Analysis of the Liver Transplant Waiting List in Our Center.

BACKGROUND: Liver transplantation (LT) is an important treatment for acute liver failure and end-stage liver disease. Due to the limited supply of livers, there are still thousands of candidates waiting for transplantation in Turkey. We aimed to analyze LT waiting list access by demographics and etiology, particularly the diagnosis of hepatocellular carcinoma (HCC), which has been prioritized for LT in recent years. MATERIALS AND METHODS: Between 2011 and 2018, all patients listed for LT in our center were retrospectively reviewed. Demographic features, etiology of liver disease, waiting time, Model for End-Stage Liver Disease (MELD) score, and survival data were recorded. Differences between the LT group and deceased patients on the waiting list were evaluated. RESULTS: During this period, 266 patients were included in the LT waiting list. Only 119 patients (44.7%) underwent LT (men, 94; women, 25; mean age, 53 years), whereas 103 (38%) died (men, 60; women, 43; mean age, 53 years) in the waiting period. Seventeen patients were status 1A or 1B and of these, 7 patients died from fulminant hepatic failure. MELD score was significantly higher in deceased group (28 ± 7 vs 25 ± 6; P = .014). The frequency of HCC was significantly higher in LT group (29% vs 11%; P = .002). Overall survival of the patients in the waiting list with and without liver transplantation were 63% and 41%, respectively. CONCLUSIONS: HCC is one of the leading etiologies that is considered for cadaveric LT from the waiting list in our center. These patients had slightly lower MELD scores compared to deceased patients with shorter waiting times. We recommend early referral and close monitoring of the patients who are LT candidates.

Postoperative Myocardial Injury Does Not Predict Early and 1-Year Mortality After Living Donor Liver Transplantation.

BACKGROUND: Preoperative cardiac troponin-I (cTnI) elevation has been shown to be a predictor of mortality after liver transplantation. Myocardial injury after non-cardiac surgery (MINS) has been defined as elevation of serum cardiac troponin levels in the perioperative period that does not fulfill the criteria for myocardial infarction. MINS has been shown to be a prognostic factor for in-hospital and long-term mortality, but there is limited data in patients undergoing living-donor liver transplantation (LDLT). In this study, we aimed to evaluate the relationship between MINS and postoperative mortality. MATERIAL AND METHODS: Patients who had undergone adult LDLT at Florence Nightingale Hospital Liver Transplantation Unit between December 2012 and December 2015 were retrospectively analyzed for 30-day in-hospital and 1-year mortality. Myocardial injury was defined as cTnI level above 0.04 ng/mL. Patients (N = 214) were divided into 2 groups according to postoperative cTnI levels. The following were the exclusion criteria: 1. patients under 18 years old, 2. patients undergoing deceased-donor liver transplantation or dual liver-kidney transplantation, 3. cTnI elevation due to other causes (sepsis, renal failure, pulmonary embolism, myocardial infarction), and 4. patients without postoperative troponin levels. RESULTS: MINS occurred in 123 (57.4%) patients after LDLT. There was no difference between the groups according to age, sex, creatinine levels, presence of ischemic heart disease, hypertension, diabetes mellitus, and tobacco use. The presence of MINS did not predict 30-day and 1-year mortality in the study population. CONCLUSION: Myocardial injury detected by serum cTnI elevation was frequent after LDLT; however, it was not associated with 30-day in-hospital and 1-year mortality.

The Utility of Noninvasive Scoring Systems for Prediction of Hepatic Steatosis in Liver Transplantation Donor Candidates.

BACKGROUND: The degree of liver steatosis is an important factor for donor selection in living donor liver transplantation. Multidetector computed tomography (MDCT) has long been used in many transplantation centers to determine donor liver steatosis. Noninvasive scoring methods based on laboratory tests have been investigated as potential methods for altering liver biopsy and imaging techniques in evaluating the liver steatosis. In this study, we assess the utility of several noninvasive methods for the evaluation of donor hepatosteatosis. In comparison, MDCT was used for the evaluation of liver steatosis. METHODS: A total of 205 donor candidates with significant hepatosteatosis were included in the study and divided into 4 groups according to the degrees of steatosis as measured by MDCT (mild, mid- to moderate, moderate to severe, and severe). In comparison, the aspartate aminotransferase-platelet ratio index (APRI), nonalcoholic fatty liver disease fibrosis score, BARD score, and FIB-4 scores were calculated. RESULTS: The diagnostic performance of APRI in prediction of all degrees of hepatosteatosis on MDCT was significantly higher (P < .01). The BARD score showed the second best performance (P = .018), whereas FIB-4 and nonalcoholic fatty liver disease fibrosis score were not correlated with degree of liver steatosis on MDCT. CONCLUSION: Some noninvasive scoring methods including APRI and BARD score seem to be more beneficial for the detection of hepatic steatosis in donor candidates and may reduce the need for other invasive and expensive diagnostic techniques.

Body Mass Index and Unenhanced CT as a Predictor of Hepatic Steatosis in Potential Liver Donors.

BACKGROUND: In living-donor liver transplantation, donor hepatic steatosis is crucial for both the donor and the recipient. Body mass index (BMI) and the unenhanced computed tomography liver attenuation index (CT LAI) are noninvasive methods to predict hepatic steatosis in living-donor liver candidates. AIM: To analyze the diagnostic accuracy of CT LAI in conjunction with different BMI values for macrovesicular steatosis in living-donor liver candidates. METHODS: A total of 264 potential liver donors were included. The diagnostic accuracy of 2 CT LAI cut-offs and 3 BMI cut-off values for the assessment of hepatic steatosis ≥15% and ≤5% was determined. RESULTS: Using CT LAI, the area under the receiver operating characteristic curve was 0.97 (95% CI = 0.89-0.99) for hepatic steatosis ≥15% in donors with BMI <25 kg/m2. For detecting hepatic steatosis ≥15%, a CT LAI ≤0 had specificities of 100%, 76.2%, and 55.6% and positive predictive values of 100%, 95.5%, and 93.5% for patients with BMI values <25 kg/m2, 25 to 29.9 kg/m2, and ≥30 kg/m2, respectively. According to logistic regression analyses, only CT LAI ≤0 was found to be independently associated with hepatic steatosis ≥15%. CONCLUSIONS: In donors with BMI <30 kg/m2 and a CT LAI value >6, liver biopsy might be avoided. Biopsy may be reserved solely for donors with CT LAI value >0 and BMI ≥30 kg/m2 as the diagnostic accuracy of computed tomography for predicting hepatic steatosis decreases with increasing BMI.

A Changing Etiologic Scenario in Liver Transplantation: A Single-Center Cohort Study From Turkey.

PURPOSE: Nonalcoholic steatohepatitis (NASH) is an increasing cause of liver transplantation (LT) worldwide, especially in Europe and North America. In this study, we aimed to investigate the changing pattern of etiologic causes of LT in our center for the past 15 years. MATERIALS AND METHODS: A cohort of 967 consecutive adult patients with history of LT between 2004 and 2018 in our center was reviewed regarding etiologies for LT. All patients who had a transplant during this time frame were divided into 3 time periods as follows: 2004 to 2009, 2010 to 2013, and 2014 to 2018. All explanted liver samples were sent to pathology for establishment of a definitive etiologic cause. RESULTS: Chronic hepatitis B virus (HBV) infection was the leading cause of LT in the overall cohort (37%), followed by hepatitis C virus (HCV) infection (11%), and alcoholic liver disease (9.5%). NASH accounted for 7.5% of the cases. While HBV decreased from 44% in 2004 to 2009 to 36% in 2014 to 2018, NASH increased from 1.1% to 9.4% in overall transplants during the same period, accounting for one-third of the etiologies for LT following HBV and HCV. CONCLUSIONS: There might be a global changing figure regarding etiology for LT in Turkey, especially NASH, which is the fastest growing cause of LT. However, this topic needs to be evaluated in large cohort series from collaborative multicenter studies from Turkey.

Effectiveness of Noninvasive Fibrosis Markers for the Prediction of Hepatocellular Carcinoma in Chronic Hepatitis B and Chronic Hepatitis B+D Induced Cirrhosis.

PURPOSE: Despite advances in prevention techniques, screening, and new technologies in both diagnosis and treatment, the incidence and mortality of hepatocellular carcinoma (HCC) continue to rise. To obtain the best treatment result for HCC, early diagnosis is the key. In this study, we investigated the accuracy of noninvasive fibrosis markers, which have been typically used to predict liver fibrosis in recent years, in the prediction of HCC development in patients with chronic hepatitis B and chronic hepatitis B + D-induced cirrhosis. METHODS: Between 2004 and 2018, 1216 patients with chronic liver disease were retrospectively reviewed, and 331 patients (27%) with hepatitis B and hepatitis B+D virus-related cirrhosis were enrolled in our study. Patients were divided into 2 groups based on HCC diagnosis (HCC and non-HCC group). Eleven noninvasive fibrosis markers were evaluated in the groups. These markers included 3 alpha-fetoprotein (AFP)-based models (PAPAS index, Fibro-alpha, and BRC score) and 8 non-AFP based models (Lok index, FIB-4, Fibro-O index, APRI, King's score, Forns index, Bonacini score, and HUI model) for each Child-Pugh score in the prediction of HCC. RESULTS: AFP-based models were higher in HCC group patients, and statistically significant outcomes were detected with these methods in each Child-Pugh score group for HCC prediction (P < .05). Non-AFP based-methods showed different and inconsistent results in each Child-Pugh score group. CONCLUSION: These easily applied fibrosis markers, particularly AFP-based models, may provide an effective, simple, and low-cost way to predict HCC development in patients with hepatitis B and hepatitis B + D cirrhosis.

Does Multiple Bile Duct Anastomosis in Living Donor Liver Transplantation Affect the Postoperative Biliary Complications?

PURPOSE: The variation of multiple bile ducts in a living donor graft is not infrequent; however, the literature on the impact of the number of bile ducts on postoperative biliary complications is scarce. We investigated whether the number of biliary duct anastomoses affects the rate of postoperative biliary complications in patients undergoing living donor liver transplantation (LDLT). MATERIALS AND METHODS: Between January 2016 and January 2018, all patients who underwent LDLT were reviewed. The patients were divided into 2 groups according to the number bile duct anastomoses (single duct [group A, n = 78] or multiple ducts [group B, n = 94]). Data collection included demographic features, Child Pugh Score (CPS), graft-recipient weight ratio (GRWR), surgical data including technique of biliary anastomosis (duct-to-duct, duct-to-sheath, double duct-to-duct, and hepaticojejunostomy), and postoperative morbidity and mortality. RESULTS: The duct-to-duct anastomosis was the mostly commonly performed technique in group A, whereas double duct-to-duct and duct-to-sheath were significantly higher in group B. Operating time was quite high in group B compared to group A (438 ± 72 minutes vs 420 ± 61 minutes, respectively; P = .05). Regarding biliary complications (n = 40, 23.2%), the rates of biliary leakage (n = 17, 9.9%) and strictures (n = 25, 14.5%) were similar in both groups (P = .164 and .773, respectively). CPS was positively correlated (for Child B and C, odds ratio [OR]: 10.669 and 17.866, respectively), whereas GRWR was negatively correlated (OR: 9.530) with biliary stricture. Increased risk for bile leakage was observed in younger donors (OR: .929). Although overall mortality rate was 9.8% (n = 17), only 5 of the patients (29%) died of biliary complications. CONCLUSION: The number of biliary ducts and anastomoses did not affect the rate of complications. However, CPS, GRWR, and young donor age were found to be predisposing factors for postoperative biliary complications. Mortality was mostly based on the causes other than biliary complications.

Experience in Liver Transplantation Due to Primary Sclerosing Cholangitis: A Single Center Experience.

PURPOSE: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown origin. Although the course of PSC is variable, it frequently is progressive, leading to cirrhosis and requiring a liver transplantation (LT) in more than half of the patients. PSC is the fifth most common indication for LT in the United States and one of the leading indications in Scandinavian countries, whereas PSC affects fewer than 5% of patients undergoing LT in Turkey. In this study, we analyzed our results in the patients with LT owing to PSC. MATERIALS AND METHODS: Between March 2013 and August 2017, all adult patients (>18 years) with LT owing to PSC were analyzed, and clinical data were obtained via retrospective review of patient charts. Demographic features, presence of any concomitant inflammatory bowel disease (IBD), time to LT, and outcome data were recorded. RESULTS: There were 15 patients (8 men and 7 women) with a mean age of 46 ± 13 (age at diagnosis = 36 y). Median time to transplantation was 3 years (range: .5-14 yrs.). All patients had a pretransplant history of IBD. Concomitant cholangiocarcinoma was diagnosed in 1 patient (6.5%). Postoperative complications were observed in 4 patients (26%), and in 2 patients (13%) PSC recurred at a mean of 52 months postorthotopic LT. Disease-free survival and overall survival were 37.3 and 38 ± 21 months, respectively. One of the patients with recurrence and 1 with graft failure owing to rejection died in the follow-up period. CONCLUSIONS: In one single-center study of adults with PSC, we found that all patients with PSC had IBD at diagnosis. The recurrence rate (13%) was comparable to the literature (20% [5.7-59%]). Despite the low frequency of PSC in our clinic, LT in these patients resulted in favorable outcomes regarding postoperative morbidity and mortality compared with other etiologies.

Liver Graft Volume Estimation by Manual Volumetry and Software-Aided Interactive Volumetry: Which is Better?

PURPOSE: Estimation of graft volume is critical in living donor liver transplantation (LDLT). In this study, we aimed to evaluate the accuracy of software-aided automated computer tomography (CT) volumetry in the preoperative assessment of graft size for LDLT and to compare this method with manual volumetry. MATERIALS AND METHODS: Forty-one donors (27 men; 14 women) with a mean age in years ± standard deviation (28.4 ± 6.6) underwent contrast-enhanced CT prior to graft removal for LDLT. A liver transplant surgeon determined the weights of liver grafts using automated 3-dimensional volumetry software, and an abdominal radiologist specializing in liver imaging independently and blindly used the commercial interactive volumetry-assisted software on a viewing workstation to determine the liver volume on CT images. Both results were then compared to the weights of actual grafts obtained during surgery. Intraclass correlation coefficients were used to assess the consistency of numerical measurements and Pearson correlation coefficients were calculated to detect a linear relationship between numerical variables. To compare correlation coefficients, z scores were used. RESULTS: Regarding the right and left lobe graft volume estimation by the surgeon, there was a positive correlation between the results and actual graft weight (r = 0.834; P = .001; and r = 0.587; P = .001, respectively). Likewise, graft volume estimation by the radiologist for the right and left lobe was also positively correlated with the actual graft weight (r = 0.819; P = .001 and r = 0.626, P = .001, respectively). There was no significant difference between correlation coefficients (P = .836). CONCLUSION: Volumetric measurement of donor graft using 3-dimensional software provides comparable results to manual CT calculation of liver volume.

Living Donor Liver Transplantation.

In 50 years after the first liver transplantation, the medical world has witnessed the liver transplantation to become one of the widely recognized and leading branches of surgery. In this period, liver transplantation combined with surgical technique, patient selection, advancements in anesthesia and postoperative care and increased experience has become the most effective treatment option in treatment of several acute and chronic liver diseases. Yet, the worldwide organ restriction and associated high mortality rates in organ transplantation waiting list has compelled referring to living donors in order to expand the donor pool. This paper explains liver transplantation indications from living donors, the surgical technique involved, the complications of the procedure and the medical treatments used.

Primary Sjögren's Syndrome Adversely Affects the Female Sexual Function Assessed by the Female Sexual Function Index: A Case-Control Study.

OBJECTIVES: This study aims to evaluate the sexual function of females with primary Sjögren's syndrome (pSS) in comparison to healthy females by using the Female Sexual Function Index (FSFI). PATIENTS AND METHODS: This case-control study included 31 female patients (mean age 46.0±10.2 years; range 30 to 68 years) with pSS and 27 healthy females (mean age 44.2±8.5 years; range 30 to 55 years) as control group. The sexual function of the participants was assessed by 19-item FSFI. RESULTS: Mean duration of pSS in the patient group was 35.9 months (range 3 to 264 months). Significantly higher number of pSS patients reported positive history for vaginal infection compared to controls (n=26, 83.9% vs. n=7, 25.9%, respectively; p<0.001) without any difference in endocervical culture result. Cervical smear assessment revealed more inflammation and atrophy in patient group compared to control group (p=0.001). Mean FSFI total score was significantly lower in patient group than control group (18.9±9.9 vs. 25.1±5.1, respectively; p=0.004). Similarly, five out of six domains of FSFI -arousal, lubrication, orgasm, satisfaction, and pain- were significantly lower in patient group. FSFI total and subscale scores, except for pain, were found to be negatively correlated with duration of pSS. CONCLUSION: The pSS causes sexual dysfunction in female patients. Furthermore, as disease duration increases, female sexual function decreases. Clinical management of female patients with pSS should cover the assessment of their sexual functionality and taking the necessary precautions to maintain satisfactory quality of life and treatment outcome.

The Ameliorative Effects of Pycnogenol® on Liver Ischemia-Reperfusion Injury in Rats.

OBJECTIVES: Pycnogenol® (PYC®), a standardized extract from the bark of Pinus maritima, consists of different phenolic compounds. PYC® has shown to have protective effects on chronic diseases such as diabetes, asthma, cancer, and immune disorders. The aim of this study was to determine the effects of PYC® against the DNA damage and biochemical changes in blood, liver, and lung tissues of ischemia-reperfusion (IR)-induced Wistar albino rats. MATERIALS AND METHODS: A sham group, IR injury-induced group, and IR+PYC® group were formed. Ischemia was induced and sustained for 45 min, then the ischemic liver was reperfused, which was sustained for a further 120 min at the end of this period. After anesthesia and before the IR inducement, 100 mg/kg PYC® was given to the IR+PYC® group through intraperitoneal injections. The total oxidant (TOS) and total antioxidant status (TAS), total thiol levels (TTL), advanced oxidation protein products (AOPP), and biochemical parameters [myeloperoxidase (MPO), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH)] in the rats were analyzed using spectrophotometric methods and DNA damage was assessed using single-cell gel electrophoresis. RESULTS: The levels of TOS, TTL, MPO, AOPP, ALT, AST, and LDH were significantly decreased in the IR+PYC® group compared with the IR group (p<0.05). The levels of TAS were significantly increased in the IR+PYC® group compared with the IR group (p<0.05). PYC® reduced the DNA damage when compared with the IR group (p<0.05). CONCLUSION: The present results suggest that PYC® treatment might have a role in the prevention of IR-induced oxidative damage by decreasing DNA damage and increasing antioxidant status.

Co-existence of cecal volvulus with situs inversus totalis: A case report.

Detorsion, cecopexy, cecostomy and tube cecostomy are the treatment options for acute cecal volvulus if there is no intestinal ischemia. Resection required if intestinal viability, necrosis, gangrene or perforation exists. After resection, primary anastomosis or ileostomy can be performed. First colonoscopic decompression testing may be appropriate in terms of saving time for elective surgery. The co-existance of situs inversus totalis with cecal volvulus may cause uncertainty of the definite diagnosis and delay of surgical procedure. This is a case report about cecal volvulus together with situs inversus totalis.

Effects of everolimus on a rat model of cerulein-induced experimental acute pancreatitis.

OBJECTIVE: To analyze the biochemical and histopathological effects of everolimus in an experimental rat model of cerulein-induced acute pancreatitis. The aim of the present study was to determine the effects of everolimus on blood biochemical parameters and tissue histopathology in an experimental rat model of cerulein-induced acute pancreatitis. MATERIAL AND METHODS: In 30 Wistar albino rats (male; 240-260 g), acute pancreatitis was induced by an intraperitoneal injection of cerulein (50 µg/kg) administered twice in 2 h. They were equally divided into the following three groups: 0.9% isotonic solution (Group 1; control), everolimus once (Group 2), and everolimus twice (Group 3) by oral gavage after cerulein injection. Thirty hours after the induction of pancreatitis, blood samples were collected by direct intracardiac puncture, rats were sacrificed, and pancreatic tissue samples were obtained. RESULTS: Biochemical analyses of the blood samples showed statistically significant difference in red blood cell count as well as hemoglobin, hematocrit, urea, and alanine transaminase levels among the study groups (p<0.05 in all). Everolimus proved to significantly increase red blood cell count in a dose-independent manner. Hemoglobin and hematocrit levels significantly increased only after treatment with one dose of everolimus. Urea level was significantly different between the Groups 2 and 3; however, no change was observed in both groups when compared with the control. Alanine transaminase level significantly decreased only after treatment with two doses of everolimus. Histopathological analyses revealed that everolimus significantly decreased inflammation and perivascular infiltrate in a dose-dependent manner (35% in Group 2, 75% in Group 3; p=0.048). CONCLUSION: Treatment with two doses of everolimus improved some biochemical and histopathological parameters of experimental rat models of cerulein-induced acute pancreatitis and implied the specific inhibition of inflammatory response pathways.

Effect of Intraoperative Valsalva Maneuver Application on Bleeding Point Detection and Postoperative Drainage After Thyroidectomy Surgeries.

The purpose of this paper was to analyze the effect of Valsalva maneuver application before finalizing thyroidectomy operations on the identification of bleeding points and postoperational drainage. One hundred patients (age range, 24-76 years) with multinodular goiter, recurrent multinodular goiter, toxic diffuse multinodular goiter, or papillary thyroid cancer were included in the study and were divided into 2 groups of 50 randomly. Both groups underwent thyroidectomy operation, only 1 group received intraoperative Valsalva maneuver application (twice, 30 seconds of 30-cm PEEP). The size of the thyroid gland, the duration of operation, hospital stay, and drain usage were reported. Postoperational occurrences of drainage, hematoma, reoperation, and additional complications were compared between the groups. Valsalva maneuver application helped to identify minor bleeding points in 32% of the cases. There was no significant difference between the study groups regarding the thyroid gland size, operation duration, hospital stay, and the duration of drain usage (P > 0.05 for all). The amount of drainage as well as the frequencies of hematoma, reoperation, and further complications was not significantly different between the study groups (P > 0.05 for all). Intraoperative application of Valsalva maneuver is only useful to detect minor bleeding points in some patients during thyroidectomy operations, but it had no effect on the duration of postoperative drain usage, the amount of drainage, and risk of hematoma. Therefore, intraoperative application of Valsalva maneuver has no beneficial effect on postoperative hemorrhagic complication after thyroidectomy operations.

Well-differentiated abdominal liposarcoma: experience of a tertiary care center.

BACKGROUND: We presented abdominal liposarcoma cases diagnosed and managed in a tertiary care center and also conducted a literature review on main features of this tumor. METHODS: Chart reviews of eight cases were conducted, and clinical, surgical, histopathological, and follow-up data were recorded. RESULTS: Overall, complete surgical resection was performed with adjacent organ resection in 25% of cases, and radiotherapy was not administered. Recurrence was developed in only one case and died after 2 years and 3 months, and other cases are under follow-up without recurrence. Histopatological examinations revealed findings of well-differentiated liposarcoma. CONCLUSIONS: According to our surgical experience, the surgical margin positivity may not be a determining factor for the survival of patients with well-differentiated liposarcoma, and in the absence of macroscopic invasion, adjacent organ resection may not be required. Radiotherapy may not be preferred when complete resection of abdominal mass was achieved.

Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis.

OBJECTIVES: To determine the serum and tissue levels of markers of impaired oxidative metabolism and correlate these levels with the histopathology and Alvarado score of acute appendicitis patients. METHOD: Sixty-five acute appendicitis patients (mean age, 31.4±12.06 years; male/female, 30/35) and 30 healthy control subjects were studied. The Alvarado score was recorded. Serum samples were obtained before surgery and 12 hours postoperatively to examine the total antioxidant status, total oxidant status, paraoxonase, stimulated paraoxonase, arylesterase, catalase, myeloperoxidase, ceruloplasmin, oxidative stress markers (advanced oxidized protein products and total thiol level) and ischemia-modified albumin. Surgical specimens were also evaluated. RESULTS: The diagnoses were acute appendicitis (n = 37), perforated appendicitis (n = 8), phlegmonous appendicitis (n = 12), perforated+phlegmonous appendicitis (n = 4), or no appendicitis (n = 4). The Alvarado score of the acute appendicitis group was significantly lower than that of the perforated+phlegmonous appendicitis group (p = 0.004). The serum total antioxidant status, total thiol level, advanced oxidized protein products, total oxidant status, catalase, arylesterase, and ischemia-modified albumin levels were significantly different between the acute appendicitis and control groups. There was no correlation between the pathological extent of acute appendicitis and the tissue levels of the markers; additionally, there was no correlation between the tissue and serum levels of any of the parameters. CONCLUSIONS: The imbalance of oxidant/antioxidant systems plays a role in the pathogenesis acute appendicitis. The Alvarado score can successfully predict the presence and extent of acute appendicitis.

Oxidative Stress and Lipid Peroxidation in the Ischemic Small Intestine: Pathological and Biochemical Evaluation in a Rat model of Superior Mesenteric Ischemia.

The purpose of our study was to evaluate the role of oxidative stress and lipid peroxidation in acute mesenteric ischemia. Thirty male Wistar albino rats weighing 240-260 g were randomized into control (no operation), sham (operation without ischemia), and ischemia groups. To induce ischemia, the superior mesenteric artery was sutured. Total antioxidant and oxidant capacity and lipid peroxidase activity were measured in blood samples collected at 0 min, 60 min, and 240 min, and the pathology of ileum segments resected at 240 min was evaluated. Total oxidant status did not differ among the groups. Total antioxidant status increased significantly with time in the ischemia group compared to the control and sham groups (P < 0.001). Although basal arylesterase activity was lower in the ischemia group than controls (P < 0.05), post-ischemia values were similar among the groups. Similarly, basal and stimulated paraoxonase activity in blood samples did not differ among the groups. In conclusion, oxidative stress and lipid peroxidation have no significant role in the pathophysiology of acute mesenteric ischemia.

Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis

OBJECTIVES: To determine the serum and tissue levels of markers of impaired oxidative metabolism and correlate these levels with the histopathology and Alvarado score of acute appendicitis patients. METHOD: Sixty-five acute appendicitis patients (mean age, 31.4±12.06 years; male/female, 30/35) and 30 healthy control subjects were studied. The Alvarado score was recorded. Serum samples were obtained before surgery and 12 hours postoperatively to examine the total antioxidant status, total oxidant status, paraoxonase, stimulated paraoxonase, arylesterase, catalase, myeloperoxidase, ceruloplasmin, oxidative stress markers (advanced oxidized protein products and total thiol level) and ischemia-modified albumin. Surgical specimens were also evaluated. RESULTS: The diagnoses were acute appendicitis (n = 37), perforated appendicitis (n = 8), phlegmonous appendicitis (n = 12), perforated+phlegmonous appendicitis (n = 4), or no appendicitis (n = 4). The Alvarado score of the acute appendicitis group was significantly lower than that of the perforated+phlegmonous appendicitis group (p = 0.004). The serum total antioxidant status, total thiol level, advanced oxidized protein products, total oxidant status, catalase, arylesterase, and ischemia-modified albumin levels were significantly different between the acute appendicitis and control groups. There was no correlation between the pathological extent of acute appendicitis and the tissue levels of the markers; additionally, there was no correlation between the tissue and serum levels of any of the parameters. CONCLUSIONS: The imbalance of oxidant/antioxidant systems plays a role in the pathogenesis acute appendicitis. The Alvarado score can successfully predict the presence and extent of acute appendicitis. .