Evaluating the effect of infliximab on the healing of left colonic anastomosis in the presence of intra-abdominal sepsis

Background and study aims: infliximab [IFX] is a chimeric anti-TNF-alpha body which is effectively used in the treatment of inflammatory bowel diseases and a variety of autoimmune diseases. The effect of IFX on the healing of intestinal anastomosis has been evaluated studies, however with conflicting results. Furthermore, the effect of IFX on colonic anastomosjs in sepsis has not been evaluated to date. In this study, we aimed to investigate whether IFX has an adverse effect on the healing process of colonic anastomosis either under normal or septic condition

Material and method: the efficiency of IFX was assessed with respect to anastomotic bursting pressure [ABP], tissue hydroxyproline levels [THL] and histopathological examination of left colonic anastomosis in 40 male rats. The rats were randomly allocated into four groups of 10 rats each as control [C], septic control [SC], control IFX[C-IFX] and septic IFX [S-IFX]

Results: the anastomotic bursting pressure was measured at 182 +/- 19.1, 158 +/- 15.4, 161 +/- 26.8 and 100 +/- 10.3 mm/Hg, in C, SC, C-IFX and S-IFX; respectively. IFX administration did not influence the anastomotic strength under normal condition whereas in sepsis significantly induced the reduction of APB. The mean THL was almost similar in both control groups [p = 0.87], whilst IFX reduced the level of TH in sepsis comparing with control groups [p=0.01]. IFX significantly impaired immune response in sepsis resulting in poor anastomotic healing in S-IFX group

Conclusion: Our study demonstrated that IFX had no detrimental effect on the healing of colonic anastomosis under normal condition whilst significantly impaired the healing process in sepsis

Syrian civil war: the experience of the surgical intensive care units

Objective: Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre

Methods: The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II [APACHE II] score and Injury Severity Score [ISS], surgical procedures, complications, length of stay and mortality

Results: A total of 80 wounded patients [70 males and 10 females] with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors [P=0.001]. No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission

Conclusion: The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts