Mehmet Hascalik

Melatonin reduces torsion-detorsion injury in rat ovary: biochemical and histopathologic evaluation

Abstract:  This experimental study was designed to determine the effects of melatonin on the levels of malondialdehyde (MDA), reduced glutathione (GSH), xanthine oxidase (XO) after adnexial torsion/detorsion (ischemia/reperfusion, I/R) of the ovaries of in rats. Forty adult albino rats were divided into five groups: sham operation, torsion, I/R plus saline, I/R plus melatonin and torsion plus melatonin. Rats in the sham‐operated group underwent a surgical procedure similar to the other groups but the adnexa was not occluded. Rats in the torsion group were killed after adnexal torsion for 3 hr. Melatonin and saline were injected intraperitoneally (10 mg/kg) 30 min before detorsion to the I/R plus melatonin group and I/R plus saline group respectively. After 3 hr of ovarian detorsion, the rats were killed and ovaries were removed. Melatonin was injected intraperitoneally (10 mg/kg) 30 min before torsion to the torsion plus melatonin group. After 3 hr of ovarian torsion, the rats were killed and ovaries were harvested. The tissue levels of MDA, GSH and XO were measured. MDA and XO levels in the I/R plus saline group increased significantly when compared with torsion and sham‐operated groups (P < 0.001). MDA and XO levels in the I/R plus melatonin group were lower than I/R plus saline and differences between the two groups were statistically significant (P < 0.001). GSH levels in the I/R plus saline group decreased significantly when compared with ischemia and sham‐operated groups (P < 0.001). GSH levels in the I/R plus melatonin treated rats were significantly higher than I/R plus saline and ischemia groups (P < 0.001). The tissue levels of XO, MDA and GSH were similar between ischemia and ischemia plus melatonin groups. Morphologically, polymorphonuclear neutrophil infiltration and vascular dilatation were obvious in the I/R‐damaged ovaries, and the changes also partially reversed by melatonin. This study demonstrates that melatonin protects the ovaries against oxidative damage associated with reperfusion following an ischemic insult.

Resveratrol, a Red Wine Constituent Polyphenol, Protects from Ischemia-Reperfusion Damage of the Ovaries

Objective: The aim of this study is to investigate the effects of resveratrol on histopathological changes, antioxidant status and lipid peroxidation, in torsion-detorsion injury in rat ovaries. Method: To determine whether ischemia followed by reperfusion can induce ovarian oxidative damage, we created a model of adnexal ischemia-reperfusion by using rats. Ischemia was induced by unilateral occlusion of the tubo-ovarian vessels for 3 h. Reperfusion was achieved by releasing the occlusion and restoring the circulation for 3 h. Thirty-two adult female albino rats were divided equally into 4 groups: sham operation, torsion, saline/detorsion and resveratrol/detorsion. Rats in the torsion group were killed after 360° clockwise adnexal torsion for 3 h. Resveratrol was injected intraperitoneally 30 min before detorsion in the resveratrol/detorsion group, and saline was administered in the saline/detorsion group. After 3 h of adnexal detorsion in both of these groups, the rats were killed and adnexa were removed. The tissue levels of malondialdehyde, reduced glutathione and xanthine oxidase activity were measured. Results: Malondialdehyde and xanthine oxidase levels in the saline/detorsion group were increased significantly when compared to the torsion and sham operation groups (p < 0.001). Malondialdehyde levels in the resveratrol group were lower than in the saline/detorsion group, and differences between the two groups were statistically significant (p < 0.001). Xanthine oxidase levels in the resveratrol group were lower than in the saline/detorsion and torsion groups, and differences between these groups were statistically significant (p < 0.001). Reduced glutathione levels in the saline/detorsion group were decreased significantly when compared to the torsion and sham operation groups. Reduced glutathione levels in the resveratrol group were significantly higher than in the saline/detorsion group (p < 0.006). Histological examination showed a significant improvement in ovarian morphology in the resveratrol-treated rats compared with the ischemia and ischemia-reperfusion groups. Conclusion: Our results demonstrated that intraperitoneal resveratrol administration reduced the lipid peroxidation products of ischemic rats and ovarian damage was reduced as indicated by histological examination.

Transient ovarian failure: a rare complication of uterine fibroid embolization

Uterine myomas are the most common solid pelvic tumors and the most frequent cause of chronic abnormal uterine bleeding and a common indication for hysterectomy in women (1). Although hysterectomy or myomectomy has been the standard surgical treatment for uterine myomas, alternative treatments have been developed in recent years (2). Uterine artery embolization (UAE) is an effective therapy in the management of uterine fibroids and a valuable alternative to myomectomy or hysterectomy (3). Complications of UAE have been extremely rare. However, concern has been expressed about possible complications of UAE on subsequent fertility due to the embolization of the ovaries through the collateral uteroovarian artery (4). Goodwin et al. estimated that 1–2% of subjects will experience ovarian failure after this procedure (5). We present a 42-year-old woman who developed transient ovarian failure 6 weeks after UAE for a uterine fibroid.

Cerebrospinal fluid leptin levels in preeclampsia: relation to maternal serum leptin levels

Background.  To determine whether cerebrospinal fluid (CSF) and circulating levels of leptin differ between women with preeclampsia and women who had an uncomplicated pregnancy.

Cerebrospinal fluid nitric oxide level changes in preeclampsia

OBJECTIVE The purpose of this study was to determine the level of nitric oxide (NO) metabolites, nitrite and nitrate in human cerebrospinal fluid (CSF) and serum and to assess whether there is any relationship among CSF, serum nitrate-nitrite levels and preeclampsia. STUDY DESIGN Twenty-one preeclamptic and 27 healthy pregnant women as control group who underwent cesarean section (C/S) were included in the study. Before administering local anesthetic for spinal anesthesia, 2 ml CSF and 4 ml venous blood sample were taken. CSF and serum total nitrite, direct nitrite and nitrate levels were determined spectrophotometrically. RESULTS CSF total nitrite, direct nitrite and nitrate levels were significantly different between the two groups (21.00+/-1.68, 8.28+/-0.89 and 12.71+/-1.08 micromol/l, respectively versus 15.53+/-1.49, 5.57+/-0.39 and 9.96+/-1.45 micromol/l, respectively, P<0.05). Significantly higher serum nitrate level was found (31.84+/-2.31 micromol/l) in the control group compared to the preeclamptic group serum nitrate level (25.06+/-2.02 micromol/l). Statistical comparisons were performed by the Mann-Whitney U-test. CONCLUSION CSF-NO is significantly higher but serum NO is lower in preeclamptic group compared with control group may suggest independent regulation of NO in the two compartments. The determination of CSF-NO metabolites could be useful to clarify whether increased NO production is predominantly associated with poor perfusion of the brain in preeclampsia.

Anaesthetic management of an infant with Conradi's syndrome.

SIR—We report our experience in the anaesthetic management of 6 months old boy, 4550 g, with Conradi’s syndrome who underwent surgery for bilateral congenital cataracts. He was the fourth child of consanguineous parents. Their first and third babies died soon after birth. The mother did not smoke cigarettes and denied drug and/or alcohol abuse. There was no exposure to warfarin. Rhizomelic chondrodysplasia punctata had been diagnosed at the age of 3 months as a result of growth retardation, ichthyosis around the umbilicus and hyperkeratosis that penetrated to the depths of the hair follicles. The parents noted the lack of responsiveness of the child to light. The physical examination revealed bilateral cataracts in addition to growth retardation, microcephaly, saddle nose, flat face with upward slanting palpebral fissures, hypertelorism, high arched palate, contractures of the knee, elbow, wrist and ankle joints, symmetrical proximal shortening of the extremities, bilateral congenital hip dislocation, ichthyosis around the umbilicus and hyperkeratosis that penetrated to the depths of the hair follicles and hypospadias. Magnetic resonance imaging of the brain showed no malformation. Urine analysis and the other laboratory examination were normal except increased blood sedimentation rate (35 mmÆh), hypochromic microcytic anaemia (haemoglobin: 10.7 gÆdl) and increased CRP (13.2 mgÆdl, normal range 0–5 mgÆdl). The radiographic anomalies were calcified stippling of the epiphyses, short humeri and femora with wide metaphyses and metaphyseal cupping. There were only 11 pairs of ribs which appeared slender and minimal infiltration was seen at the right basal lung area. Computed tomography (CT) scan of the neck showed no evidence of tracheal stenosis. In the operating room the patient was monitored with three lead electrocardiogram, pulse oximetry and noninvasive blood pressure. The initial preoperative blood pressure was 100/51(67) mmHg, heart rate was 153 bÆmin and SpO2 was 94%. Anaesthesia was induced with propofol 2.5 mgÆkg, remifentanil 1 lgÆkg and vecuronium bromide 0.1 mgÆkg. After ventilation for 2 min, intubation was performed with an uncuffed 3 mm tracheal tube with a Murphy eye, which was one size smaller than expected. Maintenance anaesthesia was with 50% nitrous oxide in oxygen and 2% sevoflurane. After induction, the blood pressure was 120/80 mmHg, heart rate was 101 bÆmin and SpO2 100%. Surgery was completed over 45 min. At the end of surgery, the patient was extubated after neostigmine 0.050 mgÆkg and atropine 0.015 mgÆkg. The perioperative period was uneventful and he was discharged home on the third postoperative day. Conradi’s syndrome (rhizomelic chondrodysplasia punctata) is a rare autosomal recessive disorder associated with numerous dysfunctional peroxisomal enzymes (1). A literature search found many articles that focus on the biochemical aspect of the syndrome, but only a very few clinical reports. Autosomal recessive chondrodysplasia punctata (rhizomelic type) is distinguished as a separate entity from the Conradi-Hünermann or the X-linked dominant type of chondrodysplasia punctata by Spranger et al. but also involving numerous dysfunctional peroxisomal enzymes (1). Chondrodysplasia punctata is associated with cataracts, hypertelorism, optic nerve atrophy, disproportionate shortening of the proximal extremities, psychomotor retardation, failure to thrive and spasticity (2). The preanaesthetic management of these patients requires a multidisciplinary examination. Abnormal cholesterol biosynthesis is a characteristic of some clinical syndromes with rhizomesomelic dwarfing and chondrodysplasia punctata. Severe pulmonary arterial stenoses, mitochondrial myopathies and defects in oxidative phosphorylation, lactic acidosis, abnormal myelin formation and mitochondrial dysfunction have been described in some patients with peroxisomal disorders (3–6). These may have implications for anaesthesia. If rhizomelic chondrodysplasia punctata is suspected, preoperative measurement of plasmalogen levels in red blood cells is suggested, although these levels may be normal (7). The diagnosis of rhizomelic chondrodysplasia punctata relies on a finding of calcified stippling of the hyaline cartilage and bones, which usually disappears at the age of 2 or 3 years (8). Whether respiratory tract cartilage is also involved in this disease remains unclear. However, there are several reports of tracheal stenosis in this syndrome (8). Prior knowledge of this is essential for the anaesthesiologist before intubation and for perioperative airway management. Perioperative gastric reflux and aspiration is also a risk and would cause an eventful perioperative period (2,9,10). In this case we were ready for a difficult intubation and we had a tracheal tube one size smaller than expected and a percutaneous tracheostomy kit. Our case was 6 months old and had no evidence of the characteristic calcified stippling of the tracheal cartilage or the cricoid, which usually disappears after the age of 3 (8). We performed successful general anaesthesia with propofol, remifentanil, vecuronium, sevoflurane in nitrous oxide without complication. In summary, in cases of Conradi’s syndrome the anaesthesiologist must be careful to choose a suitable Paediatric Anaesthesia 2003 13: 841–845