The place of intraoperative antegrade colonic irrigation in emergency left-sided colonic surgery

The healing of colinic or colorectal anastomoses depends, at least partially, on the volume of fecal residue. Intraoperative antegrade colonic irrigation enables the surgeon to prepara the colon adequately at the time of surgery and to perform safely an immediate resection and primary anastomosis in obstructive lesions of the left colon. Its indications have been extended to other left-sided colonic emergencies, especially perforation and hemorrhage. The technique is described in this study and its value is assessed in the light of available experimental and clinical evidence     

Management of cystic prolactinomas: a review

Introduction

Cystic prolactinoma is a variant of prolactin-secreting pituitary adenoma. The strategies for the management of cystic prolactinoma have not been addressed thoroughly in clinical guidelines.

Methods

A literature search was performed using Pubmed to review the current approaches to the treatment of cystic prolactinoma.

Results

Transsphenoidal resection is an effective and relatively safe approach for the treatment of cystic prolactinoma, however, morbidity of surgery is dependent on the skill of the surgeon. Emerging studies allude to the efficacy and safety of dopamine agonists in the management of cystic prolactinoma. Dopamine agonists are associated with considerable rates of clinical improvement and tumor shrinkage, hence reducing the need for surgical intervention.

Conclusions

Recent studies suggest that dopamine agonist therapy may be an effective and safe treatment option in a considerable portion of patients with cystic prolactinomas. We suggest that dopamine agonists should be considered as a first-line therapy for cystic prolactinoma in the absence of indications for early surgical intervention.

     

Hyperinsulinemia induces a reversible impairment in insulin receptor function leading to diabetes in the sand rat model of non-insulin-dependent diabetes mellitus.

The insulin receptor was evaluated at differentdisease stages in the sand rat (Psammomys obesus), a model for nutrition-induceddiabetes. Nondiabetic sand rats showed markedly low receptor number in livercompared with albino rats. Their receptor had an intact tyrosine kinase activitybut a higher Km for ATP in the phosphorylation reaction of exogenous substrates.The initial effects of overeating (i.e., development of hyperinsulinemia withouthyperglycemia) were associated in the sand rat with a dramatic decrease in invitro and in vivo insulin-induced receptor tyrosine kinase activity in bothliver and muscle. In muscle, this coincided with a decrease in receptor numberand an increase in basal tyrosine kinase activity. Similar changes were observedupon development of hyperinsulinemia with hyperglycemia. Upon recovery from thediabetic state by diet restriction, the impaired receptor kinase activation wascorrected. Complete restoration occurred only in animals that fully recoveredfrom the diabetic state and became normoinsulinemic. These observations indicatethat loss and gain of receptor tyrosine kinase activity were dependent oninsulin levels. Thus, overeating may lead to the development of hyperinsulinemiathrough ineffective extraction of excess insulin by the scarce liver receptors.Hyperinsulinemia, in turn, causes a reversible reduction in receptor kinaseactivity, leading to insulin resistance. This sequence of events may be relevantto diet-related changes in human non-insulin-dependent diabetesmellitus.     

Acute Cholecystitis Complicating Unrelated Disease: Etiological Considerations

The phenomenon of acute cholecystitis complicating an unrelated operation has been reported with increasing frequency, and may be preceded by a variety of operative procedures and a lack of previous biliary tract symptoms. Among eight such patients treated by us, seven developed acute cholecystitis postoperatively, and in one it was discovered during operation for bleeding duodenal ulcer. Two patients had undergone wide excision of the breast; two, highly selective vagotomy; one, nephrolithotomy; one, truncal vagotomy and gastroenterostomy; and one, left hemicolectomy and colostomy. In three patients, urgent cholecystectomy was performed, and four were treated conservatively with subsequent elective cholecystectomy. Histopathological studies revealed acute and chronic cholecystitis in all eight patients and cholelithiasis in four. One patient died in septic shock. Numerous contributing factors have been suggested, including hypovolemia and biliary stasis, as well as the presence of stones. It would appear that chronic cholecystitis or other biliary pathology, as found in our eight patients, is a major factor in the development of this manifestation.     

Are adult patients with Laron syndrome osteopenic? A comparison between dual-energy X-ray absorptiometry and volumetric bone densities

Severe short stature resulting from a deficiency in IGF-I is a prominent feature of Laron syndrome (LS). Although low bone mineral density (BMD) has been noted in LS patients examined by dual energy x-ray absorptiometry (DEXA), this technique does not take volume into account and may therefore underestimate the true bone density in patients with small bones. The aim of the present study was to evaluate the BMD yielded by DEXA in our LS patients using estimated volumetric values. Volumetric density was calculated with the following formulas: bone mineral apparent density (BMAD) = bone mineral content (BMC)/(area)(3/2) for the lumbar spine and BMAD = BMC/area(2) for the femoral neck. The study sample included 12 patients (mean age, 43.9 yr; mean height, 123.7 cm). Findings were compared with 10 osteopenic subjects without developmental abnormalities (mean age, 56 yr; mean height, 164.8 cm) and 10 healthy control subjects matched for sex and age to the LS patients (mean height, 165.5 cm). BMAD in the LS group was 0.201 +/- 0.02 g/cm(3) at the lumbar spine and 0.201 +/- 0.04 g/cm(3) at the femoral neck; corresponding values for the osteopenic group were 0.130 +/- 0.01 and 0.140 +/- 0.01 g/cm(3), and for the controls, 0.178 +/- 0.03 and 0.192 +/- 0.02 g/cm(3). Although areal BMD was significantly lower in the LS and osteopenic subjects compared with controls (P < 0.02) at both the lumbar spine and femoral neck, BMAD was low (P < 0.01) in the osteopenic group only. In conclusion, DEXA does not seem to be a reliable measure of osteoporosis in patients with LS.     

Actual Colonic Perforation in Virtual Colonoscopy: Report of a Case

Computed tomography colonography, also termed virtual colonoscopy, is a new imaging method to investigate the colon, which may be a potential alternative to the conventional endoscopic colonoscopy in some cases. The high safety profile of this imaging method was considered as an additional advantage of this procedure. A case of colonic perforation in computed tomography colonography is presented, highlighting a potential risk related to this procedure. It is assumed that perforation was the result of overinflation of air into an obstructed colon caused by a lesion at the rectosigmoid junction. Thus, it is suggested that in such cases, air insufflation should be gradual, thereby minimizing the risk of perforation.     

Inhibition of concanavalin A-induced acute T cell dependent hepatic damage in mice by hypothyroidism

Abstract: Aims/Background: Concanavalin A (Con A) activates T lymphocytes and causes acute T-cell-mediated hepatic injury in mice. Decreased thyroid hormonal production is associated with a variety of immunological manifestations, including inactivation of macrophages with reduced TNF production and reduced soluble IL-2 receptors in the serum. We have recently shown that hypothyroidism prevents the development of cirrhosis and also minimizes hepatic damage in rats with fulminant hepatic failure. In the present study we examined the effects of hypothyroidism on a mouse model of Con A induced T cell-mediated acute hepatitis. Methods: Hypothyroidism was induced both medically (MMI, PTU) and surgically. Eight groups of 10 mice each were studied: euthyroid controls (2 groups: water, Con A) and hypothyroid (6 groups: MMI, PTU, Surgical, MMI-Con A, PTU-Con A, Surgical-Con A). Results: Hepatic inflammation was significantly decreased in each of the Con A treated hypothyroid groups of mice. The serum transaminases, TNF-α and IL-6 levels were significantly elevated in the Con A treated group while near normal levels were found in the hypothyroid Con A treated groups (mean±SE AST: 1499±18 vs 78±10 IU/1, p<0.001; TNF: 2500±250 vs 135± 15 pg/ml. p<0.001, IL-6: 12,200±300 vs 1260±140 pg/ml, p<0.001, respectively). Conclusions: Hypothyroidism, independent of the mode of induction, can effectively inhibit the development of acute T cell-mediated liver damage in mice. These results suggest that some decrease in thyroid function might have a role in the prevention of immune mediated liver diseases.