Journal of Investigative Surgery (J Investig Surg)

Publications in this journal

• Article: The Rabbit as Experimental Model for Research in Implant Dentistry and Related Tissue Regeneration.

  Stefan Stübinger, Michel Dard
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  ABSTRACT: ABSTRACT The use of rabbits for experimental research has a long historical tradition. The aim of this review consists in outlining the use of the rabbit for research in implant dentistry and related tissue regeneration. Rabbits appear as a first-hand choice for fundamental implant design studies because of their size, easy handling, short life span, and economical aspects in purchasing and sustaining. In the following, the various anatomical sites in the rabbit will be summarized to provide an overview of current possibilities and limitations of this model for bone research in oral implantology.
  Journal of Investigative Surgery 04/2013;
• Article: The Use of Live Fluorescence Staining Techniques in Surgery: A Review.

  Harry W Roberts, Jack F Donati-Bourne, Victoria Lf Wilson, Joanne C Wilton
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  ABSTRACT: ABSTRACT Intraoperative fluorescence may allow improvements to existing surgical procedures or offer scope for new operations. Despite articles describing its use dating back more than a decade, its emergence as a commonly used adjunct is still anticipated. While awareness and availability of special equipment may limit the uptake of these techniques, intraoperative fluorescence could represent a key innovation in the future of surgery. Further awareness of techniques and more clinical trials are needed to promote a wide base of clinical expertise from which further innovations can be made. This literature review begins with a discussion of the physics and chemistry of fluorophores and the properties needed for use in clinical practice. Uses in the majority of surgical specialties will be considered and the current literature addressed. Common uses include delineating hollow visci such as blood vessels or demonstrating pathology such as tumors. Fluorescent stains used have been safe, effective, and often easier to use than the established methods. Finally, novel materials such as antibodies and nanoparticles will be mentioned as new developments on the horizon of intraoperative fluorescent staining.
  Journal of Investigative Surgery 04/2013;
• Article: Laparoscopy Splenectomy for Massive Splenomegaly.

  Wang Bo, Wu He-Shui, Wang Guo-Bin, Tao Kai-Xiong
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  ABSTRACT: ABSTRACT Objective: This study is aimed to evaluate the feasibility of laparoscopic splenectomy (LS) for massive splenomegaly in patients with hypersplenism secondary to portal hypertension and liver cirrhosis. Method: A retrospective study of adult patients was conducted for splenectomy occurring from January 2006 to December 2010. We have performed the surgical procedures of splenectomy in 80 patients who were suffering from splenomegaly or hypersplenism secondary to portal hypertension and liver cirrhosis, among whom 40 patients underwent LS and another 40 patients received open surgery (OS). Results: Among the patients who had undergone LS, 2 patients were converted to OS and the other 38 patients underwent complete LS. The operation time, intraoperative blood loss, and the length of stay in LS group and OS group were 100-200 min (mean: 150 ± 30 min) vs. 120-210 min (mean: 100 ± 30 min), 50-1,000 ml (mean: 150 ± 110 ml) vs. 60-900 ml (mean: 140 ± 50 ml) and 4-9 days (mean: 6.1 ± 2.2 days) vs. 8-14 days (mean: 11.3 ± 2.3 days), respectively. No deaths occurred in the two groups, and there are no significant differences between the two groups in terms of estimated blood loss, complications, length of stay, and operating time. Conclusion: LS for treatment of massive splenomegaly is a feasible, effective, and safe surgical technique. Hypersplenism secondary to portal hypertension and liver cirrhosis are not supposed to be considered absolute contraindications to LS.
  Journal of Investigative Surgery 04/2013;
• Article: Laparoscopic cholecystectomy with previous gastrectomy.

  Mingliang Wang, Tao Zhang, Chenghong Peng
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  ABSTRACT: ABSTRACT Introduction: To evaluate the safety and efficacy of laparoscopic cholecystectomy (LC) in patients with a history of gastrectomy. Methods: The clinical data of 9,403 consecutive patients who underwent LC from January 2003 to September 2010 in our hospital were retrospectively analyzed; 30 of them had undergone previous gastrectomy. We compared the operative duration, hospitalization, and conversion rate between patients with, and those randomized selected patients without, a history of gastrectomy. Results: All patients were treated by laparoscopic procedure successfully. The mean operative duration (55.00 min vs. 29.63 min, P < .05) and mean hospitalization duration (4.57 days vs. 3.00 days, P < .05) were significantly longer in the patients with a history of gastrecotomy. There are no complications such as bile duct and bowel injury in control group, however two bile duct injuries emerged in the observed group, which required surgical intervention. Conclusions: Although the operation is difficult, LC is a safe and effective treatment for the patients with a history of gastrectomy.
  Journal of Investigative Surgery 04/2013; 26(2):96-8.
• Article: Hippocrates of cos.

  Luis H Toledo-Pereyra
  Journal of Investigative Surgery 04/2013; 26(2):61-2.
• Article: Oral carbohydrate supplementation reduces preoperative discomfort in laparoscopic cholecystectomy.

  Huseyin Yildiz, Solmaz Eruyar Gunal, Gulsen Yilmaz, Safak Yucel
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  ABSTRACT: ABSTRACT The aim of this study was to investigate the effects of oral carbohydrate solution (CHO) on perioperative discomfort, biochemistry, hemodynamics, and patient satisfaction in elective surgery patients under general anesthesia. Sixty cases in ASA I-II group who were planned to have operation under general anesthesia were included in the study. The cases were randomly divided into two groups having 30 subjects in each. The patients in the study group were given CHO in the evening prior to the surgery and 2-3 hr before the anesthesia while routine fasting was applied in the control group. In the study group; 2-3 hr before the surgery; malaise, thirst, hunger, and weakness; just before the surgery malaise, thirst, hunger, and fatigue; 2 hr after the operation thirst, hunger, weakness, and concentration difficulty; 24 hr after the operation malaise and weakness were found significantly lower. Fasting blood glucose (FBG) level was found to be higher in the control group at the 90th min of the operation. Gastric volumes were higher in the control group; gastric pH values were found significantly higher in the study group. The level of anxiety and depression risk rate were found lower in the study group. In conclusion, preoperative CHO reduces perioperative discomfort and improves perioperative well being when compared to overnight fasting.
  Journal of Investigative Surgery 04/2013; 26(2):89-95.
• Article: The Effect of Rabeprazole on LES Tone in Experimental Rat Model.

  Mustafa Duman, Erdal Polat, Mahmut Ozer, Yeliz Demirci, Necdet Fatih Yasar, Cebrail Akyuz, Orhan Uzun, Kıvanc Derya Peker, Ece Genc, Sinan Yol
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  ABSTRACT: ABSTRACT Introduction: Despite adequate treatment with proton pump inhibitors (PPIs), symptoms of gastroesophageal reflux disease (GERD) may remain persistent as well as Barrett's esophagus may emerge. It may be proposed that the relaxant effect of PPIs on the smooth muscles may lead to resistance of symptoms. The aim of this study is to investigate effects of rabeprazole on the lower esophageal sphincter (LES) pressure with a rat model. Materials and Methods: Sixteen rats were grouped as control and treatment groups. After obtaining LES tissues followed by a 60 min equilibration period for stabilization, contractile response to carbachol was obtained by application of single dose of carbachol to have a final concentration of 10(-6) M in the organ bath. After the contractions reached a plateau, concentration-response relationships for rabeprazole were obtained in a cumulative manner in the treatment group. Results: In the carbachol contracted LES preparations; 1.5 × 10(-6) and 1.5×10(-5) M of rabeprazole caused 6.08% and 11.34% relaxations respectively which were not statistically significant. However, mean integral relaxation value for 4.5 × 10(-5) M of rabeprazole was 17.34% and this relaxation was significant compared with controls. Conclusions: In the present study, rabeprazole caused no direct significant change in LES tone in the therapeutic dose range applied to the organ bath. However, rabeprazole at the high dose caused a significant decrease in the LES tone.
  Journal of Investigative Surgery 03/2013;
• Article: The Role of Antibiotics after Surgical Treatment of Simple Hand Infections: A Prospective Pilot Study.

  Theodora Manoli, Ashin Rahmanian-Schwarz, Kathrin Konheiser, Phillipp Gonser, Hans-Eberhard Schaller
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  ABSTRACT: ABSTRACT Background: Manifested hand infections are usually treated by sufficient debridement and drainage followed by splinting and elevation of the corresponding upper extremity. The role of antibiotics in the postoperative prognosis of hand infections is contradictory. Methods: Three groups of 30 patients each with subcutaneous or subfascial localized hand infections without infiltration of tendons, joints, or bones, have been treated in a different way regarding the use of antibiotics postoperatively. Group 1 was treated with systemic cephalosporins as well as locally inserted Gentamycin bead chains in the wound after debridement. Group 2 was only treated locally with Gentamycin bead chains but no systemic antibiots, while Group 3 did not receive any antibiotics at all. Results: No substantial differences could be observed between the three patient groups regarding the convalescence in terms of duration of splinting and recovery of hand function in relation to hand mobility as assessed by the sum of finger-palm distance and to the disabilities of the arm, shoulder, and hand score. Conclusions: The use of antibiotics after surgical treatment of simple hand infections seems to be unnecessary.
  Journal of Investigative Surgery 03/2013;
• Article: Comparison of Two Gelatin and Thrombin Combination Hemostats in a Porcine Liver Abrasion Model.

  Kevin M Lewis, Holly D Atlee, Angela J Mannone, Joseph Dwyer, Lawrence Lin, Andreas Goppelt, Heinz Redl
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  ABSTRACT: ABSTRACT Background: Surgical hemostasis is achieved using adjunctive hemostats when conventional methods fail. Objective: This study compares the effectiveness of two adjunctive gelatin-thrombin hemostats. Hypothesis: To determine effectiveness, hemostats were compared in vivo, in vitro, and using scanning electron microscopy (SEM). Methods: In vivo, a heparinized porcine liver abrasion model was used to compare hemostatic success, degree of bleeding, and blood loss at 2, 5, and 10 minutes post-treatment. In vitro, thrombin in the supernatant of each hemostat and Red Blood Cells (RBC'S) in the supernatant of clots formed by each was compared. Results: Ultrastructure of one gelatin was smooth and the other stellate. In vivo, smooth gelatin provided superior hemostatic success at 5 (85% vs. 60%; OR: 5.3; 95% CI: 1.66 to 17.9) and 10 mins (72.5% vs. 47.5%; OR: 5.0; 95% CI: 1.55 to 16.1). Smooth gelatin had a statistically different degree of bleeding at 5 (0.58 ± 0.87 [Mean ± SD] vs. 1.03 ± 1.12; OR: 3.36; 95% CI: 1.34 to 8.41) and 10 mins (1.13 ± 1.14 vs. 1.65 ± 1.05; OR: 3.87; 95% CI: 1.62 to 9.21). Mean blood loss was less with smooth gelatin at 2 (0.07 ± 0.19 vs. 0.13 ± 0.63 ml/min), 5 (0.04 ± 0.13 vs. 0.23 ± 0.45 ml/min), and 10 mins (0.09 ± 0.24 vs. 0.21 ± 0.32 ml/min). In vitro, supernatant of smooth gelatin had significantly less thrombin (6.81 vs. 10.9 IU/ml, p = .001), and significantly less RBC's than stellate gelatin (0.07 vs. 0.09 × 10(6)/ul, p = .0085). Conclusion: Smooth gelatin has an increased ability to retain thrombin and RBC's in vitro which may explain why it provides superior hemostatic effectiveness, superior control of bleeding, and greater reduced blood loss in vivo.
  Journal of Investigative Surgery 03/2013;
• Article: Effects of Ozone Oxidative Preconditioning on Liver Regeneration after Partial Hepatectomy in Rats.

  Fatma Ayca Gultekin, Guldeniz Karadeniz Cakmak, Ummuhani Ozel Turkcu, Gamze Yurdakan, F Ebru Ofluoglu Demir, Mustafa Comert
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  ABSTRACT: ABSTRACT Aim: Similar protective effect of ischemic and ozone oxidative preconditioning (OzoneOP) in hepatic ischemia-reperfusion (I/R) injury was demonstrated, providing evidences that both preconditioning settings shared similar biochemical mechanisms of protection. We investigated the effects of OzoneOP on liver regeneration after 70% partial hepatectomy (PHx) in rats. Methods: Rats were divided into three groups: PHx, I/R + PHx, and OzoneOP + I/R + PHx groups. Ozone (intraperitoneal, 1.2 mg/kg) was given to rats subjected to I/R and 70% hepatectomy daily five times before operation. At 24 hr and 48 hr after resection, samples were collected for the measurement of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), tumor necrosis factor alpha (TNF-α), and interleukin-6 (IL-6). Moreover, liver regeneration rate, proliferating cell nuclear antigen (PCNA) labeling index, mitotic index, and histopathological examination were evaluated. Results: OzoneOP reduced liver injury determined by liver histology and serum transaminases. There was a rise in serum TNF-α and IL-6 levels in the I/R + PHx group whereas OzoneOP significantly decreased the rise in the level of TNF-α but not IL-6 on the 24 hr and 48 hr of reperfusion. Moreover, liver regeneration in OzoneOP + PHx group, as assessed by the regenerated liver weight, mitotic, and PCNA-labeling index, was significantly improved when compared to I/R + PHx group. Conclusion: These results suggest that OzoneOP ameliorates the hepatic injury associated with I/R and has a stimulatory effect on liver cell regeneration that may make it valuable as a hepatoprotective modality.
  Journal of Investigative Surgery 03/2013;
• Article: Co-Culture of Adipose Derived Stem Cells and Chondrocytes with Surface Modifying Proteins Induces Enhanced Cartilage Tissue Formation.

  Heather A Waters, Chris P Geffre, David A Gonzales, William A Grana, John A Szivek
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  ABSTRACT: ABSTRACT Objectives: Current treatments for focal cartilage defects include osteochondral allograft transplants-a common treatment for large defects and revisions of previously autografted joints. Allografts with weak osseous regions are usable, since bone remodeling replaces inferior quality bone. However, poor quality chondral surfaces on grafts preclude their use, leading to grafting material shortages. Endogenous adult stem cells can make hyaline-like cartilage tissue on scaffolds. To increase the number of usable allografts, tissue culture methods using adipose derived stem cells (ASCs) were developed to grow cartilage on grafts. Methods: Co-cultures utilized living chondrocytes in host cartilage, modeling in vivo conditions, and ASCs seeded on the allografts. Sterilized allografts were treated with Poly-L-Lysine and ProNectin. Tissue growth was analyzed and quantified with histological techniques. Results and Conclusions: Monoculture experiments produced tenuous cartilage formation when proteins were utilized and allograft surfaces were perforated. Extensive tissue formation was observed with co-culture and the presence of type II collagen was confirmed with immunohistochemistry. Results demonstrate that co-culture techniques offer a better means of growing tissue on allograft cartilage surfaces. Additionally, the use of proteins to facilitate surface attachment produced more tissue formation demonstrating that cell attachment is crucial when growing cartilage on allografts. Development of new culture techniques to evaluate treatment strategies will accelerate the rate at which cartilage procedures using endogenous cells are possible. This will increase the number of usable grafts and allow critical selection of grafts to fit specific surfaces increasing surgical success by returning the joint to its native structure.
  Journal of Investigative Surgery 03/2013;
• Article: Triptolide-Conditioned Dendritic Cells Induce Allospecific T-Cell Regulation and Prolong Renal Graft Survival.

  Gutian Zhang, Junhao Chen, Yong Liu, Rong Yang, Hongqian Guo, Zeyu Sun
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  ABSTRACT: ABSTRACT Background: Previous studies show that triptolide (TPT), a diterpenoid isolated from the Chinese herb Tripterygium wilfordii Hook.f, inhibits dendritic cell (DCs) maturation. Whether TPT-conditioned DCs (TPT-DCs) may regulate allospecific immune responses remains unclear. In this study, we investigated the effects of TPT on allostimulatory function and phenotype of rat bone marrow-derived DCs (BMDCs). Methods: Brown Norway rats BMDCs were cultured with or without TPT and then stimulated with lipopolysaccharide (LPS). IL-10 in supernatants was quantitatively measured, and the cells were analyzed by flow cytometry and used as stimulators in mixed leukocyte reaction in which naive Lewis rat T lymphocytes were used as responders. The tolerogenic potential of TPT-BMDCs was evaluated in vivo in a rat model of MHC fully mismatched kidney transplantation. Results: After treatment with TPT, BMDCs remained immature with low expression of CD80 and CD86 in the presence of LPS. At low concentrations of TPT (1 and 2.5 nM), BMDCs produced higher levels of IL-10 than the untreated cells (431 and 205.4 pg/ml, respectively, vs. 122.9 pg/ml, p < .05). T cells cocultured with TPT-BMDCs were hyporesponsive in allogeneic mixed lymphocyte reaction. The CD25+foxp3+Treg cell populations increased from 19.9% to 29.7% in the coculture system. Without immunosuppressive therapy, infusion of TPT-BMDCs in recipients before transplantation prolonged rat kidney allograft survival (18.8 ± 1.30 days). Conclusions: Our findings demonstrate that TPT inhibits the maturation and allogenicity of BMDCs and promotes the expansion of CD25+foxp3+ regulatory T cells. It suggests that TPT-DCs are potentially useful for preventing kidney transplant rejection.
  Journal of Investigative Surgery 03/2013;
• Article: Overexpression of ADAM9 Promotes Colon Cancer Cells Invasion.

  Junsheng Li, Zhenling Ji, Cunzhong Qiao, Yuhua Qi, Wen Shi
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  ABSTRACT: ABSTRACT Introduction: ADAM9 is a membrane-anchored metalloprotease that is markedly upregulated in several human carcinomas. We previously showed that ADAM9 staining was increased in colon cancer tissues. In the present work, we investigated the expression pattern of ADAM9 in colon cell lines, and the effects of overexpression ADAM9 on colon cancer proliferation and invasion. Materials and Methods: ADAM9 mRNA expression was determined in colon cancer tissues by RT-PCR assay, meanwhile, ADAM9 DNA and protein levels were measured in colon cancer cell lines by PCR and western blot, respectively. ADAM9 transfection was carried out in HT-29 colon cancer cells, and cell growth was measured by MTT assay, cell invasion ability was assessed by Matrigel assay. Results: ADAM9 mRNA was upregulated in colon cancer tissues, ADAM9 DNA and protein was overexpressed in Lovo cell lines, while the ADAM9 expression levels in HT-29, HCT-8, and Ls174t cells were below the levels of detection. Enhanced ADAM9 expression by ADAM9 transfection in HT-29 cells promoted cell invasion without increasing cell proliferation. Conclusions: These results suggest that ADAM9 contributes to cell invasion and progression in colon cancer.
  Journal of Investigative Surgery 03/2013;
• Article: Effects of Metoclopramide on Healing of Colonic Anastomoses in a Rat Model of Abdominal Sepsis Metoclopramide and Healing of Colonic Anastomoses.

  Silvana Marques E Silva, Fabiana Pirani Carneiro, Vânia Maria Moraes Ferreira, Paulo Gonçalves de Oliveira, João Batista de Sousa
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  ABSTRACT: ABSTRACT Introduction: Metoclopramide is often used in the treatment of postoperative nausea and vomiting, but a literature review failed to find reports on the influence of this drug on the healing of bowel anastomoses in the setting of abdominal sepsis. The aim of this study was to evaluate the effects of metoclopramide on the healing of left colonic anastomoses in rats with induced abdominal sepsis. Materials and Methods: Forty rats were divided into two groups of 20 animals each to receive either metoclopramide (experimental group: E) or saline (control group: C). Each group was further divided into subgroups of 10 animals each to be killed on the third (E3 and C3) or seventh postoperative day (E7 and C7). A segmental resection of the left colon was performed, followed by end-to-end anastomosis. Sepsis was induced by cecal ligation and puncture. On the day of reoperation, the total number of adhesions was assessed and the anastomosed bowel segment was removed for tensile strength testing, histopathological analysis, measurement of hydroxyproline levels, and histomorphometric evaluation of collagen. Results: Intraoperative findings, number of intra-abdominal adhesions in the anastomosed area, and tensile strength before anastomosis rupture were similar among all subgroups at all assessments. On the third postoperative day, the anastomoses of animals treated with metoclopramide showed significantly lower hydroxyproline levels (p = 0.01) when compared with controls. Collagen content was similar among all subgroups. Conclusions: Metoclopramide does not have deleterious effects on the healing of bowel anastomoses in rats subjected to experimental abdominal sepsis.
  Journal of Investigative Surgery 03/2013;
• Article: Laparoscopic Surgery for Inflammatory Bowel Disease-The Experience in China.

  Yi Han, Mou-Bin Lin, Yong-Gang He, Hao-Bo Zhang, Ya-Jie Zhang, Lu Yin
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  ABSTRACT: ABSTRACT Background: The incidence of inflammatory bowel disease (IBD) has risen rapidly in China over the last 15 years. Increasing numbers of people with IBD require surgery during their lifetime, but few reports of IBD in Eastern populations have been described to date. The aim of this study was to assess the short-term effects of the laparoscopic surgery for IBD in Chinese patients. Materials and methods: From February 2010 to March 2012, 35 patients with IBD underwent laparoscopic operations and the clinical data obtained for these patients were reviewed. Results: Patients with Crohn's disease (CD) (N = 21) and ulcerative colitis (UC) (N = 14) underwent laparoscopic surgery. In the CD group, the mean age was 37.4 years. Two patients (9.5%) required conversion to an open procedure. The median length of postoperative hospitalization was 9 (7-40) days. Overall morbidity was 26.3% and no patients required re-operation. In the UC group, the mean age was 55.2 years. The conversion rate was 14.3% (2/14). The median time to regular diet was 4 (3-10) days and the median length of postoperative hospitalization was 8 (7-25) days. Four patients developed postoperative complications and one patient developed ileostomy retraction requiring urgent operative intervention to rebuild the stoma. Conclusions: Laparoscopic surgery in patients with IBD can be accomplished safely and with reasonable operative times, conversion rates and morbidity rates. The main advantages of the laparoscopic approach are rapid recovery, improved cosmesis, less postoperative pain, and patient satisfaction.
  Journal of Investigative Surgery 03/2013;
• Article: Posteromedial Approach in Treatment of Talar Posterior Process Fractures.

  Zhongmin Shi, Jian Zou, Xincheng Yi
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  ABSTRACT: ABSTRACT To evaluate the surgical outcomes of talar, posterior process displaced fractures with posteromedial approach. From January 2008 to December 2010, 18 patients with displaced fracture of talar posterior process were treated in our department. Open reduction and screw fixation through posteromedial approach was performed after soft tissue swelling were subsided. The results were evaluated with Visual Analog Scale Pain Score (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores. The average follow-up period was 16.8 months. There was no wound infection or nerve injury. There was no screw loosening, implant breakage, nonunion, or malunion. The average AOFAS score was 83.1, and the VAS score was 1.4. Two patients developed posttraumatic subtalar joint arthritis 1 year after operation, and one of them had subtalar arthrodesis performed due to pain and walking disability. Posteromedial approach can provide a good surgical exposure to the posterior portion of the talus without compromising the surrounding neurovascular structures. Small fragment screws can provide stable fixation and early mobilization of the ankle and subtalar joint. Open reduction and internal fixation via posteromedial approach is an effective and reliable method for the treatment to displaced fractures of the posterior process of the talus.
  Journal of Investigative Surgery 03/2013;
• Article: Peritonitis from Perforated Peptic Ulcer and Immune Response.

  Mario Schietroma, Federica Piccione, Francesco Carlei, Federico Sista, Emanuela Marina Cecilia, Gianfranco Amicucci
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  ABSTRACT: ABSTRACT Background: Elevated intra-abdominal pressure during the laparoscopy may promote bacteremia, endotoxemia, and systemic inflammatory response. In patients with generalized peritonitis from perforated peptic ulcer (PPU), we sought to compare acute phase response, immunologic status, and bacterial translocation from laparoscopic and open approach. Study Design: From July 2005 to September 2011, 115 consecutive patients underwent peptic ulcer repair for PPU: 58 cases laparoscopic peptic ulcer repair (LR) and 57 cases open peptic ulcer repair (OR). Bacteremia, endotoxemia, white blood cells population, human leukocyte antigen-DR (HLA-DR), neutrophil-elastase, interleukin-1 and 6 (IL-1 and IL-6), and C-reactive protein (CRP) were investigated. Results: Patients characteristics and grade of peritoneal contamination were similar in the two groups. One hour after intervention, bacteremia was significantly higher in the "open" group than in the laparoscopic group (p < .001). A significantly higher concentration of systemic endotoxin was detected intraoperatively in the "open" group of patients in comparison to the laparoscopic group (p < .0001). Laparotomy caused a significant increase in neutrophil concentration, neutrophil-elastase, IL-1 and IL-6, CRP, and decrease of HLA-DR. We recorded six cases (10.3%) of intra-abdominal abscess in the "open" group and one (1.7%) in laparoscopic group (p < .001). Conclusions: OR, in case of peritonitis after PPU, increased the incidence of bacteremia, endotoxemia, and systemic inflammation compared with LR. Early enhanced postoperative systemic inflammation may cause lower transient immunologic defense after laparotomy (decrease of HLA-DR), leading to enhanced sepsis in these patients.
  Journal of Investigative Surgery 03/2013;
• Article: Four Decades of Vascularized Heterotopic Cardiac Transplantation in the Mouse.

  Robert J Plenter, Martin R Zamora, Todd J Grazia
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  ABSTRACT: ABSTRACT Since the first clinical heart transplant in 1967, there has been a heightened need to understand immune and inflammatory responses to "foreign" tissues. Research efforts in those early days were based on species that would now be considered "large" and were typically out-bred individuals. While this closely mirrors the clinical scenario, where genetic mismatches of donors and recipients can only be minimized in the selection process, these were not ideal models for studying the complexities and nuances of the immune system. Even when the rat was considered the standard model those early endeavors were limited by a small number of rat strains. The mouse model has provided us with an overwhelming array of strains, knockouts, knockins and transgenics that allow us to investigate the many layers of the innate and adaptive immune systems leading to a much greater understanding of immune responses. Fully vascularized heterotopic cardiac transplantation in the mouse has now been with us for four decades; the original papers describing this technique being published by Corry in 1973. In the subsequent 40 years, this technique has been used by many laboratories, including our own, and has become a powerful tool for the investigation of transplant immunity and ischemia reperfusion injury. Given the modern availability of mouse strains and mouse-related reagents, our current understanding of transplant immunity undoubtedly would not exist without such a technique.
  Journal of Investigative Surgery 03/2013;