Mehmet Fatih Yuzbasioglu

In Vitro Effectiveness of Different Chemical Agents on Scolices of Hydatid Cyst

In the surgical history of hepatic hydatid disease, multiple scolicidal agents have been used for sterilization of the cyst contents. However, none of these agents can be safely used, because most have unacceptable side effects, such as toxicity, caustic sclerosing cholangitis, bile duct stricture, and hypernatremia. Protoscolices were aseptically removed from liver hydatid cysts obtained from sheep slaughtered at the municipal abattoir in Kahramanmaras, Turkey. In this study, the effects of 0.9% NaCl (control group), 20% NaCl (hypertonic saline), 20% silver nitrate, albendazole 20 mg/cm3, 50% dextrose (hypertonic glucose), and 20% mannitol and aminomix-1 solutions on echinococe cysts were investigated under in vitro conditions. After 5, 10, 15, 20, 25, 30, 45, and 60 min for each concentration, the first 100 protoscolices were counted on the 10× microscopical field. Protoscolices, which showed positive staining by eosine were considered as dead ones. The averages of dead and total protoscolices were calculated. Our results showed that all observed protoscolices were dead after the treatments by 20% silver nitrate in 20 min, by 50% dextrose and by aminomix-1 solution in 30 min, and by 20% NaCl and by 20% mannitol in 45 min. Albendazole at 20 mg/cm3 was observed to lead to death of 65% of protoscolices in the first 5 min and 70% of protoscolices at the end of 60 min. Compared with 0.9% NaCl (saline), all of these scolicidal agents were significantly effective (p <. 05). Aminomix-1, 20% mannitol, and 50% dextrose solutions may be used in percutaneous and surgical treatment of hydatid cyst. They may be preferred because they are readily available, can be administered intravenously, and have an equal or greater effectiveness than 20% hypertonic saline.

Effects of Intravenous Anesthetics on Renal Ischemia/Reperfusion Injury

Background. Renal ischemia/reperfusion (I/R)-induced tubular epithelial cell injury, called ischemic acute renal failure, is associated with high mortality in humans. Protecting the kidney against I/R injury is very important during complicated renal operations, transplantation surgery, and anesthesia. Aim. The purpose of this study was to investigate and compare the efficiency of ketamine, thiopental, propofol, etomidate, and intralipid in reducing the injury induced by free radicals in a rat model of renal I/R. Method. Forty-two Wistar rats were divided into seven groups in our study. Rats in the sham group underwent laparotomy and waited for 120 minutes (min) without ischemia. Rats in the control group were given nothing with ischemia-reperfusion. Rats in the I/R groups were given ketamine (20 mg/kg), thiopental (20 mg/kg) propofol (25 mg/kg), etomidate (10 mg/kg) and 10% intralipid (250 mg/kg) intraperitoneally 15 min prior to the ischemia for 60 min, followed by reperfusion for 60 min. The blood samples and kidney tissues of the rats were obtained under anesthesia at the end of the reperfusion period. Biochemical malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), blood urea nitrogen (BUN), creatine (Cr), aspartate aminotransferase (AST) were determined, and histopathological analysis was performed with these samples. Results. MDA level was increased significantly in the control group (p < 0.05). Histopathological findings of the control group confirmed that there was renal impairment by tubular cell swelling, interstitial edema, medullary congestion, and tubular dilatation. MDA levels were lower in the ketamine, thiopental, and propofol groups compared to the control group (p < 0.05). In the thiopental and propofol groups, the levels of histopathological scores were significantly lower than control and etomidate groups in ischemia-reperfusion. Conclusion. Our results demonstrated that I/R injury was significantly reduced in the presence of propofol and thiopental. The protective effects of these drugs may belong to their antioxidant properties. These results may indicate that propofol and thiopental anesthesia protects against functional, biochemical, and morphological damage better than control in renal I/R injury.

Protective effects of propofol against ischemia/reperfusion injury in rat kidneys

Aim: The purpose of this study was to investigate and compare the efficiency of propofol in the reduction of injury induced by free radicals in a rat model of renal ischemia/reperfusion (I/R). Method: Twenty-four Wistar rats were divided into four groups in our study. Rats in the sham group underwent laparotomy and were made to wait for 120 min without ischemia. Rats in the control group were given nothing with ischemia–reperfusion. Rats in the I/R groups were given propofol (25 mg/kg) and 10% intralipid (250 mg/kg) ip, respectively, 15 min before the ischemia for 60 min followed by reperfusion for 60 min. The kidney tissues of the rats were taken under anesthesia at the end of the reperfusion period. Evaluation of biochemical malondialdehyde (MDA), superoxide dismutase, and catalase activities and histopathological analysis were performed with these samples. Results: I/R significantly increased MDA levels (p < 0.05). Histopathological findings of the control group confirmed that there was renal impairment by tubular cell swelling, interstitial edema, medullary congestion, and tubular dilatation. MDA levels were lower in the propofol group compared to control group (p < 0.05). In the propofol group, the level of histopathological scores is significantly decreased than control and intralipid groups in ischemia–reperfusion. Conclusion: Our results demonstrate that I/R injury was significantly reduced in the presence of propofol. The protective effects of propofol may be due to their antioxidant properties. These results may indicate that propofol anesthesia protects against functional, biochemical, and morphological damage better than control in renal I/R injury.

Administration of honey to prevent peritoneal adhesions in a rat peritonitis model

AIM We investigated the effects of intraperitoneal honey on the development of postoperative intra-abdominal adhesions and oxidative stress in a model of bacterial peritonitis. METHODS Bacterial peritonitis was induced in 18 rats by cecal ligation and puncture. The rats were randomly assigned to three groups. Group 1 (n=6) received honey intraperitoneally, group 2 (n=6) received 5% dextrose intraperitoneally, and the third group received no fluid or medicine intraperitoneally one day after cecal ligation and puncture procedure. All animals were killed 14 days later so we could assess the adhesion score. Tissue antioxidant levels were measured in 1-g tissue samples taken from the abdominal wall. RESULTS Adhesion scores of honey treated group were significantly lower according to the control group (P<0.05) and statistically significant. Adhesion scores of honey were lower from 5% dextrose but not statistically significant (P>0.05). Malondialdehyde values of honey group were significantly lower from the control group (P<0.05) and levels in 5% dextrose group was higher than the honey group. Catalase levels were high in control and 5% dextrose groups. Superoxide dismutase levels were higher in the control group than the honey group (statistically significant). CONCLUSIONS Intraperitoneal honey decreased the formation of postoperative intra-abdominal adhesions without compromising wound healing in this bacterial peritonitis rat model. Honey also decreased the oxidative stress during peritonitis.

Protective Effects of N-Acetylcysteine and β -Glucan Pretreatment on Oxidative Stress in Cecal Ligation and Puncture Model of Sepsis

This study was designed to compare the effect of pretreatment with N-acetylcysteine (NAC) and β -glucan (β GLU) on inflammatory response in a rat model of sepsis. The study was performed in the animal laboratory of the Kahramanmaras Sutcu Imam University, School of Medicine. Forty rats were randomized into four groups (control, sham, NAC, and β GLU). Control and Sham groups received saline or NAC (200 mg/kg, po) in the NAC group and β GLU (50 mg/kg, po) in the βGLU group via intragastric gavage once a day for 10 days and 30 min prior to surgery. Sepsis was induced by cecal ligation and puncture (CLP) in rats. In the NAC, β GLU, and control groups, a laparotomy was performed with the CLP procedure. In the sham group, laparotomy was performed and cecum was manipulated but not ligated or perforated. TNF-α and IL-6 levels were significantly elevated in the control group and decreased in the NAC and β GLU groups. IL-10 levels were significantly increased in the β GLU group (p <. 05). Superoxide dismutase and catalase levels in the liver tissue were significantly increased in the NAC and β GLU groups, whereas superoxide dismutase levels were higher in the β GLU pretreatment group than the NAC pretreatment group (p < 0.05). Malondialdehyde levels in the liver tissue were significantly elevated in the control group and decreased in the NAC and β GLU groups (p <. 05). Prophylactic administration of NAC or β GLU similarly ameliorated sepsis syndrome by reduction of the proinflammatory cytokines and increase of the anti-inflammatory cytokine levels and accession of cellular antioxidants, which protect cells from oxidative stress, thereby recruiting inflammatory cells into tissue.

The Effect of Intraperitoneal Catalase on Prevention of Peritoneal Adhesion Formation in Rats

The objective of our study was to investigate the efficacy of catalase in preventing the formation of peritoneal adhesions induced by cecal serosal laceration in rats. A research study was set up using a randomized complete block design. This study was performed in the Experimental Surgical Research Center, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey. Thirty Wistar albino rats were assigned to 3 groups of 10 animals each. The animals were anesthetized, a median laparotomy was performed, and the cecum was traumatized. In the final stages of surgery, the first group received 30,000 U of catalase intraperitoneally (ip) (catalase group), the second group received 2 mL of saline solution ip (isotonic group), and the last group received no treatment (control group). All rats were sacrificed on day 14. Adhesions were counted and blood samples were taken for measuring the catalase level. There were significant differences between the adhesion scores among all groups (p <. 05, Kruskal–Wallis test). The catalase group had significantly lower adhesion scores than the other groups (post hoc Mann–Whitney test). At day 14, blood catalase levels in the catalase group were significantly lower than in the other groups (p <. 05). We conclude that introduction of catalase into the peritoneal cavity during surgery inhibited adhesion formation.

Thiopental improves renal ischemia–reperfusion injury

Ischemia/reperfusion (I/R) occurs in a number of pathological conditions, including myocardial infarction, stroke, aortic surgery, cardiopulmonary bypass surgery, organ transplantation, resuscitation, and critical care. Massive and abrupt release of oxygen-free radicals after reperfusion triggers oxidative damage. Before critical operations or after resuscitation, it would be wise to find a suitable prophylactic treatment to avoid I/R damage. We aimed to determine whether several commonly used intravenous anesthetics protect against renal I/R injury. Methods: Animals were randomly divided into seven groups, each consisting of six animals: sham group, control group, thiopental group, propofol group, intralipid group, etomidate group, and ketamine group. At the end of the 60-min ischemic period, 60 min reperfusion was established and the materials administered 15 min before the reperfusion. At the end of the reperfusion period, the samples of blood and tissue were reaped for biochemical and serological evaluation. Results: I/R procedure significantly increased malondialdehyde (MDA) levels, decreased catalase (CAT) activities, and superoxide dismutase (SOD) levels. The lowest MDA mean level was in the thiopental group and the highest MDA mean level was in control group. The lowest CAT mean level was in the intralipid group and the highest CAT mean level was in the etomidate group. The lowest SOD mean level was in the control group and the highest SOD mean level was in the propofol group. Conclusion: Thiopental and propofol, especially thiopental, are more effective to protect renal I/R injury.

Prevention of postoperative peritoneal adhesions by administration of estrogen.

Aim: Postoperative abdominal adhesions represent one of the most common causes of intestinal obstruction in surgical patients. In this study, the effects of intraperitoneal administration of estrogen on the development of postoperative intraabdominal adhesions and peritoneal leucocytes in a rat adhesion model were investigated. Methods: Sixty Wistar albino rats were divided into three groups. Group 1 (control group) had their abdomen closed after surgery without administration of any material or drug. Group 2 (saline group) received 2 ml of 0.9% NaCl, and group 3 (estrogen group) animals received a single intraperitoneal dose of 2 cc (1 mg) estrogen (Estradiol propionate, 50.000U, Akrofilline®, Biofarma, Turkey). All the groups were exposed to the same adhesion-creating procedure (Swolin K. Experimental studies on the prevention of intra-abdominal adhesions. Studies on rats with an emulsion of lipid and prednisolone. Acta Obstet Gynecol Scand. 1966;45:473–498.). After 7–42 days, all animals were sacrificed. Adhesions were scored and peritoneal leucocytes were counted. Results: The adhesion formation and peritoneal leucocyte count of the estrogen group were significantly less than the control and saline groups and a statistically significant difference was determined in comparison of those groups (p <. 05). Conclusion: We concluded that intraperitoneal estrogen decreases the incidence of postoperative intraabdominal adhesion formation in rat adhesion model.

Effects of Epidural-and-General Anesthesia Combined Versus General Anesthesia Alone on Femoral Venous Flow During Laparoscopic Cholecystectomy

BACKGROUND AND OBJECTIVE The pneumoperitoneum has been shown to decrease femoral blood flow, resulting in venous stasis. We analyzed the effects of the pneumoperitoneum and epidural analgesia on femoral vein diameter and the peak flow rate of femoral vein during laparoscopic cholecystectomy. PATIENTS AND METHODS Forty patients were randomly allocated to receive either combined epidural analgesia (EA) and general anesthesia (GA) (group EA/GA) or GA alone (group GA). Laparoscopic cholecystectomy was the standard operation for the selected patients. Then, 10 mL of 1% lidocaine in group EA/GA or physiologic serum in group GA was injected via epidural catheter. Peak flow rates (PFRs) of femoral vein cross-sectional areas (CSAs) were measured from the right femoral vein at three different times: after induction of anesthesia, during the pneumoperitoneum, and after abdominal deflation, but prior to reversal of anesthesia. RESULTS The two groups were similar in age, sex, body mass index, and duration of operation. The CSA slightly increased after the induction of anesthesia, compared with the previous measurements, although there was no statistical significance between them for both groups (P > 0.05). The PFR decreased, whereas the CSA increased during the pneumoperitoneum in each group. The PFR values after basal measurements were significantly higher in the EA/GA than in the GA group (P < 0.05). Group EA/GA had significantly lower heart-rate and blood-pressure levels during surgery than those in group GA (P < 0.05). CONCLUSIONS Abdominal insufflation during laparoscopic cholecystectomy results in dilation and decreased flow in the common femoral vein. Epidural analgesia added to the GA partially compensated for the reduction in femoral PFR.

Eggshell calcification after intrathyroidal hemorrhage of retrosternal thyroid

We report a rare event of old hemorrhage into a thyroid causing respiratory distress. A 67-year-old man with chronic cough and recent dysphagia was found to have a retrosternal mass extending into the visceral mediastinum on chest roentgenogram. A computed tomographic (CT) scan confirmed eggshell callcification, which was 53 × 53 × 80 mm in size a retrosternal thyroid mass and revealed significant tracheal deviation to the right due to an extensive mass surrounded by a calcificated capsule in the left lobe of the thyroid gland with extension to the upper mediastinum. He successfully underwent left lobectomy of the thyroid gland with sternotomy. The pathological examination revealed intrathyroidal hemorrhage of the thyroid gland with massive intracystic old bleeding.