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Parpoudi S, Mantzoros I, Gkiouliava A, Kyziridis D, Makrantonakis A, Chatzakis C, Gekas C, Konstantaras D, Ioannidis O, Bitsianis S, Miliaras D, Aggelopoulos S. The effect of N-acetyl-l-cysteine on inflammation after intraperitoneal mesh placement in a potentially contaminated environment: Experimental study in the rat. Asian J Surg 2021; 45:2191-2196. [PMID: 34801356 DOI: 10.1016/j.asjsur.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use of prosthetic meshes in abdominal wall reconstruction is a well-established approach; however, in certain cases where a bowel resection coexists its application is disputed. Any underlying inflammatory process may augment adhesion formation which is a major postoperative complication. In this animal study, our aim was to investigate the effect of N-acetyl-l-cysteine (NAC) on adhesion formation and the expression of inflammatory markers when a mesh was used in a clean or a potentially contaminated environment. METHODS Sixty male Wistar rats were randomly and equally allocated in 3 groups: A, B and C. Animals in all groups underwent laparotomy, a prosthetic mesh was placed and chemoprophylaxis with ciprofloxacin was administered. In groups B and C an enterectomy was also performed. NAC was injected intraperitoneally in group C. Adhesion formation, IL-1a, IL-6, TNF-a and histological data including fibrosis, neutrophils' infiltration and neovascularization were assessed. Mesh samples were sent for cultivation. RESULTS Adhesion formation was significantly less and inflammation markers were also lower in group C compared to group B (p<0.05). Histological findings were significant for greater fibrosis, neutrophils' infiltration and neovascularization in group B compared to both group A and C. Regarding mesh cultures, more specimens were tested positive in group B (p <0.05). Outcomes between group A and C did not differ. CONCLUSION NAC effectively ameliorated adhesion formation and inflammation in a potentially septic environment where a prosthetic mesh was placed.
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Affiliation(s)
- Styliani Parpoudi
- 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Mantzoros
- 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Gkiouliava
- Anaesthesiology Department, Georgios Papanikolaou General Hospital, Thessaloniki, Greece.
| | - Dimitrios Kyziridis
- 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Makrantonakis
- 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Chatzakis
- 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Gekas
- Orthopaedic Department, Ippokrateio Hospital, Thessaloniki, Greece
| | - Dimitrios Konstantaras
- 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Orestis Ioannidis
- 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Bitsianis
- 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimosthenis Miliaras
- Laboratory of Histology-Embryology, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stamatios Aggelopoulos
- 4th Surgical Clinic, School of Medicine, Faculty of Health Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tsalis K, Parpoudi S, Kyziridis D, Ioannidis O, Savvala NA, Antoniou N, Symeonidis S, Konstantaras D, Mantzoros I, Pramateftakis MG, Kotidis E, Angelopoulos S. Klatskin tumors and "Klatskin-mimicking lesions": our 22-year experience. Rev Esp Enferm Dig 2018; 111:121-128. [PMID: 30421957 DOI: 10.17235/reed.2018.5749/2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background and study purpose: Hilar cholangiocarcinoma, also known as Altemeier-Klatskin tumor, is a rare malignancy that arises in the confluence of the hepatic ducts of the porta hepatis. The prognosis is rather poor. Several lesions mimic these tumors and lead to a misdiagnosis, resulting in radical hepatic resections. These lesions are known as Klatskin-mimicking lesions. We present our experience with the diagnosis and treatment of pathological lesions that can mimic a perihilar cholangiocarcinoma and establish an algorithm of treatment Methods: For the current retrospective study, a prospectively established bile-duct tumor database was analyzed by selecting patients with a preoperative diagnosis of perihilar cholangiocarcinoma. Results: In the last 22 years (from January 1, 1996, to December 31, 2017), 73 patients who were referred to our tertiary center with a primary diagnosis of a Klatskin tumor were treated. All patients underwent a thorough evaluation before deciding upon the treatment. However, only 58 cases had a confirmed preoperative diagnosis of hilar cholangiocarcinoma in the final histopathological examination. The final diagnosis in 15 patients differed from the primary cause for referral and the lesions were regarded as Klatskin-mimicking lesions. Conclusions: Clinicians should always highly suspect Klatskin-mimicking lesions when they evaluate a patient for a possible hilar cholangiocarcinoma in order to avoid a misdiagnosis and propose a proper treatment.
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Affiliation(s)
- Konstantinos Tsalis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki , Gre
| | - Styliani Parpoudi
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki , Gre
| | - Dimitrios Kyziridis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki ,
| | - Orestis Ioannidis
- Fourth Surgical Department, Medical School Aristotle University Thessaloniki, Greece
| | - Natalia-Antigoni Savvala
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki , Gre
| | - Nikolaos Antoniou
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki ,
| | - Savvas Symeonidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki , Gre
| | - Dimitrios Konstantaras
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki ,
| | - Ioannis Mantzoros
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki , Gre
| | | | - Efstathios Kotidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki , Gre
| | - Stamatios Angelopoulos
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki , Gre
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Tsalis K, Ioannidis O, Cheva A, Antigoni Savvala N, Antoniou N, Parpoudi S, Kyziridis D, Tatsis D, Konstantaras D, Kitsikosta L, George Pramateftakis M, Kotidis E, Avgerinos A, Mantzoros I. A 20-year single center experience in the surgical treatment of colorectal liver metastasis. J BUON 2018; 23:1640-1647. [PMID: 30610788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To present our experience in the treatment of patients with liver metastases from colorectal cancer. METHODS The surgical and histopathological records of our department dating from 1st January 1997 to 31 December 2016 were examined, searching for patients who have undergone surgical treatment of colorectal liver metastasis. RESULTS A total of 90 patients with colorectal liver metastases were treated in the last 20 years in our department. Their mean age was 65.28 years and 54 (60%) were male. The primary tumor was in the colon in 71 patients (78.9%) and in 19 (21.1%) patients in the rectum. Thirty-six (40%) patients presented with synchronous metastatic liver disease, from which 27 were subjected to simultaneous resection, 2 underwent a liver-first approach and 7 were subjected to resection of primary tumor first. Regarding the number of metastases 67 (74.4%) patients had single metastasis, 12 (13.3%) had 2 lesions, 4 (4.4%) had 3 lesions and 7 (7.8%) had 4-8 lesions. In-hospital and 30-day mortality was 3.85%. Median survival was 41 months. CONCLUSION Surgical resection is the treatment of choice for the management of liver metastasis from colorectal cancer and can be safely performed. Follow up of patients with colorectal cancer is imperative as metachronous metastasis presents in a significant percentage of patients with negative locoregional lymph nodes of the primary tumor. The order of resection doesn't seem to alter outcome in synchronous metastasis. Recurrence is common and re-resection if feasible is the only chance of cure.
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Affiliation(s)
- Konstantinos Tsalis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Despoudi K, Mantzoros I, Ioannidis O, Cheva A, Antoniou N, Konstantaras D, Symeonidis S, Pramateftakis MG, Kotidis E, Angelopoulos S, Tsalis K. Effects of albumin/glutaraldehyde glue on healing of colonic anastomosis in rats. World J Gastroenterol 2017; 23:5680-5691. [PMID: 28883693 PMCID: PMC5569282 DOI: 10.3748/wjg.v23.i31.5680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 06/08/2017] [Accepted: 07/24/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate the effect of local surgical adhesive glue (albumin/glutaraldehyde-Bioglue) on the healing of colonic anastomoses in rats.
METHODS Forty Albino-Wistar male rats were randomly divided into two groups, with two subgroups of ten animals each. In the control group, an end-to-end colonic anastomosis was performed after segmental resection. In the Bioglue group, the anastomosis was protected with extraluminar application of adhesive glue containing albumin and glutaraldehyde. Half of the rats were sacrificed on the fourth and the rest on the eighth postoperative day. Anastomoses were resected and macroscopically examined. Bursting pressures were calculated and histological features were graded. Other parameters of healing, such as hydroxyproline and collagenase concentrations, were evaluated. The experimental data were summarized and computed from the results of a one-way ANOVA. Fisher’s exact test was applied to compare percentages.
RESULTS Bursting pressures, adhesion formation, inflammatory cell infiltration, and collagen deposition were significantly higher on the fourth postoperative day in the albumin/glutaraldehyde group than in the control group. Furthermore, albumin/glutaraldehyde significantly increased adhesion formation, inflammatory cell infiltration, neoangiogenesis, and collagen deposition on the eighth postoperative day. There was no difference in fibroblast activity or hydroxyproline and collagenase concentrations.
CONCLUSION Albumin/glutaraldehyde, when applied on colonic anastomoses, promotes their healing in rats. Therefore, the application of protective local agents in colonic anastomoses leads to better outcomes.
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Affiliation(s)
- Kalliopi Despoudi
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Ioannis Mantzoros
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Orestis Ioannidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Aggeliki Cheva
- Department of Pathology, General Hospital “G. Papanikolaou”, 57010 Thessaloniki, Greece
| | - Nikolaos Antoniou
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Dimitrios Konstantaras
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Savvas Symeonidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | | | - Efstathios Kotidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Stamatis Angelopoulos
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Konstantinos Tsalis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
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