, 62 (68,9 por cento) no grupo "isolada" e 28 (31,1 por cento) no "associada". Pacientes do grupo "isolada" necessitaram mais de métodos diagnósticos complementares. O tempo de diagnóstico até o tratamento foi significantemente menor no grupo "associada", e estes pacientes apresentavam ISS mais elevado (média de 22,5 versus 17,2 no grupo "isolada"). A morbidade e mortalidade nos grupos foram, respectivamente, 51,6 por cento e 16,1 por cento no grupo "isolada", e 53,6 por cento e 28,6 por cento no "associada", sem diferença estatística. Demora para o diagnóstico foi comum no grupo "isolada", porém sem agravar a evolução dos pacientes. Pacientes com lesões "associadas", quantificadas pelo ISS, tiveram maior mortalidade. CONCLUSÃO: A presença de lesões abdominais "associadas" significativamente interferiu no quadro clínico e momento do diagnóstico em pacientes com lesão de delgado, porém não influenciou na morbimortalidade. No grupo "isolada" a demora para tratamento cirúrgico foi freqüente, porém sem interferir nas complicações. A elevada mortalidade foi reflexo da gravidade de lesões associadas.

Ileal perforatrion caused by swallowed foreign body, case presentation and review of literature

This is a case report of a 67 year old female patient who incidentally ingested a chicken bone, and presented to the emergency room with acute abdomen that required exploratory laparotomy later on

Look twice before your clamp: decapitation of an omphaloenteric duct. A case report

To report a case of accidental decapitation of a persistent omphaloenteric duct [POD] in congenital hernia of the umbilical cord in a newborn male. The newborn was transferred to an intensive care unit, where under closer inspection the diagnosis of an omphalocele was presumed. Surgical exploration at our Pediatric Surgical University Clinic revealed a clamped and decapitated POD in the umbilical cord. The decapitation had gone unnoticed due to severe asphyxia resulting from meconium aspiration encountered at the time of delivery. Using general anesthesia, the clamp was removed under sterile conditions. The decapitation of the POD in the herniated umbilical cord was confirmed at this time. The severed intestine was sutured and closed using 5-0 Vicryl sutures. The further course was uneventful. Herniation of the umbilical cord at the time of birth by intestinal loops or POD is rare, but caution should be taken by midwives before clamping in order to avoid the type of injury seen in this case

Intestinal perforation--a unique cause.

An illiterate, 65 years old, male attended surgery emergency with features of perforation peritonitis. Exploratory laparotomy revealed perforation in the terminal ileum and a sharp metallic object pointing at the perforation site. This, on removal, was found to be the sharp edge of a blister pack (with intact tablet within). The perforation was repaired. The abdomen was closed after leaving a drain. Postoperatively the patient had a morbid period and ultimately responded to management.

Ruptura do jejuno-íleo na criança, secundária à contusäo / Rupture of the jejunum-ileum in children by clunt trauma

Os autores estudaram 31 crianças portadoras de ruptura do jejuno-íleo, por contusäo, tratadas no Hospital Joäo XXIII, em 10 anos. Houve prevalência do sexo masculino 25 (80 por cento). Acidentes de trânsito foram as causas das lesöes em 14 (51,8 por cento). A indicaçäo de laparotomia foi feita exclusivamente pela clínica, em 15 (48,5 por cento), em 9 (29 por cento) pela clínica e radiologia e 7 (22,5 por cento) pelo lavado peritoneal. Lesäo isolada ocorreu em 27 casos (87,1 por cento). A lesäo ocorreu no jejuno proximal em 20 casos, íleo terminal em 10 e ambos em um caso. Em 14 casos (45,1 por cento), a operaçäo foi realizada nas primeiras seis horas, em cinco casos (16,1 por cento) entre 7 e 12 horas e em 11 casos (35,4 por cento) mais de 12 horas. O tempo entre a lesäo e a cirurgia näo modificou a conduta, ou seja, em todos os pacientes foi feita correçäo primária da lesäo (sutura e/ou anastomose). Houve um óbito (3,2 por cento) consequente à lesäo associada de fígado, veia cava e hepática direita.

Exclusive jejunal and ileal lesions due to blunt trauma

Twenty-six patients with jejuno-ileal lesion due to blunt trauma were treated at the Trauma Surgery Department of the State University of Campinas, UNICAMP. Twenty-two were male (84.6%), white, and age varied from 11 to 60 years. Blun trauma was caused by automobile accident (38.7%), falls (26.8%) and other causes (11.5%). The time elapsed between the trauma and the surgical correction was less than 6 hours in 15 patients, from 6 to 12 hours in 4 patients, from 12 to 24 hours in 1 patient and over 24 hours in 6 patients. The indication for laparotomy was based on the clinical picture, diagnostic peritoneal lavage, peritoneal paracentesis and radiologic findings. The lesions were treated by resection in 16 cases (61.5%) and debridamente and suture in 10 cases (38.5%). Only 1 patient died, due to septic shock. He had multiple ileal lesions and more than 24 hours delay. Most of the patients (16) stayed in the hospital for 6 to 10 days. Tje results revela that diagnostic peritoneal lavage associated with a strong suspicion on the part of the surgeon will aasure an early diagnosis and if followed by immediate surgery will determine a better prognosis for these patients

Lesäo intestinal exclusiva em contusöes abdominais / Isolated intestinal lesions due to abdominal contusions

Realizou-se estudo retrospectivo de 40 pacientes com lesäo intestinal exclusiva, devidas a traumatismos abdominais. Trinta e cinco pacientes (87,5%) eram do sexo masculino e cinco (12,5% do sexo feminino. A idade variou de 4 a 86 anos (mediana de 32,5 anos). Foram Analisados todos os casos em relaçäo à história, achados clínicos, laboraroriais e radiológicos. A indicaçäo de laparotomia baseou-se no quadro clínico evolutivo ou lavagem peritoneal. A mortalidade global foi de 20% sendo que 2/3 dos pacientes vieram a falecer de complicaçöes infecciosas pela exploraçäo cirúrgica abdodminal tardia e estes pacientes apresentavam lesäo de jejuno ou íleo. Tendo em vista os resultados, ressaltamos que a única maneira de melhorar o prognóstico destes doentes é a exploraçäo cirúrgica precoce

Estudio experimental sobre las reparaciones ileales con parche total pediculado yeyunal / Experimental study of ileal repair with total jejunal pediculate patch

Se propone la utilización de un parche pediculado yeyunal para reparar lesiones extensas del íleon terminal, basada en su aplicación experimental. Se analiza la vascularización ileal, destacando la importancia de la circulación intramural. Se compara brevemente el método con otras posibilidades terapéuticas existentes