Median nerve’s loop in the arm penetrated by a superficial brachial artery: case report and neurosurgical considerations

Median nerve is commonly formed by the union of the lateral and medial cord of the brachial plexus, which embrace the third part of the axillary artery. Formation of a median nerve’s loop is a very rare condition. We present a cadaveric case, in which the right median nerve was found at the upper arm forming a fusiform neural loop penetrated by a superficial brachial artery, which continued over the forearm as the radial artery. The literature concerning nerve loops and traversing arteries is discussed, as well as the relevant embryology. We consider that such nerve loops constitute vulnerable sites of the nerve trunk since it is compressed by the pulsation of the abnormal traversing artery. Moreover, neurosurgeons should keep in mind that in case of existing arterial variation, variation of the associated neural structures may co-exist

Synbiotics and omega-3 fatty acids combination in the treatment of ulcerative colitis: an experimental study in rats

The aim of the current study was to estimate the effects of Synbiotics and diet high in omega-3 polyunsaturated fatty acid (N3PUFA’s) on macroscopic and histopathologic features in the Wistar rat model of dextran sodium sulphate (DSS) -induced experimental colitis. Material and Methods. Seventy-two male Wistar rats were divided in 4 groups of 18 rats. Each group received 5% DSS in their drinking water for eight days. After eight days, the DSS was removed, and two rats from each group were sacrificed and the colonic tissue was examined to confirm the presence of experimental colitis. For the next eight days post-DSS, group A animals received tap-water, group B animals received Synbiotic compound once per day, group C were fed a meal containing high levels of N3PUFAs once per day and group D received Synbiotics and a meal containing high levels of N3PUFAs once per day. Eight rats from each group were sacrificed on the 4th day post-DSS, and the remaining eight rats from each group were sacrificed on the 8th day post-DSS. The distal colon was examined macroscopically and histopathologically. The lymphoid organs such as liver and draining mesenteric lymph nodes, were isolated for histology and for immunohistochemistry on cryostat sections to determine bacterial translocation. Results. Following 8 days of 5% DSS administration, very severe colitis and many hemorrhagic erosions were observed in the rat colon. After eight days of treatment, the mean body weight in the control group animals increased slightly. However, after 8 days of DSS treatment the body weight was significantly increased in D Group in comparison with the other groups (P<0.05). Moreover, after eight days of treatment the mean length of colon in Group D (Synbiotics and N3PUFA diet and group B was significantly increased (P=0.0191), while in the non-treated group A it was, respectively decreased. Eight days post treatment Synbiotics and N3PUFAs diet caused elevation in red blood cell count and disease activity index (DAI) was significantly decreased (P<0.05). Administration of Synbiotics or Synbiotics and N3PUFAs diet resulted in an overall decrease in bacterial translocation. Administration of diet rich in N3PUFAs and Synbiotics for 8 days post-DSS induced a marked reduction on clinical manifestations in comparison with the other groups. Dietary administration of diet rich in omega-3 polyunsaturated fatty acid or Synbiotics did not affect the progression of DSS-associated histopathological lesions. The combination of diet rich in omega-3 polyunsaturated fatty acids and Synbiotics ameliorated epithelial erosions and improved macroscopic and histological scores of colitis (P<0,05). Conclusion. Αdministation of 5% DSS to Wistar rats produces variably severe symptoms and significant structural and ultrastructural alterations similar to human ulcerative colitis, which included epithelial disruption, focal lesions and superficial inflammation. The combination of diet rich in omega-3 polyunsaturated fatty acids and Synbiotics could have beneficial effects on the clinical manifestations of ulcerative colitis, improving macroscopic and histological scores of colitis shows promising results. The combination of diet rich in omega-3 polyunsaturated fatty acids and Synbiotics could be included in human ulcerative colitis treatment.Σκοπός της παρούσας πειραματικής μελέτης ήταν η εκτίμηση της αποτελεσματικότητας της συγχορήγησης συμβιοτικών και Ω-3 λιπαρών οξέων στις μακροσκοπικές και ιστοπαθολογικές αλλοιώσεις σε πειραματική κολίτιδα με άλας του θειοδεξτρανικού νατρίου (DSS) σε επίμυες στελέχους Wistar. Υλικό και Μέθοδοι. 72 άρρενες επίμυες τυχαιοποιήθηκαν σε τέσσερις ομάδες των 18 πειραματόζωων. Σε κάθε ομάδα χορηγήθηκε 5% DSS μαζί με το πόσιμο νερό για 8 ημέρες. Μετά το πέρας των 8 ημερών διακόπηκε η χορήγηση του DSS και δύο πειραματόζωα από κάθε ομάδα θυσιάστηκαν για την ιστοπαθολογική επιβεβαίωση της κολίτιδας. Για τις υπόλοιπες 8 ημέρες στα πειραματόζωα της ομάδας Α χορηγήθηκε μόνο πόσιμο νερό, στα πειραματόζωα της ομάδας Β χορηγήθηκε σκεύασμα συμβιοτικών, στα πειραματόζωα της ομάδας Γ χορηγήθηκε δίαιτα πλούσια σε Ω-3 λιπαρά οξέα και στα πειραματόζωα της ομάδας Δ χορηγήθηκε σκεύασμα συμβιοτικών και δίαιτα πλούσια σε Ω-3 λιπαρά οξέα. Εν συνεχεία, εκτελέστηκαν δύο θυσίες την 4η και 8η μέρα μετά την θεραπευτική αγωγή σε όλες τις ομάδες και το παρασκεύασμα του κατιόντος κόλου εξετάζονταν μακροσκοπικά και ιστοπαθολογικά. Κατά την λαπαροτομία ελήφθησαν υπό άσηπτες συνθήκες παρασκευάσματα από το λοβό του ήπατος και από τους μεσεντέριους λεμφαδένες για την αξιολόγηση της βακτηριακής μετεγκατάστασης. Αποτελέσματα. Οκτώ ημέρες μετά τη χορήγηση 5% άλας του θειοδεξτρανικού νατρίου-DSS σε όλες τις ομάδες, ο εντερικός βλεννογόνος εμφανίστηκε οιδηματώδης με παρουσία αιμορραγικών αλλοιώσεων σε όλο το μήκος του κόλου. Μετά τη χορήγηση θεραπείας για 8 ημέρες το μέσο σωματικό βάρος στην ομάδα ελέγχου αυξήθηκε ελάχιστα. Ωστόσο, μετά το πέρας 8 ημερών θεραπείας της κολίτιδας το μέσο σωματικό βάρος αυξήθηκε στατιστικώς σημαντικά στην ομάδα Δ σε σχέση με τις άλλες ομάδες (P<0.05). Επιπλέον, 8 ημέρες μετά τη θεραπεία ο μέσος όρος του μήκους του κατιόντος κόλου αυξήθηκε σημαντικά στις ομάδες Δ και Β (P=0.0191), ενώ στην ομάδα Α μειώθηκε αντιστοίχως. Στις ομάδες Β, Γ, καθώς και της ομάδας Δ αντίστοιχα την 16η ημέρα παρατηρήθηκε αύξηση της συγκέντρωσης των ερυθρών αιμοσφαιρίων σε σχέση με τις υπόλοιπες ομάδες. Κατά τη διάρκεια της πειραματικής διαδικασίας παρατηρήθηκε στατιστικώς σημαντική μείωση του δείκτη έντασης της νόσου (P<0.05) στην ομάδα Δ και στην ομάδα Γ την 16η ημέρα μετά την έναρξη της θεραπείας. Μείωση της βακτηριακής αλλόθεσης σημειώθηκε στο ήπαρ και στους μεσεντέριους λεμφαδένες στις ομάδες Β και Δ με υπερίσχυση αναερόβιων μικροβίων την 16η ημέρα της πειραματικής διαδικασίας. Η συγχορήγηση δίαιτας πλούσιας σε Ω-3 λιπαρών οξέων και συμβιοτικών βελτίωσαν τόσο τις διαβρώσεις του επιθηλίου όσο και τη μακροσκοπική και ιστολογική βαθμονόμηση της κολίτιδας (P<0,05). Συμπέρασμα. Η χορήγηση 5% DSS σε επίμυες στελέχους Wistar προκαλεί πειραματική κολίτιδα με παθολογικές αλλοιώσεις ελκώδους κολίτιδας εφάμιλλες με τις αντίστοιχες εκδηλώσεις στον άνθρωπο τόσο στην κλινική πορεία όσο και στην εντόπιση των παθολογικών αλλοιώσεων με εκτεταμένη διάβρωση του επιθηλίου της επιφάνειας και διήθηση φλεγμονικών κυττάρων στο χόριο. Ο συνδυασμός δίαιτας πλούσιας σε Ω-3 λιπαρά οξέα και συμβιοτικών μπορεί να έχει ευεργετικά αποτελέσματα στις κλινικές εκδηλώσεις της ελκώδους κολίτιδας βελτιώνοντας τα μακροσκοπικά ευρήματα και την ιστολογική βαθμονόμηση της κολίτιδας. Το γεγονός αυτό έχει ως αποτέλεσμα ότι θα μπορούσαν να περιληφθούν στην θεραπευτική αντιμετώπιση της ελκώδους κολίτιδας στον άνθρωπο με πολλά υποσχόμενα αποτελέσματα

Omega 3 fatty acids supplementation has an ameliorative effect in experimental ulcerative colitis despite increased colonic neutrophil infiltration Los suplementos de ácidos grasos omega 3 tienen efectos beneficiosos en colitis ulcerosa a pesar del aumento de la infiltracción por neutrófilos del colon

Purpose: omega 3 polyunsaturated fatty acids have anti-inflammatory properties and can be beneficial in the treatment of inflammatory diseases, such as ulcerative colitis. Dextran sodium sulphate (DSS) colitis in rats appears to mimic nearly all of the morphological characteristics and lesion distributions of ulcerative colitis. The purpose of the current study was to investigate the efficacy of omega 3 fatty acids in the treatment of experimental ulcerative colitis. Methods: thirty-six Wistar rats were randomly assigned to group A or group B receiving 5% dextran sulfate sodium (DSS) in their drinking water for eight days. For the next eight days post-DSS, group A animals received tap-water, and group B animals were fed a nutritional solution containing high levels of omega 3 polyunsaturated fatty acids (ProSure®, Abbott Laboratories, Zwolle, Netherlands) once per day, administrated with a orogastric feeding tube. Results: animals fed an omega 3 rich diet exhibited a statistically significant increase in hematocrit and hemoglobin levels, compared to animals drinking tap water, and a trend towards histopathological and clinical improvement, with the administration of omega 3 fatty acids ameliorating epithelial erosion by day 8 post-DSS, but no statistically significant difference was observed between group A and group B animals at 4 or 8 days post-DSS. Also, a statistically significant increase in neutrophil infiltration was observed, as depicted by myelohyperoxidase activity. Conclusion: our findings support a positive role of omega 3 polyunsaturated fatty acids supplementation in an experimental model of ulcerative colitis despite the increased colonic neutrophil infiltration. Further studies are needed in order to investigate the role of increased neutrophils in colonic mucosa

Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

BackgroundFournier’s gangrene (FG) is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease.MethodsThe current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical presentation and demographics of the patients were recorded. Also we recorded the laboratory data, the comorbidities, the etiology, and microbiology and the therapeutic interventions performed, and we calculated the various severity indexes. Patients were divided to survivors and non-survivors, and all the collected data were statistically analyzed to assess mortality factors using univariate and then multivariate analysis.ResultsIn our series, we treated a total of 24 patients with a mean age 58.9 years including 20 males (83.4%) and 4 females (16.6%). In most patients, a delay between disease onset and seeking of medical help was noted. Comorbidities were present in almost all patients (87.5%). All patients were submitted to extensive surgical debridements and received broad-spectrum antibiotics until microbiological culture results were received. Regarding all the collected data, there was no statistically significant difference between survivors and non-survivors except the presence of malignancy in non-survivors (p = 0.036) and the lower hemoglobin (p &lt; 0.001) and hematocrit (p = 0.002) in non-survivors. However, multivariate analysis did not reveal any predictor of mortality.ConclusionEarly diagnosis, aggressive thorough surgical treatment, and administration of the proper antibiotic treatment comprise the cornerstone for the outcome of this disease. In small populations like in the present study, it is difficult to recognize any predictors of mortality and even the severity indexes, which take into account a lot of data cannot predict mortality