The effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained. MATERIAL AND METHODS: The gastric pH (pHi) and gastric CO2 (gpCO2) were measured with gastric tonometry catheter, preoperatively and postoperatively at 24 hours, in patients with suspicion of acute mesenteric ischemia. Simultaneous evaluation of blood gases and blood lactate levels were performed. Patients were divided into two groups after surgery. Group 1 included patients with mesenteric ischemia, and Group 2 consisted of patients without mesenteric ischemia. RESULTS: Forty-two patients (26 males, 16 females) were evaluated. The mean age was 61.4±13.3 years. There was no significant difference between the groups in terms of demographic factors and co-morbid diseases. There were no significant differences between groups in terms of pHi and gpCO2 levels (7.24±0.2 and -3±12.0 in Group 1, 7.18±0.06 and -3±1.9 in Group 2, respectively), intra-abdominal pressure, lactate levels, and survival. Among all the study parameters, only arterial pH had statistical significance in the diagnosis of acute mesenteric ischemia (7.23±0.21 versus 7.35±0.07 for Groups 1 and 2, respectively,) (p<0.05). CONCLUSION: Gastric tonometry is not a useful method in the early diagnosis of acute mesenteric ischemia.

A rare cause of acute mesenteric ischemia: JAK2 positivity and chronic active hepatitis B.

Short bowel syndrome occurs as a result of insufficiency in the total length of the small intestine to provide adequate supply of nutrients. Seventy-five percent of cases are due to massive intestinal resection. A 35-year-old male complaining of abdominal pain was admitted to the gastroenterology department. A CT scan was performed, showing total occlusion of the portal vein and superior mesenteric vein. During the operation, widespread edema and necrosis of the small intestine were found. The necrotic segments of the small intestine were resected. The spleen was larger than normal and, in some parts, infarcts were evident, thus asplenectomy was also performed during surgery. A second-look procedure was performed 24 hours later, and an additional 10 cm jejunal resection and anastomosis was performed. His further evaluations revealed myeloproliferative disease and chronic active hepatitis B leading to thrombosis. Essential thrombocytosis and portal vein thrombosis are common in hepatitis B infection. Patients with complaints of abdominal pain in the context of essential thrombocytosis and hepatitis B should be handled with caution as they are at risk of developing portal vein thrombosis.

Identifying Factors Associated with Non-mesenterovascular Pathology in Patients Undergoing Surgical Treatment for Acute Mesenteric Ischemia.

AIM: To identify factors that can help us to avoid a preoperative incorrect diagnosis of vascular occlusion by evaluating patients who underwent laparotomy with a probable preoperative diagnosis of acute mesenteric ischemia (AMI), but later at laparotomy, were diagnosed to have a different pathology than AMI. MATERIAL AND METHODS: A total of 213 patients who were operated with the diagnosis of AMI were enrolled in this study. Based on their operational, clinical, and pathological findings, they were divided into two groups. Patient demographic data, along with the American Society of Anesthesiology (ASA) score, Charlson comorbidity index, history of previous abdominal surgery, and computed tomography (CT) findings were compared between groups. RESULTS: There were 37 patients in Group 1 (non-mesenterovascular pathology) and 176 patients in Group 2 (mesenterovascular pathology). The percentage of ASA 4 patients was higher in Group 2, with 48.3%, compared to 35.1% in Group 1 (p-value: 0.028). Upon admission, Group 2 had a higher rate of pathologic findings on CT examinations. 21.8% of the patients with non-mesenterovascular pathology had normal intra-abdominal findings. In univariate and multivariate analysis for no-nmesenterovascular pathology, patient age less than 65, Charlson comorbidity index 1-2, INR level >1.2, history of previous abdominal operation, and pneumatosis intestinalis were identified as independent risk factors. DISCUSSION: The possibility of non-mesenterovascular pathology in presumed AMI patients should be kept in mind, especially if the patients have a history of abdominal surgery, a low comorbidity index, an elevated international normalised ratio (INR), and are younger than 65 years of age. CONCLUSION: Evaluating the significant parameters identified in this study among patients with a preliminary diagnosis of AMI may prove useful in avoiding misdiagnosis and unnecessary surgeries.

Resection and radiofrequency ablation in the treatment of hepatocellular carcinoma: a single-center experience.

BACKGROUND: We have been utilizing both resection and laparoscopic radiofrequency ablation (RFA) to treat hepatocellular carcinoma (HCC). The aim of this study is to describe patient characteristics and outcome for each treatment modality from a single institution. METHODS: Medical records of HCC patients who underwent resection (n = 92) or laparoscopic (RFA) (n = 92) between 1997 and 2010 were reviewed. Univariate Kaplan-Meier and multivariate Cox proportional-hazards model were used to analyze survival. RESULTS: Patients with normal liver function and larger tumors were resected, and those with liver dysfunction, portal hypertension, and multiple tumors were ablated. Tumor size was larger in the Resection group, whereas number of tumors was higher in the RFA group. Child class and Barcelona Clinic Liver Cancer (BCLC) staging were more advanced in the RFA group. Hospital stay was longer, and morbidity and mortality higher in the Resection versus the RFA group. There was no difference in disease-free survival, but the 5-year actual survival was significantly higher (40% versus 21%) in the Resection group. On univariate analysis, number of tumors, tumor size, platelet count, BCLC stage, Child class, and type of surgery were predictors of overall survival. On multivariate analysis, Child class and number of tumors were independent predictors of overall survival. CONCLUSIONS: To our knowledge, this is the largest North American series reporting on RFA and resection for HCC from a single institution. Herein, we describe the perioperative and oncologic outcomes to be expected when these modalities are used in a certain treatment algorithm.

A huge solitary fibrous tumor localized in the pancreas: a young women.

CONTEXT: Solitary fibrous tumor is an uncommon spindle cell tumor which were first described in 1931 at pleura; it should be seen rarely in extra-pleural localization. CASE REPORT: We report the ninth case of pancreatic solitary fibrous tumor in a 24-year-old woman who presented with mild epigastric pain radiating to the back and chronic constipation. Imaging studies confirmed a solitary mass in the epigastric region that begins from posterior of stomach, fills little curvature and extends to pelvis, invades vascular structures by encircling them and extends to retroperitoneal regions that was considered as it may have mesenchymal origin. The patient underwent an enucleation of the mass which was diagnosed as solitary fibrous tumor, supported by immunohistochemical studies showing positivity for CD34, vimentin and SMA. CONCLUSION: There is limited data regarding biological behavior of solitary fibrous tumors with extra-pleural localization, because they are rare tumors. They are generally asymptomatic and slow growing tumors and it is difficult to distinguish them from other mesenchymal tumors. These issues as well as the prior nine cases are discussed.

Regulatory T cells and monocytes crosstalk in patients with gastric cancer.

INTRODUCTION: Primary function of regulatory T(Treg) cells is to control and regulate the immune responses. In many patients with tumor tissues, increased Treg cell numbers have been reported. In this study, we aimed to measure the cellular content of blood samples in patients with gastric cancer (GC) and define their role in tumor progression. METHODS: We prospectively evaluated 34 gastric cancer cases and 20 healthy control samples. The blood was collected from both the gastric coronary and peripheral veins of the patients and only from the peripheral vein of the control group. Cellular content and lymphocyte subset including, regulatory T cells, were determined by flow cytometric analysis. RESULTS: The GC patients revealed similar percentages of T cells, B cells, neutrophils, and eosinophils in the venous samples from periphery vein and gastric coronary. The percentage of monocytes from the tumor-draining gastric coronary vein was significantly lower than monocytes from the peripheral vein in gastric cancer patients (p=0.03). T-regulatory cells had a higher percentage in samples obtained from gastric cancer patients compared with the control group. CONCLUSION: Our findings confirmed that patients with gastric cancer have a significantly higher percentage of regulatory T cells than the control group, suggesting that they may contribute to the tumor progress. Regulatory T cells and monocytes interact in patients with GC, which can be used as a parameter in the clinical follow-up of patients with GC. KEY WORDS: Gastric cancer, Treg cell, Flow cytometry, FoxP3.

Techniques of radiofrequency-assisted precoagulation in laparoscopic liver resection.

BACKGROUND: Although radiofrequency-assisted (RF) precoagulation has been described for open resections, there is little data evaluating precoagulation options in laparoscopic liver resection. The purpose of this study is to provide an algorithm for the use of monopolar and bipolar RF devices in laparoscopic liver resection. METHODS: Patients undergoing laparoscopic liver resection utilizing precoagulation during the period 2007-2009 were identified from a prospectively maintained, institutional review board-approved database. RF-assisted precoagulation was performed using a second-generation monopolar RF ablation catheter (Starburst XL, AngioDynamics) or bipolar RF device (Habib 4X, AngioDynamics). RESULTS: Precoagulation was utilized in 31cases (monopolar, n = 19, and bipolar, n = 12). Procedures performed included segmentectomy/wedge resection in 19 patients and bisegmentectomy in 12 patients. The bipolar RF device was used for left lateral sectionectomies (90%) in which there was linear transaction, whereas the monopolar RF catheter was used for nonlinear segmental and wedge resections involving the right lobe (95%). Time required for precoagulation was 22.5 ± 7.2 min for the bipolar and 33.6 ± 15.9 min for the monopolar device. No patient developed postoperative bleeding, bile duct injury, or liver abscess. At follow-up, one patient in the monopolar group developed a suspected local recurrence. CONCLUSIONS: We have suggested an algorithm to select a given device based on tumor location and type of resection. With approximately 30 min of time spent for precoagulation, the blood loss and rate of local recurrence were favorable. There also could be an oncologic benefit due to additional functional margin obtained with the RF effect.

Prognostic significance of the neutrophil to lymphocyte ratio in patients with curative resection of esophageal cancer. A single center experience.

AIM: In this study, we aimed to determine the clinical value and prognostic significance of the Neutrophil / Lymphocyte Ratio in patients undergoing curative surgery due to esophageal cancer. MATERIAL AND METHOD: Patients who underwent curative resection for esophageal cancer between 2015-2019 were included in the study. Two groups, Group1 (low NLR) and Group2 (high NLR), were created. Demographic and clinical features, intraoperative and postoperative results, tumor characteristics and mean survival were compared in the groups. RESULTS: A total of 48 patients participated in our study. Group 1 consisted of 18 patients and Group 2 consisted of 30 patients. Male sex was dominant in both groups (66.7% vs 73.3%, p. 0.431). Preoperative CEA was higher in Group 2 (3.97 vs 9.57, p. 0.032). Tumor diameter was larger in Group2 (3.33 vs 5.40 cm, p. 0.000). Adenocarcinoma was higher in Group 2 (33% vs 53.3%, p. 0.047), while squamous cell carcinoma was higher in Group 1 (66.7% vs 33.3%, p. 0.047). Lymph node positivity was higher in Group 2 (66.7% vs 93.3%, p. 0.024). The anastomosis leak was higher in Group 2 (0% vs 20%, p. 0.048). Postoperative hospital stay was longer in Group 2 (13.27 vs 23.9 days, p. 0.009). 90-day readmission was higher in Group1 (33.3% vs 3.3%, p. 0.008). Survival duration was shorter in Group 2 (29 vs 15 months, p. 0.005). CONCLUSION: This study revealed that preoperative high NLR was associated with poor survival, along with greater tumor diameter, increased lymph node metastasis rate, and increased anastomosis leakage in patients with esophageal cancer. These results suggest that modifying inflammatory responses and modulating the immune system may improve survival outcomes in patients with esophageal cancer. KEY WORDS: Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative neutrophil/lymphocyte ratio, Prognosis.

Surgical treatment and outcome for primary duodenal adenocarcinoma. Single center experience.

AIM: In this study, we aimed to evaluate patients who underwent curative surgical treatment for primary duodenal adenocarcinoma and to present our experience. MATERIAL AND METHODS: Patients diagnosed with primary duodenal adenocarcinoma between 2006 and 2018 participated in the study. The demographic and clinical characteristics of the patients, details of the operation, pathological features of the tumors, short- and long-term follow-up results, and mean survival were evaluated retrospectively. RESULTS: Nine patients with a mean age of 54.7 participated in the study. 55% of the patients were male. The most common presenting symptom was abdominal pain (n: 6; 67%). The most common tumor localization was D2-3 (n: 7; 78%), and the most common surgical operation was pancreaticoduodenectomy (n: 7; 78%). There were no intraoperative complications in any patient. The mean tumor diameter was 3.5 cm. The mean number of lymph nodes dissected was 8.3 and the mean number of metastatic lymph nodes was 2. The most common postoperative complication was pancreatic fistula (n: 3; 33%). The mean length of stay was 21.8 days. One patient developed septic shock and mortality happened within the 30-day period. The most common cause of unplanned admission to the hospital within 90 days was wound infection (n: 2; 22%). One patient developed local recurrence and two patients had systemic metastasis. We found an average survival of 40 months. DISCUSSION: Pancreaticoduodenectomy is the most common approach in its curative surgery and it has a long survival despite the high postoperative complication rate. We recommend radical resection in the surgical treatment of primary duodenal adenocarcinoma. KEY WORDS: Adenocarcinoma, Duodenum, Pancreaticoduodenectomy.

The prognostic value of Tumor Volume Index in patients with esophageal cancer who had curative resection A single center experience.

AIM: We aim to evaluate the prognostic significance of tumor volume in esophageal cancer. METHODS: Patients who underwent curative resection due to esophageal cancer between the years 2015 and 2019 were included in the study. The Tumor Depth Parameter (TDP) was defined as mucosa and submucosa =1, muscularis propria =2, adventitia =3, and invasion into adjacent organs=4. The Tumor Volume Index (TVI) was defined as the major axis X the minor axis X TDP. Two groups were formed based on TVI: Group 1 (low TVI) and Group 2 (high TVI). In the groups; patients were compared in terms of demographic and clinical features, intraoperative and postoperative outcomes, characteristics of the tumor and average survival. RESULTS: The patients were divided into two groups based on the cut-off value of 4,000. Group 1 (low TVI) consisted of 16 patients and Group 2 (high TVI) consisted of 28 patients. Male sex ratio was higher in Group 2 (50% vs 85%, p:0.011) Tumor diameter was observed to be larger in Group 2 (3.06 vs 5.54, p:0.000). Adenocarcinoma histologic type was more common in Group 2 (25% vs 64.3%, p:0.012). Incidence of respiratory complications was higher in Group 2 (0% vs 35.7%, p:0.024),Survival time (months) was shorter in Group 2 (36 vs 11, p:0.005). TVI's being over 4000 (HR)(95%-Confidence Interval ((Cl) 0.057 (0.011-0.311),p:0.001) was an independent risk factor to determine the rate of survival. CONCLUSION: TVI can be used as a prognostic factor in patients with esophageal cancer who underwent surgical therapy. TVI is closely associated with tumor histology and postoperative outcomes. KEY WORDS: Esophageal cancer, Prognosis, Postoperative complication, Surgical manangment, Survey, Tumor volume.

Robotic versus laparoscopic resection of liver tumours.

BACKGROUND: There are scant data in the literature regarding the role of robotic liver surgery. The aim of the present study was to develop techniques for robotic liver tumour resection and to draw a comparison with laparoscopic resection. METHODS: Over a 1-year period, nine patients underwent robotic resection of peripherally located malignant lesions measuring <5 cm. These patients were compared prospectively with 23 patients who underwent laparoscopic resection of similar tumours at the same institution. Statistical analyses were performed using Student's t-test, χ(2) -test and Kaplan-Meier survival. All data are expressed as mean ± SEM. RESULTS: The groups were similar with regards to age, gender and tumour type (P= NS). Tumour size was similar in both groups (robotic -3.2 ± 1.3 cm vs. laparoscopic -2.9 ± 1.3 cm, P= 0.6). Skin-to-skin operative time was 259 ± 28 min in the robotic vs. 234 ± 17 min in the laparoscopic group (P= 0.4). There was no difference between the two groups regarding estimated blood loss (EBL) and resection margin status. Conversion to an open operation was only necessary in one patient in the robotic group. Complications were observed in one patient in the robotic and four patients in the laparoscopic groups. The patients were followed up for a mean of 14 months and disease-free survival (DFS) was equivalent in both groups (P= 0.6). CONCLUSION: The results of this initial study suggest that, for selected liver lesions, a robotic approach provides similar peri-operative outcomes compared with laparoscopic liver resection (LLR).

The value of D-dimer test in the diagnosis of patients with nontraumatic acute abdomen.

BACKGROUND: A patient with acute abdominal pain requires rapid evaluation. In these patients, it is very important to distinguish between surgical and nonsurgical pathology. Our aim was to compare the accuracy of the leukocyte count and D-dimer test in the diagnosis of acute abdomen. METHODS: In this prospective study, 225 patients admitted to the emergency unit due to nontraumatic acute abdomen between June 2006 and November 2007 were evaluated. The patients were divided into two groups: Group 1 patients who needed immediate laparotomy and Group 2 patients who did not. Age, gender, leukocyte count, D-dimer level, causes of acute abdominal pain, and operative findings were investigated. P values of <0.05 were considered statistically significant. RESULTS: There was a positive correlation between the plasma D-dimer level and leukocyte count. D-dimer acted similarly to the leukocyte count in emergency abdominal conditions. The area under the receiver operating characteristic curve was statistically higher with the D-dimer test (p<0.0001). Additionally, in patients needing immediate laparotomy, the sensitivity of the D-dimer test was 95.7% versus 74.8% for leukocyte counts. CONCLUSION: In a patient with acute abdomen, D-dimer test may be a strong alternative or an adjuvant to the leukocyte count.

Effects of bradykinin preconditioning in an experimental intestinal ischemia reperfusion model on rats.

PURPOSE: To investigate the effects of bradykinin on reperfusion injury in an experimental intestinal ischemia reperfusion model. METHODS: We used 32 Wistar-Albino rats. We composed 4 groups each containing 8 rats. Rats in sham group were sacrified at 100 minutes observation after laparotomy. Thirty minutes reperfusion was performed following 50 minutes ischaemia in control group after observing 20 minutes. Ischaemic preconditioning was performed in one group of the study. We performed the other study group pharmacologic preconditioning by infusional administration of 10 µg/kg/minute bradykinin intravenously. We sacrified all of the rats by taking blood samples to evaluate the lactate and lactate dehydrogenase (LDH) after resection of jejunum for detecting tissue myeloperoxidase (MPO) activity. RESULTS: Lactate and LDH levels were significantly higher in control and study groups than the sham group (P<0.001). There is no difference between the study groups statistically. (P>0.05). The results were the same for MPO levels. Although definitive cell damage was determinated in the control group by hystopatological evaluation, the damage in the study groups observed was lower in different levels. However, there was no significant difference between the study groups statistically (P>0.05). CONCLUSION: Either ischeamic preconditioning or pharmacologic preconditioning made by bradykinin reduced the ischemia reperfusion injury at jejunum.

Ectopic adrenal tissue in a hernia sac in an adult. A case report.

The discovery of ectopic adrenal tissue in the hernial sac is very rare, and in the majority of reported cases it is in children, while it is never described in adult subjects. This could be due to a progressive previous atrophy of the ectopic tissue or to an insufficient examination of the sac removed surgically. The most frequent site of these ectopias is the kidney, adjacent to the adrenal glands. The presence of ectopic adrenal tissue is important because of its neoplastic and hyperplastic potential. We report a case of a 69-year-old male patient who underwent a surgical operation of a left inguinal hernia and that the presence of ectopic adrenal tissue was reported in the pathologist's report. Preoperative abdominal ultrasound should therefore be performed in patients destined for an inguinal hernia surgery, because also the rare existence of ectopic adrenal tissue in the hernial sac should be kept in mind. KEY WORDS: Adrenal, Adult, Ectopia, Herni sac.

Necessity of preventive colostomy for Fournier's gangrene of the anorectal region.

BACKGROUND: The aim of this study was to evaluate the necessity of preventive colostomy for Fournier's gangrene of the anorectal region. METHODS: The medical records of 37 patients with perianal Fournier's gangrene were evaluated retrospectively. Debridement(s) alone was performed in 18 patients (Group D), while debridement(s) plus Hartmann colostomy was performed in 19 patients (Group D&HC). RESULTS: There were no statistically significant differences between the D and D&HC groups with respect to mean age (p=0.73), sex ratio (p=1.00), diabetes mellitus (p=0.88), concomitant diseases (p=0.57), and number of debridements (p=0.75). The medical and surgical complication and mortality rates and duration of hospital and intensive care unit stays were also not significantly different between the D and D&HC groups (p>0.05). Fecal diversion was done at the initial operation in 11 patients, at second operation in 6 patients, and at third operation in 2 patients. When compared, morbidity rates were similar, but mortality rates were statistically different (p=0.031). CONCLUSION: Fournier's gangrene remains a difficult surgical problem. Despite aggressive multidisciplinary treatment, it still has a high mortality rate. Fecal diversion in the treatment of Fournier's gangrene is controversial. If necessary, preventive colostomy should be performed during the initial debridement.

Effects of melatonin and phospholipid on adhesion formation and correlation with vascular endothelial growth factor expression in rats.

BACKGROUND: The aim of this experimental study was to investigate the effects of melatonin and phospholipid on adhesion formation and the correlation with vascular endothelial growth factor (VEGF) expression in rats. METHODS: Sixty Wistar-Albino rats were divided into four groups as sham, control and two study groups, each including 15 rats. In the sham group, laparotomy was the only procedure. Left lower parietal peritoneum was abraded after laparotomy and serosal defects formed on the cecum, ileum and right uterine horn in the study and control groups. Ringer lactate was then applied to the control group, while melatonin and phospholipid suspension were applied separately in the two study groups. Relaparotomy was performed in all groups on the 15th day to score and evaluate the adhesion formation. RESULTS: Adhesion formation was significantly lower in the sham, melatonin and phospholipid groups than in the control group (p<0.05). VEGF staining was significantly higher in the control group with adhesion areas compared to the other groups (p<0.05). When VEGF staining was compared, there was no significant difference between VEGF- stained and normal areas in the melatonin and phospholipid groups. CONCLUSION: Melatonin and phospholipid decreased the adhesion formation in an experimental adhesion model in rats. There is a correlation between adhesion severity and VEGF expression.

[Unusual causes of intestinal perforation and their surgical treatment]. / Bagirsak delinmelerinin nadir nedenleri ve cerrahi tedavisi.

BACKGROUND: Intestinal perforation is one of the major causes of obligatory surgical intervention. There can be many different causes of perforation. The aim of this study was to evaluate the unusual causes and the surgical treatment. METHODS: In our clinic, we operated 675 patients due to intestinal perforation over a period of six years. Perforation due to brid, trauma, colorectal tumor, mesenteric ischemia, hernias, and iatrogenic injuries were considered as usual causes and excluded from the study. The remaining 37 patients (22 male, 15 female; mean age 53.2; range 25 to 80 years) were analyzed. For statistical analysis, Mann-Whitney U and chi-square tests were used, and p < 0.05 was considered significant. RESULTS: A localized or generalized peritonitis was the most common symptom. Leukocytosis was found in 18 patients and free abdominal air was seen in 20 patients; bedside ultrasonographic examination was done in 17 patients. The most prevalent etiological factors were non-Hodgkin lymphoma, Crohn disease and internal herniation, respectively. Eight patients died; their time to laparotomy was significantly longer (8.7 days), and half of them had malignant small bowel tumor in perforation etiology. CONCLUSION: Mortality and morbidity rates are high in intestinal perforations due to unusual causes. Delayed laparotomy and malignant etiology may be the main factors.

Sigmoid colon cancer presenting as complete prolapse.

BACKROUND: The association of rectal prolapse and colorectal cancer is quite rare and only a few cases have been reported previously in the literature. It is unclear whether colorectal cancer triggers rectal prolapse. CASE PRESENTATION: A 77-year-old male patient presented to our emergency department with complete rectal prolapse, and an anterior resection was performed after rectal digital examination revealed a mass. The pathology result came back as mucinous adenocarcinoma in the sigmoid colon and the postoperative period was uneventful. CONCLUSIONS: Considering the age group in which rectal prolapse is most commonly seen, and the change in bowel habits, chronic constipation and irritation chronic seen in rectal prolapse may be responsible for the development of rectum cancer, therefore endoscopic screening should not be overlooked in rectal prolapse cases. KEY WORDS: Anorectal emergencies, Colon cancer, Rectal prolapse.

Ameliorative effects of bombesin and neurotensin on trinitrobenzene sulphonic acid-induced colitis, oxidative damage and apoptosis in rats.

AIM: To investigate the effects of bombesin (BBS) and neurotensin (NTS) on apoptosis and colitis in an ulcerative colitis model. METHODS: In this study, a total of 50 rats were divided equally into 5 groups. In the control group, no colitis induction or drug administration was performed. Colitis was induced in all other groups. Following the induction of colitis, BBS, NTS or both were applied to three groups of rats. The remaining group (colitis group) received no treatment. On the 11th d after induction of colitis and drug treatment, blood samples were collected for TNF-alpha and IL-6 level studies. Malondialdehyde (MDA), carbonyl, myeloperoxidase (MPO) and caspase-3 activities, as well as histopathological findings, evaluated in colonic tissues. RESULTS: According to the macroscopic and microscopic findings, the study groups treated with BBS, NTS and BBS + NTS showed significantly lower damage and inflammation compared with the colitis group (macroscopic score, 2.1 +/- 0.87, 3.7 +/- 0.94 and 2.1 +/- 0.87 vs 7.3 +/- 0.94; microscopic score, 2.0 +/- 0.66, 3.3 +/- 0.82 and 1.8 +/- 0.63 vs 5.2 +/- 0.78, P < 0.01). TNF-alpha and IL-6 levels were increased significantly in all groups compared with the control group. These increases were significantly smaller in the BBS, NTS and BBS + NTS groups compared with the colitis group (TNF-alpha levels, 169.69 +/- 53.56, 245.86 +/- 64.85 and 175.54 +/- 42.19 vs 556.44 +/- 49.82; IL-6 levels, 443.30 +/- 53.99, 612.80 +/- 70.39 and 396.80 +/- 78.43 vs 1505.90 +/- 222.23, P < 0.05). The colonic MPO and MDA levels were significantly lower in control, BBS, NTS and BBS + NTS groups than in the colitis group (MPO levels, 24.36 +/- 8.10, 40.51 +/- 8.67 and 25.83 +/- 6.43 vs 161.47 +/- 38.24; MDA levels, 4.70 +/- 1.41, 6.55 +/- 1.12 and 4.51 +/- 0.54 vs 15.60 +/- 1.88, P < 0.05). Carbonyl content and caspase-3 levels were higher in the colitis and NTS groups than in control, BBS and BBS + NTS groups (carbonyl levels, 553.99 +/- 59.58 and 336.26 +/- 35.72 vs 209.76 +/- 30.92, 219.76 +/- 25.77 and 220.34 +/- 36.95; caspase-3 levels, 451.70 +/- 68.27 and 216.20 +/- 28.17 vs 28.60 +/- 6.46, 170.50 +/- 32.37 and 166.50 +/- 30.95, P < 0.05). CONCLUSION: The results of this study suggest BBS and NTS, through their anti-inflammatory actions, support the maintenance of colonic integrity and merit consideration as potential agents for ameliorating colonic inflammation.

Melatonin reduces bacterial translocation and apoptosis in trinitrobenzene sulphonic acid-induced colitis of rats.

AIM: To investigate the effects of exogenous melatonin on bacterial translocation and apoptosis in a rat ulcerative colitis model. METHODS: Rats were randomly assigned to three groups: group I: control, group II: experimental colitis, group III: colitis plus melatonin treatment. On d 11 after colitis, plasma tumor necrosis factor-alpha, portal blood endotoxin levels, colon tissue myeloperoxidase and caspase-3 activity were measured. Bacterial translocation was quantified by blood, lymph node, liver and spleen culture. RESULTS: We observed a significantly reduced incidence of bacterial translocation to the liver, spleen, mesenteric lymph nodes, portal and systemic blood in animals treated with melatonin. Treatment with melatonin significantly decreased the caspase-3 activity in colonic tissues compared to that in trinitrobenzene sulphonic acid- treated rats (16.11 +/- 2.46 vs 32.97 +/- 3.91, P < 0.01). CONCLUSION: Melatonin has a protective effect on bacterial translocation and apoptosis.