Ferruh Isman

Evaluation of oxidative stress in laparoscopic cholecystectomy.

Abstract.Purpose: We conducted a prospective study to evaluate the effect of CO2 pneumoperitoneum and increased intra-abdominal pressure on arterial blood gases, end-tidal CO2 (ETCO2), nitric oxide (NO), blood and tissue malondialdehyde (MDA), and total antioxidant (TAOx) levels during laparoscopic cholecystectomy. Methods: Fifty selected patients with cholelithiasis were randomized to undergo either laparoscopic or open surgery. Blood samples were taken pre-, mid-, and postinsufflation, and 24 h postoperatively. To determine the tissue MDA level, tissue samples were taken from the gallbladder just after removal. Results: The increased levels of ETCO2 and PCO2, caused by CO2 pneumoperitoneum resulted in a minimal decrease in blood pH during the laparoscopic surgery. Although low levels of blood MDA were seen 30 min after the start of laparoscopy, due to less oxidative stress response and tissue trauma, increased levels of tissue MDA levels indicated that the gallbladder was more traumatized during laparoscopic dissection and handling. NO levels were slightly lower in the laparoscopic cholecystectomy (LC) group, but there were no significant differences compared with the open cholecystectomy group (OC). TAOx levels were similar in both groups 30 min after the start the procedure, but were much lower in the LC group 24 h postoperatively. Conclusions: These findings suggest that the antioxidant defense system is stimulated less with less oxidative stress, providing further evidence to support the opinion that LC is a safe technique.

Circulating levels of copeptin, a novel biomarker in pre‐eclampsia

Aims:  Increasing evidence supports the participation of metabolic syndrome and insulin resistance in the pathogenesis of pre‐eclampsia. Copeptin is co‐synthesized with vasopressin and is a new and promising novel marker of metabolic syndrome and insulin resistance. Our aim was to investigate copeptin levels in normotensive pregnant, mild and severe pre‐eclamptic women.

Effect of Increased Abdominal Pressure on Cytokines (IL1β, IL6, TNFα), C-reactive Protein (CRP), Free Radicals (NO, MDA), and Histology

Background It is generally accepted that proinflammatory mediators, including cytokines, are responsible for the metabolic changes associated with injury. Recent clinical and experimental studies have also shown that the laparoscopic procedures actually produce ischemia-reperfusion injury in the organs by oxygen-derived free radicals. This study aimed to assess the effect of different insufflation pressures and laparotomy on tissue response by comparing the proinflammatory cytokines, C-reactive protein, and serum and tissue levels of oxygen-derived free radicals. Methods Forty mature New Zealand white rabbits were assigned to 4 groups of 10 animals. In groups 1 to 3, CO2 pneumoperitoneum was created using an automatic insufflator to the designated pressure of 10, 15, and 20 mm Hg, respectively. The remaining 10 animals underwent laparotomy using 10 cm midline incision (group 4). Blood samples were collected before (0 min) and at the end of the procedure (60 min). After the collection of last blood samples, all animals were killed and samples from liver and gut were obtained for measurements of tissue malondialdehyde levels and histology. Results The proinflammatory cytokine levels were increased significantly in groups 1 to 3, but did not change in the laparotomy group. Serum C-reactive protein levels were elevated in all groups. The comparison of the results between the laparotomy and laparoscopy groups showed that serum interleukin 6 and nitric oxide levels were significantly elevated in relation the intra-abdominal pressure, and serum interleukin 6 and nitric oxide levels peaked in group 3. Tissue malondialdehyde levels were significantly higher in groups 1 and 2 than in groups 3 and 4. Conclusions The findings of our experiment suggest that the elevated intra-abdominal pressure is responsible for ischemia, free radical production, and proinflammatory cytokine response-mediated cell damage during laparoscopic surgery.

Influence of pulsed electromagnetic fields on healing of experimental colonic anastomosis

PURPOSE: The study investigated the influence of pulsed electromagnetic fields (PEMFs) on the mechanical strength and collagen content of uncomplicated colonic anastomosis in rats. METHODS: A standardized left colonic resection was performed 3 cm above the peritoneal reflection, and end-to-end anastomosis was constructed with eight interrupted inverting sutures. Beginning immediately after surgery, randomly assigned groups were exposed to one of the following: 1) 100 Hz (frequency), 1 mT (intensity) PEMFs with 16-hour on/8-hour off cycles (n=8); 2) 100 Hz, 2 mT PEMFs with 16-hour on/8-hour off cycles (n=8); 3) 100 Hz, 1 mT PEMFs with 6-hour on/6-hour off cycles (n=6), whereas the control group (n=10) received no PEMFs. Relaparatomy was performed at 72 hours postoperatively, and the bursting pressure of the anastomotic segment was recordedin situ.The hydroxyproline contents of the anastomotic and adjacent perianastomotic segments of equal lengths were determined. RESULTS: Mean bursting pressure values of the groups that received 100 Hz, 1 or 2 mT PEMFs with 16-hour on/8-hour off cycles (90.88±19.13 and 83.88±7.08 mmHg, respectively) were significantly higher than those of the control group (61.66±10.6 mmHg) and the group with 6-hour on/6-hour off cycles (64.83±7.36 mmHg;P<0.05 for all comparisons). Hydroxyproline contents of the anastomotic and perianastomotic segments were consistently higher in the 16-hour on/8-hour off PEMF groups, compared with those of the corresponding segments of the control group. CONCLUSIONS: PEMFs applied externally to unrestrained rats within a “window of PEMF parameters” provided a significant gain in the mechanical strength of the colonic anastomosis, at least 72 hours postoperatively. Associated relative increases in the hydroxyproline contents of the (peri)anastomotic colonic segments suggest that an altered collagen metabolism might contribute to this enhancement of the anastomotic repair. Further investigations based on these preliminary data and the definition of the exact measures regarding the effects of PEMFs on biologic systems, in general, may lead to an efficient and new adjunctive modality in colorectal surgery.

Increased Chitotriosidase Activities in Patients with Rheumatoid Arthritis: A Possible Novel Marker?

Abstract Background: Chitotriosidase and YKL-40 are well-known in humans as Glyco_18 domain-containing proteins that are the common feature of mammalian chitinases and chitinaselike proteins. Previously, increased levels of YKL-40 were found correlated with the disease activity of rheumatoid arthritis. However, serum chitotriosidase activity in rheumatoid arthritis is not known yet. The aim of this study was to determine YKL-40 and chitotriosidase in patients with rheu - matoid arthritis and to compare these markers with traditi - onal ones such as C-reactive protein and erythrocyte sedimentation rate. Methods: Chitotriosidase, YKL-40 and C-reactive protein were measured in serum samples from 27 patients with rheumatoid arthritis and 27 healthy people. Chitotriosidase, YKL-40, C-reactive protein, and erythrocyte sedimentation rate were determined by a fluorometer, ELISA, nephelometer, and Western Green method, respectively. Results: Serum chitotriosidase activities and YKL-40 levels were higher in rheumatoid arthritis group than in control. A significant positive correlation was found between chitotriosidase and YKL-40. In ROC analysis, the areas under curves for chitotriosidase, C-reactive protein, erythrocyte sedimentation rate, and YKL-40 were 0.96, 0.84, 0.76, and 0.65, respectively. Area under the curve for chitotriosidase was significantly higher than the area for erythrocyte sedimentation rate (p=0.005) and for YKL-40 (p=0.0001), but not for Creactive protein (p=0.055). Conclusions: Serum chitotriosidase was significantly in creas - ed in patients with rheumatoid arthritis. Among all the param - eters evaluated, chitotriosidase was the most sensitive and specific one. Comprehensive studies covering larger populations are needed to elucidate the relationship bet ween chitinases, in particular chitotriosidase and rheumatoid arthritis. Kratak sadržaj Uvod: Hitotriazidaza i YKL-40 su dobro poznati kao proteini koji sadiže domen Gliko_18, koji je zajednička karakteristika hitinaze sisara i proteina sličnih hitinazi. Ranije se pokazalo da su povećani nivoi YKL-40 povezani sa delovanjem reuma- toidnog artritisa. Svrha ove studije je određivanje nivoa YKL- 40 i hitotriozidaza kod bolesnika sa reumatoidnim artritisom i upoređivanje sa uobičajenim indikatorima kao što su C- reaktivni protein i brzina sedimentacije eritrocita. Metode: Nivoi hitotriozidaza, YKL-40, C-reaktivni protein i brzina sedimentacije eritrocita u uzorcima seruma 27 boles- nika sa reumatoidnim artritisom i 27 zdravih osoba izmereni su redom fluorometrijskom, ELISA, nefelometrijskom i Western-Green metodom. Rezultati: U serumu grupe bolesnika sa reumatoidnim artritisom je zabeležena veća aktivnost hitotriozidaza i nivo YKL-40 u poređenju sa zdravim ispitanicima. Između hito- triozidaza i YKL-40 postoji statistički značajna pozitivna korelacija. U analizi ROC, za hitotriozidaze, C-reaktivni pro-tein, brzine sedimentacije eritrocita i YKL-40, područja ispod krive su redom zauzela 0,96, 0,84, 0,76 i 0,65. Vrednost područja ispod krive testa za hitotriozidaze je bila znatno veća od vrednosti područja ispod krive brzine sedimentacije eritrocita (p= 0,005) i YKL-40 (p=0,0001), ali identična sa područjem za C-reaktivni protein (p= 0,055). Zaključak: Aktivnost hitotriozidaze u serumu bolesnika sa reumatoidnim artritisom je u vidljivom porastu. Između svih procenjenih parametara utvrđeno je da je hitotriozidaza naj- osetljivija i najspecifičnija. Pbstoji potreba za opsežnim studi- jama na polju hitinaze, koje obuhvataju veće populacije i koje će istražiti odnos između hitotriozidaza i reumatoidnog artritisa.

Serum chitotriosidase activity in acute appendicitis: preliminary results.

Chitotriosidase is one of the most quantitative proteins secreted by activated macrophages, so its activity has been proposed as a biochemical marker of macrophage accumulation. The clinical importance of the chitotriosidase is still largely unknown. Our aim was to evaluate diagnostic accuracy of serum chitotriosidase activity in acute appendicitis (AA). A total of 34 patients with preoperative AA diagnosis (18 men and 16 women; mean age, 28.8±10.9 years) were enrolled in this study. The appendix specimens were classified as normal appendix (10 patients) and AA (24 patients). The serum chitotriosidase activity was measured preoperatively. Diagnostic value of the preoperative chitotriosidase activity as assessed through the corresponding receiver operating characteristic curve was well (area under the curve, 0.771; 95% confidence interval, 0.647-0.877; P<.05). Preoperative serum chitotriosidase activity may be a useful marker for diagnosis of AA, and future studies are required to confirm the results presented here.

Serum visfatin levels in acute appendicitis

The clinical importance of the novel adipokine visfatin are still largely unknown. Our aim was to evaluate diagnostic accuracy of visfatin serum concentrations in Acute appendicitis(AA). Total of 34 patients with preoperative AA diagnosis (18 men and 16 women, mean age 28.8 +/- 10.9 years) were enrolled this study. The appendix specimens were classified as normal appendix (10 patients), acute appendicitis (24 patients). The serum levels of visfatin measured Diagnostic value of the preoperative serum visfatin levels as assessed through the corresponding ROC curve was well. (area under the curve [AUC] = 0.926, P < .001). In this small case series, visfatin level was found to be useful marker for diagnosis of AA.

The Value of Urinary BDNF Levels on Assessment of the Botulinum Toxin Type A Treatment for Neurogenic Detrusor Overactivity in Children with Myelodysplasia

Purpose: Urinary cytokines are proposed to predict urodynamic findings and outcome of intradetrusor botulinum neurotoxin type A injection in children with myelodysplasia. The relationship between urinary brain-derived neurotrophic factor and neurogenic and nonneurogenic detrusor overactivity has been shown as well. We prospectively investigated the effect of intradetrusor botulinum neurotoxin type A injection on urine brain-derived neurotrophic factor levels in children with nonneurogenic detrusor overactivity due to myelodysplasia. Materials and Methods: Urine samples of 23 children with nonneurogenic detrusor overactivity due to myelodysplasia were collected and analyzed before and 1 and 3 months after intradetrusor botulinum neurotoxin type A injection, and urodynamics were performed before and 6 weeks after injection. Brain-derived neurotrophic factor levels and urodynamic findings were analyzed and statistical comparisons were done. Results: Mean ± SD age was 100.0 ± 34.5 months. Ratio of girls to boys was 2.8. Brain-derived neurotrophic factor levels significantly decreased (p <0.006), and maximum cystometric capacity and maximum detrusor pressure improved significantly following intradetrusor botulinum neurotoxin type A injection compared to preoperatively (p <0.001). No statistical correlations were determined between brain-derived neurotrophic factor levels and urodynamics. Of all analyses only bladder compliance 5 ml/cm H2O or less vs greater than 5 ml/cm H2O at postoperative urodynamics was associated with statistically increased urine brain-derived neurotrophic factor levels, suggesting that increased urine brain-derived neurotrophic factor predicts treatment failure. Conclusions: The present study does not suggest that urine brain-derived neurotrophic factor is a reliable followup marker in children with nonneurogenic detrusor overactivity due to myelodysplasia. However, this factor may have a role in treatment planning, which needs to be established in future large prospective studies.

Triglyceride Response to Oral Glucose Load: Is it Exaggerated in Metabolic Syndrome?

Objective: Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors related to insulin resistance. Data show that triglyceride (TG) levels following an oral glucose tolerance test (OGTT) are higher among obese and insulin-resistant cases associated with metabolic risk factors. In this study, we aimed to assess whether an exaggerated TG response was present in cases with MetS who had undergone OGTT. Methods: In total, 88 cases (70 females, 18 males) without diabetes who were aged older than 18 years were recruited. All the cases underwent 75-gram OGTT. Fifty-one cases (42 females, 9 males; mean age: 48.69±10.13 years) with MetS according to the International Diabetes Foundation formed the MetS group, while 37 cases without MetS (28 females, 9 males; mean age: 48.78±9.18 years) formed the control group. Results: OGTT 0-, 1-, and 2-hour TG levels were 170.96±81.10 mg/dL, 166.94±72.82 mg/dL, and 157.76±74.29 mg/dL in the MetS group and 116.46±47.60 mg/dL, 115.35±46.01 mg/dL, and 108.51±49.33 mg/dL in the control group, respectively. The 2-hour TG levels were significantly decreased in both groups compared with the 0and 1-hour levels (p=0.001 for both). In both the groups, glucose and insulin levels significantly increased in the 1st hour compared with the 0th hour and significantly decreased in the 2nd hour compared with the 1st hour (p=0.001 for both). Conclusion: In this study, the presence of MetS did not have an effect on TG response to OGTT. The decrease in TG levels in both groups may be associated with the acute decreasing effect of early-phase insulin on TG.