The management of acute gastric volvulus.

Acute gastric volvulus occurs when the stomach or a part of it rotates more than 180 degrees which leads to obstruction (closed loop syndrome), that finally concludes to incarceration and ischemia of the organ. It can be observed as a result of diaphragmatic hernia, a gap of the diaphragm, pancreatic or gastric cancers, traumatic injuries and fixation anomalies. Parï first described acute gastric volvulus in 1579, in a patient with diaphragmatic injury after trauma. The first reports of successful surgical repair and anatomo-pathologic findings were published in 1866 and 1897.

Changes in circulating levels of vascular endothelial growth factor and vascular endothelial growth factor receptor-2 after carotid endarterectomy.

It has been shown that vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor-2 (VEGFR-2) are upregulated in severe carotid stenosis. However, it is unknown whether carotid endarterectomy (CEA) affects serum level of these molecules. We investigated changes in concentration of VEGF and VEGFR-2 in patients undergoing carotid endarterectomy. Forty-three patients with extracranial carotid stenosis (>70%), were studied. Patients with severe vertebrobasilar stenosis, recent (<1 month) vascular event (stroke, coronary infarction, arterial thromboembolism), critical ischemia of lower extremity, recent infection, autoimmune disease or malignancy were excluded from the study. Blood samples were taken before CEA and on the second post-operative day. Thirty healthy blood donors served as a control group. We used enzyme linked immuno-absorbent assay as a method for the determination of VEGF and VEGFR-2. Pre-operative levels of VEGF (371+/-42 pg/ml) and VEGFR-2 (8424+/-356 pg/ml) were significantly elevated. There was significant decrease in both VEGF (152 pg/ml) and VEGFR-2 (1297 pg/ml) after CEA, without however reaching normal values. In asymptomatic patients and in patients with a contralateral carotid stenosis of >50%, however, the observed reduction of VEGF did not reach statistical significance. On the other hand, in the same subgroups, a major decrease of VEGFR-2 values was observed. VEGF and VEGFR-2 showed a very significant increase in serum of patients with severe carotid stenosis. These pre-operative levels decreased significantly after endarterectomy, and the changes emphasize the importance of these molecules in carotid disease progression.