Background. We investigated the occluded essential vessel tributaries, both arterial and venous, occluded superior mesenteric vein and artery in rats, consequent noxious syndrome, peripherally and ...centrally. As therapy, we hypothesized the rapidly activated alternative bypassing pathways, arterial and venous, and the stable gastric pentadecapeptide BPC 157 since it rapidly alleviated venous occlusion syndromes. Methods. Assessments were performed for 30 min (gross recording, venography, ECG, pressure, microscopy, biochemistry, and oxidative stress), including portal hypertension, caval hypertension, aortal hypotension, and centrally, the superior sagittal sinus hypertension; systemic arterial and venous thrombosis, ECG disturbances, MDA-tissue increase, the multiple organs lesions, heart, lung, liver, kidney and gastrointestinal tract, including brain (swelling, and cortex (cerebral, cerebellar), hypothalamus/thalamus, hippocampus lesions). Rats received BPC 157 medication (10 µg/kg, 10 ng/kg) intraperitoneally at 1 min ligation-time. Results. BPC 157 rapidly activated collateral pathways. These collateral loops were the superior mesenteric vein-inferior anterior pancreaticoduodenal vein-superior anterior pancreaticoduodenal vein-pyloric vein-portal vein pathway, an alternative pathway toward inferior caval vein via the united middle colic vein and inferior mesenteric vein through the left colic vein, and the inferior anterior pancreaticoduodenal artery and inferior mesenteric artery. Consequently, BPC 157 counteracted the superior sagittal sinus, portal and caval hypertension, aortal hypotension, progressing venous and arterial thrombosis peripherally and centrally, ECG disturbances attenuated. Markedly, the multiple organs lesions, heart, lung, liver, kidney, and gastrointestinal tract, in particular, as well as brain lesions, and oxidative stress in tissues were attenuated. Conclusions. BPC 157 therapy rapidly recovered rats, which have complete occlusion of the superior mesenteric vein and artery.
Background. Gastric pentadecapeptide BPC 157 therapy in rats compensated irremovable occlusion of various vessels and counteracted the consequent multiorgan dysfunction syndromes by activation of the ...corresponding collateral bypassing loops. Thus, we used BPC 157 therapy against the irremovable occlusion of the end of the superior mesenteric vein. Methods. Assessments, for 30 min (gross recording, venography, ECG, pressure, microscopy, biochemistry, and oxidative stress) include the portal and caval hypertension, aortal hypotension, and centrally, the superior sagittal sinus hypertension, systemic arterial and venous thrombosis, ECG disturbances, MDA-tissue increase, and heart, lung, liver, kidney and gastrointestinal tract, in particular, and brain (cortex (cerebral, cerebellar), hypothalamus/thalamus, hippocampus) lesions. Rats received BPC 157 medication (10 µg/kg, 10 ng/kg) intraperitoneally at 1 or 15 min ligation time. Results. BPC 157 rapidly activated the superior mesenteric vein–inferior anterior pancreati-coduodenal vein–superior anterior pancreaticoduodenal vein–pyloric vein–portal vein pathway, reestablished superior mesenteric vein and portal vein connection and reestablished blood flow. Simultaneously, toward inferior caval vein, an additional pathway appears via the inferior mesenteric vein united with the middle colic vein, throughout its left colic branch to ascertain alternative bypassing blood flow. Consequently, BPC 157 acts peripherally and centrally, and counteracted the intracranial (superior sagittal sinus), portal and caval hypertension, aortal hypotension, ECG disturbances attenuated, abolished progressing venous and arterial thrombosis. Additionally, BPC 157 counteracted multiorgan dysfunction syndrome, heart, lung, liver, kidney and gastrointestinal tract, and brain lesions, and oxidative stress in tissues. Conclusion. BPC 157 therapy may be specific management also for the superior mesenteric vein injuries.
We report of a patient with abdominal aortic aneurysm and renal transplant who underwent aneurysm repair. These patients can be treated by eather open or endovascular approach, depending on several ...factors, including aneurysm morphologic suitability for endovascular tretament, age of patient, and comorbidities.The main challange with open repair approach is to maintain renal transplant perfusion during the aortic cross clamping. Several methods of renal transplant perfusion during aneurysm repair have been described. In this case, we opted for open aneurysm repair beacuse of the age of the patient. The femoral venoarterial perfusion technique using extracorporal circulation machine was employed. We found this technique safe and easy in treating such patients.
Liver abscess still represents a significant clinical entity with mortality rates of up to 10%. Traditional treatment of liver abscesses is open surgical treatment. Recently, percutaneous and ...laparoscopic drainage has been increasingly used. Still, in spite of these relatively novel techniques and improved imaging, liver abscess can sometimes be difficult to diagnose or treat. Here we present two cases of chronic liver abscess treated at our department. First patient was twice hospitalized in other hospitals without reaching definitive diagnosis. He was admitted at our department because of clinical presentation of sepsis, and definitive diagnosis of liver abscess was established only during open surgery. Second patient was admitted after laparoscopic drainage and repeated percutaneous drainage had failed to resolve his symptoms. In both cases, liver segment resection led to complete healing. These cases indicate that chronic liver abscess can still present a diagnostic and therapeutic challenge.
The controversy of the choice between open and laparoscopic appendectomy still remains. The benefits as well as disadvantages of laparoscopy are well known.
We designed a prospective 3-year clinical ...study (January 1, 2008-December 31,2010) with 123 patients operated on for acute appendicitis. They were prospectively divided into laparoscopic appendectomy (LA) group with 42 results and open appendectomy (OA) group with 81 results. The following parameters were analyzed: age, sex, preoperative leukocyte count, C-reactive protein (CRP) value, preoperative ultrasound finding (US), analgesic administration and histopathologic finding. The length of the operation, length of hospitalization (LOS) and complications were compared between the two groups, along with personal postoperative satisfaction estimated by telephone survey after discharge from the hospital.
In 90% of cases, histopathology was positive for inflammation. CRP was determined in 42 (34%) patients preoperatively, with a mean value of 59; positive histopathology finding was recorded in 31 (74%) patients with increased preoperative CRP. US was performed in 68 (55%) patients; positive US was consistent with histopathology in 44 (65%) cases. The mean time of LA/ OA was 75/72 minutes. The only statistical difference was found for LOS: 4 versus 6 days (p < 0.01).
LA and OA are comparable for the number of complications. The slight benefit of LA offers the surgeon free hand in decision when dealing with acute appendicitis needing urgent operation.
Jetreni apscesi i dalje predstavljaju ozbiljan klinički entitet sa stopom smrtnosti i do 10%. Tradicionalno liječenje apscesa jetre je putem otvorenog kirurškog zahvata, iako se u posljednje vrijeme ...sve češće rabi perkutana ili laparoskopska drenaža. Usprkos tim načinima liječenja i sve boljim dijagnostičkim metodama apsces jetre ponekad nije jednostavno niti dokazati ni liječiti. Ovdje prikazujemo dva slučaja kroničnog apscesa jetre liječena na našem odjelu. U prvom slučaju bolesnik je bio u dva navrata hospitaliziran u drugim ustanovama pod dijagnozom jetrene ehinokokoze. Kod nas je bio primljen zbog kliničke slike sepse. Cistična tvorba u jetri je dijagnosticirana kao apsces tek tijekom operacije. Učinjena je resekcija VII . segmenta jetre gdje se apsces nalazio. Drugi bolesnik je primljen nakon pokušaja laparoskopske drenaže i više pokušaja perkutane drenaže apscesa. U oba slučaja je učinjena segmentektomija jetre, što je dovelo do izliječenja bolesnika. Ova dva slučaja pokazuju kako kronični jetreni apscesi još uvijek ponekad predstavljaju dijagnostički i terapijski izazov.
O izboru između otvorene i laparoskopske apendektomije postoje kontroverzni stavovi. Dobro su poznate prednosti i nedostatci laparoskopije. Tijekom 3 godine proveli smo prospektivnu studiju (1. ...siječnja 2008.- 31. prosinca 2010.) 123 bolesnika operiranih zbog akutne upale crvuljka. Bolesnici su slučajno odabrani, a podijeljeni su u dvije skupine: (LA) - laparoskopska apendektomija sa 42 i (OA) – otvorena apendektomija sa 81 zapisom. Proučavali smo: dob, spol; vrijednosti broja leukocita prije operacije, CRP, nalaz ultrazvuka (UZ), prepisanu analgeziju i poslijeoperacijski PHD nalaz, te usporedili duljinu trajanja kirurškog zahvata, duljinu hospitalizacije i komplikacije. Provedena je telefonska anketa s pitanjima o osobnom zadovoljstvu nakon operacije. U 90% bolesnika PHD nalaz bio je pozitivan na upalu. CRP je u 42 bolesnika preoperacijski (34%) bio sa srednjom vrijednosti 59; u 31 (74%) bolesnika s povišenim preoperacijskim vrijednostima CRP PHD nalaz bio je pozitivan. UZV je učinjen u 68 bolesnika (55%): u 44 (65%) pozitivni UZV bio je sukladan PHD nalazu. Prosječno vrijeme operacije u LA/OA bilo je 75/72 minute. Jedina statistički značajna razlika između dviju skupina bila je za duljinu hospitalizacije: 4 prema 6 dana (p<0,01 ). U zaključku treba istaknuti da je LA i OA moguće usporediti brojem komplikacija. Neznatna prednost LA nudi kirurgu slobodu odlučivanja u hitnom kirurškom liječenju akutne upale crvuljka.
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