Impactul disulfurii de alil asupra distrugerii oxidative æi regenerãrii hepatice pe un model experimental de hepatectomie

Backgraund: We investigated the effects of allyl disulfide (a garlic extract) on tissue damage, regeneration, proliferation and oxidative damage in an experimental liver resection model. Materials and Methods: In the study, 24 female Wistar albino rats weighing approximately 200-250 g were used. Group 1: The rats in the experimental group all received a 70% hepatectomy and were fed an Allyl disulfide (30 µg/kg/day, Allyl disulfide, Sigma-Aldrich, formula: C6H10S2, CAS Number: 2179-57-9, formula weight: 146.27 g/mol) in supplement to a regular diet for 1 week both preoperatively and postoperatively. Group 2: The rats in the control group also underwent a 70% hepatectomy and were given regular food and water for 1 week both preop and postop. Group 3: In the sham group, all rats were sacrificed 7 days after surgery. For biochemical evaluation, SGOT, SGPT, bilirubin, CRP and MDA were studied. In a histopathological examination, the fattening of the liver tissue, existence of (macro-micro vesicular), fibrosis, pleomorphism at hepatocyte nuclei, portal inflammation, existence of intralobular inflammatory cells, dilation at sinusoids, congestion, congestion at the central vein, regeneration, existence of Kupffer cells in the sinusoidal lumen and ki-67 proliferation index at hepatocytes were examined. Results: A significant difference between group 1 and group 2 was observed regarding the existence of regeneration, (p:0.06), the occurrence of nuclear pleomorphisms (p:0,001) and the fibroblast activity status (p:0.001). Significant differences were found between the experimental groups in regard to Kupffer cell increase and dilation and the hyperemia status in the sinusoid lumens (p:0.013 and p:0.001, respectively). In the Allyl disulfide group, the proliferation index was significantly higher than that of the other groups (p:0,001), while the average plasma MDA value was lower than that of the other groups (p: 0,042). No significant differences were found among the groups with respect to tissue MDA values (p:0,720). No significant difference was found for SGPT (ALT) and SGOT (AST) levels between Group 1 and the other groups (p:0.247 and p:0.539, respectively). The average total bilirubin (T. Bili) values were 0,12, 0,08 and 0,04 in the allyl disulfide group, control group and Sham group, respectively. This difference among the groups is statistically significant (p:0.001). The average direct bilirubin (D. Bili) values were 0,06, 0,02 and 0,02 in the allyl disulfide group, control group and Sham group, respectively. This variation among the groups is also statistically significant (0.001). Conclusion: We observed that the use of Allyl disulfide supplementation after major hepatectomy has a positive impact on liver regeneration, proliferation and oxidative damage. Abbreviations: Postop: post-operative, Preop: pre-operative, SGOT(AST): serum glutamic oxaloacetic transaminase, SGPT(ALT): serum glutamate-pyruvate transaminase, CRP: C- Reactive protein, MDA: Malondialdehyde, DAS: Garlic extract diallyl sulfide, AGE: aged garlic extract.Date generale: Am investigat efectele disulfurii de alil (un extract de usturoi) asupra distrucåiei tisulare, regenerãrii, proliferãrii æi distrugerii oxidative pe un model experimental de rezecåie hepaticã. Materiale æi metode: În acest studiu 24 de femele de æobolani albi Wistar cu greutãåi de aproximativ 200-250 g au fost utilizaåi. Grupul 1: toåi æobolanii din acest grup experimental au fost supuæi unei hepatectomii de 70% din dimensiunea ficatului æi au fost hrãniåi cu disulfurã de alil (30 μg/kg/zi, disulfurã de alil, Sigma-Aldrich, formula: C6H10S2, NumãrulCAS: 2179-57-9, greutate molecularã: 146.27 g/mol) suplimentar faåã de dieta normalã timp de câte o sãptãmânã pre- æi postoperator. Grupul 2: Æobolanii din grupul control au fost de asemenea supuæi unei hepatectomii în proporåie de 70% æi au primit un regim nutriåional æi de hidratare normale atât pre-, cât æi postoperator. Grupul 3: În grupul de control non-placebo toåi æobolanii au fost sacrificaåi la 7 zile dupã intervenåia chirurgicala. În vederea evaluãrii biochimice, AST, ALT, bilirubina, CRP æi malondialdehida sericã au fost studiate. În cadrul analizei histopatologice au fost examinate acumularea de åesut grãsos la nivel hepatic, existenåa fibrozei (macro-micro veziculare), pleomorfismul nucleilor hepatocitelor, inflamaåia portalã, existenåa de celule inflamatorii intralobulare, dilatarea la nivelul sinusoidelor, congestia, congestia venei centrale, regenerarea, existenåa de celule Kupffer în lumenul sinusoidal æi indicele de proliferare ki-67 la nivelul hepatocitelor. Rezultate: S-a observat o diferenåã semnificativã între grupurile 1 æi 2 în ceea ce priveæte prezenåa regenerãrii, (p:0.06), pleomorfismelor nucleare (p:0,001) æi statusului de activitate fibroblasticã (p:0.001). Diferenåe semnificative au fost gãsite între grupurile experimentale vizând creæterea numericã æi dilatarea celulelor Kupffer æi statusul hiperemic la nivelul lumenelor sinusoidelor (p:0.013 æi p:0.001 respectiv). În grupul cu administrare de disulfurã de alil indicele de proliferare a fost semnificativ mai ridicat decât în celelalte grupuri (p:0,001), în timp ce valoarea medie a malondialdehidei serice a fost mai scãzutã comparativ cu celelalte 2 grupuri (p: 0,042). Nu s-au înregistrat diferenåe semnificative între grupuri referitor la valorile de malondialdehidã tisularã (p:0,720). Nu s-au gãsit diferenåe importante între nivelurile de ALT æi AST din grupul 1 în comparaåie cu celelalte grupuri (p:0.247 æi p:0.539 respectiv). Valorile medii de bilirubinã totalã au fost de 0,12, 0,08 æi 0,04 în grupurile 1, 2 æi 3. Aceastã diferenåã dintre grupuri prezintã semnificaåie statisticã (p:0.001). Valorile medii ale bilirubinei directe au fost 0,06, 0,02 æi 0,02 în grupul experimental, grupul control æi grupul control non-placebo. Æi aceastã variaåie între grupuri este semnificativã din punct de vedere statistic (0.001). Concluzii: Am observat cã suplimentarea de disulfurã de alil dupã o hepatectomie majorã are un impact pozitiv asupra regenerãrii, proliferãrii æi distrugerii oxidative la nivel hepatic

Adrenomedulline improves ischemic left colonic anastomotic healing in an experimental rodent model

BACKGROUND: Leakage from colonic anastomosis is a major complication causing increased mortality and morbidity. Ischemia is a well-known cause of this event. This study was designed to investigate the effects of adrenomedullin on the healing of ischemic colon anastomosis in a rat model. METHODS: Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats that were divided into four groups. To mimic ischemia, the mesocolon was ligated 2 cm from either side of the anastomosis in all of the groups. The control groups (1 and 2) received no further treatment. The experimental groups (3 and 4) received adrenomedullin treatment. Adrenomedullin therapy was started in the perioperative period in group 3 and 4 rats (the therapeutic groups). Group 1 and group 3 rats were sacrificed on postoperative day 3. Group 2 and group 4 rats were sacrificed on postoperative day 7. After careful relaparotomy, bursting pressure, hydroxyproline, malondialdehyde, interleukin 6, nitric oxide, vascular endothelial growth factor, and tumor necrosis factor alpha levels were measured. Histopathological characteristics of the anastomosis were analyzed. RESULTS: The group 3 animals had a significantly higher bursting pressure than group 1 (p<0.05). Hydroxyproline levels in group 1 were significantly lower than in group 3 (p<0.05). The mean bursting pressure was significantly different between group 2 and group 4 (p<0.05). Hydroxyproline levels in groups 3 and 4 were significantly increased by adrenomedullin therapy relative to the control groups (p<0.05). When all groups were compared, malondialdehyde and nitric oxide were significantly lower in the control groups (p<0.05). When vascular endothelial growth factor levels were compared, no statistically significant difference between groups was observed. Interleukin 6 and tumor necrosis factor alpha were significantly decreased by adrenomedullin therapy (p<0.05). The healing parameters and inflammatory changes (e.g., granulocytic cell infiltration, necrosis, and exudate) were significantly different among all groups (p<0.05). CONCLUSION: Adrenomedullin had positive effects on histopathologic anastomotic healing in this experimental model of ischemic colon anastomosis

Case Report Pure Squamous Cell Carcinoma of the Duodenum

Primary carcinomas of the small intestine are extremely rare neoplasms. Most of these are adenocarcinomas. Primary squamous cell carcinoma (SCC) of small intestine is exceptionally rare with only occasional case reports in the literature. We report here a surgically treated patient with squamous cell carcinoma arising from duodenal diverticula in the third part of the duodenum

Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases

Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum

Coughing May Lead to Spontaneous Chylothorax and Chylous Ascites

Chylous ascites is a rare form of ascites resulting from the accumulation of lymph in the abdominal cavity. It is due to an interruption in the lymphatic system. Surgical management is indicated in cases of recurrence or failure after conservative treatment. We report a case of spontaneous chylous peritonitis after chylothorax, which is a rare clinical event. The primary reason was unclear and the outcome of medical and surgical treatment was successful

The difficulties encountered in conversion from classic pancreaticoduodenectomy to total laparoscopic pancreaticoduodenectomy

WOS: 000384291900008PubMed ID: 27251830Background: Recently, total laparoscopic pancreatectomy has been performed at many centres as an alternative to open surgery. In this study, we aimed to present the difficulties that we have encountered in converting from classic open pancreaticoduodenectomy to total laparoscopic pancreatectomy. Materials and Methods: Between December 2012 and January 2014, we had 100 open pancreaticoduodenectomies. Subsequently, we tried to perform total laparoscopic pancreaticoduodenectomy (TLPD) in 22 patients. In 17 of these 22 patients, we carried out the total laparoscopic procedure. We analysed the difficulties that we encountered converting to TLPD in three parts: Preoperative, operative and postoperative. Preoperative difficulties involved patient selection, preparation of operative instruments, and planning the operation. Operative difficulties involved the position of the trocars, dissection, and reconstruction problems. The postoperative difficulty involved follow-up of the patient. Results: According to our experiences, the most important problem is the proper selection of patients. Contrary to our previous thoughts, older patients who were in better condition were comparatively more appropriate candidates than younger patients. This is because the younger patients have generally soft pancreatic texture, which complicates the reconstruction. The main operative problems are trocar positions and maintaining the appropriate position of the camera, which requires continuous changes in its angles during the operation. However, postoperative follow-up is not very different from the classic procedure. Conclusion: TLPD is a suitable procedure under appropriate conditions

Cholangiocarcinoma presenting with hypercalcemia and thrombocytopenia

Malignant hypercalcemia and thrombocytopenia may result from bone metastasis of cholangiocarcinoma (CC). Our case was 53-year-old man admitted to emergency department with symptoms of anorexia, weight loss, nausea, vomiting, and general fatigue in February 2012. His laboratory findings showed hypercalcemia and thrombocytopenia. CT showed a large multinodular mass in the right lobe and, extending through left lobe of the liver. We considered the diagnosis of hypercalcemia of malignancy with elevated calcium levels and suppressed PTH level with the existence of skeletal bone metastasis and the absence of parathyroid gland pathology. Treatment of hypercalcemia with IV saline, furosemide, and calcitonin improved the patient symptoms. After the 8th day of admission, calcium level, thrombocytopenia, and other symptoms were normalized. Patient was sustained surgically inoperable and transferred to medical oncology department for the purpose of palliative chemotherapy and intended radiotherapy for bone metastasis. Hypercalcemia relapsed 4 weeks after discharge and patient died at the 5th month after admission due to disseminated metastasis. We should be aware of CC with symptomatic hypercalcemia and rarely low platelet count. The correction of hypercalcemia provides symptomatic relief and stability of patients

Pure Squamous Cell Carcinoma of the Duodenum

Primary carcinomas of the small intestine are extremely rare neoplasms. Most of these are adenocarcinomas. Primary squamous cell carcinoma (SCC) of small intestine is exceptionally rare with only occasional case reports in the literature. We report here a surgically treated patient with squamous cell carcinoma arising from duodenal diverticula in the third part of the duodenum