AIM:To e va l u a t e t h e e f fe c t s o f p r e o p e ra t i v e immunonutrition and other nutrition models on the cellular immunity parameters of patients with gastrointestinal tumors before surgical intervention. In addition, effects on postoperative complications were examined. METHODS:Patients with gastrointestinal tumors were randomized into 3 groups. The immunonutrition group received a combination of arginine, fatty acids and nucleotides. The second and third group received normal nutrition and standard enteral nutrition, respectively. Nutrition protocols were administered for 7 d prior to the operation. Nutritional parameters, in particular prealbumin levels and lymphocyte subpopulations (CD4+, CD8+, CD16+/56+, and CD69 cells) were evaluated before and after the nutrition protocols. Groups were compared in terms of postoperative complications and duration of hospital stay. RESULTS:Of the 42 patients who completed the study, 16 received immunonutrition, 13 received normal nutrition and 13 received standard enteral nutrition. prealbumin values were low in every group, but this parameter was improved after the nutritional protocol only in the immunonutrition group (13.64 ± 8.83 vs 15.98 ± 8.66, P = 0.037). Groups were similar in terms of CD4+, CD16+/56, and CD69+ prior to the nutritional protocol; whereas CD8+ was higher in the standard nutrition group compared to the immunonutrition group. After nutritional protocols, none of the groups had an increase in their lymphocyte subpopulations. Also, groups did not differ in terms of postoperative complications and postoperative durations of hospital stay.CONCLUSION: P re o p e ra t i ve i m m u n o n u t r i t i o n provided a significant increase in prealbumin levels, while it did not significantly alter T lymphocyte subpopulation counts, the rate of postoperative complications and the duration of hospital stay.
Warfarin-dependent spontaneous intramural hematoma of the small intestine is a rare complication. The first symptom is usually abdominal pain, frequently accompanied by nausea and vomiting. In some cases, concomitant gastrointestinal bleeding might be seen. Ultrasonography and computed tomography are the most useful radiographic methods for the diagnosis of an intramural hematoma of the intestines. Although it is usually treated conservatively, surgical intervention is required in cases involving active bleeding, intestinal obstruction, or acute abdominal symptoms. Here we present two patients who were treated surgically. Both patients had intestinal obstruction and ischemia, and one had concomitant gastrointestinal bleeding and intussusception due to an intramural hematoma.
Gallbladder carcinosarcoma is one of the rarest subsets of gallbladder malignancies. To date, only 34 cases have been reported in the English literature. Therefore the knowledge and experience regarding this disease is limited. This report describes a 70-year-old male patient who was diagnosed by documenting the epithelial and mesenchymal components with histopathological and immunohistochemical methods, and treated by a radical cholecystectomy. The pediculated polypoid tumor had filled the lumen, originating from the gallbladder fundus. The tumor infiltrated the surrounding connective and adipose tissue overlapping the muscular layer of its primary site, but had not perforated the serosa nor invaded the liver. The patient, who was treated only surgically, has remained healthy after 54 months of follow-up, which is the longest documented survival for this disease. This case indicates that curative treatment of a tumor confined to the gallbladder without liver or serosa invasion, or lymph node involvement, is therefore possible.
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