The effect of surgically induced weight reduction on the serum levels of the cytokines: interleukin-3 and tumor necrosis factor.

BACKGROUND: Morbid obesity and malnutrition have both been demonstrated to have deleterious effects on the immune function. Cytokines are immunomodulatory peptides that have profound effects on immune function. To the authors' knowledge, the effect of surgically induced weight reduction on the cytokine levels has yet not been studied. In the present study, the authors determined the effect of surgically induced weight reduction on the levels of the cytokines interleukin-3 (IL-3) and tumor necrosis factor-alpha (TNF-alpha). METHODS: 14 patients undergoing silicone ring vertical gastroplasty were included in the study (mean BMI 48.85 kg/m2; range 38.1-52.0 kg/m2). Determination of the IL-3 and TNF-alpha levels was performed preoperatively and 14 days and 6 months postoperatively, when all patients had lost 25% to 30% of their preoperative weight. RESULTS: The IL-3 values before the procedure, and 14 days and 6 months after, were as follows: 9.69 +/- 1.82, 9.36 +/- 1.28, and 8.42 +/- 1.26 pg/mL, respectively (P < 0.05 preoperative versus 6 months postoperative level). The preoperative TNF-alpha levels showed a wide distribution. For this reason, the patients were divided into two groups: Group A with preoperative values >10 pg/mL and Group B with values <10 pg/mL. In Group A, a significant decrease from the preoperative level of 24.46 +/- 6.83 to 7.59 +/- 4.56, and 6.69 +/- 5.46 pg/mL was measured at 14 days and 6 months postoperatively, respectively (P < 0.05). In Group B, the TNF-alpha levels were not significantly changed and were 5.45 +/- 2.26, 7.59 +/- 4.56, and 8.82 < or = 6.27 pg/mL, respectively. CONCLUSION: The present study demonstrates a significant decrease in the levels of the cytokines, IL-3 and TNF-alpha. These changes can be responsible for alteration of the immune function after surgically induced weight reduction.

Giant splenomegaly caused by splenic metastases of melanoma.

Splenic metastases are rare and usually occur in the setting of widespread visceral metastases. Splenomegaly as manifestation of metastatic spread is extremely rare. A patient with melanoma and metastases to the skin and lung is described. He developed a giant painful splenomegaly. The splenectomy specimen demonstrated that the spleen was occupied by metastases from the melanoma. Metastases of melanoma may cause extreme enlargement of the spleen. If the patient's general condition is good, splenectomy is indicated in order to prevent spontaneous rupture of the spleen.

The effect of octreotide on wound healing: an in vitro and in vivo experimental study.

OBJECTIVE: To investigate the effect of octreotide on wound healing. DESIGN: Experimental studies in vitro and in rats. SETTING: Teaching hospital, Israel. MATERIAL: Cultured human diploid fetal fibroblasts, and 36 male Wistar rats. INTERVENTIONS: Octreotide was added to cultures of fibroblasts in doses of 2, 10, 30, 60 and 120 ng/ml and fibroblasts were counted after 2, 4, and 6 days. Intestinal anastomoses were made in 36 rats. Rats in the octreotide group (n = 18) were given subcutaneous injections of 0.25 microg/kg twice daily and 6 rats were killed at 3, 7, and 14 days. The control group were given injections of saline. Anastomotic bursting pressures and hydroxyproline content were measured at each of the three times. MAIN OUTCOME MEASURES: Fibroblast counts, anastomotic bursting pressures, and hydroxyproline concentrations. RESULTS: Octreotide did not inhibit fibroblast proliferation in any of the doses at any of the time periods. The anastomotic bursting pressure was slightly higher in the octreotide group at each of the time points, but not significantly so, and there was no difference in hydroxyproline content between the octreotide and control groups. Octreotide did not inhibit wound healing either in vitro or in vivo.

Comparative study of the early postoperative course and complications in patients undergoing Billroth I and Billroth II gastrectomy.

Distal gastric resection can be followed by reconstruction according to the Billroth I (BI) or Billroth II (BII) techniques. The aim of this study was to compare the early postoperative results and complications of patients undergoing BI and those undergoing BII resection. Eighty-eight patients operated during the years 1991 to 1994 underwent distal gastric resection (41 had BI, and 43 had BII resections). The indications for BI resections were gastric tumors in 39 patients (95%) and duodenal ulcer in 2 (5%). The indications for BII resection were malignancy in 28 patients (65%) and duodenal ulcer disease in 15 (35%). The average duration of the procedure was 147 +/- 28 minutes for the BI resection and 175 +/- 38 minutes for the BII resection (p < 0.05). No patient in the BI group developed anastomic leakage. Two patients who underwent BII resection developed duodenal stump leakage (4.7%). Relaparotomy was indicated in five patients, two from the BI group (malignant cells in the resection margins) and three from the BII group (one due to duodenal stump leakage and two for bleeding). There was no postoperative mortality in the BI group. The postoperative mortality in the BII group was 7.1% (p < 0.05). The average proximal gastric resection margins were significantly smaller in the BI group than in the BII group (3.65 +/- 2.83 cm and 5.18 +/- 2.57 cm, respectively; p < 0. 05). The number of lymph nodes found in the resected specimen did not differ significantly between the two groups. Recurrent tumor at the gastric remnant developed in two patients in the BI group but not in the BII group. The results of our study revealed that the BI procedure is accompanied by significantly lower postoperative complication and mortality rates than the BII procedure in cases of gastric malignancy. BI resection performed for malignancy seems to achieve smaller proximal gastric resection margins, which may influence the recurrence rate.

Massively bleeding gastric pouch ulcer after silastic ring vertical gastroplasty successfully treated endoscopically: a report of two cases.

Two patients who developed massive bleeding from a gastric pouch ulcer are described. This rare complication occurred during the early postoperative course after silicone ring vertical gastroplasty (SRVG). In both cases the bleeding stopped after the ulcers were injected with epinephrine and alcohol. Both ulcers healed after 1 month of treatment with omeprazole (Losec). The probable etiology of this rare complication is discussed.

Repair of fascia with polyglycolic acid mesh cultured with fibroblasts--experimental study.

In the present study polyglycolic acid (PGA) mesh was used for repair of fascial defects experimentally made in rats. In the experimental group fibroblasts were cultured on the mesh before implantation and in the control group the mesh alone was used. Rats were sacrificed 7, 14, 28 and 60 days after the implantation of the mesh. Tissues were examined microscopically and for hydroxyproline content. Microscopically good incorporation of the mesh was noted in both the control and experimental groups. However, it seems that in the experimental group earlier dissolution of the mesh occurred. The hydroxyproline content was higher in the experimental group after 7 (statistically not significant) and 14 days (p < 0.05) and in the control group after 28 (p < 0.025) and 60 days (p < 0.05). These results suggest that the use of PGA mesh with cultured fibroblasts might have a beneficial effect on wound healing.

Healing of the esophageal suture line: does it differ from the rest of the alimentary tract?

We investigated the healing pattern of the esophageal suture line in rats. Fifty male wistar rats were divided into experimental (n = 40) and control (n = 10) groups. The rats in the experimental group underwent esophogostomy at the abdominal esophagus, which was immediately sutured, and sacrificed 2, 4, 7 and 14 days later. Esophageal bursting pressure and hydroxyproline content were determined in both groups. The measured bursting pressures in the experimental group on days 2, 4, 7 and 14 were (mean +/- SD) 78 +/- 35, 95 +/- 12, 1,163 +/- 98 and 1,224 +/- 22 cm H2O, respectively, and 1,308 +/- 87 cm H2O in the control group (P <0.05 vs. all the experimental group values). The hydroxyproline content in the experimental group on days 2, 4, 7 and 14 were 13.9 +/- 2.1, 12.53 +/- 2.68, 15.6 +/- 0.85 and 17.75 +/- 5.65 microg/mg, respectively, and 27.88 +/- 2.5 microg/mg in the control group (P <0.05 vs. all the experimental group values). We conclude that the esophagus demonstrates the same healing pattern as the rest of the alimentary tract, but its healing seems to occur at a slower pace.

Patient satisfaction in two departments of surgery in a community hospital.

Patient satisfaction with medical and nursing care was evaluated in two surgical departments of a community teaching hospital in Petah Tikva (now called Rabin Medical Center, Golda Campus). The interview, conducted before the patients were discharged, related to their perception of the preoperative period, the attitude of the personnel in the operating room before anesthesia was administered, and their satisfaction during the postoperative period. The questionnaire completed by the interviewer included questions on the time that elapsed from admission to the first examination by a physician and a nurse, whether the patient received information about the operation and its possible complications, was examined by the anesthetists, received details regarding the results of the surgical procedure, and what his or her impression was of the attitude of the nursing staff. The patients were asked to rate their evaluation on a scale from 1 to 10. The results showed high satisfaction with the services provided and were similar for both departments. The small number of patients whose satisfaction rated from 5 to 8 complained about the sanitary conditions in the toilets, the overcrowded departments, and the lack of sufficient number of registered nurses during the night shifts.

Outcome of Silicone Ring Vertical Gastroplasty in Patients Aged 50 Years and Older.

BACKGROUND: The authors studied the results Of silicone ring vertical gastroplasty (SRVG) in Patients aged 50 years and older. METHODS: The early and late Postoperative results in 28 patients aged.50 Years or older undergoing SRVG were reviewed retrospectively, The results were compared to those of 370 Patients Younger than 50 years operated during the same period. RESULTS: There was no Postoperative mortality among patients aged 50 years and older. There was a significantly higher incidence Of Pulmonary embolus and wound infection among patients aged 50 years and older (P < 0.05). The weight loss did not differ significantly between the two studied age groups. CONCLUSION: SRVG may performed on patients aged 50 years or older with acceptable complication rate and favorable postoperative results.

Patient-Controlled Analgesia Following Vertical Gastroplasty: a Comparison with Intramuscular Narcotics.

BACKGROUND: patient-controlled analgesia PCA is a rapidly spreading approach to the management of post-operative pain. The suitability of this method for the morbidly obese patient undergoing bariatric surgery has not yet been determined. METHODS: in the present study we randomly compared two groups of patients undergoing silastic ring vertical gastroplasty. One group received PCA (12 patients) and the other (11 patients) received intermittent doses of pethidine intramuscularly. RESULTS: the cumulative morphine use during the first post-operative day was 52.71 +/- 1.83 mg by the PCA group and an equivalent of 24.55 +/- 3.42 mg morphine by the IM pethidine group (p = 0.0002). The analgesic and sedative effects by the PCA were found to be superior. There were no significant differences between the groups in the incidence of side-effects or complications, except a higher, unexplained incidence of wound infection in the PCA group. CONCLUSION: use of PCA in patients undergoing bariatric surgery has obvious advantages and appears to be a safe procedure.

Improvement of rat survival and liver mitochondrial function in biliary obstruction after treatment with sodium thiosulfate.

The exact cause of liver failure occurring after long standing biliary obstruction is not known. Impairment of hepatic mitochondrial respiration was postulated in some studies. Sodium thiosulphate (STS) is known to have a protective effect on liver function during administration of hepatotoxic chemotherapy. In the present experimental study the effect of treatment with STS in the presence of obstructive jaundice was studied by determination of the survival rate of rats subjected to biliary obstruction and by polarographic determination of the hepatic mitochondrial function. Treatment with STS was found to result in a significant improvement in rats' survival rate (p < 0.05). Polarography demonstrated significant preservation of mitochondrial respiratory capacity after treatment with STS. The results of the present study show that the deterioration in liver function in the presence of biliary obstruction is probably caused by impairment of mitochondrial respiration. This may be preserved by treatment with STS. The exact explanation of its effect is not yet clear.

Erroneous diagnosis of left ureteric injury leading to insertion of double J catheter to the left spermatic vein.

A case of erroneous diagnosis of left ureteric injury and its results is reported. An 86-year-old man was operated on for perforated diverticulitis. A tubular structure was injured at the left paracolic gutter and repaired over double J catheter. Six months later the proximal side of the catheter was found in the right ventricle, because it has been introduced into the spermatic vein and not into the left ureter.

Peritoneal band containing talc: rare cause of small bowel obstruction in a previously unoperated child.

The authors report on a 10-year-old boy who was operated on for small bowel obstruction. The obstruction was caused by a peritoneal band that was found to contain talc of an unknown source. The possible explanation for this rare pathology is discussed.

Kinetics of cortisol, interleukin-2 and interleukin-3-like activity levels following surgical intervention.

Cortisol, interleukin(IL)-2 and IL-3-like activity (IL-3-LA) levels were examined in two groups of patients before and after surgery. One group consisting of 11 patients underwent cholecystectomy; the other comprising 17 patients with malignant diseases of the gastrointestinal tract underwent a removal of the tumor. In both groups there were similar fluctuations in cortisol levels after surgery, i.e. a statistically significant increase at day 2 after operation with a decrease to normal values at day 14. The levels of IL-2 and IL-3-LA production in the two groups followed a different pattern. In patients with cholecystectomy the IL-2 and IL-3-LA levels showed a marked decrease at day 2 with a gradual increase on the following days. In cancer patients IL-2 was at its lowest level before surgery and started to increase gradually till day 14 after surgery. The lowest level of IL-3-LA was at day 2 after surgery and it increased gradually from day 7 to 14. It is suggested that the fluctuations of these two cytokines after surgery are related to the levels of corticosteroids which have been shown to inhibit the production of IL-2 and IL-3-LA in vitro. The observed increase of cortisol level with a concomitant decrease of IL-2 and IL-3-LA after surgery may further explain the immunosuppression observed after operation.