Ömer Rıdvan Tarhan

Peritoneal fibrinolytic activity in peritonitis

BACKGROUND Peritonitis may cause a reduction in abdominal fibrinolytic activity. The reduced local fibrinolysis seems to be an important process in the subsequent development of adhesion formation. The aim of the study was to evaluate peritoneal fibrinolytic capacity in inflamed and normal peritoneum. METHODS Peritoneal biopsy specimens were taken at the beginning of operation from 15 patients with peritonitis and 10 patients who underwent elective operation. Levels of tissue-type plasminogen activator (tPA), urokinase-type plasminogen activator (uPA), plasminogen activator inhibitor (PAI) type 1 (PAI-1) and type 2 (PAI-2), and tPA/PAI complex in tissue extracts were determinated by commercially available enzyme-linked immunosorbent assay kits. RESULTS tPA was significantly reduced in peritonitis compared with normal peritoneum (P <0.001), whereas it was found that the levels of PAI-1, PAI-2, uPA, and tPA/PAI complex in peritonitis were significantly higher than those in normal controls. CONCLUSIONS Plasminogen activator activity was significantly reduced in peritoneal biopsy samples from patients with peritonitis compared with those from patients without peritonitis.

Effects of seprafilm on peritoneal fibrinolytic system

Background:  There is a high incidence of adhesions after ventral hernia repair with polypropylene mesh. The purpose of the present study was to evaluate the efficacy of Seprafilm in the prevention of adhesion formation and effect on peritoneal fibrinolytic activity.

Lipoma of the parietal peritoneum: an unusual cause of abdominal pain

Ann Saudi Med 2006;26(5):388-390 A lipoma is a very common benign soft tissue tumor that is composed of mature fat. It represents by far the most common mesenchymal neoplasm in adults, occurring throughout the whole body.1-3 It can be single or multiple (lipomatosis) and superficially or deeply localized.2 Most become apparent in patients between the ages 40 and 60 years and, when unexcised, persist for the remainder of life; they hardly increase in size after an initial growth period. Statistics as to incidence by sex vary, but most studies report a higher incidence in men.1 Mature lipomas in adults have a predilection for the trunk. Deep lipomas have been reported in the thorax, mediastinum, chest wall, pelvis, retroperitoneum, and paratesticular region.4 In the gastrointestinal tract, lipomas are mainly found in the submucosa and subserosa of the small and large intestines, and are mostly an incidental finding at laparotomy and autopsy. They are solitary or multiple, and present as a sessile or pedunculated mass; sometimes they are associated with ulceration and bleeding, intussusception, Crohn’s disease, or malignancies.1 These benign tumors can cause various gastrointestinal symptoms such as obstruction and abdominal pain.5 Intraperitoneal lipoma is extremely rare.4 We encountered a case of a lipoma of the parietal peritoneum in 67-year-old woman presenting with acute abdominal pain.

Higher incidence of cholelithiasis in chronic renal failure patients with secondary hyperparathyroidism undergoing peritoneal dialysis

Background. In this study, we endeavored to determine whether the incidence of cholelithiasis (CL) was increased in chronic renal failure (CRF) patients with secondary hyperparathyroidism on a peritoneal dialysis (PD) program. We also evaluated the factors that might have some influence on the development of CL. Methods. A total of 59 CRF patients undergoing PD were included in the study. We studied the following groups to determine whether parathyroid hormone (PTH) levels were increased in CRF-PD patients: twenty patients with secondary hyperparathyroidism (group 1) and 39 patients with normal PTH levels (group 2). PTH levels were maintained at three times the upper limit of normal. Biochemical parameters were obtained for each CRF-PD patient. All patients underwent abdominal ultrasonography to screen for the presence of cholelithiasis. For statistical analysis, χ2, t test, and logistic regression analysis were used; p < 0.05 was considered as significant. Results. We found an almost ten times higher incidence (25% vs. 2.6%) of CL in group 1 patients with statistical significance (p = 0.007). When the incidence of CL according to sex, creatinine, and PTH levels were considered, female gender, creatinine, and PTH levels were higher in group 1, which was also significant statistically. No significant relationship was detected between gallbladder stone formation and the other analyzed biochemical parameters. Conclusions. We found that the incidence of CL in CRF-PD patients with secondary hyperparathyroidism was higher than CRF-PD patients with normal PTH levels. It was also detected that female gender, high creatinine levels, and elevated PTH levels might influence the development of CL in CRF-PD patients.

Fibrinolytic responses of human peritoneal fluid in laparoscopic cholecystectomy: a prospective clinical study

BackgroundThe reduction in peritoneal fibrinolysis is believed to be the pathogenetic mechanism of adhesion formation. The general conclusion based on previous clinical and experimental studies is that laparoscopic procedures produce less adhesion formation. The association between this beneficial effect of laparoscopic cholecystectomy and peritoneal fibrinolytic changes is not clear. Therefore, the authors aimed to compare the effects of open and laparoscopic cholecystectomy on peritoneal fibrinolysis. For this purpose, fibrinolytic parameters in peritoneal fluid were investigated 24 h after laparoscopic and open cholecystectomies.MethodsIn a prospective clinical study, peritoneal fluid was sampled via a drain 24 h after laparoscopic (n = 10) and open (n = 9) cholecystectomies. Activities and concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1), and tPA/PAI-1 complex were determined by enzyme-linked immunosorbent assay (ELISA) kits.ResultsIn peritoneal fluids, tPA and tPA/PAI-1 complex concentrations were higher in the open cholecystectomy group (p = 0.009 and p < 0.001, respectively), but tPA activity and PAI-1 concentrations did not differ between the groups (p = 0.514 and p = 0.716, respectively).ConclusionsFibrinolytic changes in peritoneal fluid have several similarities in open and laparoscopic cholecystectomies with regard to tPA activity and PAI-1 levels. However, higher tPA levels after the open procedure probably are secondary to more intense tissue handling leading to mesothelial release of tPA.

Structural deteriorations of the human peritoneum during laparoscopic cholecystectomy. A transmission electron microscopic study

BackgroundIn previous studies, changes in the surface of the peritoneum during laparoscopic surgery are well defined. Nevertheless, almost all of these studies were performed on rodents via scanning electron microscopy. In the present study, structural alterations of the mesothelial cells of peritoneum were examined during laparoscopic cholecystectomy using transmission electron microscopy.MethodsTwenty patients with symptomatic cholelithiasis were included in the study. Peritoneal biopsy was performed immediately after CO2 pneumoperitoneum creation and at the end of surgery just before gallbladder removal. Biopsies were taken from the right upper quadrant, i.e., apart from operative manipulation. Peritoneal sample cross-sections were compared using transmission electron microscopy.ResultsThe carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy caused deteriorations of the peritoneal mesothelium. Apoptosis were developed in mesothelial cells. Bulging of mesothelial cells, irregular cell junctions, focal intercellular clefts, apical cell membrane degeneration, deep nuclear invaginations, and lipid droplets in the cytoplasm of the mesothelial cells were other remarkable findings. Mesothelial edema also was determined.DiscussionAs seen in previous studies, basement membrane nudity appeared after carbon dioxide pneumoperitoneum could be attributable to mesothelial cell apoptosis, deterioration of the cell structure, and cell organelles.

EFFECT OF BENCYCLANE FUMARATE ON INTESTINAL ISCHAEMIA REPERFUSION INJURY

Background:  Post‐ischaemic intestinal tissue damage appears to be due to the formation of oxygen radicals. Free radical‐initiated lipid peroxidation following intestinal ischaemia/reperfusion (I/R) may disrupt mucosal integrity. Indirectly, the radicals trigger the accumulation of neutrophils within the affected tissue, initiating inflammatory processes that lead to severe mucosal lesions. We have investigated the protective effect of bencyclane fumarate, a vasodilating Ca2+ channel blocker, which has been used for the treatment of peripheral arterial occlusive diseases, on intestinal ischaemia reperfusion (IR) injury in rats.

Comparison of Granisetron with Granisetron Plus Droperidol Combination Prophylaxis in Post-Operative Nausea and Vomiting after Laparoscopic Cholecystectomy

The aim of this study was to evaluate the effects of granisetron and granisetron plus droperidol combination therapy on post-operative nausea and vomiting (PONV) in 60 patients who had undergone elective laparoscopic cholecystectomy. Induction of anaesthesia was achieved using 5 mg/kg thiopentone, 2 μg/kg fentanyl and 0.5 mg/kg atracurium, and anaesthesia was maintained with 2–2.5% sevoflurane. The patients were randomly assigned to two groups: group G (granisetron) (n = 30) patients received 3 mg granisetron and group GD (granisetron plus droperidol) (n = 30) patients received 3 mg granisetron and 1.25 mg droperidol shortly before the induction of anaesthesia. PONV incidence was recorded post-operatively at 15 min, 30 min, 60 min, 2 h, 4 h, 12 h and 24 h. While PONV prophylaxis provided almost complete emetic control in patients who received the granisetron plus droperidol combination, patients who received granisetron prophylaxis alone experienced PONV more frequently at 30 min and 60 min post-operatively. We conclude that addition of a low dose of droperidol to granisetron prophylaxis is more effective than granisetron prophylaxis alone for successful control of PONV.

Effects of saline lavage temperature on peritoneal fibrinolysis and adhesion formation.

BACKGROUND Peritoneal lavage with saline at room temperature causes peritoneal hypothermia, vasoconstriction, hypoxia, and acidosis, which are effects that are known to reduce fibrinolysis. Decreased fibrinolysis causes permanent adhesions. Normothermic lavage may prevent this deleterious process and reduce peritoneal adhesions. METHODS A rat model of cecal abrasion was used. Control animals received no medication while hypothermic or normothermic saline lavage were administered intraperitoneally to the experimental groups (n=24 for each group). Cardinal parameters of peritoneal fibrinolysis (tissue plasminogen activator [tPA] and plasminogen activator inhibitor type 1 [PAI-1]) were determined in peritoneal tissue samples on postoperative day 1, 3, and 10. On postoperative day 10, adhesions were graded. In the sham group (n=8), following laparotomy, peritoneal samples were taken to determine basal values of tPA and PAI-1 in healthy peritoneum. RESULTS Cecal abrasion increased PAI-1 levels about tenfold on postoperative day 1 and caused adhesions. Normothermic saline lavage prevented this traumatic PAI-1 increase and stabilized it to baseline values throughout the experiment and reduced peritoneal adhesion formation. Hypothermic lavage also caused an inhibition of PAI-1 rise but adhesion, prevention was not significant. CONCLUSION Our results suggest that normothermic saline lavage reduces adhesions by improving peritoneal fibrinolysis.