Mesut A. Unsal

The effects of carbon dioxide pneumoperitoneum on ovarian blood flow, oxidative stress markers, and morphology during laparoscopy: a rabbit model.

OBJECTIVE To determine the effect of CO(2) pneumoperitoneum on the ovaries in an experimental pneumoperitoneum model. DESIGN Experimental controlled study. SETTING University hospital. PATIENT(S) Sixteen adult female conventional rabbits. INTERVENTION(S) Group I (8 rabbits) was not subjected to intra-abdominal pressure (IAP). In group II (8 rabbits), IAP insufflation was performed at 12 mm Hg. In total, 60 minutes of pneumoperitoneum and 10 minutes of reperfusion were maintained. Ovarian blood flow (OBF) was studied using laser Doppler flowmetry. The time points of OBF measurements were as follows: OBFbaseline, 10 minutes before insufflation; OBF30min, 30 minutes after pneumoperitoneum; OBF60min, 60 minutes after pneumoperitoneum; and OBFreperfusion, 10 minutes after pneumoperitoneum desufflation. Mean OBF changes during CO(2) pneumoperitoneum (OBFmean) were also assessed. MAIN OUTCOME MEASURE(S) Blood perfusion units, tissue malondialdehyde values, and histopathologic damage scores. RESULT(S) In group II, mean OBF values were significantly lower than in group I, especially for OBF30min, OBF60min, OBFreperfusion, and OBFmean. The mean tissue malondialdehyde value for group II was significantly higher than in the control group (104.48 +/- 20.07 nmol/g vs. 64.12 +/- 8.77 nmol/g, respectively). Compared with group I, in group II histologic specimens of the ovaries had higher scores for follicular cell degeneration, vascular congestion, hemorrhage, and inflammatory cell infiltration. CONCLUSION(S) Pneumoperitoneum, even at normal IAP levels, leads to significant oxidative stress-induced biochemical and histologic damage to the ovaries.

The novel ischemia marker ‘ischemia-modified albumin’ is increased in normal pregnancies

The aim of this prospective case‐control study was to determine the change in serum maternal ischemia‐modified albumin (IMA) during normal pregnancies. A total of 117 pregnant (first trimester (n = 24), second trimester (n = 34), and third trimester (n = 35)) and non‐pregnant healthy women (n = 23) were included. Maternal serum IMA, Malondialdehyde (MDA), and albumin levels were measured. Compared with non‐pregnant women, the cross‐sectional mean IMA levels in pregnant women were significantly increased, while the mean serum MDA and albumin levels were significantly decreased throughout pregnancy. Furthermore, a significant negative correlation between serum IMA and albumin levels (r = −0.354, p<0.001) was found, and there was a weak positive correlation between serum albumin and MDA levels (r = 0.334, p<0.001). Serum IMA, which has recently been developed as a clinical marker of ongoing myocardial ischemia, appears to be elevated in normal pregnancy. This may be due to the physiologic oxidative stress state of pregnancy.

Serum ischemia-modified albumin as a novel marker of ovarian torsion: An experimental study

OBJECTIVE To evaluate the effect of ovarian torsion on serum levels of ischemia-modified albumin (IMA) in an experimental model. STUDY DESIGN Sixteen female adult Sprague-Dawley rats were involved in the study. Rats were allocated randomly to group I or group II on the day of the experiment. Group I (eight rats) comprised the control (sham operated) group. In group II (eight rats), a torsion model was created by using atraumatic vascular clips just above and below the right ovary. At the end of a 3-h period of ischemia, the ovaries were removed. Blood was sampled before and after operation to assess serum IMA levels. Serum IMA levels (absorbance units) and histopathologic damage scores were evaluated. RESULTS Initial serum IMA levels were similar in both groups. After the operation, significant elevation was observed in group II in contrast to group I (0.191+/-0.034 and 0.277+/-0.089 ABSU, p=0.05). Histologic specimens of the ovaries in group II had higher scores of follicular cell degeneration, vascular congestion, hemorrhage and inflammatory cell infiltration than those in group I (p<0.001). CONCLUSIONS The elevated serum IMA levels observed in the ovarian torsion model seem to have a potential role as a serum marker in the early diagnosis of ovarian torsion.

Carbon dioxide pneumoperitoneum induces systemic oxidative stress: a clinical study

OBJECTIVE To investigate the effect of carbon dioxide pneumoperitoneum on systemic oxidative stress by using serum oxidative stress markers (ischemia modified albumin (IMA), malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI)) and to compare their effectiveness at clinically accepted safe intra-abdominal pressure levels (<12 mmHg). STUDY DESIGN A total of 33 consecutive patients who had a unilateral ovarian cyst were enrolled for this prospective clinical study. All women underwent a laparoscopic ovarian cystectomy procedure. Venous blood was collected from patients preoperatively, 10 min after induction of anesthesia and 30 min after insufflation. Preoperative, 10(min), and 30(min) serum IMA, MDA, TOS, OSI and TAS levels were compared. RESULTS The mean age was 29.3 ± 6.4 and the range of operation time was 45-80 min. The mean serum IMA levels showed a significant increase 30 min later from CO(2) insufflation (p<0.05). Significant alterations were not observed in serum MDA, TOS, OSI or TAS levels. CONCLUSIONS Laparoscopic surgery causes systemic ischemia and this ischemic effect can be revealed by measuring serum ischemia modified albumin. IMA is more sensitive than MDA, TOS, OSI and TAS in early detection of systemic oxidative stress.

Psychotropic drugs in pregnancy: a case-control study

Psychotropic drug exposure during pregnancy is a common problem. Among the 601 cases exposed to drugs during pregnancy, who were followed by our Toxicology Information and Follow-up Service, 124 cases had used psychotropic drugs for depression, anxiety, or psychotic disorders. As the control group, 248 women, who did not use any drugs were selected. Of the 124 cases, 80 (64.5%) had healthy babies, and 17 (13.7%) decided to terminate the pregnancy. Spontaneous abortions, intrauterine death (in the 38th week) and premature deliveries were observed in the 9 (7.3%), 1 (0.8%) and 3 (2.4%) cases, respectively, in the drug exposure group. Pregnancies of the 14 (11.3%) cases were continuing during the preparation of this manuscript. Of the 248 controls, 151 (60.9%) had healthy babies, 9 (3.6%) experienced spontaneous abortion and 3 (1.2%) decided to terminate their pregnancies, 3 (1.2%) had premature deliveries, and we observed one (0.4%) congenital abnormality, 81 (32.7%) cases were still pregnant. Odds Ratio (95% confidence interval) for spontaneous abortion was found to be 1.35 (1.27-11.82) in the cases exposed to psychotropic drugs (P=0.02). No developmental problems were observed in the babies followed for 12 months. These data may give information about the early- but not the late-term effects of psychotropic drugs used in pregnant women.

Apoptotic and morphological features of the umbilical artery endothelium in mild and severe pre-eclampsia

Background. The pathology of the umbilical arterial endothelium in normal pregnancy and in pregnancy complicated with pre‐eclampsia remains unclear. In this study the changes that occur in the umbilical artery endothelial cells were examined and endothelial cell morphology and apoptosis were compared among control, mild, and severe pre‐eclamptic subjects. Methods. Umbilical cords with a gestational age of between 35 and 40 weeks were collected from women with normal pregnancies (n=17), mild pre‐eclampsia (n=10), and severe pre‐eclampsia (n=12). We studied the umbilical artery endothelial cells using flow cytometry, and light and electron microscopy. Apoptosis was measured using flow cytometry and the terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling technique. The Kruskall–Wallis variance analysis and Mann–Whitney U‐tests as post hoc were applied. Results. In mild pre‐eclamptics, the endothelial cells appeared ultrastructurally separated. A dilated endoplasmic reticulum, swollen mitochondria, and vanished mitochondrial cristae were observed. In severe pre‐eclamptics, the cells were disorganized, highly contracted and vacuolated, separated from each other, and protruding prominently into the lumen. The percentages of endothelial cells that underwent apoptosis in mild (p<0.017) and severe pre‐eclamptics (p<0.017) were higher than those in the controls. These apoptosis values were highest in severe pre‐eclamptics (p<0.0001). Conclusion. Apoptosis and structural disruptions in the arterial endothelium of severe pre‐eclamptics were prominent in all subjects. Increased endothelial apoptosis and structural disruptions are clinically related to intensity of pre‐eclampsia, and may be associated with adaptation of the endothelial cells to pre‐eclampsia.

Acute Alterations in Biochemistry, Morphology and Contractility of Rat Isolated Urinary Bladder via Increased Intra-Abdominal Pressure

Objective: To determine the acute effects of increased intra-abdominal pressure (IAP) on the biochemistry, morphology and contractility of the rat isolated urinary bladder using an experimental laparoscopy model. Methods: We divided 24 adult female Sprague–Dawley rats into three groups. The control group (group I) was not subjected to increased IAP. In groups II and III, IAPs of 10 and 20 mm Hg, respectively, were established by carbon dioxide pneumoperitoneum for 60 min. Thirty minutes after desufflation, the rat urinary bladder dome was removed for in vitro pharmacological investigation, measurement of malondialdehyde (MDA) levels and histopathological examination. Statistical comparisons between groups were performed. Results: Tissue MDA levels in groups II and III were significantly higher than in the control group. In group II, only the lamina propria was significantly damaged. However, the epithelium, lamina propria, and serosa were significantly damaged in group III. Acetylcholine potentiated contractions in both IAP groups. Increased responses to electrical field stimulation in the IAP groups were significant only in group II. Conclusions: In this experimental model, 10 and 20 mm Hg of IAP induced by pneumoperitoneum increased MDA levels and caused important changes in the morphology and contractile response of the urinary bladder.

The effect of CO2 insufflation-desufflation attacks on tissue oxidative stress markers during laparoscopy: a rat model

OBJECTIVE To determine the effects of sudden intra-abdominal pressure (IAP) changes on the terminal ileum in a pneumoperitoneum model. DESIGN An experimental controlled study. SETTING University hospital in Turkey. ANIMAL(S) Thirty-two adult female Sprague-Dawley rats. INTERVENTION(S) The rats were divided into four groups. Group 1 was not subjected to IAP. In group 2, IAP insufflation was performed continuously to keep the IAP at 10 mmHg. Groups 3 and 4 underwent an insufflation-desufflation procedure: group 3 was fluctuated 5 times, and group 4 was fluctuated 10 times within the pneumoperitoneum period of 60 minutes. Thirty minutes after the desufflation, the terminal ileum was removed for the measurement of tissue malondialdehyde (MDA) values and histopathological examination. MAIN OUTCOME MEASURE(S) The tissue MDA values and histopathological damage scores. RESULT(S) The tissue MDA values in the IAP groups (groups 2, 3, and 4) were significantly increased when compared with those of the control group. The mean MDA value in group 4 was higher than that in groups 2 and 3. Histopathologic oxidative damage scores in the mucosa and submucosal layers were significantly higher in groups 2 and 3, compared with those of the control group. However, the highest histopathologic damage scores were observed in group 4. CONCLUSION(S) Unexpected desufflation-insufflation even at normal IAP levels during laparoscopy leads to significant oxidative stress-induced damage in the terminal ileum.

The effects of short-term raloxifene therapy on fibrinolysis markers: TAFI, tPA, and PAI-1.

Background.  Markers of fibrinolysis, thrombin‐activatable fibrinolysis inhibitor (TAFI), tissue‐type plasminogen activator (tPA), and plasminogen activator inhibitor‐1 (PAI‐1) levels were studied for the evaluation of short‐term effects of raloxifene administration in postmenopausal women.

The Relationship Between Intraabdominal Hypertension and Preeclampsia

OBJECTIVE: We aimed to measure abdominal pressure and placental levels of malondialdehyde in patients with preeclampsia and investigate the relationship between intraabdominal pressure and clinical features of preeclampsia. STUDY DESIGN: Study was conducted at a tertiary referral clinic. Study group consisted of patients with preeclampsia and control group consisted of normotensive pregnant women. Both placental malondialdehyde and intraabdominal pressure levels were studied in all patients. Intraabdominal pressure was assessed indirectly via a Foley bladder catheter both antepartum and postpartum period. Statistical comparisons among groups were made using the Mann-Whitney U test, independent T test and Chi-square test. Statistical significance was set as p<0.05. RESULTS: Study and control group consisted of 35 pregnant patients. The mean patients’ age, gravidity, parity, weight and BMI were not different between study and control groups. In the study group, Caesarean, preterm delivery and abdominal hypertension rate were significantly higher whereas the mean neonatal birth weight was lower. The mean antepartum and postpartum intraabdominal pressure levels were significantly higher in study group. The mean intraabdominal pressure was highest in patients with oliguria (19.8±1.8 cmH2O). Abdominal hypertension was detected in 30 (86%) patients in study group and in 3 (9%) patients in control group. The mean placental malondialdehyde level was significantly higher in patients with intraabdominal hypertension. CONCLUSION: Abdominal hypertension rate is very high in patients with preeclampsia. Abdominal hypertension may have an additional role in preeclampsia.