Laparoscopic transperitoneal adrenalectomy for adrenal tumours of 6 cm or greater: A single-centre experience.

BACKGROUND: The present study aimed to evaluate the safety and efficacy of transperitoneal laparoscopic adrenalectomy (LA) for large adrenal tumours by comparing the outcomes of tumours larger than 6 cm with those smaller than 6 cm and also to identify the risk factors associated with prolonged operative time in transperitoneal LA. PATIENTS AND METHODS: One hundred and sixty-three patients underwent LA at our clinic from January 2014 to December 2020. Bilateral LA was performed in 20 of these 163 patients. A total of 143 patients were included in this study. Data were analysed retrospectively from the patients' medical records collected. RESULTS: Large tumour (LT) group consists of 33 patients and the small tumour (ST) group consists of 110 patients. There was no statistically significant difference between the groups regarding conversion to open surgery and complications. A multiple regression analysis was conducted to identify the independent predictors of prolonged operation time. The tumour size ≥8 cm (odds ratio [OR], 19.132; 95% confidence interval [CI], 3.881-94.303; P < 0.001) and diagnosis of pheochromocytoma (OR, 2.762; 95% CI, (1.123-6.789, P = 0.026) were the significant predictors of prolonged operation time. CONCLUSION: Our study shows that LA can be considered the treatment of choice for small and large adrenal tumours. The tumour size ≥8 cm and diagnosis of pheochromocytoma are the independent risk factors for the prolonged operative time in transperitoneal LA.

The relationship of patients, giving or not giving a pathological full response, with YAP (Yes Associated Protein) in breast cancer cases to which neo-adjuvant chemotherapy is applied.

AIM: We aimed to evaluate (immunohistochemically) the YAP expression in breast cancer patients undergoing neoadjuvant chemotherapy and to clarify the relationship between the molecular characteristics, treatment response and survival data and the YAP expression, and hence, to clarify the prognostic significance. MATERIAL AND METHODS: One hundred and four patients who were diagnosed with Breast Cancer between 2015-2020 and underwent Neo Adjuvant Chemotherapy were included in the study. Estrogen Receptor(ER), Progesterone Receptor(PR), Human Epidermal Growth Receptor-2(HER2) and Ki-67. Expression are routinely stained immunohistochemically. In this study, existing immunohistochemical markers were reviewed and also, the relationship of YAP with these biological markers was evaluated by using immunohistochemistry and its effect on prognosis has been investigated. RESULTS: The average age of the patients was 52.37. While YAP was positive in 78 patients (75%), it was negative in 26 patients (25%). In the evaluation after neoadjuvant therapy, pathological complete response (MillerPayne Grade5 response) in 28 patients (26.9%), relapse in 6 patients (5.8%), and exitus in 6 patients (5.8%) were detected. In the pathological evaluation, invasive Ductal Carcinoma was the most common one observed in 88 patients (84.6%). As a result of the statistical evaluation, no significant result was obtained between the parameters and YAP negative/positive. CONCLUSION: As a result of staining with additional YAP in patients who were diagnosed with breast cancer and routinely stained with ER, PR, Cerb B2 and Ki-67 in pathology samples, we could not reach a result that would contribute positively to survival. Longer studies to be conducted prospectively will be meaningful. KEY WORDS: Breast Cancer, Chemotherapy, Neoadjuvant, Yes Associated Protein.

Investigation of the effects of systemic meperidine administration on fascia healing in an experimental rat model.

PURPOSE: To evaluate the effects of meperidine on fascial healing. METHODS: Seventy adult male Sprague-Dawley rats divided into 7 groups with 10 rats in each group. One of these groups was determined as the sham group, 3 of the remaining 6 groups as meperidine groups, and 3 as control groups. These were grouped as 1st, 2nd, and 6th weeks. In the anterior abdominal wall of the rat, the skin was detached and a wound model including the peritoneum was created with a median incision. Mice in the meperidine group were injected with meperidine intraperitoneally (IP) 3 × 20 mg/kg meperidine on postoperative days 0, 1 and 2, and 2 × 20 mg/kg meperidine on postoperative days 3, 4, 5, and 6 after surgical intervention. Similar to the control group, an equal volume of saline was administered, corresponding to the doses. After sacrifice, the midline fascia was used for facial tensile strength measurement, and the other for histopathological analysis. RESULTS: When compared, the meperidine and control groups inflammatory cell density was higher in the 1st week (p < 0.05) in the meperidine group, fibroplasia density was found to be higher at the 2nd week in the meperidine group than the control group (p < 0.05) When the tensile strength in the meperidine and control groups were compared, there was no significant difference (p > 0.05) at each of the three weeks. CONCLUSION: The application of postoperative systemic meperidine affects positively wound healing in the inflammatory stage and fibroplasia without changing the resistance to traction.

Investigation of the effects of systemic meperidine administration on fascia healing in an experimental rat model

Abstract Purpose: To evaluate the effects of meperidine on fascial healing. Methods: Seventy adult male Sprague-Dawley rats divided into 7 groups with 10 rats in each group. One of these groups was determined as the sham group, 3 of the remaining 6 groups as meperidine groups, and 3 as control groups. These were grouped as 1st, 2nd, and 6th weeks. In the anterior abdominal wall of the rat, the skin was detached and a wound model including the peritoneum was created with a median incision. Mice in the meperidine group were injected with meperidine intraperitoneally (IP) 3 × 20 mg/kg meperidine on postoperative days 0, 1 and 2, and 2 × 20 mg/kg meperidine on postoperative days 3, 4, 5, and 6 after surgical intervention. Similar to the control group, an equal volume of saline was administered, corresponding to the doses. After sacrifice, the midline fascia was used for facial tensile strength measurement, and the other for histopathological analysis. Results: When compared, the meperidine and control groups inflammatory cell density was higher in the 1st week (p < 0.05) in the meperidine group, fibroplasia density was found to be higher at the 2nd week in the meperidine group than the control group (p < 0.05) When the tensile strength in the meperidine and control groups were compared, there was no significant difference (p > 0.05) at each of the three weeks. Conclusion: The application of postoperative systemic meperidine affects positively wound healing in the inflammatory stage and fibroplasia without changing the resistance to traction.

Comparison of Clinical Features and Treatment Results of Mix Mucinous Carcinomas and Other Atypical Carcinomas of the Breast.

OBJECTIVE: There are multiple subtypes of breast cancer with different biological and pathological features and accordingly exhibit different clinical behaviors. The aim of this study was to compare the treatment modalities, clinical features and prognostic characteristics of Mix Mucinous Carcinomas (MMBC) and other rare tumors of the breast. MATERIALS AND METHOD: A total of 2152 patients who were operated on for breast cancer in our clinic between 2010-2019, with pathological diagnoses of tubular, pure mucinous, mix mucinous or papillary carcinoma were enrolled in the study. Patients were divided into two groups as mix mucinous patients (Group1) and other rare tumors (Group2). The demographic, clinical and prognostic characteristics and treatment approaches were compared between Groups, and additionally between the subtypes of Group 2. RESULTS: 42 patients participated in our study. Group 1 consisted of 7 patients, and Group2 consisted of 35 patients. The subtypes in Group2 were papillary (n=21), pure mucinous (n=10) and tubular (n=4). Progesterone Receptor Positivity was found to be significantly higher in Group 2 patients than in Group1 patients (p=0.005, p<0.05). Multicentricity rates in the tumors of the patients in Group1 were found to be statistically significantly higher than the patients in Group 2 (p=0.024, p<0.05). In subtype analysis in Group2, there were no statistically significant differences parameters in the subgroups (p>0.05). Mean survival was 19.5+5.6 (8.5-30.5) months in Group 1 and 46.3+5.2 (36.1-56.6) months, in Group2 when evaluated separately (p:0.002). CONCLUSION: The prognosis of pure mucinosis (PMBC) and other atypical cancers of the breast compared to the (MMBC) is quite good. Rare pathological types of breast cancer can have favorable outcomes when treated with necessary oncological principles.

Determination of risk factors causing hypocalcaemia after thyroid surgery.

OBJECTIVE: The most common complication after thyroid surgery is hypocalcaemia and it sometimes leads to problems that are difficult to correct in patients. The present study was aimed to determine the risk factors causing the development of hypocalcaemia after thyroid surgery. METHODS: 818 adult patients were included in the study. The data were recorded by examining the hospital automation system and patient files retrospectively. Patients' demographic characteristics, radiological imaging findings, serum biochemical parameters, extent of the performed surgery, histopathological diagnoses were recorded. RESULTS: The rate of hypocalcaemia was 28.4% (1.7% permanent). In multivariate analysis: the female gender (p = 0.002), heavier thyroid gland (p = 0.084), substernal location (p = 0.004) and cervical lymph nodes dissection (CLND) (p < 0.001) were found to be significantly. Malignant thyroid pathology (p = 0.006) and total thyroidectomy (p = 0.025) increased the risk of hypocalcaemia significantly in univariate analysis. However, this increase in risk was not found to be statistically significant in regression analysis. Significant statistical result was not found on postoperative hypocalcaemia in terms of advanced age, hyperthyroidism and re-operation. The duration of hospitalization was higher in patients with postoperative hypocalcaemia (m = 2 days) (p < 0.001). CONCLUSION: In our analyses CLND, female gender, substernal location and heavier thyroid gland was found to be the independent risk factors in the development of postoperative hypocalcaemia. The development of postoperative hypocalcaemia may be predicted and measures may be taken to prevent clinical findings.

Effects of erythropoietin on bacterial translocation in a rat model of experimental colitis.

OBJECTIVES: In this experimental study, it was aimed to assess the effects of erythropoietin (EPO) on bacterial translocation in a rat model of colitis. MATERIAL AND METHODS: The rats were randomly assigned into control, colitis and EPO-treated groups (n= 8 in each group). Saline solution (NS) was administered to control rats via rectal route. A trinitrobenzene sulfonic acid and ethanol mixture (TNBS-E) was used to induce colitis in the experiment groups. No treatment was administered to colitis group after induction. Starting at one day after induction of colitis with TNBS-E, EPO (1000 IU/kg) was administered subcutaneously for three days to the rats in the EPO-treated group. Colonic inflammation was assessed by gross and microscopic examination on day five. Blood samples were obtained to evaluate bacterial translocation while hepatic, mesenteric tissue samples and mesenteric lymph node (MLN) samples were collected for tissue culture. Tissue myeloperoxidase (MPO) levels, and tumor necrosis factor alpha (TNF- α) and endotoxin levels in the sera were studied. RESULTS: Significant gross and microscopic differences were found in the comparison between colitis and EPO-treated groups (p <0.05). MPO level was significantly lower when compared to the colitis group (p <0.05). Serum TNF-α and plasma endotoxin levels were significantly lower in the EPO-treated group than the colitis group (p <0.05). Bacterial translocation was lower in the liver, spleen, MLNs and systemic blood in the EPO-treated group when compared to the colitis group (p <0.05). CONCLUSION: In TNBS-E-induced rat model of colitis, EPO significantly decreased inflammation and bacterial translocation based on histopathological, biochemical and microbiological parameters.

Spontaneous and Excellent Healing of Bilateral Brown Tumors in Mandible after Endocrinal Therapy and Subtotal Parathyroidectomy: Case Report with 4-Year Follow-Up.

Primary hyperparathyroidism is an endocrine disorder occurring due to increased secretion of parathormone resulting in a complex of clinical, anatomical, and biochemical alterations. On the other hand, excision of a parathyroid adenoma can normalize the metabolic status. A 24-year-old man was referred to the hospital with bilateral swelling and spontaneous gingival bleeding from posterior of the mandible also with radiolucent well-demarcated lesions bilaterally in the mandibular third molar regions. After consultations, the patient was hospitalized in the endocrinology department where further tests were performed due to highly increased PTH level as 714 pg/ml. Bilateral brown tumors started to regress spontaneously, and no additional surgery was required after subtotal parathyroidectomy was performed. The presented case is the first patient whose bilateral brown tumors in the jaws spontaneously and totally healed after subtotal parathyroidectomy and endocrinal therapy who was strictly followed up for 4 years even though the lesions were associated with impacted third molars.

Prediction of nonsentinel lymph node metastasis in breast cancer patients with one or two positive sentinel lymph nodes.

OBJECTIVE: The aim of the present study was to investigate the association between non sentinel lymph node metastasis (NSLNM) and clinicopathological factors, particularly in the case of sentinel lymph node (SLN) metastasis in one or two, in clinically node negative patients with breast cancer. METHODS: Between 10/2010 and 10/2014, 350 sentinel lymph node biopsy (SLNB) were performed in patients with histologically proven primary breast cancer in our clinic. The data collection includes the following characteristics: age, pathological tumor size, histological type, histological grade, lymphovascular invasion (LVI), number of positive SLN, size of the SLN metastasis (macrometastasis, micrometastasis, isolated tumor cells), multifocality (MF), extracapsuler invasion (ECI) of the SLN, the estrogen receptor (ER) status, the progesterone receptor (PR) status and the Her 2 receptor status, Ki 67 reseptor status. Data were collected retrospectively and then analyzed. RESULTS: A successful SLN biopsy were performed in 345 (98.5%) cases. SLN metastases were detected in 110 (31.8%) cases. These patients then underwent axillary dissection; among these patients, 101 (91.8%) had only one to two positive SLNs. Of the 101 patients with positive SLN biopsies, 32 (31.6%) had metastases in the NSLNs. Univariate and multivariate analysis showed that lymphovascular invasion, extracapsular invasion (ECI), Her-2 receptor positive, and Ki-67 > 14% were related to NSLNM (p<.0.05). CONCLUSION: The predicting factors of NSLNM were LVI, ECI, Ki-67 level, Her-2 reseptor positive and but should be further validated in our institutions, different institutions and different patient groups prospectively.

Prognostic value of E2F1 in rectal cancer.

OBJECTIVE: To evaluate whether E2F transcription factor 1 is a potential prognostic marker in patients with rectal cancer. MATERIAL AND METHODS: Eighty-two patients who were treated with curative resection because of rectal cancer in the Erciyes University School of Medicine, Department of General Surgery were included in the study and analyzed retrospectively. Data were obtained from patient files, pathology reports, and hospital information system. Nuclear and cytoplasmic staining of E2F transcription factor 1 was performed for immunohistochemical analysis on paraffin-embedded and blocked tumor tissue samples of patients. The findings of the study were assessed with using IBM Statistical Package for Social Sciences Statistics 20. RESULT: In the 5-year follow-up period, 34 (41.5%) patients were alive. Local recurrence was identified in 7 patients. According to E2F transcription factor 1 nuclear staining, the average survival rate in patients was 60% for strong nuclear staining and 28% for weak nuclear staining. There was significant statistical difference between groups according to their degree of nuclear staining (p=0.017). When the patients were evaluated according to cytoplasmic staining with E2F transcription factor 1, the average overall survival rate of patients with positive E2F transcription factor 1 cytoplasmic staining was 48.0±4.6% versus 55.9±7.9% for patients without staining (p=0.408). CONCLUSION: The survival rates are higher in rectal cancer patients with strong immunohistochemical nuclear staining of E2F transcription factor 1.

A comparison of surgical outcome of fasciocutaneous V-Y advancement flap and Limberg transposition flap for recurrent sacrococcygeal pilonidal sinus disease.

OBJECTIVE: The aim of this study was to compare the surgical outcome of fasciocutaneous V-Y advancement flap and limberg transposition flap used to treat recurrent sacrococcygeal PSD. METHODS: A total of 58 patients with recurrent pilonidal sinus who underwent surgery were evaluated retrospectively between January 2008 to December 2013. Fasciocutaneous V-Y advancement flap was performed in 25 patients (Group VYF), and limberg transposition flap repair was performed in 33 patients (Group LTF). Patient demographics, operative and postoperative outcomes were recorded then retrospectively analyzed. RESULTS: The mean age (p = 0.69), sex ratio (p = 0.48), and concomitant diseases (p = 0.98) were not statistically different when compared the VYF with LTF groups. Mean operative time was 55 ± 19 min for the LTF group and 75 ± 25 min for the VYF group (p = 0.01). When length of hospital stay were compared, there was a significant difference between the groups (p = 0.01). Return to work was carryed out after a mean of 23 ± 1.1 days in VYF group and 16.7 ± 1.2 days in LTF group, which is significantly different (p < 0.0004). Between the groups, there was no significantly different regarding surgical complication and recurrent rate. Only one recurrence (4%) was found in VYF group. CONCLUSION: Limberg transposition flap may be use in recurrent cases of PSD, because of the lower recurrence rate and less hospital stay time, early return to work. Most important advantage of fasciocutaneous V-Y advancement flap is the ability to close larger defects in recurrent cases.

Plasma citrulline measurement in the diagnosis of acute mesenteric ischaemia.

BACKGROUND: The differential diagnosis in acute mesenteric ischaemia (AMI) is essential and sometimes life-saving. A marker for early diagnosis is lacking. Citrulline is an amino acid mainly synthesized by small bowel enterocytes from glutamine. In this study, we aimed to evaluate the diagnostic and prognostic values of citrulline with those of the D-dimer in patients with AMI. METHODS: The patients were divided into two groups; group 1: patients with acute abdominal findings which were attributed preoperatively to AMI, and group 2: patients with acute abdominal findings which were attributed preoperatively to causes other than AMI. All patients underwent surgical exploration. Blood samples were taken before surgery. The demographic features, laboratory examinations, citrulline concentration, D-dimer level and surgical findings were evaluated. RESULTS: Overall, 48 patients were enrolled in the study. AMI was diagnosed in 23 of the 48 patients. There was no significant difference between the groups with regard to gender, leucocyte count and creatinine levels but group 1 was significantly older than group 2. Citrulline, D-dimer and lactate levels were also significantly higher in group 1. Age, lactate, D-dimer and citrulline levels were statistically significant for mortality. The most significant factor was increased lactate level at admission. CONCLUSION: Plasma citrulline level may be helpful in the diagnosis of patients with AMI.

Laparoscopic surgery in functional and nonfunctional adrenal tumors: A single-center experience.

BACKGROUND: Laparoscopic adrenalectomy (LA) is a safe and minimally invasive operation for benign adrenal tumours. The purpose of this study was a retrospective analysis of outcomes following laparoscopic lateral transabdominal adrenalectomy performed for benign adrenal tumours responsible for various endocrinological disorders and non-functioning tumours. METHODS: A total of 100 laparoscopic adrenalectomy were carried out between January 2007 and March 2013 via the lateral transabdominal approach. The analysed factors included demographic data of patients, indication for surgery, tumour size and side, intraoperative and postoperative outcome of laparoscopic lateral transabdominal adrenalectomy including duration of surgery, length of hospital stay, the complication rate, as well as the conversion rate to open adrenalectomy. RESULTS: There were 34 patients with non-functioning tumours (Group 1) and 66 with functioning tumours (Group 2). The intraoperative and postoperative outcomes were not significantly different in the cases among the analysed groups of patients. The median operative time was 101 ± 4.3 (range, 30-210) minute in group 1 and 95 ± 5.9 (range, 30-190) minute in group 2, there was not statistically significant (p = 0.56). The median duration of the postoperative hospital stay in the group 1 was bigger than group 2, this did not differ significantly (p = 0.08). Peroperative complications were occured in 9 (9%) patients, observing 6 (9%) patients in Group 1 and 3 (8.8%) patients in Group 2. There was not statistically significant (p = 0.96). In the postoperative period, three patients in group I, 1 patient in group II developed complications, this difference was not statistically significant (p = 0.69). The conversion to open surgery was found in 9 (9%) patients. CONCLUSION: This study shows that laparoscopic lateral transabdominal adrenalectomy is a safe, effective, and technically feasible procedure in the treatment of both functioning and nonfunctioning benign tumours of the adrenal gland.

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 Pregnant Woman Who Underwent Laparoscopic Adrenalectomy due to Cushing's Syndrome.

Cushing's syndrome (CS) may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertension-induced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone- (ACTH-) independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

Comparison of the histopathology and prognosis of bilateral versus unilateral multifocal multicentric breast cancers.

BACKGROUND: Multiple breast cancers may present with different clinical and biological characteristics. The data indicate that multifocal (MF), multicentric (MC), and bilateral synchronous (BS) breast cancers (BC) are more aggressive and have an equivalent or moderately poorer survival rate compared with unilateral cases. However, a comparison of these multiple breast cancers has not been covered in the literature. The aim of this study was to describe the histopathological characteristics of patients suffering from MF, MC, and BS breast carcinoma and to compare their prognoses. METHODS: Retrospective data for MF, MC, and BS breast carcinoma patients treated in five different breast cancer units in Turkey between 2003 and 2012 were collected. MF and MC cancers were defined as more than one lesion in the same quadrant or in separate quadrants, respectively. RESULTS: There were 507 patients (271 MF, 147 MC, and 89 BS) treated in this time period. BS breast carcinoma patients were younger than the other groups (44.83 ± 9.6, 47.27 ± 11.6, and 51.11 ± 11.8 years for BS, MF, and MC breast carcinoma patients, respectively). MFBC and MCBC patients in this study were younger than the ages reported in Western literature, but this result was similar to the ages reported in Eastern literature. The five-year survival rates and recurrence rates were not statistically different among groups (P = 0.996 and P = 0.263, respectively). According to univariate analyses, tumor size, histological grade, and lymph node status were statistically significant factors that affected survival. However, only lymph node involvement was significant for survival according to multivariate analyses. CONCLUSIONS: The clinical significance of MF, MC, and BS breast cancers is still unclear and their influence on prognosis is controversial. Disease-free and overall survival rates of BS breast cancers might be similar to MF and MC breast cancers.

Idiopathic Granulomatous Mastitis: Comparison of Wide Local Excision with or without Corticosteroid Therapy.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is an uncommon chronic inflammatory disease of the breast with uncertain optimal treatment regimen. In this study, our purpose was to report our clinical experience with 74 IGM patients who were treated wide local excision with or without steroid therapy. PATIENTS AND METHOD: 74 cases diagnosed histologically as IGM were identified from surgical and pathological records between January 1995 and January 2012. Group 1 (surgery-only group) comprised 53 patients, and the 21 patients in group 2 were treated with corticosteroids prior to surgical treatment (steroid-and-surgery group). RESULTS: Follow-up data were complete for 67 (91.7%) of the 73 patients. Recurrence developed in 4 (7.5%) patients in the surgery-only group, while there was no recurrence in the steroid-and-surgery group; the difference was not statistically significant (p = 0.19). CONCLUSION: Systemic steroid therapy with surgical resection is the recommended first-line treatment strategy for IGM.

Effects of piperine in experimental intestinal ischemia reperfusion model in rats.

BACKGROUND: Piperine is a spice principle, and its protective role against oxidative damage and lipid peroxidation has been reported. In this study, we aimed to investigate the effects of piperine in the prevention of ischemia-reperfusion injury to the small intestine. METHODS: Rats were allocated to three groups of 8 rats each. Rats in the sham group underwent laparotomy and observation only. Animals in the control and study groups underwent 45 minutes ischemia followed by 60 minutes reperfusion. In the study group, 10 mg/kg piperine was administered intraperitoneally just before the reperfusion procedure. Blood samples were obtained for measurement of lactate levels, and resection of the terminal ileum was performed to evaluate the histopathologic specimens and tissue malondialdehyde, superoxide dismutase, and glutathione activities. All results were expressed as mean±SD. Comparisons between groups were made by using the one way analysis of variance (ANOVA). RESULTS: Lactate and malondialdehyde levels were significantly higher in the control group than the study and sham groups (p<0.001). In the study group, superoxide dismutase, and glutathione activities were significantly higher than in the control group (p<0.001). The sham group had the highest activities. Histopathologic examination showed disruption of villous pattern and lamina propria in the control group. CONCLUSION: Intraperitoneal administration of 10 mg/kg piperine just before the reperfusion may reduce ischemia-reperfusion injury to the small intestine.

Effects of glucagon-like peptide-2 on bacterial translocation in rat models of colitis.

BACKGROUND/AIMS: The aim of this trial was to study the role of glucagon-like peptide-2 in reducing bacterial translocation by virtue of its anti-inflammatory effects and ability to decrease intestinal permeability in rat models of inflammatory bowel diseases. On the basis of our results and those of other recent studies, we suggest a new treatment modality for colitis. To our knowledge, this is the first study of the effectiveness of glucagon-like peptide-2 on bacterial translocation, in treating an experimental colitis model. METHODS: Rats were randomized into 3 groups of 7 rats each-the control group, colitis group, and treatment group. On the 7 th day after induction of colitis, the levels of tissue myeloperoxidase, serum tumor necrosis factor-alpha, and plasma endotoxin were measured. Tissue samples were obtained from the liver, spleen, and mesenteric lymph nodes for evaluating bacterial translocation. RESULTS: Bacterial translocation in samples of the liver, spleen, mesenteric lymph nodes, and portal and systemic blood obtained from the treatment group was lower than that in samples obtained from the colitis group (p < 0.05). The levels of tissue myeloperoxidase, serum tumor necrosis factor-alpha, and plasma endotoxin in the treatment group were significantly lower than those in the colitis group (p < 0.05). CONCLUSIONS: In experimental colitis models, which were induced using trinitrobenzene sulfonic acid in ethanol, glucagon-like peptide-2 treatment reduced inflammation and bacterial translocation from the intestinal mucosa. Our results indicate that glucagon-like peptide-2 is a potential agent for treating colitis; however, extensive trials are needed to confirm our results.

Predisposing factors and surgical outcome of complicated liver hydatid cysts.

AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease. METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics. RESULTS: When the predisposing factors for complications were evaluated, younger age, superficial position, and larger cyst dimensions (P < 0.05; range, 0.001-0.017) increased peritoneal perforation rates. It was shown that older age increased cyst dimensions, and presence of multiple and bilobar cysts increased intrabiliary rupture rates (P < 0.05; range, 0.001-0.028). Partial pericystectomy and drainage was the most frequent surgical procedure in all groups (71.6%). The incidence of post-operative complications in the peritoneal perforated group, in the intrabiliary ruptured group, and in the noncomplicated group was 25%, 16.1% and 5.5%, respectively. When compared, complication rates were significantly different (P = 0.002). When length of hospital stay was compared, there was no significant difference between the groups (P > 0.05). The overall recurrence rate was 3.8% (14 patients), but there was not any statistical difference among the patient groups (P = 0.13). The early postoperative mortality rate was 1.1%. CONCLUSION: In peritoneally perforated and intrabiliary ruptured cases, the most important steps are irrigation of the peritoneal cavity and clearance of the cystic material from the biliary tree.