Fadil Ayan

Involvement of neutrophils in ischemia-reperfusion injury of inguinal island skin flaps in rats

&NA; Increased production of oxygen free radicals and infiltration of neutrophils into tissue subjected to ischemia‐reperfusion have emphasized that neutrophils play a direct role in the development of injury. The present study was designed to elucidate the effect of FK506, a new immunosuppressive drug, on 11 hours of complete ischemia and reperfusion of the inguinal island skin flaps in rats. Group 1 (n = 10) control animals underwent ischemia and reperfusion and no treatment. Group 2 (n = 10) animals received FK506 0.3 mg/kg/day, and group 3 (n = 9) animals received 0.5 mg/kg/day intramuscularly for 3 days before the ischemia. The effect of the drug was evaluated by measuring flap survival and tissue malondialdehyde content and myeloperoxidase activity and also by histopathologic examination of the skin specimens taken at the 1st and 24th hour after reperfusion. The survival of flaps controlled for 7 days was found to be significantly improved in group 2 (65.0 ± 10.93 percent) and group 3 (93 ± 6.25 percent) when compared with the control group (14 ± 10.12 percent) (p < 0.04 and p < 0.0001). The tissue contents of malondialdehyde and activities of myeloperoxidase were significantly lower in groups 2 and 3 than in the control group. Three days of pretreatment with FK506 significantly reduced neutrophil infiltration in groups treated with either of the doses. These results showed that neutrophils play an important role in island flap survival associated with ischemia‐reperfusion injury. Increased neutrophil infiltration was found related with increased levels of malondialdehyde and myeloperoxidase. Flap necrosis and the increase in malondialdehyde, myeloperoxidase, and neutrophil infiltration were improved by FK506 pretreatment, a neutrophil modulating agent. (Plast. Reconstr. Surg. 102: 153, 1998.)

Fournier's gangrene : A retrospective clinical study on forty-one patients

Background:  Fourniers gangrene, first described by Dr Jean Alfred Fournier in 1883, still has a high mortality rate. The prognosis and outcome of such patients were analysed.

Effects of allopurinol, ibuprofen and cyclosporin A on local microcirculatory disturbances due to burn injuries

This experiment was designed to study the reactions in the surrounding area of burn injury that may lead to further necrosis in 24 h. To prevent extension of burn size into the tissue adjacent to burn injury, it was attempted to reduce progressive microvascular damage by different drugs (ibuprofen, allopurinol or cyclosporin A (CyA)) in a rat model. The burn model consisted of a row of four 10 x 20 mm burn areas separated by three unburned 5 x 20 mm skin bridges (interspaces). To evaluate microcirculation and perfusion of panniculus carnosus muscle which is beneath the burned area of skin, the radioactive agent, technetium-99m methoxyisobutylisonitrile (99Tc01-MIBI) was used 24 h after the burn. Capillary permeability of injured tissue was assessed by the wet and dry weight technique. In all study groups, interspaces showed higher uptakes of 99Tc01-MIBI between 40 and 95 per cent, in comparison with burn sites in the first 24 h following burn. Among the treated rats better results were obtained by allopurinol and CyA treatment that commenced before burn than ibuprofen. Wet and dry ratios were found to be significantly lower in interspaces in rats pretreated with allopurinol and CyA. Results of this experiment showed that neutrophils and free radical-mediated injury may be involved in the pathogenesis of local response to thermal injury, and allopurinol and CyA have some effects to prevent progressive ischemia, capillary compromise and oedema.

Neutrophil-mediated injury in ischemic skin flaps : Amelioration of ischemic injury by cyclosporine in the rat

The role of neutrophils, their presence, and their degree of infiltration was examined in ischemic skin flaps. In a rat model, caudally based dorsal flaps were studied and neutrophils were manipulated by giving cyclosporine at two different doses (15 and 30 mg per kilogram), administrated either for 5 days as a pretreatment or 15 minutes before flap elevation. The presence of neutrophils and lymphocytes in both intravascular and extravascular space was assessed at 15, 30, and 60 minutes by skin biopsies, taken after elevation of the flap, by direct quantitative counting under the light microscope. The correlation between the counts and localization of the neutrophils, but not the lymphocytes, and the percentage of necrosis showed an early and definite role of neutrophils on skin flap survival during ischemic insult. Cyclosporine-treated flaps showed a 24% to 37% increase in viability when compared to control flaps. These data suggest that neutrophils, probably their interactions and/or products, play an important role in ischemic flap survival, and cyclosporine A is able to inhibit neutrophil accumulation and sequestration.Cetinkale O, Bilgic L, Ayan F, Kandilci A. Neutrophil-mediated injury in ischemic skin flaps: amelioration of ischemic injury by cyclosporine in the rat.

The Effect of Halofuginone, a Specific Inhibitor of Collagen Type 1 Synthesis, in the Prevention of Pancreatic Fibrosis in an Experimental Model of Severe Hyperstimulation and Obstruction Pancreatitis

BACKGROUND The aim of this paper is to assess the effects of halofuginone, a specific inhibitor of synthesis of collagen Type 1, on fibrogenetic process in an experimental model of early pancreatic fibrosis. METHODS Thirty rats were divided into three equal groups: group 1, sham laparotomy; group 2, severe hyperstimulation and obstruction pancreatitis (SHOP) with no treatment; group 3, SHOP with halofuginone treatment group. SHOP model was induced by complete pancreatic duct obstruction and daily cerulein hyperstimulation (50 microg/kg, intraperitoneally). Halofuginone was administered daily from the operative day (5 mg/kg, intraperitoneally). All of the animals were sacrificed, and blood and pancreatic tissue samples were obtained for biochemical and histopathological examination on the 5th postoperative day. RESULTS No mortality was observed in any group. Serum amylase, lipase, hyaluronic acid, and nitric oxide levels were significantly higher in groups 2 and 3 compared with group 1 (P < 0.05), but were significantly lower in group 3 compared with group 2 (P < 0.05). No significant differences were observed regarding serum malondialdehyde and glutathione levels between groups 1 and 3. Tissue hydroxyproline levels were found to be significantly higher in groups 2 and 3 compared with group 1 (P < 0.001), but were significantly lower in group 3 compared with group 2 (P < 0.001). Although tissue hydroxyproline levels were significantly higher in the halofuginone treatment group compared with the control group, histopathological evaluation did not reveal a significant difference between these groups regarding collagen deposition. When group 3 was compared with group 2, halofuginone significantly reduced inflammation and acinar atrophy in the pancreas as well (P < 0.05). CONCLUSION Halofuginone was found to be effective in reducing SHOP-related inflammation, acinar atrophy, and fibrosis in the pancreas.

Gastro-intestinal bezoars: thirty-five years experience.

Abstract Background and aims: Because of their rarity and late diagnosis, gastro-intestinal bezoars can be treated after the occurrence of some complications such as acute intestinal obstruction, strangulation, decubitus ulceration and bleeding. In this study, reasons for bezoar formation, measures to be taken and treatment modalities were investigated. Patients and methods: The files of the patients who were found to have gastro-intestinal bezoars and who were treated at Istanbul University, Cerrahpasa Medical Faculty General Surgery Department and Emergency Unit between the years 1970 and 2005 were analysed. Results: Thirteen (30%) of the 44 patients in the study were women, 31 (70%) were men: the mean age was 55.5 ± 19.6 (range 22–96) years. Enzymatic dissolution (3 patients) and endoscopic fragmentation (four patients) were unsuccessful. Laparoscopic gastrotomy (n = 2), gastrotomy(n = 16), gastric resection (n = 3), enterotomy (n = 12), segmental intestinal resection (n = 3), gastroduodenotomy (n = 1), and gastrotomy + enterotomy (n = 3) were performed. In two patients, bezoars were fragmented and milked to caecum. There were no major postoperative complications, except abdominal wound infection in 4 patients and one patient who had a recurrent intestinal bezoar five years after the operation. One of the patients died because of heart failure on the 7th postoperative day. Mean hospital stay was 9.5 ± 3.6 days. Conclusion: Even though rarely seen in digestive tract diseases, the probability of BZ formation should always be remembered. After the removal of BZs by conservative methods or surgery, precautions should be taken against recurrence and possible underlying psychiatric disorders should be treated.

The use of FK506 and skin allografting for the treatment of severe burns in an animal model

A 30% burn injury was found highly immunosuppressive in mice by means of two in vivo measurements of cell-mediated immunity, and this immunosuppression could be prevented by early excision and grafting. FK506, a new immunosuppressive agent, was given at different doses for 12 days after early excision and grafting following burn and all doses prolonged the acceptance time of allografts from 14 to 20 days. Allograft rejection was not seen when animals were on the drug. Higher doses prolonged the rejection more, even after the cessation of the drug, and they caused some degree of immunodepression. Immunosuppressive treatment with FK506 when used following burn injury affected cell-mediated immunity minimally to moderately when compared to burned control groups.

An alternative treatment of massive burns: skin allografts and cyclosporin immunosuppression without severe additional depression of cellmediated immunity in an animal model

This study investigated the effects of early excision of eschar and grafting with cyclosporin immunosuppression on immunological changes following burn injury. The immunological status of the rat was studied using two in vivo measures following a (30 per cent TBSA) full skin thickness burn injury. Cyclosporin was found to be a powerful immunosuppressive agent in skin transplantation, and its risks, efficacy and possible side-effects after thermal injury have been investigated. This study demonstrated that a large burn was profoundly immunosuppressive, and early excision and grafting was able to restore cell-mediated immunity significantly as reflected by two in vivo assays. The short course of the immunosuppressive treatment to delay skin allograft rejection did not cause a severe additional effect on cell-mediated immunity after thermal injury. Allograft survival appeared to be related to immunosuppression caused mainly by cyclosporin treatment and also by the immunosuppressive effect of the burn.

An Atypical Etiology of Suprasphincteric Fistula: A Forgotten Surgical Material

While the majority of fistulas in ano result from infection of the anal crypts, complex, recurrent, and/or nonhealing fistulas should always raise the suspicion of a chronic underlying condition. In this paper, we present a 30-year-old male patient with a diagnosis of a complex suprasphincteric fistula caused by a surgical thread left behind after an orthopedic hip operation performed sixteen years ago. Partial fistulectomy, extraction of the foreign material, and debridement procedures were performed. Few cases of such complex fistulas in ano due to foreign materials have been described in the literature. After careful history-taking, meticulous physical examination under general anesthesia should be done in order to deal with this rare type of fistula.

Is it necessary to perform prophylactic cholecystectomy for all symptomatic gallbladder polyps diagnosed with ultrasound

OBJECTIVE The main aim of this study is to determine the necessity of cholecystectomy in patients with ultrasound diagnosed symptomatic polypoid lesions of the gallbladder. MATERIAL AND METHODS The data of 82 patients with polypoid lesions of the gallbladder who had cholecystectomy between 2000 and 2012 were analyzed retrospectively with preoperative ultrasound and histopathology results. RESULTS The mean age was 48.05±11.18 years (range 25-74 years). All patients underwent preoperative ultrasound examination. Eighteen (22%) of the 82 patients were asymptomatic; their polypoid lesions of the gallbladder were detected with ultrasound during a check-up or other reasons. In 45 (55%) of cases pathology reported no polypoid lesions of the gallbladder. Right upper quadrant or epigastric pain was the most common symptom (41.46%) that led to hepatobiliary ultrasound, the other symptom was dyspepsia (36.59%). On preoperative ultrasound evaluation, 22 patients had multiple polyps, and 9 of these 22 patients had at least 3 polyps. CONCLUSION There is an inaccuracy of ultrasound to detect polypoid lesions of the gallbladder. After diagnosing polypoid lesions of the gallbladder by using standard ultrasound, further pre-operative diagnostic tests are needed to help discriminating benign lesions from malignant ones, which may prevent unnecessary surgery regardless of symptoms.