Gökhan Karaca

Anti-inflammatory efficiency of Ankaferd blood stopper in experimental distal colitis model.

Background/Aim: Ankaferd blood stopper (ABS) is a herbal extract that enhances mucosal healing. In this study, we aimed to investigate the efficiency of ABS in the treatment of experimental distal colitis. Materials and Methods: Twenty one male albino rats were divided into three groups: Sham control (Group 1), colitis induced by acetic acid and treated with saline (Group 2), colitis induced by acetic acid and treated with ABS (Group 3). At end of the 7th day of induction, all the rats were lightly anesthetized with intramuscular ketamine (8 mg/kg) and thereafter laparotomy and total colectomy were performed. The distal colon segment was assessed macroscopically and microscopically. In addition malondialdehyde (MDA), superoxide dismutase (SOD) and nitric oxide (NO) levels of the colonic tissue and changes in body weight were measured. Results: The MDA and NO levels of the colonic tissues and weight loss were significantly higher in Group 2 compared to Group 1 and Group 3. Microscopic and macroscopic damage scores were significantly higher in Group 2 and Group 3 than Group 1 (P: 0.001, P: 0.004, respectively). Although the microscopic and macroscopic damage scores in Group 3 were slightly lower than Group 2, the difference was not statistically significant. The SOD levels of the colonic tissues were not different between the three groups. Conclusion: Weight alterations and high-levels of the colonic tissue MDA and NO suggested that ABS might have anti-inflammatory effects on experimental distal colitis. However, this suggestion was not supported by histopathological findings.

Primary squamous cell carcinoma of the stomach in a 68‐years‐old man

Although adenocarcinoma of the stomach is one of the most common tumors, primary squamous cell carcinoma (SCC) of the stomach is extremely rare. SCC occurs mostly in men and the peak incidence is in older age. A 68-year-old man was admitted to our outpatient clinic with darkened, oily and bad odor stool and 4–5 kg weight loss in 3 months. He was also fatigued with an increased severity. Past medical history was unremarkable. On physical examination, sensitivity and blunt pain on the epigastric area were felt by the patient. The abdomen was distended. Other systems were normal. Melena was observed on rectal examination. The laboratory tests revealed anemia and leukocytosis. Hemoglobin level was 8.9 g/dL, and white blood cell count was 12.700/mm with 84% neutrophils. Occult blood test for stool was positive. Biochemical parameters including liver and renal tests were normal. Upper gastrointestinal endoscopy revealed a protruding and cauliflower-shaped mass on the lesser curvature of the stomach, beginning 5 cm distal from the gastroesophageal junction and was approximately 10 cm in diameter. The mass was white-gray in color and fragile, with active bleeding foci. Other parts of the stomach and the duodenum were normal. Multiple endoscopic biopsies were taken. Endoscopic biopsy revealed the diagnosis of SCC. Thoracoabdominal computerized tomography (CT) showed a thickened stomach wall and a protruding mass into the stomach lumen. The lungs, liver and other abdominal organs were normal (Fig. 1). The tumor marker levels were: carcinoembryonic antigen, 0.74 ng/mL (normal 0–2.5); CA 19–9, 9.45 U/ m-Ll (normal 0–30.9); and a-fetoprotein, 1.1 ng/mL (normal 0–8). The patient underwent laparotomy and total gastric resection with Roux-Y gastrojejunostomy operation was performed (Fig. 2). Pathological examination of the specimen demonstrated SCC of the stomach (Fig. 3). The surgical margins were negative. Nodal metastasis was not observed. Esophagogastric junction was negative for tumor. Chemotherapy and radiotherapy were not given to the patient. At the time of writing, the patient is in the 10th month after the operation and still alive without any evidence of metastasis or recurrence. Pure SCC of the stomach is an extremely rare malignancy with a worldwide incidence of 0.04–0.07%. The peak incidence is in the sixth decade. This is a somewhat earlier age than adenocarcinoma of the stomach. Because the tumor is very uncommon and most of the published data are of solitary cases, the pathogenesis has not been well elucidated. Several theories regarding the origin of SCC in the stomach were proposed including nests of ectopic squamous cells in gastric mucosa, squamous metaplasia of the gastric mucosa before malignant transformation, squamous differentiation in a pre-existing adenocarcinoma, multipotential stem cells in the gastric mucosa and gastric vascular endothelial cells. In addition, some authors proposed that the tumor could arise from squamous metaplasia secondary to chronic mucosal damage whereas others proposed that the carcinoma arises from misplaced squamous cell nests of the stomach. However, in most of the gastric SCC cases precursor lesions were not demonstrated. In our case, the complaints of the patient, especially the weight loss, were caused by the gastric tumor. The past history of the patient was not specific, especially for gastric ulcer or chronic gastritis. Tests for Helicobacter pylori were negative. Therefore, the origin of the cancer was speculative. Pure gastric SCC needs to meet the following diagnostic criteria: (i) the tumor must not be located in the cardia; (ii) the tumor must not extend into the esophagus; and (iii) there should be no evidence of SCC in any other part of the body. In our case, the tumor was Geriatr Gerontol Int 2010; 11: 119–120

Effects of renin-angiotensin-aldosterone system blockade on chlorhexidine gluconate-induced sclerosing encapsulated peritonitis in rats.

Sclerosing encapsulated peritonitis (SEP) is a rare complication of long term peritoneal dialysis. Renin‐angiotensin‐aldosterone system (RAAS) may play a role in the development of peritoneal fibrosis in CAPD patients. We aimed to evaluate the effect of aliskiren, valsartan, and aliskiren + valsartan therapy on SEP. The study included 30 Wistar albino rats which were divided into five groups: I (Control) SF solution i.p.; II (CG group) chlorhexidine gluconate i.p.; III aliskiren oral plus CG i.p.; IV valsartan oral plus CG i.p.; and V aliskiren oral, valsartan oral and CG i.p. On the twenty‐first day, all of the rats were sacrificed. All of the groups were analyzed in terms of peritoneal thickness, degree of inflammation, vasculopathy, neovascularization and fibrosis. Also, the parietal peritoneal tissue samples were evaluated for matrix metalloproteinase 2 (MMP‐2) using the ELISA method. Peritoneal thickness and fibrosis scores were lower in the valsartan group compared to the CG group (P < 0.05). Peritoneal fibrosis scores were lower in the aliskiren group compared to CG group (P < 0.05) but no difference was observed between the peritoneal thickness scores of the two groups (P > 0.05). Tissue MMP‐2 levels were significantly higher in the CG group compared other groups (P < 0.05). There were no statistically significant differences between the aliskiren, valsartan and aliskiren + valsartan groups according to the tissue MMP‐2 levels. Due to the antifibrotic properties of valsartan, it is thought to be a possible choice to prevent SEP development. We found no positive impact of aliskiren or aliskiren + valsartan combination compared to valsartan alone.

The effects of scalpel, harmonic scalpel and monopolar electrocautery on the healing of colonic anastomosis after colonic resection

Purpose In our study, the effects of harmonic scalpel, scalpel, and monopolar electrocautery usage on the health and healing of colon anastomosis after resection was investigated. Methods In this study, 120 female albino Wistar rats were divided into 3 groups each containing 40 rats. Group A, resection with scalpel; group B, resection with monopolar electrocautery; group C, resection with harmonic scalpel. The groups were divided into 4 subgroups consisting of 10 rats and analysed in the postoperative 1st, 3rd, 5th, and 7th days. Anastomotic bursting pressures, hydroxyproline levels and histopathological parameters were surrogate parameters for evaluating wound healing. Results The tissue hydroxyproline levels did not show any significant difference between the groups and subgroups. The mean bursting pressure of group A on the 5th day was significantly higher than groups B and C (P < 0.001). When the fibroblast and fibrosis scores were evaluated, scores of group C on the 5th day were significantly higher than the other groups, but the results of bursting pressures and biochemical parameters did not support the fibroblast and fibrosis scores. There were not any significant differences between the groups in other histopathologic parameters. Conclusion The use of monopolar electrocautery needs more attention since the device causes tissue destruction. The obliterating effect of harmonic scalpel on luminal organs is an important problem, especially if an anastomosis is planned. Despite the disadvantages of scalpel, its efficacy on early wound healing is better than the other devices.

Effectiveness of thymoquinone, zeolite, and platelet-rich plasma in model of corrosive oesophagitis induced in rats

Purpose The effectiveness of platelet-rich plasma (PRP), thymoquinone, and zeolite in corrosive esophageal burns was investigated in a rat model. Methods Four groups were comprised as containing 10 rats in each group. For group I, oesophagitis was induced and no other procedure was performed (control group). For group II, oesophagitis was induced and thymoquinone was administered for 1 week via oral gavage once a day (thymoquinone group). For group III, oesophagitis was induced for 1 week via oral gavage once a day (PRP group). For group IV, oesophagitis was induced and zeolite was administered for 1 week via oral gavage once a day (zeolite group). On the 10th day, the rats were sacrificed under anaesthesia and venous blood sampling was performed from the vena portae. The oesophaguses were totally excised. Biochemically, interleukin (IL)-1B, IL-6, TNF-α, and MCP-1 were examined from venous blood. Inflammation score was evaluated histopathologically in oesophageal tissue that was collected. Results There was a statistically significant difference among groups in terms of IL-1, IL-6, MCP levels, compared to the control group; median IL-1, IL-6, MCP levels of thymoquinone, PRP, and zeolite groups were statistically significantly lower. There was a statistically significant difference among groups in terms of inflammation scores, compared to group I; median inflammation scores of groups II, III and IV were statistically significantly lower thymoquinone. Conclusion PRP, and zeolite exhibited positive effect on recovery in oesophagitis by reducing inflammation in the involved segment.

The effect of mesenchymal stem cell use on intra-abdominal adhesions in a rat model

Purpose Intra-abdominal adhesions (IAA) are among the most frequently seen pathologies in general surgery practice with an increased morbidity and mortality. In the present study, we investigated the effect of locally applied mesenchymal stem cells (MSCs) on IAA. Methods Twenty-four Wistar Albino rats were used in the study. The rats were divided into three groups including: Sham, control, and MSCs group. On day 0, cecum was reached under anesthesia in all groups, except the Sham group. Scraping with a sponge was performed until petechial bleeding occurred. The control group received no treatment. In the stem cell group, MSCs were applied topically immediately after surgery on adhesions. The rats were sacrificed on day 10 and colon tissues and blood samples were collected for macroscopic, histopathological, and biochemical analysis. Results In our study, E-selectin, P-selectin, TNF-α and IL-1 levels were statistically significantly lower in the MSC group than the control group, while the sham group has the lowest levels. In both the macroscopic and histopathological analyses (Zühlkes scale), the least amount of adhesion was observed in the Sham group. In addition, although there was less adhesion in the MSC group than the control group, the difference did not reach statistical significance. Conclusion Topical MSC application immediately after surgery suppresses the inflammatory process. However it was found to be ineffective in histopathological and macroscopic examinations performed on the 10th day.

Effect of ankaferd blood stopper in experimental peritoneal adhesion model

Purpose Ankaferd Blood Stopper (ABS) is an herbal extract attained from 5 different plants. It has the therapeutic potential to be used for the management of external hemorrhage and controlling gastrointestinal bleedings. To date, the safety of ABS for intraperitoneal usage is not clear. In this study, we investigated the effectiveness and safety of using intraperitoneal ABS in an experimental peritoneal adhesion model. Methods Twenty-four male Wistar Albino rats were used in the study. The rats were randomly divided into 3 groups: saline, ABS, and control. On the 10th day, all rats were euthanized. The adhesions were evaluated by Nairs macroscopic adhesion classification, and pathologically evaluated with Zühlkes microscopic adhesion classification. Results macroscopic and microscopic comparison between the ABS and saline groups did not show any differences but both the ABS and saline groups were superior when compared to the control group. Conclusion ABS was found equally effective with saline on the abdominal adhesions and to no effect on postoperative adhesion formation.

Sigmoid Colon Perforation Mimics a Tuboovarian Absces

Introduction An adnexal mass may be diagnosed after a routine pelvic ultrasonographic examination or an emergent hospital admission due to rupture of ectopic pregnancy, adnexal torsion or rupture of tuboovarian abscess. It is necessary to evaluate the origin of the mass initially and to classify patients who need further evaluation and treatment for an urgent condition. Case presentation We report a case of sigmoid colon rupture due to sigmoid colon adenocarcinoma presenting as acute abdomen with left adnexal mass in a 28 years old woman. Abdominopelvic computed tomography revealed a left adnexal mass with suspicion of tuboovarian abscess. In laparatomy, rupture of sigmoid colon was observed and resection of sigmoid colon was performed. Histological examination of resection part revealed diagnosis of sigmoid colon adenocarcinoma due to familial adenomatous polyposis. Conclusion This case may be interesting for clinicians because pelvic pain, fever, increased infection markers in the laboratory and mass at ultrasonography or other screening methods could cause a misdiagnosis of tubaovarian abscess especially in reproductive age women. Before the operation of the pelvic mass of all age women with the diagnosis of tuboovarian abscess other causes of the pelvic abscess should come into mine and necessary preparation for operation must be done.

What is the protective effect of metformin on rat ovary against ischemia‐reperfusion injury?

The aim of this study was to investigate the protective effect of metformin on the rat ovary against ischemia‐reperfusion injury.

Platelet-Rich Plasma May Offer a New Hope in Suppressed Wound Healing When Compared to Mesenchymal Stem Cells

Background: The present study investigated the effectiveness of platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) in wound healing suppressed by corticosteroid in rats. Methods: Forty rats were separated into four groups. To disrupt the wound-healing processes, intraperitoneal single dose 10 mg/kg methylprednisolone was administered to all rats with the exception of Sham-S group. Then, full-thickness incision was performed to the abdominal skin of all animals, and PRP or MSCs were applied to the incision line except the Sham-S and Sham-M group animals. Ten days later, all animals were sacrificed to investigate: tissue collagenization, inflammation, and re-epithelialization grades histopathologically; and tissue hydroxyproline (HP), interleukin-1β (IL-1β), tumor necrosis factor-α levels biochemically. Results: Collagenization (p = 0.003) and inflammation grade (p = 0.002) values were higher in PR group. Tissue HP level value was found to be high in MC group (p < 0.001). Tissue IL-1β level value of Sham-M group was lower than those of other groups (p < 0.001). Conclusions: This preliminary study revealed that PRP could improve the histopathological grades in wound healing which was suppressed by corticosteroid in rats, while MSCs could show their therapeutic effects via biochemical route. These positive effects were more salient in PR group.