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This study was designed to demonstrate bacterial translocation following bile duct ligation and investigate preventive effects of hyperbaric oxygen on obstructive jaundice-related bacterial translocation in an animal model. Hyperbaric oxygen treatment significantly reduced the endogenous colony counts in distal ileum of normal rats both in the short (two days) and long (seven days) term. Endogenous bacteria in distal ileum significantly increased in bile duct ligated rats in the short and long term, and presence of bacterial translocation was proven by bacterial growth in mesenteric lymph nodes, liver, spleen, and blood. Short- and long-term hyperbaric oxygen treatments significantly reduced the intestinal colony counts and prevented the bacterial translocation almost completely in rats with bile duct ligation. It is concluded that obstructive jaundice causes bacterial overgrowth and translocation, and hyperbaric oxygen treatment can prevent both bacterial overgrowth and translocation effectively.

Background: Laparoscopic surgery has proven to be safe and effective. However, the value of laparoscopic resection for malignancy in terms of cancer outcome can only be assessed by large prospective randomized clinical trials with sufficient follow-up. Methods: COLOR (COlon carcinoma Laparoscopic or Open Resection) is a European multicenter randomized trial which has started in September 1997. In 24 hospitals in Sweden, The Netherlands, Germany, France, Italy and Spain, 1,200 patients will be included. The primary end point of the study is cancer-free survival after 3 years. Results: Within Conclusions: Although laparoscopic surgery appears of value in colorectal malignancy, results of randomized trials have to be awaited to determine the definitive place of laparoscopy in colorectal cancer. Considering the current accrual rate, the COLOR study will be completed in 2002.

Background/Aims: New prognostic factors in gastric carcinoma to determine the prognosis of the disease or to identify patients who will benefit from adjuvant therapy are being researched. The aim of this study is to investigate the correlation between microvessel count (MVC) and various clinicopathologic features in gastric carcinoma in order to evaluate the role of angiogenesis on the prognosis of gastric cancer. Methods: Fifty-seven patients who underwent surgical intervention for gastric carcinoma between 1993 and 1997 were reviewed retrospectively. The relationship between MVC and various clinicopathological features was assessed. The effect of angiogenesis on overall survival and the role of MVC and other prognostic factors on distant metastases were assessed by multivariate analysis. Microvessels were outlined by anti-factor VIII, which is a specific monoclonal antibody to factor VIII in vessel endothelial cells, using the streptavidin-biotin method and counted under light microscopy ×200 magnification. Results: There was no correlation between MVC and age or sex of the patient, duration of symptoms or tumor size. Proximally located, undifferentiated, diffuse type, serosal invasion positive, lymph node invasion positive, advanced stage, or distantly metastasized tumors had higher MVCs. Higher MVCs affected the overall survival adversely. Lymph node metastasis, serosal invasion and MVC were found as independent prognostic factors affecting distant metastases. MVC was the sole factor affecting recurrent liver metastasis. Conclusion: It is concluded that MVC in gastric carcinoma may be a valuable prognostic factor to predict patients at high-risk for possible recurrences and to decide on postoperative adjuvant therapy.

Hydatid disease of the liver is highly prevalent in oriental countries including Turkey, in which their population live mostly in rural areas. The outcome of surgical methods used in the management of a cystic cavity in patients with hepatic hydatid disease was evaluated. Three hundred and forty consecutive patients who presented to Department of General Surgery between 1988 and 1996 with hepatic hydatid disease were reviewed retrospectively. In the first group surgical methods without drainage such as cystectomy (n = 11), capitonnage (n = 55), omentoplasty (n = 91) and capitonnage + omentoplasty (n = 53), in the second group surgery with drainage such as external drainage (n = 74), internal drainage (n = 7), and combined methods (n = 21) were applied. Symptoms, physical findings, types of surgical management, complication rate, hospitalisation period, mortality and recurrence rates were evaluated. Complication rate, average hospitalisation period, recurrence and mortality rates were 12.5%, 9.5 days, 9.9% and 0% respectively in patients without drainage and 63.7%, 26.5 days, 12.7% and 0.9% respectively in patients with drainage. It is concluded that surgical treatment of hydatid disease of the liver without drainage decreases postoperative complication rate and average hospitalisation period, and drainage or nondrainage of cystic cavity has no effect on recurrence.

To evaluate the effects of CO2 or helium insufflation on bacteremia and bacterial translocation in rats with peritonitis.Forty male Wistar-Albino rats were divided into four groups, each containing 10 rats. The rats in the first group were injected only with E. coli into their peritoneal cavities with no further manipulation. The second group, following E. coli injection, underwent midline laparotomy without manipulation of the viscera for 1 hour. After the injection of E. coli in the third and fourth groups, CO2 and helium pneumoperitoneum, respectively, were maintained for 1 hour under 14 mm Hg pressure. At the end of the sixth hour, tissue samples were taken from the liver, spleen, lung, and mesenteric lymph nodes in order to evaluate bacterial translocation. During the study, blood samples were taken from each rat at 0, 1, 2, 4, and 6 hours to demonstrate bacteremia.There was a significant increase in bacteremia in the CO2 pneumoperitoneum group compared with the laparotomy-only and helium groups at 1 and 2 hours. Although all the blood samples at the fourth hour were positive for E. coli in every rat of all groups, helium was associated with a lower incidence of bacteremia at the sixth hour compared with other groups (P0.05). The CO2 pneumoperitoneum caused bacterial translocation to all organs from which tissue samples were taken. Although there was an insignificant decrease in translocation to the liver, spleen, and lung with helium compared with CO2 insufflation, helium did not increase bacterial translocation to the spleen compared with laparotomy alone, as did CO2 (P0.05).Helium might be an alternative to CO2 insufflation in patients with peritonitis if these results are confirmed by further experimental and clinical trials.

Twenty-seven thousand four hundred and eight adult males between 20 and 22 years of age who were otherwise healthy were examined to detect inguinal hernias. Eight hundred and eighty-five (3.2%) inguinal hernia cases were detected. These were 479 (54.1 %) right inguinal hernias, 351 (39.7%) left inguinal hernias and 55 (6.2%) bilateral inguinal hernias. One hundred and eighty-five (20.9%) subjects reported first degree relatives and 147 (16.6%) subjects reported second degree relatives with inguinal hernias. It is concluded that these results may be a useful guide for future studies about the prevalence of inguinal hernias in the populations as a whole and suggest a familial predisposition.