Healing of Ischemic Colon Anastomosis in Rats Could Be Provided by Administering Dexpanthenol or Coenzyme Q10.

BACKGROUND: In this study, the effectiveness of dexpanthenol and coenzyme Q10 (CoQ10) on the healing of ischemic colon anastomosis was investigated. METHODS: Forty eight male Wistar Albino rats were divided into four equal groups (Sham-S, Sham-I, DXP, Q10). Following full layer colon resection, single layer colon anastomosis, without creating ischemia, was performed on the Sham-S group. The same experimental model was performed on remaining groups after ischemia was created. Intraperitoneal dexpanthenol and CoQ10 was administered to the DXP and Q10 groups once a day for three days. Ten days later, all colon anastomoses were investigated histopathologically and biochemically, as well as their burst pressure values, in all sacrificed rats. RESULTS: The highest burst pressure value was observed in the Sham-S group, decreasing from high to low in the DXP, Q10, and Sham-I groups, respectively (p = 0.008). Furthermore, tissue hydroxyproline (p = 0.001) level values were significantly different among the groups. Additionally, histopathological analysis revealed a significant difference among groups regarding reepithelization (p = 0.027) and polymorphonuclear leukocyte density (p = 0.022). CONCLUSIONS: This preliminary study has shown that ischemia-reperfusion injury may impair the healing of colon anastomosis and it has been concluded that dexpanthenol and CoQ10 may have positive effects on the healing of ischemic colon anastomosis in rat, although re-epithelization may be adversely affected using CoQ10.

The Effects of Simvastatin on Ischemia Reperfusion Injury in an Experimental Colon Anastomosis Model.

Anastomotic leakage is more frequently reported in colonic anastomoses. Ischemia reperfusion injury is one of the main reasons for anastomotic leakage. Simvastatin is known to prevent tissue damage induced by free oxygen radicals after ischemia reperfusion injury. The effect of simvastatin on colonic anastomosis impaired by ischemia reperfusion injury is investigated. Single layer, end-to-end colocolic anastomosis after 0.5-cm colon resection was performed in Wistar Albino rats. In Group 1 (control) (n = 10), colonic anastomosis without I-R was performed. In Group 2 (n = 10), the superior mesenteric artery was clamped for 10 min followed by 60 min of reperfusion after which resection anastomosis was performed. In Group 3 (n = 10), 10 mg/kg simvastatin was given by gavage for 7 days after I-R and resection anastomosis. In Group 4 (n = 10), the rats received 10 mg/kg simvastatin by gavage 7 days before and 7 days after ischemia reperfusion and surgery. All of the rats were sacrificed 8 days after surgery. Anastomotic bursting pressure and tissue hydroxyproline levels were measured. Postoperative administration of simvastatin restored the anastomotic bursting pressure and hydroxyproline levels to that of control group thus overcoming the effect of ischemia reperfusion injury. Simvastatin administered postoperatively in an experimental model of colonic resection anastomosis impaired by ischemia reperfusion injury increased anastomotic bursting pressures and tissue hydroxyproline levels. Further experimental and clinical studies will show whether administration of simvastatin will increase reliability of the anastomosis and decrease postoperative morbidity and mortality in colonic anastomosis after ischemia reperfusion injury.

The Effect of Simvastatin on Pulmonary Damage in Experimental Peritonitis in Rats.

Statins are widely used in the treatment of hyperlipidemia, as they inhibit cholesterol synthesis. They also have anti-inflammatory, antioxidant, immunomodulatory, and positive endothelial-functional effects. It is hypothesized that simvastatin ameliorates pulmonary damage secondary to peritonitis in rats. Forty Wistar albino rats were divided into four groups. In sham group, laparotomy was the standard procedure. In simvastatin group, simvastatin was given perorally before laparotomy. In sepsis group, peritoneal sepsis was constituted by cecal ligation and puncture technique. In sepsis + simvastatin group, the procedures of simvastatin and sepsis groups were applied together. After sacrification at the 72nd hour, tissue samples from lungs were harvested for histopathological examination, wet and dry weight measurements, and tissue culture, tissue malondialdehyde, and nitric oxide tests. Blood samples were taken for C-reactive protein and whole blood count. While the malondialdehyde levels were found to be significantly higher in sepsis group, nitric oxide levels were found to be significantly lower in simvastatin + sepsis group. Alveolar hemorrhage was highest in simvastatin + sepsis group. There was no difference for C-reactive protein, leukocyte levels, and histopathological examination between any groups. The ratios of wet and dry lung weights were higher in simvastatin-given groups. Simvastatin has no positive effect in terms of lung dysfunction on experimental sepsis model. For a better understanding of the effects of simvastatin on lung injury in peritoneal sepsis, experimental models of longer duration that enable to search the effects of simvastatin beyond 3 days will be more useful.

The value of CRP, IL-6, leptin, cortisol, and peritoneal caspase-3 monitoring in the operative strategy of secondary peritonitis.

BACKGROUND: We aimed to investigate the impact of C-reactive protein (CRP), interleukin (IL)-6, leptin, cortisol, and caspase-3 on the decision of terminating planned abdominal repair in secondary peritonitis. METHODS: Fifteen patients with peritonitis were enrolled into the study. Serum CRP, IL-6, leptin, cortisol, and peritoneal caspase-3 activities were measured. RESULTS: APACHE II scores at 48 hours (h) and age were significantly higher in non-survivors. A significant decrease was observed in caspase-3 activities of patients in whom ≤4 laparotomies were performed when compared with those who underwent >4 laparotomies. For patients who underwent ≤4 laparotomies, there was a significant difference in caspase-3 levels between 0 and 72 h. There was no significant difference in caspase-3 levels in non-survivors; caspase-3 levels were significantly lower in the survivors at 48 and 72 h. Changes in CRP, IL-6, leptin, and cortisol levels were not statistically significant. CONCLUSION: CRP, IL-6, leptin, cortisol, and caspase-3 are not valuable in discriminating the number of planned operations, even though there is a significant decrease in caspase-3 "within" survivors. The discriminative value of caspase-3 for closure should be evaluated in studies in which caspase-3 is monitored for a longer duration in a large number of patients.

Effect of carnitine on cutaneous wound healing in immunosuppressed rats.

BACKGROUND: The wound is ischemic in nature. Chronic steroid administration impairs wound healing by changing enzymes in the glycolytic pathway. Carnitine supplementation may help to restore the energy deficiency caused by chronic steroid administration in the wound. The aim of this study was to evaluate the effect of carnitine on impaired wound healing. METHODS: The study was conducted in three groups. Surgical intervention was a 4 cm long midline skin incision at the back. In Group A, eight rats received methylprednisolone for 7 d prior to surgical intervention, and it was continued until the end of the experiment. In Group B, 12 rats received methylprednisolone for 7 d prior to surgical intervention. After surgery, methylprednisolone injection was continued and carnitine was supplemented until the end of the experiment. In Group C, eight rats received no medication. The wound of half of the animals in each group was harvested on the seventh day after surgical intervention and the remaining on the 14th d. Tensile strength and hydroxyproline content were measured in all groups. RESULTS: There was no significant difference in parameters in any of the groups on day seven. On day 14, all parameters were statistically different between methylprednisolone and control groups (P < 0.05). Values for tensile strength were higher in the methylprednisolone/carnitine group compared with methylprednisolone group (P < 0.05). Carnitine administration had also increased hydroxyproline levels in the methylprednisolone/carnitine group compared with the control group (P < 0.05). CONCLUSIONS: Carnitine is shown to increase tensile strength of the wound when supplemented to immunosuppressed rats in which wound healing is impaired by methylprednisolone.

Effects of different anesthetic techniques on serum leptin, C-reactive protein, and cortisol concentrations in anorectal surgery.

AIM: To compare the effects of intratracheal general anesthesia (ITGA) and regional (saddle block) anesthesia on leptin, C-reactive protein (CRP), and cortisol blood concentrations during anorectal surgery. METHODS: Fifty-eight patients suffering from hemorrhoidal disease, pilonidal sinus, anal fissure, or anal fistula were included the study. Patients were randomly assigned into one of the two groups (n=29). Patients in one group received ITGA. After thiopental and fentanyl induction, vecuronium was used as a muscle relaxant. Anesthesia was maintained with sevoflurane. In the other group we applied saddle block, injecting hyperbaric bupivacaine into the subarachnoid space, through the L3-L4 intervertebral space, in the sitting position. Blood samples were collected for leptin, CRP, and cortisol analysis before the induction of anesthesia at 3 and 24 hours postoperatively. RESULTS: Preoperative leptin, CRP, and cortisol concentrations were comparable between the groups. There was no significant difference in postoperative levels of leptin and CRP in both groups. Although not significant, leptin and CRP concentrations were lower in the saddle block group at three hours postoperatively (mean-/+SD, 6.95-/+8.59 and 6.02-/+12.25, respectively) than in the ITGA group (mean-/+SD, 9.04-/+9.89 and 8.40-/+15.75, respectively). During early postoperative period, cortisol increased slightly in the ITGA group and remained at similar level in the saddle block group, but later decreased in both groups. Cortisol levels in the saddle block group were significantly lower than in the ITGA group at 3 hours postoperatively (343.7-/+329.6 vs 611.4-/+569.8; P=0.034). CONCLUSION: Saddle block, a regional anesthetic technique, may attenuate stress response in patients undergoing anorectal surgery, by blocking afferent neural input during early postoperative period.

Similar effects of general and spinal anaesthesia on perioperative stress response in patients undergoing haemorrhoidectomy.

Surgery induces release of neuroendocrine hormones (cortisol), cytokines (interleukin-6: IL-6, tumour necrosis factor-alpha: TNF-alpha), acute phase proteins (C-reactive protein: CRP, leptin). We studied the effects of general and spinal anaesthesia on stress response to haemorrhoidectomy. Patients were assigned to general and spinal anaesthesia groups (n = 7). Blood samples were drawn before induction and 24 hours after surgery. Perioperative levels of IL-6, TNF-alpha, CRP, cortisol, and leptin were comparable among the groups. Twenty four hours after surgery, TNF-alpha and cortisol did not change; IL-6 and CRP increased significantly in all patients. Significant increase in leptin levels was found in patients undergoing spinal anaesthesia. Except for the increase in leptin levels, there was no significant difference related to the effects of general and spinal anaesthesia.

Gold and gold-palladium coated polypropylene grafts in a S. epidermidis wound infection model.

BACKGROUND: The use of non-absorbable mesh grafts in both abdominal wall defects and inguinal hernias are impossible in the presence of contamination. This study was conducted for evaluation of the efficiencies of polypropylene mesh grafts coated with gold and palladium-gold. MATERIALS AND METHODS: Ten piece of 1 x 2 cm of polypropylene mesh grafts were used in each group of naïve, gold-coated, and palladium-gold-coated. The grafts were incubated in physiological saline buffered and 0.5 McFarland slime positive Staphylococcus epidermidis for 24 h. At intervals of 6, 12, 24, 48, 72 h grafts were washed with saline and vortexed for 2 min in 2 ml of physiological saline. There were 100 microl of samples of vortexed material incubated in blood agar and 24 h later, colony numbers were assessed. In the second part of study, the grafts were implanted below the musculoaponeurotic layer at inguinal region of rats following the same procedure of incubation and washing. On the 8th day, the rats were examined for infection rate and their wound cultures were obtained. RESULTS: The least amount of bacterial growth was detected in the samples obtained from gold-palladium coated grafts; whereas the highest rate of growth was found in samples of naive grafts. The superficial surgical site infection rate was 0% in gold-palladium coated, 30% in gold-coated and 100% in naïve polypropylene group. The bacterial growth rate from wound cultures confirmed the superficial surgical site infection rates in all groups. CONCLUSION: Prosthetic graft infection with S. epidermidis can be prevented by coating the graft with gold-palladium or gold.

The effect of G-CSF in an experimental MRSA graft infection in mice.

Wound infection after prosthetic material implantation is a troublesome complication with an incidence of 2% to 10%. The effect of granulocyte colony-stimulating factor (G-CSF) was studied in an experimental methicillin-resistant Staphylococcus aureus (MRSA) graft infection model. Eighty adult mice were used. Under general anesthesia an abdominal incision of 2 cm in length was performed. A subcutaneous cavity of 2 x 2 cm in size was created. Polypropylene mesh pieces of 2 x 1 cm and MRSA solution of 0.1ml of 10(8) CFU/mL were used. G-CSF was applied systemically or locally in a dosage of 0.02 MU/30 g body weight. There were 8 groups: group I, wound + MRSA; group II, wound + mesh + MRSA; group III, wound + mesh + MRSA + G-CSF (ip, 48 h before operation); group IV, wound + mesh + MRSA + G-CSF (ip, 24 h before operation); group V, wound + mesh + MRSA + G-CSF (locally, into the cavity); group VI, wound + mesh (incubated in G-CSF solution for 4 h) + MRSA; group VII, wound + mesh + MRSA + G-CSF, ip, 24 h from operation; and group VIII (positive control group), wound + mesh + MRSA + Teicoplanin (0.03 mg/30 g body weight, ip, 1/2 h before operation). Three days after, animals were killed and incisions were examined for possible infection or abscess formation and wound failure. Meshes were removed; after vortexing and dilution, samples were incubated with 5% agar media. Results of bacterial incubation were evaluated 24 h and 48 h later. There were symptoms of wound infection and abscess formation in all groups except group VIII. In group VIII, MRSA was isolated in 7 events with a colony count below 10(3). Bacterial counts were above 10(6) (10(6)-10(8)) in all other groups. Thus, it was observed that wound infection could be created with this model, but G-CSF could not prevent the development of wound infection, whether it was administered systemically or locally. Teicoplanin decreased the number of colony-forming units of MRSA, and prevents wound infection in this MRSA wound infection model.

Superior mesenteric artery syndrome: CT and ultrasonography findings.

PURPOSE: The purpose of the study was to describe computed tomography (CT) and ultrasonography findings in superior mesenteric artery syndrome (SMAS). MATERIALS AND METHODS: The study was performed on 89 CT examinations. Ultrasonography was performed on 32 and barium study was performed on four of these subjects. Group A consisted of cases with one or more of the following complaints: postprandial epigastric pain, weight loss and vomiting. Group B consisted of the remaining cases. Cases who had all of the above-mentioned clinical findings and duodenal dilatation, to-and-fro barium movement and SMA indentation in barium study were diagnosed as having SMAS. Body mass index (BMI, kg/m2) was calculated. The distance between SMA and aorta, at the location where the duodenum passes from, was measured on CT and ultrasonography. The angle between SMA and aorta was measured on ultrasonography images. Group and gender differences were analyzed with t-test, the relationship between clinical and CT findings was analyzed with Mann Whitney U test and the relations between BMI-CT and CT-ultrasonography measurements were analyzed with Pearson coefficients. RESULTS: Of 13 cases in Group A, 3 were diagnosed as SMAS. Eight of the cases showed gastric and/or duodenal dilatation. In 6 cases, antrum had an abnormally high location at portal hilus. In Group A, the SMA-aorta distance was 6.6 +/- 1.5 mm and the SMA-aorta angle was 18.7 +/- 10.7 degrees . In Group B, these values were 16.0 +/- 5.6 mm and 50.9 +/- 25.4 degrees , respectively (p < 0.001). Cut-off values between SMAS and Group B were 8 mm (100% sensitivity and specificity), and 22 degrees (42.8% sensitivity, 100 % specificity). CT and ultrasonography measurements (p < 0.001) and SMA-aorta distance and BMI (p=0.004) were significantly correlated. The SMA-aorta distance was significantly shorter in females (p=0.036). CONCLUSION: Gastric and/or duodenal dilatation and a diminished SMA-aorta distance have a significant correlation with clinical symptoms of SMAS that include postprandial pain, vomiting and weight loss.

Limberg flap repair for pilonidal sinus disease.

PURPOSE: There are many methods described for the treatment of sacrococcygeal pilonidal sinus disease, and none of them has been accepted as an optimal modality. Plastic procedures have some advantages, such as short duration of hospitalization, quick healing time, low risk of wound infection, and lower recurrence rates. Our choice is Limberg flap repair; we present here our experience with this procedure. METHODS: From August 1998 to July 2000, 147 male patients were treated with Limberg flap repair under regional anesthesia in a soldier's hospital. RESULTS: No major anesthetic complication or wound infection developed. Three patients (2 percent) had a seroma (with negative culture) and six patients (4.1 percent) had partial wound detachment. Patients returned to full activity on the 10th to 25th postoperative day (mean, 18.8). Patients were followed from 1 to 40 (mean; 13.1) months. Seven patients (4.8 percent) had a recurrence. CONCLUSION: The Limberg flap procedure is an easy and effective technique. Patient comfort, quick healing time, early return to full activity, and low complication and recurrence rates are the important advantages of this procedure.

The effects of anesthetic techniques on acute phase response at delivery (anesthesia and acute phase response).

OBJECTIVES: To investigate the effects of anesthetic techniques and delivery types on stress response during uncomplicated delivery. DESIGN AND METHODS: Forty pregnant women at term were divided into four groups. Group-I, cesarean section with general anesthesia; Group-II, section with spinal anesthesia; Group-III, section with epidural anesthesia; and Group-IV, vaginal delivery with epidural analgesia. C-reactive protein and albumin were measured on hospital admission, immediately after delivery and 24 h later. RESULTS: Albumin and CRP levels decreased significantly in Group-II and Group-III, just after delivery. CRP increased significantly in all groups at the 24(th) hour of delivery. The effect of hemodilution on CRP and Albumin, due to volume loading, during spinal and epidural anesthesia disappeared after 24 h. CONCLUSION: We found no influence of anesthetic techniques on acute phase response except hemodilution effect. In the view of delivery types, vaginal delivery caused less stress response than section.