The effect of fundectomy on histopathological findings and metabolic hormones in rats.

AIM: Fundectomy, shown as an alternative to restrictive techniques, causes absorption restriction and metabolic changes. This study aimed to examine the histopathological changes caused by the fundectomy as a technique applied to rats by hormones that affect stomach and obesity metabolism and its effect on weight loss. MATERIAL AND METHODS: 2randomly selected Winstar-Hannover rat groups were evaluated by measuring their pre-and postoperative weights and biochemically measuring Gastrin, Ghrelin, and Leptin levels on day 30. After sacrification, the stomachs were taken for histopathological examination. RESULTS: Significant weight loss was observed in the fundectomy group in the 1stmonth postoperatively. Biochemically, Gastrin means in the fundectomy group were statistically significantly higher than in the control group. The mean Ghrelin and Leptin levels of the Fundectomy Group were statistically significantly lower (p=0.005). Immunohistochemically, Gastrin means ™at the antrum and proximal stomach parts of the Fundectomy Group were significantly higher than in the control group. As Ghrelin, a significant decrease was observed in all 3regions of the Fundectomy Group compared to the control group. Leptin results were significantly lower at the antrum and proximal stomach parts of the Fundectomy Group. Histopathologically, in the Fundectomy Group, cystic glandular hyperplasia was moderate at the proximal stomach, foveolar hyperplasia was mild at the antrum, fibrosis was moderate at the antrum and corpus, and high at the proximal stomach. CONCLUSION: Fundectomy is an effective method in terms of weight loss. This animal experiment, conducted as a pilot study, will be an essential step in elucidating metabolic and histopathological changes. KEY WORDS: Bariatric surgery, Fundectomy, Obesity.

The Potential Prognostic Significance of the Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) Score in Necrotizing Fasciitis.

Background: We discuss the role of Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) on the prognosis of this disease. Necrotizing Fasciitis (NF) is characterised by rapid spreading of infection and necrosis of the soft tissues and fascia. Methods: Thirty patients (17 male, 13 female, mean age 57.5 years) were treated between 2011- 2016 (in our center); they were analysed retrospectively regarding age, sex, isolated microbiological agents, modalities of treatment and mortality rate. Results: The majority of the infections were detected in the perineum (14 patients). Other sites of infection were: the presacral region (3 patients), as well as abdominal region after elective (10 patients) and emergency surgery (2 patients), respectively. 53.3% of patients had at least one predisposing comorbid factor such as diabetes mellitus, hypertension, cardiomyopathy and congestive heart failure. The tissue cultures were positive in 12 patients. Mean LRINEC score on admission was 8.5 +-2.85. There was a strong correlation between LRINEC score and patient age (p=0.018, R=0.43). LRINEC score was affected by neither gender nor the presence of any comorbidities. The patients were classified according to Wang and Wong staging system, as follows: one patient in stage 1, 15 patients in stage 2 and 14 patients in stage 3. Patients with higher Wang and Wong stages had significantly higher LRINEC scores. The mortality rate was 16.7%. The mean LRINEC score of deceased patients compared to patients who were successfully treated was 9.2Â+-2.2 and 8.36Â+-2.9. Conclusion: Even though LRINEC score and Wang and Wong stage were significatly related with ICU stay, their direct effect on mortality wasn't significant in our study.

Preventive effects of enoxaparin and hesperidin in cerulein-induced acute pancreatitis in rats.

BACKGROUND/AIMS: Acute pancreatitis accounts for almost 250.000 hospital admissions annually in the United States. Most promising treatment approaches are preventive; however, little is known about the early factors initiating acute pancreatitis. We aimed to evaluate the preventive effects of enoxaparin and hesperidin in cerulein-induced acute pancreatitis. PATIENTS AND METHODS: We used 70 Wistar albino rats for this study. Rats were divided into 7 groups: control group, and groups that were administered cerulein(Group 2), enoxaparin (Group 3), hesperidin (Group 4), cerulein with enoxaparin (Group 5), cerulein with hesperidin (Group 6), and cerulein with both enoxaparin and hesperidin (Group 7). Edema formation; leukocyte infiltration; measurement of the amylase level, pancreatic tissue weight, and pancreatic tissue oxidative capacity; and chemiluminescence using luminol, lucigenin, and nitric oxide levels as indices of tissue oxidative capacity were used to evaluate pancreatitis. RESULTS: Acute edematous mild pancreatitis was induced in groups 2, 5, and 6 by cerulein injections. Enoxaparin and hesperidin significantly decreased (p < 0.001) all the tested parameters in these rats. Enoxaparin and hesperidin did not offer complete protection but showed 50% decrease in edema formation. The preventive agents showed no superiority to each other. Further, when enoxaparin and hesperidin were used in combination, no significant additive effects with regard to anti-inflammatory and anti-oxidative actions were present. CONCLUSION: We showed that both enoxaparin and hesperidin exerted significant preventive effects in all the parameters related to acute pancreatitis in our experimental rat model.

Analysis of the factors that have an effect on hypocalcemia following thyroidectomy.

OBJECTIVE: The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this study. MATERIAL AND METHODS: One hundred and ninety thyroidectomy patients were evaluated retrospectively for factors that might contribute to postoperative hypocalcemia; age, hyperthyroidism, malignancy, the extent of surgery (total/near total/subtotal thyroidectomy), cervical lymph node dissection, and incidental parathyroidectomy. RESULTS: The rate of transient hypocalcemia/hypoparathyroidism was 19.47%, with a permanent hypoparathyroidism rate of 4.74%. Factors affecting the development of transient hypocalcemia were found as being operated for hyperthyroidism, and use of total thyroidectomy as the surgical method. Total thyroidectomy increased the risk of postoperative hypocalcemia by 3.16 fold. Patients undergoing operations for hyperthyroidism had a 2.3 fold increase, and those undergoing total thyroidectomy had a 3.16 fold risk of postoperative hypocalcemia. CONCLUSION: Hyperthyroidism surgery and total thyroidectomy lead to a higher risk of developing early postoperative or transient hypocalcemia. According to our results, no significant relationship could be established between any of the study parameters and persistent hypocalcemia.

Laparoscopic management of left thoracoabdominal stab wounds: a prospective study.

BACKGROUND: Left thoracoabdominal stab wounds (LTSWs) leading to diaphragmatic injuries can cause serious morbidity and mortality. The diagnosis and treatment of LTSWs are controversial. This study investigated the reliability of laparoscopy for the diagnosis and treatment of diaphragmatic lacerations in hemodynamically stable patients with an LTSW, hypothesizing that laparoscopy is sufficient for diagnosing and treating diaphragmatic injury after an LTSW. METHODS: This study included 36 cases of LTSWs with no hemodynamic instability or abdominal tenderness seen between June 2002 and June 2007. After systemic examination and resuscitation of the patients, chest x-ray and focused assessment with sonography for trauma were carried out and then laparoscopic exploration was performed in all cases. RESULTS: Of the 36 cases, 36.1% (n=13) had injuries to the diaphragm and 53.8% (7/13) had associated intraabdominal injuries. Nine (69.2%) of the patients with diaphragmatic injuries, but no hollow organ injuries, were repaired through laparoscopy. The hemopneumothorax was found in 33.3% (n=12) of the patients. No relationship was seen between diaphragmatic injuries and the location of the LTSW and existence of hemopneumothorax. CONCLUSIONS: Laparotomy was required in only 11.1% (4/36) of the cases with LTSWs and 30.8% (4/13) of the cases with diaphragmatic injury. Diagnostic and therapeutic laparoscopy was a sufficient and necessary surgical procedure in cases with a hemodynamically stable LTSW, when emergency surgery (laparotomy or thoracotomy) was not necessary.

Impact of ligating gonadal or adrenal collateral veins with the left renal vein on renal function and histology in right-nephrectomized rats.

BACKGROUND: In cases of trauma to the left renal vein (LRV), its ligation near the inferior vena cava (IVC) is considered, but the consequences are not always good. We investigated the role of collateral venous drainage after ligation of the LRV by studying the renal function and histology after ligation of the LRV near the IVC alone or with ligation of the gonadal or adrenal collaterals, in right-nephrectomized (RN) rats. MATERIAL AND METHODS: Ligation of the LRV near the IVC alone (group 1) or with ligation of the adrenal (group 2) or gonadal (group 3) collaterals was studied in RN Wistar rats (n=18 per group). The renal histopathology (ischemic cortical necrosis) and functional status (urea, creatinine, sodium, and potassium) were compared. RESULTS: In RN rats, the results were better when ligating the LRV near the IVC alone or with the adrenal collaterals [mortality 4/18 (22.2%) and 3/18 (16.7%), respectively] than when ligating the LRV near the IVC plus the gonadal collaterals [mortality 15/18 (83.3%)] (p<0.0001). All early deaths occurred within three days and resulted from serious histopathological (ischemic cortical necrosis) and functional (increased urea, creatinine, and potassium; decreased sodium) renal damage. CONCLUSION: In right-nephrectomized rats, the LRV near the IVC and the adrenal collateral can be ligated, while the gonadal collateral should be preserved.

Comparison of controlled-intermittent anal dilatation and lateral internal sphincterotomy in the treatment of chronic anal fissures: a prospective, randomized study.

AIM: The results of controlled-intermittent anal dilatation (CIAD) or lateral internal sphincterotomy (LIS) in the treatment of chronic anal fissures are presented. MATERIAL AND METHODS: Forty patients who were randomized to two groups underwent CIAD or a LIS. The pre- and post-operative mean anal canal resting pressures (MACRPs) and symptoms were recorded and the results were compared. RESULTS: Two months post-operatively, 18 patients in the CIAD group and 17 patients in the LIS group had healed completely, and had no anal incontinence or other complications. The post-operative improvement in pain, bleeding, and constipation did not differ significantly between the two groups. In the CIAD and LIS groups, the pre-operative MACRPs were 89.7+/-16.5 and 87.6+/-12.3 mmHg, respectively; 2 months post-operatively, the MACRPs had significantly decreased to 76.9+/-13.7 and 78.1+/-11.3 mmHg in the CIAD and LIS groups, respectively. No statistical difference existed in the pre- or post-treatment MACRPs between the groups. CONCLUSION: CIAD applied with a standardized technique reduced anal canal resting pressure and provided symptomatic healing that was equivalent to a LIS. Since there were no findings of incontinence, or situations which resulted in sphincter damage, we conclude that CIAD is suitable for patients with chronic anal fissures because it is less invasive than LIS, with equivalent efficacy and safety. In addition, the CIAD method may be an alternative procedure in older and multiparous women who has a higher risk of incontinence.

Laparostomy in patients with severe secondary peritonitis.

BACKGROUND: The aim of this study was to evaluate the effectiveness of laparostomy with the Bogota bag for the management of patients with severe secondary peritonitis and the risk factors for survival. METHODS: Thirty-seven patients (22 males, 15 females; mean age 63.5; range 44 to 83 years) with secondary peritonitis were treated by laparostomy and temporary closure with Bogota bag. APACHE II scores and Mannheim Peritonitis Index (MPI) were used to calculate the disease severity. The outcomes and effectiveness of APACHE II and MPI values were analyzed retrospectively. RESULTS: The mortality rate was 43.2%. Significant differences were noted between survivors and non-survivors according to initial APACHE II and MPI scores and the number of operations. The non-survivors had higher APACHE II (r=0.81, p=0.001) and MPI (r=0.39, p=0.02) scores. The patients who survived were re-operated 1.6 times and those who died were re-operated 4.7 times. In five patients, laparostomy was closed primarily, while in the others, the wound was left open to heal secondarily. CONCLUSION: Patients with higher APACHE II and MPI scores and number of operations had higher rates of mortality due to their major risk factors. Temporary abdominal closure using the Bogota bag in patients with secondary peritonitis is an inexpensive-simple method, permitting evaluation of underlying viscera and recognition of infection.

[The therapeutic effect of normobaric oxygen in experimental peritonitis and the efficiency of rectal fever, WBC, CRP and procalcitonin in monitoring response of the therapy]. / Normobarik oksijenin deneysel peritonitin tedavisindeki yeri ve tedavinin izlenmesinde rektal ates, lökosit, CRP ve prokalsitoninin etkinligi.

BACKGROUND: It was investigated the effect of using normobaric oxygen (NO) in addition to antibiotherapy in experimental peritonitis and the changes of rectal fever (RF), WBC, CRP and procalcitonin levels were evaluated. METHODS: After the preliminary research of the normal values, rats were infected by E. coli intraperitoneally. Four groups were assigned into "no therapy", "given NO", "given antibiotic", "given antibiotic + NO" groups. RESULTS: The decline of RF and WBC levels on 3rd and 5th days was recorded in antibiotic + NO group versus the other groups. It was observed that group 4 was superior to the others. The positivity of periton cultures and the inflammation in the muscle were found to be less in antibiotic + NO group. No correlation was found between pathological and microbiological recovery and blood CRP level in all groups. But a significant decrease in blood procalcitonin level was determined in group 4 compared to the other groups. On day 3, procalcitonin and CRP levels increased with increasing WBC levels. On day 5, procalcitonin levels also decreased in groups with decreased WBC levels, but no significant correlation was found between CRP and WBC levels. CONCLUSION: It was concluded that using of NO in addition to antibiotherapy could increase the success rate of experimental intraabdominal sepsis therapy and blood procalcitonin and WBC levels could be more beneficial than CRP levels in monitoring of the severity of the sepsis.

[pH value and potassium level of diagnostic peritoneal lavage fluid in the early diagnosis of acute mesenteric ischemia secondary to arterial occlusion in rats]. / Siçanlarda arteriyel oklüzyona bagli akut mezenterik iskeminin erken tanisinda diyagnostik peritoneal lavaj sivisinda pH ve potasyum.

BACKGROUND: In this experimental study we evaluated the pH and potassium changes of the peritoneal irrigation fluid in the early phase of mesenteric ischemia. METHODS: The Wistar albino rats were assigned randomly to 5 equal groups of 10 rats: sham operation, 30, 60, 120 and 180 minutes ischemia by arterial occlusion. We enregistred the ranges of pH and potassium in peritoneal irrigation fluid and serum pH. RESULTS: Lower pH and increased potassium levels in peritoneal irrigation fluid were observed in 30 and 60 min ischemia groups. In 120 and 180 ischemia groups the level of pH continued to be lower and potassium level increased gradually, the serum pH were markedly lower in these groups. Histological analysis showed a positive correlation between the intestinal injury and ischemia time. CONCLUSION: In contrast to sham group, increase in potassium and decrease in in pH levels in peritoneal irrigation fluid were seen in 30 and 60 min ischemia groups. The decrease of serum pH was enregistred after 120 min of ischemia. In early phase the measurement of potassium and pH in peritoneal irrigation fluid may be an early diagnostic tool for mesenteric ischemia.

[The effect of selective bowel decontamination and mechanical bowel preparation on bacterial translocation due to intraabdominal hypertension]. / Kariniçi hipertansiyon modelinde gelisen bakteriyel translokasyon üzerine selektif bagirsak dekontaminasyon ve mekanik bagirsak temizliginin etkileri.

BACKGROUND: The objective of our study is to evaluate the preventive effects of selective digestive decontamination (SDD) and mechanical bowel preparation in rats with experimentally induced bacterial translocation. METHODS: Fourty adult male Sprague Dowley rats weighing 250-300 g. were divided equally into four groups as Group 1 (sham [control]), Group 2 (experimentally induced IAH at 19 mmHg), Group 3 ( SDD group) and Group 4 (SDD and mechanical bowel preparation with 19 mmHg intraabdominal pressure). Group 3 and 4 were treated at 12 hours intervals with oral gentamycine 5 mg/kg and IM sefotaxime 100mg/kg Mechanical bowel preparation was performed by oral administration of sodium phosphate. After 24 hours all rats were sacrified; mesenteric lymph nodes, spleen and liver biopsy specimens were harvested aseptically. Specimens were diluted and cultured in McConkey medium and the colony-forming units (CFU/gr ) were calculated. RESULTS: In Kruskal Wallis tests there were no significant differences between Group 1 and 3 or 4, and also Group 3 and 4 (p>0.05, p=0.872 respectively), while differences between Group 1 and 2, and also Group 3 and 4 were statistically significant (p<0.001) with respect to CFU/g estimates. CONCLUSION: These data indicate that selective intestinal decontamination and mechanical bowel preparation prevent bacterial translocation due to intraabdominal hypertension.