Ilhan Mavioglu

Ischemic preconditioning reduces intestinal epithelial apoptosis in rats.

Recent experimental studies have described protective effect of ischemic preconditioning (IPC) on ischemia–reperfusion (I/R) injury of the intestine. We hypothesize that to reach a new point of view on the effect of IPC in intestinal barrier function, the relationship between I/R-induced mucosal injury and apoptosis must first be clarified. The present study was undertaken to investigate the role of IPC on intestinal apoptosis and probable contributions of bcl-2 expression to this process. We also investigated the effect of intestinal IPC on ileal malondyaldihyde levels. Forty-four male Wistar rats were randomized into four groups each consisting of 11 rats: sham-operated control, I/R group (30 min of superior mesenteric artery occlusion), IPC-I/R group (10 min of temporary artery occlusion prior before an ischemic insult of 30 min), and IPC alone group (10 min of preconditioning). Twenty-four hours later, ileum samples were obtained. Ileal malondyaldihyde levels were increased in the I/R group (31.9 ± 18.8 vs. 106.8 ± 39.8) but not in the IPC alone and IPC-I/R groups (38.1 ± 13.6 and 44.7 ± 12.7;P < 0.01). The number of apoptotic cells was significantly lower in IPC-I/R group than that of I/R group, and these findings were further supported by DNA laddering and M30 findings. Diminished bcl-2 expression observed in the ileal specimens of I/R group was prevented by IPC. Our results indicate that IPC may provide a protective effect on ileal epithelium and that this effect is probably the result of a significant increase in the expression of bcl-2 after the insult. The reversal of apoptosis by IPC might help preserving the vitality of intestinal structures that have a critical function, cessation of which often leads to multiorgan dysfunction syndrome.

Consequences of PTFE membrane used for prevention of re-entry injuries in rheumatic valve disease

BACKGROUND The value of polytetrafluoroethylene (PTFE) surgical membrane as a pericardium substitute in patients who undergo reoperation for rheumatic valve disease is reported in this observational study. METHODS PTFE was used for pericardial closure in 56 rheumatic valve patients. During reoperation of seven cases, adhesions were classified as none, minimal, moderate to severe and scored in the sections of heart. Data found at reoperations were collected prospectively in all patients. RESULTS Seven of 56 patients reoperated mean period of 67.1+/-23.4 (SD) months later. No infection, complication and operative or late death attributable to the membrane were observed. There were two right ventricular, three minimal right atrial and one innominate vein lacerations during resternotomy and all of them were controlled. During histological examination, a microscopically significant foreign body reaction was found. CONCLUSION PTFE membrane produced an undesirable fibrous membrane that obscured the epicardial anatomy and hardened the dissection in patients with rheumatic heart disease.

Poly(ADP-ribose) synthetase inhibition prevents lipopolysaccharide-induced peroxynitrite mediated damage in diaphragm

Although the precise mechanism by which sepsis causes impairment of respiratory muscle contractility has not been fully elucidated, oxygen-derived free radicals are thought to play an important role. In our experimental study, the effects of poly(ADP-ribose) synthetase (PARS) inhibition on the diaphragmatic Ca(2+)-ATPase, malondialdehyde (MDA), and 3-nitrotyrosine (3-NT) levels and additionally histopathology of the diaphragm in lipopolysaccharide (LPS)-induced endotoxemia are investigated.Thirty-two male Wistar rats, weighing between 180-200 g were randomly divided into four groups. The first group (control; n=8) received saline solution and the second (LPS group; n=8) 10 mgkg(-1) LPS i.p. 3-Aminobenzamide (3-AB) as a PARS inhibitor; was given to the third group (C+3-AB, n=8) 20 min before administration of saline solution while the fourth group (LPS+3-AB, n=8) received 3-AB 20 min before LPS injection. Six hours later, under ketamin/xylasine anesthesia diapraghmatic specimens were obtained and the rats were decapitated. Diaphragmatic specimens were divided into four parts, three for biochemical analyses and one for histopathologic assessment. In the LPS group, tissue Ca(2+)-ATPase levels were found to be decreased and tissue MDA and 3-NT levels were found to be increased (P<0.05). In the LPS+3-AB group, 3-AB pretreatment inhibited the increase in MDA and 3-NT levels and Ca(2+)-ATPase activity remained similar to those in the control group (P<0.05). Histopathologic examination of diaphragm showed edema between muscle fibers only in LPS group. PARS inhibition with 3-AB prevented not only lipid peroxidation but also the decrease of Ca(2+)-ATPase activity in endotoxemia. These results highlights the importance of nitric oxide (NO)-peroxynitrite (ONOO(-))-PARS pathway in preventing free radical mediated injury. PARS inhibitors should further be investigated as a new thearapetic alternative in sepsis treatment.

Fistula Between An Abdominal Aortic Aneurysm and the Transverse Colon: Case Report

Aortoenteric fistula is one of the rare complications of abdominal aortic an eurysm. The segment of intestine most frequently involved in aortoenteric fis tula is the duodenum, whereas the colon is a very rare site of fistula formation. To the authors knowledge, only 13 cases have been reported in the literature to have a primary arteriocolic fistula caused by abdominal aortic aneurysm. Pri mary repair of the fistulization between aorta and transverse colon, resection of aneurysm, and left axillofemoral, femorofemoral bypass were performed on the patient, who represents the fourteenth case in the literature. No important com plication developed and the patient was discharged from the hospital on the fifteenth postoperative day but died on the twenty-fourth postoperative day at another hospital from myocardial infarction.

Kinking of Aortobifemoral Graft as a Rare Complication: Case Report

Aortobifemoral arterial bypass grafting (Y-graft) is an important operation in vascular surgery. Early complications of Y-graft implantation are generally technical and infrequent. These are postoperative hemorrhage, acute occlusion of graft limb, distal atheroembolism (trash foot), and early thrombosis of the graft. Early occlusion of the graft is attributable to twisting or kinking of the graft in the retroperitoneal tunnel. In this patient, who was operated on at another center, the symptoms were seen six months after the operation. At the reoperation, both limbs of the Y-graft were found to be kinked in the retroperitoneal tunnel. The kink was solved and excised, and profundoplasty was applied to both of the deep femoral arteries.