Endothelin-A receptor antagonism improves small bowel graft perfusion and structure after ischemia and reperfusion.

BACKGROUND: We hypothesized that endothelin-A (ET-A) receptor activation plays a central role in intestinal ischemia-reperfusion-induced hemodynamic changes and may trigger the process of mucosal barrier destruction. Our aims were to investigate and compare the effects of systemic and intragraft ET-A receptor antagonist therapy during the early revascularization phase of small bowel transplants. METHODS: In Groups 1, 2, and 3 orthotopic small bowel autotransplants were performed in anesthetized dogs. Group 4 served as sham-operated control. Group 2 was treated i.v. with the ET-A receptor antagonist ETR-p1/fl peptide at the onset of reperfusion. In Group 3, intragraft infusion of the ETR-p1/fl peptide was applied during cold ischemia. The mucosal myeloperoxidase activity and the free radical-producing capacity of the granulocytes passing the intestinal graft were determined, and the systemic hemodynamic features were recorded. The extent of the mucosal injury was determined from tissue biopsies taken after 4 hr of reperfusion. RESULTS: Reperfusion progressively decreased the mesenteric blood flow, increased the mesenteric vascular resistance, and enhanced the accumulation and free radical production capacity of the leukocytes. These changes were significantly inhibited in Group 2 with systemic (i.v.) administration of the ET-A receptor antagonist. The local, intragraft treatment improved the mesenteric hemodynamic changes and decreased the accumulation but not the activation of the circulating leukocytes. The structural injury of the graft was prevented in both treated groups. CONCLUSIONS: Endothelins are involved in the hemodynamic events leading to structural injury of the intestinal graft after ischemia-reperfusion. The antagonism of intestinal ET-A receptors by a combination of local and systemic drug delivery offers a rational treatment modality in these conditions.

[Laparoscopic cholecystectomy: analysis of 1122 operations]. / Laparoscopos cholecystectomia: 1122 mütét elemzése.

The results of 1122 laparoscopic cholecystectomies have been analyzed which were performed within a two year period of time. In 1097 (97.8%) cases the authors managed to carry out the laparoscopic procedure, however in 25 patients (2.2%) the operation had to be converted to an open surgery. There was no hospital mortality, however 1 patient died at home due to pulmonary embolism. (Mortality: 0.09%) According to their survey 758 patients exhibited concurrent medical risk factors and 413 previous abdominal operations increased the "surgical" risk of laparoscopic procedures. 27 early and 46 late postoperative complications have been observed. In 3 instances (0.26%) bile duct injury occurred and in 5 cases (0.44%) reoperations had to be carried out secondary to postoperative complications. Forty patients (3.6%) have had recognized common bile duct stones, these were removed, in part preoperatively (28pts), in part postoperatively (11pts) by endoscopic sphincterotomy (EST). In one case a laparoscopic retrieval of common bile duct stone was accomplished via the dilated cystic duct. 47% of their patients left the hospital on the first day and 78% of them were discharged within 2 days.