Ziya Taner Ozkececi

Effect of IL-18 binding protein on hepatic ischemia-reperfusion injury induced by infrarenal aortic occlusion

Purpose Severe local and systemic tissue damage called ischemia/reperfusion (IR) injury occurs during the period of reperfusion. Free oxygen radicals and proinflammatory cytokines are responsible for reperfusion injury. IL-18 binding protein (IL-18BP) is a natural inhibitor of IL-18. The balance between IL-18 and IL-18BP has an important role in the inflammatory setting. The present study aimed to investigate whether IL-18BP had a protective role in remote organ hepatic IR injury. Methods Wistar-Albino rats were divided into three groups that contained seven rats. Group I (sham): Laparotomy and infrarenal abdominal aorta (AA) dissection were done but no clamping was done. Group II (I/R): The infrarenal AA was clamped by atraumatic microvascular clamp for 30 minutes and then was exposed to 90 minutes of reperfusion. Group III (IR + IL-18BP): 75 µg/kg of IL-18BP in 0.9% saline (1 mL) was administered 30 minutes before infrarenal AA dissection and clamping; 30 minutes of ischemia was applied and then was exposed to 90 minutes of reperfusion. Results Serum AST, ALT, and LDH levels were remarkably higher in IR group and returned to normal levels in treatment group. The proinflammatory cytokine levels had decreased in treatment group, and was statistically significant compared with the IR group. Serum levels of total oxidant status and oxidative stress index decreased and levels of total antioxidant status increased by IL-18BP. Conclusion This study suggested that IL-18BP has antioxidant, anti-inflammatory and hepatoprotective effects in cases of IR with infrarenal AA induced liver oxidative damage.

A Rare Cause of Acute Abdomen: An Isolated Falciform Ligament Necrosis

The falciform ligament is one of the anatomical structures which attach the liver to the diaphragm and anterior abdominal wall. Primary falciform ligament is very rare. In this article, we present a case of an isolated falciform ligament necrosis, a rare primary pathology of the falciform ligament, who was admitted with acute abdomen. Case presentation: A 64-year-old female patient was admitted with the complaints of pain. Laboratory test results showed a leukocyte count of 17,000/mm3. Imaging studies demonstrated intra-abdominal reactionary fluid along with a heterogeneous mass localized in the falciform ligament. Exploratory laparotomy revealed a necrotic mass of the falciform ligament. No other pathology responsible for falciform ligament necrosis was found. We believe that falciform ligament necrosis should be considered a preliminary diagnosis, if any ligament abnormality, tumor, intraligament air density, or the presence of reactionary fluid surrounding the ligament is detected through abdominal imaging studies.

Antioxidant, Antiapoptotic and Inflammatory Effects of Interleukin-18 Binding Protein on Kidney Damage Induced by Hepatic Ischemia Reperfusion

Objective: Acute kidney injury (AKI) is a serious condition that can be induced by liver transplantation, major hepatic resection or prolonged portal vein occlusion. The AKI can increase the frequency of postoperative complications. In the current study, we aimed to investigate whether interleukin‐18 binding protein (IL‐18BP) pretreatment has a protective effect against possible kidney injury–mediated liver ischemia‐reperfusion (IR) achieved by Pringle maneuver in an experimental rat model. Materials and Methods: A total of 21 Wistar albino rats were included in this study. Animals were equally and randomly separated into 3 groups as follows: Sham (n = 7), IR group (n = 7) and IR + IL‐18BP group (n = 7). Serum aspartate transaminase, alanine aminotransaminase and lactate dehydrogenase enzyme activities and serum urea and creatinine levels were determined. Tumor necrosis factor‐&agr;, IL‐6, IL‐1&bgr;, interferon gamma, total oxidant status, total antioxidant status and oxidative stress index were measured in kidney tissue homogenate samples. Histopathological examination and immunohistochemical Caspase‐3 staining were applied to examine the general morphologic structure and apoptosis. Results: Renal total oxidant status; oxidative stress index; IL‐18 levels; serum aspartate transaminase, alanine aminotransaminase and lactate dehydrogenase activities and creatinine levels were significantly lower in IR + IL‐18BP group, when compared with the IR group. Beside this, total antioxidant status levels were remarkably higher in IR + IL‐18BP group, when compared with the IR group. The caspase‐3 expression degree in IR group was remarkably higher than other groups. Conclusions: It has been demonstrated that IL‐18BP pretreatment may have inflammatory, antioxidant and antiapoptotic effects against AKI induced by hepatic IR.

Investigation of the effect of safranal and crocin pre-treatment on hepatic injury induced by infrarenal aortic occlusion

Ischemia-reperfusion (IR) injury of the liver is an unresolved problem that occurs during certain surgical approaches, including hepatic, cardiac and aortic operations. In this study we aimed to investigate whether crocin and safranal had protective effects on liver IR injury induced in an infrarenal aortic clamping (IRAC) model. Male Wistar-Albino rats (n=32) were divided into four groups with 8 animals each as follows: Sham, IR, IR+crocin, and IR+safranal. The infrarenal aorta (IRA) was clamped for 60min for the ischemic period and allowed to reperfuse for 120min. Blood and tissue samples were collected for biochemical, histological and immunohistological analysis. Plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were found to be significantly higher in the IR group than the sham group (respectively; p=0.015, p<0.001). There were significant differences between the IR group and the IR+crocin group or the IR+safranal group in AST levels (respectively; p=0.02, p<0.001). ALT showed a significant decrease in the IR+crocin group compared to the IR group (p<0.05). We also observed histopathological changes among the groups. Bax and Caspase-3 expression in the IR group was remarkably higher than in the other groups. Caspase-3 and Bax expression in the IR+crocin and the IR+safranal groups were significantly lower than in the IR group. Nevertheless, there were no significant differences in BCL2 expression among the groups. IRAC is a cause of IR injury in the liver. This study showed that crocin and safranal have protective effects on IR induced liver injury.

The effect of enoxaparin on seroma and mesh-tissue adhesion in a hernia model

The aim of this study was to investigate whether enoxaparin (ENX) administration would increase seroma risk and worsen mesh tissue recovery in an experimental rat hernia repair model. Fifty‐six adult male Wistar–Albino rats were included in the study. Rats were equally and randomly separated into seven groups: Group 1, Control, only subcutaneous dissection was performed; group 2, Sham, Hernia defect was primary sutured; Group 3, Prolene mesh; Group 4, Dual mesh; Group 5, ENX + Sham; Group 6, ENX + Prolene mesh; Group 7, ENX + Dual mesh. ENX was subcutaneously injected at a dose of 180 U/kg per day for 7 days. Rats were killed after the amount of subcutaneous seroma was determined by ultrasound on day 7 following the surgical procedure. Mesh‐tissue healing was evaluated using histopathological and immunohistochemical (CD31) staining methods. The mean seroma amount significantly increased in Groups 5–7 compared to Groups 2–4. CD31 immunostaining showed a reduction in neovascularization in Groups 6 and 7, compared to Groups 3 and 4. Neovascularization decreased and hemorrhage, necrosis and oedema findings remarkably increased in Groups 6 and 7, when compared to Groups 3 and 4. Fibroblastic activity and inflammation were more prominent in Groups 3 and 4. It should be kept in mind that ENX interferes with inflammation, which is desired in the early period of healing and leads to an increase in overall seroma amount with anti‐coagulant effects, which in turn may disrupt wound healing and mesh‐tissue adhesions, as was indicated in our study.

Evaluation of mean platelet volume as a predictor of gastric disorders

Aim: Gastric disorders present in a wide range, including malignant and benign diseases of the upper gastrointestinal system. Increased MPV levels are associated with inflammation. The goal of this study was to determine the diagnostic importance of MPV in gastric disorders and evaluate level of MPV in patients that underwent upper gastrointestinal endoscopy. Materials and Methods: Patients who had undergone endoscopy and shown to have a gastric disorder with blood count performed were included in the study. Only one surgeon performed all of the endoscopies. MPV value, platelet count, hemoglobin and white blood cell count levels were analyzed. Results: 116 patients were included in the study. Mean age of all patients was 47,8±16,4. Mean value of MPV was determined to be 7,79±1,21, within the range of 5,85 to 12,5 fL. There was no significant correlation between diagnoses and MPV levels (P>0,05). Additionally, there was no significant difference in MPV levels in histopathological diagnoses groups (p>0,05). There was a highly negative correlation between platelet count and MPV levels in a Scatter Plot correlation graph (r=0,083). Conclusions: MPV is a frequently used hematological parameter that indicates platelet function and activity affected by inflammation. It was hypothesized that changes in MPV levels could be associated with gastric disorders. Statistical analysis of the data revealed there was no association between MPV and gastric disorders. It is suggested that MPV is not a suitable marker to determine gastric disorders, however further larger studies can be useful to determine the importance of MPV such a context.

Laparoskopik low anterior rezeksiyon sonrası oluşan anastomoz darlığında balon dilatasyon uygulaması: İki olgu sunumu

Benign anastomoz darliklari kolorektal cerrahi sonrasi ortaya cikabilen gec komplikasyonlardandir. Tedavide her ne kadar endoskopik girisimler onerilmekteyse de balon dilatasyonu dusunulmesi gereken ilk secenektir. Laparoskopi yardimli low anterior rezeksiyon ve stapler anastomoz yapilan iki hastamizdan birinde postoperatif 6. ayinda digerinde ise 9. ayinda ileri derecede anastomoz strikturu tespit edildi. Hastalardan biri ishal-kabizlik ataklari, rektal kanama gibi yakinmalarla basvururken diger hasta tamamen asemptomatikti ve anastomoz darligi kontrol kolonoskopisinde saptandi. Her iki hastaya da akalazya tedavisinde kullanilan “ower-the-wire” balonu ile iki seans endoskopik dilatasyon uygulandi.

Meckel Divertikülü’nün Nadir Rastlanan Komplikasyonu: İleus ve Divertikülit Birlikteliği

Gastrointestinal sistemin en sik rastlanan konjenital anomalisi Meckel divertikuludur. Cogunlukla asemptomatiktir. Genellikle komplikasyonlarin gelistigi durumlarda tani alirlar. Klinik yasa bagli degisiklik gostermektedir. Eriskin yas grubunda en sik rastlanan komplikasyon obstruksiyon tablosu iken ikinci sirayi divertikulit almaktadir. Bu makale ile obstruksiyon ve divertikulit tablosunu es seansli barindiran bir olguyu literatur bilgileri isiginda sunmayi amacladik

A retained plastic protective cover mimicking malignancy: Case report.

INTRODUCTION Cases of retained foreign bodies during surgery are more frequently seen in developing countries. Following surgical procedures, unintentionally retained foreign bodies can cause serious complications, in addition to medico-legal issues. PRESENTATION OF CASE A 60-year-old man presented with abdominal cramps. He had previously undergone a laparoscopic radical right nephrectomy due to renal cell carcinoma. Abdominal tomography revealed a mass surrounding the main vascular structures with malignant features in the location of previously performed nephrectomy. Further evaluation of the mass was undertaken by PET/CT. Increased FDG uptake on the PET/CT scan suggested disease recurrence. Retroperitoneal lymph node dissection was performed. The dissection specimen was opened to determine the nature of the mass. Retained plastic foreign bodies were found. There were no malignant cells in the histopathological examination of the surgical specimen. DISCUSSION A granulomatous reaction which is mainly responsible for morbidity occurs around the foreign bodies due to the inflammatory response. These granulomas may cause confusion during patient follow-up, especially in those who have undergone major abdominal surgery due to cancer. CONCLUSION Following surgical resection for malignancy, unintentionally retained foreign bodies can produce a moderate increase in FDG uptake mimicking disease recurrence.