Is Cholecystectomy a cause of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography?

BACKGROUND AND STUDY AIM: In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of naive papillae is defined as difficult in the presence of more than 5 papilla contacts, more than 5min cannulation time or more than one unintended pancreatic duct cannulation or opacification. It is not known whether cholecystectomy is a cause of difficult biliary cannulation. This study aimed to investigate whether cholecystectomy (CCY) is a cause of difficult biliary cannulation in patients who have undergone Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis. PATIENTS AND METHODS: Adult patients with naive papillae and those who underwent ERCP for common bile duct stones and/or sludge were included in this retrospective study. Patient demographics, clinical presentation (acute cholangitis, biliary pancreatitis or biliary colic), periprocedural data including laboratory and radiological findings and ERCP results were compared between no-CCY and post-CCY groups. RESULTS: 438 patients were included in the present study and 347 of these patients were in the no-CCY group and 91 patients were in post-CCY group. A statistically significant difference was found in the number of patients with difficult cannulation in the post-CCY group (n=30, 33.0%) patients compared to the no- CCY group (n=67, 19.3%) (p=0.011). According the multivariate analyses results, presence of history of cholecystectomy was found an independent risk factor of difficult cannulation (Odds ratio: 2.014; 95 % Cl 1.205-3.366; p=0.008). CONCLUSIONS: The results showed that biliary cannulation was significantly more difficult in patients with cholecystectomy who underwent ERCP for common bile duct stones.

Effect of cerium oxide on erythrocyte deformability in rat lower extremity ischemia reperfusion injury.

BACKGROUND: Cerium oxide is the oxide form of cerium, which has protective effects in ischemia reperfusion (I/R) injury. The purpose of our study was to look into the effects of this rare-earth metal on erythrocyte deformability in rat lower extremity I/R injury model. MATERIALS AND METHODS: We used 24 Wistar albino rats as subjects in our study. They were divided into 4 groups; randomized control group (group C; n = 6), cerium oxide group 0.5 mg.kg-1, intraperitoneal (group CO; n = 6), I/R group (group I/R; n = 6) and I/R group with cerium oxide 0.5 mg.kg-1 intraperitoneally (group I/R-CO; n = 6). Erythrocyte packs were prepared from heparinized blood samples and deformability measurements were performed. RESULTS: We obtained similar results from the control and I/R-CO groups (p = 0.158). The results in I/R group were evidently higher than those of the control, CO, and IR-CO groups (p < 0.0001, p < 0.0001, p = 0.001, respectively). CONCLUSION: We detected unfavorable effects of I/R on erythrocyte deformability, which may impair blood flow and hence tissue perfusion in infrarenal rat aorta. We also found that cerium oxide had beneficial effects by reversing undesirable effects of I/R. Further studies with larger volume are required to support our promising results (Fig. 1, Ref. 24).

Effects of apelin-13 on myocardial ischemia reperfusion injury in streptozotocine induced diabetic rats.

AIM: We want to investigate the protective effects of apelin-13 on myocardial ischemia reperfusion (I/R) injury. MATERIAL AND METHODS: 30 Wistar Albino rat were divided into 5 groups (n:6), namely control group (C), diabetes group (D), diabetes+apelin-13 group (DA), diabetes+I/R group (DIR) and diabetes I/R+apelin-13 group (DIR-A). Rats were subjected to 30­min ischemia and 90­min reperfusion. Biochemical and histopathological parameters were measured. RESULTS: Caspase-3 enzyme activity was significantly higher in the DIR group than in the C, DA, and DIR-A groups. The intensity of caspase 3 enzyme activity was significantly higher in the I/R group than in all other groups. Inflammation and vascular dilatation were found significantly higher in the DIR group than in all other groups. Congestion was significantly higher in the DIR group than in the C and D groups. TOS enzyme activity was significantly higher in the DIR group than in the C, DA and DIR-A groups. TAS enzyme activity was significantly lower in the DIR group than in the C and DIR-A groups. CONCLUSION: We believe that the protective effects of apelin-13 in ischemia-reperfusion injury and its use indications can be demonstrated in detail as long as the findings we have reached in our study are supported by other studies (Tab. 2, Fig. 10, Ref. 43).

Effect of apelin-13 on erythrocyte deformability during ischaemia-reperfusion injury of heart in diabetic rats.

OBJECTIVES: Erythrocyte deformability and plasma viscosity are of crucial importance for the perfusion of tissues and organs. The aim of this study was to evaluate the effect of apelin-13 on erythrocyte deformability during IR heart injury in diabetic rats. METHODS: Eighteen Wistar Albino rats were included in the study after streptozotocin (55 mg/kg) treatment for four weeks of observation for diabetes existence. The animals were randomly assigned to one of five experimental groups. In the Group C, DC (sham-control group) and DCA (sham-control group-apelin-13), the coronary artery was not occluded or re-perfused. In the Group DIR, a branch of the left coronary artery was occluded for 30 minutes followed by 90 minutes of re-perfusion to produce IR. In the Group DIRA, a branch of the left coronary artery was occluded for 30 minutes followed by 90 minutes of re-perfusion to produce IR, and apelin-13 was administrated via 10 µg.kg-1 IP route 30 minutes before ligating the left coronary artery.Deformability measurements were performed in erythrocyte suspensions containing Htc 5% in a PBS buffer. RESULTS: The deformability index was significantly increased in diabetic rats; however, it was similar in Group DC, DCA and DIRA. It was significantly increased in the Group DIR when compared to the Group C, DIRA, DCA and DC. The relative resistance was increased in IR models. CONCLUSION: Erythrocyte deformability was decreased in rats having diabetes and IR injury. This injury might lead to further problems in microcirculation. It was shown that apeline-13 may be useful in enhancing the adverse effects of this type of injury (Fig. 1, Ref. 35).

Evaluation of Potential Donors in Living Donor Liver Transplantation.

INTRODUCTION: Correct donor selection in living donor liver transplantation (LDLT) is essential not only to decrease the risks of complications for the donors but also to increase the survival of both the graft and the recipient. Knowing their most frequent reasons of donor elimination is so important for transplantation centers to gain time. In this study we evaluated the effectiveness of potential donors in LDLT and studied the reasons for nonmaturation of potential liver donors at our transplantation center. PATIENTS AND METHODS: We studied the outcomes of 342 potential living donor candidates for 161 recipient candidates for liver transplantation between January 2013 and June 2014. Donor candidates' gender, age, body mass index (BMI), relationship with recipient, and causes of exclusion were recorded. RESULTS: Among 161 recipients, 96 had a LDLT and 7 had cadaveric liver transplantation. Twelve of the 342 potential donors did not complete their evaluation; 106 of the remaining 330 donor candidates were accepted as suitable for donation (32%) but 10 of these were excluded preoperatively. The main reasons for unsuitability for liver donation were small remnant liver size (43%) and fatty changes of the liver (38.4%). Other reasons were arterial anatomic variations, ABO incompatibility, and Gilbert syndrome. Only 96 of the candidates (29% of the 330 candidates who completed the evaluation) underwent donation. Effective donors were 29% of potential and 90.5% of suitable donors. CONCLUSIONS: In our center, 106 of 330 (32%) donor candidates were suitable for donation and the main reasons for unsuitability for liver donation were small remnant liver size and fatty changes of the liver.

To what extent can local anesthetics be reduced for infraclavicular block with ultrasound guidance?

OBJECTIVES: To assess the adequacy of different amounts of local anesthetics (LA) in infraclavicular blockade (ICB) under ultrasonographic (US) guidance and neurostimulation and compare them to the conventional doses under neurostimulation (NS). MATERIAL AND METHODS: In this study 100 patients scheduled for upper limb surgery and suitable for ICB were randomly allocated to 1 of 5 groups: group NS (NS alone group 0.5 ml/kg LA), group FD (full-dose US group 0.5 ml/kg LA), group 30 (30% reduced dose LA 0.35 ml/kg), group 50 (0.25 ml/kg LA) and group 70 (0.15 ml/kg LA). The ICB was performed under US in conjunction with NS in all groups except group NS in which neurostimulation was used alone. When necessary local anesthetic supplementation to the operation site was administered during surgery and propofol infusion for sedation ensued. Evaluation of sensory and motor block was performed for each terminal nerve (i.e. radial, ulnar, median and musculocutaneous nerves). Block quality (assessing the need for rescue LA and propofol sedation) and duration of the block were documented. RESULTS: None of the patients in the FD and 30 groups required any supplementation or sedation, whereas LA supplementation rates were 5% in group 50 and 10% in groups 70 and NS. The propofol sedation rates were 20% in group NS, 25% in group 50 and 40% in group 70. Sensory block was significantly better in groups FD, 30 and NS at 30 min. A complete block was achieved more rapidly in all nerve territories in the full-dose group (p = 0.0001). Block duration was longest in group FD and was significantly longer in group 30 than in the other two groups (p = 0.0001). CONCLUSION: The results show that US guidance is more effective in maintenance of successful ICB than neurostimulation guidance alone and a reduction of LA doses even to 70% of conventionally used doses seems possible with US guidance. This article is published in English.

34-BetaE12 expression in benign and premalignant squamous lesions of skin: relation to cell proliferation (Ki-67).

The antibody 34-betaE12 stains selectively the keratins of basal cells. The aim of this study is to investigate the staining pattern of 34-betaE12 in borderline (keratoacanthomas and solar keratosis), and benign lesions (seborrheic keratoses). The proliferation index Ki-67 staining was also evaluated in these and also in malignant (basal and squamous cell carcinomas) cases. The staining pattern where the 34-betaE12 positive cells found in the basal, suprabasal epidermal layers was called "focal"; and the staining in all layers including upper spinous layer was called "diffuse". Mean proliferation index and the distribution pattern of Ki-67 immunohistochemical expression were assessed. Basal and suprabasal expression of 34-betaE12 significantly predominated in the normal parts of the epidermis, in eight out of 11 seborrheic keratoses (%73), one out of the 19 keratoacanthomas (%5), two out of 11 solar keratosis (18%). Statistical analysis revealed significant differences between mean level of Ki-67 expression of malignant (squamous cell carcinoma, basal cell carcinoma), benign (seborrheic keratoses) and premalignant (solar keratoses, keratoacanthomas) lesions (p<0.01). The distribution of staining pattern for Ki-67 paralleled to the staining pattern of 34-betaE12. Basal cell status assessment completed by 34-betaE12 may resolve some, but not all of the problems in terms of determining the presence of dysplasia.