Histological evaluation of pure NOTES - related complications in a survival animal study.

Considered as an extension of both laparoscopic surgery and interventional endoscopy, natural orifice transluminal endoscopic surgery (NOTES) is emerging as a new alternative of minimal invasive surgery. Literature on the gastrointestinal complications of this novel technique is sparse. The goal of this study was the histopathologic evaluation of postoperative complications in a NOTES experimental animal group. Ten female pigs (Sus scrofus domesticus) underwent transgastric endoscopic oophorectomy and tubectomy followed by gastric closure using OTSC clips. Fourteen days after surgery, the animals were sacrificed. Based on the gross examination during necropsy focused excisional biopsies were performed. Gross and microscopic evidence of gastric ulcer distal to the puncture site and perigastric lymph node abscess were found on one animal. Histological evaluation plays a determinant role in the correct evaluation of postoperative complications of pure NOTES procedures.

Retropancreatic cystic lymphangioma - considerations upon a case.

UNLABELLED: Cystic lymphangiomas are benign tumors developing as an anomaly of the lymphatic channels. Most of them are discovered in children and are located mostly in the head and neck with no differences between sexes. Retroperitoneal locations are rare, clinical symptoms not specific and are discovered incidentally. We report the case of a 32-year-old female sex patient with a cystic tumor situated in the retroperitoneum, behind the pancreas, discovered by abdominal ultrasound during a diagnostic work-out for urinary infection and hypertension. Anamnesis, physical examination and CT-scan could not indicate the nature of the cyst. The cystic tumor had a shape of a butterfly, crossing the midline in front of the aorta and vena cava. A laparotomy was indicated and established the diagnosis of a cystic lymphagioma based on its macroscopic appearance. The tumor was approached from its right side by a generous Kocher maneuver and then from the left by disinsertion of the Treitz ligament and elevating the pancreatic body and splenic vessels. It was completely removed. Postoperative course was uneventful. Histopathologic examination confirmed the diagnosis of benign cystic lymphangioma. At 2 years of follow-up the patient was free of recidive. CONCLUSIONS: Retropancreatic cystic lymphangioma are rarely seen in adults. Precise diagnosis is made at laparotomy, imagistic test give details about walls, content, relationship with the surrounding structures and major blood vessels. Complete surgical resection represents the treatment of choice avoiding recurrence.

A critical Evaluation of Surgical Treatment of Perforated Ulcer.

The treatment of perforated ulcer disease continues to evolve because of recent advances in pharmacology, bacteriology, and operative techniques. Despite antisecretory medication and Helicobacter pylori eradication, it is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. A clinical study was carried out on patients with perforated gastric or duodenal ulcer, admitted in the 1st Surgery Department between 2002 and 2008. During the 7 years of study there were admitted 256 patients with perforated ulcer - 212 cases of duodenal and 44 cases of gastric perforated ulcer. The main surgical treatment option was simple closure with Graham patch, followed by ulcer excision and vagotomy with pyloroplasty. The second major objective was the topical treatment of peritonitis and consisted in the lavage of the peritoneal cavity and drainage. Distal gastric resection has now very limited indications. We recorded no complications postoperatively. In the modern treatment of ulcer, surgery is reserved for the acute (perforation and bleeding) and chronic complications (stenosis / penetration) and exceptionally or the patients with a prolonged history of uncomplicated ulcers with lack of response to conservative therapy.

The role of biliodigestive derivations in the treatment of choledocholithiasis.

The obstructive jaundice is a complex syndrome with both benign etiology (choledocholithiasis, hydatid cyst, chronic pancreatitis) and malignant (cancer of the pancreas, cholangiocarcinoma and gallbladder cancer) and it has a special place in biliopancreatic pathology, with up most importance due to changes in local and general status of the organism, difficult etiologic diagnostic problems for the clinician and whose solution requires teamwork, which involves both the surgeon, gastroenterologist, anesthesiologist etc. The introduction of laparoscopic approach and upper gastrointestinal endoscopy for gallstone disease giving the opportunity to solve choledocholithiasis only by laparoscopic approach or by combining laparoscopic cholecystectomy with extraction of the common bile duct stones using endoscopic retrograde cholangiopancreatography, which greatly restricted the classical surgical indications. In these circumstances, I consider appropriate to review the place and indications of biliodigestive derivations in obstructive jaundice caused by coledocholithiasis.

[The evaluation of immunoinflammatory response in acute bacterial peritonitis]. / Cercetarea rasspunsului imunoinflamator în peritonitele acute bacteriene.

AIM: To evaluate the immunoinflammatory markers that shape the evolution of acute peritonitis and to assess their utility in specifying the development of septic shock from peritonitis. MATERIAL AND METHOD: We conducted a prospective study on a sample of 100 patients with acute peritonitis, hospitalized during 2001-2005 and immunologically monitored. We realized 2000 dosages of immunoinflammatory markers for 15 days by 1200 simple radial immunodiffusion tests (IDRS), the Mancini-Carbonara method for C reactive protein, complement component C3, immunoglobulins and 836 ELISA tests to evaluate cytokines. Results were reported to a witness group. RESULTS: C reactive protein (CRP) values were significantly elevated in patients with peritonitis (12-310 ng%) vs. witness group (1.5-8 ng%). Postoperative, elevated values were maintained at the patients who will develop serious complications and were correlated with multiple organic dysfunction in deceased patients. Determination of circulating immune complexes have shown elevated values in patients with peritonitis. Dosage of pro/antiinflammatory cytokines may be specific to the severity of inflammatory response to infection. The level of procalcitonin was increased in patients with sepsis and severe inflammatory reactions and become an important prognostic tool. CONCLUSIONS: The study of biological markers in microbial aggression highlights the role of cytokines as messengers and important mediators of immunoinflammatory response. PCT test can be introduced in the daily tracking protocol for septic patients.

[Correlation of adenomatous polyps and early colorectal cancer. Diagnostic and therapeutic implications]. / Relatia polip adenomatos--cancer colorectal precoce. Implicatii diagnostice si terapeutice.

AIM: To detect the patients with colorectal adenomatous polyps or those with adenocarcinoma areas with a view to prevent and to treat the malignant disease. MATERIAL AND METHOD: A prospective study including 309 patients hospitalized between 2000-2005 diagnosed with isolated adenomatous polyps after repeated colonoscopies. The research method was selective screening with identification of risk factors regarding the evolution of colorectal polyps in early cancer, using colonoscopy and histopathological examination. RESULTS: We identified 464 single or multiple isolated polyps of which 399 were adenomas, 59 hyperplastic polyps and 6 other types of lesions. Histologically we recorded 41 (13.27%) polyps with a low grade of dysplasia, 56 (18.12%) with severe dysplasia and 30 (9.7%) intramucosal adenocarcinoma with submucosal invasion. TREATMENT: Colonoscopic polypectomy was used for benign polyps and in situ carcinoma. In case of adenocarcinoma is probable the invasion of submucosal lymphatics being shown a colorectal resection as appropriate. We performed 279 colonoscopic polypectomies and 30 conventional resections. CONCLUSIONS: High grade of dysplasia, the number of polyps, ulceration, bleeding, intraepithelial areas of neoplastic transformation are predictive factors for early colorectal cancer. Depth of submucosal invasion of malignant transformed polyps are important pathological factors to predict lymphatic metastasis and to select the therapeutic procedure.

[A study of the incidence and the specific risk factors for surgical site nosocomial infections]. / Studiu asupra incidentei reale a infectiilor nosocomiale de sediu chirurgical si a factorilor de risc specific.

UNLABELLED: The aim of our study is to estimate the incidence of surgical site nosocomial infections in a general surgery department and also to present the importance of the risk factors associated with these infections using the latest diagnostic protocols. MATERIAL AND METHOD: a retrospective analysis of 3038 surgical procedures performed between 2000-2002. We identified all the patients with surgical site nosocomial infection (SSI) mentioned in the observation sheet using NNISS/HELICS protocols to appreciate the risk for surgical site nosocomial infections. The results were compared to those published in the literature. RESULTS: we selected 198 cases (6,55%) with surgical site nosocomial infections of 3024 surgical patients (we excluded 14 cases): 41.4% of them were superficial infections, 49% profound infections, 7.1% organ-space infections and 2.5% with mixed nosocomial infections. We analysed the incidence depending on the risk factors and the type of surgical procedure, the agents involved in the development of the postoperative nosocomial infections, the germs concerned and their antibiotics resistance. CONCLUSIONS: the rates of different NNISS values after surgical procedures with nosocomial infections are analysed relative to the rates published by HELICS study for Romania and other European countries and it shows larger rates than the european average, maybe because our country has not started yet the HELICS protocol for SSI.

Age influences the expression of GAP-43 in the rat hippocampus following seizure.

BACKGROUND: Normal aging is associated with impairments in learning and memory and motor function. One viable hypothesis is that these changes reflect an age-related decrease in brain plasticity. OBJECTIVE: The aim of the present study was to identify age-related changes in the time course of expression of the axonal growth associated protein 43 (GAP-43) in a rat model of brain plasticity. METHODS: We examined by Northern blotting, in situ hybridization, and immunohistochemistry the effects of age on the time course of the expression GAP-43 following pentylenetetrazole-induced seizure in the hippocampus of 3-, 18-, and 28-month-old rats. RESULTS: In this model of brain plasticity, young rats displayed a decrease in GAP-43 mRNA levels in CA1, CA3, and polymorphic regions, lasting from 10 h to 3 days after seizure. This was followed by recovery, with peak expression between days 10 and 20. The baseline levels of GAP-43 mRNA decreased with age, especially in the CA3 region. Despite lower baseline levels, middle-aged rats showed the same pattern of upregulation of GAP-43 mRNA expression as the young animals. Old rats showed only minimal upregulation, however, and this occurred only in the polymorphic layer. The level GAP-43 protein itself was higher in old control rats than in the other two control groups, a condition that was transiently reversed by seizure activity. CONCLUSIONS: Middle-aged rats are still capable of a sustained, though diminished, response to seizure activity, while old rats lose this ability. Disruption of the temporal and anatomical coordination of expression of GAP-43 may contribute to the general decline in brain plasticity with age.

Effects of ingestion of radioactive cesium on behavioral indices in rats.

The experiments were carried out on 35 male (M) and female (F) rats contaminated by ingestion of Cesium--137(Cs) for 38 or 84 days; the total Cs activity was 288 Bq 460 Bq, and respectively. The duration of forced swimming decreased significantly in the contaminated groups as compared with controls (n = 16). The active avoidance reaction in the shuttle-box shows an increase in F groups and a decrease in M groups. The total latency time of the same reaction was lower in F and M treated rats on the first day of learning. The score of aggressive behavior rose significantly, especially in group F. These results can be explained by the sex dependence of Cs accumulation and by the neurotoxic action of the radionuclide on several central neural areas including monoaminergic and endocrine mechanisms.

The in vitro cellular immune response to quartz.

It is known that macrophages release into medium in vitro biologically active substances which modulate immune response. In recent years, increase attention has been directed towards the role of prostaglandin in macrophage function. Guinea pig splenic lymphocytes and peritoneal macrophage cultures were incubated with quartz (DQ12), Corundum and aspirin as prostaglandin inhibitor. Lymphocyte proliferation measured by 3H-thymidine incorporation, and lymphokine release by Bendixen-Soborg capillary test (MIF) were applied. EA rosetting and phagocytosis were determined for macrophage function assessment. Quartz suppressed the immune response evidenced by reduced 3H-thymidine incorporation and decreased lymphokine production. Aspirin (as a specific prostaglandin synthesis inhibitor) restored the affected by quartz immunological parameters. This observation gives support to the hypothesis that the immunological response to quartz involves macrophage prostaglandin release, presumably as a first step of lipid peroxidation.