Oxidative stress due to anesthesia and surgical trauma: importance of early enteral nutrition.

Anesthesia and surgical trauma are considered major oxidative and nitrosative stress effectors resulting in the development of SIRS. In this study we evaluated the usefulness of early enteral nutrition after surgical trauma. Sixty male Wistar rats were subjected to midline laparotomy and feeding-gastrostomy.

Retroperitoneal compartment pressure elevation impairs pancreatic tissue blood flow.

Objectives: To investigate whether the increase of the retroperitoneal compartment pressure, as in the case of peripancreatic fluid accumulation in severe acute pancreatitis, simulated by infusing a colloid fluid into the retroperitoneum, has any effect on pancreatic tissue blood flow.

Methods: Six male anesthetized swine were subjected to a transcutaneous placement of catheters into the retroperitoneal space. Through these catheters, a colloid solution was infused, under continuous retroperitoneal pressure monitoring, to achieve a pressure up to 20 mm Hg.

Enteral nutrition affects nitric oxide production in peripheral blood and liver after a postoperative lipopolysaccharide-induced endotoxemia in rats.

Objectives: Sepsis is a common complication in the early postoperative period, leading to the augmentation of oxidative and nitrosative stresses. The present study investigated the role of enteral nutrition on nitric oxide (NO) production after a lipopolysaccharide (LPS)-induced endotoxemia as an index of nitrosative stress.

Methods: Fifty rats were subjected to midline laparotomy and feeding gastrostomy.

Benefits of a synbiotic formula (Synbiotic 2000Forte) in critically Ill trauma patients: early results of a randomized controlled trial.

Background: Since probiotics are considered to exert beneficial health effects by enhancing the host's immune response, we investigated the benefits of a synbiotics treatment on the rate of infections, systemic inflammatory response syndrome (SIRS), severe sepsis, and mortality in critically ill, mechanically ventilated, multiple trauma patients. Length of stay in the intensive care unit (ICU) and number of days under mechanical ventilation were also evaluated.

Method: Sixty-five patients were randomized to receive once daily for 15 days a synbiotic formula (Synbiotic 2000Forte, Medipharm, Sweden) or maltodextrin as placebo.

Hepatic microcirculation after continuous 7-day elevated intra-abdominal pressure in cirrhotic rats.

It is well known that IAP elevation, even at the level of 10mmHg used for laparoscopic surgery leads to an increase in portal pressure and decrease in portal blood flow. Since hepatic hemodynamics are already disturbed in cirrhotics, we decided to investigate the possible role of chronically elevated intra-abdominal pressure thus simulating ascites under tension-in liver perfusion and function in cirrhotic portal hypertensive rats. Four groups of 10 rats each were studied, including two control and two CCl(4)(-) induced cirrhotic groups.

Endoprosthesis implantation at the pharyngo-esophageal level: problems, limitations and challenges.

Aim: To present our experience with endoscopic placement of an esophageal endoprosthesis in 19 patients.

Methods: A retrospective evaluation was made for the use of 19 stents positioned at the level of the cervical esophagus: 11 for malignant tumours (7 causing obstruction, 4 complicated by an esophago -tracheal or -cutaneous fistula), and 8 for an acquired benign tracheo-esophageal fistula due to prolonged intubation. The covered Ultraflex stent was used in all cases except two.

The influence of continuous seven-day elevated intra-abdominal pressure in the renal perfusion in cirrhotic rats.

Since hepatorenal syndrome is a functional renal failure due to renal ischemia in cirrhotics with refractory ascites, we investigated whether increased intra-abdominal pressure (IAP) impairs the renal function and perfusion in cirrhotic portal hypertensive rats. Eight groups of 32 rats each were studied, including 4 control and 4 CCl(4) cirrhotic groups. These were subdivided into two groups each, with and without an increased IAP, and further subdivided into groups of rats with and without NO inhibition.

Therapeutic fistuloscopy: an alternative approach in the management of postoperative fistulas.

Background/aim: Since the treatment of postoperative fistulas remains a difficult problem, we applied endoscopic treatment in such 14 persistent fistulas.

Methods: Fourteen patients presented with postoperative fistulas: 7 patients (low-output group) due to residual cavity after liver hydatid disease surgery and 7 patients (high-output group) after small-bowel resection (n = 3), diverted duodenostomy (n = 1), vertical gastroplasty (n = 1), external pancreatic cyst drainage (n = 1), and transduodenal sphincteroplasty (n = 1). The therapeutic procedures included mechanical removal of silk sutures, necrotic material, and hydatid membranes in the low-output group and fibrin sealing in the high-output group.