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Biomedical subjects

S Wattanasirichaigoon

Publications and source records attributed to S Wattanasirichaigoon.

At least 19 recordsLinked to original sources
PubMed2001

Ringer's ethyl pyruvate solution ameliorates ischemia/reperfusion-induced intestinal mucosal injury in rats.

OBJECTIVE: Pyruvate has been shown to be protective in numerous in vitro and in vivo models of oxidant-mediated cellular or organ system injury. Unfortunately, the usefulness of pyruvate as a therapeutic agent is abrogated by its very poor stability in solution. In an effort to take advantage of the ability of pyruvate to scavenge reactive oxygen species while avoiding the problems associated with the instability of pyruvate in solution, we sought to determine whether a simple derivative, ethyl pyruvate, would be protective in an animal model of reactive oxygen species-mediated tissue injury, namely mesenteric ischemia and reperfusion in rats. DESIGN: Prospective, randomized trial. SETTING: Animal research center. SUBJECTS: Male Sprague-Dawley rats. INTERVENTIONS: Under general anesthesia, rats were subjected to 60 mins of mesenteric ischemia followed by 60 mins of reperfusion. Controls (n = 6) received intravenous lactated Ringer's solution according this dosing schedule: 1.5 mL/kg bolus before ischemia, 3.0 mL/kg bolus before resuscitation, and 1.5 mL.kg-1.hr-1 by continuous infusion. Two experimental groups received similar volumes of either pyruvate (n = 6 each) or ethyl pyruvate (n = 9) solution made up exactly like lactated Ringer's solution except for the substitution of either pyruvate or ethyl pyruvate for lactate, respectively. MEASUREMENTS AND MAIN RESULTS: To obtain tissues for assessing mucosal permeability and histology, five 10-cm long segments of small intestine were obtained at the following time points: baseline, after 30 and 60 mins of ischemia, and after 30 and 60 mins of reperfusion. Mucosal permeability to fluorescein isothiocyanate dextran (molecular weight 4000 Da) was assessed ex vivo by using an everted gut sac method. Compared with controls, treatment of rats with either pyruvate solution or ethyl pyruvate solution significantly ameliorated the development of intestinal mucosal hyperpermeability during the reperfusion. Treatment with ethyl pyruvate solution also significantly decreased the extent of histologic mucosal damage after mesenteric reperfusion. CONCLUSIONS: Treatment with Ringer's ethyl pyruvate solution ameliorated structural and functional damage to the intestinal mucosa in a rat model of mesenteric ischemia/reperfusion. Ethyl pyruvate solution warrants further evaluation as a novel therapeutic agent for preventing oxidant-mediated injury in various disease states.

Animals↗
PubMed2001

Palliative esophageal stent or surgery in advanced esophageal malignancy.

Esophageal malignancy is one of the most aggressive malignancies. Unfortunately, the majority of patients present with incurable disease. Then palliative treatment to relieve dysphagia is the mainstay of treatment. We compared the mortality, procedure-related complications, hospital stay, intervention time, improvement of dysphagia and survival time between esophageal stent and surgery. There were twenty patients who underwent esophageal stent and twenty-three patients underwent surgical treatment. Pretreatment characteristics were similar between the two groups. The mortality between the surgical group and the esophageal stent group was 30.43 per cent (7/23) and 5 per cent (1/20) (p<0.05). The complications in the surgical group included anastomotic leakage 39.13 per cent (9/23), wound dehiscence 4.35 per cent (1/23), small bowel obstruction 4.35 per cent (1/23) and late anastomotic stricture 37.5 per cent (6/16). In the esophageal stent group, the complications were severe chest pain 10 per cent (2/20), stent displacement 10.52 per cent (2/19), stent obstruction from food impaction 15.78 per cent (3/19) and tumor overgrowth leading to stent obstruction 5.26 per cent (1/19). More intervention time and hospital stay (post intervention period and ICU period) was spent in the surgical group (320.43+/-133.84 mins vs 57.5+/-23.98 mins p<0.001, 30.39+/-20.69 days vs 4.9+/-2.61 days p<0.001, 9.79+/-16.64 days vs 0 days p<0.05). The improvement of dysphagia was 1.00+/-1.03 vs 1.75+/-0.72 (p<0.05). Survival between the two groups was not statistically different (p>0.05).

Chi-Square Distribution↗
PubMed2000

Hyperdynamic circulation in portal hypertension: a comparative model of arterio-venous fistula.

Complications of portal hypertension remain perplexing physiologic phenomena in the understanding of shunt hemodynamics with multiple theories. Hyperdynamic circulation was also found in sepsis, chronic anemia and arterio-venous (A-V) fistula which relate to an increase in nitric oxide. We hypothesize that portosystemic collaterals may mimic an A-V fistula in which the high-pressure portal blood connects with the lower pressure systemic venous circulation. Although these collaterals decompress the portal circulation, a number of secondary hemodynamic phenomena occur which increase portal blood flow and tend to counteract the portal hypotensive effect of the portosystemic shunt. The consequent increases in cardiac output and portal blood flow perfuse the compromised liver. As portal blood flow increases, collateral flow increases and is nearly totally shunted in the systemic circulation. This shunt may eventually introduce a vicious cycle of hyperdynamic circulation into a compromised host. Ultimately, high-output cardiac failure occurs, leading to cirrhotic cardiomyopathy.

Animals↗
PubMed2000

Lisofylline ameliorates intestinal and hepatic injury induced by hemorrhage and resuscitation in rats.

OBJECTIVE: We sought to determine whether treatment with lisofylline (LSF) preserves intestinal barrier function in rats subjected to hemorrhagic shock and resuscitation (HS/R). SETTING: Research laboratory at a major university teaching hospital. DESIGN: Rats were bled to a mean arterial pressure of 30 mm Hg and maintained at that pressure for 90 mins. One group (n = 8) was treated with LSF (bolus doses of 15 mg/kg at 45 and 89 min plus infusion at 10 mg x kg(-1) x hr(-1)), whereas another group (n = 8) received only the lactated Ringer's solution (LRS) vehicle. At 90 mins, the animals were resuscitated with shed blood and LRS (55 mL x kg(-1) x hr(-1)). Intestinal mucosal permeability was determined by measuring the mucosal-to-serosal clearance of fluorescein isothiocyanate dextran (molecular weight = 4 kDa) into everted gut sacs. MEASUREMENTS AND MAIN RESULTS: Intestinal and hepatic blood flow (assessed by laser Doppler flowmetry) was greater in LSF-treated rats. Treatment with LSF ameliorated the development of histologic evidence of mucosal damage and hyperpermeability. Rats treated with LSF had lower plasma concentrations of the intracellular hepatic enzyme, aspartate aminotransferase. After 90 mins of resuscitation, concentrations of adenosine triphosphate in intestinal and hepatic tissue were greater in LSF-treated as compared with LRS-treated rats, but concentrations of the endogenous antioxidant, glutathione, in intestinal and hepatic tissue, although lower than in rats not subjected to HS/R, were similar in the two treatment groups. CONCLUSION: Treatment with LSF ameliorated HS/R-induced derangements in intestinal structure and function and hepatic injury, possibly by preserving microvascular perfusion and tissue adenosine triphosphate concentrations.

Animals↗
PubMed2000

Ischemic preconditioning ameliorates ischemia- and reperfusion-induced intestinal epithelial hyperpermeability in rats.

We hypothesized that ischemic preconditioning (IPC) would ameliorate ischemia (I) and reperfusion (R)-induced intestinal mucosal hyperpermeability and that this effect would be diminished by lowering local adenosine concentrations using adenosine deaminase (ADA). The small intestine of anesthetized rats (group 1; n = 6) was divided into six 10-cm segments (A1-F1) each perfused by a different set of mesenteric branches. Segments D1-F1 were subjected to 3 cycles of IPC (2 min I/5 min R). Segments A1, B1, and C1 were excised at baseline, after 60 min of I (160), and after 60 min of I followed by 60 min of R (160/R60), respectively. Segment D1 was excised immediately after the last cycle of IPC, E1 was excised at 160 after IPC, and F1 was excised at 160/R60 after IPC. In group 2 (n = 6), the intestine was divided into five 10-cm vascularly isolated segments (A2-E2). Segment A2 was resected at baseline. The lumen of the remaining segments was filled with ADA (32 U/50 cm). Segment B2 was removed at the end of the experiment having been exposed to ADA for 150 min (ADA150). Segments C2, D2, and E2 were subjected to IPC. Segment C2 was excised immediately thereafter. Segments D2 and E2 were excised at 160 and 160/R60, respectively. Intestinal permeability to fluorescein isothiocyanate-labeled dextran (molecular weight 4000 D) was assessed ex vivo by using an everted gut sac method. IPC ameliorated intestinal hyperpermeability induced by 160 (43.0+/-7.6 vs. 70.4+/-8.3 nLmin/cm2; P = 0.024) and 160/R60 (20.2+/-3.7 vs. 69.5+/-10.8 nL/min/cm2; P= 0.003). IPC prevented ischemia-induced reduction in villus height. Treatment with ADA partially reversed the protective effect of IPC on the changes in permeability and villus height induced by I/R. We conclude that IPC partially protects against mucosal barrier dysfunction in rats subjected to mesenteric I/R. Adenosine is a mediator of IPC in the gut mucosa, but other factors also may be important.

Adenosine↗
PubMed1999

Lisofylline ameliorates intestinal mucosal barrier dysfunction caused by ischemia and ischemia/reperfusion.

In an effort to determine whether treatment with lisofylline (LSF) ameliorates intestinal barrier dysfunction in rats subjected to mesenteric ischemia and reperfusion (I/R), regional mesenteric vessels were occluded for 60 min and then unclamped for 60 min more. In Protocol 1, intravenous LSF (15 mg/kg bolus then 10 mg/kg/h) was administered 5 min before ischemia. In Protocol 2, LSF (same dose) was given 1 min before reperfusion. Controls received an equivalent volume of Ringer's lactate solution. Permeability was assessed by determining the mucosal-to-serosal clearance of fluorescein isothiocyanate-conjugated dextran (4 kDa) in everted ileal gut sacs incubated ex vivo. In Protocol 1, LSF treatment during ischemia ameliorated mucosal barrier dysfunction; mean +/- SEM clearances for the LSF and Ringer's lactate solution groups after 60 min of ischemia were 34.4+/-6.1 and 64+/-7.1 nL/min/cm2, respectively; p = .007. Clearances after reperfusion were the same in the two groups. In Protocol 2, LSF treatment just before reperfusion ameliorated barrier dysfunction measured 60 min after the restoration of blood flow; clearances for the LSF and Ringer's lactate solution groups were 23.1+/-3.8 and 40.2+/-4.5 nL/min/cm2, respectively; p = .012. Treatment with LSF did not affect intestinal levels of reduced glutathione or adenosine triphosphate or the extent of histological damage to the mucosa after I/R. Nevertheless, villus height was greater in animals treated with LSF than RLS prior to ischemia in Protocol 1 (250+/-37 and 160+/-15 microm, respectively; p = .04) and during reperfusion in Protocol 2 (170+/-21 and 82+/-7 microm, respectively; p = .002). We conclude that LSF is effective in reducing both ischemia- and I/R-induced gut barrier dysfunction, possibly due to a mechanism related to preservation of villus height.

Adenosine Triphosphate↗
PubMed1999

Effect of mesenteric ischemia and reperfusion or hemorrhagic shock on intestinal mucosal permeability and ATP content in rats.

In a reductionist in vitro system, intestinal epithelial permeability appears to be dependent on cellular ATP content. In order to extend these prior observations, we used rat models of mesenteric ischemia/reperfusion (I/R) and pressure-controlled hemorrhagic shock to test the hypothesis that intestinal barrier function is directly proportional to tissue ATP content. I/R was induced by clamping the mesenteric vessels for 60 min followed by 60 min of reperfusion. Normal, ischemic, and reperfused ileal segments were prepared from each rat (n = 12). Hemorrhagic shock was induced by bleeding rats (n = 9) to a mean arterial pressure of 30 mmHg and maintaining this pressure for 4 h by infusing Ringer's lactate solution as necessary. Ileal segments were harvested before induction of hemorrhage and at 1 h intervals thereafter. Everted gut sacs were prepared to measure the mucosal-to-serosal passage of fluorescein-conjugated dextran (FD4; M.W. = 4 kDa). Tissue ATP levels were determined using a luciferase assay. FD4 clearance rates were plotted as a function of tissue ATP content. Linear regression analyses showed a strong inverse relationship between intestinal permeability and tissue ATP level in rats subjected to I/R (r2 = 0.78; P < 0.001) or hemorrhage (r2 = 0.82; P < 0.001). These data support the idea that ATP content is a determinant of intestinal epithelial barrier function in vivo.

Adenosine Triphosphate↗
PubMed1998

The incidence of K-ras codon 12 mutations in cholangiocarcinoma detected by polymerase chain reaction technique.

In the study, to analyse a K-ras oncogene mutated at codon 12 in 24 patients with cholangiocarcinomas, four (16.67%) of them contained this point mutation. One of 4 was peripheral and the others were hilar tumors. There was no significant relationship between mutation and clinical features in terms of age, sex, endemic area, tumor location, tumor grading and pathological features. In our study, the incidence of K-ras codon 12 mutation in Thai patients with cholangiocarcinoma was lower than that found in British and Japanese patients. The discrepancy of incidence and type of the mutations, in different races and environment probably indicates that there is/are different etiologic mechanism(s) in the pathogenesis of cholangiocarcinoma.

Adult↗
PubMed1997

Laparoscopic lumbar sympathectomy.

BACKGROUND: Lumbar sympathectomy retains a role in the treatment of patients with causalgia, Symptomatic vasospasm, and nonreconstructable arterial occlusive disease. Open surgical sympathectomy, with its attendant morbidities, remains the standard. Chemical sympathectomy has been introduced as a less invasive means of achieving sympatholysis. However, this has been associated with incomplete and transient denervation. METHODS: We present a series of five lumbar sympathectomies performed laparoscopically. RESULTS: All patients sustained symptomatic relief and no postoperative complications were noted. Postoperative skin thermometry and resistance measurements confirmed adequacy of sympatholysis. CONCLUSION: We conclude that lumbar sympathectomy can be performed laparoscopically. Our preferred technique is now the extraperitoneal approach. Such an approach combines the durability and reliability of standard open sympathectomy with the minimal invasiveness of laparoscopic surgery.

Adult↗
PubMed1997

Laparoscopic transperitoneal lumbar sympathectomy: a new approach.

A report of five sympathectomies for the treatment of vasospastic symptoms of coldness, rest pain and trophic lesions at the affected feet. Three patients had a right-sided sympathectomy done and the other two had left-sided done via laparoscopic surgery. This report has advocated original techniques: Under general anesthesia, a patient is put into a lateral position with the table broken between the ribs and iliac crest. The telescope port is inserted horizontally at the edge of the rectus sheath in line with the umbilicus. Two secondary ports (5 mm, 10 mm) are inserted under direct vision in the midclavicular line. The peritoneal reflection lateral to the colon is incised down to the pelvic brim. The use of the lateral position facilitates medial displacement of the colon and the kidney by virtue of gravity. The L2, L3, L4 sympathetic ganglia are then doubly clipped and divided between clips. When such a small piece of the sympathetic trunk has been removed, a laparoscopic transperitoneal lumbar sympathectomy should be a very reasonable, safe, minimally invasive alternative to the traditional operation.

Adult↗
PubMed1996

Transmural migration of a retained surgical sponge into the intestinal lumen: an experimental study.

A retained surgical sponge in the peritoneal cavity is an occasional misadventure in modern surgery. Such a sponge can migrate into the intestinal lumen, but its mechanism is still unknown. A piece of surgical sponge, measuring 4 x 4 centrimetres, was placed at different sites of the abdominal cavity of Wistar rats. Inspite of the absence of infection, entry of the sponge into the intestinal lumen was shown microscopically in 10 out of 36 rats. Parallel statistical analysis by Cutler-Ederer estimation was found to be 0.58 of condition probability at 6 months. Transmural migration of a retained surgical sponge was not only associated with different sites placing in the abdominal cavity (P = 0.680), but also whether a seromuscular incision was made or not (P = 0.306). A hypothesis, based on a study of microscopic and macroscopic pathology, is proposed as four stages: foreign body reaction, secondary infection, mass formation and remodeling.

Animals↗
PubMed1996

Totally extraperitoneal laparoscopic lumbar sympathectomy: an initial case report.

A 27-year-old man with a diagnosis of Buerger's disease presented with vasospastic symptoms of coldness and pain at rest of his right foot. Physical examination of his affected limb revealed absent popliteal pulse, cool skin hyperhidrosis and dry gangrene of the big toe. He had been operated on for a ruptured liver and liver abscess 20 years ago. He was scheduled for totally extraperitoneal laparoscopic lumbar sympathectomy on July 26, 1994. The technique was performed under general anesthesia and the patient was put in a supine position with slight extension between the rib and the iliac crest. The working space was created by digital blunt dissection and direct insufflation of carbon dioxide. The right sympathetic trunk was found between the medial edge of the psoas muscle and inferior vena cava. The L2, L3, L4 sympathetic ganglia were identified above the vertebral column and meticulously dissected cephalocaudally. Based on the concept of traditional approach, we believe that this laparoscopic technique is relatively safe and should become the procedure of choice in the future.

Adult↗
PubMed1996

Recent approach for common bile duct stone.

One hundred and thirty-nine patients underwent cholecystectomy from 1992 through 1994. Twenty-seven patients demonstrated preoperative risk factors for common bile duct (CBD) stones and underwent endoscopic retrograde cholangiopancreatography (ERCP). ERCPs were successful in 25 (92.6%) patients and there were two failures, due to pyloric obstruction and duodenal diverticulum. Of 25 patients suspected of harboring CBD stones, 48 per cent had bile duct stones on preoperative ERCP. In contrast, 3 of 112 patients (2.7%) thought not to have stones indeed had choledocholithiasis. Laparoscopic cholecystectomies (LC) were performed on 19 (76%) of 25 patients. Of these 19, 13 (68%) had negative ERCP, 5 (26.3%) had stones removed by endoscopic sphincterotomy (ES), and only one was accomplished with laparoscopic choledochoduodenostomy. Open exploration of CBD was performed on 3 patients who had complex CBD stones and bilio-enteric bypasses in 2 patients who had multiple impacted stones in the left main duct. Overall, three endoscopic failures (2 ERCPs and 1 ES) were managed by open biliary surgery. We suggest that patients with complex CBD stones who are not successful in stone extraction via ES should undergo open CBD surgery. LC following successful ES has been accepted as the gold standard for the treatment of simple CBD stones.

Adolescent↗
PubMed1996

Inferior segmentectomy IV: a surgical approach for hilar cholangiocarcinoma.

To access the proximal dilated bile duct of hilar cholangio-carcinoma, an inferior segmentectomy IV was proposed to be a beneficiary means of exposure of the whole length of the confluence of the hepatic duct. This method consists of partial resection of the quadrate lobe along the inferior sulcus, between the mid-axis of the gallbladder fossa and the falciform ligament. Eleven patients were enrolled into this study. In addition to removal of all the tumor mass, the author could access four secondary confluences and restore bilio-enteric bypasses. Six of them with curative resection had 24 months of mean survival (range 1 to 48 months: median 26 months). The remaining five patients with palliative resection had 7.2 months of mean survival (range 1 to 15 months: median 8 months). Regarding operative mortality, two patients died from massive intraoperative bleeding during the resection of the tumor. Successful approaches to perform a hilar resection and biliary bypass, an inferior segmentectomy IV are required for better access.

Adult↗
PubMed1994

Leukocytic count in the diagnosis of acute appendicitis.

Two hundred and thirty-three patients with a pathological diagnosis of acute appendicitis from 1989 to 1990 were reviewed. A comparative series of 235 elective cases who were admitted during the same period, was similarly reviewed. Using these data, the binary tables could be constructed and the cutoff point was obtained by plotting the positive and negative predictive values. This series yielded the clinically significant laboratory findings that the cutoff point of total leukocytic count, percentage of neutrophils and total neutrophilic count were 11,500 mm3, 75 per cent and 8,000 mm3 respectively. Combined specificity of all three tests is higher (95.74%), but the sensitivity is lower (61.55%).

Acute Disease↗