Ali Kağan Gökakın

The protective effects of sildenafil in acute lung injury in a rat model of severe scald burn: A biochemical and histopathological study

Severe burn induces biochemical mediators such as reactive oxygen species that leads to lipid peroxidation which may have a key role in formation of acute lung injury (ALI). Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5. Sildenafil preserves alveolar growth, angiogenesis, reduces inflammation and airway reactivity. The purpose of the present study was to evaluate the effects of different dosages of sildenafil in ALI due to severe scald burn in rats. Twenty-four rats were subjected to 30% total body surface area severe scald injury and were randomly divided into three equal groups as follow: control, 10 and 20mg/kg sildenafil groups. Levels of malondialdehyde (MDA), activities of glutathione peroxidase (Gpx), catalase (Cat), total oxidative stress (TOS), and total antioxidative capacity (TAC) were measured in both tissues and serums. Oxidative stress index (OSI) was calculated. A semi-quantitative scoring system was used for the evaluation of histopatological findings. Sildenafil increased Gpx, Cat, TAC and decreased MDA, TOS and OSI. Sildenafil decreased inflammation scores in lungs. Our results reveal that sildenafil is protective against scald burn related ALI by decreasing oxidative stress and inflammation and the dosage of 10mg/kg could be apparently better than 20mg/kg.

The impact of Ramadan on peptic ulcer perforation

BACKGROUND Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP. METHODS A retrospective analysis of 229 patients who were operated due to PUP between 1999-2009 was made. Patients were divided into two groups. Group I (n=188) included the patients who were operated in other periods of the year, while Group II (n=41) included the patients who were operated during Ramadan, the Muslim period of fasting. Patients in Group II were analyzed in terms of duration of fasting. RESULTS The increase in surgeries per group was higher in Group II than Group I (p<0.05). Predisposing factors, anti-ulcer drug usage and demographic variables were seen to have no role in this difference. Duration of fasting may have a minimal effect on the perforation. CONCLUSION The results of this study demonstrate that PUP is detected as relatively higher during Ramadan among those who are fasting for more than 12 hours daily. We suggest that people with predisposing factors should be informed before making a decision to fast.

The effects of sildenafil in liver and kidney injury in a rat model of severe scald burn: a biochemical and histopathological study.

BACKGROUND Severe burn induces systemic inflammation and reactive oxygen species leading to lipid peroxidation which may play role in remote organs injury. Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5. Sildenafil reduces oxidative stress and inflammation in distant organs. The aim of the present study was to evaluate the effects of different dosages of sildenafil in remote organs injury. METHODS A total of thirty-two rats were randomly divided into four equal groups. The groups were designated as follows: Sham, Control, 10, and T20 mg/kg sildenafil treatment groups. Levels of malondialdehyde (MDA), vascular endothelial growth factor (VEGF), VEGF receptor (Flt-1), activities of glutathione peroxidase (Gpx), levels of total antioxidative capacity (TAC), and total oxidant status (TOS) were measured in both tissues and serum, and a semi-quantitative scoring system was used for the evaluation of histopathological findings. RESULTS Sildenafil increased levels of Gpx, and Flt-1, and decreased MDA and VEGF levels in tissues. Sildenafil also increased serum levels of TAC and Flt-1 and decreased TOS, OSI, and VEGF. CONCLUSION Sildenafil decreased inflammation scores in remote organs in histopathological evaluation. It has protective effects in severe burn-related remote organ injuries by decreasing oxidative stress and inflammation.

Oxidative stress markers in laparoscopic vs. open appendectomy for acute appendicitis: A double-blind randomized study

Background: Oxidative stress is a complicated process, which was defined as an increase in prooxidants and decrease in antioxidants caused by various mechanisms, including inflammation and surgical trauma. The association between acute appendicitis and oxidative stress has been showed in previous studies. However, comparison of oxidative stress in laparoscopic or open appendectomy (OA) has not been established. Patients and Methods: Patients who were diagnosed as acute appendicitis between October 2012 and January 2013 were randomized to open (OA, n = 50) and laparoscopic appendectomy (LA, n = 50). Blood samples for oxidative stress markers (total oxidant status [TOS] and total antioxidant status [TAS]), C-reactive protein (CRP) and white blood cells (WBCs) were collected just before the surgery and 24 h after surgery. Results: There were no differences in preoperative values of WBC and CRP between LA and OA groups (P = 0.523 and 0.424), however, in postoperative 24th h, CRP was reduced in LA group (P = 0.031). There were no differences in preoperative levels of TOS, TAS, and oxidative stress index (OSI) between LA and OA groups. In the postoperative 24th h, TOS and OSI were found to be significantly higher in OA group when compared to LA group (P = 0.017 and 0.002) whereas no difference was detected in TAS level in the postoperative 24th h (P = 0.172). Conclusions: This double-blind, randomized clinical trial provides evidence that LA for uncomplicated appendicitis is associated with significantly lower oxidative stress compared with OA. Some of the advantages of LA may be attributed to the significant reduction of oxidative stress in these patients.

Conversion to open surgery in the era of laparoscopic cholecystectomy: Rates and reasons

Abstract Aim. In the era of minimally invasive surgery; laparoscopic cholecystectomy has become the first choice for gallstone disease both for urgent and elective surgery .However, a number of cases still necessitate conversion to open procedures. Identifying the reasons and rates involved in conversion at the early period can help the surgeons in deciding when to exclude the choice of e laporoscopic procedure. The goal of this study is to evaluate the rates and causes of conversion to open cholecystectomy in elective cases. Methods. The study included all of the patients who had undergone elective surgery in our clinic due to gallstone disease from January, 1999 to December, 2010. Detection of malignancy and/or polyps, and existence of acute cholecystitis were accepted as criterion for exclusion. The existence of previous abdominal surgery, demographic parameters, and the causes and rates of conversion to open cholecystectomy were noted and analyzed. Results. Of the 823 patients for whom laparoscopic cholecystectomy was applied, 782 were included in this study.The rate of conversion was 6.1% (n=48) in total. Twenty of these 48 converted patients were male and 28 of them were female with a mean age of 49,27 years (range: 24-89). In male and female patients, the conversion rates were 9,8% and 4,8%, respectively. Adhesions due to inflammation or prior abdominal surgery were found to be the most common reasons for conversion. Conclusion. There is no question that laparoscopic cholecystectomy is the gold standard when all other treatment modalities are considered. Laparoscopic cholecystectomy can be safely applied by experienced hands to all patients with a low conversion rate. Conversion should not be seen as a complication. Keywords: Laparoscopic cholecystectomy, gallstone , laparatomy, cholecystectomy Ozet Amac. Minimal invaziv cerrahi caginda laparaskopik kolesistektomi, safra kesesi tasi hastaliginda hem acil hem de elektif sartlarda ilk secenek haline gelmistir. Ancak, halen bazi hastalarda laparatomiye donulmek zorunda kalinmaktadir. Bu tip vakalarin onceden tespit edilerek laparaskopi tercihinden vazgecilmesi icin nedenlerinin ve oranlarinin ortaya konmasi cerrahlara yardimci olabilir. Bu calismanin amaci, elektif vakalarda laparaskopik yontemden acik cerrahiye donus neden ve oranlarini ortaya koymaktir. Yontem. Ocak 1999 ile Aralik 2010 arasinda klinigimizde safra tasi hastaligi nedeni ile elektif kolesistektomi yapilan tum hastalar calismaya dahil edildi. Malignite ve/veya polip tespiti ve akut kolesistit varligi calismada haric tutma kriteri olarak kabul edildi.Onceki abdominal cerrahi varligi, demografik ozellikler, aciga donus neden ve oranlari kaydedilerek analiz edildi. Bulgular. Calisma periyodunu kapsayan donemde laparaskopik kolesistektomi yapilan toplam 823 hastanin 782’si calismaya dahil edildi. Toplam aciga donus orani % 6,1 (n=48) idi. Bu 48 hastanin 20’si erkek, 28’i kadin, ortalama yaslari 49,27 (aralik 24-89) idi. Erkek ve kadin hastalar icin aciga donus oranlari sirasi ile %9,8 ve %4,8 idi. Daha onceki cerrahilere ve enflamasyona bagli yapisiklik acik cerrahiye donmenin en sik nedeni olarak tespit edildi. Sonuc. Tum tedavi yaklasimlari goz onune alindiginda laparaskopik kolesistektominin safra tasi hastaliginda altin standart olmasi konusunda herhangi bir soru isareti yoktur. Laparaskopik kolesistektomitecrubeli cerrahlar tarafindan tum hastalarda dusuk donusum oranlari ile guvenle uygulanabilir. Ancak aciga donus bir komplikasyon olarak gorulmemelidir. Anahtar sozcukler: Laparaskopik kolesistektomi, safra kesesi tasi, laparatomi, kolesistektomi