Çiğdem Tokyol

Can preconditioning reduce laparoscopy-induced tissue injury?

Background: Pneumoperitoneum (P) created to facilitate laparoscopy (L) is associated with splanchnic perfusion, ischemia/reperfusion (I/R) injury, and oxidative stress. In this randomized controlled experimental study with blind outcome assessment, we evaluated the effect of preconditioning (PRE) on L-induced I/R injury. Methods: The subjects were 40 Sprague-Dawley male rats. P was created in all except controls, using carbondioxide (CO2) insufflation under a pressure of 15 mmHg. PRE consisted of 10 min of P, followed by 10 min of deflation (D). The rats were randomized to the following groups: Group P was subjected to 60 min of P. Group P/D was subjected to 60 min of P, followed by 45 min of D. Group PRE/P was subjected to PRE, followed by 60 min of P. Group PRE/P/D was subjected to PRE, followed by 60 min of P and 45 min of D. Group C (control) was subjected to a sham operation, without P. Its anesthesia time was equal to that for group PRE/P/D. At the end of the experiments, the rats were killed; blood, liver, and kidney samples were then obtained and coded. Plasma alanine aminotransferase (ALT) and malondialdehyde (MDA), as well as homogenized tissue MDA levels and glutathione (GSH) activities, were measured; tissue samples were assessed for histopathological evidence of injury; all assessments were done by investigators blinded to the study design. The results were decoded and analyzed statistically with the Kruskal-Wallis and Mann Whitney tests. A p < 0.05 was considered significant. Results: Plasma ALT as well as plasma, liver, and kidney MDA levels and liver and kidney injury scores were increased, whereas liver and kidney GSH values were decreased in groups P and P/D, as compared to group C. Rats subjected to PRE before P had plasma ALT, kidney MDA, and kidney and liver GSH levels comparable to controls; their kidney and liver injury scores were higher than controls but significantly lower than nonpreconditioned animals. PRE enabled decreased plasma, kidney, and liver MDA as well as increased kidney GSH if applied before P; its efficacy on oxidative stress was limited to providing decreased kidney MDA and increased kidney GSH if applied before P/D. However, PRE significantly attenuated kidney and liver injury after P as well as P/D. Conclusion: PRE consisting of 10 min of P followed by 10 min of D decreases the oxidative stress induced by sustained P in the plasma, liver, and kidney. PRE significantly limits liver and kidney injury after prolonged P and P/D. After further studies to define its ideal timing, PRE before L incorporating P may have clinical relevance, especially for elderly patients or those with impaired hepatic and/or renal function or perfusion.

Protective effect of erythropoietin on renal ischemia and reperfusion injury

Background:  Multiple protective effects of erythropoietin (EPO), such as antiapoptotic, antioxidant, angiogenic and neuroprotective effects, against ischemia have been demonstrated in cell culture and animal models. Genistein is also a potent tyrosine kinase inhibitor. The aims of the present study were to evaluate the effects of EPO on renal ischemia/reperfusion injury and to determine the role of the tyrosine kinase pathway on this process.

The Effects of Desferrioxamine and Quercetin on Liver Injury Induced by Hepatic Ischaemia-Reperfusion in Rats

Abstract Background: This study was designed to examine the effects of desferrioxamine and quercetin on hepatic ischaemia-reperfusion injury in rat. Methodology: Thirty Wistar albino rats were randomized into five groups. Group I was the control group. Group II received no treatment. Group III and group IV received intramuscular injections of desferrioxamine (100 mg/kg per day) and quercetin (50 mg/kg per day) respectively. Group V was administered desferrioxamine and quercetin in combination. After treatment for 3 days, groups II, III, IV, and V were exposed to total hepatic ischaemia for 45 minutes. Plasma alanine aminotransferase levels, malondialdehyde and reduced glutathione activities were measured after reperfusion for 1 hour. Histopathological analysis of liver tissues was carried out. Results: Our results indicated that tissue malondialdehyde levels and histopathological liver damage scores were significantly higher in the ischaemia-reperfusion group than in the control group. Administration of desferrioxamine, quercetin, and desferrioxamine+quercetin significantly decreased these parameters. Plasma alanine aminotransferase levels were also increased after ischaemia-reperfusion. Quercetin and desferrioxamine + quercetin significantly decreased the activity of this enzyme when compared to ischaemia-reperfusion group. Conclusions: The present data suggest that both desferrioxamine and quercetin may be useful to protect against ischaemia-reperfusion induced liver damage.

Expression of cyclooxygenase-2 and matrix metalloproteinase-2 in adenomyosis and endometrial polyps and its correlation with angiogenesis.

This study investigates the expression of cyclooxgenase (COX)-2 and matrix metalloproteinase (MMP)-2 in patients with adenomyosis or endometrial polyps and their possible relation to microvascular density in these lesions. The subjects were 25 patients with adenomyosis, 30 patients with endometrial polyps, and 20 female controls. The expression of COX-2, MMP-2, and CD34 was studied immunohistochemically. Microvesseldensity (MVD) was calculated by the counting of CD34-positive vascular endothelial cells. The quantity and intensity of COX-2 expression in endometrium did not vary during the menstrual cycle in the control group and in patients with endometrial polyps. In patients with adenomyosis, it was higher in the secretory phase. MMP-2 expression in stromal cells in adenomyotic foci and endometrial polyps were higher than in normal endometrium. In the proliferative phase, MVD in adenomyosis foci was higher than in normal endometrium and endometrial polyps. In the secretory phase, MVD in adenomyotic foci and endometrial polyps was higher than in normal endometrium. Overexpression of stromal MMP-2 may play a role in the development of adenomyosis and endometrial polyps. Aberrant COX-2 expression in eutopic endometrium during the luteal phase may be associated with the pathogenesis of adenomyosis; however, expression of COX-2 does not seem to play a role in the development of endometrial polyps. MVD was high in both lesions, but there was no significant correlation between MVD and the expression of MMP-2 or COX-2. Mechanisms other than COX-2 and MMP-2 may contribute to the promotion of angiogenesis in these lesions.

The protective effect of erythropoietin on ischaemia/reperfusion injury of liver

BACKGROUND Besides its haematopoietic effect, erythropoietin (EPO) has multiple protective effects, i.e. antiapoptotic, antioxidant and angiogenic properties. The neuroprotective effects of EPO against ischaemia have all been demonstrated in cell culture and animal models. The aim of the study was to evaluate the effect of erythropoietin on ischaemia-reperfusion injury (I/R injury) of the liver. METHODS Forty-eight adult male Sprague-Dawley rats weighing 250-300 g were divided into three groups: group I, hepatic ischaemia-reperfusion (Hepatic I/R); group II, hepatic ischaemia-reperfusion + EPO (Hepatic I/R+ EPO); group III, sham. Hepatic ischaemia was created by placing a microvascular clamp on the hepatic pedicle for 45 minutes. EPO was given to group II at a dose of 1000 U/kg 120 minutes before the onset of the ischaemia. Blood samples and liver tissues were obtained after 45 minutes of reperfusion from half of the rats in each group. The remaining rats were killed after a 24-hour observation period and blood and tissue samples were obtained. Blood alanine aminotransferase, tumour necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2) and liver tissue malondialdehyde (MDA) levels were determined. Liver tissue histopathology was also evaluated by light microscopy. RESULTS In rats with hepatic ischaemia, serum levels of ALT, TNF-alpha, IL-2 and liver tissue levels of MDA were reduced by the administration of erythropoietin and the histopathological score was also less severe. CONCLUSION This study demonstrates that pre-ischaemic administration of EPO has protective effects on hepatic I/R injury.

Bacterial vaginosis: comparison of Pap smear and microbiological test results

Our purpose was to determine the reliability of the Pap smear in making the diagnosis of bacterial vaginosis and to examine the characteristics of Pap smear vs vaginal culture in diagnosis of bacterial vaginosis, with the vaginal Gram stain used as the diagnostic standard. We performed a prospective, blinded study involving 245 women who referred to the Department of Gynecology and Obstetrics in our hospital for routine genital examination between September 2001 and September 2002. Exclusion criteria included vaginal bleeding and pregnancy. Each patient had standard Pap smear, Gram-stained vaginal smear and culture of vaginal swab. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic value of Pap smear and vaginal culture results were determined with Gram stain used as the standard for diagnosis of bacterial vaginosis. Using Gram stain diagnosis of bacterial vaginosis as the standard, Pap smear and vaginal culture test results had sensitivity of 43.1 and 77.8%, specificity of 93.6 and 97.7%, positive predictive value of 73.8 and 93.3%, negative predictive value of 79.8 and 91.4%, diagnostic value of 78.8 and 91.8%, respectively, for the diagnosis of bacterial vaginosis. Compared to the microbiological test results, Pap smear is not sensitive enough for screening of bacterial vaginosis. However, because of its high specificity, it may be an adequate diagnostic criteria when it is positive.

Middle Ear Hemangioma: A Case Report

Hemangiomas are common benign vascular tumors, but they have rarely been reported in the middle ear. They can mimic glomus tumor in appearance when encountered as middle ear masses. A case of a right-sided middle ear hemangioma in a 51-year-old woman who suffered from pulsatile tinnitus is presented with a review of the relevant literature.

Primary retro peritoneal mucinous cystadenoma

Mucinous cystadenomas and cystadenocarcinomas of the ovary are clinically and histopathologically well-established common tumors. The retroperitoneal location of cystic tumors resembling ovarian mucinous cystadenoma and cystadenocarcinoma is rare. We report the clinical and pathological features of a rare retroperitoneal tumor in the presence of normal ovaries, primary retroperitoneal cystadenoma, and discuss the possible origin of retroperitoneal mucinous cystadenomas.

Epithelioid sarcoma-like hemangioendothelioma: a case report.

Seven cases of an unusual low-grade vascular tumor were reported in a recent study. Despite its similarity to epithelioid sarcoma, this tumor was termed epithelioid sarcoma-like hemangioendothelioma because of the subtle histopathological and immunohistochemical differences. Another case of this rare entity in a 70-year-old woman who suffered from a painful mass on the anterior aspect of the right cubital fossa is presented here, together with a review of the relevant literature.

Comparison of Placental PTEN and β1 Integrin Expression in Early Spontaneous Abortion, Early and Late Normal Pregnancy

Background: PTEN seems to play an important role in cell cycle, growth, migration, and death. Integrins are cell surface receptors that play a role in the regulation of cell proliferation, differentiation, implantation, and embryogenesis. PTEN inhibits β1 integrin signaling. The objective of this study is to investigate the expression of PTEN and β1 integrin in placental tissues of early spontaneous abortion and first and third trimesters of normal pregnancy. Method: A total of 43 placental tissue samples were evaluated using immunohistochemistry for PTEN and β1 integrin. Group 1 included placental tissues of volunteer termination of normal pregnancy during the first trimester (5-10 wk gestation). Group 2 included placental tissues of normal vaginal delivery at the third trimester of pregnancy (36-40 wk gestation). Group 3 included placental tissues of pregnancy termination because of spontaneous abortion during the first trimester (5-10 wk gestation). Results: PTEN expression of villous trophoblast was decreasing as the pregnancy advanced. PTEN staining of decidual cells was significantly stronger in tissue samples from early spontaneous abortion than in tissue samples from early and late normal pregnancy (p=0.003, p=0.001, respectively). There was no significant difference between β1 integrin expression of villous trophoblast and decidual cells in three groups. Conclusion: Our findings suggest that altered patterns of PTEN expression may be associated with abortion, but it seems that β1 integrin does not contribute to this process as a signaling protein. Further evaluation is needed to highlight this subject.