Intraperitoneal aerosolization of bupivacaine is a safe and effective method in controlling postoperative pain in laparoscopic Roux-en-Y gastric bypass.

INTRODUCTION: Obesity is a worldwide problem and has grown in severity in the last few decades making bariatric surgery and, in particular, laparoscopic banding and Roux-en-Y gastric bypass efficacious and cost-effective procedures. The laparoscopic approach has been shown to offer significant healthcare benefits, of particular interests are reports of decreased postoperative pain resulting in a shorter hospital stay and an earlier return to normal activity. However, many patients still experience significant pain, including shoulder tip pain, that require strong analgesia including opiates during their early recovery period. The aims of this study were to establish the safe use of the aerosolization technique in bariatric surgery and to investigate the possible benefits in reducing postoperative pain. METHODS: In this study, fifty patients undergoing laparoscopic gastric bypass were recruited and divided into two groups; control (n = 25) and therapeutic (n = 25). The control group received intraperitoneal aerosolization of 10 mL of 0.9% normal saline while the therapeutic group received 10 mL of 0.5% bupivacaine. All the patients had standard preoperative, intraoperative, and postoperative care. Pain scores were carried out by the nursing staff in recovery and 6 h, 12 h and 24 h postoperatively using a standard 0-10 pain scoring scale. In addition, opiate consumption via patient-controlled analgesia (PCA) was recorded. RESULTS: Aerosolized bupivacaine reduced postoperative pain in comparison to normal saline (p < 0.05). However, PCA usage showed no statistically significant change from the control group. CONCLUSION: The aims of this study were achieved and we were able to establish the safe use of the aerosolization technique in bariatric surgery and its benefits in reducing postoperative pain

Induction of Proteases in Peritoneal Carcinomatosis, the Role of ICAM-1/CD43 Interaction

Introduction: The development of peritoneal metastases is a significant clinical issue in the treatment of abdominal cancers and is associated with poor prognosis. We have previously shown that ICAM-1-CD43 interaction plays a significant role in tumor adhesion. However, an invasive phenotype is critical to establish tumor progression via cell associated and secreted proteases including matrix metalloproteinases. High metalloproteinases level significantly enhanced metastasis phenotype on tumors, a detrimental effect on surgical outcome. We investigated the role of direct and indirect signaling between the mesothelium and the tumor cells in enhancing tumor invasion and possible therapeutic intervention.Methods: Mesothelial cells were enzymatically derived from human omental tissue and implanted in 24 wells plates. Colorectal cancer cells were then introduced and allowed a direct and an indirect contact with the mesothelial layer. Anti-ICAM antibodies, anti-CD43 antibodies, and heparin were used to block MMP production. Gelatin zymography was performed on the supernatant to detect MMPs activity.Results: MMP production was observed in mesothelial and tumor cells. Direct contact between cell types enhanced MMP9 and 2 (p < 0.05). Indirect contact also stimulate MMPs but at a lower degree. ICAM-1 blocking antibodies attenuated MMP production in direct contact to that observed in the indirect. Heparin introduction achieved a similar outcome. Conclusions: ICAM-1-CD43 interaction plays a vital role in tumor cells-peritoneum adhesion and invasion, which is manifested by the increased production of MMPs leading to tumor invasion and peritoneal loco-regional. Blocking this interaction with heparin can provide a new therapeutic option

Gene frequencies of ABO and rhesus blood groups in Sabians (Mandaeans), Iraq

The present study aimed to determine the frequency of ABO and Rh blood group antigens among Sabians (Mandaeans) population. This paper document the frequency of ABO and Rh blood groups among the Sabians (Mandaeans) population of Iraq.There is no data available on the ABO/Rh (D) frequencies in the Sabians (Mandaeans) population. Total 341 samples analyzed; phenotype O blood type has the highest frequency 49.9%, followed by A 28.7%, and B 13.8% whereas the lowest prevalent blood group was AB 7.6%. The overall phenotypic frequencies of ABO blood groups were O>A>B>AB. The allelic frequencies of O, A, and B alleles were 0.687, 0.2 and 0.1122 respectively. Rhesus study showed that with a percentage of 96.2% Rh (D) positive is by far the most prevalent, while Rh (d) negative is present only in 3.8% of the total population. The Sabians (Mandaeans) ethnic group showed the same distribution of ABO and Rh blood groups with others ethnic groups in Iraqi population

Cell–cell and cell–matrix dynamics in intraperitoneal cancer metastasis

The peritoneal metastatic route of cancer dissemination is shared by cancers of the ovary and gastrointestinal tract. Once initiated, peritoneal metastasis typically proceeds rapidly in a feed-forward manner. Several factors contribute to this efficient progression. In peritoneal metastasis, cancer cells exfoliate into the peritoneal fluid and spread locally, transported by peritoneal fluid. Inflammatory cytokines released by tumor and immune cells compromise the protective, anti-adhesive mesothelial cell layer that lines the peritoneal cavity, exposing the underlying extracellular matrix to which cancer cells readily attach. The peritoneum is further rendered receptive to metastatic implantation and growth by myofibroblastic cell behaviors also stimulated by inflammatory cytokines. Individual cancer cells suspended in peritoneal fluid can aggregate to form multicellular spheroids. This cellular arrangement imparts resistance to anoikis, apoptosis, and chemotherapeutics. Emerging evidence indicates that compact spheroid formation is preferentially accomplished by cancer cells with high invasive capacity and contractile behaviors. This review focuses on the pathological alterations to the peritoneum and the properties of cancer cells that in combination drive peritoneal metastasis