Cilostazol and diltiazem attenuate cyclosporine-induced nephrotoxicity in rats.

AIM: Cyclosporine (CsA), an important agent used in organ transplantation to prevent rejection, displays nephrotoxicity as the most important side effect limiting usage. In this study, we sought to evaluate the effects of cilostazol and diltiazem to counter the nephrotoxicity induced by the calcineurin inhibitor CsA. MATERIALS AND METHODS: Animals were randomly divided into seven groups, each consisting of eight animals: sham, controls, cilostazol, diltiazem, CsA, CsA plus diltiazem, and CsA plus cilostazol treatment. At the end of a 60-minute ischemic period, we administered the drugs after reperfusion for 7 days thereafter. CsA (10 mg/kg/d) was intraperitoneally for 7 days; cilostazol (10 mg/kg/d) orally by catheter for 7 days; diltiazem (5 mg/kg/d) intraperitoneally for 7 days. At the end of the 7-day treatment period, blood and tissue samples were harvested for biochemical, and serological evaluation. RESULTS: Ischemia-reperfusion injury significantly increased malondialdehyde (MDA) levels as well as decreased catalase (CAT) activities and superoxide dysmutase (SOD) content. The lowest MDA mean level was observed in the diltiazem and, the highest in the control group. The lowest CAT mean levels were noted in the CsA and diltiazem groups with highest CAT content was in the CsA and cilostazol groups. The lowest SOD mean level occurred in the sham group; the highest, in the CsA group. CONCLUSION: Cilostazol and especially diltiazem were effective to mitigate renal ischemia-reperfusion injury.

The comparison of the effects of hepatic regeneration after partial hepatectomy, silybum marinaum, propofol, N-acetylcysteine and vitamin E on liver.

AIM: We investigated the comparison of the effects of N-acetylcysteine, silybum marinaum, propofol, and vitamin E on liver hepatic regeneration after partial hepatectomy. METHOD: Forty-eight rats were randomized into 6 different groups of the same age and weight. After partial hepatectomy, all animals were resuscitated with 5 ml of isotonic sodium chloride solution administered subcutaneously while group 1 (sham) did not receive any injection, group 2 (control) received serum physiologic intraperitoneally, group 3 received 25 mg /kg of propofol intraperitoneally, group 4 received 20 mg/kg of N-acetylcysteine intraperitoneally, group 5 received 400 mg/kg of vitamin E intraperitoneally, and group 6 received 10 mg/kg of silybum intraperitoneally. None of these groups were given antibitotics. On the third day, a half of the rats, and on the seventh day, the other half of rats were reoperated and sacrificed. RESULTS: Blood samples were used for biochemical parameters (AST, ALT). Ki-67 proliferation index was used for histopathologic parameters. A statistically meaningful difference was detected in silybum, vitamin E, N-acetylcysteine, and propofol groups for AST, ALT levels when compared to control and sham groups (p<0.05). Ki-67 regeneration proliferation index of all groups, which were given agents on the third and seventh days were statistically higher than the control and sham groups (p<0.05). During the evaluation, AST, ALT, Ki-67, Ro (regeneration value) levels of silybum group displayed a statistically significant difference according to other groups (p<0.05). CONCLUSION: Our experimental study indicates that hepatic regeneration after partial hepatectomy was meaningful and significant in groups with intraperitoneal administration of silybum marinaum,vitamin E, N-acetylcysteine and propofol. Hepatic regeneration rate was particularly higher in silybum group compared to other groups (Fig. 16, Ref. 26).

Diagnosis of fasciola hepatica cases in an operating room.

Fascioliasis is a zoonotic disease that is acquired by ingestion of the metacercaria form on uncooked aquatic plants, and humans act as an accidental host. Diagnosis is confirmed by the demonstration of the parasites or evidence of them in faeces and serology. In the absence of these data, delays or misdiagnosis may occur since it may mimic many diseases. In this study, we present three cases, among them two were similar to the above-mentioned statement. The first case, to the best of our knowledge, is the first case with adult-type living fluke in the gall bladder, diagnosed by laparoscopic cholecystectomy.

An unusual presentation of polyarteritis nodosa: A case report.

Polyarteritis nodosa with gallbladder involvement is a rare condition. Autosomal dominant polycystic kidney disease is also a rare condition and rarely complicated. We describe an extremely rare case of Polyarteritis nodosa, involving gallblader and ureter without obstruction, in a patient with autosomal dominant polycystic kidney disease. To the best of the authors' knowledge, such a case has not been reported previously.

An unusual presentation of polyarteritis nodosa: A case report / Una manifestación poco usual de la poliarteritis nodosa: Reporte de un caso

Polyarteritis nodosa with gallbladder involvement is a rare condition. Autosomal dominant polycystic kidney disease is also a rare condition and rarely complicated. We describe an extremely rare case of Polyarteritis nodosa, involving gallblader and ureter without obstruction, in a patient with autosomal dominant polycystic kidney disease. To the best of the authors' knowledge, such a case has not been reported previously.

La periarteritis nodosa con compromiso de la vesícula es una condición rara. La enfermedad poliquística renal autosómica dominante es también una condición rara y raramente complicada. Describimos un caso extremadamente raro de poliarteritis nodosa, con compromiso de la vesícula y el uréter sin obstrucción, en un caso de enfermedad poliquística renal autosómica dominante. Al leal saber y entender de los autores, no ha sido reportado antes un caso como éste.

Nonalcoholic Wernicke's encephalopathy with prominent astasia and optic neuropathy.

OBJECTIVE: To present a case with nonalcoholic Wernicke's encephalopathy (WE) developing astasia and optic neuropathy as major sequelae. CLINICAL PRESENTATION AND INTERVENTION: A 47-year-old woman developed WE following operation for pyloric stenosis. She received total parenteral nutrition before and after operation, but on the second postoperative day she developed visual hallucination and confusion, followed by nystagmus, ophthalmoplegia, apathy, dysarthria and coma. Although the patient has recovered with thiamine treatment, astasia and optic neuropathy persisted s major morbidities. CONCLUSION: The report shows that astasia and optic neuropathy may be prominent sequelae in some patients with WE.

Prevention of deleterious effects of reperfusion injury using one-week high-dose allopurinol.

Allopurinol has been widely used to reduce the severity of the reperfusion injury. However, conflicting data have been reported regarding the dosage, the duration of the timing, and the administrative regimen of the drug. The aim of this study was, therefore, to evaluate the effects of short versus long periods of allopurinol pretreatment on the anastomotic healing of intestines, directly after being subjected to ischemia-reperfusion (IR) stress. Furthermore, the effects of an allopurinol pretreatment on the survival rate following IR stress, was also assessed. One hundred thirty-seven male Wistar rats with a median weight of 235 (range, 180-275) g used in the study. In group I (control group, N = 20) superior mesenteric artery (SMA) and collateral vessels were isolated but not occluded. In group II, the profound IR group (PIR, N = 42), the SMA was occluded immediately distal to the aorta with collateral interruption using an atraumatic arterial clip for 30 min. In group III [two days of allopurinol (ALL) pretreatment group, 2ALL, N = 38], allopurinol (100 mg/kg body wt) was given intraperitoneally on a daily basis for two days prior to the experiment. In group IV (seven days of allopurinol pretreatment group, 7ALL, N = 37), the same pretreatment and the allopurinol schedule was performed for seven days before surgery. All animals underwent 3 cm of ileal resection and primary anastomosis, 10 cm proximal to ileocecal valve. Within each group, animals were anesthetized either on the third or seventh postoperative days. Abdominal wound healing, intraabdominal adhesions, anastomotic complications, anastomotic bursting pressure measurements, and bursting site were recorded as were the histopathologic evaluation. No rats in group I, 20 rats in group II, 18 rats in group III, and 7 rats in group IV died (P = 0.0003). Anastomotic dehiscence was found in one of 20 group I, in 11 of 22 in group II, in 9 of 20 in group III, and in 3 of 30 in group IV (P = 0.0003). On the third and seventh days, the median bursting pressures of the anastomosis were determined: 42 and 235 mm Hg in group I, 17 and 105 mm in Hg in group II, 22 and 183 mm Hg in group III, and 36 and 214 mm Hg in group IV (P < 0.0001). The burst occurred at the anastomoses in all animals tested on the third postoperative day, one in group I, six in group II, four in group III and one in group IV on the seventh postoperative day (P < 0.01). All deleterious effects of reperfusion injury on intestinal anastomosis healing, including survival rates and the histopathological parameters, were significantly prevented by seven days, but not two days, of high-dose allopurinol pretreatment.

Effect of ischemia/reperfusion as a systemic phenomenon on anastomotic healing in the left colon.

Intestinal ischemia/reperfusion provokes a local inflammatory response leading to a systemic inflammatory state. In this study we aimed to assess the effects of intestinal ischemia/reperfusion injury on anastomotic healing in the left colon with an intact vascular supply. A total of 94 Wistar albino rats were divided into three groups: sham-operated control (group I, n = 25), 30 minutes of intestinal ischemia/reperfusion (group II, n = 40), and 7-day allopurinol pretreatment and intestinal ischemia/reperfusion (group III, n = 29). After the reperfusion experiment, a segmental left colon resection and anastomosis were done. On postoperative days 3 and 7 anastomotic bursting pressure, anastomotic and operative complications, and intraabdominal adhesions were assessed. Mortality rates were 1/25, 16/40, and 4/29 for groups I, II, and III, respectively (p = 0.001). There was no difference among the groups for wound and anastomotic healing parameters evaluated by macroscopic criteria. On postoperative day 7 the mean bursting pressures were 220.3 +/- 18.5, 162.0 +/- 21.0, and 213.9 +/- 24.7 for groups I, II, and II, respectively (p = 0.000). Significantly dense adhesions were found in group II (p = 0.000). Allopurinol pretreatment prevented the effects of ischemia/reperfusion on anastomotic healing of the left colon. Intestinal/ischemia reperfusion causes impairment of anastomotic healing of the left colon. In addition to remote organ effects, reperfusion injury may affect anastomotic healing in the viscera with an intact vascular supply.

Obstructive jaundice promotes bacterial translocation in humans.

BACKGROUND/AIMS: Significant bacterial translocation was demonstrated following experimental biliary obstruction, however very little is known about the importance and the prevalence of gut-origin sepsis in obstructive jaundice patients. Therefore, the aim of this study was to investigate the concept of gut-origin sepsis in obstructive jaundiced patients and its clinical importance. METHODOLOGY: Twenty-one patients requiring laparotomy for obstructive jaundice (group I) and thirty patients operated on electively mainly for chronic cholecystitis (group II) were studied. Peritoneal swab, mesenteric lymph node, portal venous blood, liver wedge biopsy and bile were sampled for culture immediately after opening the peritoneum. Additionally, peripheral blood samples were taken pre- and post-operatively from all patients. Post-operatively, patients were monitored for infectious complications. RESULTS: The mean serum bilirubin concentration, gamma glutamyl transferase and alkaline phosphatase levels in jaundiced patients before therapeutic intervention were significantly higher than in control patients. Five patients demonstrated bacterial translocation in group I (24%), whereas only one did so in group II (3.5%, p < 0.05). Septic complications were detected in three patients, but only in two with bacterial translocation in group I. There was one patient with bacterial translocation who had septic complication in group II. CONCLUSIONS: The present study demonstrated that obstructive jaundice significantly promotes bacterial translocation in humans, however, its clinical importance has yet to be defined.

Colonic anastomotic healing after preoperative chemo-radiotherapy in rat.

PURPOSE: To prevent micrometastasis at an earlier stage and to increase the lateral or circumferential tumor free margins, there is a rationale for neo-adjuvant chemo-radiotherapy in patients with colorectal cancer. In order to investigate the effects of such a protocol on colonic anastomotic healing, an experimental study resembling the clinical use of neo-adjuvant concomitant 5-FU+ irradiation treatment of colorectal cancer was conducted. MATERIALS AND METHODS: Seventy-one male Wistar rats were divided into three groups: a control group (I) underwent left colon resection and primary anastomosis (n = 20); a sham-treated group (II, n = 20); and a study group (III) which received fractionated irradiation to the whole pelvis to a total dose of 22 Gy, 5.5 Gy per fraction, in four consecutive days with linear accelerator and concomitant intra-peritoneal 5-FU (20 mg/kg/day) for five consecutive days. The last fraction of irradiation and the last injection were given four and three days before colonic resection and anastomosis, respectively. Within each group one-half of the animals were anesthetized on the third postoperative day and one-half on the seventh postoperative day. Abdominal wound healing, intraperitoneal adhesions, anastomotic complications, and anastomotic bursting pressure measurements were recorded. Following these measurements the anastomotic segment was resected for hydroxyproline content, myeloperoxidase activity, and histopathological evaluation. RESULTS: There were no differences in the abdominal wound healing, intraperitoneal adhesions, and anastomotic complications between groups. At three and seven days, the mean bursting pressures of the anastomoses were 36.5 mm Hg and 208 mm Hg in group I, 34.5 and 228 in group II, and 27 and 167 in group III, respectively (p < 0.01, group III vs both groups I and II on day seven). The burst occurred at the anastomosis in all animals tested on the third postoperative day, and one in group I (10%), none in group II, and four in group III (40%) on the seventh postoperative day. CONCLUSION: Preoperative pelvic fractionated irradiation and concomitant 5-FU delays anastomotic healing.

Intra-operative enteroscopy for obscure gastrointestinal bleeding.

Small bowel enteroscopy has been reported useful in the non-surgical evaluation of the small intestine in patients with obscure gastrointestinal bleeding but findings may be limited due to incomplete small bowel intubation and a lack of tip deflection. Intra-operative enteroscopy (IOE) is accepted as the ultimate diagnostic procedure for complete evaluation of the small bowel in these patients. Two patients with obscure gastrointestinal bleeding and deep anemia underwent IOE during surgical exploration. Angiodysplastic lesion with a diameter of 3 cm was found at jejunum in the first patient and segmental jejunal resection was performed. Enteroscopy showed red punctate lesions with a diameter of 1-3 mm located at proximal jejunum and extending to the ileum in the second patient. Total jejunal resection was performed. There was no recurrence of gastrointestinal bleeding during 36 months follow-up.

Laparoscopic versus open appendectomy: prospective randomized trial.

Although classic open surgery is simple, expeditious, and effective, it has some drawbacks, including wound sepsis, delayed recovery, operative difficulties, and possibility of unnecessary appendectomies for false appendicitis. The aim of this study was to assess the applicability and safety of laparoscopic appendectomy (LA) in a prospectively randomized trial. Seventy nonselective patients with suspected appendicitis were randomized to laparoscopic (n = 35, 17 male) or open appendectomy (n = 35, 15 male) and operated on an emergency basis. Operative findings, operating time, postoperative complications, and length of hospital stay were compared. We found that LA is associated with a shorter hospital stay, fewer postoperative complications, and better diagnostic accuracy, and it is recommended as the procedure of choice for the diagnosis and management of acute appendicitis.

Histological evaluation of colonic anastomotic healing in the rat following preoperative 5-fluorouracil, fractionated irradiation, and combined treatment.

There is a growing interest in neoadjuvant chemo- and radiotherapy as a treatment modality for colorectal cancer which could affect mechanical and biochemical parameters of anastomotic healing. This study investigated the effect of such protocols on colonic anastomotic healing by evaluating the histopathological parameters. One hundred and sixty male Wistar rats were divided into six groups: a control group (I, n = 20), a saline group (II, n = 30) which received 1 ml NaC1 intraperitoneally, a sham-irradiated group (III, n = 20), a 5-fluorouracil (5-FU) group (IV, n = 30), which received 5-FU (20 mg/kg) intraperitoneally for 5 consecutive days, an irradiated group (V, n = 40) which received fractionated irradiation to the whole pelvis to a total dose of 22 Gy, 5.5 Gy per fraction on 4 consecutive days, and a concomitant 5-FU + irradiation group (VI, n = 20) which received 5-FU as in group IV and irradiated as in group V. All groups underwent left colonic resection with primary anastomosis, and the last fraction of irradiation and the last injection were given 4 and 3 days before the operation, respectively. Within each group one half of the animals were killed on the third postoperative day and the other half on the seventh postoperative day. After the resection of the anastomotic segments, histopathological examination was evaluated. Apposition of the wound edges of the mucosa and the muscularis were not affected by the therapy. The level of granulocytes was high, inflammatory exudate and necrosis persisted, granulation tissue formation was delayed, and the levels of macrophages and fibroblasts were low. We conclude that colonic anastomotic healing can be affected by the administration of preoperative chemotherapy, irradiation, and chemoirradiation.

Reperfusion injury delays healing of intestinal anastomosis in a rat.

BACKGROUND: Revascularization of ischemic bowel may induce further local tissue damage due to reperfusion injury. Therefore, we aimed to investigate the effect of ischemia-reperfusion injury on the healing of intestinal anastomosis in experimental models. METHODS: One hundred and two male Wistar rats were divided into three groups: a control group (group I, n = 23); an ischemia group (group II, n = 32), in which only the superior mesenteric artery (SMA) was occluded for 30 minutes; and a profound ischemia group (group III, n = 47), in which SMA was occluded as well as collateral vessels for 30 minutes. The pulsations were seen to return to marginal vessels and the bowels began to appear pinker and healthier in all groups following the restoration of arterial flow. Then, all animals underwent a 3-cm ileal resection and primary anastomosis, 10 cm proximal to the ileocecal valve. Within each group, animals were anesthetized either on the third or seventh postoperative days. Abdominal wound healing, intraabdominal adhesions, anastomotic complications, anastomotic bursting pressure measurements, and bursting site were recorded. RESULTS: Statistically significant differences were detected in intraperitoneal adhesion scores in group II and III (P <0.001). Anastomotic dehiscence was found in 2 of 23 (9%) in group I, 5 of 32 (16%) in group II, and 16 of 47 (34%) in group III (P <0.001). On the third and seventh days, the median bursting pressures of the anastomosis were determined to be 42 mm Hg and 250 mm Hg in group I, 46 and 253 in group II, and finally 19 and 90 mm Hg in group III (P <0.01). The burst occurred at the anastomoses in all animals tested on the third postoperative day, none in group I, 4 (28%) in group II, and 8 (67%) in group III on the seventh postoperative day (P <0.005). CONCLUSION: The present study demonstrated that ischemia-reperfusion impairs anastomotic healing. Despite the fact that the intestines are well perfused and viable after revascularization, one must bear in mind that intestinal reperfusion may compromise anastomotic healing.

The presence of hemorrhagic shock increases the rate of bacterial translocation in blunt abdominal trauma.

BACKGROUND: Sepsis and multisystem organ failure are common after hemorrhagic shock. The aims of this study were to determine whether hemorrhagic shock would promote the translocation of bacteria and if it correlates with clinical outcome in patients with blunt abdominal trauma. METHODS: Twenty-six patients requiring laparotomy for blunt abdominal trauma (group I) and 30 patients operated electively (group II) were studied. Injury Severity Score, Trauma Score, and Acute Physiology and Health Evaluation (APACHE) II score were recorded before the operation. Peritoneal swab, mesenteric lymph node, portal venous blood, liver wedge biopsy, and spleen biopsy (in splenectomized patients) were sampled for culture after surgical hemostasis. Additionally, peripheral blood samples were taken preoperatively and postoperatively in group I patients for culture. The same samples were taken in group II patients except for the spleen biopsy. Moreover, patients in group I were further subdivided into subgroups A and B, indicating the presence or absence, respectively, of hemorrhagic shock (defined as systolic blood pressure < 90 mm Hg with identifiable blood loss). Postoperatively, patients were checked for infectious and septic complications. RESULTS: Mean Injury Severity Score, Trauma Score, and APACHE II score were 32.0, 12.1, and 10.9 in group I and 2.1 (APACHE II,p < 0.01) in group II, respectively. Two patients in group IA, eight patients in group IB, and one patient in group II demonstrated bacterial translocation (BT) (p < 0.01). Five patients with blunt abdominal trauma had major infectious complications, but only one had BT, and the same microorganism grew in the intra-abdominal abscess. There were two infectious complications in the control group. One of these patients had BT, and the same microorganism grew in the wound infection. CONCLUSION: We conclude that BT occurs after blunt abdominal trauma in humans and correlates with the presence of hemorrhagic shock, but the clinical significance of BT in trauma patients remains unclear.

Porta choledochal fistula: an unusual complication of a cholangiocarcinoma arising from a type I choledochal cyst.

A vena porta choledochal fistula caused by an adenocarcinoma arising from a type I choledochal cyst was detected in a 42-year-old woman. The diagnostic and therapeutic aspects of this malignancy are discussed.