Course of sepsis in rats with thyroid dysfunction.

OBJECTIVE: Numerous studies show the relationship between sepsis and thyroid hormones. Virtually all these studies investigate changes in post-sepsis thyroid hormones and the relationship between these changes and the progression of the disease. Our aim in this study was to investigate the progression of sepsis in rats with thyroid dysfunction. MATERIAL AND METHODS: The study involved four groups, each containing seven female Wistar albino rats: Group 1: Sham, Group 2: Control (Sepsis), Group 3: Hyperthyroidism-Sepsis, and Group 4: Hypothyroidism-Sepsis. Group 1 only received laparotomy. Group 2 only had sepsis. Sepsis was induced in Group 3 and Group 4 following formation of hyperthyroidism and hypothyroidism, respectively. After 24 hours, relaparotomy and thoracotomy were performed, and tissue and blood samples were drawn. RESULTS: Dysfunctions seen in the liver, lungs, and kidneys during sepsis and other findings of sepsis were milder in the hyperthyroidism group in comparison to both the control and hypothyroidism groups. CONCLUSION: The results of Simon's grade, histopathological organ damage, and laboratory parameters revealed that the progression of sepsis was milder in the hyperthyroid group than in the hypothyroid and euthyroid groups. The progression in the hypothyroid group was the most severe. Therefore, the results of the study raise the question of whether immediate treatment in cases of hypothyroidism and slow return of thyroid function to normal levels in cases of hyperthyroidism are adequate treatment approaches in patients who may develop sepsis or septic shock." To determine the answer to this question, more detailed studies are required with a higher number of subjects.

Parathyroid autotransplantation in rats having hypoparathyroidism.

Re-implantation techniques of extracted parathyroid tissue were developed in order to prevent temporary hypocalcemia. During thyroid surgery; inadvertently removed or devascularized parathyroid gland is usually implanted in the sternocleidomastoid muscle. In this experimental study using rats with hypoparathyroidism, our aim was to investigate whether the excised parathyroid tissue could be seeded in the liver and in the peritoneum, instead of the SCM muscle. In our study, four different groups, each consisting of 10 Wistar albino rats were used (Control group, sternocleidomastoid muscle group, liver group, peritoneum group). Parathyroidectomy was performed and the parathyroid tissue was seeded into the sternocloid mastoid muscle, liver and peritoneum. After 14 days, the rats were sacrificed and levels of calcium, magnesium, phosphorus, alkaline phosphatase and parathyroid hormone were measured in rats' blood samples. The autotransplanted parathyroid tissue was then excised and examined. In all groups, parathyroid tissues were analyzed histopathologically according to calcification, necrosis, tissue loss, foreign body reaction, inflammation and fibrosis. Regarding Ca, Mg, PO4, ALP; There were no difference between the groups. When we compared control group with the other groups; a difference was observed in the levels of PTH (P<0.05). In pathological examination; regarding tissue loss; there was a difference between liver and peritoneum groups (P<0.05). In our study, we expected better result in plantings inside liver and peritone compared to SKM. However, there were no difference between the groups.

Thyroid lipomatosis.

Thyroid lipomatosis is a rare condition characterized by the presence of abundant mature adipose tissue in the thyroid gland. We herein report the case of a 43-year-old man with chronic renal failure caused by amyloidosis presenting with an asymmetrically enlarging thyroid gland. The patient's thyroid hormone levels were normal, and test results for thyroid autoantibodies were negative. A thyroid scan showed diffuse uptake of the radioisotope with a cold area in the left lobe. The pathology of the thyroidectomy material indicated thyroid lipomatosis, and minimal amyloid staining was noted around the thyroid follicles. Thyroid lipomatosis should therefore be kept in mind when making a differential diagnosis of fatty infiltration of amyloid goiter.

A comparison of the application of fibrin glue and adhesive film for repair of anastomotic leaks in the rat.

BACKGROUND: Anastomotic leaks constitute one of the most serious intraoperative complications and although many studies have been devoted to finding a solution for this problem, none of them has yet been able offer a decisive, successful method. In this study, the ability of fibrin glue and adhesive film to repair anastomotic leaks in an experimental model was compared. MATERIALS AND METHODS: The sample comprised four groups of seven rats: Group 1 (Control): the distal colon was transected and anastomosis was performed. Group 2 (Primary repair): incomplete anastomosis produced a leak that was closed by primary repair on day 3. Group 3 (Fibrin glue): incomplete anastomosis produced a leak that was closed by primary repair and fibrin glue applied on day 3. Group 4 (Adhesive film): incomplete anastomosis produced a leak that was closed by primary repair and adhesive film was applied on day 3. The rats were sacrificed on day 6 following anastomosis. Anastomotic blast compressions were measured and fibroblast activation, inflammation, neovascularization and levels of collagen were evaluated. RESULTS: The results from Group 4 showed that blast compression values were high and statistically significantly increased over control values (p < 0.05). Inflammation in Group 2 was significantly higher than the other groups (p < 0.05). No significant differences were detected in the comparison of the groups regarding the other scoring criteria (p > 0.05). CONCLUSION: Adhesive film is more effective in reducing anastomotic leakage than fibrin glue.

The effects of selenium and vitamin E on lung tissue in rats with sepsis.

PURPOSE: In this study we examined the ability of selenium and vitamin E to prevent sepsis-induced changes in lung tissue. METHODS: Fifty rats were divided into five groups: Group 1: Control group; Group 2: Sepsis group. In this group only cecal ligation and perforation (CLP) was performed. Group 3: Selenium group. An intraperitoneal dose of 100 µg selenium was given for the first two days followed by a daily dose of 40 µg for the next five days. CLP was performed the following day. Group 4: Selenium and vitamin E group. In addition to selenium, vitamin E was given intramuscularly in a dose of 250 mg/kg/day for seven days. CLP was performed the following day. Group 5: Vitamin E group. Vitamin E was given intramuscularly in a dose of 250 mg/kg/day for seven days. CLP was performed the following day. RESULTS: There were significant differences between Group 2 and all other groups in terms of blood gas values (pH, pCO2, SaO2), and leukocyte, C-reactive protein (CRP) and glutathione peroxidase levels (p < 0.005). There was no statistically significant difference between groups 3, 4 and 5 in terms of histopathological changes in lung tissue (p > 0.05), but all groups were significantly different compared with Group 2 (p < 0.05). CONCLUSION: Sepsis-induced lung tissue damage can be reduced or prevented by pre-treatment with of selenium and/or vitamin E in a rat model.

Effects of selective iNOS inhibition in sepsis: evaluation of lung tissue damage and blood gases.

NO is an important mediator in the generalized inflammatory response of the body during sepsis and septic shock. We investigated the possible effects of L-arginine and aminoguanidine on plasma NO levels and the interaction between NO levels and lung tissue damage and blood gases in sepsis. Fifty Wistar male rats were used in this study and divided into five groups: group 1, sham group; group 2, CLP (sepsis); group 3, CLP + 10 mg/kg L-arginine administration; group 4, CLP +15 mg/kg aminoguanidine administration; group 5: CLP + L-arginine + aminoguanidine given in similar doses. Sepsis was induced by cecal ligation and puncture (CLP) method. Drugs were administered at postoperative hours 4 and 12. The levels in the aminoguanidine and aminoguanidine + L-arginine groups were similar to the sham group. Lung tissue damage in the sepsis and L-arginine groups was more severe than the other groups.

Clinical and surgical profile and follow up of patients with liver hydatid cyst from an endemic region.

AIM: The aim of this study is to present the changes in the treatment of liver hydatid cyst during the last 20 years in our clinic according to literature data. MATERIAL AND METHODS: Clinical, laboratory and operational findings and pre- and postoperative complications of 650 from 700 patients with liver hydatid cysts, examined and treated at Selcuk University Meram Medicine Faculty, General Surgery Department, between 1985-2005, were evaluated in two groups: 1st period (1985-1995) and 2nd period (1995-2005). RESULTS: 436 of the cases were females (67.1%) and 214 (32.9%) males. The mean age of the females was 35 years (ranges 10-73) and of the males 46 years (ranges 12-76). Surgical treatment comprised radical and obliterative conservative techniques in the first period, while non-obliterative conservative techniques and percutaneous puncture and aspiration of the cyst, injection of scolex eliminating substance and reaspiration (PAIR) were preferred in the second period. During the follow-up (498 cases were followed for a mean period of 32 [12-72] months), recurrence occurred in 12 in the first period and in 9 in the second period, a total of 21 patients (4.21%). CONCLUSION: We consider that regardless of the surgical treatment used in liver hydatid cyst cases, combination with chemotherapy is the safest and most effective approach.

Gastric heterotopia together with intestinal metaplasia in the gallbladder: case report and review of literature.

Heterotopic gastric mucosa in the gallbladder is extremely unusual. In this study, we aimed to report a case of gastric heterotopia together with intestinal metaplasia in the gallbladder of a 16-year-old male patient who experienced a sudden onset of epigastric pain with nausea. He was admitted to the hospital with a prediagnosis of mild degree obstructive jaundice. Cholecystectomy and hepaticoduodenostomy were carried out. In the microscopical examination of the gallbladder, an antral and pyloric type gastric mucosa together with intestinal metaplasia were clearly evident in the gallbladder submucosa, and the adjacent gallbladder mucosa showed typical features of chronic cholecystitis.

Intraoperative determination of intestinal viability: a comparison with transserosal pulse oximetry and histopathological examination.

BACKGROUND: In this study, we aimed to measure the O2 saturation of ischemic intestinal segments and the relationship between these measures and concomitant pathological gradings. MATERIALS AND METHODS: We used 14 New Zealand White rabbits, anesthetized with a combination of 80 mg/kg (i.m.) Ketamine hydrochloride and 10 mg/kg Acepromazine (i.m.). The superior mesenteric artery (SMA) was explored, and O2 saturation was measured by pulse oximetry 5 cm proximal to the ileocecal valve at the 0th hour. At the same time a 0.5-cm full-thickness wedge biopsy was taken from the same region. Thereafter, the SMA was ligated and the abdomen was closed. All rabbits were undertaken relaparotomy at the 4th hour; O2 saturation was measured by pulse oximetry at 5 cm away from the region of the first biopsy and a 0.5-cm full-thickness wedge biopsy was taken. The abdomen was then closed. The same procedure was performed at the 8th and the 12th hour. Mucosal hemorrhage, transmural congestion, mucosal necrosis, and transmural necrosis were examined in the specimens. RESULTS: Pathologically, transmural necrosis was concomitant with 64% O2 saturation (sensitivity: 100%; specificity: 86%). Mucosal necrosis was concomitant with 76% O2 saturation values (sensitivity: 100%; specificity: 75%). Transmural congestion was concomitant with 81% O2 saturation values (sensitivity: 89%; specificity: 58%). Mucosal hemorrhage was concomitant with 91% O2 saturation (sensitivity: 100%; specificity: 31%). CONCLUSION: O2 saturation measures > 76% may indicate reversible changes as mucosal necrosis, transmural congestion, or mucosal hemorrhage, and O2 saturation measures < 64% may indicate permanent transmural necrosis. As a result, intraoperative evaluation of intestinal viability by pulse oximetry may give us an idea about the degree of pathological changes and subsequently might reduce the number of second-look operations.

The effects of serum estrogen levels on hypoxemia and blood nitric oxide levels in experimental hepatopulmonary syndrome.

BACKGROUND: : Hepatopulmonary syndrome (HPS) is a well-defined cause of hypoxemia in patients who have liver disease due to abnormal intrapulmonary vascular dilatation. The pulmonary symptoms of HPS are the result of oxygenation defects that occur as a result of acquired dilatations of the pulmonary blood vessels. In this study, we investigated the effects of estrogen and nitric oxide (NO) in experimental HPS, especially in intrapulmonary vascular dilatation. METHODS: : Fifty female Sprague-Dawley rats were used in this study. The animals were divided into five groups of 10. Group l (the control group): the common bile duct (CBD) was dissected but not ligated. Group 2 (the cirrhosis group): the CBD was ligated. Group 3 (the cirrhosis+oophorectomized group): the CBD was ligated and a bilateral oophorectomy performed. Group 4 (the cirrhosis+estrogen group): the CBD was ligated and exogenous estrogen (5000U/kg) given. Group 5 (the control+estrogen group): the CBD was dissected, but not ligated and exogenous estrogen (5000U/kg) given. A 5-week waiting period was observed for the development of cirrhosis and the rats' lungs and liver were taken for histopathological examination. Pulmonary vessel diameters were measured. The total bilirubin, direct bilirubin, alkaline phosphatase (ALP), estrogen and serum nitric oxide (NO) levels were measured. RESULTS: : The mean perialveolar vessel diameters were significantly higher in the cirrhotic rats (Groups 2, 3, and 4) than the control and control+estrogen administered groups. Again, when we compared the cirrhosis+oophorectomized group and the cirrhosis+estrogen group, the mean perialveolar vessel diameter was significantly lower in the cirrhosis+oophorectomized group than the cirrhosis+estrogen administered group (p=0.001). The mean perialveolar vessel diameter in the cirrhosis+oophorectomized group was significantly lower than the cirrhosis group (p=0.01). When we compared the cirrhotic rats (Groups 2, 3, and 4) and the control group, the plasma NO levels were significantly higher in the cirrhotic rats than the control group (p<0.001). Among the cirrhotic rats, the plasma NO levels were 47.2+/-0.7 and 70.9+/-1.5mumol/l in the cirrhosis+oophorectomized group and the cirrhosis+estrogen administered group, respectively (p=0.004). CONCLUSIONS: : We consider that raised levels of estrogen have a potential role in intrapulmonary vascular dilatation and hypoxemia in HPS. Also, we consider that this effect of estrogen is due to increased levels of NO. Antiestrogenic surgical therapy may decrease the serum estrogen and NO levels, and may decrease the diameter of perialveolar vessels in order to relieve hypoxia in cirrhotic cases.

Effects of gender on the severity of sepsis.

PURPOSE: To investigate the differences between male and female rats and the effects of sex hormones on tissue changes in the lung and liver in a sepsis model. METHODS: Sixty Sprague-Dawley rats were divided into six groups of ten. Groups 1 and 2 were the control male and female groups, respectively, subjected only to sepsis; groups 3 and 4 were the male and female groups, respectively, subjected to sepsis, then given 0.04 mg/kg estrogen + progesterone (E-P) intramuscularly (i.m.); and groups 5 and 6 were the male and female groups, respectively, subjected to sepsis, then given 0.5 mg/kg testosterone (T) i.m. The rats were killed and the histopathological changes in the lung and liver were examined, and plasma endotoxin levels were measured. RESULTS: Histopathological examination revealed less congestion, portal inflammation, and focal necrosis of the liver, and less congestion, edema, and emphysematous and inflammatory changes in the lung in the E-P groups than in the other groups. Moreover, signs of systemic endotoxemia in plasma were proportionally less in the female rats and in the E-P groups than in the male rats and the T groups. CONCLUSION: Female rats subjected to sepsis showed less liver and lung tissue damage and less systemic endotoxemia than male rats, because of the effects of female sex hormones.

Determination of operation time in colorectal diseases: preoperative chemotherapy application.

BACKGROUND: Our aim was to determine the time it takes for wound healing to return to normal in cases where patients have undergone preoperative chemotherapy. MATERIALS AND METHODS: Eighty-four Wistar-albino rats were included in the study. Twelve of them were placed in the control group (Group I), with no further drug administration. Another 12 rats were placed in a sham group (Group II) and were peritoneally injected with 1 cc of isotonic saline solution 5 days a month, for a period of 6 months. The remaining 60 rats were placed in five chemotherapy groups (Groups III-VII) and were administered 20 mg/kg 5-fluorouracil through peritoneal injection, 5 days a month for a period of 6 months. At the end of the sixth cure, 12 rats from the control (Group I), sham (Group II), and chemotherapy groups (Group III) were operated on, and an intestinal transsection was applied to the rectosigmoid junction, followed by one-by-one anastomosis using 5/0 vicryl. Other groups (Groups IV-VI) with chemotherapy treatment were operated on at 1-week intervals and subjected to the same procedure. The subjects were reoperated on on the eleventh day. A full-layer 4 x 4 cm piece was removed from the abdominal wall containing the previous incision line at the middle, for tensile strength pressure measurements. In addition, a 4 cm colon segment was removed for bursting pressure measurements. Plasma albumin and tissue hydroxyproline levels were measured, and fibroblast numbers were counted in the sections prepared from the abdominal wall. RESULTS: The control and sham groups were found to be similar to each other with respect to all parameters measured (P > 0.05). Significant reductions were observed in all parameters in the early chemotherapy groups compared with the control and sham groups (P <0.05). All parameters measured in Groups V, VI, and VII were found to be similar to those in the control and sham groups (P <0.05). CONCLUSION: Wound healing is impaired in rats with chemotherapy, but following the second week after the chemotherapy, disrupted parameters return to their normal levels.

Electron-microscopic alterations of the peritoneum after both cold and heated carbon dioxide pneumoperitoneum.

BACKGROUND: Carbon-dioxide (CO(2)) is used universally as an insufflation agent to create a laparoscopic pneumoperitoneum. In this study, we aimed to examine the electron and light microscopic alterations of the peritoneum after both cold-dry and heated-humidified CO(2) pneumoperitoneum. MATERIALS AND METHODS: Thirty male Sprague-Dawley rats were used in this study. The rats were separated into three groups each comprising 10 rats. Group-I: (Control group): Gas insufflation was not applied to these animals. Group-II: These animals received standard cold-dry (21 degrees C, 2% relative humidity) CO(2). Group-III: These animals received heated-humidified (40 degrees C, 98% relative humidity) CO(2). In groups II and III, peritoneal gas was emptied 2 h after pneumoperitoneum application. All rats were killed after 12 h. Peritoneal samples were examined both by scanning electron and light microscopy by two different pathologists who were not aware of the groups. RESULTS: According to light microscopic examination; in group II and III, cellular response (increased lymphocyte) was significantly higher than the control group (P < 0.01). Similarly, in group II cellular response was significantly higher than group III. (P < 0.01). There was no difference in increased capillarity among all groups. (P > 0.05). According to scanning electron microscopic examination, in group I, normal peritoneum was covered by a sheet of flat mesothelial cells densely covered with microvilli. No intercellulary clefts and no free basal lamina were detected. In group II, drastic alterations of the surface layer were seen. The mesothelial cells had extreme desquamation, and the basal membrane was clearly visible. In group III, the mesothelial cells had bulged up to the surface layer and retracted. Intercellulary clefts become visible, but the basal lamina was not seen. CONCLUSIONS: Electron and light microscopic examination revealed that heated-humidified CO(2) results in less peritoneal alteration than cold-dry CO(2.) Accordingly, we believe that heated-humidified CO(2) is more suitable for pneumoperitoneum application in laparoscopic surgery especially in selected cases.

Primary echinococcus infestation of the bone and muscles.

Hydatid diseases of the bone and muscles are rare, generally are incurable, and have a high level of recurrence. We attempted to ascertain whether the recurrence rate decreased in patients with hydatid disease infestation of the bone and skeletal muscle who were treated with current surgical techniques and antihelminthic chemotherapy, and whether the outcomes for bone infestation were different when compared with outcomes for muscular infestation. We retrospectively reviewed 15 patients with hydatid disease of the bone (eight patients) and muscle (seven patients). The average followup was 30 months (range, 6-69 months). Recurrence was observed in four patients with bone involvement. No patient with muscle involvement had a recurrence after excision. Hydatid disease of the bone often is recurrent and progressive despite using advanced diagnostic studies, improved surgical techniques, and newly developed antihelminthic drugs. The disease status also was not as good as for patients with bone lesions when compared with patients with muscular lesions.

A rare case of rectal prolapse associated with rectal adenocarcinoma: case report.

Despite the fact that colorectal polyps and solitary rectal ulcers may be present in conjunction with rectal prolapse, association between rectal prolapse and rectal cancer is very rare. As far as we could determine, there are only a few articles concerning rectal cancer in association with rectal prolapse in the literature. This case, a 63-year-old female patient, had suffered from a rectal prolapse since childhood and presented as a case of rectal cancer. At presentation, she complained of constipation and rectal bleeding for the previous six months. At physical examination there was a relaxed anal sphincter and a large reddish mass protruding via the anal canal when the patient strained. There was a fungating lesion in the upper left part of the rectal mucosa. An incisional biopsy was performed, the histopathological result of which was adenocarcinoma of the rectum. Changes in bowel habits, chronic constipation and chronic irritation seen in rectal prolapse may be responsible for the development of rectal cancer. Thus, a detailed history, digital rectal examination and rectosigmoidoscopic examination are important, particularly in patients with long-term rectal prolapse.