Fournier's gangrene current approaches.

Fournier's gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi-Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi-Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi-Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients.

Protective effect of propolis in protecting against radiation-induced oxidative stress in the liver as a distant organ.

Stresses caused by ionizing radiation can also damage tissues and organs through the circulatory system. In this study, we aimed to determine the radioprotective effect of propolis, a natural and powerful antioxidant product, against oxidative liver damage caused by cranial irradiation. Thirty-two male albino Sprague-Dawley rats, divided into four groups, were designed as sham group, irradiation (IR) group, propolis plus IR, control group of propolis. Biochemical parameters were measured in liver tissue of rats. While Total enzymatic superoxide scavenging activity (TSSA) and non-enzymatic superoxide scavenging activity (NSSA), glutathione peroxidase (GSH-Px) activities of all groups were statistically significantly higher than rats receiving only-irradiation, Glutathione-S-transferase (GST) activity in the IR group was significantly lower than in the sham control group and IR + propolis group. Superoxide dismutase (SOD) activity in the IR group was found to be significantly higher than both the sham control group and the propolis control group, but lower than the IR + propolis group. Malondialdehyde level and xanthine oxidase activity were higher in the IR group than in the other groups. Compared to the sham control group, in the group treated with propolis, a significant elevation in antioxidant parameters, specifically TSSA, NSSA, SOD, and GST activities, was noted, with corresponding increases of 32.3%, 23.2%, 47.6%, and 22.6%, respectively. Our findings show that propolis can be a radioprotective agent against ionized radiation damage by increasing antioxidant activity and reducing oxidant stress in liver tissue.

Nidogen-2: A new biomarker in colon cancer patients.

AIM: In the present study, we followed Nidogen-2 levels and clinicopathological parameters of patients with colon cancer. MATERIAL AND METHODS: Eighty-eight patients (F/M, 43/45; Mean age ± SD, 57.86 ± 1.78 years) were included. The results of serum Nidogen-2 levels were shown with respect to stage, gender, age, and metastasis. Nidogen-2 levels in the sera of colon cancer patients and healthy donors were analyzed with ELISA. RESULTS: The expression levels were significantly higher in patients (1010.8 ±184.36 pg/mL) than in healthy subjects (51.85 ± 1.44 pg/mL; p<0.001). Moreover, the Nidogen-2 expression significantly increased in the clinical stages of colon cancer (p<0.01). The Nidogen-2 levels did not vary by patient age or gender. DISCUSSION: Under normal conditions, Nidogen-2 is a basal membrane protein. Nidogen-2 is primarily expressed in the extracellular matrix. Nidogen-2 has been defined as a major means to analyze the molecular pathways involved in cancer development and progression. Besides its important functions, it has been hypothesized that secreted Nidogen-2 may be a diagnostic biomarker for cancer detection. CONLUSION: These findings suggest that increased expression of Nidogen-2 may have great pathological importance in the development of colon cancer and may also show a diagnostic value for colon cancer. KEY WORDS: Angiogenesis, Metastasis, Nidogen-2.

Increased oxidant stress and decreased antioxidant status in erythrocytes of rats fed with zinc-deficient diet.

The aim of this study was to evaluate the lipid peroxidation, nitric oxide (NO), and free radical scavenging enzyme activities in erythrocytes of zinc (Zn)-deficient rats and to investigate the relationship among these parameters in either group. Sixteen male rats with a weight of 40-50 g were used for the experiment. The rats were divided into control (n = 8) and Zn-deficient groups. At the end of the experiment, the animals were anesthetized with ketamine-HCl (Ketalar, 20 mg/kg(-1), i.p.), and the blood was collected by cardiac puncture after thoracotomy. Blood samples were collected in vacutainer tubes without and with K(3)-EDTA as anticoagulant. Erythrocyte catalase (CAT), glutathione peroxidase (GSH-Px), glutathione reductase (GRD), glutathione-S-transferase (GST), superoxide dismutase (SOD) activities, total (enzymatic plus nonenzymatic) superoxide scavenger activity (TSSA), nonenzymatic superoxide scavenger activity (NSSA), antioxidant potential (AOP), and serum zinc (Zn) values in the Zn-deficient group were significantly lower than those of the control group, whereas NO and malondialdehyde (MDA) levels were significantly higher than those of the control group. The results show that Zn deficiency causes a decrease in antioxidant defense system and an increase in oxidative stress in erythrocyte of rats.

Intraoperative Endoscopic Retrograde Cholangiopancreatography in patients with complex benign biliary tract pathologies A case series.

INTRODUCTION: This study presents data about the intraoperative performance of Endoscopic Retrograde Cholangiopancreatography (ERCP) for different types of cases with acute, complex pathologies of the biliary tract. MATERIALS AND METHODS: We retrospectively enrolled cases with intraoperative ERCP performed for different acute complex bile duct pathologies (including injury and cystic stump leak). All patients were analyzed according to demographic findings, etiologies, management and results. RESULTS: Intraoperative ERCP was performed in 4 patients of whom 2 (50%) were female and 2 (50%) were male with different diagnoses. The median age of patients was 46.8 (range of 28-75) years. The diagnosis was bile duct injury in three patients and one had a complicated hydatid cyst with jaundice (T Bil: 18 mg dl-1). All patients were in septic condition. Patients underwent laparotomy and intraoperative ERCP was performed successfully by using the Rendezvous technique. For the last patient, intraoperative ERCP was used for diagnosis and management of bile leak in the cavity. CONCLUSION: Intraoperative endoscopic retrograde cholangiopancreatography is a safe and effective method for treatment of acute complex bile duct pathologies. KEY WORDS: Bile Duct Injury, Intraoperative ERCP, Rendezvous Technique.

Does protocatechuic acid, a natural antioxidant, reduce renal ischemia reperfusion injury in rats?

BACKGROUND: Protocatechuic acid (PCA), which has antioxidant property, is a simple phenolic compound commonly found in many plants, vegetables, and fruits, notably in green tea and almonds. Present study was an investigation of the effects of PCA on rat kidney with ischemia/reperfusion (IR) injury. METHODS: Sprague-Dawley rats were randomly divided into 4 groups: (1) Sham, (2) Renal IR, (3) Renal IR+Vehicle, and (4) Renal IR+PCA. Renal reperfusion injury was induced by clamping renal pedicle for 45 minutes after right nephrectomy was performed, followed by reperfusion for 3 hours. Dose of 80 mg/kg PCA was intraperitoneally administered to 1 group immediately before renal ischemia; 33% polyethylene glycol was used as vehicle. Total antioxidant status (TAS), malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor alpha (TNF-α), and interleukin-6 levels were measured in blood and kidney tissue samples taken from sacrificed rats. Kidney tissue samples were examined and scored histopathologically. Terminal deoxynucleotidyltransferase-mediated dUTP digoxigenin nick end labeling assay method was used to detect apoptotic cells. RESULTS: It was found that PCA significantly reduced serum MDA, TNF-α, and kidney MDA levels, while it increased serum and kidney TAS and SOD levels. Histopathological scores were significantly higher for the group given PCA. CONCLUSION: PCA reduced oxidative stress and can be used as an effective agent in treatment of renal IR injury.

L-carnitine has a protective effect on the colonic mucosa during abdominopelvic radiotherapy in rats.

PURPOSE:: To evaluate histopathologically the radioprotective effect of L-carnitine on the colonic mucosa in rats undergoing abdominopelvic irradiation. METHODS:: Thirty-two rats were randomly assigned to four experimental groups: intraperitoneal administration of normal saline (group 1) or L-carnitine (300 mL/kg; group 2), followed in groups 3 and 4, respectively, by one dose of abdominopelvic radiation (20 Gy) 30 min later. Rats were sacrificed 5 days after radiation, and their descending colons were resected for histopathological evaluation of the presence and severity of damage. RESULTS:: Average damage scores did not differ significantly between groups 1 and 2 (0.13 ± 0.35 and 0.25 ± 0.46, respectively); the group 3 score was highest (10.25 ± 0.71), and the group 4 score (3.63 ± 1.41) was significantly lower than that of group 3 (both p = 0.0001). Pre-radiation L-carnitine administration significantly reduced mucosal thinning, crypt distortion, reactive atypia, inflammation, cryptitis, and reactive lymph-node hyperplasia (all p < 0.01). CONCLUSIONS:: L-carnitine had a radioprotective effect on rat colonic mucosa. L-carnitine use should be explored for patients with gastrointestinal cancer, who have reduced serum L-carnitine levels.

The radio-protective effects of caffeic acid phenethyl ester and thymoquinone in rats exposed to total head irradiation.

BACKGROUND: Many cancer patients treated with radiotherapy suffer severe side effects during and after their treatment. The aim of this study was to investigate the effects of irradiation and the addition of caffeic acid phenethyl ester (CAPE) and thymoquinone (TQ) on the oxidant/antioxidant system in the liver tissue of irradiated rats. METHODS: A total of 40 Sprague-Dawley rats were divided into five groups to test the radioprotective effectiveness of thymoquinone and caffeic acid phenethyl ester administered by intraperitoneal injection. Appropriate control groups were also studied. RESULTS: While liver tissue total oxidant status, lipid hydroperoxide level, and oxidative stress index were significantly increased in the irradiated (IR) group, compared with other groups, total antioxidant status, sulfhydryl levels, and paraoxonase (PON) activity were significantly decreased. Ceruloplasmin activity in IR plus TQ and IR groups was higher than the control group. Arylesterase and PON activities in IR plus TQ- and IR plus CAPE-supplemented groups were lower than those of control groups. CONCLUSIONS: TQ and CAPE decrease oxidative stress markers and have antioxidant effects, which also augment antioxidant capacity in the liver tissue of irradiated rats.

Antioxidant Activity of Syringic Acid Prevents Oxidative Stress in l-arginine-Induced Acute Pancreatitis: An Experimental Study on Rats.

The aim of this study was to investigate the possible protective role of antioxidant treatment with syringic acid (SA) on l-arginine-induced acute pancreatitis (AP) using biochemical and histopathologic approaches. A total of 30 rats were divided into 3 groups. The control group received normal saline intraperitoneally. The AP group was induced by 3.2 g/kg body weight l-arginine intraperitoneally, administered twice with an interval of 1 hour between administrations. The AP plus SA group, after having AP induced by 3.2 g/kg body weight l-arginine, was given SA (50 mg kg(-1)) in 2 parts within 24 hours. The rats were killed, and pancreatic tissue was removed and used in biochemical and histopathologic examinations. Compared with the control group, the mean pancreatic tissue total oxidant status level, oxidative stress index, and lipid hydroperoxide levels were significantly increased in the AP group, being 30.97 ± 7.13 (P < 0.05), 1.76 ± 0.34 (P < 0.0001), and 19.18 ± 4.91 (P < 0.01), respectively. However, mean total antioxidant status and sulfhydryl group levels were significantly decreased in the AP group compared with the control group, being 1.765 ± 0.21 (P < 0.0001) and 0.21 ± 0.04 (P < 0.0001), respectively. SA reduces oxidative stress markers and has antioxidant effects. It also augments antioxidant capacity in l-arginine-induced acute toxicity of pancreas in rats.

The Effect of Systemic Carnitine Administration on Colon Anastomosis Healing in an Experimental Sepsis Model.

AIM: This study aimed to investigate the effects of L-carnitine, with its known antioxidant properties and positive effects on wound healing, on the healing of colon anastomosis in a cecal ligation and puncture sepsis model in rats. MATERIALS AND METHODS: A total of 40 Sprague-Dawley rats were used. The rats were randomly divided into four groups of 10 (n = 10). Groups 1 and 2 had laparotomy and colon anastomosis performed. Groups 3 and 4 had cecal ligation and puncture (CLP) and colon anastomosis performed. Rats in Groups 1 and 3 were given 15 mL/kg intraperitoneal 0.9% isotonic NaCl, while the rats in Groups 2 and 4 were given 100 mg/kg intraperitoneal L-carnitine. On the postoperative fifth day, the rats were sacrificed and the burst pressure of anastomosis, histopathological effects, and tissue hydroxyproline levels were investigated. RESULTS: In Groups 2 and 4, the anastomosis burst pressure and histopathological results in both noninfected abdomen and presence of peritonitis were statistically high compared to the control group (p < 0.05). Though the hydroxyproline levels were also high, there was no statistically significant difference for this parameter (p > 0.05). CONCLUSIONS: The findings obtained from the experimental sepsis model showed that healing of anastomosis in both the presence of peritonitis and noninfected abdomen was positively affected by the systemic administration of L-carnitine and this may contribute to the safety of anastomosis.

Radioprotective effects of Nigella sativa oil against oxidative stress in liver tissue of rats exposed to total head irradiation.

OBJECTIVE: Many cancer patients treated with radiotherapy suffer severe side effects during and after their treatment. The aim of this study was to investigate the effects of irradiation and the addition of Nigella sativa oil (NSO) on the oxidant/antioxidant system in the liver tissue of irradiated rats. METHODS: A total of 24 Sprague-Dawley rats were randomly distributed into three groups of equal numbers. The control group received neither NSO nor irradiation but received 1-ml saline orally. The irradiation group (IR) received total head 5 gray (Gy) of gamma irradiation as a single dose, plus 1-ml saline orally. The IR plus NSO group received both total head 5 Gy of gamma irradiation as a single dose and 1 g/kg/day NSO orally through an orogastric tube starting one hour before irradiation and continuing for 10 days. RESULTS: While liver tissue total oxidant status (TOS), lipid hydroperoxide (LOOH) level, and oxidative stress index (OSI) were significantly increased in the IR group compared to the control group, total antioxidant status (TAS), sulfhydryl (-SH) levels, and PON activity were significantly decreased. Cp activity in the IR plus NSO and IR groups was higher than in the control group. ARYL activity in the IR plus NSO supplemented group was higher than that in other groups. CONCLUSIONS: NSO reduces oxidative stress markers and has antioxidant effects, which also augments the antioxidant capacity in the liver tissue of rats.

Drug-induced esophageal ulcers: case series and the review of the literature.

BACKGROUNDS/AIMS: Drugs can cause several complications in the esophagus and lead to pill esophagitis. In this paper, our purpose is to share our clinical experience in light of the literature and put forward the general characteristics of pill esophagitis. MATERIALS AND METHODS: In our clinic, between January 2008 and June 2012, by excluding other factors, 48 patients were included in the study, diagnosed as drug-induced esophagitis with their history, endoscopic view, and histopathologic evaluation. RESULTS: There were 34 (70.9%) female and 14 (29.1%) male patients in the study, and their average ages were 35.1 and 32.4, respectively. Clinical symptoms were odynophagia (79.1%), retrosternal pain (62.5%), and dysphagia (47.9%). The reason for these symptoms for 85.5% of the patients was related to insufficient water consumption while taking the pill, taking the pill in recumbent position, or both. Tetracycline and its variant, doxycycline, were responsible for 52% of the patients, and 62.5% of the drugs were in capsule form. Ulcers were at the proximal and middle third of the esophagus in 79.2% of the patients. In the histopathologic evaluation, nonspecific acute inflammatory changes were found in 29.1% of the cases. Various proton pump inhibitors and sucralfate were used in the treatment. While no perforation and structure were detected, 1 patient died because of repetitive arterial bleeding. CONCLUSION: Almost every kind of drug, particularly doxycycline, can cause ulcer in the esophagus. Pill esophagitis can be prevented by warning patients about drinking water sufficiently and sitting up while taking the pill.

Agenesis of isthmus of the thyroid gland in a patient with graves-basedow disease and a solitary nodule.

The thyroid is a vascular endocrine gland with two lateral lobes connected by a narrow, median isthmus. Although a wide range of congenital anomalies of the thyroid gland has been reported in the literature, agenesis of the thyroid isthmus is a very rare congenital anomaly. Thyroid isthmus agenesis does not manifest clinical symptoms, and it can be confused with other thyroid pathologies. We describe a patient with no isthmus of the thyroid, associated with Graves-Basedow disease. Thyroid isthmus agenesis should be kept in mind in order for surgical procedures involving thyroid pathologies to be carried out safely.

Perianal giant condyloma acuminatum-buschke-löwenstein tumor: a case report.

Condyloma acuminatum caused by Human Papillomavirus is the most commonly occurring sexually transmitted infection in the anogenital region. Buschke-Löwenstein tumor (BLT) known also as giant condyloma acuminatum is a rare disease. The disease, for which the most important treatment method is the surgical excision, differs from normal condyloma acuminatum cases with its high degree of malignancy. The purpose of this paper is to present the case that reached huge dimensions in the perianal region and that was treated with wide resection in the literature.

Impact of lymph node metastases in esophageal carcinoma patients is independent of patient age.

OBJECTIVE: The purpose of the present study was to define the clinicopathological features and prognosis of esophageal cancer. METHODS: Between 2004 and 2009, 128 patients with esophageal cancer were enrolled in a retrospective database and divided into two groups on the basis of number positive lymph nodes with the cut-off as four. RESULTS: The findings for 18 patients (14.0%) Group A were compared with those of 110 patients Group B. In the group A, there were significantly more women (12/6 vs. 54/56, P < 0.001). In both groups, the most frequent histological morphology was squamous cell carcinoma (83% and 75%, respectively), although the percentages were significantly different (P < 0.005). In the group A, lesions were more frequently located in the middle one-third of the esophagus than in the group B (61% vs. 28%, P < 0.001). Group A was more likely to be Stage IIa. Survival rates in group A patients at 5 years after resection were 15.8%, similar to those in group B patients (12.1%, difference not significant). Local lymph node metastases and microscopic residual tumor at the line of resection were also more prevalent in the young patients, but not to a statistically significant degree. CONCLUSIONS: These findings suggested that the clinical and pathologic features of carcinomas of the esophagus in young patients do not significantly differ from those in older patients.

L-carnitine has a protective effect on the colonic mucosa during abdominopelvic radiotherapy in rats

ABSTRACT PURPOSE: To evaluate histopathologically the radioprotective effect of L-carnitine on the colonic mucosa in rats undergoing abdominopelvic irradiation. METHODS: Thirty-two rats were randomly assigned to four experimental groups: intraperitoneal administration of normal saline (group 1) or L-carnitine (300 mL/kg; group 2), followed in groups 3 and 4, respectively, by one dose of abdominopelvic radiation (20 Gy) 30 min later. Rats were sacrificed 5 days after radiation, and their descending colons were resected for histopathological evaluation of the presence and severity of damage. RESULTS: Average damage scores did not differ significantly between groups 1 and 2 (0.13 ± 0.35 and 0.25 ± 0.46, respectively); the group 3 score was highest (10.25 ± 0.71), and the group 4 score (3.63 ± 1.41) was significantly lower than that of group 3 (both p = 0.0001). Pre-radiation L-carnitine administration significantly reduced mucosal thinning, crypt distortion, reactive atypia, inflammation, cryptitis, and reactive lymph-node hyperplasia (all p < 0.01). CONCLUSIONS: L-carnitine had a radioprotective effect on rat colonic mucosa. L-carnitine use should be explored for patients with gastrointestinal cancer, who have reduced serum L-carnitine levels.

Multidrug resistant typhoid fever outbreak in Ercek Village-Van, Eastern Anatolia, Turkey: clinical profile, sensitivity patterns and response to antimicrobials.

The present study discusses the clinical features and treatment outcomes during an outbreak caused by multidrug resistant (MDR) Salmonella typhi isolates from Van, Turkey. Of the 867 typhoid fever patients from the same village, 154 (17.8%) were hospitalised. A total of 42 (27.3%) cultures were positive. All S. typhi isolates were resistant to chloramphenicol, ampicillin and co-trimoxazole. Ceftriaxone was the most commonly used antibiotic (89%). It was found that the time-to-fever defervescence and the length of the hospital stay were greater for patients who were treated by ciprofloxacin than ceftriaxone (P < 0.001). Inappropriate antibiotic treatment should be discouraged in order to prevent the development of resistant strains of S. typhi.