OBJECTIVEThis study aimed to investigate the presence of indoleamine-2,3-dioxygenase and bacterial translocation after the administration of 3-aminobenzamide and infliximab in the TNBS model of rat colitis.METHODSThe study group was divided into five categories as follows: group 1: (control), group 2: colitis+saline, group 3: colitis+3-aminobenzamide, group 4: colitis+infliximab, and group 5: colitis+3-aminobenzamide+infliximab. Intestinal mesenteric cultures were incubated on specific agar media plates under aerobic and anaerobic conditions, bacterial translocation was evaluated and assessed as colony-forming units per gram of tissue. Colonic tissue samples were evaluated by Western blotting method to detect the presence of indoleamine-2,3-dioxygenase.RESULTSThe results obtained were as follows: group 1: normal gut flora; group 2: eight of nine samples had bacterial translocation, of which six of them had positive indoleamine-2,3-dioxygenase protein; group 3: five of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; group 4: three of nine samples had bacterial translocation, of which seven of them had positive indoleamine-2,3-dioxygenase; and group 5: only one sample had exact indoleamine-2,3-dioxygenase protein.CONCLUSIONAltered expression of indoleamine-2,3-dioxygenase results in a lower bacterial translocation via infliximab compared with 3-aminobenzamide treatment. Combined treatments emphasized different approaches for the new molecules related to indoleamine-2,3-dioxygenase.

Horseshoe kidney is one of the most common congenital fusion anomalies and may be an important option due to the limited donor pool for kidney transplantation. Horseshoe kidneys may be used for transplantation to selected patients with a single recipient or divided and transplanted into to separate receivers. A Graves Type 2 horseshoe kidney obtained from a cadaver was successfully transplanted into two recipients in our clinic. KEY wOrDS: Renal transplantation, Horseshoe kidney, Transplantation to two recipients

Primer hiperparatiroidi (PHPT); benign hiperkalseminin en sık nedenidir ve paratiroid bezlerinden aşırı parathormon (PTH) salınımı ile karakterizedir. PHPT olgularının yaklaşık %80-85'inde neden sporadik, tek paratiroid adenomudur. PHPT'de cerrahi, hâlen başlıca tedavi yöntemi olma özelliğini korumaktadır. Tek adenomlarda unilateral sınırlı cerrahi yaklaşım (minimal invaziv paratiroidektomi) giderek daha geniş kabul görmeye başlamıştır. Bu çalışmada, insidental tek paratiroid adenomu nedeni ile opere edilen ve erken dönemde nüks hiperparatiroidi gelişen bir olgu sunulmuştur. Klinik bulgular ve görüntüleme sonuçlarına göre nüks hiperparatiroidi sebebinin aynı lojda ikinci bir paratiroid adenomu olduğu anlaşılmış ve ikinci paratiroid adenomunun tedavisinde yardımcı bir cerrahi teknik olan ''radioguided occult lesion localization (ROLL)'' yöntemi kullanılmıştır. Bu çalışmada, paratiroid adenomlarının preoperatif görüntülenmesinde kullanılan yöntemler, görüntülemede hata kaynakları ve paratiroid cerrahisinde ROLL yönteminin kullanımı tartışılmıştır.

The innate immune network is responsible for coordinating the initial defense against potentially noxious stimuli. This complex system includes anatomical, physical and chemical barriers, effector cells and circulating molecules that direct component and system interactions. Besides the direct effects of breaching pulmonary protective barriers, cyclic stretch generated during mechanical ventilation (MV) has been implicated in the modulation of the innate immunity. Evidence from recent human trials suggests that controlling MV-forces may significantly impact outcome in acute respiratory distress syndrome. In this paper, we explore the pertinent evidence implicating biotrauma caused by cyclic MV and its effect on innate immune responses. Introduction The natural or innate immune system is present in some form in most living organisms and consists of mechanisms for defending the host against foreign invaders and for healing injured tissues. We now know that many of the mechanisms of resistance to infection are also involved in the individual’s response to noninfectious foreign substances and environmental stresses, including mechanical stretch. Furthermore, mechanisms that normally protect individuals and eliminate foreign substances are themselves capable of causing tissue injury and disease. This inherent defense network includes anatomical, physical and chemical barriers, circulating molecules, cells with specific phagocytic or lytic abilities, and soluble mediators that orchestrate the activities of each component and their interactions with the acquired immune system. Normally, this is a well integrated system of host defense and preservation of self-integrity, in which numerous cells and molecules function cooperatively. However, dysregulation of the fine balance between proinflammatory and anti-inflammatory stimuli may explain the pathophysiologic processes that underlie syndromes such as sepsis and acute lung injury (ALI) [1]. Although patients undergoing positive pressure mechanical ventilation may have impaired lung function, and possibly impaired systemic immune defenses by virtue of their underlying lung pathology, further dysregulation of natural defenses occurs in these patients. The presence of an endotracheal tube bypassing natural upper airway defenses, decrease or loss of coughing, paralysis of bronchial ciliae, alterations in surfactant and phagocyte and epithelial defensins – a critical first line antibacterial defense mechanism – all contribute to impairment in host defense [2–4]. Apart from the direct effects of breaching pulmonary protective barriers, cyclic stretch generated during mechanical ventilation has been implicated in the modulation of the innate immune system. In this short review we revisit some of the pertinent evidence exploring the relationship between biotrauma caused by cyclic mechanical ventilation and its effect on innate immune responses. This is not intended to be a comprehensive and structured review of the Review Bench-to-bedside review: Biotrauma and modulation of the innate immune response Claudia C dos Santos1, Haibo Zhang2, Mingyao Liu3 and Arthur S Slutsky4 1Clinical Associate and Post Doctoral Fellow, Departments of Medicine and Critical Care Medicine, St. Michael’s Hospital, and Inter-Departmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada 2Assistant Professor, Departments of Medicine and Critical Care Medicine, St. Michael’s Hospital, and Inter-Departmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada 3Professor, Departments of Medicine and Critical Care Medicine, St. Michael’s Hospital, and Inter-Departmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada 4Vice President of Research, Departments of Medicine and Critical Care Medicine, St. Michael’s Hospital, and Inter-Departmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada Corresponding author: Arthur S Slutsky, arthur.slutsky@utoronto.ca Published online: 5 January 2005 Critical Care 2005, 9:280-286 (DOI 10.1186/cc3022) This article is online at http://ccforum.com/content/9/3/280 © 2005 BioMed Central Ltd

Objectives: This study was designed to evaluate effects of hyperbaric oxygen (HBO) plus 3-aminobenzamide (3-AB) cotreatment on tissue oxidative stress parameters (TOSp), tissue histopathology scores (THSc), and bacterial translocations (Bact-Trans) in an experimental model of severe acute pancreatitis (AP).Methods: Seventy-five Sprague-Dawley rats were randomized into 5 groups. Group 1 received sham. Severe AP was induced by intraductal taurocholate infusion and then group 2 received saline, group 3 received 3-AB, group 4 received 3-AB plus HBO, and group 5 received HBO. 3-Aminobenzamide (10 mg/kg per day, once daily, intraperitoneal) and saline (1 mL/kg) were started right after the induction, whereas HBO (2,8 atm pressure, BID, 90 minutes each) was started at the sixth hour. The rats were euthanized at the 54th hour, and TOSp, THSc, and Bact-Trans were studied.Results: In treatment groups 3 and 5, Bact-Trans (P < 0.05, P < 0.05), TOSp (P < 0.05, P < 0.05), and THSc (P < 0.001, P < 0.001) were significantly lower than controls. In addition to these findings, group 4 (cotreatment) showed the most significant effect on Bact-Trans and THSc (P < 0.001, P < 0.001) and also better in TOSp (P < 0.02).Conclusions: Poly(ADP-ribose) polymerase inhibition by 3-AB and HBO treatment alone was effective in the course of severe AP, and favorable with cotreatment because of the improved cascades of inflammatory process by different aspects.

BACKGROUND/AIMS:The anti-inflammatory activity of 3-aminobenzamide (3-AB) has been shown via histopathology and immunohistochemistry in various colitis models. We aimed to study the effects of 3-AB on tissue mechanical endurance and, associatively, preventing perforation in colitis. MATERIALS AND METHODS:Thirty male Wistar albino rats were randomly divided into three groups. Rectal saline was administered to Group 1 (sham+saline). Rectal trinitrobenzensulphonic acid was applied to induce colitis in Group 2 (colitis+saline) and Group 3 (colitis+3-AB). Groups 1 and 2 were treated intraperitoneally with saline (1 ml every 12 hours) and Group 3 was treated with 3-AB (10 mg/kg every 12 hours). After seven days, rats were sacrificed and colon lipid peroxidation levels, the serum tumor necrosis factor alpha (TNF-α) level, bowel bursting pressures, and bowel wall tensions were measured. RESULTS:Bowel bursting pressure in Group 2 was significantly lower than in Groups 1 and 3 (p<0.001 for both groups). Bowel wall tension in Group 2 was significantly lower than in Groups 1 and 3 (p<0.001 for both groups). There were no significant differences between groups for serum TNF-α levels. For lipid peroxidation, malondialdehyde (MDA) levels were increased in Groups 2 and 3 compared to Group 1. CONCLUSION:3-AB may aid prevention of perforations that develop in inflammatory bowel disease, requiring surgical treatment.

Appendicitis and endometriosis are commonly encountered surgical problems. Endometrial involvement of the appendix is rare and very few cases have been reported in the literature. True diagnosis of appendix invagination is highly difficult due to variable symptoms. Noting the findings which are in favour of invagination in patients diagnosed with acute appendicitis is of great significance in order to be prepared for changing surgical attempts. This case describes a 34 year old female patient diagnosed with infertility who was operated on for acute appendicitis. In the pathological assessment, endometrial involvement of the appendix was seen. The classification, symptoms, radiological appearance and treatment of appendix invagination described in the literature are discussed.

BACKGROUND & OBJECTIVES:Translocation of bacteria from the gut is an important factor in the development of septic complications and mortality in acute pancreatitis (AP). The present study was designed to assess the effects of infliximab treatment on bacterial translocation (BT) in experimental acute necrotizing pancreatitis.METHODS:Male Sprague-Dawley rats (n=45) were allocated into three groups. AP was induced in group II (positive control, n=15) and group III (Infliximab; n=15) by retrograde injection of taurocholate into the common biliopancreatic duct. Group I rats (Sham; n=15) received normal saline infusion into the common biliopancreatic duct as placebo. Groups I and II were treated by normal saline and group III was treated with infliximab intraperitoneally on 6, 30 and 54 h after induction of pancreatitis. All surviving animals were killed 60 h after the induction of pancreatitis, and specimens were collected for amylase measurement as well as histopathologic and microbiologic examinations.RESULTS:Oedema, acinar cell necrosis, inflammatory infiltration, haemorrhage, fat necrosis and perivascular inflammation in group III rats were decreased with infliximab treatment when compared with group II (P<0.001). BT to mesentery lymph node in groups I, II and III were 20, 100 and 46 per cent, respectively. BT to peritoneum and pancreas in group III was lower than group II (P<0.05).INTERPRETATION & CONCLUSIONS:Infliximab administration resulted in beneficial effects on BT and histopathologic changes in the experimental necrotizing pancreatitis. Whether anti-TNF therapy has a role in prevention of complications of ANP needs to be established.

Retroperitoneal paragangliomas are rare tumors. They usually present abdominal pain and mass clinically. A literature review suggests that only a few cases have been reported so far. A case of giant retroperitoneal paraganglioma 20x30 cm in size with extraadrenal origin in a 66-year-old patient is reported alongside with its clinical presentation, diagnosis, surgical management and literature review.

BACKGROUND/AIMS One of the most important complications of acute pancreatitis is the secondary bacterial infections of the pancreas and gut. Translocation of bacteria from the gut is accepted as being responsible for the development of septic complications in acute pancreatitis. In this study, our aim was to investigate the effect of PARP inhibition via 3-aminobenzamide on the bacterial translocation in acute pancreatitis. METHODS 45 male Sprague-Dawley rats were randomly allocated into three groups. Group I (Sham+saline) received normal saline infusion into the common biliopancreatic duct. Acute pancreatitis was induced in Group II (acute pancreatitis+saline) and Group III (acute pancreatitis+ 3-aminobenzamide) by the retrograde injection of taurocholate into the common biliopancreatic duct. Six hours after induction of pancreatitis, the rats in Group I and II were treated with saline (1 ml, every 12 hours), while the rats in Group III were treated with 3-aminobenzamide (10 mg/kg/day every 12 hours), intraperitoneally. In the 54th hour of the study, blood and tissue samples were taken for biochemical, microbiological and histopathological analysis. RESULTS Acute pancreatitis developed in Groups II and III. Pathologic score [median (25-75% percentiles)] of the pancreatitis in Group III [8 (7-9)] was significantly lower than in Group II [19 (18-21)] (p<0.001). Bacterial translocation to mesenteric lymph node (53.3%), peritoneum (60%) and pancreas (46.7%) in Group III was significantly lower than in Group II (100% for all) (p<0.02, p<0.03, p<0.005, respectively). Pancreatic tissue glutathione peroxidase, superoxide dismutase, and malondialdehyde levels were better in Group III compared to Group II (p<0.001 for all). Comparison of Groups II and III demonstrated reduced severity of inflammation of the gut in Group III (p>0.05). Improvement in bacterial translocation was correlated with reducing oxidative stress. CONCLUSIONS We demonstrated that 3-aminobenzamide therapy improved histopathologic score and oxidative stress in experimental pancreatitis. In addition, it was demonstrated microbiologically and histopathologically that 3-aminobenzamide therapy improves bacterial translocation. Further survival studies demonstrating the efficacy of 3-aminobenzamide therapy and explaining the potential mechanisms of bacterial translocation prevention in acute necrotizing pancreatitis will be beneficial.

Tracheal diverticulum is a rarely encountered entity which is frequently an incidental finding in the postmortem examination, reported in 1% of patients in an autopsy series. Most cases are asymptomatic, but when symptoms are present they usually have airway symptoms with cough or recurrent respiratory infection. We herein report a case of a tracheal diverticulum, which had cervical dysphagia and sensation of friction.

Aim: To investigate the effects of allopurinol (ALLO) and hyperbaric oxygen (HBO) therapy on biochemical and histopathological changes, oxidative stress (OS) and bacterial translocation (BT) in rat acute pancreatitis (AP). Materials and Methods: Eighty-five Sprague-Dawley rats were included. AP was induced by intraductal taurocholate infusion in seventy rats. Fifteen animals served as controls. AP induced rats were divided into 4 groups. Group I received saline, Group II ALLO, Group III ALLO plus HBO and Group IV HBO alone. Serum amylase, tissue OS parameters, BT and histopathologic scores were determined. Group V served controls. Results: Serum amylase levels were lower in Groups II, III and IV compared to Group I (P < 0.05, for all). Combination treatment revealed significantly lower histopathological scores compared to individual administrations (P < 0.01). OS markers improved significantly in all treatment groups compared to controls. BT into pancreas and mesenteric lymph nodes was lower in Groups II, III and IV compared to Group I (P < 0.05, for all). Conclusion: The present study confirms the benefit of HBO and allopurinol treatment when administered separately in experimental rat AP. Combination of these treatment options appears to prevent progression of pancreatic injury parameters more effectively.