Sevim Aydin

The effect on the middle-ear cavity of an absorbable gelatine sponge alone and with corticosteroids

Abstract. The objectives of this study were to establish whether there is an obvious difference between intact mucosa and abraded mucosa of the middle-ear cavity in respect to the potential side effects from the application of absorbable gelatine sponge (Gelfoam) and to investigate if Gelfoam combined with corticosteroid ointment (cortimycine, sterile 1% hydrocortisone acetate) can reduce the occurrence of these effects. Twenty Albino rats were used in the study. These animals were divided into four groups, with ten ears in each group. In group A, the middle-ear mucosa was kept intact, and Gelfoam was inserted into the middle-ear cavity. In group B, the middle-ear mucosa was abraded, and Gelfoam was inserted. In group C, Gelfoam with corticosteroid was implanted over the intact mucosa, and in group D, the mucosa was abraded prior to the insertion of Gelfoam with corticosteroid. The changes were evaluated 8 weeks postoperatively. In group A, there was a minimal increase in fibroblastic activity, vascular proliferation with mild to moderate fibrosis and all but two tympanic membranes were perfectly normal. However, in group B, we encountered a significant increase in fibroblastic activity, vascular proliferation and fibrosis, and we observed that all tympanic membranes were moderately to severely thickened. These histopathologic changes related to Gelfoam were noted to be decreased in group C and especially in group D. As previously reported in the literature, Gelfoam was found to promote the formation of connective tissue in the middle-ear cavity regardless of the status of the mucosa. The unwanted effects of this material may be decreased if it is combined with corticosteroids in the middle-ear cavity.

Effects of immunonutrition on intestinal mucosal apoptosis, mucosal atrophy, and bacterial translocation in head injured rats

BACKGROUND Immunonutrition has been demonstrated to modulate gut function, reduce infectious complications, hospital stay, and ventilator days in the critical patients. AIM OF THE STUDY We assessed the effect of immunonutrition for the prevention of intestinal mucosal atrophy, apoptosis, and bacterial translocation in head injured rats. METHODS Thirty five rats were randomised into 5 groups. Following moderate closed head injury, in Group 1; Standard Enteral Nutrition, Group 2; Immunonutrition, Group 3; TPN, Group 4; pe. saline were applied. Group 5 was control group (chow-fed). The rats were sacrificed and segments of the ileum were removed for histologic examination, and samples of tissues taken for microbiologic evaluation. RESULTS Both intestinal apoptosis and mucosal atrophy were significantly lower in Group 2 and Group 5 (p<0.008). Bacterial translocation was significantly lower in Group 2 than Group 1 (p<0.008). CONCLUSION The enteral immunonutrition prevents intestinal barrier function in brain injured rats.

Effects of Early Versus Delayed Nutrition on Intestinal Mucosal Apoptosis and Atrophy After Traumatic Brain Injury

PurposeTo determine the optimal time to start nutritional support after traumatic brain injury (TBI).MethodsRats were divided into six groups of seven. All but one of these groups were subjected to moderate closed head trauma under general anesthesia. Groups Ia and Ib were commenced on immunonutrition and standard enteral nutrition, respectively, 8 h later; groups IIa and IIb were commenced on immunonutrition and standard enteral nutrition, respectively, 72 h later; and group III was commenced on a parenteral saline infusion 8 h later. Group IV was a control group fed a laboratory diet and not subjected to trauma. The rats were killed 7 days later, and ileal segments were examined using light and electron microscopy. We used the deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) technique to detect intestinal mucosal apoptosis.ResultsGroup III had a lower body weight than the other groups (P < 0.005). The mean villous height was highest in groups Ia and IV and lowest in group III. The villi count was lower in groups Ib, IIa, IIb, and III than in group IV (P < 0.005). The apoptotic index counts were higher in groups IIa, IIb, and III than in group IV (P < 0.005).ConclusionsThe addition of enriching immunonutrients to early enteral feeding helps preserve an almost normal gut mucosa.

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.