EXPERIMENTAL ACUTE PANCREATITIS INDUCED BY THE CLOSED DUODENAL LOOP TECHNIQUE

AIM OF THIS EXPERIMENTAL STUDY WAS THE EVALUATION OF THE ROLE OF BILE AND GASTRIC JUICE IN THE PATHOGENESIS OF ACUTE PANCREATITIS INDUCED BY THE CLOSED DUODENAL LOOP TECHNIQUE. THE EXPERIMENTS WERE PERFORMED IN TWO STEPS IN ORDER TO AVOID OBSTRUCTIVE JAUDICE, AND MINIMIZE ISCHAEMIA AND TRAUMA. AFTER LIGATION ABOVE (WHEN IT NEEDED) AND BELOW THE MAJOR AND MINOR DUODENAL PAPILLAS, A CLOSED DUODENAL LOOP CONSTRUCTED IN 24 MONGREL DOGS, DIVIDED INTO 4 GROUPS (6 ANIMALS IN EACH). IN THE ANIMALS OF THE 1ST GROUP (CONTROL) THAT WAS THE ONLY MANEUVER, BUTIN THE OTHER GROUPS ANOTHER OPERATION HAD PERFORMED IN A FIRST STEP FEW MONTHSAGO: IN THE 2ND GROUP A GASTRO-DUODENAL DISCONNECTION (DISTAL TO PYLORUS) FOLLOWED BY GASTROJEJUNOSTOMY WITH LONG AFFERENT LOOP; IN THE 3RD GROUP A DIVISION-LIGATION OF THE COMMON BILE DUCT, FOLLOWED BY A ROYX-EN-Y CHOLECYSTO-JEJUNOSTOMY; IN THE 4TH GROUP A COMBINATION OF THE OPERATIVE PROCEDURES USED IN THE 2ND AND 3RD GROUPS. ONE ANIMAL OF THE 1ST GROUP, 2 OF THE 2ND, NONE OF THE 3RD, AND 1 OF THE 4TH DEVELOPED ACUTE PANCREATITIS. IN ADDITION 2 ANIMALS IN EVERY GROUPDEVELOPED SOME INDICATIONS OF PANCREATIC DAMAGE (MINOR HISTOLOGICAL CHANGES INTHE PANCREAS, HYPERAMYLASAEMIA OR COMBINATION). OUR RESULTS SHOWED THAT: A. THE CONSTRUCTION OF THE CLOSED DUODENAL LOOP DID NOT SUCCEED, IN OUR EXPERIMENTS,FREQUENT DEVELOPMENT OF ACUTE PANCREATITIS. B. THE PRESENCE OF BILE IN THE CLOSED DUODENAL LOOP PREDISPOSES TO THE DEVELOPMENT OF ACUTE PANCREATITIS, WHILE THE PRESENCE OR PASSAGE OF GASTRIC JUICE THROUGH THE DUODENUM PROTECTS AGAINST ACUTE PANCREATITIS. C. THE EXPERIMENTAL MODEL USED IN OUR EXPERIMENTS, WHICH WASATRAUMATIC, IS OFFERED FOR FUTURE DEVELOPMENTS AND STUDIES ON THE AETIOLOGICALFACTORS OF ACUTE PANCREATITIS.ΣΤΟ ΠΡΩΤΟ ΜΕΡΟΣ ΤΗΣ ΕΡΓΑΣΙΑΣ ΓΙΝΕΤΑΙ ΕΥΡΕΙΑ ΑΝΑΣΚΟΠΗΣΗ ΤΗΣ ΒΙΒΛΙΟΓΡΑΦΙΑΣ ΠΟΥ ΑΦΟΡΑ ΣΤΗΝ ΠΑΘΟΓΕΝΕΙΑ ΤΗΣ ΟΞΕΙΑΣ ΠΑΓΚΡΕΑΤΙΤΙΔΑΣ, ΕΝΩ ΣΤΟ ΔΕΥΤΕΡΟ ΜΕΛΕΤΑΤΑΙ Η ΣΗΜΑΣΙΑ ΤΗΣ ΧΟΛΗΣ ΚΑΙ ΤΟΥ ΓΑΣΤΡΙΚΟΥ ΥΓΡΟΥ ΣΤΗΝ ΠΑΘΟΓΕΝΕΙΑ ΤΗΣ ΠΕΙΡΑΜΑΤΙΚΗΣ ΟΞΕΙΑΣ ΠΑΓΚΡΕΑΤΙΤΙΔΑΣ, ΠΟΥ ΠΡΟΚΑΛΕΙΤΑΙ ΜΕ ΤΗ ΜΕΘΟΔΟ ΤΗΣ ΚΛΕΙΣΤΗΣ ΔΩΔΕΚΑΔΑΚΤΥΛΙΚΗΣ ΕΛΙΚΑΣ. ΟΙ ΠΕΙΡΑΜΑΤΙΣΜΟΙ ΕΚΤΕΛΕΣΘΗΚΑΝ ΣΕ ΔΥΟ ΧΡΟΝΟΥΣ ΓΙΑ ΝΑ ΕΛΑΧΙΣΤΟΠΟΙΗΘΟΥΝ ΤΟ ΤΡΑΥΜΑ ΚΑΙ Η ΙΣΧΑΙΜΙΑ ΚΑΙ ΝΑ ΑΠΟΦΕΥΧΘΕΙ Ο ΑΠΟΦΡΑΚΤΙΚΟΣ ΙΚΤΕΡΟΣ. ΚΛΕΙΣΤΗ ΔΩΔΕΚΑΔΑΚΤΥΛΙΚΗ ΕΛΙΚΑ ΕΓΚΑΤΑΣΤΑΘΗΚΕ ΣΕ 24 ΜΙΓΑΔΕΣ ΣΚΥΛΟΥΣ, ΧΩΡΙΣΜΕΝΟΥΣ ΣΕ 4 ΟΜΑΔΕΣ ΤΩΝ 6,ΜΕ ΑΠΟΛΙΝΩΣΗ ΤΟΥ ΔΩΔΕΚΑΔΑΚΤΥΛΟΥ ΠΑΝΩ (ΟΤΑΝ ΧΡΕΙΑΖΟΤΑΝ) ΚΑΙ ΚΑΤΩ ΑΠΟ ΤΟ ΜΕΙΖΟΝ ΚΑΙ ΤΟ ΕΛΑΣΣΟΝ ΔΩΔΕΚΑΔΑΚΤΥΛΙΚΟ ΦΥΜΑ. ΣΤΗΝ ΟΜΑΔΑ Ι (ΟΜΑΔΑ ΕΛΕΓΧΟΥ) ΑΥΤΗ ΗΤΑΝ Η ΜΟΝΗ ΕΓΧΕΙΡΗΤΙΚΗ ΠΡΑΞΗ, ΣΤΙΣ ΥΠΟΛΟΙΠΕΣ ΟΜΩΣ Η ΚΛΕΙΣΤΗ ΕΛΙΚΑ ΕΓΚΑΤΑΣΤΑΘΗΚΕ ΑΦΟΥ ΣΕ ΠΡΩΤΟ ΧΡΟΝΟ ΕΙΧΕ ΓΙΝΕΙ: ΣΤΗΝ ΟΜΑΔΑ ΙΙ ΓΑΣΤΡΟ-ΔΩΔΕΚΑΔΑΚΤΥΛΙΚΟΣ ΔΙΑΧΩΡΙΣΜΟΣ ΑΜΕΣΩΣ ΜΕΤΑΠΥΛΩΡΙΚΑ ΚΑΙ ΓΑΣΡΟΝΗΣΤΙΔΙΚΗ ΑΝΑΣΤΟΜΩΣΗ ΜΕ ΜΑΚΡΑ ΠΡΟΣΙΟΥΣΑ ΕΛΙΚΑ, ΣΤΗΝ ΟΜΑΔΑ ΙΙΙ ΔΙΑΤΟΜΗ ΜΕΤΑΞΥ ΑΠΟΛΙΝΩΣΕΩΝ ΤΟΥ ΧΟΛΗΔΟΧΟΥ ΠΟΡΟΥ ΚΑΙ ΧΟΛΟΚΥΣΤΟΝΗΣΤΙΔΙΚΗ ΑΝΑΣΤΟΜΩΣΗ ΚΑΤΑ ROUX-EN-Y ΚΑΙ ΣΤΗΝ ΟΜΑΔΑ IV ΣΥΝΔΥΑΣΜΟΣ ΤΩΝ ΕΓΧΕΙΡΗΤΙΚΩΝ ΠΡΑΞΕΩΝΤΩΝ ΟΜΑΔΩΝ ΙΙ ΚΑΙ ΙΙΙ. ΕΝΑ ΠΕΙΡΑΜΑΤΟΖΩΟ ΤΗΣ ΟΜΑΔΑΣ Ι, ΔΥΟ ΤΗΣ ΙΙ, ΚΑΝΕΝΑ ΤΗΣ ΙΙΙ ΚΑΙ ΕΝΑ ΤΗΣ ΙV ΑΝΑΠΤΥΞΑΝ ΟΞΕΙΑ ΠΑΓΚΡΕΑΤΙΤΙΔΑ. ΕΠΙΠΡΟΣΘΕΤΑ ΔΥΟ ΠΕΙΡΑΜΑΤΟΖΩΑ ΑΠΟ ΚΑΘΕ ΟΜΑΔΑ ΕΜΦΑΝΙΣΑΝ ΚΑΠΟΙΕΣ ΕΝΔΕΙΞΕΙΣ ΠΑΓΚΡΕΑΤΙΚΗΣ ΒΛΑΒΗΣ (ΥΠΕΡΑΜΥΛΑΣΑΙΜΙΑ,ΚΑΠΟΙΕΣ ΙΣΤΟΛΟΓΙΚΕΣ ΑΛΛΟΙΩΣΕΙΣ ΤΟΥ ΠΑΓΚΡΕΑΤΟΣ ΟΧΙ ΑΠΟΔΕΙΚΤΙΚΕΣ ΠΑΓΚΡΕΑΤΙΤΙΔΑΣ 'Η ΣΥΝΔΥΑΣΜΟ ΤΩΝ ΠΑΡΑΠΑΝΩ). ΤΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΜΑΣ ΕΔΕΙΞΑΝ: Α. Η ΚΑΤΑΣΚΕΥΗ ΚΛΕΙΣΤΗΣ ΔΩΔΕΚΑΔΑΚΤΥΛΙΚΗΣ ΕΛΙΚΑΣ ΔΕ ΣΥΝΟΔΕΥΤΗΚΕ, ΣΤΑ ΠΕΙΡΑΜΑΤΑ ΜΑΣ, ΜΕ ΣΥΧΝΗ ΑΝΑΠΤΥΞΗ ΟΞΕΙΑΣ ΠΑΓΚΡΕΑΤΙΤΙΔΑΣ. Β. Η ΠΑΡΟΥΣΙΑ ΧΟΛΗΣ ΣΤΗΝ ΚΛΕΙΣΤΗ ΔΩΔΕΚΑΔΑΚΤΥΛΙΚΗ ΕΛΙΚΑ ΠΡΟΔΙΑΘΕΤΕΙ ΣΕ ΑΝΑΠΤΥΞΗ ΟΞΕΙΑΣ ΠΑΓΚΡΕΑΤΙΤΙΔΑΣ, ΕΝΩ Η ΠΑΡΟΥΣΙΑ ΣΤΟ ΔΩΔΕΚΑΔΑΚΤΥΛΟ 'Η Η ΔΙΟΔΟΣ ΑΠΟ ΑΥΤΟ ΓΑΣΤΡΙΚΟΥ ΥΓΡΟΥ ΠΡΟΦΥΛΑΣΣΕΙ ΑΠΟ ΤΗ ΝΟΣΟ. Γ. Η ΠΕΙΡΑΜΑΤΙΚΗ ΜΑΣ ΔΙΑΤΑΞΗ, ΣΑΝ ΑΤΡΑΥΜΑΤΙΚΗ, ΠΡΟΣΦΕΡΕ ΓΙΑ ΠΑΡΑΠΕΡΑ ΜΕΛΕΤΕΣ ΤΩΝ ΑΙΤΙΟΛΟΓΙΚΩΝ ΠΑΡΑΓΟΝΤΩΝ ΤΗΣ ΟΞΕΙΑΣ ΠΑΓΚΡΕΑΤΙΤΙΔΑΣ

Gastric Volvulus and Wandering Spleen: A Rare Surgical Emergency

Gastric volvulus is a rare but potentially life-threatening clinical entity due to possible gastric necrosis. A wandering spleen may also be associated with gastric volvulus. Patients presenting with the triad epigastralgia, vomiting followed by retching, and difficulty or inability to pass a nasogastric tube into the stomach are likely to have gastric volvulus. The operating surgeon should include this rare entity in the differential diagnosis when dealing with a patient with such a clinical profile. Herein, we present a case of gastric volvulus associated with a wandering spleen in a 28-year-old Caucasian woman and we provide a brief review of the literature on this issue

An Uncommon, Life-Threatening, Traumatic Hematoma in the Neck Area

It is well known that blunt neck trauma, when compared to a penetrating injury in the same anatomical area, is very rare. We report a case of an 81-year-old Caucasian woman with a blunt life-threatening neck trauma due to a bully goat. Although rare, direct evaluation should always be done in these cases because any misinterpretation may result in unfavorable outcomes. We have to highlight that close medical attention and prompt surgical treatment should be always considered in order to avoid dramatic consequences

Surgical management of hydatid liver disease

Background: large retrospective clinical study describing the long-term experience of a single center in the surgical management of liver echinococcosis in an endemic area. Methods: 232 patients were operated for liver hydatid disease between 1978 and 2012. Seventy-three patients (Group A) underwent a radical procedure (total pericystectomy or hepatectomy), while 145 (Group B) were treated with a more conservative method (partial cystectomy, with external drainage, omentoplasty or capitonnage) and 14 (Group C) received a combination of total and partial cystectomies. Morbidity, mortality, post-operative complications and recurrence rates in the long-term setting were retrospectively evaluated. Results: Group A patients were treated with zero mortality and a morbidity rate of 10.95%. No recurrence was documented. In Group B, mortality reached 2.76%, (p = 0.153 compared to Group A) morbidity 24.13% (p = 0.021) and there were 10 cases of relapse (6.9%) at three-year complete follow-up (p = 0.989). Extrahepatic sites of disease were not uncommon. Discussion: radical surgical procedures were better tolerated by patients and yielded better results in terms of recurrence rate