Müjdat Balkan

Beneficial effects of N-acetylcysteine on sodium taurocholate-induced pancreatitis in rats

BackgroundAcute pancreatitis (AP) is a complex disease associated with significant complications and a high rate of mortality. Although several mechanisms are put forward, oxidative stress seems the most important early event in the pathophysiology of AP. Therefore, we evaluated the beneficial effects of N-acetylcysteine (NAC), a strong antioxidant, in experimental AP.MethodsForty-nine Sprague-Dawley rats were used. Acute pancreatitis (AP) was induced by the intraductal infusion of sodium taurocholate. Rats were divided into seven groups (each containing seven rats): control, sham-operated (saline-treated, 3.5 and 12 h), non-treated AP (3.5 and 12 h) and NAC-treated AP (3.5 and 12 h). Treated rats received intraperitoneal (i.p.) NAC 1000 mg/kg 24 h before and just before the induction of pancreatitis.ResultsRats with AP had extensive parenchymal and fat necrosis and NAC treatment at 12 h reduced tissue necrosis significantly (P ≪ 0.05). NAC treatment at 12 h reduced leukocytic infiltration significantly (P ≪ 0.05). Edema and hemorrhage were significantly increased in the AP groups when compared to controls (P ≪ 0.001). NAC treatment reduced edema and hemorrhage at both 3.5 and 12 h slightly but not significantly. The total pathological mean score was significantly increased in the AP groups (P ≪ 0.05) and it was reduced by NAC treatment (P ≪ 0.05). NAC treatment decreased plasma amylase and lipase levels significantly (P ≪ 0.05). While glutathione peroxidase (GPx) activity of pancreatic tissue was similar in the NAC-treated and AP groups, hepatic tissue GPx activity was lower in the AP groups, and NAC treatment restored it (P ≪ 0.05). NAC had no effect on pancreatic superoxide dismutase level. In the NAC-treated rats, the serum NO2/NO3 (nitrite/nitrate) level was significantly increased in the 3.5-h group when compared to the respective AP group (P ≪ 0.05). NAC treatment also significantly reduced the serum concentration of the lipid peroxidation product, malondialdehyde, at 12 h (P ≪ 0.05).ConclusionsNAC treatment had beneficial effects in sodium taurocholate-induced AP in rats. It reduced pancreatic tissue necrosis and lipid peroxidation. In our study, the mechanism underlying the beneficial effects of NAC seemed to be its antioxidant activity, either by increasing hepatic GPx activity, or by a direct scavenging effect on free radicals, thus enhancing the production of and/or inhibiting the degradation of nitric oxide.

Pharmacologic characterization of contractile serotonergic receptors in human isolated mesenteric artery.

The 5-hydroxytryptamine (5-HT) receptors mediating contraction in human isolated mesenteric arteries were characterized. Endothelium-denuded human isolated mesenteric arteries were used. 5-HT induced concentration-dependent contractions in mesenteric arteries (Emax, 127.37 ± 7.61% of 80 m M KCl maximal contraction; pD2, 6.73 ± 0.09 [−logEC50]). Sumatriptan, a selective 5-HT1B/1D receptor agonist, induced concentration-dependent contractions in some of the arteries (Emax, 61.82 ± 10.04%; pD2, 6.56 ± 0.21, n = 9) but not in the others (Emax < 5%, n = 13), suggesting that functional 5-HT1B/1D receptors exist in some but not in all mesenteric arteries. GR127935 (a selective 5-HT1B/1D receptor antagonist, 3 n M) inhibited sumatriptan-induced contractions in arteries in which sumatriptan responses were strong in an insurmountable manner. GR127935 (10 n M) also inhibited 5-HT responses and shifted the concentration–response curve of 5-HT to the right significantly (p < 0.05; pD2s were 6.54 ± 0.18 and 5.93 ± 0.11 in the presence of vehicle and GR127935, respectively). Ketanserin (0.01–1 &mgr;M) competitively antagonized 5-HT responses in human mesenteric arteries: pA2 value was 8.40 ± 0.25 (slope of Schild regression, 1.43 ± 0.18; r2, 0.98). Tropisetron (5-HT3 receptor antagonist) and prazosin (&agr;1-adrenoceptor antagonist) did not affect the contractions induced by 5-HT. These results suggest that 5-HT2A and 5-HT1B/1D receptors, but not 5-HT3 and &agr;1-adrenoceptors, are involved in the 5-HT–induced contractions in human isolated mesenteric arteries. Sumatriptan-induced and 5-HT1B/1D receptor-mediated responses vary greatly among patients.

The importance of urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis

PURPOSE Acute appendicitis is one of the most common surgical emergencies. Diagnosis is usually made depending on the presenting history, clinical evaluation, and laboratory tests. The aim of this study was to investigate the role of urinary 5-hydroxyindoleacetic acid (U-5-HIAA) in the early diagnosis of acute appendicitis. METHODS Thirty-five pigmented male rabbits were divided into 5 groups. Group 1 is the control (n = 7); group 2 is the sham (n = 10). The appendix was ligated from its base, and an appendectomy was performed after 12, 24, 36 hours in group 3 (n = 7), group 4 (n = 7), and group 5 (n = 7), respectively. Spot urine samples were obtained for U-5-HIAA determination, and appendectomy tissues were examined histopathologically. RESULTS Acute appendicitis was diagnosed in all animals in group 3, group 4, and group 5, and the mean levels of U-5-HIAA in group 3 were higher than in the other groups. The mean of U-5-HIAA levels between animals with appendicitis and those without showed a significant difference (P = .003). The U-5-HIAA cutoff point of 4.15 mg/g creatinine had a sensitivity of 85%, a specificity of 64.29%, and an accuracy of 76% (area under curve = 0.805) for acute appendicitis. The probability of acute appendicitis is found to be 10, 2 times more when the U-5-HIAA level is greater than 4.15 mg/g creatinine. CONCLUSION We have concluded that spot U-5-HIAA level increases significantly in the early stages of acute appendicitis.

Larrey hernia complicated with colonic obstruction in a 77-year-old woman: a case report.

Abstract Congenital Larrey hernia has a rare incidence and is frequently diagnosed in the later decades of life. This case study presents a 77-year-old woman with Larrey hernia and an intestinal obstruction complication, treated with laparatomic surgery.

Can D-dimer become a new diagnostic parameter for acute appendicitis?

INTRODUCTION In this study, we investigated D-dimer serum level as a diagnostic parameter for acute appendicitis. MATERIALS AND METHODS Forty-nine patients were enrolled in the study. Patients were classified according to age; sex; duration between the beginning of pain and referral to a hospital or clinic; Alvarado scores; and in physical examination, presence of muscular defense, the number of leukocytes, preoperative ultrasonography, and D-dimer levels of histopathologic study groups were analyzed. RESULTS Of the patients enrolled in the study, 26.5% were females and 73.5% males. The average age was 21 years (range, 16-38 years) and 81.7% acute appendicitis (AA). According the duration of pain, 63.2% of the patients were referred to the hospital within the first 24 hours, 26.5% of the patients were referred to the hospital within 24 to 48 hours, and 10.3% were referred to the hospital within a period of more than 48 hours. No statistically significant difference was determined regarding D-dimer levels between the histopathologic study groups (P > .05). Alvarado scores lower than 7 were found in 36.7% and 7 or higher in 63.3% of the patients. There was no statistically significant difference related with D-dimer levels between histopathologic study groups (P > .05). The ratio of cases with a number of leukocytes below the upper limit were determined respectively as 32.7% and 67.3%, and no statistically significant difference was found regarding d-dimer levels between histopathologic study groups (P > .05). CONCLUSION Increased D-dimer levels should not be considered as a diagnostic parameter in diagnosis of acute appendicitis.

Retinoic Acid and Intestinal Wound Healing in Intra-operatively Irradiated Rat

Abstract Aim: This study was undertaken to assess the effect of intra-operative radiotherapy on intestinal wound healing and prevention of its side effects by retinoic acid. Materials and methods: Thirty Spraque-Dawley rats were divided into 3 groups of (n = 10). All the groups had laparotomies and terminal ileum exteriorization. Group I was the control group with no irradiation and no anastomosis; group II had both irradiation and anastomosis and group III rats had peroral retinoic acid conditioning and irradiation + anastomosis. On the seventh postoperative day, tensile strength and intestinal elongation measurements were to evaluate the effect of retinoic acid on wound healing. Results: Compared to the non-retinoic acid conditioned group, the retinoic acid conditioned group had statistically significant higher tensile strength and lower intestinal elongation values, revealing better wound healing. Conclusion: Peroral retinoic acid supplement administration has a preventive effect on radiation-induced wound-healing inhibition in intra-operative abdominopelvic irradiation and anastomoses.

Pneumoscrotum following perineal trauma

Abstract Pneumoscrotum is a rare entity. A case is reported of a patient associated with subcutaneous emphysema, pneumoperitoneum and pneumoretroperitoneum. We present the demonstrative findings on X-ray and computerized tomography of the case with pneumoscrotum following a penetrating trauma of the perineum.

Muir-Torre Syndrome Presenting with Ileus: a Case Report

Abstract The Muir-Torre syndrome is characterized by cutaneous neoplasms and visceral malignancies. At least one sebaceous adenoma, epithelioma or carcinoma and at least one internal malignancy are required to make a reliable diagnosis. According to medical literature only two cases of Muir-Torre syndrome with jejunal carcinoma have been reported to date and there is no reported case with intestinal obstruction. Here, we report an unusual case of jejunal carcinoma presenting with ileus.

Role of alkaline phosphatase intestine-isomerase in acute mesenteric ischemia diagnosis.

BACKGROUND The aim of the present study was to investigate the diagnostic value of alkaline phosphatase (ALP) intestine-isomerase, plasma lactate dehydrogenase (LDH), and D-dimer levels in acute mesenteric ischemia. METHODS Thirty Wistar rats were divided into 5 groups of 6 rats each. In Group 1, blood samples were obtained to determine normal parameter levels. In the sham group, Group 2, blood samples were obtained following laparotomy. In Group 3, blood samples were obtained 2 hours after ligation. In Groups 4 and 5, blood samples were obtained at 4 and 6 hours after ligation, respectively. Ischemic damage was assessed using a pathological scoring system. Blood samples were analyzed for hourly changes in parameters. RESULTS No statistically significant difference in D-dimer levels was found between ischemia groups (p=0.337). A statistically significant difference in LDH levels was found between the control group, Group 1, and Group 4 (p=0.018). ALP intestine-isomerase enzyme levels were not statistically significant in other groups (p=0.077). CONCLUSION Findings indicate that plasma LDH levels higher than 1900 IU/L may be a useful marker in the early diagnosis of acute mesenteric obstruction. However, ALP intestine-isomerase enzyme and D-dimer plasma levels were not found to contribute to the diagnosis.

Spermatocele: a rare complication of rectal surgery and radiotherapy. Case report.

Abstract A 47-year-old man developed a presacral mass after abdominoperineal resection, which is combined with pre and postoperative radio-chemotherapy for carcinoma of the rectum. CT-guided biopsy and cytological examination of the mass revealed no malignancy but spermatocele, which is a very unusual complication of rectal surgery.