Η μελέτη των μεταβολών της εντερικής διαπερατότητας σε ασθενείς με μείζονες χειρουργικές επεμβάσεις

According to recent data increased intestinal permeability has been imlpicated in the pathogenesis of postoperative sepsis. There is evidence that erythropoietin (EPO) and Saccharomyces boulardii (S.b.) have an anti-inflammatory action and can stabilize cell structure, protecting gut barrier function. Aim of this study is the evaluation of the prophylactic effect of erythropoietin and Saccharomyces boulardii on intestinal permeability (IP) after major abdominal surgery. Twenty patients undergoing elective major abdominal surgery for malignancy were included in this prospective, randomized study. They were divided in three groups: patients receiving EPO orally two days and one day before surgery and the day after surgery (40.000IUX1 each day) composed the EPO group(seven patients), those receiving S.b. orally on the same days (56.5mgX3 each day) composed the S.b. group(seven patients), and those not receiving anything the control group(six patients). IP was measured by urine lactulose/mannitol test and was estimated three days before surgery and on postoperative days 3, 6, and 8 in all patients. Mean change of IP was significantly reduced on the 3rd postoperative day in the S.b. group compared to the preoperative values of the same group (p=0.03). Moreover, mean IP changes in the EPO group were significantly reduced on the 8th postoperative day compared to control group (p=0.02) and to preoperative values of EPO group (p=0,03). Early effect on IP may be attributed to its anti-inflammatory action or interference with actin while the absence of any late effect could possibly reflect a dose-dependent action. In contrast, delayed EPO effect may suggest a trophic or an angiogenic effect on intestine and a time-depended way of action. Wε hope that these results will be confirmed in the future by larger studies.Σύμφωνα με πρόσφατα δεδομένα η αύξηση της εντερικής διαπερατότητας ενοχοποιείται στην παθογένεια της μετεγχειρητικής σήψης. Υπάρχουν ενδείξεις ότι η ερυθροποιητίνη (ΕPO) και o σακχαρομύκητας boulardii (S.b) εμφανίζουν αντιφλεγμονώδη δραστηριότητα και σταθεροποιούν τον κυτταροσκελετό, προστατεύοντας τον εντερικό φραγμό. Ο σκοπός της τυχαιοποιημένης αυτής μελέτης είναι να καθορίσει την προφυλακτική δράση της ΕPO και του S.b. στην εντερική διαπερατότητα μετά από μείζονες χειρουργικές επεμβάσεις της κοιλίας. Είκοσι ασθενείς που υπεβλήθησαν σε μείζονες χειρουργικές επεμβάσεις κοιλίας τυχαιοποιήθηκαν σε τρεις ομάδες: στην ομάδα που έλαβε ΕPO δυο ημέρες πριν την επέμβαση, την προεγχειρητική και την πρώτη μετεγχειρητική ημέρα σε δόση 40.000 IU EPO/ ημέρα από του στόματος (επτά ασθενείς), στην ομάδα του S.b που έλαβε τις αντίστοιχες ημέρες από του στόματος 56,5mg S.b Χ 3/ημέρα (επτά ασθενείς) και στην ομάδα ελέγχου (έξι ασθενείς). H εντερική διαπερατότητα υπολογίστηκε βάση του λόγου λακτουλόζη/μαννιτόλη ούρων και πραγματοποιήθηκε τρεις ημέρες προ της επέμβασης καθώς και τις μετεγχειρητικές ημέρες 3, 6 και 8. Στην ομάδα του σακχαρομύκητα η μέση μεταβολή της διαπερατότητας μειώθηκε στατιστικά σημαντικά την τρίτη μετεγχειρητική ημέρα σε σχέση με τις προεγχειρητικές τιμές (p=0,03). Ομοίως στην ομάδα της ΕPO η μέση μεταβολή της διαπερατότητας μειώθηκε την όγδοη ημέρα σε στατιστικά σημαντικά επίπεδα σε σχέση με την ομάδα ελέγχου ( p=0,02) και με τις προεγχειρητικές τιμές ( p=0,03). Η πρώιμη προφυλακτική δράση του σακχαρομύκητα μπορεί να αποδοθεί στην αντιφλεγμονώδη δράση του ή στην αλληλεπίδραση του με την ακτίνη, ενώ η απουσία ευεργετικής επίδρασης την έκτη και όγδοη ημέρα μπορεί απλώς να αντανακλά ένα δοσοεξαρτώμενο τρόπο δράσης. Η καθυστερημένη έναρξη δράσης της EPO υποδηλώνει τροφική ή αγγειογόνο δράση και χρονοεξαρτώμενο τρόπο δράσης. Ελπίζουμε ότι τα αποτελέσματα αυτά θα επιβεβαιωθούν στο μέλλον σε μεγαλύτερες μελέτες

Rectal Ischemia Mimicked Tumor Mass

Ischemic proctitis is a rare disease which is usually encountered in elderly with comorbidities. We present a case of an 80-year old man with severe coronary disease who presented with severe hematochezia and hypotension. Endoscopy revealed a rectal mass 3-4 cm above the dental line and rectosigmoid mucosal inflammation compatible with ischemic colitis. The rectal insult was so intense that it resembled a neoplasmatic lesion. We discuss the causes, the prognostic factors, and the clinical and therapeutic challenges of this rare, albeit life-threatening entity, and we review the relative literature. A percentage of 10%–20% of patients with ischemic colitis usually have a distal potentially obstructing lesion or disorder such as cancer, diverticulitis or fecal impaction. Ischemic colitis, when mucosal and submucosal edema is severe and hemorrhagic nodules are large enough, can mimic a neoplasmatic lesion. The best treatment approach is a conservative management initially with a close clinical followup and after stabilization a repetition of rectal endoscopy with new biopsies. Early recognition of this clinical entity is of paramount importance to implement appropriate therapy (conservative or surgical) and avoid potentially fatal treatment of presumed inflammatory or infectious bowel diseases

Comparative Studies of Hyaluronic Acid Concentration in Normal and Osteoarthritic Equine Joints

Osteoarthritis (OA) is the most common major disabling disease in humans and horses. Hyaluronic acid (HA), naturally abundantly present in synovial fluid (SF), is thought to have crucial impact on the functional rheological and biochemical features of SF in healthy and osteoarthritic joints. Here we present comparative measurements of HA concentration in SF from 35 normal and osteoarthritic equine joints, between two different approaches. On the one hand, an established biochemical HA-specific Enzyme–Linked Immunosorbent Assay (ELISA) assay was employed, which determined that SF in healthy and osteoarthritic equine joints is characterized by HA concentration of ca 0.3–2 mg/mL and 0.1–0.7 mg/mL respectively. On the other hand the same SF samples were also examined with a new exploratory approach of finding out HA concentration, which is based on SF rheology. This was done following “calibration” using appropriate model HA solutions. Comparative analysis of the results obtained by both the biochemical and the rheological approaches, revealed that in most cases the rheological approach greatly overestimates HA concentration in SF, by ca 3 to 8 times and 6 to 11 times, in healthy and diseased SF respectively. Overall these findings support the notion that, contrary to the established view, HA may not be the major contributor of equine SF rheology. This should be taken into account for the development of new more effective preventive strategies, as well as more effective early-stage interventions in osteoarthritis

Value of real-time three-dimensional adenosine stress contrast echocardiography in patients with known or suspected coronary artery disease

Aim The aim of this study was to evaluate the feasibility of myocardial wall-motion and perfusion assessment using contrast echocardiography during real-time three-dimensional (RT3D) adenosine stress test, and compare its diagnostic accuracy with the two-dimensional (2D) method using coronary angiography as reference. Methods and results Patients with known or suspected coronary artery disease (CAD) have been submitted to adenosine stress contrast echocardiography and coronary angiography, within a 1-month period. Two-dimensional apical four, two, and three chamber, as well as three-dimensional (3D) pyramidal full-volume data sets were acquired at rest and at peak stress. The 17-segment division of the left ventricle was used and each segment was evaluated based on wall motion and perfusion. Sixty patients (age: 60.1+/-8.5 years, 38 men) were enrolled, i.e. 1020 segments were evaluated at rest and at peak stress. Wall-motion analysis per patient revealed that the sensitivity and specificity of 2D to detect CAD were 80 and 82% and of RT3D echocardiography were 82 and 64%, respectively, whereas in the per patient perfusion analysis the respective percentages were 88, 64% for 2D and 90, 73% for RT3D. Regarding left anterior descending artery and right coronary system, there seems to be no statistical significant difference in terms of wall-motion and perfusion evaluation between the two modalities. Conclusions Real-time 3D adenosine stress echocardiography is a feasible and valuable technique to evaluate myocardial wall motion and perfusion in patients with suspected CAD, despite existing problems concerning lower spatial and temporal resolution when compared with 2D echocardiography

Carotid Disease and Ageing: A Literature Review on the Pathogenesis of Vascular Senescence in Older Subjects

Aging is a natural process that affects all systems of the human organism, leading to its inability to adapt to environmental changes. Advancing age has been correlated with various pathological conditions, especially cardiovascular and cerebrovascular diseases. Carotid artery (CA) is mainly affected by age-induced functional and morphological alterations causing atheromatous disease. The evolvement of biomedical sciences has allowed the elucidation of many aspects of this condition. Symptomatic carotid disease (CD) derives from critical luminar stenosis or eruption of an atheromatous plaque due to structural modifications of the vessels, such as carotid intima-media thickening. At a histologic level, the aforementioned changes are mediated by elastin fragmentation, collagen deposition, immune cell infiltration, and accumulation of cytokines and vasoconstrictors. Underlying mechanisms include chronic inflammation and oxidative stress, dysregulation of cellular homeostatic systems, and senescence. Thus, there is an imbalance in components of the vessel wall, which fails to counteract exterior stress stimuli. Consequently, arterial relaxation is impaired and atherosclerotic lesions progress. This is a review of current evidence regarding the relationship of aging with vascular senescence and CD. A deeper understanding of these mechanisms can contribute to the production of efficient prevention methods and targeted therapeutic strategies

Carotid Disease and Ageing: A Literature Review on the Pathogenesis of Vascular Senescence in Older Subjects.

Aging is a natural process that affects all systems of the human organism, leading to its inability to adapt to environmental changes. Advancing age has been correlated with various pathological conditions, especially cardiovascular and cerebrovascular diseases. Carotid artery (CA) is mainly affected by age-induced functional and morphological alterations causing atheromatous disease. The evolvement of biomedical sciences has allowed the elucidation of many aspects of this condition. Symptomatic carotid disease (CD) derives from critical luminar stenosis or eruption of an atheromatous plaque due to structural modifications of the vessels, such as carotid intima-media thickening. At a histologic level, the aforementioned changes are mediated by elastin fragmentation, collagen deposition, immune cell infiltration, and accumulation of cytokines and vasoconstrictors. Underlying mechanisms include chronic inflammation and oxidative stress, dysregulation of cellular homeostatic systems, and senescence. Thus, there is an imbalance in components of the vessel wall, which fails to counteract exterior stress stimuli. Consequently, arterial relaxation is impaired and atherosclerotic lesions progress. This is a review of current evidence regarding the relationship of aging with vascular senescence and CD. A deeper understanding of these mechanisms can contribute to the production of efficient prevention methods and targeted therapeutic strategies