The protective effect of diosmin on hepatic ischemia reperfusion injury: an experimental study.

Liver ischemia reperfusion injury (IRI) is an important pathologic process leading to bodily systemic effects and liver injury. Our study aimed to investigate the protective effects of diosmin, a phlebotrophic drug with antioxidant and anti-inflammatory effects, in a liver IRI model. Forty rats were divided into 4 groups. Sham group, control group (ischemia-reperfusion), intraoperative treatment group, and preoperative treatment group. Ischemia reperfusion model was formed by clamping hepatic pedicle for a 60 minute of ischemia followed by liver reperfusion for another 90 minutes. Superoxide dismutase (SOD) and catalase (CAT) were measured as antioaxidant enzymes in the liver tissues, and malondialdehyde (MDA) as oxidative stress marker, xanthine oxidase (XO) as an oxidant enzyme and glutathione peroxidase (GSH-Px) as antioaxidant enzyme were measured in the liver tissues and the plasma samples. Hepatic function tests were lower in treatment groups than control group (p<0.001 for ALT and AST). Plasma XO and MDA levels were lower in treatment groups than control group, but plasma GSH-Px levels were higher (p<0.05 for all). Tissue MDA levels were lower in treatment groups than control group, but tissue GSH-Px, SOD, CAT and XO levels were higher (p<0.05 for MDA and p<0.001 for others). Samples in control group histopathologically showed morphologic abnormalities specific to ischemia reperfusion. It has been found that both preoperative and intraoperative diosmin treatment decreases cellular damage and protects cells from toxic effects in liver IRI. As a conclusion, diosmin may be used as a protective agent against IRI in elective and emergent liver surgical operations.

Recurrent pyogenic cholangitis in a case with congenital biliary anomaly.

Recurrent pyogenic cholangitis is endemic to South-east Asia but has been very rarely reported from natives of other parts of the world. A 43-years-old woman was presented with sepsis that had a history of recurrent epigastric pain and fever attacks. Her liver tests were unremarkable suggesting any hepatobiliary diseases. Recurrent pyogenic cholangitis and congenital extrahepatic biliary anomaly have been diagnosed after serial diagnostic and therapeutic procedures including endoscopic retrograde cholangiography, MR-cholangiography, percutaneous transhepatic cholangiography and finally left hepatectomy. She was cured completely following surgical treatment.

The effect of oral honey and pollen on postoperative intraabdominal adhesions.

BACKGROUND/AIMS: We evaluated the effect of oral usage of honey and pollen, either separately or together, on postoperative intraabdominal adhesions. METHODS: Forty rats were randomly separated into 4 groups of 10 rats each. Abrasion was performed on the cecum, and a patch of peritoneum located opposite to the cecal abrasion was completely dissected. Group 1 rats received no treatment; Group 2 rats received 4 g/kg/day honey; Group 3 rats received 4 g/kg/day pollen; and Group 4 rats received 4 g/kg/day honey and pollen mixed in equal amounts, in addition to the standard feeding for postoperative 21 days. All the rats were sacrificed on the 21st day. Following the adhesion scoring, tissue specimens of the peritoneum and bowel were subjected to histopathological investigation. The tissue and blood specimens were also taken for biochemical analysis to investigate the antioxidant capacity. RESULTS: Adhesion scores were significantly different between the control and other groups. No dense adhesion was observed in the treatment groups. Tissue malondialdehyde levels were significantly different between the control and honey and honey+pollen groups. Superoxide dismutase and glutathione-peroxidase levels were significantly different between the control and other groups. Catalase levels were different between the control and honey groups. Plasma antioxidant levels were different between the control and other groups. The pathological scores for fibrosis and inflammation were significantly different between the control and other groups. CONCLUSIONS: Honey and pollen were found to be effective in preventing postoperative intraabdominal adhesions, and these effects were thought to be a result of their antiinflammatory and antioxidant properties.

Ultrastructural changes in the liver after experimental spinal cord injury in rats: effects of methylprednisolone, immunoglobulin g and albumin.

AIM: Spinal Cord Injury (SCI) is routinely treated with standardized methyl prednisolone sodium succinate (MPSS) dose, so it is reassuring to find its effects on liver. We also evaluated the effects of albumin and immunoglobulin G (Ig G) therapies on liver if they are used in case of experimental SCI. MATERIAL AND METHODS: The rats were allocated into six groups as control, trauma, vehicle, MPSS, Ig G and albumin consisting 8 rats for each. The rats with SCI were assigned to 30mg/kg MPSS, 5 mg/kg albumin and 400 mg/kg Ig G treatments. Tissue samples from liver were obtained for light and electron microscopy examinations and determination of myeloperoxidase (MPO) activity. RESULTS: Trauma increased MPO activity and caused cellular changes of liver tissue. Both albumin and Ig G treatments decreased MPO activity significantly. The light and electron microscopic evaluations showed remarkable preservation of liver ultra-structure with all treatments including MPSS. CONCLUSIONS: SCI resulted in neutrophil infiltration and changes in ultrastructure of liver. It was revealed that MPSS has no detrimental effects on liver. Although all treatments preserved liver tissue structure, Although all treatments preserved liver tissue structure, Ig G and albumin treatments also prevented neutrophil infiltration. To provide protection from secondary liver injury after SCI, use of albumin and Ig G treatments may be beneficial.

Prolonged hungry bone syndrome in a 10-year-old child with parathyroid adenoma.

We report a case of primary hyperparathyroidism associated with prolonged hungry syndrome (HBS) after parathyroid adenomectomy in a 10-year-old girl. Bone mineral density (BMD) revealed severe loss of cancellous BMD. Overt bone disease, high alkaline phosphatase, decreased cancellous BMD and a large adenoma can be used as preoperative predictive risk factors of HBS in children.

Risk factors special to eastern culture for the development of anal fissure.

AIM: To reveal the effect of diet, bowel functions and toilet habits on the development of anal fissure. METHODS: One hundred patients complaining of anal fissure were included to the case group; and one hundred age- and gender-matched patients referred for other reasons except for anorectal complaints were included to the control group. The information was obtained by face to face interviews using questionnaires. RESULTS: Statistically significant differences were found in coffee, fruit, and meat consumption between the groups. The patients suffering from anal fissure avoided paprika consumption. The rate of anal fissure incidence was higher in squat toilet users. CONCLUSION: This study is the first study which evaluates the risk factors such as paprika consumption and squat toilet usage that are specific to Eastern culture. Further studies including large numbers of population are needed to evaluate different risk factors for anal fissure development (Tab. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

Peritoneal hydatid cyst perforation: a rare cause of emergency abdominal surgeries.

INTRODUCTION: In hydatid cyst disease, perforation and spontaneous fistula formation are rare, yet very serious, complications. In this study we describe five cases of hydatid cyst disease in which the cysts perforated. METHODS: In this retrospective study we evaluated five patients who were surgically treated for perforated hydatid cysts between 2002 and 2006. All patients were admitted to a local hospital with acute abdominal symptoms. RESULTS: The mean age of the patients (four males and one female) was 39 years. The perforations occurred spontaneously in four patients, and were the result of trauma in one. Three of the hydatid cysts were located in the liver and two in the spleen. Only one patient had a recurrent hydatid cyst. Diagnostic tools included ultrasonography (n=5), computerized tomography (n=1), and diagnostic peritoneal lavage (n=1). The cysts were treated by radical (n=2) or conservative (n=3) methods. There was no postoperative morbidity or mortality, and no recurrences of hydatid disease after follow-up (mean: 14 months). CONCLUSION: Cyst perforation in the peritoneal cavity is a serious complication of hydatid disease and should be treated immediately. The literature suggests that recurrences may be related to the operative technique, the location of the cyst, and inadequate irrigation of the peritoneal cavity with scolicidal agents. The findings of this study suggest that if treated promptly, cyst perforation can be successfully treated.

Effect of honey on intestinal morphology, intraabdominal adhesions and anastomotic healing.

In the present study, attempts have been made to determine the effects of honey on intestinal morphology, postoperative adhesions, and the healing of colonic anastomoses in the rats after colonic resection and anastomosis. Thirty-six rats were randomly divided into three groups each including 12 animals. Colonic resection and anastomosis were performed on all animals. Rats were fed with standard rat chow in group I, standard rat chow plus 10 g/kg/day honey in group II and artificial honey including the same caloric amount with honey in group III. Adhesion scores, bursting pressures and histopathological examinations were evaluated. Colonic bursting pressures of honey group were significantly better than control and artificial honey groups. Histological analysis of anastomotic site showed that submucosa and muscularis propria were nearly filled with granulation tissue and regular fibrin matrix in honey group. There was statistically significant difference between the adhesion scores of honey vs artificial honey and control groups. The scores of histological changes of ileum in honey group were significantly different from other groups. These results indicate a protective role of honey against intraabdominal adhesions and anastomotic dehiscence.

Effect of honey on bacterial translocation and intestinal morphology in obstructive jaundice.

AIM: To evaluate the effects of honey on bacterial translocation and intestinal villus histopathology in experimental obstructive jaundice. METHODS: Thirty Wistar-Albino rats were randomly divided into three groups each including 10 animals: group I, sham-operated; group II, ligation and section of the common bile duct (BDL); group III, bile duct ligation followed by oral supplementation of honey (BDL + honey) 10 g/kg per day. Liver, blood, spleen, mesenteric lymph nodes, and ileal samples were taken for microbiological, light and transmission electrone microscopic examination. RESULTS: Although the number of villi per centimeter and the height of the mucosa were higher in sham group, there was no statistically significant difference between sham and BDL + honey groups (P > 0.05). On the other hand, there was a statistically significant difference between BDL group and other groups (P < 0.05). The electron microscopic changes were also different between these groups. Sham and honey groups had similar incidence of bacterial translocation (P > 0.05). BDL group had significantly higher rates of bacterial translocation as compared with sham and honey groups. Bacterial translocation was predominantly detected in mesenteric lymph nodes. CONCLUSION: Supplementation of honey in presence of obstructive jaundice ameliorates bacterial translocation and improves ileal morphology.

The effects of scolicidal agent propolis on liver and biliary tree.

BACKGROUND: This study was designed to examine the effects of propolis on the liver and biliary system when used as a scolicidal agent. MATERIALS AND METHODS: Thirty Wistar-Albino rats were divided into two groups. Propolis and 0.9% saline (NaCl) were injected into the biliary tract of the rats. Three rats from control group and four rats from propolis group died within 5 days after the procedure. Blood samples of remaining 23 rats were obtained 1 week after and at the end of the experimental study for liver function tests. Six months after the procedure, retrograde and magnetic resonance cholangiography were performed and liver, common bile duct, and duodenum were excised en bloc for histopathological examination. RESULTS: Liver function tests were slightly elevated 1 week after the procedure and were found to be normal at the end of the sixth month in both groups. No stricture in the biliary tree was found on the retrograde and magnetic resonance cholangiograms. The tissue samples of the propolis group showed no histomorphological difference from the control group. CONCLUSIONS: Propolis may be used as a scolicidal agent even in the case of cystobiliary communication with no side effects on liver and biliary tree.

Effects of honey as a scolicidal agent on the hepatobiliary system.

AIM: To examine the effects of 10% diluted honey, which has been shown to be scolicidal, on the liver and biliary system and determine whether it could be used as a scolicidal agent in the presence of biliary-cystic communication. METHODS: Thirty Wistar-Albino rats were divided into two groups. Honey with 10% dilution in the study group and 0.9% saline (NaCl) in the control group were injected into the common bile ducts of rats through a 3-mm duodenotomy. The animals were sacrificed 6 mo after the procedure. Histopathological, biochemical, and radiological examinations were performed for evaluation of side effects. RESULTS: At the end of the sixth month, liver function tests were found to be normal in both groups. The tissue samples of liver and ductus choledochus of the honey group showed no histomorphologic difference from the control group. No stricture on the biliary tree was detected on the retrograde cholangiograms. CONCLUSION: According to these results, we concluded that 10% diluted honey could be used as scolicidal agent safely in the presence of biliary-cystic communication.

The ultrastructural research of liver in experimental obstructive jaundice and effect of honey.

BACKGROUND: To examine the effects of honey on oxidative stress and apoptosis in experimental obstructive jaundice model. METHOD: Thirty rats were divided into 3 groups: group I, sham-operated; group II, ligation and division of the common bile duct (BDL); group III, BDL followed by oral supplementation of honey 10 g/kg/d. Liver samples were examined under light microscope and transmission electron microscope. Hepatocyte apoptosis was quantitated using the terminal deoxy-nucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) assay. Plasma and blood malondialdehyde (MDA) and glutation activities were measured for determining the oxidative stress. RESULTS: The liver levels of MDA and GSH were significantly different between the honey and BDL groups (P = .006 and .001, respectively). However, there was no significant difference between the plasma MDA and GSH levels of these groups (P > .05). In group III, significant reductions in the size of enlarged hepatocytes and the edema were demonstrated. The dilatation of the bile canaliculi dramatically turned to original dimention. By TUNEL assay, it was shown that administration of honey decreased the number of apoptotic cells. CONCLUSIONS: In the present study, we found that honey diminished the negative effects of BDL on the hepatic ultrastructure. We conclude that this effect might be due to its antioxidant and anti-inflammatory activities.

Adenomyoepithelial Adenosis of the Breast: Clinical, Radiological, and Pathological Findings for Differential Diagnosis.

BACKGROUND: Myoepithelial cells are widely present in the breast, and their hyperplasia may result in a spectrum of disease ranging from myoepitheliosis to myoepithelial carcinoma. CASE REPORT: A 46-year-old woman presented with a palpable mass in her right breast. Mammography and ultrasonography showed a lesion in the upper quadrant of the right breast with spiculated borders and shape. Excisional biopsy showed adenomyoepithelial adenosis. CONCLUSIONS: Although considered benign, adenomyoepithelial lesions tend to recur due to inadequate excision. Therefore, possibility of recurrence and even metastasis should be considered during follow-up of patients with a diagnosis of adenomyoepithelial lesions.

Propolis reduces bacterial translocation and intestinal villus atrophy in experimental obstructive jaundice.

AIM: To investigate the effects of propolis on bacterial translocation and ultrastructure of intestinal morphology in experimental obstructive jaundice. METHODS: Thirty Wistar-Albino male rats were randomly divided into three groups, each including 10 animals: group I, sham-operated; group II, ligation and division of the common bile duct (BDL); group III, BDL followed by oral supplementation of propolis 100 mg/kg per day. Liver, blood, spleen, mesenteric lymph nodes, and ileal samples were taken for microbiological, light and transmission electron microscopic examination on postoperative 7th d after sacrification. RESULTS: The mean number of villi per centimeter and mean mucosal height of the propolis group were significantly different in the BDL group (P = 0.001 and 0.012, respectively). The electron microscopic changes were also different between these groups. Sham and BDL + propolis groups had similar incidence of bacterial translocation (BT). The BDL group had significantly higher rates of BT as compared with sham and BDL + propolis groups. BT was predominantly detected in MLNs and the most commonly isolated bacteria was Escherichia coli. CONCLUSION: Propolis showed a significant protective effect on ileal mucosa and reduced bacterial translocation in the experimental obstructive jaundice model. Further studies should be carried out to explain the mechanisms of these effects.

Use of serum leptin levels for determination of nutritional status and the effects of different enteral nutrients on intestinal mucosa after minor surgery: an experimental study.

BACKGROUND: We planned to evaluate the effects of different enteral nutrients on the levels of serum leptin, protein and albumin changes and also to compare their effects on mucosal morphology of small intestine. METHODS: Rats were randomly divided into 5 groups each including 10 animals. Group I rats were given rat chow and water. Group II rats were fed with standard enteral nutrient. Group III rats were fed with calorie enriched enteral nutrient. Group IV rats were given enteral nutrition supplemented with fiber. Group V rats were fed with immunonutrient. Serum albumin, protein, leptin levels were measured. Terminal ileum of each rat was scored. RESULTS: We found no difference in serum leptin, protein and albumin levels. The average mucosal atrophy of rats fed with standard chow was significantly different than that of rats fed with standard and calorie enriched nutrients. Feeding with nutrients supplemented with fiber and immunonutrient did not cause significant distortion in mucosal integrity when compared with feeding with standard chow. CONCLUSION: Low levels of leptin may show malnutrition but for determination of nutritional status of a patient receiving enteral nutrition, studies with long duration are required.

Effects of various enteral nutrition solutions on bacterial translocation and intestinal morphology during the postoperative period.

Bacterial translocation is the passage of bacteria or endotoxins from the gastrointestinal tract to extraintestinal sites, such as mesenteric lymph nodes, liver, spleen, and bloodstream. In this study, the investigators examined the effects of various enteral nutrients on bacterial translocation and intestinal morphology during the postoperative period. Sixty rats were randomly divided into 5 groups, each of which included 12 animals; cecal mobilization was performed in all groups. Group I rats were fed rat chow and water; group II was given standard enteral nutrients; group III, high-energy enteral nutrients; group IV, enteral nutrients supplemented with fiber; and group V, immunonutrients. Bacterial translocation was detected in mesenteric lymph nodes, spleen, liver, and blood cultures. Changes in the terminal ileum were scored from 0 to 4 with the morphologic scoring system. Bacterial translocation was predominantly detected in mesenteric lymph nodes. Rats fed immunonutrients (group V) showed a significant reduction in bacterial translocation compared with other groups. Although minor morphologic alterations in the villi were observed in groups IV and V, the histologic scores of these groups were not statistically different from the scores of control group members. In the present study, investigators evaluated the effects of various enteral nutritional solutions on bacterial translocation and intestinal morphology during the postoperative period. Enteral diets supplemented with arginine, nucleotides, and omega-3 fatty acids were found to reduce bacterial translocation. The investigators concluded that this effect might be related to improvement in immune function resulting from the use of immunonutrients.

Case report: mesenteric schwannoma.

Schwannomas are benign neurogenic tumors that arise from Schwann cells that line the sheaths of peripheral nerves. Schwannomas are commonly located in the soft tissues of the head and neck, extremities, mediastinum, retroperitoneum, and pelvis, but they are very rare in the mesentery. A 56-y-old man was admitted to the emergency service with nausea, vomiting, acute abdominal pain, and constipation. He reported weight loss and an intra-abdominal mass. On physical examination, the abdomen was distended, and a mass that was approximately 15 cm in diameter was palpated at the middle abdomen. Generalized abdominal tenderness and muscle spasm were noted. Air-fluid levels were seen on plain radiographs. Ultrasonography identified an intra-abdominal mass with intra-abdominal hemorrhage or perforation. Clinical signs and laboratory findings suggested an intra-abdominal mass, mechanical bowel obstruction, and an acute abdomen. The patient underwent surgery. The mass was completely excised and included a 4-cm-long intestinal segment that was densely adherent to the mass. Histopathologic and immunohistochemical examination revealed a mesenteric schwannoma. The patient was well 11 mo after surgery. Although schwannomas are very rare and generally asymptomatic, these tumors can become quite large and may cause acute abdominal problems such as mechanical bowel obstruction.

Evaluation on scolicidal efficacy of propolis.

BACKGROUND: Propolis is a resinous material collected by bees from various plants. It has antimicrobial, antioxidative, immunostimulative, and regenerative properties. We determined the scolicidal effect of propolis in different concentrations and various exposure times. MATERIALS AND METHODS: Tubes containing Echinococcus granulosus protoscoleces were supplemented with different concentrations of ethyl alcohol extract of propolis. At the end of the incubation times, viability of protoscoleces was assessed by trypan blue exclusion test. We also applied 5 ml of 1 microg/ml propolis intraperitoneally for determination of side effects and mortality rates. RESULTS: We determined that 1 microg/ml concentration of propolis killed all of the protoscoleces at the end of the 3rd minute. In the in vivo part of the study, intraperitoneal application of propolis did not cause any side effects or mortality. CONCLUSION: We concluded that this natural agent can be used as a potent scolicidal agent after studies which will determine in vivo efficacy and the effects on liver and biliary tree when injected directly into the common bile duct.

A rare case: spontaneous cutaneous fistula of infected splenic hydatid cyst.

Hydatid disease is caused by the larval stage of the genus Echinococcus. Live hydatid cysts can rupture into physiologic channels, free body cavities or adjacent organs. Although hydatid disease can develop anywhere in the human body, the liver is the most frequently involved organ, followed by the lungs. Cysts of the spleen are unusual. There are only five case reports of spontaneous cutaneous fistulization of liver hydatid cysts in the literature. But there isn't any report about cutaneous fistula caused by splenic hydatid cyst. We report a first case of spontaneous cutaneous fistula of infected splenic hydatid cyst. A 43-year-old man was admitted to our Emergency Service with abdominal pain and fluid drainage from the abdominal wall. He has been suffering from a reddish swelling on the abdominal wall skin for four months. After a white membrane had been protruded out from his abdominal wall, he was admitted to our Emergency Service. On physical examination, a white membrane was seen to protrude out from the 2 cm x 1 cm skin defect on the left superolateral site of the umblicus. Large, complex, cystic and solid mass of 9.5 cm-diameter was located in the spleen on ultrasonographic examination. At operation, partial cystectomy and drainage was performed. After the operation, he was given a dosage of 10 mg/kg per day of albendazole, divided into three doses. He was discharged on the postoperative 10(th) d. It should be kept in mind that splenic hydatid cysts can cause such a rare complication.

The scolicidal effects of honey.

Echinococcosis is a zoonosis that is caused by adult or larval tapeworms belonging to the genus Echinococcus. Until now, no studies have sought to determine the scolicidal effects of honey. Therefore, the present study was undertaken to explore the scolicidal effects of honey in different concentrations for various exposure times. Tubes that contained at least 500 protoscolices were supplemented with 1%, 5%, 10%, 25%, and 50% concentrations of honey. Tubes were maintained at room temperature for 0.5, 1, 2, 3, 4, 5, and 10 min. At the end of the incubation times, the viability of protoscolices was assessed through a trypan blue exclusion test. The effective dose of honey was applied intraperitoneally to determine whether it caused an anaphylactic reaction or hyperglycemia. Honey concentrations of 10% or greater killed all protoscolices. The scolicidal effects of honey began at the end of the third minute. Honey did not cause adverse effects when applied intraperitoneally. In this study, an investigation of the scolicidal effects of honey showed that it is highly effective at a 10% concentration. On the basis of in vivo study results, the investigators concluded that honey is a potent scolicidal agent.