Gulcin Kamali

Ductoscopy in the Evaluation and Management of Nipple Discharge

BackgroundNipple discharge is a relatively common complaint among patients visiting specialized outpatient clinics for disease of the breast. With advancing technology, it became possible to diagnose and manage nipple discharge using minimally invasive procedures. The aim of this study is to report our experience with ductoscopic evaluation of patients with nipple discharge.Materials and MethodsBetween September 2005 and February 2009, 236 patients with complaint of nipple discharge were admitted prospectively into the study. All patients were evaluated with ductoscopy. Data concerning age, ductoscopic and postsurgical diagnosis, duration, and complications with the procedure were statistically analyzed.ResultsFor 236 patients evaluated, there were 249 ductoscopic investigations. Of these, 39 patients were found to have intraductal solitary papilloma of which 24 were excised ductoscopically. Of the 24 ductoscopically excised solitary papillomas, it was possible to remove 17 completely, but 7 papillomas could be removed partially. For 13 patients with solitary papillomas large enough or unfavorably localized so that they could not be snare-excised and for 14 patients with multiple papillomas, we offered surgical removal of the lesions by limited excision of the ducts with the help of ductoscopic localization and marking. There were 35 patients who had debris within the canalicular system, and the debris was washed out. Ductoscopy revealed atypical ductal hyperplasia in 3 patients, ductal carcinoma in situ in 6 patients, and invasive carcinoma in 3 patients; all patients underwent surgery.ConclusionsWe believe that, as the technology quickly improves, ductoscopy will become more widely accepted and applied for breast disorders, not only as a diagnostic tool but also as a privileged therapeutic option for certain pathologies.

VEGF-A and FGF gene therapy accelerate healing of ischemic colonic anastomoses (experimental study)

BACKGROUND Reducing ischemic damage is one of the goals of surgery. The aim of this study was to apply human VEGF-A and FGF-2 DNA-mediated gene therapy in order to identify their effects in the healing of ischemic colon anastomoses and eliminating the negative effects of ischemia. METHODS Forty male Wistar albino rats weighing 250-280 g were divided into five equal groups (n = 8) as follows: group 1: control, ischemic left colonic anastomosis; group; 2: ischemic left colonic anastomosis with control plasmid delivery; group 3: ischemic left colonic anastomosis with VEGF plasmid delivery; group 4: ischemic left colonic anastomosis with FGF plasmid delivery; group 5: ischemic left colonic anastomosis with VEGF and FGF plasmid delivery. All rats were sacrificed on the 4th postoperative day. Anastomosis burst pressures were measured for mechanical examination of anastomosis. Tissue hydroxyprolin, VEGF and FGF levels were determined as biochemical parameters. Necrosis, epithelisation, inflammatory processes, fibroblastic activity, collagen deposition and neovascularisation at the anastomic site were studied. RESULTS VEGF, FGF and combined therapy significantly accelerated many of the histological parameters of healing, including fibroblast activation, collagen deposition, and angiogenesis, and augmented the levels of hydroxyproline and bursting pressure. CONCLUSIONS This is the first study to use gene therapy with growth factors for the healing of ischemic colonic anastomosis. This therapy can be effectively used in increasing ischemic anastomosis wound healing.

The effect of progesterone in the prevention of the chemically induced experimental colitis in rats.

PURPOSE To study the effects of progesterone on an experimental colitis model. METHODS Wistar albino rats were treated subcutaneously with 2mg/kg once a day during seven days Colitis was induced by intrarectal administration of 5mg trinitrobenzene sulfonic acid (TNBS). Disease activities, macroscopic and microscopic scores were evaluated. To determine the response provoked by progesterone we measured Colonic malondialdehyde (MDA), TNF alfa, IL-6 and Nitric oxide (NO) levels in addition to the MPO (Myeloperoxidase) and caspase-3 activities. RESULTS Progesterone ameliorated significantly the macroscopic and microscopic scores. TNBS-induced colitis significantly increased the colonic MDA levels and caspase-3 activities in group 2 in comparison to the control group. The results of the study revealed a decline in MDA, NO, IL6 and TNF-α levels in the colon tissue and in blood due to progesterone therapy in group 3 when compared to the group 2, a significant improvement. Progesterone treatment was associated with decreased MDA, MPO, TNF alfa and caspase-3 activity. CONCLUSION Progesterone therapy decreased oxidative damage in the colonic mucosa.

Adrenomedulline improves ischemic left colonic anastomotic healing in an experimental rodent model

BACKGROUND: Leakage from colonic anastomosis is a major complication causing increased mortality and morbidity. Ischemia is a well-known cause of this event. This study was designed to investigate the effects of adrenomedullin on the healing of ischemic colon anastomosis in a rat model. METHODS Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats that were divided into four groups. To mimic ischemia, the mesocolon was ligated 2 cm from either side of the anastomosis in all of the groups. The control groups (1 and 2) received no further treatment. The experimental groups (3 and 4) received adrenomedullin treatment. Adrenomedullin therapy was started in the perioperative period in group 3 and 4 rats (the therapeutic groups). Group 1 and group 3 rats were sacrificed on postoperative day 3. Group 2 and group 4 rats were sacrificed on postoperative day 7. After careful relaparotomy, bursting pressure, hydroxyproline, malondialdehyde, interleukin 6, nitric oxide, vascular endothelial growth factor, and tumor necrosis factor alpha levels were measured. Histopathological characteristics of the anastomosis were analyzed. RESULTS The group 3 animals had a significantly higher bursting pressure than group 1 (p<0.05). Hydroxyproline levels in group 1 were significantly lower than in group 3 (p<0.05). The mean bursting pressure was significantly different between group 2 and group 4 (p<0.05). Hydroxyproline levels in groups 3 and 4 were significantly increased by adrenomedullin therapy relative to the control groups (p<0.05). When all groups were compared, malondialdehyde and nitric oxide were significantly lower in the control groups (p<0.05). When vascular endothelial growth factor levels were compared, no statistically significant difference between groups was observed. Interleukin 6 and tumor necrosis factor alpha were significantly decreased by adrenomedullin therapy (p<0.05). The healing parameters and inflammatory changes (e.g., granulocytic cell infiltration, necrosis, and exudate) were significantly different among all groups (p<0.05). CONCLUSION Adrenomedullin had positive effects on histopathologic anastomotic healing in this experimental model of ischemic colon anastomosis.

Iloprost reduces colonic injury in ischemic colitis in rats

PURPOSE Evaluate the effects of iloprost administration in the early period of ischemic colitis and the mechanism that how these effects develop. METHODS Thirty two Wistar albino female rats with an average weight of 220g were divided into four groups of eight rats. In group 1 the rats were given iloprost and sacrificed after 24 hours and in group 2 they were sacrificed after 24 hours without any iloprost. The rats in group 3 were administrated iloprost and sacrificed after 72 hours and in group 4 they were sacrificed at 72th hour without iloprost. The differences between the groups as tissue damage, vascularization or apoptosis were assessed statistically. RESULTS Oxidative damage and apoptosis were less pronounced and vascularization was better developed in rats that were given iloprost and sacrificed at 24th hour later in contrast to the rats that were not treated with iloprost. But there was no statistical difference among the groups at 72th hour. CONCLUSION Iloprost inhibited leucocyte infiltration, decreased proinflammatory cytokines and enhanced angiogenesis so that the oxidative stress and inflammatory response decreased resulting in lesser tissue damage.

The Comparison between Laparoscopic vs. Open Surgery for Trinitrobenzene Sulfonic Acid-Induced Rat Colitis

Introduction: The etipathogenesis of inflammatory bowel disease (IBD) includes immunologic, genetic and environmental factors. In addition to the colon, frequent extra-intestinal alterations related to pancreas and hepatobiliary system are evaluated in several studies. A minimally invasive approach was applied to the IBD, with the expectation of earlier recovery, fewer postoperative complications. The aim of the study is to compare the effects of laparoscopic and open techniques applied for the surgical treatment of ulcerative colitis on the gastrointestinal system and pancreas, and related systemic consequences. Methods: Colitis was induced in 20 rats by rectal injection of a 5% 0.25mL 10mg/kg TNBS (Sigma, USA) in 50% ethanol. The rats were randomly divided into two groups: rat control, laparotomy was made for two-hour duration (n=10), a pneumoperitoneum was applied for a two-hour duration (n=10). Following the surgical procedures, samples were drawn for biochemical and histopathologic examinations. TNF-?, IL-6, MDA, NO, MPO and PAP levels were evaluated in serum and in tissues of pancreas and colon. Results: Except the MDA and NO levels in colonic tissues, all the parameters indicating the oxidative injury and inflammation were found significantly lower in a pneumoperitoneum group. There was no difference in histopathologic examinations of the both groups. Discussion: The results revealed that despite the pathophysiologic effects of pneumoperitoneum laparoscopic surgery in patients with ulcerative colitis elicited less oxidative damage and inflammation compared to conventional surgery. Regarding the findings we concluded that laparoscopic procedures are safe in patients with IBD but to comment on the effects of pneumoperitoneum related to the longer surgery duration further studies with variable operation times are required.

The Effect of Erythropoietin on Ischemic Colitis: An Experimental Rodent Model: Original Article

Background: Erythropoietin (Epo), a hormone produced by the kidney that promotes the formation of red blood cells in the bone marrow, is considered anti-inflammatory,anti-apoptotic, angiogenetic and sitoprotective. In this study, high dose erythropoietin is examined on an animal model for ischemic colitis (IC) to detect its possible potential benefits. Methods: Thirty female Wistar albino rats weighing 250-300 g were randomized into three experimental groups as follows: in Group 1, animals were sham operated (n = 10) and received distilled water; in Groups 2 and 3, the rats underwent a standardized surgical procedure to induce IC (n = 10 in each group). Group 2 animals served as the controls, receiving only tap water, while Group 3 animals received 3000 IU/kg eritropoetin as a single high dose. All animals were sacrificed 72 h after devascularization. Colonic malondialdehyde (MDA) levels, glutathione (GSH), myeloperoxidase (MPO), and caspase 3 activities of the sacrified rats were measured. CD-34 was evaluated by the immunohistochemical examination of the colonic tissue. Results: Colonic ischemia significantly increased the colonic MDA levels, caspase 3 activity, and TNF alfa in comparison to the control group. Epo treatment was associated with increased GSH levels, decreased MDA, and caspase 3 activity. Histopathological examination revealed that the intestinal mucosal structure was preserved in the Epo treated group. Moreover, treatment with Epo significantly increased CD-34 (stem cell) when compared to the ischemic colitis group. Conclusion: Epo reduced colonic damage in ischemic colitis. The mechanism of the protection associated with Epo was due to its mobilization of the stem cells as well as its anti-apoptotic and anti-inflammatory effects.

Protective effects of pentoxifylline in small intestine after ischemia–reperfusion

Objective This study was performed to determine the healing effects of pentoxifylline on molecular responses and protection against severe ischemic damage in the small intestine. Methods Thirty-six Wistar albino rats were divided into six groups. The superior mesenteric artery was clamped for 120 minutes, and reperfusion was performed for 60 minutes. Saline (0.4 mL), pentoxifylline (1 mg/kg), and pentoxifylline (10 mg/kg) were intraperitoneally administered to the rats in the C1, P1, and P3 groups, respectively, 60 minutes before ischemia and to the rats in the C2, P2, and P4 groups, respectively, during reperfusion onset. Malondialdehyde, myeloperoxidase, tumor necrosis factor alpha, interleukin-1 beta, and interleukin-6 in serum and tissue were measured by enzyme-linked immunosorbent assay. Intestinal ischemic injury was histopathologically evaluated by the Chiu score and immunohistochemical staining. Results All serum and tissue molecular responses were significantly blunted in the pentoxifylline-treated groups compared with the controls. Significant improvement in ischemic damage was demonstrated in the pentoxifylline-treated groups by histological grading and immunohistochemical scoring. Conclusions The protective effects of pentoxifylline were confirmed by molecular responses and histopathological examination.

Primary Hydatidosis of the Gluteus Muscle: Report of a Case and Review of the Literature

Hydatid disease is a parasitic infestation of humans and herbivorous animals, caused by Echinococcus granulosus. A 55-year-old woman had no prior surgery for hydatid disease earlier. Total cystopericystectomy was performed without cyst rupture. Albendazole was given postoperatively. Neither systemic or local complications nor recurrences were found after minimum follow-up of 12 months, and the laboratory test results were within the normal ranges. Since primer muscular hydatidosis is a very rare disease, care should be taken in diagnosis of cystic mass of skeletal muscle, especially in endemic areas.