Mustafa Atabey

The impact of Ramadan on peptic ulcer perforation

BACKGROUND Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP. METHODS A retrospective analysis of 229 patients who were operated due to PUP between 1999-2009 was made. Patients were divided into two groups. Group I (n=188) included the patients who were operated in other periods of the year, while Group II (n=41) included the patients who were operated during Ramadan, the Muslim period of fasting. Patients in Group II were analyzed in terms of duration of fasting. RESULTS The increase in surgeries per group was higher in Group II than Group I (p<0.05). Predisposing factors, anti-ulcer drug usage and demographic variables were seen to have no role in this difference. Duration of fasting may have a minimal effect on the perforation. CONCLUSION The results of this study demonstrate that PUP is detected as relatively higher during Ramadan among those who are fasting for more than 12 hours daily. We suggest that people with predisposing factors should be informed before making a decision to fast.

The effects of sildenafil in liver and kidney injury in a rat model of severe scald burn: a biochemical and histopathological study.

BACKGROUND Severe burn induces systemic inflammation and reactive oxygen species leading to lipid peroxidation which may play role in remote organs injury. Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5. Sildenafil reduces oxidative stress and inflammation in distant organs. The aim of the present study was to evaluate the effects of different dosages of sildenafil in remote organs injury. METHODS A total of thirty-two rats were randomly divided into four equal groups. The groups were designated as follows: Sham, Control, 10, and T20 mg/kg sildenafil treatment groups. Levels of malondialdehyde (MDA), vascular endothelial growth factor (VEGF), VEGF receptor (Flt-1), activities of glutathione peroxidase (Gpx), levels of total antioxidative capacity (TAC), and total oxidant status (TOS) were measured in both tissues and serum, and a semi-quantitative scoring system was used for the evaluation of histopathological findings. RESULTS Sildenafil increased levels of Gpx, and Flt-1, and decreased MDA and VEGF levels in tissues. Sildenafil also increased serum levels of TAC and Flt-1 and decreased TOS, OSI, and VEGF. CONCLUSION Sildenafil decreased inflammation scores in remote organs in histopathological evaluation. It has protective effects in severe burn-related remote organ injuries by decreasing oxidative stress and inflammation.

Oxidative stress markers in laparoscopic vs. open appendectomy for acute appendicitis: A double-blind randomized study

Background: Oxidative stress is a complicated process, which was defined as an increase in prooxidants and decrease in antioxidants caused by various mechanisms, including inflammation and surgical trauma. The association between acute appendicitis and oxidative stress has been showed in previous studies. However, comparison of oxidative stress in laparoscopic or open appendectomy (OA) has not been established. Patients and Methods: Patients who were diagnosed as acute appendicitis between October 2012 and January 2013 were randomized to open (OA, n = 50) and laparoscopic appendectomy (LA, n = 50). Blood samples for oxidative stress markers (total oxidant status [TOS] and total antioxidant status [TAS]), C-reactive protein (CRP) and white blood cells (WBCs) were collected just before the surgery and 24 h after surgery. Results: There were no differences in preoperative values of WBC and CRP between LA and OA groups (P = 0.523 and 0.424), however, in postoperative 24th h, CRP was reduced in LA group (P = 0.031). There were no differences in preoperative levels of TOS, TAS, and oxidative stress index (OSI) between LA and OA groups. In the postoperative 24th h, TOS and OSI were found to be significantly higher in OA group when compared to LA group (P = 0.017 and 0.002) whereas no difference was detected in TAS level in the postoperative 24th h (P = 0.172). Conclusions: This double-blind, randomized clinical trial provides evidence that LA for uncomplicated appendicitis is associated with significantly lower oxidative stress compared with OA. Some of the advantages of LA may be attributed to the significant reduction of oxidative stress in these patients.

Investigation of the association between the MDM2 T309G polymorphism and gastric cancer

Murine double minute clone 2 oncoprotein (MDM2) is a key component in the regulation of the tumour suppressor p53. The association between the MDM2 polymorphism and gastric cancer (GC) has been investigated in Turkish population. In the present case-control study, the aim was to investigate the association between genetic polymorphisms of the MDM2 gene (a major regulator of p53 function) and primary GC risk in a Turkish population. The polymorphism, T309G (rs2279744) in the MDM2 gene was determined in patients with GC (n=65) and in healthy control subjects (n=67) using the polymerase chain reaction-restriction fragment length polymorphism method. The findings were evaluated using logistic regression and χ2 tests. No statistically significant differences were observed between the control subjects and patients with GC regarding smoking status. A comparison between GC cases and control subjects indicated a statistically significant difference for family history of cancer [odds ratio (OR)=0.17; 95% confidence interval (CI), 0.05-0.56; χ2=0.19; P=0.01]. A significant difference was identified in the GG genotype distribution between GC patients and control subjects (OR=4.58; 95% CI, 1.18-17.79; P=0.022). Thus, the results of the present study indicate that the MDM2 gene T309G intron (GG) genotype may be an important risk factor for GC development in the Turkish population.

Short time antioxidant effect of sevoflurane and desflurane anesthesia, immediately before coronary artery bypass grafting

Abstract Aim. Volatile anesthetics may represent a choice to attenuate oxidant effects. The aim of this study is to investigate the antioxidant status during sevoflurane and desflurane anesthesia immediately before coronary artery bypass graft surgery (CABG) with malondialdehyde (MDA), superoxide dismutase (SOD) and gluthation peroxidase (GPx). Methods. Forty patients, undergoing coronary artery bypass surgery, were enrolled in the study and randomized into two groups of 20 patients each. Anesthesia was maintained with 40% oxygen in air mixture, 1 minimum alveolar concentration (MAC) of desflurane in Group D and sevoflurane in Group S. Blood sampling for the measurements of MDA, SOD and GPx were performed at, T1-before anesthesia induction (baseline), T2-before surgical incision (about 20 min after T1), T3-before cardiopulmonary bypass (about 60 min after T2). Results. Plasma concentrations of MDA, SOD and GPx levels increased significantly during T2 and T3 periods as compared with the baseline values in both groups. This increase was greater in group D versus group S. Conclusion. We conclude that desflurane may cause more systemic lipid peroxidation than sevoflurane during immediately before CABG. Keywords: Cardiac anesthesia, desflurane, sevoflurane, oxidative stress, antioxidant effect Ozet Amac. Volatil anestezikler oksidan etkiyi zayiflatabilirler. Bu calismanin amaci koroner arter bypass greft ameliyatinin hemen oncesinde malondialdehit (MDA), superoksit dismutaz (SOD) ve glutatyon peroksidaz (GPx) ile sevofluran ve desfluranin antioksidan etkisinin arastirilmasidir. Yontemler. Koroner arter baypas greft ameliyati gecirecek 40 hasta calismaya alindi, hastalar rastgele 20’ser kisilik iki gruba ayrildi. Anestezi %40 oksijen ile hava karisimi yaninda Grup D’de 1MAC desfluran, Grup S’de 1MAC sevofluran ile surduruldu. MDA, SOD ve GPx icin kan ornekleri; T1; anestezi induksiyonundan once (bazal), T2; cerrahi insizyondan once (yaklasik T1den 20 dk sonra), T3; kardiyopulmoner baypastan once (yaklasik T2 den 60 dk sonra) alindi. Bulgular. Bazal degerlere gore her iki grupta MDA, SOD ve GPx degerleri T2 ve T3 zamanlarinda anlamli artis gosterdi. Grup D icin bu artis Grup S’den daha fazlaydi. Sonuc. Koroner arter baypas greft ameliyatinin hemen oncesinde desfluran, sevoflurandan daha fazla sistemik lipid peroksidasyonuna neden olur sonucuna vardik. Anahtar sozcukler: Kardiyak anestezi, desfluran, sevofluran, oxidatif stres, antioxidan etki

Conversion to open surgery in the era of laparoscopic cholecystectomy: Rates and reasons

Abstract Aim. In the era of minimally invasive surgery; laparoscopic cholecystectomy has become the first choice for gallstone disease both for urgent and elective surgery .However, a number of cases still necessitate conversion to open procedures. Identifying the reasons and rates involved in conversion at the early period can help the surgeons in deciding when to exclude the choice of e laporoscopic procedure. The goal of this study is to evaluate the rates and causes of conversion to open cholecystectomy in elective cases. Methods. The study included all of the patients who had undergone elective surgery in our clinic due to gallstone disease from January, 1999 to December, 2010. Detection of malignancy and/or polyps, and existence of acute cholecystitis were accepted as criterion for exclusion. The existence of previous abdominal surgery, demographic parameters, and the causes and rates of conversion to open cholecystectomy were noted and analyzed. Results. Of the 823 patients for whom laparoscopic cholecystectomy was applied, 782 were included in this study.The rate of conversion was 6.1% (n=48) in total. Twenty of these 48 converted patients were male and 28 of them were female with a mean age of 49,27 years (range: 24-89). In male and female patients, the conversion rates were 9,8% and 4,8%, respectively. Adhesions due to inflammation or prior abdominal surgery were found to be the most common reasons for conversion. Conclusion. There is no question that laparoscopic cholecystectomy is the gold standard when all other treatment modalities are considered. Laparoscopic cholecystectomy can be safely applied by experienced hands to all patients with a low conversion rate. Conversion should not be seen as a complication. Keywords: Laparoscopic cholecystectomy, gallstone , laparatomy, cholecystectomy Ozet Amac. Minimal invaziv cerrahi caginda laparaskopik kolesistektomi, safra kesesi tasi hastaliginda hem acil hem de elektif sartlarda ilk secenek haline gelmistir. Ancak, halen bazi hastalarda laparatomiye donulmek zorunda kalinmaktadir. Bu tip vakalarin onceden tespit edilerek laparaskopi tercihinden vazgecilmesi icin nedenlerinin ve oranlarinin ortaya konmasi cerrahlara yardimci olabilir. Bu calismanin amaci, elektif vakalarda laparaskopik yontemden acik cerrahiye donus neden ve oranlarini ortaya koymaktir. Yontem. Ocak 1999 ile Aralik 2010 arasinda klinigimizde safra tasi hastaligi nedeni ile elektif kolesistektomi yapilan tum hastalar calismaya dahil edildi. Malignite ve/veya polip tespiti ve akut kolesistit varligi calismada haric tutma kriteri olarak kabul edildi.Onceki abdominal cerrahi varligi, demografik ozellikler, aciga donus neden ve oranlari kaydedilerek analiz edildi. Bulgular. Calisma periyodunu kapsayan donemde laparaskopik kolesistektomi yapilan toplam 823 hastanin 782’si calismaya dahil edildi. Toplam aciga donus orani % 6,1 (n=48) idi. Bu 48 hastanin 20’si erkek, 28’i kadin, ortalama yaslari 49,27 (aralik 24-89) idi. Erkek ve kadin hastalar icin aciga donus oranlari sirasi ile %9,8 ve %4,8 idi. Daha onceki cerrahilere ve enflamasyona bagli yapisiklik acik cerrahiye donmenin en sik nedeni olarak tespit edildi. Sonuc. Tum tedavi yaklasimlari goz onune alindiginda laparaskopik kolesistektominin safra tasi hastaliginda altin standart olmasi konusunda herhangi bir soru isareti yoktur. Laparaskopik kolesistektomitecrubeli cerrahlar tarafindan tum hastalarda dusuk donusum oranlari ile guvenle uygulanabilir. Ancak aciga donus bir komplikasyon olarak gorulmemelidir. Anahtar sozcukler: Laparaskopik kolesistektomi, safra kesesi tasi, laparatomi, kolesistektomi