Hamza Cinar

The Effect of Silymarin on Mesenteric Ischemia-Reperfusion Injury

Objective: To examine the effect of silymarin (SM), a mixture of flavonoids and polyphenols extracted from Silybum marianum, on mesenteric ischemia-reperfusion (I-R) injury in a rat model. Materials and Methods: Fifty rats were randomly divided into 5 groups (n = 10). Group 1 was sham operated, while groups 2-5 were subjected to mesenteric I-R lasting 1 h. Group 2 received isotonic sodium chloride, group 3 received SM (100 mg/kg/day) for 7 days before I-R, group 4 received SM for 7 days after I-R, and group 5 received SM for 7 days both before and after I-R. The rats were sacrificed by exsanguination in groups 1-3 at the 24th hour and groups 4 and 5 were sacrificed on the 7th day of reperfusion. Blood and intestinal specimens were taken for biochemical and pathological evaluations. Results: Serum superoxide dismutase (SOD) and heat shock protein 70 levels were significantly higher in group 2 (5.24 ± 1.76 U/l and 261.4 ± 16.8 ng/ml) compared to the sham group (2.08 ± 1.76 U/l and 189.9 ± 28.7 ng/ml) (p < 0.001 and p < 0.0001, respectively). However, SOD activity and the extent and severity of the histopathological lesions were significantly less in groups 3 [3.11 ± 1.18 U/l, 1.0 (range 0.0-2.0)], 4 [2.15 ± 0.87 U/l, 1.0 (range 1.0-3.0)], and 5 [1.80 ± 0.61 U/l, 0.5 (range 0.0-2.0)], treated with SM, than in group 2 [5.24 ± 1.76 U/l, 2.0 (range 2.0-3.0)] (p = 0.002, p < 0.001, and p = 0.0001; p < 0.001, p = 0.007, and p = 0.0001, respectively). Also, TNF-α levels were lower in the SM-supplemented groups compared to group 2. Serum thiobarbituric acid-reactive substance concentrations were low in the pre-/posttreatment groups treated with SM compared to group 2. No statistical difference was observed for protein carbonyls between the groups. Conclusion: Our findings suggest that SM therapy may attenuate the oxidative and intestinal damage induced by I-R injuries.

Preventing intraperitoneal adhesions with linezolid and hyaluronic acid/carboxymethylcellulose: a comparative study in cecal abrasion model

BACKGROUND We aimed to compare the effectiveness of linezolid in preventing intraperitoneal adhesions with hyaluronic acid + carboxymethylcellulose (Seprafilm). METHODS Thirty rats were divided randomly into 3 groups: Group I (control), untreated; Group II (Seprafilm); and Group III (linezolid). All rats were sacrificed on the 14th day after surgery. Macroscopic adhesion, inflammation, and fibrosis were evaluated. RESULTS The multiple comparisons between groups showed a statistically significant difference for adhesion. There were statistically significant differences between Group I and II and I and III, but no statistically significant difference between Group II and III. The multiple comparisons between the groups showed a statistically significant difference for inflammation and fibrosis. For inflammation and fibrosis, there was a statistically significant difference between Group I and II and I and III, but no statistically significant difference between Group II and III. CONCLUSION The efficiency of linezolid in reducing the formation of intraperitoneal adhesions was statistically significant compared with the control group.

Preventing intraperitoneal adhesions with ethyl pyruvate and hyaluronic acid/carboxymethylcellulose: a comparative study in an experimental model

OBJECTIVE To compare the effectiveness of ethyl pyruvate (EP) with that of hyaluronic acid+carboxymethyl cellulose (Seprafilm) for the prevention of intraperitoneal adhesions. Seprafilm has been shown to be effective in many experimental and clinical studies. STUDY DESIGN Thirty rats were divided into three groups at random, and uterine horn abrasion was performed by laparotomy. One group received no treatment (control group), one group received a single intraperitoneal dose of EP 50mg/kg (EP group), and a 2×1-cm patch of Seprafilm was applied in the third group (Seprafilm group). All rats were killed 14 days after surgery. Macroscopic and histopathological evaluation were performed by a surgeon and a pathologist who were blinded to group allocation. Histopathologically, inflammation, fibroblastic activity, foreign body reaction, collagen proliferation, vascular proliferation, Masson-Trichrome score, matrix metalloproteinase-2 score and vascular endothelial growth factor score were studied. RESULTS Median macroscopic intraperitoneal adhesion scores for the control, EP and Seprafilm groups were 2.8, 1.2 and 1.1, respectively. Multiple comparisons between groups showed a significant difference (p<0.05). In binary comparisons, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p<0.05). No significant difference was found between the adhesion scores for the EP group and the Seprafilm group (p>0.05). After histopathological evaluation, significant differences in all parameters were found between the groups (p<0.05). In the paired comparison, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p<0.0167), but no significant difference was found between the EP group and the Seprafilm group (p>0.0167). CONCLUSIONS In comparison with the untreated control group, EP and Seprafilm were found to reduce the formation of intraperitoneal adhesions. No significant difference was found between EP and Seprafilm.

Protective effect of ethyl pyruvate on ischemia-reperfusion injury in rat ovary: biochemical and histopathological evaluation.

BACKGROUND To investigate the protective effect of ethyl pyruvate (EP), an anti-oxidant agent, against ischemia-reperfusion injury in a rat model of ovarian torsion, considering biochemical and histopathological aspects. METHODS Forty Wistar Albino rats were divided into five groups: Group I, sham operation; Group II, ischemia alone, Group III, ischemia-reperfusion; Group IV, ischemia-reperfusion+50 mg/kg EP; and Group V, ischemia-reperfusion+100 mg/kg EP. Through laparotomy, 360° torsion was performed and maintained for 3 h, and detorsion was maintained for a further 3 h. Intraperitoneal EP was given 30 min before the surgical procedure. Ovarian tissues and blood samples were obtained after surgery. Malondialdehyde (MDA) and asymmetric dimethyl arginine (ADMA) levels were measured in both plasma and tissue samples. Tissue sections were evaluated histopatologically. Analysis of variance was used for statistical analyses. RESULTS In both serum and tissue samples, ADMA and MDA levels were found to be significantly lower in the EP groups compared with the ischemia alone and ischemia-reperfusion groups (p=0.0001). However, no significant difference was found between groups treated with 50 mg/kg or 100 mg/kg EP. On histopathological evaluation, the total tissue injury score was found to be lower in rats treated with EP. No significant difference was detected between groups treated with 50 mg/kg or 100 mg/kg EP. CONCLUSION Ethyl pyruvate may exert positive effects in ischemia-reperfusion injury in cases of ovarian torsion. However, no difference was detected between 50 mg/kg and 100 mg/kg EP.

Non-operative treatment approach for blunt splenic injury: is grade the unique criterion?

BACKGROUND We aimed to investigate the results of a non-operative approach to blunt spleen injury to re-evaluate the importance of injury grade. METHODS Thirty-one blunt splenic trauma cases subjected to non-operative treatment were evaluated retrospectively. The patients were classified into two groups as isolated spleen trauma (ST) group and multi-trauma (MT) group. The hospitalization and blood replacement needs, success of non-operative follow-up, and post-traumatic complications were compared between the two groups. The patients were evaluated via follow-up abdominal ultrasonography (US) and computerized tomography (CT). The results were evaluated with regard to post-splenic trauma complications. RESULTS According to the organ injury scale of the American Association for the Surgery of Trauma, 25.8% were grade-1, 32.2% grade-2, 29% grade-3, and 12.9% grade-4 injuries. It was observed that the transfusion amount was directly proportional to the injury grade. All patients with grade-4 injury and 14 patients with MT were treated successfully with the non-operative method. Splenic pseudoaneurysm developed in one patient in the MT group. One patient was diagnosed with late splenic rupture. CONCLUSION Hemodynamic stability is the most important criterion for the indication of non-operative treatment. However, in well-selected cases, patients with grade 4 splenic traumas and those with extra-splenic injuries could also be treated successfully with the non-operative method.

Pilonidal sinüs hastalığında ameliyat yöntemlerinin komplikasyon ve hastaların yaşam kalitesine etkisi

GIRIŞ Pilonidal sinus agirlikli olarak calisma cagindaki erkekleri etkileyen sakrokoksigeal bolgenin sik gorulen bir hastaligidir. Hastalik genellikle apse veya kronik akintili olan bir sinus trakti ile kendini gosterir. Sikligi bolgesel ve irksal olarak degismektedir. Etyoloji ve patogenezi yillardir tartisilmaktadir. Pilonidal sinus hastaliginin tedavisi icin bircok medikal ve cerrahi yontem tarif edilmesine karsin tartismalar devam etmektedir. Pilonidal sinuste uygulanacak ideal tedavi az agrili, hastanede kalis suresi kisa, dusuk komplikasyon riski, hastanin normal aktivitesine hizli donmesini saglayan ve dusuk nuks orani olan bir yontem olmalidir (1-3). Eksizyon sonrasi primer onarimda ameliyatin kisa surmesi, hastanede kalis suresinin kisa olmasi gibi avantajlari olmasina karsin flep yontemlerinde orta hattin lateralize olmasi nedeniyle nuks oranlarinin daha dusuk olmasi beklenmektedir.

The significance of hemogram on diagnosis of acute appendicitis during pregnancy

BACKGROUND Acute appendicitis (AA) is the most common emergency surgical condition during pregnancy after obstetric and gynecological pathologies. Urgent and accurate diagnosis of AA in pregnant patients reduces maternal and fetal morbidity/mortality rates. This study evaluated the significance of hemogram to diagnose AA during pregnancy. METHODS Forty-seven pregnant patients operated for AA in the Ordu or Ondokuz Mayis University Medical School Hospitals between January 2007 and December 2017 were compared with 47 healthy pregnant women in terms of hemogram parameters, including the white blood cell (WBC) count, neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) values. The operated group was evaluated based on post-operative pathologic results and subclassified into appendicitis positive (Group A) and appendicitis negative (Group B) groups. The subgroups were compared to the control group. RESULTS The WBC and neutrophil count and mean NLR and PLR values were significantly higher in Group A compared to Group B and the control group (p<0.001). The mean lymphocyte count was significantly lower in Group A compared to other groups (p<0.001). The MPV and RDW values and mean platelet count showed no significant difference between groups (p>0.05). When cutoff values for WBC, neutrophil count, NLR, PLR, and lymphocyte counts were set to >10300, >7950, >5.50, >155.2, and ≤1330, respectively, the sensitivity rates were 72.5%, 80%, 90%, 77.5% and 85%, whereas specificity rates were 72.3%, 79.7%, 89.4%, 74.5%, and 82.5%, respectively. CONCLUSION When comparing pregnant women diagnosed with AA to patients operated for suspected AA and healthy pregnant women, the WBC and neutrophil count and NLR and PLR values were found to be significantly higher, whereas lymphocyte counts were lower. In addition to medical history, physical examination and imaging techniques, hemogram parameters should be considered to diagnose AA in pregnant women.

Old appendectomy scar metastasis of colon adenocarcinoma: a rare case report -

In colorectal cancer, subcutaneous metastasis is a very uncommon event. Generally, this metastasis is described after primary colon carcinoma and signifies widespread disease and poor prognosis. Skin metastasis without liver metastasis is very rare. Cutaneous and subcutaneous metastases in laparotomy or laparoscopy scar are reported but there are only a few reports about metastasis to old incision scar. In this article, we described a case of colon cancer presenting as a cutaneous metastasis in an old appendectomy scar and discussed possible pathophysiological mechanisms.

Effects of Oleuropein on Serum Inflammatory Cytokines and Histopathological Changes in Rats with Pancreatitis

OBJECTIVES Acute pancreatitis is a severe debilitating disease with high morbidity and mortality. The severity of the disease is largely due to the actions of various inflammatory mediators. No specific therapy is indicated for AP and its treatment remains largely supportive. This study investigated the effect of oleuropein on serum inflammatory cytokines and distant organ injury in rats with acute pancreatitis induced by bile-pancreatic duct obstruction. MATERIAL AND METHODS Thirty adult male Wistar rats were randomly assigned to 3 groups of 10 rats each: group I: sham, group II: pancreatitis and group III: pancreatitis+oleuropein. Rats in Group III received oleuropein 20 mg/kg intragastrically during 10 days before surgery. The rats were sacrificed at 24 h after surgery and venous blood, pancreatic and lung tissue samples were obtained for analysis. RESULTS A statistically significant difference was found between groups regarding serum amylase, LDH, lipase, pancreatic amylase, IL-6, IL-10 and TNF-α values with a Kruskal-Wallis test (p<0.05). No statistically significant difference was found between Group II and III regarding pairwise comparison of amylase, LDH, lipase, pancreatic amylase, IL-6, IL-10 and TNF-α value by using pairwise comparisons with a Mann-Whitney U test (p>0.01). A statistically significant difference between groups was found regarding edema, inflammation, hemorrhage and acinar cell necrosis in histopathological examination of the pancreas (p<0.05). No difference was found between group II and III (p>0.01). A difference was found between the groups in terms of lung tissue edema (p<0.05) but no difference was found regarding hemorrhage and inflammation (p>0.05). No statistically significant difference was found between group II and III with pairwise comparison (p>0.01). CONCLUSIONS The experimental model used in this study showed to be appropriate for creation of acute pancreatitis. It was concluded that oleuropein as a prophylactic treatment has no protective effect on serum proinflammatory and anti-inflammatory cytokines as well as pancreatic tissue.

First-line therapy in Helicobacter pylori eradication therapy: experience of a surgical clinic.

OBJECTIVE Helicobacter pylori (HP) is the worlds most common infectious agent. Despite conventional therapy consisting of proton pump inhibitor (PPI), amoxicillin (AMO) and clarithromycin (CLA), approximately half of the patients remain infected. We compared the PPI-based triple therapy with quadruple treatment (BPMT) including bismuth citrate (BS), PPI, metronidazole (MET) and tetracycline (TET). MATERIAL AND METHODS Forty-three patients who used triple therapy (LAC) consisting of lansoprazole (L), AMO and CLA and 42 patients who used quadruple therapy (BPMT) for 14 days between May 2008 and November 2013 were included in the study. The LAC group included patients who received 30 mg L 2×1, 1000 mg AMO 2×1, and 500 mg CLA 2×1 for 14 days, whereas the BPMT group was designed from patients who received 600 mg BS 2×1, 40 mg omeprazole (O) 2×1 or 30 mg L 2×1, 500 mg MET 3×1 and 500 mg TET 4×1. RESULTS Demographic characteristics and endoscopic findings were similar in both groups. The eradication rate was 53.4% in the LAC group and 78.5% in the BPMT group (p<0.05). Compliance problems and side effects were significantly higher in the BPMT group as compared to the LAC group (p<0.05). CONCLUSION Due to high antibiotic resistance in Turkey, the efficacy of LAC treatment has reduced. The BPMT protocol should be kept in mind in the first line of treatment, since it provides a higher eradication rate.