Pre-and Postoperative Periods Research Articles

Arthroereisis with interference screw in flexible flatfoot, a comparison with the conventional surgical technique

Objective: To evaluate functional results of subtalar arthroereisis with non-conventional implants, as well as their clinical, radiographic, and functional results, comparing them with those of the conventional technique. Methods: Documentary research consisting of the analysis and review of medical records of six patients, with application of the Orthopaedic Foot and Ankle Score (AOFAS) and Short Form Health Survey 36 (SF-36) questionnaires and evaluation of pre-and postoperative radiographic results. Results: Patients achieved satisfactory clinical and functional results, indicated by an improvement in the pitch, kite, Giannestras, and Meary angles analyzed and by comparing the pre-and postoperative periods. There was also an improvement in the AOFAS and SF-36 questionnaire scores postoperatively, suggesting an evolution in the quality of life of patients studied. Conclusion: Subtalar arthroereisis is a non-invasive surgical procedure that contributes to the clinical improvement of patients. The use of interference screw showed good results, with the advantage of it being a low-cost implant when compared to the conventional ones, which makes the procedure more accessible. Level of Evidence III; Therapeutic Studies; Case control study.

Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses.

Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.

Perioperative hemorheological status of oncological patients with primary knee replacement

Introduction. Endoprosthesis of large joints is associated with high risk of venous thromboembolism. Researchers focus on biochemical characteristics of homeostasis, blood clotting in particular, as the main reason for abnormal blood flow. At the same time, biophysical condition of homeostasis, namely decreased blood fluidity, is rarely considered. Study of rheological behavior of blood after primary oncological endoprosthesis of large joints in patients can potentially affect the selection of perioperative thromboprophylaxis and patient rehabilitation approach.Aim. To study the indicators of the hemorheological status of patients with tumours of long bones in the preand postoperative periods of primary oncological knee replacement.Materials and methods. The study included 36 patients (26 men and 10 women, mean age 46 years) without cardiovascular diseases and pathology of the veins of the lower limb admitted to the Russian Scientific Center of Roentgen Radiology for oncological endoprosthesis of the knee joint. All patients were prescribed: an antiplatelet agent (acetylsalicylic acid) and an anticoagulant (enoxaparin sodium 40 mg daily). Distal resection of the femur (on average 14 cm) was performed in 28 patients, and proximal resection of the tibia (on average 12 cm) in 8 patients, followed by knee replacement. Before the operation, on the 1st and 6th days after the operation, the hemorheological status and the state of the hemostasis system were evaluated in all patients. To determine the reference values, 24 healthy people were examined, comparable in gender and age. Statistical analysis using Statistica 10.0.Results. During the preoperative examination, integral assessment showed the differences in the severity of hemorheological disorders between patients, and two groups were identified: Group 1 – 21 (61 %) patients whose hemorheological disorders were classified as severity degree I, and Group 2 – 14 (39 %) patients with severity degree II d. On day 1 after the surgery, both patient groups showed negative dynamics: hemorheological disorders in group 1 worsened from grade I to II d., and in group 2 to III d. (critical) (p <0.05). On day 6, the parameters did not change significantly in all patients. Similar dynamic changes were observed in the haemostasis system.Conclusion. Activation of the blood coagulation system and deterioration of hemorheology occurred after surgery during administration of anticoagulant and antiplatelet therapy. None of the patients had venous thromboembolic complications, however the risk of their development remained high. A differential model describing hemorheological status can be useful for selection of thromboprophylaxis and rehabilitation methods which include physical factors that improve the hemorheological profile: low-frequency magnetic and/or laser therapy in patients.

Prostate spindle cell neoplasm associated with early voiding difficulty after transurethral resection of the prostate

This report presents the case of 75-year-old men with spindle cell neoplasm. The patient underwent percutaneous nephrolithotomy and transurethral resection of the prostate (TURP) for renal stones and benign prostatic hyperplasia. One month postoperatively, the patient was able to void without any difficulty. Five months later, the patient experienced difficulty voiding and presented to the emergency room with severe pelvic pain. Computed tomography (CT) showed regrowth of the prostate mass into the posterior bladder and penile root. The prostate-specific antigen level remained constant at 1.14 ng/mL during the pre-and postoperative periods. Five months before the TURP operation, the patient’s CT scan showed a soft and mildly enlarged prostate with no protrusion into the bladder. Biopsy of the prostate, however, showed a protruding mass, indicative of a spindle cell neoplasm. The patient was subsequently treated with the chemotherapeutic drug adriamycin. Unfortunately, treatment was unsuccessful, and the patient died 18 months later.

Bariyatrik Cerrahi Sonrası Dürtü Kontrol Problemleri ve Fluoksetin Tedavisiyle Ekstrapiramidal Yan Etki Gelişen Bir Olgu Sunumu

Although bariatric surgery is an effective method used in the treatment of obesity today, many psychiatric difficulties are detected when patients are evaluated biopsychosocially during the pre-and postoperative periods. Especially when surgery is used in patients with eating disorders, different addiction problems and impulse control disorders may arise afterward. We present a clinical case of a patient with increased obsessive-compulsive symptoms, various impulsive control problems, and bulimia nervosa starting after bariatric surgery. Another feature that made this case interesting was the extrapyramidal adverse effects that occurred after fluoxetine treatment used for her psychiatric treatment. Our aim, thus, was to contribute to the literature by discussing psychiatric problems evolving after bariatric surgery and the rare adverse effect of fluoxetine.

Circulating ciRS-7 as a potential non-invasive biomarker for epithelial ovarian cancer: An investigative study.

BackgroundOvarian cancer (OC) is the most common malignant neoplasm of the female reproductive system in developed countries. Early detection, diagnosis and prognosis are particularly important to OC. The potential of circulating circular RNAs (circRNAs) as non-invasive biomarkers of various tumors has been especially described in recent years. The aim of this study was to explore the diagnostic and prognostic value of circulating cirRS-7 in patients with epithelial ovarian cancer (EOC).MethodsPre- and postoperative plasma samples from 111 EOC patients (47 cases with FIGO stage IA-IIB and 64 cases with FIGO stage IIB-IV) and healthy female volunteers was collected. Circulating ciRS-7 and hsa-miR-7-5p was analyzed using reverse transcription polymerase chain reaction (qRT-PCR). The diagnostic and prognostic value of circulating cirRS-7 as biomarker was estimated by the Receiver Operating Characteristic (ROC) curve and the area under the curve (AUC) and Kaplan–Meier analysis.ResultsThe preoperative expression levels of circulating ciRS-7 were increased in plasma of EOC FIGO stage I-IV patients than in the healthy controls (p < 0.001). However, the expression levels of ciRS-7 in the postoperative period were significantly lower in EOC FIGO stage IIA-IIA patients than healthy controls and EOC FIGO stage IIB-IV patients (p < 0.05, p < 0.001). The AUC of ciRS-7 for diagnosing EOC FIGO stage I-IV patients in pre-and postoperative periods was 0.90, 0.92, 0.84, 0.88, 0.58 and 0.86, respectively. Higher circulating ciRS-7 expression is associated with lymph node invasion, FIGO stage, distant metastasis, and worse overall survival (OS) of patients. Moreover, multivariate Cox analysis showed that higher circulating ciRS-7 was an independent predictor of OS in EOC FIGO stage IIB-IV patients. In addition, in plasma of EOC patients, ciRS-7 negatively correlated with has-miR-7-5p in pre-and postoperative periods (p < 0.001).ConclusionsCirculating ciRS-7 levels in plasma can be considered a potential candidate biomarker for diagnosing EOC patients. Dysregulation of ciRS-7 may participate in the molecular mechanism of EOC through hsa-miR-7-5p sponging.

ARE SOME INFLAMMATORY MARKERS BETTER THAN OTHERS AT DETERMÄ°NING GASTRÄ°C CANCER PROGNOSIS?

Purpose: In patients with stomach cancer, the inflammatory response of the host, and tumor markers, play essential roles in determining the prognosis. This study aimed to predict prognosis in previously untreated gastric cancer patients using inflammatory markers. Materials and Methods: This retrospective study evaluated 100 patients with stomach cancer, treated between 2015 and 2018. Pre-and postoperative blood samples were analyzed for the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), the systemic inflammatory index (SII), and other immune markers. Results: The survival rate was significantly higher in patients with an SII level &amp;amp;lt; 1190.4 compared to patients with an SII level &amp;amp;gt; 1190.4 (p &amp;amp;lt; 0.05). The disease-free survival was 47.7 months in the group with a low SII (84.4%) and 37 months in the group with a high SII (80%). In the ROC analysis, the AUC for NLR, PLR, and SII was 0.611, 0.65, and 0.64, respectively (p-values: 0.058, 0.010, and 0.011). The preoperative values were not significant; however, the postoperative values were significant for prognosis. Conclusion: During the pre-and postoperative periods, analysis of the inflammatory markers (NLR, PLR, and SII) guides the treatment and follow-up as much as the histopathological features of the tumor. High NLR and SII levels shortened overall survival during the 4-year follow-up.

The effect of virtual reality on Children's anxiety, fear, and pain levels before circumcision

Circumcision is one of the oldest and most frequently performed surgical interventions in many societies across the world. Boys undergoing this procedure experience anxiety and fear during the preoperative period. In addition, postoperative pain in children is reported to be associated with anxiety and fear. This study aimed to examine the effects of using virtual reality (VR) intervention before circumcision on the pre-and postoperative anxiety and fear levels and postoperative pain symptoms in children. This randomized controlled experimental study included 5-10-year-old boys referred to a pediatric hospital for circumcision between June and September 2019. Randomization was performed using the randomized block design, and the subjects were divided into control (n=38) and experimental (n=40) groups. The data were collected using a participant information form, the children's fear scale (CFS), the children's anxiety meter scale (CAM-S), and the Wong-Baker Faces Pain Rating Scale (WBS); data were analyzed using SPSS 22.0 package program. Of the children included in the study, 59% were between the ages of five and six years and 78.2% had no previous hospital experience. Children in the experimental group had significantly lower mean scores of CAM-S and CFS in the pre-and postoperative periods than those in the control group. Also, the mean postoperative WBS score was significantly lower in the experimental group than in the control group. Results of this study were similar to those reported previously that VR interventions were effective in reducing fear and anxiety in the preoperative period (Dehghan etal., 2019, Ryu etal., 2018; Olbrechta etal., 2020). Previous studies have shown that patient immersion in interactive VR provides a distraction from painful stimuli and can decrease an individual's perception of the pain (Pouarmand etal., 2018; Chad etal., 2018). Distracting children using a VR intervention before circumcision decreased their anxiety and fear both before and after the surgery, and it was found that the pain symptoms were lower in the postoperative period.

Anterior Cervical Discectomy fusion: Cervical PEEK Cage vs Dynamic Cervical Implant

Background: There are wide treatment modalities for degenerative disc diseases of cervical spines. However, surgery is indicated when conservative treatment fails, and each procedure had its limitation. Aim of the work: to compare the outcome between cervical peek cage and dynamic cervical implant for anterior cervical discectomy fusion (ACDF) for patients with degenerated cervical disc disease. Patients and methods: Fifty patients with degenerative disk disease (DDD) were treated by cervical poly- etherether-ketone (PEEK) cage (25 patients) and another 25 with dynamic cervical implant (DCI). All patients assessed pre- and post-operatively by clinical and radiological examinations, with pain assessment by visual analogue scale and calculation of the range of motion. Any neurological deficits were documented in both pre-and post-operative periods. Results: Both groups were comparable regarding patient characteristics, preoperative pain and preoperative range of motion. The mean percentage of pain reduction was significantly higher among PEEK when compared to DCI group (81.93±7.07 vs 66.23±11.48 respectively). In DCI group, preoperative mean range of motion at the operated level was 7.56, changed to 6.64 postoperatively, which is statistically significant. Similarly, in PEEK cage group, preoperative mean range of motion at operated level was 7.60 Changed to 7.52 which is statistically non-significant. Complications were mild and treated conservatively. Conclusion: PEEK cage is associated with better alleviation of pain either at the neck or arm pain. On the other side, DCI is associated with slightly better range of motion. However, global range of motion is comparable between both groups.

Radiological Examination of Postoperative Cervical Alignment and Stability in Patients with Dialysis-Associated Spondylosis Excluding Destructive Spondyloarthropathy: Comparison with Patients with Cervical Spondylotic Myelopathy.

Introduction Several reports have demonstrated the surgical treatment strategy for patients with dialysis-associated spondylosis in the cervical spine (CDAS) with destructive spondyloarthropathy (DSA). However, studies focusing on the clinical outcome of patients with CDAS without DSA remain scarce. We aimed to review the treatment strategy of patients with CDAS but without DSA. Methods The clinical data and surgical records of consecutive patients with CDAS without DSA (n = 9; D-group) and cervical spondylotic myelopathy (CSM) (n = 30; C-group) who underwent modified double-door laminoplasty(DDL) were reviewed retrospectively. We investigated four radiologic factors in the pre-and postoperative periods that have been reported to be the risk factors for worsening of clinical symptoms in various studies and examined statistical comparison between the D and C groups. Results In the D group, the pre- versus postoperative C2-C7 sagittal angles were not significantly different, and only two patients (22%) had kyphosis postoperatively. There was a significant difference in the pre- and postoperative C2-C7 angles in the two groups (P = 0.031). Regarding the change in segmental alignment, the local open angle increased at the C4/C5 level in the D group. Also there was a significant difference in the local angles between the two groups at C4/5 and C5/6 (P = 0.00038, and 0.037), suggesting that postoperative segmental mobility at C4/5 and C5/6 was higher in the D group than in the C group. Conclusions In the present study, DDL in patients with CDAS without DSA did not adversely affect the postoperative alignment and stability compared with CSM patients with CSM. However, patients in the D group may have a chance to develop DSA change at the C4/5 level in the future, and careful long-term follow-up is warranted.

The outcomes of transurethral incision/resection of the prostate (TUIP/TURP) performed early after renal transplantation.

In the early period after renal transplantation, urinary retention stemming from bladder outlet obstruction (BOO) may directly affect graft success. The aim of this study was to evaluate the early and long-term outcomes of transurethral resection of the prostate (TURP) and transurethral incision of prostate (TUIP) procedures performed in the first month following RT due to BOO. Between February 2009 and March 2016, 38 male patients underwent TURP/TUIP due to BOO within the first 30 days of renal transplantation. The urodynamic and renal function assessment results of all patients were collected during the pre-and postoperative periods. All patients were followed up for a minimum of 12 months for short and long-term complications. The results were evaluated retrospectively. The mean age of the patients who underwent operations was 59.2±12 years. The median duration of dialysis was 41 months (range 0-180). Before the operation the mean serum creatinine (sCr) level was 1.8±0.7 mg/dL, the mean total PSA level was 1.6±1.1 ng/mL. Of the voiding parameters, the mean Qmax and Qave were measured as 8.2±4.5 mL/sec and 4.6±2.5 mL/sec, respectively. The median post-micturition residual urine (PMR) was 105 mL (range 10-400). TURP/TUIP operations were performed at a median of 19 days (range 8-30) after renal transplantations. None of the patients experienced major complications. In the early postoperative period, 5 patients (13.1%) developed urinary tract infection. The mean decrease in sCr in the first month following TURP/TUIP was 1.4±0.4 mg/dL (p<0.001). The mean Qmax (22.4±11.1 mL/sec), and Qave (11.7±5.4 mL/sec) increased significantly (p<0.001), while the median PMR (15 mL, range 0-205) decreased significantly (p<0.001). The mean follow-up period after the procedure was 46.8±23.3 months. During the follow-up period, 3 (7.8%) patients suffered from urethral stricture and 2 (5.2%) patients from bladder neck obstruction. In the surgical treatment of urinary retention arising from BOO in the first month following renal transplantation, TURP/TUIP yield safe and successful results. In addition, regarding the short and long term outcomes, these procedures may be safely performed with low morbidity.

К ВОПРОСУ ОБ УЛУЧШЕНИИ ИСХОДОВ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПРОЛАПСА ГЕНИТАЛИЙ В ПОСТМЕНОПАУЗЕ

Currently, the frequency of genital prolapse in the structure of common gynecological diseases has no tendency to decrease and may take up to 15% of large gynecological operations. With the aim of improving outcomes of surgical treatment of this category of patients, at the stage of preoperative preparation and the postoperative period used vaginal capsules containing Lactobacillus + progesterone 2 mg + estriol 0.2 mg (Triozhinal). The study included 239 patients in postmenopausal women with genital prolapse and phenomena cystourethroscopy and vaginal atrophy. Of these, the main group consisted of 122 women who underwent the proposed scheme of preoperative preparation and postoperative period. Group comparisons were presented 117 patients admitted to the gynecological Department for surgical treatment of prolapse with traditional preoperative and postoperative management. The results of the study showed that in the group of patients receiving local therapy estriola in combination with progesterone and lactobacilli, was observed a significant improvement of the clinical picture of urinary disorders, quality of life, symptoms of urogenital atrophy during surgical correction of urinary incontinence or genital prolapse, and this tactic can be recommended as in the pre-and postoperative periods.

ЛІКУВАЛЬНА ТАКТИКА ТА ІНТЕНСИВНА ТЕРАПІЯ В ДООПЕРАЦІЙНОМУ ТА РАННЬОМУ ПІСЛЯОПЕРАЦІЙНОМУ ПЕРІОДАХ У НОВОНАРОДЖЕНИХ ДІТЕЙ З ГАСТРОШИЗИСОМ.

&lt;p&gt; Дана робота присвячена аналізу проведення інтенсивної терапії новонароджених дітей з гастрошизисом в до- та післяопераційному періодах.Показано переваги даної'тактики та її ефективність в зниженні летальності дітей з гастрошизисом.&lt;br /&gt;&lt;br /&gt;&lt;/p&gt;

Health-related quality of life outcome of children with prominent ears after otoplasty

To investigate health-related quality of life changes that occurred in children with prominent ears applied pre- and postoperatively. A prospective study was performed in 67 consecutive children who underwent otoplasty procedures between April 2008 and July 2010 and followed up for more than 2 years. Evaluations and interviews performed in the pre-and postoperative periods included the patients' history, clinical and routine laboratory examinations. Glasgow children's benefit inventory was the basis of the used inquiry for detecting the changes in health-related quality of life after otoplasty. For the children's cohort, the mean total Glasgow children's benefit inventory score was 23.9 (p < 0.001), indicating a benefit from the operation. All Glasgow children's benefit inventory subscores (emotion, physical health, learning, and vitality) were raised (mean 30.84, 14.98, 18.89, and 23.96, respectively). The health-related quality of life was raised in 63 of 67 children (94.03%). Negative Glasgow children's benefit inventory scores or subscores were not found in a single case. Otoplasty can significantly increase patients' health-related quality of life and leads to a high rate of patient satisfaction in children with prominent ears.

Профилактика и лечение осложнений у больных с позвоночно-спинномозговой травмой (часть 1)

The various types of complications at patients with spinal trauma are described. The data concerning etiology, pathogenesis, clinical signs of complications related to course of traumatic disease of spinal cord are presented. The pyoinflammatory and vascular complications in pre-and postoperative periods as well as the data concerning the features of microflora at patients with spinal trauma are listed. The periods of various complications development are presented in relation to severity of spinal cord trauma, presence of concomitant injury as well as to trauma periods and surgical treatment. The prevention measures for avoiding complications in pre-and postoperative periods are presented. The technical complications of operative interventions on vertebral column and spinal cord connected with surgical approaches, implants placement, performance of corporectome and/or laminectomy for all vertebral levels are described in details. The data concerning various delayed complications in postoperative period because of spondylodesis failure as well as fracture and dislocation of fixators are also described.

ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА ФАКТОРІВ РИЗИКУ

&lt;p&gt;To optimize the therapeutic tactics and improve the treatment of peritonitis on the basis of retrospective analysis there are determined the significant risk factors: female gender, age 60 – 90 years, time to hospitalization for more than 48 hours, a history of myocardial infarction, stroke, cardiac arrhythmia, biliary, fecal and fibrinous purulent exudate, the terminal phase flow, operations with resection of the intestine and postoperative complications such as pulmonary embolism, myocardial infarction, pleurisy, early intestinal obstruction. Changes in the electrolyte composition of blood and lower albumin &amp;lt;35 % of high risk prognostic course of peritonitis that requires immediate correction in the pre-and postoperative periods. The combination of three or more risk factors for various systems, creating a negative outlook for further treatment and the patient's life.&lt;/p&gt;

Análise radiológica da degeneração discal experimental em coelhos

OBJETIVO: Validar a avaliação radiográfica da degeneração discal experimental em coelhos. MÉTODOS: Os discos intervertebrais lombares de coelhos New Zealand foram puncionados três vezes com uma agulha 18G com profundidade limitada de 5mm, através de abordagem lateral. Foram realizadas radiografias seriadas pré e pós-operatórias imediatas, e depois de quatro, oito e 12 semanas do procedimento, com posterior análise da altura discal, formação de osteófito, esclerose da placa vertebral e presença de degeneração discal. A análise estatística dos dados foi validada pelo coeficiente de concordância Kappa, com intervalo de confiança (IC) de 95%. RESULTADOS: Observou-se diminuição significativa do espaço discal nas radiografias em AP após 12 semanas de pós-operatório, com Kappa = 0,489 para IC 95% (0,25-0,72) com p < 0,001. Os sinais radiográficos de degeneração discal também apresentaram valor de Kappa = 0,63 para IC 95% (0,39-0,86) com p < 0,001. Os demais critérios avaliados tiveram resultados positivos, porém, com menor valor de Kappa. CONCLUSÃO: O modelo de degeneração discal em coelhos proposto neste estudo mostrou-se factível, com correlação radiológica positiva entre as imagens pré e pós-operatórias, validando a possibilidade de indução de degeneração discal nesse modelo animal para futuros estudos.

RADIOLOGICAL ANALYSIS OF EXPERIMENTAL DISC DEGENERATION IN RABBITS

Objective: To validate radiographic evaluation of a rabbit model for disc degeneration. Methods: Lumbar intervertebral discs of New Zealand rabbits were stabbed three times with a 18G needle at a limited depth of 5mm, through lateral approach. Serial radiographic images were taken on the early pre-and postoperative periods, and after four, eight and 12 weeks of the procedure, with subsequent analysis of disc height, osteophyte formation, endplate sclerosis, and presence of disc degeneration. The statistical analysis of data was validated by the Kappa coefficient, with a confidence interval (CI) of 95%. Results: A significant reduction of disc space was found on AP X-ray images after 12 postoperative weeks, with Kappa = 0.489 for CI 95% (0.25-0.72) with p < 0.001. X-ray signs of disc degeneration also presented Kappa = 0.63 for CI 95% (0.39-0.86) with p < 0.001. The remaining assessed criteria showed positive results, but with a lower Kappa value. Conclusion: The disc degeneration model using rabbits as proposed in this study was shown to be feasible, with positive X-ray correlation between pre- and postoperative images, validating the potential to induce disc degeneration in this animal model for future studies.

P088 EFFECTS OF PROBIOTICS ON SYSTEMIC AND INTESTINAL MUCOSAL IMMUNITY IN SPLENECTOMIZED RATS

Rationale: The aim of this study was to investigate the effects of probiotics on the changes of both systemic immune response and intestinal immunity arising after splenectomy. Methods: In the study totally 56 Sprague-Dawley type female rats were used. Rats were divided into eight groups. According to groups they assigned, rats were given lowEPS strain producing Lactobacillus delbrueckii subspecies bulgaricus A13 or high-EPS strain producing Lactobacillus delbrueckii subspecies bulgaricus B3 probiotic strains preoperatively, postoperatively or during both preand postoperative periods. Splenectomy was performed on day 8 and rats were killed for blood collection and partial ileum resection on day 16. Results: Assessment of intestinal mucosal immunity demonstrated no histopathologically significant differences between the groups. There were, however, significant differences between the groups with respect to the levels of TNF-a, TGF-b, IL-4, IL-12 and IL-12/IL-4 (p < 0.05). The levels of IL-6 and IL-10 cytokines were found to be similar in all the groups. Moreover, A13 strain further stimulated the changes usually seen as an increase in the TGF-b levels and the decrease in the IL-4 levels after splenectomy. In splenectomized rats A13 strain probiotic also had effect to reduce the TNFa level. In B3 strain probiotic applied groups, the level of TNF-a was reduced while the level of TGF-b was increased. It was found that B3 strain lowered the levels of Th 1 and Th 2 cell cytokines IL-12, IL-4 and IL-10. B3 strain probiotic decreased IL-12 and TNF-a levels more effectively compared to the A13 strain probiotic. Conclusion: Splenectomy causes an immune suppressive situation and probiotics create an indirect antiinflammatory effect by regulating cytokines. Despite we detected no histologic changes, probiotics may support intestinal immunity indirectly by means of revealed cytokine profile.

The effect of immunonutrition on bacterial translocation, and intestinal villus atrophy in experimental obstructive jaundice

Background & aims: Spontaneous bacterial infection and septicemia due to increased bacterial translocation (BT) in patients with obstructive jaundice result in significant morbidity and mortality. The present study evaluates the effects of enteral nutrition with immune enhancing feeds on BT and intestinal villus histopathology promoted by obstructive jaundice. Methods: Fifty male Wistar-albino rats weighing 250–300 g were assigned into five equal groups of 10. Animals in Groups I, II, and III were fed with standard chow, those in Group IV were given glutamine 1 g/kg/day and the remaining 10 animals in Group V were fed with an arginine, ω-3 fatty acids, and RNA-supplemented enteral diet for (1 g/kg/day amino acid and 230 kcal/kg) 7 days preoperatively. Group I underwent sham operation and the remaining animals in all other groups underwent common bile duct ligation. After operation, Group I had standard chow, Groups II and IV had glutamine, Groups III and V had an arginine ω-3 fatty acids, and RNA-supplemented enteral diet for 7 days. All animals were sacrificed on the 8th postoperative day and evaluated both biochemically and histopathologically. Samples from blood, liver, mesenteric lymph nodes and spleen were cultured under aerobic conditions. Results: Significantly less BT was observed in groups fed with an arginine, ω-3 fatty acids, and RNA-supplemented enteral diet or glutamine in pre-and postoperative periods as compared to others ( P<0.001). Histologic evaluation also showed significant reduction in villus atrophy in these groups. Conclusions: Enteral immunonutrition using glutamine or arginine, ω-3 fatty acids, and RNA-supplemented enteral diet during both pre-and postoperative periods seems to reduce BT and decrease atrophy of intestinal mucosal villi in rats with obstructive jaundice.