Comparison of the protective effects of selective endothelin-a receptor antagonist, ambrisentan, and dual endothelin-A/B receptor antagonist, bosentan, in experimental renal ischemia reperfusion injury.

AIM: This study aims to compare the protective effects of ambrisentan, a selective endothelin typeA receptor antagonist, and bosentan, a dual endothelin typeA/B receptor antagonist, on experimental renal ischemia reperfusion injury. METHOD: The study sample consisted of 21 female rats, which were divided into 3 groups: Control, Ambrisentan and Bosentan. For the ischemia-reperfusion injury model, left­kidney nephrectomy was performed after sacrificing the animals. In the immunohistochemical examination, caspase-3 was examined, and then the apoptotic index was determined. In the biochemical examination, the activities of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase, and the levels of nitrite (NOx), TNF-α, and IL-1ß were determined. RESULTS: There were statistically significant differences between the groups in terms of total injury score grade in range of 0‒3 (p=0.001).The glomerular and tubular apoptotic indices were higher in the control group as compared to those of the ambrisentan and bosentan groups (p=0.001).There were no statistically significant differences in terms of SOD, CAT, GPx, MDA, IL-1ß and TNF-α measurements among the groups (p>0.05). CONCLUSIONS: In the experimentally created renal ischemia reperfusion model, both ambrisentan and bosentan increased the NOx level, decreased the apoptosis, and protected the kidney from renal ischemia reperfusion injury. However, no significant superiority was found between ambrisentan and bosentan in terms of their protective effects (Tab. 3, Fig. 2, Ref. 31).

Prospective comparison of local, spinal, and general types of anaesthesia regarding oxidative stress following Lichtenstein hernia repair.

As a tension-free repair technique, Lichtenstein operation has gained great popularity worldwide during the last decade. Expert centres do this technique using local anaesthesia in nearly 95 % of cases. However, general anaesthesia is used in many hospitals, while regional anaesthesia is preferred in some centres. To date, no study has compared different types of anesthesia in respect of inflammatory response and oxidative stress specifically. The objective of this prospective study was to compare local, spinal and general types of anesthesia regarding their effects on inflammatory response and oxidative stress in Lichtenstein hernia repair. Lichtenstein hernia repair causes only a mild oxidative stress. While total WBC and neutrophil count responses fade away after 24 hours in patients who are operated under local anaesthesia, these changes in spinal and general types of anaesthesia cases stay valid at 24th hour. Spinal anaesthesia is seen to be more advantageous than local and general types of anaesthesia when C-reactive protein as an acute phase marker is considered. Total antioxidant status shows minor alterations in three types of anaesthesia, however, general anaesthesia seems to be the least reliable among them. Overall, local and spinal anaesthesia methods can be accepted as better alternatives in comparison with general anaesthesia in regard to oxidative stress (Tab. 2, Ref. 25). Full Text (Free, PDF) www.bmj.sk.

Hyperbaric oxygenation attenuates renal ischemia-reperfusion injury in rats.

BACKGROUND: Oxygen-derived free radicals play an important role in ischemia-reperfusion injury (IR). Hyperbaric oxygenation (HO) decreases free radical production. The aim of this study was to determine the effect of HO treatment on renal ischemia-reperfusion injury in rats. METHODS: Rats were divided into four groups. All groups underwent right nephrectomy. Group I served as the control group; group II had left renal ischemia-reperfusion; group III was pretreated with HO; and group IV, ischemia-reperfusion and HO pretreatment. Tissue malondialdehyde (MDA) and glutathione (GSH) levels were measured, and histopathologic damage scored. RESULTS: HO pretreatment significantly decreased tissue MDA levels and histopathologic scores among rats with IR. There was an increased GSH in HO-pretreated rats with IR; however, the difference was not significant. CONCLUSION: HO prior to ischemia displayed a beneficial effect on renal IR by reducing oxygen radical peroxidation of lipid membranes.

Changes in collagen and elastic fiber contents of the skin, rectus sheath, transversalis fascia and peritoneum in primary inguinal hernia patients.

BACKGROUND: It has been claimed that inguinal hernia is not a local disease; it is a local manifestation of a systemic disorder of collagen metabolism. Previous studies have shown that patients with inguinal hernia have some anomalies in collagen metabolism and changed ratio of collagen types. AIM: To search the changes in collagen and elastic fiber contents of the skin, rectus sheath, transversalis fascia and peritoneum in primary inguinal hernia patients. METHODS AND MATERIALS: Twenty patients operated on for inguinal hernia (HR) included in the study (11 direct and 9 indirect). Nine patients underwent open cholecystectomy served as the control group (CC). A 0.5 x 1 cm. tissue was sampled from skin, rectus sheath, transversalis fascia and peritoneum in HR group. Skin, rectus sheath and peritoneum samples were taken from the patients in CC group. The sections of those samples were submitted to two different staining methods: "Masson's trichrome" for collagen and "van Gieson" for elastin fibers and graded with light microscopy. RESULTS: The rectus sheath samples of CC had higher staining scores for both collagen and elastin fibers in comparison with HR (p = 0.032 and p = 0.026, respectively). CC had a significantly higher score for collagen in peritoneum samples (p = 0.019). There were no statistically significant differences between the patients with direct and indirect inguinal hernias for collagen or elastin fibers scores in skin, rectus sheath, transversalis fascia and peritoneum samples. CONCLUSIONS: These findings, which concur with most of the previous studies, support the theory that inguinal hernia may not be merely a local disease and can be more generalized, at least a regional connective tissue disorder. Regarding the difference between direct and indirect hernias, it could not be possible to report a certain answer, and this issue should be considered together with previous quantitative researches and more sophisticated studies may take place in the future (Tab. 2, Fig. 2, Ref. 23).

Uncommon content in groin hernia sac.

Groin hernia may have very unusual sac content. Vermiform appendix, acute appendicitis, ovary, fallopian tube and urinary bladder have been rarely reported. We aimed to present our experience with these unusual hernia contents. Records of 1,950 groin hernia patients were retrospectively analyzed. Vermiform appendix was found in 0.51% and acute appendicitis was found in 0.10% of groin hernia sacs. The incidence of appendix in femoral hernia was 5%, while inguinal hernia sac contained ovary and fallopian tube in 2.9% of the cases. The incidence of groin hernias containing urinary bladder was 0.36%. We also had 1 patient with incarcerated bladder diverticula in an indirect hernia sac. Iatrogenic bladder injury occurred in 2 patients. Although rare, a groin hernia sac may contain vermiform appendix and exceptionally acute appendicitis. Tubal and ovarian herniation in inguinal hernias can be found in adult and perimenopausal women with an incidence as high as in children. Urinary bladder hernia occurs with a similar incidence of tuba-ovarian hernia, however, it requires special attention because of a high risk of iatrogenic bladder injury during the inguinal dissection. Every effort should be made to preserve the organ found in hernia sac for an uneventful postoperative period.

Spontaneous perforation of rectum and rectosigmoid junction. Case report.

Two patients with spontaneous rectoisigmoid or rectal rupture are reported. These patients had peritonitis and they underwent sigmoid loop colostomies. A common aetiological factor was chronic constipation. It is important to recognize the condition at an early stage because of its significant mortality and possible excellent results from surgery.