The proteomic profile is altered but not repaired after bariatric surgery in type 2 diabetes pigs.

To reveal the sources of obesity and type 2 diabetes (T2D) in humans, animal models, mainly rodents, have been used. Here, we propose a pig model of T2D. Weaned piglets were fed high fat/high sugar diet suppling 150% of metabolizable energy. Measurements of weight gain, blood morphology, glucose plasma levels, cholesterol, and triglycerides, as well as glucose tolerance (oral glucose tolerance test, OGTT) were employed to observe T2D development. The histology and mass spectrometry analyses were made post mortem. Within 6 months, the high fat-high sugar (HFHS) fed pigs showed gradual and significant increase in plasma triglycerides and glucose levels in comparison to the controls. Using OGTT test, we found stable glucose intolerance in 10 out of 14 HFHS pigs. Mass spectrometry analysis indicated significant changes in 330 proteins in the intestine, liver, and pancreas of the HFHS pigs. These pigs showed also an increase in DNA base modifications and elevated level of the ALKBH proteins in the tissues. Six diabetic HFHS pigs underwent Scopinaro bariatric surgery restoring glycaemia one month after surgery. In conclusion, a high energy diet applied to piglets resulted in the development of hyperlipidaemia, hyperglycaemia, and type 2 diabetes being reversed by a bariatric procedure, excluding the proteomic profile utill one month after the surgery.

Monitoring of procalcitonin but not interleukin-6 is useful for the early prediction of anastomotic leakage after colorectal surgery.

BACKGROUND: Early recognition of patients who have developed anastomotic leakage (AL) after colorectal surgery is crucial for the successful treatment of this complication. The aim of this study was to assess the usefulness of the assessment of procalcitonin (PCT) and interleukin-6 (IL-6) levels in the prognosis of AL. METHODS: This observational study included 157 patients who underwent major elective colorectal surgery. The most common indications for surgery were cancer and inflammatory bowel diseases. Serum samples were obtained directly before surgery (D0) and 1 day (D1) after surgery, and the relationships between the serum concentrations of PCT and IL-6 and development of AL were assessed. RESULTS: In total, 10.2% of patients developed post-surgical infections due to AL. PCT levels on D1 were significantly higher in patients who developed AL [2.73 (1.40-4.62)] than in those who recovered without complications [0.2 (0.09-0.44)]. The area under the ROC curve for PCT on D1 was 0.94, 95% CI (0.89-0.98). The sensitivity and specificity of the prediction of an infection were 87% and 87%, respectively, for PCT on D1, which was higher than 1.09 ng/mL. The increase in PCT concentration between D0 and D1 was significantly higher in patients with AL (p<0.001). Patients who developed AL had higher concentrations of IL-6 on D1, but the difference was not significant (p=0.28). CONCLUSIONS: This study confirms that surgical trauma increases serum PCT concentrations and that the concentration of PCT on D1 can predict AL after colorectal surgery. However, IL-6 is not a good early marker for developing AL.

Laparoscopic abdominoperineal resection of the rectum - how is it done; initial results.

UNLABELLED: The abdominoperineal resection of the rectum is a classical operation performed in case of patients diagnosed with rectal cancer. The development of laparoscopic techniques in recent years, introduced yet another method of treatment, considering patients with rectal cancer- laparoscopic abdominoperineal resection of the rectum. The aim of the study was to present initial treatment results considering the above-mentioned patients. MATERIAL AND METHODS: The study group comprised 25 patients (16 male and 9 female) diagnosed with low-rectal cancer, subjected to surgery by means of the above-mentioned method. Mean patient age amounted to 66 years. Three (12%) patients required conversion to classical surgery (laparotomy), while one patient required reoperation, due to presacral vascular bleeding. Complications were observed in 10 (40%) patients. Average hospitalization was 7 days. In case of all patients the radial margin was negative, and mean number of removed lymph nodes amounted to 9.6. Mortality was not observed during the perioperative period. Due to the initial character of the study analysis (mean observation period in case of 68% of patients was shorter than 2 years), oncological results were not subject to evaluation. CONCLUSIONS: Laparoscopic abdominoperineal resections are considered as technically difficult operations, requiring significant experience of the operating team. However, they enable the patient to take advantage of the many assets of minimally invasive surgery, with comparable rates of postoperative complications.

Laparoscopically assisted ileo-colonic resection in patients with Crohn's disease--preliminary report.

UNLABELLED: Despite increasing number of reports indicating good treatment outcomes, laparoscopic treatment of Crohn's disease remains controversial. The aim of the study was to compare outcomes of laparoscopically assisted and open ileo-colonic resection in patients with active Crohn's disease. MATERIAL AND METHODS: 82 patients who underwent surgical treatment (44 laparoscopic and 38 open procedures) at the Department of General, Oncological and Gastrointestinal Surgery in Warsaw were enrolled to the study. The following perioperative parameters were compared in both these groups: duration of hospitalization and presence of postoperative complications in at least 12 months of follow-up. RESULTS: The conversion rate in the laparoscopy group was 29.5%. There were no statistically significant differences between the study groups with regard to duration of the surgical procedure, requirement for perioperative transfusions and total number of postoperative complications (19.3% in the laparoscopy group versus 28.9% in the open surgery group). However, amount of analgesic drugs required in the postoperative period was significantly lower (25 ± 6 vs 43 ± 9, p < 0.01) and duration of hospitalization was significantly shorter (9.0 vs 11.3 days, p = 0.021) after laparoscopic versus open procedures procedures. Most of the patients with complicated Crohn's disease who were qualified to laparoscopic treatment, underwent successful treatment using this method. Patients in whom conversion was done, were more likely to be on long term preoperative immunosuppressive therapy versus other patients. CONCLUSIONS: Laparoscopy is a demanding procedure from the technical point of view, but provides valuable benefits to patients with Crohn's disease, including those with a complicated disease. However, this method requires ongoing improvement of technical aspects and thorough analysis of failures to identify factors that could accurately select patients with indications and contraindications to this procedure.

Intraoperative difficulties and the reasons for conversion in patients treated with laparoscopic colorectal tumors.

THE AIM OF THE STUDY: Was an evaluation of conversion causes and intraoperative difficulties in patients treated with laparoscopic surgery due to colorectal tumours on the basis of authors' own material. MATERIAL AND METHODS: in the period 2009-2012 160 patients were operated on because of large bowel cancer, 79 women and 81 men. Average age of patients was 66 years. The conversion was recognized as desuflation of peritoneal cavity, trocars removal and making laparotomy. RESULTS: The conversion was made in 22 cases (13,7%). More in men (16.1%) than in women. The conversion was made twice as likely in T3 and T4 tumors than in T1 and T2. CONCLUSIONS: The main cause of conversion in laparoscopic operations of colorectal cancer is local tumor progression.

[Procalcitonin in diagnosis and monitoring of surgical infections]. / Prokalcytonina w diagnostyce i monitorowaniu zakazen chirurgicznych.

The procalcitonin (PCT) is a sensitive and reliable biochemical marker used in diagnosing and monitoring of bacterial infections. The procalcitonin assay allows for effective evaluation of the patient's health status. Elevated PCT serum level is correlated with progression and generalization of the infection. In severe infections, such as sepsis or septic shock, the PCT may reach concentrations even up to 1000 ng/ml (with a normal range below 0.1 ng/ml). High PCT levels in the first hours of the developing infection advocates for the bacterial etiology. Therefore, procalcitonin is used in differential diagnosis of severe bacterial and viral infections. Rapid and accurate diagnosis facilitates introduction of the effective therapy. Rapid decrease in PCT level after applying the therapy confirms its efficacy (control assay may be performed after 24 hours since the therapy has been applied). The usefulness of the PCT is supported by the fact, that in pathologic conditions, such as trauma (including surgery procedures), viral infections or autoimmunologic diseases, the PCT level is only slightly increased or remains in a normal range. The PCT level assay enables the detection of the developing infection already in the latent stadium, before characteristic clinical symptoms appear. Therefore, it is very important to monitor the PCT serum level. Further research will allow to determine the accurate diagnostic value and the clinical application of the PCT level as a marker of infection.