Effects of diabetes and elevated glucose on nitrergic relaxations in the isolated duodenum of the rat.

Nitrergic relaxations of the isolated duodenum, induced by streptozotocin, were investigated in the experimental 8-week diabetes rat model. The effects of elevated glucose were also examined in the incubated duodenal muscles (in Krebs-Henseleit solution containing 44 mM glucose for 6 h) taken from nondiabetic rats. The relaxations induced by electrical field stimulation (EFS) and nicotine were significantly reduced in diabetic rats compared with control rats. Incubating of duodenal tissues in medium containing elevated glucose revealed significantly impaired relaxations to EFS and nicotine compared to responses obtained after normal glucose incubation. However, the relaxant responses to sodium nitroprusside and papaverine were similar in all groups. Incubating in hyperosmolar solutions containing sucrose, the relaxant responses were not affected. In conclusion, impairment of NO-mediated relaxations in diabetes may be related to hyperglycemia. The alterations caused by elevated glucose are not due to a hyperosmotic effect because the same concentration of sucrose had no effect on the relaxations.

Surgical experience of hydatid disease of the liver: omentoplasty or capitonnage versus tube drainage.

BACKGROUND/AIMS: The aim of this paper was to report our experience and comparison of surgical treatment methods for hepatic hydatid cyst disease. METHODOLOGY: Between January 1990 and December 1998, 66 patients with hepatic hydatid disease in two centers were operated on. Patients were assessed by clinical examination, laboratory methods and ultrasonography and computed tomography and magnetic resonance. We also compared omentoplasty or cappitonage with external drainage with or without cyctectomy. RESULTS: Common pathology was solitary cysts and most of them were placed in the right lobe. Omentoplasty was performed for 35 cysts and cappitonnage for 36 and external drainage for 31 cysts. No operative mortality was reported. Patients with omentoplasty developed fewer complications and had a significantly shorter hospitalization than those with external drainage. CONCLUSIONS: Although omentoplasty seems to be the best possible surgical alternative for the radical treatment of hepatic hydatid cysts, the management of hydatid cysts should be flexible, taking into consideration a number of factors and variables.

Management of sigmoid colon volvulus.

BACKGROUND/AIMS: Sigmoid colon is the most frequent site for a volvulus. The condition has been a formidable one, fraught with innumerable complications responsible for many deaths. In this report, we reviewed our experience with sigmoid colon volvulus. METHODOLOGY: We present our experience of 61 cases of sigmoid volvulus admitted to our department. Twenty-four patients were subjected to non-operative decompression and the others underwent emergency operation. RESULTS: Intestinal volvulus has quite a high morbidity and mortality. Mortality rate of elective resection following sigmoidoscopy was 7.6%. Mortality rate for emergency surgical detortion, primary resection and Hartman procedure were respectively 13%, 16.6% and 37.5%. Important factors such as the patient's features and frequent late diagnosis can influence the complicated outcome of the disease. Plain X-ray of the abdomen is helpful. CONCLUSIONS: Management with the conservative method of treatment in the form of detortion by sigmoidoscopy and rectal tube application is initially effective in most cases of volvulus of the sigmoid colon. On the other hand, elective or emergency sigmoid resection is the most effective treatment for the disease.

Effects of chronic unilateral internal pudendal arterial occlusion on reactivity of isolated corpus cavernosum strips from rabbits.

An animal model was developed to elucidate the effect of chronic obstruction of the internal pudendal artery on the responsiveness of the corpus cavernosum. In male albino rabbits, the internal pudendal artery was chronically ligated unilaterally with a silk tie and the occlusion was maintained for 1 month. The control group was sham-operated. The reactivity of corpus cavernosum tissue from the ligated animals and the control animals was studied in organ chambers. Unilateral chronic ligation of the internal pudendal artery caused an impaired contractile response to alpha-adrenoceptor stimulation with decreased Em and pD2 values and an impaired relaxant response to electrical field stimulation but resulted in a marked increase in the endothelium-dependent relaxant response to carbachol with an increased pD2 value. However chronic obstruction of the pudendal artery had no effect on adenosine-, papaverine- and sodium nitroprusside-induced relaxant responses, and there was no change in agonist potency. These data indicate that altered penile hemodynamics have an effect on the reactivity of the corpus cavernosum and may contribute to the etiology of impotence.

Prevention of postherniorrhaphy urinary retention with prazosin.

Urinary retention that necessitates catheterization after herniorrhaphy is a well known, but usually ignored, situation. Increased sympathetic activity resulting from surgery may be the contributing factor. Blockade of alpha receptors in the bladder neck and urethral sphincter may prevent postoperative urinary retention. In this prospective placebo-controlled study, the efficacy of prazosin in preventing postoperative urinary retention after herniorrhaphy was investigated in 156 patients. Patients were randomized into two groups. Patients in Group I (control) were given placebo orally 12 hours before surgery, just before surgery, and 12 and 24 hours after surgery. In Group II, 1 mg of prazosin was given in the same manner of placebo. Nine of 84 patients (10.8%) in the prazosin group and 18 of 72 patients (25%) in the placebo group developed urinary retention. Catheterization was required in only 3 patients (3.5%) in the prazosin group compared to 10 patients (13.8%) in placebo-treated group (P < 0.05). In conclusion, prophylactic use of prazosin after herniorrhaphy significantly reduced the incidence of urinary retention and catheterization.

The protective effect of vitamin E on gastric mucosal injury in rats with cirrhosis of the liver.

OBJECTIVE: To evaluate the functional and morphologic features of stomach in liver cirrhosis model and the cytoprotective effects of Vitamin E. METHODS: Experimental cirrhosis was induced in rats by subcutaneous administration of 0.4 ml CCl4 (diluted 1:4 with olive oil) per kilogram of body weight twice a week for 12 weeks. Rats were divided into three groups. Group 1 was control. Group 2 consisted cirrhotic rats induced by CCl4 and Group 3 cirrhotic rats treated with Vitamin E (intramuscularly 100 mg/kg per day during study). At the end of 12 weeks, gastric mucosal injury was produced by instillation of absolute alcohol via an orogastric tube. After 3 hours, each animal was sacrificed. The stomachs were macroscopically, microscopically and biochemically analyzed. RESULTS: Macroscopic and microscopic area of gastric mucosal injury were significantly larger in cirrhotic rats (P < 0.05). Gastric mucosal injury was more serious in cirrhotic rats as compared with Group 1. With vitamin E treatment, tissue Malondialdehyde (MDA) and glutathione [GSH (X)] levels were significantly lower in group 3 as compared with group 2 (P < 0.001). CONCLUSION: Gastric mucosa in cirrhotic rats has distinctive histological and functional abnormalities. These abnormalities can be reversed by Vitamin E or other antioxidants.

The effects of prostaglandin E2 indomethacin & Ginkgo biloba extract on resistance to experimental sepsis.

We investigated the effect of 16,16-dimethyl prostaglandin E2 indomethacin and Ginkgo biloba extract on the survival in two experimental sepsis models in rats due to administration of 1 x 10(7) cfu and 1 x 10(9) cfu Escherichia coli. Animals in each model were then randomly divided (10/group) into four groups, administered saline, indomethacin, G. biloba extract and prostaglandin E2 respectively. When compared, there was no significant difference in the survival period between the two sepsis models (P > 0.05). The best survival rate was observed in the PGE2-administered animals in the first major model (P < 0.05). Indomethacin appeared not to decrease the mortality rates. There was no significant difference in PGE2 levels between two sepsis models (P > 0.05). Our results suggest that elevated prostaglandin E2 levels following major trauma are not responsible for the postinjury increased susceptibility to infectious complications. Our observations should also discourage aggressive use of cyclo-oxygenase inhibitors for protection against infectious complications after major trauma.

Cytoprotective effects of alpha tocopherol against liver injury induced by extrahepatic biliary obstruction.

There are several important aetiologies of extrahepatic biliary obstruction (EBO). If EBO is surgically reconstructed in the critical time period, liver damage can be halted or reversed. In this golden period, lipid peroxidations significantly intensify liver defects. We hypothesised that alpha tocopherol (alpha-T) could protect the liver from the damage caused by response to EBO. In standard conditions, albino rats of Wistar strain were divided into two groups. All rats underwent double ligations and divisions of common bile ducts (CBD). One of these groups received alpha-T (CBDL-alpha-T). The other CBDL animals received intramuscular injections of normal saline (CBDL-NS). Serum samples were taken for biochemical analyses by light microscopy. The data showed a decrease in plasma bilirubin and liver enzyme levels in CBDL-alpha-T group, when compared with CBDL-NS (p < 0.05). Morphologic analyses showed better results for CBD-alpha-T. Serum levels of Malonyldialdehyd (MDA) in the CBDL-alpha-T group was 9.2 +/- 3.4 nmol/g compared to that in CBDL-NS, 12.3 +/- 4.4 nmol/g (p < 0.05). In conclusion, a dramatic protective effect of alpha-T on functional and structural features of the liver in rats with EBO was demonstrated. The data suggest that EBO may cause liver damage by stimulation of lipid peroxidation and that alpha-T may slow down liver damage in this setting.

Factors affecting surgical mortality and morbidity in patients with obstructive jaundice.

The importance of clinical and laboratory parameters which have an effect on postoperative mortality and morbidity was evaluated in 124 patients operated on because of obstructive jaundice. The causes of obstructive jaundice were a malign disease in 38 patients (30.6%) and a benign disease in 86 patients (69.4%). Biliary enteric anastomosis in 66 patients (53%), external drainage in 46 patients (37%), and cholecystectomy in 12 patients (10%) were the surgical techniques of choice for correction of obstructive jaundice. There were significantly high mortality rates in patients with weight loss, more than 10 kg during preoperative the month (p < 0.05); jaundice longer than 21 days, (p < 0.001); and malignancy caused jaundice (p < 0.002). Haematocrite less than 30% (p < 0.05), albumin level below 3 g/dl (p < 0.01), blood urea nitrogen level above 30 mg/dl (p < 0.001), and bilirubine above 10 mg/dl (p < 0.01) were determined as risk factors in mortality. Direct relationships between the number of risk factors, complications, and mortality ratios were determined. One or more complications were determined in patients with more than six risk factors. High mortality rate was also determined in patients who had five and more risk factors. The following factors were evaluated: respiratory, circulatory, renal functions, and infection, and metabolic concomitant diseases, and comorbid scores for each patient were calculated. High rate complications in patients with eight and more comorbid scores and high mortality rates in patients with six and more were also determined. Finally, all these parameters were important in demonstrating postoperative mortality in obstructive jaundice patients. We suggest that surgery after treatment of correctable risk factors decreases postoperative morbidity and mortality.

Effects of deferoxamine and sympathectomy on endothelin-1-induced contraction and acetylcholine-induced relaxation following subarachnoid hemorrhage in carotid artery.

The role of endothelium-related factors in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage (SAH) has gained interest since the discovery of EDRF and of endothelin-1 (ET-1). The effect of SAH and both treatment of deferoxamine (DFO) and sympathectomy on endothelium-dependent vasodilation and ET-1-induced vasoconstriction of isolated rabbit carotid artery was examined using an isometric tension recording method. Thirty-five rabbits were divided into four groups: control animals, 7 days after SAH, treatment with DFO after SAH for 7 days and sympathectomy after SAH. Acetylcholine (10(-8) to 10(-5) M) was used to evoke concentration-dependent vasodilation of isolated arterial rings previously contracted by 10(-6) M phenylephrine. In the animals killed 7 days after SAH, acetylcholine-induced relaxation was suppressed and the degree of relaxation of this group was 50% of the initial contractile tone in response to the 10(-5) M acetylcholine. These relaxant responses did not return to control values in carotid arteries obtained from animals treated with DFO and subjected to sympathectomy. In isolated carotid arteries, ET-1 (10(-10) to 10(-8) M) produced concentration-dependent contractions. These contractile responses were significantly enhanced in animals 7 days after SAH compared with controls and did not return to control values in carotid arteries obtained from animals both treated with DFO and sympathectomized for 7 days after SAH. The present experiments suggest that impairment of endothelium-dependent vasodilation and the hyperreactivity of ET-1 of the carotid artery as well as cerebral arteries may be involved in the pathogenesis of cerebral vasospasm. Both treatment with DFO and sympathectomy during the chronic stage for vasospasm after SAH did not affect these vascular responses of the extradural part of the carotid artery to ET-1 and acetylcholine.

Vascular smooth muscle reactivity and endothelium derived relaxing factor in experimental obstructive jaundice.

Obstructive jaundice is associated with a predisposition to systemic hypotension and acute renal failure. Altered vascular reactivity may contribute to the development of hypotension. In this experimental study on dogs, alterations in vascular contractile responses to noradrenaline, serotonin and KCl were investigated. Contractile responses to noradrenaline, serotonin,,, KCL and relaxation responses to papaverin and acetylcholine were provoked in isolated femoral arteries of both control dogs and animals with obstructive jaundice. In this situation concentration-response curves of noradrenaline and serotonin were blunted when compared with controls. This blunting disappeared when endothelium was removed. In rings precontracted with phenylephrine, EDRF relaxation responses to acetylcholine were increased significantly as compared to controls: at lower concentrations maximal relaxation response occurred. Contractile responses to KCl and relaxation responses to papaverin did not differ between the groups, endothelium present or removed. These results indicate that obstructive jaundice induces a decrease in vascular contractile responses and an increased EDRF relaxation response. We suggest that an excess in the amount of released EDRF may be one of the causes inducing systemic hypotension in obstructive jaundice.

Effect of chronic experimental diabetes on vascular smooth muscle function in dog femoral artery.

To understand the effects of diabetes on vascular smooth muscle function and the underlying mechanisms involved, we examined the responses to noradrenaline (NA), serotonin, KCl and acetylcholine in the femoral artery of mongrel dogs with chronic diabetes (3 months)-induced subtotal pancreatectomy. Isolated ring segments of diabetic dog femoral artery exhibited an increased response to serotonin, a decreased response to NA, an unchanged response to KCl and a decreased endothelium-dependent relaxation to acetylcholine as compared with controls. The sensitivity (pD2) of diabetic femoral artery rings to NA and serotonin was markedly diminished. These results suggest that changed responsiveness of arteries from diabetic animals to NA, serotonin and acetylcholine could be the reflection of an alteration in the contractile machinery or the results of a decrease in endothelium-derived relaxing factor release in diabetic blood vessels.

Postoperative retention of urine in general surgical patients.

OBJECTIVE: To find out the incidence of retention of urine after various general surgical operations, and to assess the effects of applying a bag filled with warm water (40-45 degrees C), and encouraging early mobilisation onreducing the necessity for catheterisation. DESIGN: Open study. SETTING: Cumhuriyet University Hospital, Sivas, Turkey. SUBJECTS: 577 consecutive patients who had no history of urinary problems and had not already been catheterised, and who underwent general surgical operations between April 1989 and December 1991. MAIN OUTCOME MEASURE: Ability to pass urine spontaneously. RESULTS: 64 of 272 men (24%) and 47 of 305 women (15%) developed retention of urine (p = 0.02), and 15 and 11, respectively, required catheterisation. Patients were most likely to develop retention after repair of incisional hernia (13/32, 38%), midline laparotomy (19/82, 23%), and subcostal incisions (30/142, 21%), but there were no significant differences among these. Significantly more patients whose operations had lasted 60 minutes or more, and who had opiate analgesia, required catheterisation (5/232 compared with 21/345, p = 0.04, and 11/120 compared with 15 out of 457, p = 0.01, respectively). 85 of the 111 patients who went into retention (77%) were able to pass urine spontaneously after application of a bag containing warm water to the suprapubic region, and walking about. The mean period of catheterisation was 12 hours (range 4-76), and all patients but one passed urine spontaneously when the catheter was removed. Only two of the 26 patients who were catheterised developed microbiologically confirmed urinary tract infections. CONCLUSION: Retention of urine is a common complication after general surgical operations, but the necessity for catheterisation can be kept to a minimum by simple and inexpensive measures.

Splenic abscesses due to Salmonella (report of two cases).

Two cases with splenic abscesses due to salmonella infection have been presented and the relevant literature has been reviewed. Diagnostic and therapeutic modalities have been discussed.