M. T. Jaberansari

Activated PMNs lead to oxidative stress on chondrocytes: A study of swine knees

Using an in vitro model, based on primary cultured chondrocytes, we examined possible oxidative injury caused by activated polymorphonuclear neutrophil granulocytes (PMNs), which are thought to be part of the pathomechanism of hemarthrosis. Chondrocytes were isolated from swine knee joints and divided into three groups. Pure chondrocytes acted as the control population (group I). PMNs from the systemic circulation, and hydrogen peroxide (as an artificial source of reactive oxygen species (ROS)) were added to groups II and III, respectively. All cultures were incubated for 6 hours. After the experiment, lipid membrane degradation by ROS was assessed by monitoring changes in the levels of malondialdehyde (MDA) and 4-hydroxyalkenal contents of the chondrocyte specimens. Changes in the endogenous scavenger status of the chondrocytes were characterized by measuring of reductions in glutathione (GSH) concentration and superoxide dismutase (SOD) activity. Significant increases in MDA/4-hydroxyalkenal levels and SOD activity as well as an expressive reduction in intracellular GSH content were highlighted by comparing the control to the PMN- or H2O2-treated cell populations. These findings confirm previous suggestions that PMN-derived ROS contribute to degradation of cartilage in hemarthrosis.

Laparoscopic cholecystectomy: Risk of missed pathology of other organs

AbstractBackground: The wide acceptance of laparoscopic cholecystectomy (LC) has resulted in increased rates of cholecystectomy. However, the increased rate of LC bears the possibility of concomitantly missing other intra-abdominal pathologic states that exist concurrently with this procedure. The purpose of this report was to evaluate data on LC with regard to missed pathologies of other organs in a clinical prospective follow-up. Methods: The clinical prospective follow-up of 676 patients treated laparoscopically for gallstone disease at our unit since January 1993, was studied. Converted procedures were excluded from the follow-up study. Results: Among 676 patients who underwent LC, 4 patients (0.6%) required readmission for missed pathology of another organ. The diagnostic delay ranged from 2 weeks to 7 months. The readmissions were due to colonic cancer (2 cases), carcinoma of the stomach (1 case), and fibrosis of the mesenterium of small bowel causing ileus (1 case), which are demonstrated in detail. According to retrospective analysis of the symptoms, none of the patients had typical biliary pain at the time of laparoscopic procedure. Conclusions: The demand for LC from patients and practitioners is becoming increasingly more frequent, as all become aware of its benefits. However, on the basis of data from the literature and this study, the authors would like to emphasize the need for careful history-taking, thorough investigation, and comparison with gallstone symptoms before LC is performed. It is emphasized, however, that surgeons using laparoscopic approaches should learn techniques of full diagnostic laparoscopy, which should be performed at the beginning of every procedure.