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1.
J Invest Surg ; 28(5): 268-75, 2015.
Article in English | MEDLINE | ID: mdl-26376346

ABSTRACT

AIM: We aimed to investigate the effects of Tempol on local organ damage in an experimental acute pancreatitis model. METHODS: This experimental study was conducted on 40 male Wistar- albino rats. The animals were randomly allocated into four groups: (i) Sham-operated group, laparotomies and cannulations of the pancreatic duct without acute necrotizing pancreatitis (ANP) (n=10); (ii) Sham + Tempol group, identical to group 1 except for intravenous tempol treatment for 4 hours (n = 10); (iii) ANP group, glycodeoxycholic acid was infused into the pancreatic duct and cerulein was infused intravenously for 6 hours for development of ANP (n=10); and (iv) ANP + Tempol treated group, in addition to the procedure in group 3, rats were administered tempol intravenously for 4 hours (n = 10). Injury of the pancreas was evaluated histopathologically. Malondialdehyde and myeloperoxidase levels of the pancreatic tissue, blood gas analysis, leukocyte and hematocrit levels were measured. Wet/dry weight of pancreatic tissue was also measured. RESULTS: Serum amylase levels, pancreatic tissue malondialdehyde and myeloperoxidase levels, wet/dry weight ratio, pancreatic edema, acinar necrosis, fat necrosis and hemorrhage, inflammation and perivascular infiltration were significantly lower in the ANP + Tempol group compared with the ANP group. CONCLUSION: Tempol infusion reduced local organ damage due to acute necrotizing pancreatitis in this experimental study. These findings demonstrate that tempol has protective effects on local organ damage due to acute necrotizing pancreatitis in rats.


Subject(s)
Antioxidants/therapeutic use , Cyclic N-Oxides/therapeutic use , Multiple Organ Failure/prevention & control , Pancreas/drug effects , Pancreatitis, Acute Necrotizing/complications , Animals , Antioxidants/pharmacology , Cyclic N-Oxides/pharmacology , Disease Models, Animal , Drug Evaluation, Preclinical , Edema/etiology , Edema/prevention & control , Male , Malondialdehyde/metabolism , Multiple Organ Failure/blood , Multiple Organ Failure/etiology , Pancreas/metabolism , Pancreas/pathology , Pancreatitis, Acute Necrotizing/blood , Pancreatitis, Acute Necrotizing/pathology , Peroxidase/metabolism , Random Allocation , Rats, Wistar , Spin Labels
2.
Ulus Travma Acil Cerrahi Derg ; 21(3): 182-6, 2015 May.
Article in English | MEDLINE | ID: mdl-26033650

ABSTRACT

BACKGROUND: Accurate measurement of surgical outcomes, proper evaluation of hospitals and surgeons regardless of case can be performed by mortality prediction models. The aim of this study was to analyze factors affecting mortality, present our clinical experience and patient profile and evaluate different scoring systems in use of these patients. METHODS: A retrospective review of one hundred and twelve geriatric patients who underwent major abdominal emergency surgery between 2004 and 2008 was performed. APACHE II, ODIN, SAPS II expanded, P-POSSUM, Manheim peritonitis and Charlson comorbidity index, Goldman and ASA scores were calculated using patient data. Sensitivity, positive predictive value and Odd's ratio were calculated to predict the mortality for these scoring systems. RESULTS: The overall mortality rate for our patients was found 33.9%. The factors affecting mortality in this study were found to be the duration of initial complaint, requirement of intensive care unit, requirement of mechanical ventilation and its duration, the presence of coexisting disease and peritonitis. CONCLUSION: According to our study, in this particular group of patients, APACHE II scoring system is more valid and accurate in estimating the mortality risk when compared to other scoring systems.


Subject(s)
APACHE , Abdominal Injuries/mortality , Abdominal Injuries/surgery , Aged , Aged, 80 and over , Emergency Medical Services , Female , Geriatric Assessment , Health Services for the Aged , Humans , Intensive Care Units , Male , Mortality , Postoperative Complications , Predictive Value of Tests , Respiration, Artificial , Retrospective Studies
3.
Int J Surg Pathol ; 23(1): 5-12, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25389240

ABSTRACT

The purpose of our study was to investigate the diagnostic value of expression of IMP3, nucleophosmin, and correlation of these markers with Ki-67 proliferation index in papillary thyroid carcinoma and benign neoplasms of thyroid gland. The aim was also to investigate whether there is a difference between papillary and micropapillary carcinomas with regard to clinicopathologic parameters beside IMP3, nucleophosmin, and Ki-67 proliferation index. It was concluded that IMP3 and nucleophosmin cannot be a routine diagnostic marker for discrimination of papillary carcinomas and benign lesions. IMP3 positive staining was quite scarce in IMP3 positive papillary carcinomas although specifity of IMP3 is 100%. A statistically significant correlation was not detected between nucleophosmin, IMP-3, and Ki-67 proliferation index. A statistically significant correlation was found between tumor size, lymphovascular embolism, and Ki-67 proliferation index. There was also significant correlation between tumor size and lymphovascular embolism.


Subject(s)
Biomarkers, Tumor/metabolism , Carcinoma, Papillary/diagnosis , Ki-67 Antigen/metabolism , Nuclear Proteins/metabolism , RNA-Binding Proteins/metabolism , Thyroid Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Papillary/metabolism , Carcinoma, Papillary/pathology , Cell Proliferation , Diagnosis, Differential , Female , Goiter, Nodular/diagnosis , Goiter, Nodular/metabolism , Goiter, Nodular/pathology , Humans , Male , Middle Aged , Nucleophosmin , Sensitivity and Specificity , Thyroid Gland/metabolism , Thyroid Gland/pathology , Thyroid Neoplasms/metabolism , Thyroid Neoplasms/pathology , Thyroiditis/diagnosis , Thyroiditis/metabolism , Thyroiditis/pathology , Young Adult
4.
Am J Surg ; 199(6): 765-9, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20226438

ABSTRACT

BACKGROUND: The choice between subtotal thyroidectomy (STT) and total thyroidectomy (TT) for multinodular goiter (MNG) remains controversial. METHODS: Thyroid tissue samples of 34 patients who underwent TT for multinodular disease between October 2005 and June 2007 in Pamukkale University Hospital, Department of General Surgery were evaluated. Thyroid tissues weighing 2 g each from either side were separated from the main specimen to simulate the tissues that would be left behind if a subtotal resection were performed instead of a total resection. Ki-67 staining was performed. RESULTS: The mean age of subjects was 49.3 +/- 12 years and 25 (73.5%) were females. Papillary microcarcinomas were found in 4 patients, 1 of which was in a residual thyroid specimen (RTS). Micronodule formations were found in 73.5% of specimens simulating residual thyroid. While Ki-67 indexes of residual thyroid tissues were 4.65% in nodules and 1.91% in normal areas (P < .05), they were 5.42% and 2.84%, respectively, for nodular and normal areas in the main specimens (P < .05). CONCLUSION: Remnant thyroid tissues, following STT, have a high percentage of micronodule formation with a remarkable cellular proliferative activity.


Subject(s)
Goiter/pathology , Goiter/surgery , Thyroidectomy/methods , Carcinoma, Papillary/pathology , Carcinoma, Papillary/surgery , Female , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm, Residual , Statistics, Nonparametric , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Treatment Outcome
5.
Clin Invest Med ; 31(3): E176-81, 2008.
Article in English | MEDLINE | ID: mdl-18544281

ABSTRACT

OBJECTIVES: Phaeochromocytoma (PHEO) occasionally associates with pathological lesions of the adrenal cortex. The coexistence of PHEO and pre-clinical Cushing's syndrome (PCS) of the same adrenal gland has rarely been reported. We report a case of PHEO and PCS originating from the same adrenal gland and discuss the peculiar diagnostic aspects of this entity. CLINICAL PRESENTATION: A 64 yr old man was hospitalized to evaluate the right adrenal mass which was discovered incidentally by ultrasonography. He had a history of type 2 diabetes mellitus and hyperlipidemia. Blood pressure measurements were all normal during his hospital stay. Laboratory examination showed: urinary catecholamines were markedly increased. HbA1C of 14.3 %, midnight cortisol of 11(microg/dL), cortisol was not suppressed after the overnight 1 mg oral dexamethasone suppression test (DST): 3.42(microg/dL), 24 hr free cortisol in the urine : 213 microg/day (10-100), cortisol levels were suppressed more than 50% with 8 mg of dexamethasone. CT scan of the adrenal glands showed a 6 cm well encapsulated right adrenal mass together with a clearly normal left adrenal gland. MRI investigation of the sella turcica revealed a pituitary microadenoma on the right side of the adenohypophysis He was treated with alpha and subsequent beta blockers after the diagnosis of PHEO and PCS was made. Right adrenalectomy was performed. The pathology showed typical PHEO with adrenocortical hyperplasia. VMA, metanefrin and free cortisol levels were normalized one month after surgery. CONCLUSION: The present report is a rare case of PHEO combined with PCS in the same adrenal gland.


Subject(s)
Adenoma/complications , Adrenal Gland Neoplasms/complications , Cushing Syndrome/complications , Pheochromocytoma/complications , Pituitary Neoplasms/complications , Adrenal Gland Neoplasms/diagnostic imaging , Dexamethasone , Diabetes Mellitus, Type 2/complications , Humans , Hydrocortisone/antagonists & inhibitors , Hydrocortisone/blood , Hyperlipidemias/complications , Male , Middle Aged , Ultrasonography
6.
J Surg Res ; 149(2): 259-71, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18533188

ABSTRACT

BACKGROUND: Tempol is a stable piperidine nitroxide of low molecular weight that permeates biological membranes and scavenges superoxide anions in vitro. In a variety of animal models, deleterious effects of reperfusion injury on both local and remote organs have been demonstrated. In this study, we aimed to investigate the effects of a membrane-permeable radical scavenger, Tempol, on local and remote organ injuries caused by intestinal ischemia/reperfusion (I/R) in rats. MATERIALS AND METHODS: Male Wistar-albino rats were randomized into three groups: (I) Sham-operated control group, laparotomy without I/R injury (n = 12); (II) Intestinal I/R group, 60 min of ischemia by superior mesenteric artery occlusion followed by 2-h of reperfusion (n = 12); and (III) I/R + Tempol-treated group, identical to I/R group except for Tempol administration, 30 mg/kg bolus injection 5 min before reperfusion, followed by an infusion of 30 mg/kg/h intravenously (n = 12). Histopathologically, intestinal mucosal lesions were assessed by Chiu's classification, and pulmonary parenchymal damage was appraised by pulmonary neutrophil infiltration and acute lung injury scaling. Biochemically, myeloperoxidase activity, malondialdehyde, glutathione, and nitrite/nitrate (NO(x)) levels were determined in both intestinal mucosa and lung parenchyma. Evans blue dye concentration and organ wet/dry weight ratios were used as a marker of organ edema. Animal survival was observed up to 1 week. RESULTS: Intestinal mucosal lesions and pulmonary parenchymal damage were significantly attenuated with Tempol treatment, histopathologically (P < 0.05). Tempol administration significantly reduced myeloperoxidase activity and malondialdehyde levels, and also significantly increased glutathione and NO(x) levels of both intestinal and lung tissues, biochemically (P < 0.05). Evans blue dye extravasation and wet/dry weight ratios of organs were significantly reduced with Tempol injection (P < 0.05). The survival rates of rats in Tempol-treated group were significantly higher than that of I/R-treated group (P < 0.05). CONCLUSIONS: The present study suggests that Tempol administration significantly reduces both local and remote organ injuries caused by intestinal I/R before and throughout the reperfusion period. Further clinical studies are needed to clarify whether Tempol may be a useful therapeutic agent to use in particular operations where the reperfusion injury occurs.


Subject(s)
Cyclic N-Oxides/therapeutic use , Free Radical Scavengers/therapeutic use , Intestinal Mucosa/injuries , Reperfusion Injury/drug therapy , Respiratory Distress Syndrome/drug therapy , Animals , Capillary Permeability/drug effects , Cyclic N-Oxides/pharmacology , Edema/prevention & control , Free Radical Scavengers/pharmacology , Glutathione/metabolism , Intestinal Mucosa/metabolism , Intestinal Mucosa/pathology , Lung/immunology , Lung/metabolism , Lung/pathology , Male , Malondialdehyde/metabolism , Mesenteric Artery, Superior , Mesenteric Vascular Occlusion/complications , Mesenteric Vascular Occlusion/drug therapy , Neutrophils/drug effects , Nitrates/metabolism , Nitrites/metabolism , Peroxidase/metabolism , Rats , Rats, Wistar , Reperfusion Injury/complications , Reperfusion Injury/metabolism , Reperfusion Injury/pathology , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/metabolism , Respiratory Distress Syndrome/pathology , Spin Labels
7.
Am J Surg ; 194(2): 255-62, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17618816

ABSTRACT

BACKGROUND: Pyrrolidine dithiocarbamate (PDTC) is a low-molecular-weight thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. It has been shown to attenuate harmful effects of ischemia/reperfusion (I/R) injury in many organs. In recent animal studies, destructive effects of reperfusion injury has been demonstrated. In this study, we aimed to investigate whether PDTC prevents harmful effects of superior mesenteric I/R injury in rats. METHODS: Wistar-albino rats were randomly allocated into the following 4 groups: (1) sham-operated group--these animals underwent laparotomy without I/R injury (group I, n = 12); (2) sham+PDTC group--identical to sham-operated rats except for the administration of PDTC (100 mg/kg intravenous bolus) 30 minutes prior to the commencement of the experimental period (group II, n = 12); (3) I/R group--these animals underwent laparotomy and 60 minutes of ischemia followed by 120 minutes of reperfusion (group III, n = 12); (4) PDTC-treated group (100 mg/kg, intravenously, before the I/R, group IV, n = 12). All animals were killed, and intestinal tissue samples were obtained for investigation of intestinal mucosal injury, myeloperoxidase (MPO) activity, malondialdehyde (MDA) levels, glutathione (GSH) levels, and intestinal edema. RESULTS: There was a statistically significant decrease in GSH levels, along with an increase in intestinal mucosal injury scores, MPO activity, MDA levels, and intestinal tissue wet-to-dry weight ratios in group III when compared to groups I, II, and IV (P < .05). However, PDTC treatment led to a statistically significant increase in GSH levels, along with a decrease in intestinal mucosal injury scores, MPO activity, MDA levels, and intestinal tissue wet-to-dry weight ratios in group IV (P < .05). CONCLUSIONS: This study showed that PDTC treatment significantly prevented the reperfusion injury caused by superior mesenteric I/R. Further clinical studies are needed to clarify whether PDTC may be a useful therapeutic agent to use in particular operations where the reperfusion injury occurs.


Subject(s)
Antioxidants/therapeutic use , Intestine, Small/blood supply , Pyrrolidines/therapeutic use , Reperfusion Injury/prevention & control , Thiocarbamates/therapeutic use , Animals , Glutathione/metabolism , Intestine, Small/metabolism , Intestine, Small/pathology , Male , Malondialdehyde/metabolism , Peroxidase/metabolism , Rats , Rats, Wistar , Reperfusion Injury/metabolism , Reperfusion Injury/pathology , Warm Ischemia
8.
World J Surg ; 31(9): 1835-1842, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17566823

ABSTRACT

BACKGROUND: Pyrrolidine dithiocarbamate (PDTC) is a low-molecular-weight thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. It has been shown to attenuate local harmful effects of ischemia/reperfusion (I/R) injury in many organs. In recent animal studies, a delaying effect of remote organ I/R injury on the healing of colonic anastomoses has been demonstrated. In this study we investigated whether PDTC prevents harmful systemic effects of superior mesenteric I/R on left colonic anastomosis in rats. METHODS: Anastomosis of the left colon was performed in 40 rats randomly allocated into the following four groups: (1) Sham-operated group (group I, n = 10)-simultaneously with colonic anastomosis, the superior mesenteric artery and collateral branches divided from the celiac axis and the inferior mesenteric artery were isolated but not occluded. (2) Sham+PDTC group (group II, n = 10)-identical to sham-operated rats except for the administration of PDTC (100 mg/kg IV bolus) 30 minutes prior to commencing the experimental period. (3) I/R group (group III, n = 10)-60 minutes of intestinal I/R by superior mesenteric artery occlusion. (4) PDTC-treated group (group IV, n = 10)-PDTC 100 mg/kg before and after the I/R. On postoperative day 6, all animals were sacrificed, and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for investigation of anastomotic hydroxyproline (HP) contents, perianastomotic malondialdehyde (MDA) levels, myeloperoxidase activity (MPO), and glutathione (GSH) level. RESULTS: There was a statistically significant decrease in anastomotic bursting pressure values, tissue HP content and GSH level, along with an increase in MDA level and MPO activity in group III, when compared to groups I, II, and IV (p < 0.05). However, PDTC treatment led to a statistically significant increase in anastomotic bursting pressure values, tissue HP content and GSH level, along with a decrease in MDA level and MPO activity in group IV (p < 0.05). CONCLUSIONS: This study showed that PDTC treatment significantly prevented the delaying effect of remote organ I/R injury on anastomotic healing in the colon. Further clinical studies are needed to clarify whether PDTC may be a useful therapeutic agent for increasing the safety of the anastomosis during particular operations where remote organ I/R injury occurs.


Subject(s)
Antioxidants/pharmacology , Colon/surgery , Pyrrolidines/pharmacology , Reperfusion Injury/prevention & control , Thiocarbamates/pharmacology , Wound Healing/drug effects , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Animals , Colon/blood supply , Colon/chemistry , Colonic Diseases/surgery , Disease Models, Animal , Glutathione/analysis , Hydroxyproline/analysis , Male , Malondialdehyde/analysis , Peroxidase/analysis , Random Allocation , Rats , Rats, Wistar , Reperfusion Injury/etiology
9.
World J Surg ; 31(8): 1707-15, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17551782

ABSTRACT

BACKGROUND: Pyrrolidine dithiocarbamate (PDTC) is a low-molecular thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. It has been shown to attenuate local harmful effects of ischemia/reperfusion (I/R) injury in many organs. In this study, we aimed to study the effect of PDTC on lung reperfusion injury induced by superior mesenteric occlusion. METHODS: Male Wistar-albino rats randomized into three groups: (1) sham-operated control group (n = 12), laparotomy without I/R injury; (2) intestinal ischemia/reperfusion (I/R) group (n = 12), 60 min of ischemia by superior mesenteric occlusion followed by 2 h of reperfusion; and (3) I/R+PDTC-treated group (n = 12), 100 mg/kg injection of PDTC intravenously, 30 min after the commencement of reperfusion. Evans blue dye was injected to half of rats in all groups before the induction of I/R. We assessed the degree of pulmonary tissue injury biochemically by measuring malondialdehyde (MDA), glutathione (GSH), and nitric oxide (NO) levels, and histopathologically by establishing pulmonary neutrophil sequestration and acute lung injury scoring. Pulmonary edema was evaluated by Evans blue dye extravasation, as well as lung tissue wet/dry weight ratios. RESULTS: Pyrrolidine dithiocarbamate treatment significantly reduced the MDA and NO levels, and increased the GSH levels in the lung parenchyma, biochemically (p < 0.05), and atteneuated the pulmonary parenchymal damage, histopathologically (p < 0.05). However, pulmonary neutrophil sequestration was not affected by postischemic treatment with PDTC (p > 0.05). Pyrrolidine dithiocarbamate administration also significantly alleviated the formation of pulmonary edema, as evidenced by the decreased Evans blue dye extravasation and organ wet/dry weight ratios (p < 0.05). CONCLUSIONS: This study showed that postischemic treatment with PDTC significantly attenuated the lung reperfusion injury. Further clinical studies are needed for better understanding of the specific mechanisms of PDTC protection against I/R-related organ injury and to clarify whether PDTC may be a useful therapeutic agent during particular operations where remote organ I/R injury occurs.


Subject(s)
Antioxidants/therapeutic use , Capillary Permeability/drug effects , Lung/blood supply , Pulmonary Edema/prevention & control , Pyrrolidines/therapeutic use , Reperfusion Injury/prevention & control , Thiocarbamates/therapeutic use , Animals , Disease Models, Animal , Glutathione/analysis , Lung/metabolism , Lung/pathology , Malondialdehyde/analysis , Mesenteric Vascular Occlusion , Neutrophil Activation/drug effects , Neutrophils/pathology , Nitrates/analysis , Nitrites/analysis , Pulmonary Edema/pathology , Random Allocation , Rats , Rats, Wistar
10.
World J Surg ; 30(4): 612-9, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16479336

ABSTRACT

BACKGROUND: The effect of relaparotomies and temporary abdominal closure on colonic anastomoses and postoperative adhesions is under debate. METHODS: In the experiments reported here, colonic anastomosis was constructed 24 hours after cecal ligation and puncture in rats that were divided into three groups of eight animals each. The abdomen was closed primarily in groups I and II, and a Bogota bag was used for abdominal closure in group III. At 24 hours following anastomosis, relaparotomy was performed only in group II and III rats, and the abdomen was closed directly in group II; after removal of the Bogota bag in group III animals, the abdomen was closed directly. On the fifth day of anastomotic construction, bursting pressures and tissue hydroxyproline content of the anastomoses, along with peritoneal adhesions, were assessed and compared. RESULTS: Mean anastomotic bursting pressures and hydroxyproline contents did not differ among the groups. Median adhesion scores were significantly higher in group III than the other two groups. CONCLUSIONS: Relaparotomy and the type of temporary closure have no negative effect on anastomotic healing in rats with peritonitis. Temporary abdominal closure with a Bogota bag caused a significantly high rate of adhesions.


Subject(s)
Abdomen/surgery , Anastomosis, Surgical , Colon/surgery , Peritonitis/surgery , Postoperative Complications/pathology , Surgical Wound Infection/surgery , Suture Techniques , Animals , Colon/pathology , Hydroxyproline/metabolism , Peritoneum/pathology , Peritonitis/pathology , Rats , Rats, Wistar , Reoperation , Surgical Wound Dehiscence/pathology , Surgical Wound Infection/pathology , Tissue Adhesions/pathology , Wound Healing/physiology
11.
Tohoku J Exp Med ; 207(2): 133-42, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16141682

ABSTRACT

To investigate the role of interleukin (IL)-10 gene therapy on the reperfusion-induced lung injury, we utilised the technique of liposomal gene delivery before the induction of intestinal ischemia. Plasmid DNA encoding human IL10 (hIL-10) or empy vector was injected intraperitoneally 24 h before the study. Male Balb/c mice randomized into three groups: Sham operated control (n = 12), empty plasmid vector (n = 12), and hIL-10 gene therapy group (n = 12). The ischemia was generated by selective occlusion of superior mesenteric artery for 60 min and followed by reperfusion for 30 min. Lung tissue neutrophil infiltration was determined by myeloperoxidase assay and neutrophil counts. For the determination of lung tissue microvascular permeability, Evans blue dye injection was made and the lung edema was assessed by wet/dry ratio. hIL-10 protein expression was studied by immunostaining and ELISA. We found that pre-ischemic hIL-10 overexpression attenuated dye extravasation, leukocyte sequestration and reduced pulmonary tissue injury compared to the empty vector-injected control. Our study indicates that pre-ischemic hIL-10 overexpression attenuates lung injury caused by intestinal ischemia-reperfusion.


Subject(s)
Interleukin-10/therapeutic use , Ischemia/therapy , Lung/blood supply , Reperfusion Injury/etiology , Reperfusion Injury/therapy , Animals , Disease Models, Animal , Enzyme-Linked Immunosorbent Assay , Immunohistochemistry , Interleukin-10/genetics , Intestines/blood supply , Intestines/pathology , Ischemia/etiology , Liposomes , Lung/pathology , Male , Mice , Mice, Inbred BALB C , Random Allocation
12.
Am J Surg ; 189(2): 161-6, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15720983

ABSTRACT

BACKGROUND: Mesenteric ischemia-reperfusion (I/R) is a well-known event causing both local and remote organ injuries, including the lungs. Recently, several studies indicated that activated leukocyte-endothelial cell interactions play an important role in the mechanisms of these injuries. As a natural inhibitor of serine proteases, antithrombin was shown previously to attenuate the tissue damage after local I/R in several organ systems. Here, we examined the effects of antithrombin on pulmonary injury after mesenteric I/R. METHODS: Wistar albino rats underwent median laparotomy and were randomized into 3 groups: (1) sham-operated control (n = 12), (2) 60 minutes of mesenteric ischemia and 3 hours of reperfusion (n = 12), and (3) antithrombin-pretreated (250 U/kg) group before the I/R (n = 12). At the end of reperfusion, animals were killed and neutrophil sequestration, myeloperoxidase (MPO) activity, and Evans blue dye extravasation in the lung parenchyma were assessed and compared. RESULTS: There was a statistically significant increase in the quantity of Evans blue dye concentration, leukocyte sequestration, and MPO activity in the I/R group when compared with the control group. The pretreatment of animals with antithrombin significantly decreased the pulmonary injury characterized by increased Evans blue dye extravasation, leukocyte sequestration, and MPO activity. CONCLUSION: The data of the present study suggest that mesenteric ischemia and reperfusion induces pulmonary injury characterized by activated neutrophil sequestration and increased microvascular leakage in the lungs. A significant attenuation of intestinal I/R-related lung injury with the use of antithrombin concentrate warrants further studies to elucidate the potential role of this natural serine protease inhibitor in clinical settings.


Subject(s)
Antithrombin III/pharmacology , Reperfusion Injury/drug therapy , Reperfusion Injury/etiology , Serine Proteinase Inhibitors/pharmacology , Splanchnic Circulation , Animals , Intestines/blood supply , Intestines/pathology , Lung/blood supply , Lung/pathology , Male , Random Allocation , Rats , Rats, Wistar
13.
Am J Surg ; 188(3): 288-93, 2004 Sep.
Article in English | MEDLINE | ID: mdl-15450836

ABSTRACT

BACKGROUND: Despite its advantages, iatrogenic gallbladder perforation with resultant spillage of bile and gallstones is not uncommon during laparoscopic cholecystectomy. Although this is not generally considered a significant problem, spilled gallstones may cause problems even years after the operation. Hyaluronic acid has been introduced into clinical practice and successfully used to decrease postoperative adhesions after abdominopelvic surgery. In this study, we investigated the effectiveness of a hyaluronic-acid derivative in preventing complications related to spilled gallstones and bile leakage in an experimental study. METHODS: In 60 Wistar-Albino rats, an upper-midline abdominal incision was made, and the rats were divided into 5 groups (n = 12 in each group) as follows: group I = laparotomy alone; group II = laparotomy and intraperitoneal instillation of sterile bile plus gallstones; group III = laparotomy and instillation of infected bile and gallstones; group IV = laparotomy and instillation of sterile bile and gallstones plus hyaluronic acid; and group V = laparotomy and instillation of infected bile and gallstones plus HA. A second-look laparotomy was performed on postoperative day 10 to assess intraperitoneal adhesions and abscesses. Intraperitoneal adhesions were scored, and breaking strengths of gallstones were measured. RESULTS: Adhesion scores were significantly higher in groups II and III compared with groups I, IV, and V (P < 0.05). There was a statistically significant decrease in breaking strengths and adhesion scores in groups IV and V compared with groups II and III (P < 0.001). CONCLUSIONS: Whether infected or not, spilled gallstones and bile caused postoperative adhesions in this experimental model. An HA derivative significantly prevented postoperative adhesions and decreased breaking strengths. Further clinical studies are needed to validate these findings.


Subject(s)
Abdominal Abscess/prevention & control , Bile/drug effects , Biocompatible Materials/administration & dosage , Gallstones/complications , Hyaluronic Acid/analogs & derivatives , Hyaluronic Acid/administration & dosage , Tissue Adhesions/prevention & control , Abdominal Abscess/etiology , Abdominal Abscess/microbiology , Animals , Bile/microbiology , Biomechanical Phenomena , Escherichia coli Infections/complications , Gallstones/drug therapy , Gallstones/physiopathology , Humans , Infusions, Parenteral , Laparotomy/adverse effects , Models, Animal , Rats , Tissue Adhesions/etiology , Tissue Adhesions/physiopathology
14.
Dis Colon Rectum ; 47(12): 2178-83, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15657671

ABSTRACT

PURPOSE: The treatment of intersphincteric and low transsphincteric fistula is well defined, but controversy remains around the management of complex perianal fistula. This study was designed to assess the utility of anocutaneous flap repair in complex types of perianal fistula. METHODS: Sixty-five perianal fistula in 65 patients treated with anocutaneous advancement flap for the complex fistula, between April 1998 and December 2002, are included this prospective study. Mean age was 34 +/- 2.1 (range, 24-53) years. Magnetic resonance imaging was used for the diagnosis of fistula. Excision of the internal opening and the overlying anoderm, curettage of the fistula tract, closure of internal opening with absorbable polyglactin 3/0 suture, and drainage of the external opening(s) by insertion of penrose drain were common operational steps. Outcome was evaluated in terms of healing and incontinence. RESULTS: Successful healing of 59 of 65 complex fistulas was achieved using this technique with no disturbance of continence and minimal complications. Mean follow-up and complete healing time were 32 +/- 0.6 (range, 12-52) months and 5.4 +/- 0.8 (range, 3-7) weeks respectively. CONCLUSIONS: Although the study cases were relatively small in number, this report showed that clinical results of anocutaneous advancement flap are acceptable. However, large studies are needed to reach an ultimate conclusion for assessing the place of anocutaneous flap advancement in complex fistula.


Subject(s)
Rectal Fistula/surgery , Surgical Flaps , Adult , Attitude to Health , Contrast Media , Drainage/instrumentation , Drainage/methods , Fecal Incontinence/etiology , Female , Gadolinium DTPA , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Necrosis , Patient Selection , Polyglactin 910/therapeutic use , Prospective Studies , Rectal Fistula/diagnosis , Rectal Fistula/psychology , Surgical Flaps/adverse effects , Surgical Flaps/standards , Surgical Wound Dehiscence/etiology , Surgical Wound Dehiscence/pathology , Surveys and Questionnaires , Suture Techniques , Treatment Outcome , Wound Healing
15.
Am J Surg ; 184(2): 160-5, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12169361

ABSTRACT

BACKGROUND: Antithrombin III is known as the most important natural inhibitor of thrombin activity and has been shown to attenuate local harmful effects of ischemia-reperfusion injury in many organs. In recent animal studies, delaying effect of remote organ ischemia-reperfusion injury on healing of intestinal anastomoses has been demonstrated. In this study, we investigated whether antithrombin III reduces deleterious systemic effects of ischemia-reperfusion injury on healing of colonic anastomoses in rats. METHODS: Anastomosis of the left colon was performed in 24 rats that were divided into three groups: sham operated control (group I, n = 8), 30 minutes of intestinal ischemia-reperfusion by superior mesenteric artery occlusion (group II, n = 8), antithrombin III treated group (250 U/kg before and after the ischemia-reperfusion, group III, n = 8). On postoperative day 6, all animals were sacrificed, and bursting pressure and tissue hydroxyproline content of the anastomoses were assessed and compared. RESULTS: On postoperative day 6 the mean bursting pressures were 149.6 +/- 4.8, 69.8 +/- 13.5, and 121.8 +/- 8.7 mm Hg for groups I, II, and III, respectively (P = 0.000). Mean tissue hydroxyproline concentration values were 389.5 +/- 29.6, 263.1 +/- 10.0, and 376.0 +/- 33.8 microg/mg for groups I, II, III respectively (P = 0.005). CONCLUSIONS: This study showed that, antithrombin III treatment significantly prevented the delaying effect of remote organ ischemia-reperfusion injury on anastomotic healing in the colon. Further clinical studies are needed to clarify whether antithrombin may be a useful therapeutic agent to increase the safety of the anastomosis during particular operations where remote organ ischemia-reperfusion injury takes place.


Subject(s)
Anastomosis, Surgical/adverse effects , Antithrombin III/pharmacology , Colectomy/adverse effects , Colonic Diseases/surgery , Reperfusion Injury/prevention & control , Analysis of Variance , Anastomosis, Surgical/methods , Animals , Antithrombin III/metabolism , Colectomy/methods , Disease Models, Animal , Follow-Up Studies , Male , Probability , Rats , Rats, Wistar , Reference Values , Reperfusion Injury/physiopathology , Sensitivity and Specificity , Treatment Outcome , Wound Healing/physiology
16.
Dis Colon Rectum ; 45(7): 979-80, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12130891

ABSTRACT

PURPOSE: Ectopic prostatic tissue at various sites within and outside the genitourinary system has been reported previously. A case of ectopic prostatic tissue located in the anal canal causing rectal bleeding is presented. METHOD: The patient was referred to our clinic with rectal bleeding. At rectal examination a bleeding sessile polypoid mass 2.5 cm in size was found in anal canal and removed surgically. RESULTS: Histopathologic and immunohistochemical staining of the specimen confirmed the prostatic nature of the tissue. CONCLUSION: Prostatic heterotopia is significant in several respects. Either it may be an important cause of hematuria or unusually, as in our case, it may cause rectal bleeding. In addition, ectopic tissue may be endoscopically confused with malignancy in either urinary or lower gastrointestinal system. This and other reports may disclose the genesis and significance of this peculiar tissue remnant.


Subject(s)
Anus Diseases/diagnosis , Choristoma/diagnosis , Gastrointestinal Hemorrhage/diagnosis , Prostate , Rectal Diseases/diagnosis , Anus Diseases/surgery , Choristoma/surgery , Colonic Polyps/pathology , Colonic Polyps/surgery , Gastrointestinal Hemorrhage/surgery , Humans , Male , Middle Aged , Rectal Diseases/surgery
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