Early predictive factors and risk assessment for anastomotic leakage in patients undergoing low anterior resection for rectal cancer.

OBJECTIVE: Anastomotic leakage is a complication that creates significant concern in terms of postoperative morbidity and mortality after colorectal surgery. This study aimed to identify variables for detecting anastomotic leakage in those who had open, laparoscopic, or robotic low anterior resection for cancer and to explore their relationships. PATIENTS AND METHODS: A total of 283 patients who were diagnosed with rectal cancer and underwent low anterior resection were divided into two groups: those with and without anastomotic leakage. Demographic and clinical data were analyzed. Anastomotic leakage was detected in 23 of 283 patients who underwent low anterior resection. RESULTS: The postoperative analysis of the biochemical data of the patients showed statistically significant differences between the two groups in terms of C-reactive protein (Crp), albumin, lymphocytes, leukocytes, neutrophils, and their ratio. The performance of these parameters in predicting anastomotic leakage was statistically analyzed in the patient group with anastomotic leakage, and nomogram results were acquired. Immune system components and biomarkers were statistically tested, and nomogram results were obtained in rectal cancer patients. CONCLUSIONS: These parameters can be used together as a potential marker in anastomotic leakage. Further development of these variables has the potential to facilitate the timely detection and treatment of anastomotic leakage.

Effect of sildenafil on intestinal adaptation parameters in a rat model of short bowel syndrome.

OBJECTIVE: We aimed to evaluate the effect of sildenafil on the intestinal adaptation in short bowel syndrome (SBS). MATERIALS AND METHODS: Forty-eight male Wistar-albino rats (weight, 231-390 g) were randomly divided into four groups with 12 rats in each. Group TA had only ileal transection+anastomosis, Group TA+S was given sildenafil after ileal transection+anastomosis, Group RA had a resection of 75% of the small bowel+anastomosis, Group RA+S was given sildenafil after small bowel resection+anastomosis. Sildenafil was injected subcutaneously at 60 mg/kg/day dose throughout 3-21 days postoperatively. Bowel and mucosal weights, villus height, crypt depth, DNA and protein concentrations were determined. RESULTS: Jejunal bowel weight was lower in TA and TA+S groups than RA and RA+S groups (p < 0.05). RA+S group had higher ileal and jejunal mucosal weights than RA and TA+S groups (p < 0.05). Villus height was highest in RA+S group both in ileum and jejunum (466.1 ± 38.6 µm and 648.1 ± 65.7 µm, respectively). Jejunal crypt depth was highest in RA+S group (255.1 ± 21.9 µm) compared to other groups (p < 0.05). There was no significant difference in ileal and jejunal protein concentration between TA and TA+S groups and in ileal protein concentration between RA ve RA+S groups (p > 0.05). Ileal DNA concentration was higher in TA+S group, and jejunal DNA concentration was higher in RA and RA+S groups than TA and TA+S groups (p < 0.05). CONCLUSIONS: Sildenafil has a positive effect on intestinal adaptation parameters, particularly in jejunum in a rat SBS model. Thus, its role in the treatment of SBS should be further investigated with clinical studies.

A very late-onset deep infection after prosthetic inguinal hernia repair.

Prosthetic repair of inguinal hernias has low recurrence and infection rates in practice. However, surgical site infection is still a potential complication. A limited number of cases have been reported to date describing late-onset deep mesh infection following prosthetic repairs. We herein report a new case of postherniorrhaphy infection with a very late onset.

Basic fibroblast growth factor loaded polypropylene meshes in repair of abdominal wall defects in rats.

BACKGROUND AND AIM: Incisional hernia following laparotomy and recurrent herniation after its repair are still common problems in spite of mesh augmentation. The underlying biological mechanism may be related to collagen metabolism. Recently, some members of growth factors family have been tested in the prevention of wound failure and incisonal hernia formation. Growth factors may promote fibroblast proliferation and collagen deposition. In the present study, we searched the effects of basic fibroblast growth factor (bFGF) loaded polypropylene meshes in an incisional hernia model in rats. METHODS: A total of 80 Wistar albino rats were randomly divided into five groups. A uniform surgical procedure was employed in all groups: a 5 cm skin incision was made at the midline and a full segment of the abdominal wall sized 3 x 2 cm was excised. Abdominal wall was closed with rapidly absorbable 3/0 catgut. Following this standard surgery, five different procedures were applied to the groups before closing the skin with 4/0 monofilament polypropylene sutures. Control subjects (Group 1) received no extra procedure after abdominal wall suturing. Polypropylene meshes were used in onlay position by fixing 4/0 monofimalent polypropylene interrupted sutures in other four groups. A standard mesh with no chemical treatment was used in Group 2. Gelatin coated meshes were used in Group 3, while Group 4 and 5 received bFGF loaded meshes with 1 microgram (microg) and 5 microg doses respectively. All the groups then divided into 1st month (early: E) and 2nd month (late: L) subgroups (n=8 each) according to sacrification dates. Tensiometric and histopathological evaluations were done. The specimens for histopathology were obtained from the interface area of the meshes and stained with hematoxylin and eosin, and also Masson trichrome. The variables were examined and evaluated by a single blinded pathologist under light microscopy in respect of inflammation, vascularization, fibroblast activity, collagen fibers and connective tissue organization. The avidin-biotin-peroxidase method was performed using the primary monooclonal antibodies against collagen type I and collagen Type III. RESULTS: bFGF loaded meshes showed higher tensile strength values in comparison with a standard polypropylene mesh after 2 months. Histopathological and immunohistochemistry studies also revealed somewhat better scores in favor of bFGF loaded mesh over a standard polypropylene mesh. These limited effects of bFGF did not seem to be dose dependent. CONCLUSIONS: The use of bFGF loaded polypropylene mesh in the abdominal wall healing may cause somewhat higher tensile strength values in comparison with a standard polypropylene. However, histopathological and immunohistochemistry studies revealed only a slightly better healing in favor of bFGF loaded mesh over a standard polypropylene mesh.

Effects of N-butyl-2-cyanoacrylate on high-level jejunojejunostomy.

BACKGROUND: Morbidity and mortality due to anastomotic complications in gastrointestinal surgery remain important problems. The tissue adhesive N-butyl-2-cyanoacrylate (NB2CA) is used in many fields of surgery. This study was designed to assess the effects of NB2CA on high-level jejunojejunostomy. MATERIALS AND METHODS: Forty male albino Wistar rats were divided into 4 groups of 10 each. The groups were treated as follows: group 1 underwent only a jejunojejunostomy, group 2 underwent jejunojejunostomy followed by NB2CA application around the anastomosis, group 3 underwent jejunojejunostomy after a 60-min ischemia and a 60-min reperfusion, and group 4 underwent jejunojejunostomy after a 60-min ischemia and a 60-min reperfusion followed by NB2CA application around the anastomosis. At postoperative day 7, the subjects in all groups were sacrificed. Intra-abdominal adhesions, anastomotic complications and anastomotic burst pressures (ABP) were recorded. RESULTS: The analysis of all the groups for adhesion scores and ABP showed statistical significance (p < 0.001). CONCLUSIONS: The use of NB2CA had positive effects in terms of increasing ABP both with and without the initial ischemia- reperfusion insult. However, it had the adverse effect of significantly increasing the number of intra-abdominal adhesions.

Are uraemic children immunologically compromised?

BACKGROUND: Various immunological abnormalities leading to impaired immune status have been described in uraemic adults; however, few data are available for uraemic children. METHODS: In this study, peripheral blood total lymphocyte count and lymphocyte subsets (CD3+, CD4+, CD8+, CD16+, CD20+) were evaluated, skin tests with PPD and Candida antigens were performed, and serum immunoglobulin (IgG, IgA, IgM) and complement (C3, C4) levels were measured in 30 children with end-stage renal failure (10 before dialysis, 10 on continuous ambulatory peritoneal dialysis, and 10 on haemodialysis) and the results compared with those of 15 healthy controls. RESULTS: The data showed significant lymphopenia in predialysis and haemodialysis groups. No significant change was observed in the CD4+/CD8+ ratio or in the percentages of lymphocyte subsets in either group studied, while the absolute values of some lymphocyte subsets were significantly lower in all groups as compared with controls. In skin test evaluation, only the patients in the predialysis group showed a significantly decreased response to Candida antigen. The serum immunoglobulin levels were significantly decreased in the continuous ambulatory peritoneal dialysis group as compared with the control group. CONCLUSION: Our results, together with those of other paediatric studies, reported in the literature, suggest that uraemic children are not immunocompromised, though the effects of uraemia may cause some variation in their immune status.

Blood pressure nomograms for children and adolescents in Turkey.

In order to obtain data on blood pressure (BP) distribution in Turkish children, a total of 5,599 Turkish children from birth to 18 years were studied. BP rises with age, and both systolic and diastolic BP showed a positive correlation with height and weight in both sexes. As the sampling was representative of Turkish children at different ages, the mean systolic and diastolic BP levels were compared for each age with the results reported in the study of the Second Task Force. The mean systolic and diastolic BP of Turkish children and the increase with growth and development were different from the Second Task Force study. Genetic, ethnic, and environmental factors were suggested to be responsible for this variation. In conclusion, normal BP curves should be applied with caution in childhood, and every population should use their own normal standards to define a measured BP level in children.

Congenital microcephaly and infantile nephrotic syndrome--a case report.

A 22-month-old girl with nephrotic syndrome and microcephaly is described. She had dysmorphic facies and psychomotor retardation. Her parents were first-degree relatives and one of her siblings had died with nephrotic syndrome and renal failure in infancy. An autosomal recessive inheritance is suggested. The diagnosis of this rare combination is discussed and the relevant literature is reviewed.

Effect of corticosteroids on growth in children with steroid-sensitive nephrotic syndrome.

The effect on growth of long-term treatment with prednisolone was studied in 12 patients with steroid-sensitive nephrotic syndrome. Our patient's heights were found between the 10th and 25th percentile both at the first and last height measurement. There was no statistical difference between the first and last height standard deviation score (Ht SDS) (p greater than 0.05). When compared with chronological age, growth velocity (GV), GV SDS and bone age were found low but within the normal range for this age group. There was not any correlation between the last Ht SDS and relapse number, total doses and duration of daily and alternate-day steroid therapy (p greater than 0.05). Growth hormone (GH) responses to pharmacological stimuli were obtained as severe deficiency in 10 patients, partial deficiency in 1 patient and normal level in 1. There was statistical difference between the pulse number of the overnight GH profile of the patients and control group (p less than 0.05). But no statistical difference was found between GH pulse amplitude and GH concentration in patients and control group (p greater than 0.05).