Investigation of time-dependent alterations in adipokine levels and endoplasmic reticulum stress markers in obese patients with laparoscopic sleeve gastrectomy.

BACKGROUND AND AIMS: We aimed to investigate the time-dependent alterations of serum, adipose tissue WISP1, Nrg4, asprosin, SPX adipokines and serum ER stress markers GRP78, XBP1, ATF6, CHOP in obese patients who underwent laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: Morbidly obese patients (n = 19) and normal-weight individuals (n = 19) were compared. Preoperative (control, obese) and postoperative 1st, 3rd and 6th month (obese) follow-up measurements were obtained. Levels of adipokines, ER stress markers were measured with commercial kits. RESULTS: Body mass index (BMI), total fat, trunk fat mass, fat percentage of obese patients decreased after LSG. Postoperative serum glucose, insulin, HOMA-IR, triglyceride levels of obese patients decreased, HDL increased. In obese patients, preoperative LDL and total cholesterol, which were not different from control, were higher in the postoperative 6th month measurements. Omentum WISP1, subcutaneous adipose tissue WISP1 and SPX, and serum WISP1, asprosin, CHOP levels were higher, Nrg4 lower in obese patients. Serum Nrg4 was still lower in the postoperative 1st month measurements, while WISP1 was higher in the 3rd and asprosin in the 3rd, 6th months compared to control. 1st and 3rd month ATF6 and 3rd month CHOP concentrations were lower than preoperative values. Serum CHOP measured at the 6th month was significantly higher than control. Negative correlations were observed between serum Nrg4 and fat percentage, TG concentration. CHOP was negatively correlated with fat percentage. CONCLUSION: The correlations between changes in serum Nrg4, CHOP and fat percentage highlight the roles of Nrg4 and CHOP in the fat loss following LSG.

Pregnancy after renal transplantation.

OBJECTIVE: A well-functioning renal transplant usually reverses ESRD-related infertility and allows the reproductive function to improve. In this study, we wanted to emphasize that women who have renal transplantation can live healthy pregnancies with a careful follow-up. BACKGROUND: 204 patients underwent renal transplantation in our center and 84 of them were female. Five of our patients (one of them had two births) gave birth to a total of 6 pregnancies. METHOD: All of these patients were evaluated according to the criteria by the organ transplant team and perinatologist before the pregnancy planning and during the pregnancy processes. RESULTS: The mean age of the patients was 22.5 ± 4.5 (18-29) years. The creatinine level was below in 1.5 mg/dl in all patients in the pre-pregnancy period, and 1 + proteinuria was found in only two of them. Pregnancy periods varied between 31 weeks and 38 weeks. All births were performed by cesarean section and birth weight in babies ranged between 1650 and 3190 gram. CONCLUSION: Pregnancy in the renal transplant recipient is high-risk and should be managed by a multidisciplinary team of high-risk obstetricians, perinatalogists and transplant nephrologists. It should be closely monitored in terms of complications during pregnancy (Tab. 5, Ref. 16).

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia.

INTRODUCTION: Acute mesenteric ischemia (AMI) is an abdominal-vascular emergency which is rare and has high mortality rates (60-80 %) due to late diagnosis (1-3). Although it is known that extravascular reasons like intestinal intussusception, volvulus, strangulated hernias and obstructions can cause intestinal gangrene, these are rarely the cause of AMI (1). MATERIALS AND METHODS: In this study, we used male Wistar-Albino rats weighing 250-300 grams obtained from Pamukkale University Experimental Research Laboratory. Animals were exposed to light-dark cycles for 12 hours and had free access to food and water. They were kept in cages for 7 days to stabilise their intestinal flora. In animals of group I, nothing was made other than taking 0.5 ml blood intracardially. In other animals, abdomen was reached with midline laparotomy and superior mesenteric artery (SMA) was located. In group II (operative control group), SMA was isolated and manipulated but was not ligated. In Group III (intestinal ischemia group), SMAwas isolated and ligated with 3/0 silk tie distally to the aorta. After this process, intestinal ischemia was achieved which was confirmed by paleness and pulselessness of intestines, caecum and right colon. Later on, abdomen was closed with double 3/0 polyglactin sutures. At postoperative 1st, 4th and 6th hours 0.5 ml blood was taken intracardially from the animals in groups II and III in order to quantify D-dimer and L-lactate levels. LABORATORY TESTS: D-dimer: Blood samples which were put into tubes containing sodium citrate, were seperated from plasma with centrifugation at 4000 rpm for 7 minutes.L-lactate: Blood L-lactate levels were determined from blood taken into capillary tubes with the help of immobilised enzyme electrode technology using YSI 1500 Sport portative lactate analyzer (Yellow Springs Instruments Inc., Ohio-USA). HISTOPATHOLOGIC VERIFICATION: Two cm long intestinal samples were taken from animals in which SMA was ligated in order to achieve mesenteric ischemia and these samples were fixed in 10 % formol. DISCUSSION: As a result, in rats with SMA occlusion serum D-dimer levels were not increased significantly when compared either in the group or with the basal values of the control group and values in operative control group. Therefore, it is concluded that D-dimer is not a useful marker for early diagnosis of AMI. On the other hand, it is revealed that blood L-lactate levels began to increase significantly following 4th hour of mesenteric ischemia and it is shown that this increase continued at the 6th hour. In addition, considering the utmost importance of the early diagnosis in patients with the clinical suspicion of AMI, L-lactate seems to be a suitable marker to use in emergency departments because it is achieved with a portable device that gives fast and accurate results. Nevertheless, our results are need to be supported by clinical studies with larger patient series (Tab. 2, Fig. 11, Ref. 39).

The effects of exercise on portal venous system in splenectomized adults.

OBJECTIVES: This study was designed to assess the effects of exercise on the portal venous system in splenectomized adults. BACKGROUND: Splenectomy is a surgical intervention commonly performed at surgery clinics and recognized as a cause of portal vein thrombosis. Intensive exercise increases blood flow to the contracting muscles, causes hypercoagulability and vasoconstriction in the splanchnic area, hence the portal vein diameter, blood flow velocity and discharge decrease. METHODS: Forty adults participated in this investigation. Subjects were trained to run for twenty minutes on a treadmill at a velocity of 6 km/h and ten-degree elevation. We compared the white blood cell count, portal vein diameter, portal venous blood flow velocity and discharge of splenectomized and healthy adults before and after exercise. RESULTS: After exercise, the blood leukocyte count was significantly increased and the portal vein diameter was significantly reduced in both groups (p<0.001) but there were no statistically significant differences between the two groups. The portal venous blood flow rate in splenectomy group were significantly lower than in the control group (p<0.001). Furthermore the portal venous blood flow rates in both groups were significantly reduced after exercise (p<0.001). CONCLUSION: Exercise in splenectomized individuals can cause serious problems in form of decreasing splanchnic flow and increasing blood viscosity. After splenectomy, both healthy individuals and patients with hematologic diseases ought to avoid intensive exercises (Tab. 2, Ref. 16).

The effect of polypropylene mesh on ilioinguinal nerve in open mesh repair of groin hernia.

OBJECTIVES: Repair of groin hernia is one of the most common operations performed by general surgeons, and mesh repair methods have gained wide acceptance. Chronic pain is the most serious long-term complication that can occur after repair of groin hernia. The development of chronic pain after herniorraphy has been attributed to several mechanisms, including damage to sensory nerves and mesh inguinodynia. MATERIAL AND METHODS: Twenty-four rabbits underwent bilateral inguinal dissection and synthetic polypropylene mesh laid on one side. Bilateral inguinal dissection was performed again after 3 months, and samples of nerve tissue were taken from both sides for histological examination. RESULTS: Light microscopic examination of the sections of control group peripheral nerves were in normal appearance, but the nerve fascicles in experimental group operated with mesh showed axonal dilation and mild-to-severe loss of myelinated axons. Examination of semi-thin and ultra-thin sections in control group peripheral nerve fascicles showed normal morphology. Ultrastructural nerve morphology in experimental group operated with mesh exhibited endoneurinal edema with thickening of both endoneurium and perineurium, causing separation of nerve fibers. Myelin sheaths of fibers showed an ondulation toward the axoplasm and the endoneurium. Separation of myelin layers from each other as a prominent feature of myelin degeneration in nerve fibers was also observed. Axoplasms exhibited edema and crystallization. CONCLUSIONS: The light microscopic and ultrastructural changes seen in peripheral nerves in experimental group operated with mesh suggested that mechanical compression of peripheral nerves is associated with myelin degeneration, endoneurinal and perineurial edema, fibrosis, axonal loss, and edema that may cause peripheral neuropathy. Chronic groin pain after hernia repair can be possibly caused by the entrapment of peripheral nerves in the scar tissue formed by the mesh.