Mitochondrial Common Deletion Level in Adipose Tissue Is Not Associated with Obesity but Is Associated with a Structural Change in Triglycerides as Revealed by FTIR Spectroscopy.

OBJECTIVE: Several studies have shown that mitochondrial metabolism may be disrupted if the rate of the specific 4,977 bp deletion of mitochondrial DNA (mtDNA) reaches a threshold. This study aimed to investigate the possible associations between the mtDNA4977 deletion load and obesity-related metabolic abnormalities in the adipose tissue. METHODS: The study included thirty obese individuals, who underwent bariatric surgery, and twelve control subjects. mtDNA4977 deletion, adenine nucleotides, and lactate levels, which show the bioenergetic status were evaluated in visceral adipose tissues. Fourier transform infrared (FTIR) spectroscopy was used to investigate the structural variations and composition of adipose tissues in the context of deletion load. RESULTS: There were no differences between the two groups in terms of mtDNA4977 deletion, adenine nucleotides, and lactate levels. The FTIR spectra indicated a few obesity-related alterations in adipose tissues that were not related to the mtDNA deletion load. Also, statistical analysis showed a correlation between the deletion load and a band shift of 1,744 cm-1, which assigns C = O stretching of the carbonyl group of the ester group in triglycerides and other esterified fatty acids, although it is not associated with obesity. CONCLUSIONS: Our data suggest that the mtDNA4977 deletion in visceral adipose tissues of obese individuals do not have a significant impact on the bioenergetic status. However, the increased accumulation of deletion may be associated with a specific change in the ester bond, indicating structural differences in the lipids. These findings shed light on our understanding of the tissue-specific distribution of mtDNA deletions and obesity-related adipose tissue pathogeneses.

Investigation of Obesity-Related HAdV-36 in NAFLD Patients: a Case-Control Study.

BACKGROUND: HAdV-36 leads to adipocyte proliferation of adipose tissue through E4orf1 gene, leading to the development of obesity and related diseases. We aimed to investigate the presence and any association of HAdV-36 in non-alcoholic fatty liver disease (NAFLD) patients Methods: The patient group was composed of 116 patients; 30 obese patients with NAFLD (BMI > 30 kg/m2), 30 patients with Diabetes Mellitus (DM)+NAFLD (BMI > 30 kg/m2), 16 patients with NAFLD (BMI < 30 kg/m2), and operated obese group with NAFLD (BMI > 30 kg/m2). The control group comprised 81 non-obese healthy adults. Liver adipose tissue samples were obtained in 30 operated NAFLD patients. HAdV-36-DNA, HAdV-36 neutralizing antibodies, serum lipid, and adipokine levels were analyzed. RESULTS: HAdV-36 neutralizing antibodies (HAdV-36 Ab-positive) were detected in 10/116 and 2/81 participants in the study and control groups, respectively; the difference was statistically significant (p < 0.005). LDL, total cholesterol but not adipokine levels were found to be significantly higher in HadV-36 Ab-positive patients (p < 0.05). While HAdV-36 was identified as a risk factor with OR = 4.11 in univariate analyses, there was no significant difference in binary logistic regression analysis. HAdV-36-DNA was detected in the adipose tissue samples of two patients. CONCLUSIONS: We suggest that the presence of HAdV-36 may lead to the development of obesity with the increase in adipose tissue, and diseases such as hyperlipidemia, NAFLD, DM, and metabolic syndrome may develop on the basis of chronic inflammation caused by obesity. Thus, HAdV-36 may be a plausible risk factor for the development of NAFLD.

Original contribution: sleeve gastrectomy reduces soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) levels in patients with morbid obesity.

BACKGROUND: Early diagnosis of subclinical cardiovascular disease (CVD) in patients with morbid obesity is important. We investigated the effects of sleeve gastrectomy (SG) on serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1), oxidized LDL (oxLDL), and other metabolic and inflammatory parameters associated with atherosclerosis in patients with morbid obesity. METHODS: Body mass index (BMI) measurements and assays of metabolic and inflammatory markers were taken in patients in an SG surgery group and a healthy control group and compared at baseline and 12 months after SG. Correlations with changes in these parameters and variations in sLOX-1 were analyzed. RESULTS: Metabolic and inflammatory marker values in the surgery (n = 20) and control (n = 20) groups were significantly different at baseline (p < 0.001). The majority of surgery group biomarker levels significantly decreased with mean BMI loss (- 11.8 ± 9.0, p < 0.001) at 12 months, trending toward control group values. Baseline albumin level as well as percentage reductions in oxLDL and the cholesterol retention fraction (CRF) were found to be significantly correlated with percentage reduction in sLOX-1 at 12 months following SG. CONCLUSION: Metabolic and inflammatory biomarkers elevated at baseline significantly decreased after SG weight loss. Weight loss induced by SG may limit endothelial damage by reducing levels of oxLDL and LOX-1 as assessed by sLOX-1. These findings suggest that sLOX-1 may function as a marker of atherosclerotic disease states in patients with morbid obesity and that metabolic/bariatric surgery can play a meaningful role in CVD prevention.

The effects on oxidative DNA damage of laparoscopic gastric band applications in morbidly obese patients.

BACKGROUND: Obesity may induce oxidative stress, causing oxidative damage of DNA. We examined associations between decreasing serum and urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels and weight loss in morbidly obese patients before and 6 months after laparoscopic adjustable gastric banding (LAGB). METHODS: We compared patients who had surgery for morbid obesity with healthy, nonobese controls. Urine and fasting blood samples were collected once from the controls and from the morbidly obese patients before and 6 months after the LAGB. The serum and urinary 8-OHdG levels were evaluated in these groups using an enzyme-linked immunosorbent assay kit. RESULTS: We included 20 patients who had surgery for morbid obesity (8 men, 12 women, mean body mass index [BMI] 46.82 ± 4.47) and 20 healthy, nonobese people (10 men, 10 women, mean BMI 22.52 ± 2.08) in our study. There was no significant difference in serum 8-OHdG levels between the groups, whereas urinary 8- OHdG levels were significantly higher in morbidly obese patients than in controls. Weight, BMI and serum and urinary 8-OHdG levels were significantly decreased in morbidly obese patients 6 months after LAGB. CONCLUSION: The LAGB provides efficient weight loss in patients with morbid obesity. The systemic oxidative DNA damage was increased by the morbid obesity, but this increase was not related to weight gain, and it was more evident in serum than urine samples. After LAGB for morbid obesity, the oxidative DNA damage declined both in serum and urine.

CONTEXTE: L'obésité peut provoquer stress oxydatif qui endommage l'ADN. Nous avons analysé les liens entre une baisse des taux de 8-OHdG (8-hydroxy-2'-désoxyguanosine) sériques et urinaires et la perte de poids chez des patients atteints d'obésité morbide avant, puis 6 mois après la pose d'un anneau gastrique ajustable par laparoscopie (AGAL). MÉTHODES: Nous avons comparé des patients qui ont subi cette chirurgie pour un problème d'obésité morbide à des témoins non obèses en bonne santé. Nous avons prélevé des échantillons d'urine et de sang à jeun chez les témoins 1 fois et chez les patients atteints d'obésité morbide, avant, puis 6 mois après l'intervention pour AGAL. Les taux de 8-OHdG sériques et urinaires ont été mesurés dans les 2 groupes à l'aide d'une trousse de test ELISA (enzyme-linked immunosorbent assay). RÉSULTATS: Notre étude a inclus 20 patients soumis à la chirurgie pour obésité morbide (8 hommes, 12 femmes; indice de masse corporelle [IMC] moyen 46,82 ± 4,47) et 20 témoins non obèses en bonne santé (10 hommes, 10 femmes; IMC moyen 22,52 ± 2,08). Nous n'avons noté aucune différence significative des taux de 8-OHdG sériques entre les 2 groupes, mais les taux de 8-OHdG urinaires étaient significativement plus élevés chez les patients souffrant d'obésité morbide que chez les témoins. Le poids, l'IMC et les taux de 8-OHdG sériques et urinaires avaient significativement diminué chez les patients atteints d'obésité morbide 6 mois après l'intervention pour AGAL. CONCLUSION: L'AGAL est une technique efficace de perte de poids chez les patients souffrant d'obésité morbide. L'atteinte oxydative systémique de l'ADN était exacerbée par l'obésité morbide, mais cette hausse n'était pas reliée au gain pondéral, et elle était plus évidente dans les échantillons sériques que dans les échantillons urinaires. Après la pose d'un AGAL pour obésité morbide, l'atteinte oxydative de l'ADN a diminué dans le sérum et dans l'urine.

Laparoscopic mini-gastric bypass versus laparoscopic sleeve gastrectomy in metabolic surgery A single center experience.

AIM: The safety and effectiveness of MGB versus LSG remain unclear. In this study, we It has been shown by many clinical studies that laparoscopic sleeve gastrectomy (LSG) and mini-gastric bypass (MGB), two current methods in metabolic surgery, may be alternatives to Roux-en-Y gastric aimed to compare the postoperative outcomes of MGB and LSG procedures performed in bariatric surgery. MATERIAL METHODS: A total of 175 patients who underwent MGB and LSG surgery between 2016 and 2018 at a single metabolic surgery center were analyzed retrospectively. Two surgical procedures were compared in terms of the perioperative, early and late postoperative outcomes. RESULTS: There were 121 patients in the MGB group and 54 patients in the LSG group. No significant difference was found between the groups regarding the operating time, the conversion to open surgery and the early postoperative complications (p>0.05). The length of hospital stay was significantly shorter in the MGB group (p:0.001). The excess weight loss (EWL%) and total weight loss (TWL%) were significantly higher in the MGB group (90.3 vs. 79.2; and 36.4 vs 30.5, respectively). No significant difference was found between the two groups in terms of the remission rates of comorbidities. The symptoms of gastroesophageal reflux were observed in a significantly fewer number of the patients in the MGB group (6 patients 4.9% vs. 10 patients 18.5%). CONCLUSIONS: Both LSG and MGB are effective, reliable, and useful methods in metabolic surgery. The MGB procedure is superior to the LSG in terms of the length of hospital stay, EWL%, TWL% and the postoperative gastroesophageal reflux symptoms. KEY WORDS: Metabolic surgery, Mini gastric bypass, Postoperative outcomes, Sleeve gastrectomy.

Factors affecting the development of complications in Crohn's disease in patients undergoing intestinal resection.

Surgery is a common form of management for Crohn disease (CD) in the presence of intra-abdominal complications. In this study, we investigated the effect of various factors on the development of postoperative complications in patients who underwent surgery for complicated CD. Patients who underwent surgery between 2011 and 2018 were included in this study. Information on age, sex, presence of extraintestinal findings, operation indications, operation type, and postoperative complications was obtained. Groups with and without postoperative complications were compared according to body mass index, American Society of Anesthesiologists score, comorbidities, smoking status, preoperative drug use, presence of perianal disease, presence of a stoma, synchronous small intestine resection surgery, duration of hospital stay, and preoperative biochemical parameters. A total of 192 patients were included, of which 53.1% were female and 46.9% were male. Patients were indicated for surgery for reasons such as stricture, abscess, fistula, and tumor development. As the surgical method, patients were operated on by open or laparoscopic method (86% and 14%, respectively). Postoperative complications occurred in 30 female and 33 male patients (15.6% and 17.1%, respectively). Patient age, smoking status, steroid use, perianal disease, presence of stoma, and presence of extra intestinal findings were significantly higher in the complicated group. Surgery may be inevitable for CD in the presence of complications. In cases of patient age, smoking, steroid use, perianal disease, stoma opening, and presence of extra intestinal findings, patients with CD who undergo surgery should be followed up closely in terms of the development of complications.

Clinicopathological features and management of colonic lipomas: Case reports.

INTRODUCTION: Colonic lipomas are benign tumors of adipose tissue that are often asymptomatic, but they may present with rectal bleeding or obstructive symptoms. These tumors are unique in that they are rarely encountered within the gastrointestinal system and can mimic malignant tumors in appearance. Surgical resection and endoscopic removal of tumors have been shown to be successful in their management. PATIENT CONCERNS: In this report, we present 3 cases of colonic lipomas, 2 of which are located in the cecum and the other within the sigmoid colon. The presenting symptoms of the patients included abdominal pain, constipation, and dyspepsia. DIAGNOSIS: Patients typically presented with anemia and an elevated C-reactive protein count. Colonoscopic and computerized tomography findings were used for diagnosis. INTERVENTIONS: Hemicolectomy was performed, depending on the localization, and the pathologic specimens were consistent with lipoma. OUTCOMES: Surgical resection was curative in all patients. The postoperative period was uneventful in all patients and all patients are symptom-free and alive at 3 years follow-up. CONCLUSION: Colonic lipomas are benign mesenchymal tumors of the gastrointestinal system with a male predominance and are observed within the fourth to sixth decades of life. Various genetic abnormalities have been reported and they have been linked to the formation of intussusception. The squeeze sign on radiological imaging, cushion sign and tenting sign in colonoscopy, and naked fat sign during pathologic examination is helpful towards reaching a diagnosis. Surgical resection is the treatment of choice but minimally invasive endoscopic approaches have also been shown to be successful.

The diagnostic value of Western blot method in patients with cystic echinococcosis.

Cystic echinococcosis (CE) is the larval cystic stage (called echinococcal cysts) of a small taeniid-type tapeworm (Echinococcus granulosus). Carnivores such as dogs are usually definitive hosts. Intermediate hosts are typically herbivores such as sheep and cattle. CE can be detected using various imaging techniques such as ultrasonography or radiology. Moreover the primary diagnosis has to be confirmed by serological tests since the clinical signs of the disease are non-specific. This study examined the antigenic band patterns useful for serologic diagnosis of hydatidosis. We also report on the post-operative evolution of patients treated for this disease and also determined the diagnostic performance of Western blot IgG kit. Twenty-five (16 females and 9 males) non-operated patients with hydatid cysts (NOP) and 33 (21 females and 12 males) operated patients with hydatid cysts (OP) were included as study group and 22 healthy individuals (14 females and 8 males) with no known chronic diseases were included as a control group. The ages of the patients and control group individuals were between 16-83 years. Patient and control groups were matched for age and sex. Cyst hydatid IgG antibodies were detected in the sera from all patient groups but no antibodies were found in the sera from the control group using ELISA IgG method. Twenty-three (92%) non-operated patients and 18 (54.5%) operated patients exhibited positive results when Western blot IgG kit was used. The P7 band pattern was detected in the sera from all operated and non-operated patients. Twenty-seven of these positive cases had p7 and (p7+p16/18), (p7+p24/26) or (p7+p16/18+p24/26). No antibodies against p7, p16/18 ve p24/26 band patterns were seen in sera from the control group A statistically significant difference was detected between operated and nonoperated patients for Western blot positivity.(p<0.01). p: 0.018- X2=5,604- OR: 0.176- 95% CI: 0.037- 0.841. The sensitivity, specificity, positive prediction and negative prediction values of Echinococcus granulosus Western blot kit for 25 cases with CE and 22 healthy controls were calculated as 92%, 100%, 100% and 91.7%, respectively. In conclusion, we suggest that monitoring p7 in all non-operated patients may be useful to determine the efficiacy of medical treatment and that monitoring p7 antibodies using serological and Western blot methods in operated patients may be useful for the screening of post-operative evolution in patients with hydatid cyst.

Comparison of 12-Week Fitness Protocols Following Bariatric Surgery: Aerobic Exercise Versus Aerobic Exercise and Progressive Resistance.

BACKGROUND: Successful bariatric surgery outcomes are better maintained with an exercise program. This pilot study compared the effects on short-term functional capacity and body composition of 2 post-bariatric surgery home-based programs: aerobic exercise alone versus aerobic exercise combined with progressive resistance conditioning. METHODS: Laboratory measures and self-assessments of post-bariatric surgery patients (BMI ≥ 30 kg/m2) undergoing either aerobic exercise (AE group) or aerobic + progressive-resistance exercise (AEPR group) were compared at postoperative months 1 and 3. Anthropometric characteristic changes were recorded, as well as changes in functional capacity (e.g., 6-min walking test), muscle strength (e.g., hand grip strength test; five-times-sit-to-stand test), and quality of life (i.e., Beck Depression Inventory). RESULTS: Between July 2018 and March 2019, 35 patients completed the AE (n = 17) or AEPR (n = 18) program. The AEPR group lost statistically significantly more weight (mean 2.2 kg) relative to baseline than the AE group (p < 0.05). The AEPR group achieved significantly greater mean total muscle, liquid, and bone mass; upper-extremity muscle strength; uric acid levels; body fat loss; and performed better on the 6-min walking test (all p < 0.05). In month 3, the AEPR group achieved a greater mean walking distance (p = 0.029) and O2 saturation related to dyspnea (p = 0.001) than the AE group. Group quality of life scores were comparable. CONCLUSIONS: In a comparative 12-week post-bariatric surgery study, both aerobic exercise alone and aerobic exercise plus progressive-resistance training were positively correlated with general health improvement. However, the progressive-resistance regimen resulted in significantly greater weight loss, functional capacity, muscle mass, and upper-body strength.

Melatonin ameliorates liver fibrosis induced by bile-duct ligation in rats.

BACKGROUND: Hepatic stellate cells, the main mediators in the pathogenesis of fibrosis, are triggered by free radicals and produce collagen. Melatonin is a powerful physiologic scavenger of hydroxyl radicals. It is also involved in the inhibitory regulation of the collagen content in tissue. There is no effective treatment available for liver fibrosis. Our objective was to evaluate the effects of melatonin on liver fibrosis induced by bile-duct ligation (BDL) in rats. METHODS: We divided male Wistar rats (n = 32) into 4 groups. Two groups received BDL and 2 groups received sham operations. One of the BDL groups and one of the sham groups were administered melatonin (100 mg/kg/day via intraperitoneal injection), and the controls were given vehicle only. After 1 month, we biochemically evaluated the changes in hepatic fibrosis by measuring tissue collagen levels and histopathologic examination. We evaluated the levels of malondialdehyde (MDA), glutathione (GSH), luminal and lucigenin in tissue homogenates, and we studied proinflammatory cytokines in serum using commercially available kits. RESULTS: Bile-duct ligation caused hepatic fibrotic changes, whereas melatonin suppressed these changes in 5 of 8 rats (p < 0.001). Bile-duct ligation resulted in increased collagen, MDA, luminal and lucigenin levels and decreased GSH levels, whereas melatonin reversed these effects. CONCLUSION: We found that melatonin functions as an effective fibrosuppressant and antioxidant, and the results suggest that it can be used as a therapeutic option.

Spontaneous rectus sheath hematoma: an analysis of 15 cases.

BACKGROUND: Spontaneous rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain. The purpose of this study is to present our experiences in the diagnosis and treatment of spontaneous RSH. METHODS: This is a retrospective study of the medical histories of 15 patients admitted to our emergency surgery unit between January 2000 and July 2009 and diagnosed with spontaneous RSH (12 females, 3 males; mean age, 64.5 years; range, 20-79 years). RESULTS: All cases presented with acute abdominal pain or abdominal wall mass, or both. Eleven of the cases (73%) had been receiving some form of anticoagulation therapy. The leading indications for anticoagulation and/or anti-platelet therapy were atrial fibrillation in 5 patients (33%) and mitral valve replacement in 3 patients (20%). Diagnosis was made by abdominal ultrasonography and/or computerized tomography in 14 patients (93%). Twelve (80%) of the 15 patients were discharged uneventfully after conservative management following a mean hospital stay of 8.8 days (range, 3-24 days). The mortality rate was 20%. CONCLUSION: Spontaneous RSH must be suspected in patients with advanced age who are using anticoagulation medications and present with acute abdominal pain. Early diagnosis permits conservative management and avoids unnecessary surgical interventions.

Associations Between miRNAs and Two Different Cancers: Breast and Colon.

OBJECTIVE: Screening approaches using microRNAs (miRNAs) have been gaining increased attention owing to their potential applications in the diagnosis, prognosis, and monitoring of cancer, because aberrant miRNA expression plays a role in the development and advancement of malignancies. The objectives of this study were to characterize mir21, miR31, mir143, mir145, and control RNU43, which are differentially expressed in peripheral blood mononuclear cells (PBMCs) of breast and colorectal cancer patients, compared to that in controls and to establish whether this is specific to breast and colon cancer for use as tumor markers. METHODS: Thirty newly diagnosed patients with breast cancer and 30 patients with colorectal cancer were enrolled together with 30 healthy controls. PBMCs were isolated from venous blood samples of individuals. Next, miRNA expression analysis was performed by a two-step method of reverse transcription and qPCR. RESULTS: The expression levels of miR-143 and miR-31 were significantly decreased, whereas the expression levels of miR-145 and miR-21 were significantly increased in breast cancer patients compared to those in healthy subjects. Moreover, the expression levels of miR-143, miR-145, and miR-21 were significantly increased and, in contrast, the changes in the expression levels of miR-31 were not statistically significant in colon cancer compared to those in healthy subjects. miR-21 exhibited the highest increase in both breast and colon cancers. There was a weak positive correlation between miR-145 and CA-15.3 in patients with breast cancer (r = 0.451; p = 0.012). miR-143 was positively correlated with the TNM stage in colon cancer patients (r = 0.568; p = 0.001). CONCLUSION: A biomarker panel composed of miR-21, miR-31, miR-143, and miR-145 in PBMC may provide a new diagnostic approach for the early detection of breast and colon cancer. As miR-21 expression was found to be the highest among all the miRNAs evaluated, it may represent a new tumor biomarker and a candidate therapeutic drug or gene target in colon and breast cancer.

The Effects on Obesity Related Peptides of Laparoscopic Gastric Band Applications in Morbidly Obese Patients.

BACKGROUND: The aim of this study was to examine the relationship between weight loss and resistin, apelin, chemerin, and visfatin after laparoscopic adjustable gastric banding (LAGB). METHODS: The study group consisted of 19 patients who were operated on for morbid obesity (BMI: 48.7 ± 6.6 kg/m2), and 22 healthy, normal-weight (BMI: 22.9 ± 2.5 kg/m2) subjects formed the control group. We obtained blood samples from the study subjects at three different times: before undergoing surgery and at one month and 6 months after surgery. Blood was obtained once from the control group. RESULTS: Significant weight loss was achieved at one and 6 months after surgery. Plasma levels of apelin, resistin, chemerin, and visfatin were higher in morbidly obese patients compared with the control group. Obesity-related peptides decreased one month and 6 months after surgery. CONCLUSIONS: Elevated plasma resistin, apelin, chemerin, and visfatin levels in morbidly obese patients are gradually reduced after weight loss. According to these findings, LAGB surgery is found to be an important and efficient means for morbidly obese patients both to lose weight and to develop a better metabolic risk profile in a short time period.

Plasma protein carbonyl and thiol stress before and after laparoscopic gastric banding in morbidly obese patients.

BACKGROUND: The aim of this study is to examine the relationship between oxidative plasma protein and thiol stress and weight loss after laparoscopic adjustable gastric banding (LAGB). METHODS: Plasma protein carbonyl (PCO) concentration as a marker of protein oxidation, plasma thiol (P-SH) and erythrocyte glutathione concentration (GSH, major intracellular thiol), as an antioxidant and metabolic markers, such as Homeostatic Model Assessment - Insulin resistance (HOMA-IR), BMI and plasma lipids were determined in morbidly obese patients (n 22, mean age 34.7 +/- 11 years, BMI 48.4 +/- 6.4 kg/m2) at baseline and 1 and 6 months after operation. Baseline levels in patients were also compared with the levels in age-matched controls (n 20, BMI 21.3 +/- 1.8 kg/m2). Plasma PCO and thiols and erythrocyte GSH concentrations were determined spectrophotometrically. RESULTS: Plasma PCO were significantly higher and plasma and erythrocyte thiol concentrations were significantly lower in morbidly obese patients than in controls (for each comparison, P<0.01). BMI, plasma triglycerides and HOMA-IR were positively correlated with plasma PCO and negatively correlated with plasma P-SH and erythrocyte GSH (for each comparison, P<0.01). Plasma HDL-cholesterol levels were positively correlated with plasma erythrocyte GSH (r = 0.405, P<0.01) and negative correlated with plasma PCO (r = -0.273, P<0.01). One and 6 months after the LAGB operation, total weight loss was 13.2 +/- 6.3 and 35.5 +/- 7.5 kg, respectively. Plasma PCO concentrations were decreased and P-SH and erythrocyte GSH concentrations were elevated following weight loss (for each, P<0.01). Only plasma P-SH levels were restored to the control levels 6 months after LAGB. CONCLUSIONS: Obesity and insulin resistance appear to be associated with plasma protein oxidation and thiol concentrations. Protein and thiol oxidative stress was improved by weight loss after LAGB in the short-term.

The effects of somatostatin and ursodeoxycholic acid in preventing the ischemic injury of the liver following Pringle maneuver in obstructive jaundice-rat model.

BACKGROUND/AIMS: In our study, the effects of somatostatin (SS) and ursodeoxycholic acid (UDCA) on ischemic liver injury were studied in (obstructive) jaundice-rat model. METHODOLOGY: For this purpose, jaundice was produced in the first four groups by binding of their choleducts. We performed just laparotomy to the other four groups of animals. To groups 1 and 5, SS was given 15 mcg/kg/day intraperitoneally, and to groups 2 and 6, UDCA was given 20 mg/kg/day enterally. No drugs were given to any other group. At the end of one week, a procedure with ischemia of the liver for 60 minutes followed by reperfusion for 2 hours, was performed to each rat except for groups 4 and 8. Following this procedure, they were sacrificed. The blood samples were taken to measure SGOT, SGPT, ALP, LDH, total and direct bilirubin levels, while liver biopsies were taken for histopathological evaluation. RESULTS: Under normothermic conditions, following 60-minute liver ischemia period, no irreversible histopathological changes were detected. However, increases in liver necrosis parameters were noted biochemically. SS and UDCA were thought to be effective in preventing the injury by decreasing the liver enzymes levels to a significant degree. The damage of the hepatic ischemic injury was found to be more meaningful and prominent in liver with jaundice. CONCLUSIONS: In this study, it was noted that SS and UDCA decrease the effects of cholestatic hepatic injury especially and improve the condition.

Laparoscopy offers diagnosis and treatment in abdominal stab injuries.

PURPOSE: To assess the role of laparoscopy in the diagnosis and treatment of abdominal stab injuries (ASI). METHODS: Patients who underwent laparoscopic procedures due to ASI were included in the study. Hemodynamic instability, injuries to the posterior trunk, concomitant severe cranial injuries, and prior abdominal operations were considered as contraindication for laparoscopy. RESULTS: From January 1997 to March 2006, 88 patients underwent laparoscopic management of ASI. In 45 patients (51.1%), there was no intra-abdominal pathology requiring surgical intervention (nontherapeutic laparoscopy) and 5 patients in this group had no peritoneal penetration (negative laparoscopy). In another 25 patients (28.4%), laparoscopic treatment was performed (therapeutic laparoscopy), including bleeding control in liver, colonic, gastric, and diaphragmatic repairs and intra-abdominal bleeding control. Laparotomy was avoided in a total of 70 (79.5%) patients. In 18 patients (20.5%), laparoscopy was converted to laparotomy. There was no mortality, and except one missed small bowel injury nor perioperative morbidity in patients undergoing laparoscopy. In the laparotomy group, major complications were seen in 7 patients. CONCLUSIONS: Laparoscopy is safe and efficient in the management of ASI and should be more frequently considered as a therapeutic tool.

[Treatment approaches to rectus sheath hematoma]. / Rektus kilif hematomu olgularina yaklasimimiz.

BACKGROUND: Rectus sheath hematoma (RSH) is one of the rare causes of acute abdominal pain. This clinical entity is frequently misdiagnosed and leads to unnecessary surgical intervention. We investigated the critical points of the diagnosis and therapy in preventing these mistakes. METHODS: Five patients (5 females; mean age 67.4; range 53 to 74 years) admitted to the emergency surgery unit and diagnosed as RSH between December 2000 and July 2005 were reviewed retrospectively. Demographic characteristics, medical history complaints and physical examination, laboratory and imaging studies findings were investigated. RESULTS: Four patients had been receiving anticoagulant therapy. All of the cases were complaining of abdominal mass and abdominal pain. In the physical examination painful mass was palpated. In cases anemia determined, the diagnosis was done only by computed tomography (CT) in one case, by ultrasonography (USG) and CT in three cases, and during surgical exploration for acute abdomen in one case. Blood transfusion was administered in all of the cases. In four patients anticoagulant therapies were discontinued and intravenous vitamin K and fresh frozen plasma were administered. In one case bleeding control was done during the operation. While three cases were discharged uneventfully following mean hospital stay of 13.6 days, two cases died on the fifth and seventh days. CONCLUSION: In elderly patients with acute abdominal pain, infraumblical mass, anemia and history of anticoagulation therapy, RSH should be taken into consideration and USG and CT should be performed. Early and accurate diagnosis helps for a successful medical treatment and prevents unnecessary surgical intervention.

Detachment of the connecting tube from the port and migration into jejunal wall.

After laparoscopic adjustable gastric banding (LAGB), early recognition and treatment of uncommon complications are important. A 36-year-old man who had undergone LAGB presented at our clinic with weight gain of 14 kg during the prior 6 months. During investigation, detachment of the connecting tube from the port and migration of this tube into the jejunal wall were found. The detached port was replaced with a new port, and laparoscopically-assisted jejunorraphy was performed.

The effects of pneumoperitoneum on respiratory mechanics during bariatric surgery.

BACKGROUND: The aim of this study was to investigate the influence of laparoscopic and conventional open surgery on respiratory mechanics, and blood gases, and to determine convenient techniques from the point of view of intraoperative respiratory mechanics, for bariatric surgery. METHOD: 40 morbidly obese patients were divided into 2 groups, patients undergoing laparoscopy Group 1, and patients undergoing conventional open surgery Group 2. Resistance of airway, dynamic compliance, and peak inspiratory pressure were measured. Measurement was performed in 4 periods: a) after anesthesia induction, b) after pneumoperitoneum in the Group 1 and after incision in the Group 2, c) after gastric band placement, d) and 5 min before extubation. Blood gases were recorded concomitantly. RESULTS: There was no significant difference between the 2 groups in values of blood gases and respiratory mechanics. CONCLUSION: In the morbidly obese, laparoscopic and open surgery did not cause a significant difference for respiratory mechanics when compared with each other.

Systemic inflammatory response after laparoscopic and open application of adjustable banding for morbidly obese patients.

BACKGROUND: Surgical injury induces a systemic inflammatory metabolic-endocrine response that is proportional to the severity of the surgical stress. Compared with the conventional open method, laparoscopic surgery is mini-invasive and has decreased postoperative pain and length of hospitalization. The aim of this study was to investigate the systemic inflammatory response, after laparoscopic and open stoma-adjustable silicone band application, which is thought to be mediated by cytokines. METHOD: 30 morbidly obese patients underwent Swedish adjustable gastric banding (SAGB). 15 patients underwent laparoscopic (group 1) and 15 open SAGB (group 2). Mean operative time for the laparoscopic group was 70-110 min and for the laparotomy group 80-120 min. Gallbladders were not removed, and there were no systemic diseases in the patients. The intensity of surgical trauma was evaluated by measurement of metabolic and hormonal responses to the surgery. Plasma levels of C-reactive (CRP), haptoglobin, ceruloplasmin, albumin, transferrin, IL-6, malonic dialdehyde (MDA) and creatinine were measured before and after the operation. RESULTS: CRP and IL-6 levels increased during and after laparoscopic and open SAGB. However, postoperative responses were significantly greater after open SAGB (group 2) (p < 0.05). MDA level, an indicator of an oxidative trauma, was elevated in group 1 at the 6th postoperative hour but was significantly higher in group 2 at the 6th and 12th postoperative hours. The results were more significant in group 2 (p < 0.05). There was no statistical difference between groups 1 and 2 in terms of albumin, creatinine, and transferrin levels before and after surgery. CONCLUSION: The systemic inflammatory responses after laparoscopic SAGB were significantly reduced compared with those after open SAGB.