Turkish Journal of Surgery - 2002; 18(3)

EFFECT OF PENTAGASTRIN ON LIVER REGENERATION IN THE EXPERIMENTAL HEPATECTOMY MODEL

KAPTAN G�LBEN, HAKAN MERS�N, ��DEM IRKKAN, U�UR BERBERO�LU — 2002-09-01

Gastrin has been demonstrated to be an important trophic hormone for the mucosa of the stomach and small in testine. The aim of this study was to evaluate the effect of gastrin on liver regeneration after partial hepatectomy in rats. Rats which underwent 70% hepatectomy were assigned into four groups. Group 1 and 2 received pentagastrin 300 (g/kg three times daily after hepatectomy. Rats in group 1 and 2 underwent remnant hepatectomy and were sacrificed after 48 hours and 96 hours, respectively. Group 3 and 4 received isotonic saline as control groups. Rats in Group 3 and 4 underwent remnant hepatectomy after 48 hours and 96 hours, respectively. Administration of pentagostrin after hepatectomy significantly increased mitosis and AgNOR counts. In conclusion gastrin has hepatotrophic effect on hepatic regeneration after partial hepatectomy.

THE EFFECT OF HYDROGEN PEROXIDE ON TRYPSINOGEN ACTIVATION AND APOPTOSIS IN EXPERIMENTAL ACUTE PANCREATITIS

2002-09-01

Role of free oxygen radicals in the pathogenesis of acute pancreatitis has not been studied thoroughly in the literature. In addition to the direct toxic effect of free oxygen radicals on acinar cells, these agents may activate pancreatic enzymes and, in turn, add to the parenchymal injury. In this study we aimed to study the effect of introductal perfusion of hydrogen peroxide, a member of free oxygen radical family, on the activation of trypsinogen and induction of apoptosis in pancreatic parenchyma. Twenty Sprague-Dawley rats were randomly divided into two groups. Bile-pancreatic duct was cannulated close to the liver in all animals and perfused through the duodenum with %0.9 NaCI solution in group 1 and 250(M hydrogen peroxide in group 2 at 0.5 ml/h for 3 hours. Serum amylase and lipase levels were measured for the diagnosis of acute pancreatitis; serum and urine trypsinogen activation peptide levels measured for the determination of trypsinogen activation. Tissue samples were obtained for the evaluation of apoptosis. Mann Whitney U test was used for statistical analysis. Hydrogen peroxide perfusion induced acute pancreatitis with high serum amylase and lipase levels. There were no statistical differences in serum and urine trypsinogen activation peptide levels between the two groups. Apopitosis has not been detected in both groups. We concluded that hydrogen peroxide induced acute pancreatitis in our study. In this model, trypsiongen activation has not been detected in serum and urine after 3 hours of hydrogen peroxide perfusion. No increase in apopitosis has been found in hydrogen peroxide group when compared with control group.

THE ROLE OF ESTROGEN AND EFFECT OF ANTI-ESTROGEN THERAPY ON EXPERIMENTAL HEPATOPULMONARY SYNDROME

��KR� TOPRAK, SERDAR YOL, AD�L KARTAL, LEMA TAVLI — 2002-09-01

Background: Hepatopulmonary syndrome consists of a triad of liver dysfunction, intrapulmonary vascular dilatation, and hypoxemia. The loss of vascular tone in patients with intrapulmonary vascular dilatation is unexplained. Many studies in liver cirrhosis and pregnancy revealed that the cause of cutaneous vascular dilatation (spider nevi) is estrogen. Aim: We tried to explain the effects of estrogen in intrapulmonary vascular dilatation. Material-Methods: We used an animal model for the study of hepatopulmonary syndrome by ligating the common bile duct in rats and inducing biliary cirrhosis over 5 week period. Six groups each consist ten rats (1 :Sham-control, 2: Common bile duct ligation, 3: Common bile duct ligation and oophorectomy, 4: Common bile duct ligation and exogenous estrogen, 5:Common bile duct ligation and tamoxifen, 6: Exogenous estrogen groups) were studied. Arterial blood gases, hepatic biochemical and histological features, and oculometric measurements of intrapulmonary vascular dilatation were assessed. Results: In common bile duct ligated rats we obtained biliary cirrhosis, hypoxemia and intrapulmonary vascular dilatation. Compared with only common bile duct ligated group, degree of hypoxemia and intropulmonary vasculary dilatation were more evident in cirrhosis plus exogenous estrogen administrated group however those were less in cirrhosis plus tamoxifen and cirrhosis plus oophorectomy groups. Conclusion: We consider that estrogen has a potential role in intrapulrnonary vasculary dilatation and hypoxemia in hepatopulmonary syndrome and anti-estrogen therapy may prevent the development of intrapulmonary vascular dilatation in cirrhosis.

COMPARISON OF SUTURELESS MESH-PLUG AND PATCH REPAIR WITH LICHTENSTEIN TENSION-FREE REPAIR AND MCVAY TISSUE REPAIR

ENG�N OK, CAN K��K, ALPER AKCAN, ERDO�AN S�Z�ER, ZEK� YILMAZ — 2002-09-01

The aim of this study is to determine the differences of tension-free methods and pure tissue repair method in anterior open inguinal hernia repair. Conventional methods for hernia repair are used less frequently with implementation of tension free techniques. Inguinal hernia repair has been performed in 300 patients with using Mc Vay, Lichtenstein and sutureless mesh-plug techniques unselectively in first, second and third 100 consecutive patients respectively. Postoperative hospital stay, age, sex, primary or recurrent hernia, hernia types according to Gilbert classification, elective or emergency surgery, anesthesia type, complications and recurrence were recorded from the study follow-up papers. The patients were examined at 3rd, 6th, 12th and 24th months following hernia repair. The only significant difference between the characteristics of the groups was increased rate of emergency surgery in Lichtenstein group(17%) compared to Mc Vay (6%) and mesh-plug groups (5%) (x2= 10.478, p<0.005). Logistic regression analysis showed that the only factor, which increases the rate of complications, was need for emergency surgery (ODDS=90.086, 95% Cl=24.449-306.840). Urine retention (x2=6.186, p<0,05), scrotal edema (x2=7.655, p<0.05) and mesh retraction rates (x2=6.061, p<0.05) were significantly higher in Lichtenstein group compared to mesh-plug group. The recurrence rates were 1 (1%) in mesh-plug group, 3 (3%) in Lichtenstein group, 3 (3%) in Mc Vay group during the follow-up period (p>0.05). Although complication and recurrence rates were higher in Lichtenstein group, this may be due to higher rate of emergency surgery (incarceration and strangulation) in thisgroup. Anterior approach is safe for the three types surgery and its recurrence rate is lower. We propose sutureless mesh plug technique for anterior approach because of the safety, lower recurrence rate and for improved patient comfort.

OUR EFFORTS IN CADAVERIC RENAL TRANSPLANTATION

2002-09-01

Renal transplantation is one of the most preferable modalities of treatment for end stage renal disease. Shortage of the organs has forced physicians to use marginal donors. We have performed 137 renal transplantations which 38 (27.7%) of them were cadaveric, between Feb. 1995 and May 2001. In these procedures, 13 donors were marginal, while 25 were standard. 4 (10.5%) of them were primary nonfunctioning. The remaining 34 cadaveric transplantations were followed-up for mean 52 months. The warm ischemia time of all 5 non-heart beating kidneys was between 30 and 45 minutes, while of the remaining kidneys was below 5 minutes. The mean of the warm ischemia time was 21.5 hours. Delayed graft function was seen in 30 and 12% of the marginal and standard groups, respectively. 19 complications were seen with 31 % rate in the marginal and 48% in the standard groups. The complications were encountered as vascular (n:5), urinary (n:1), lymphocel (n:1) and malignancy (n:2). In 7 (20.5%) of the patients, graft lost was detected. 1 and 5-year graft survival were 83, 83 and 91,61% in the marginal and standard groups; respectively. 7 (20.5%) patients died. 1 and 5-year patient survival were 83, 83 and 91, 77% in the marginal and standard groups, respectively. We concluded that marginal donors are good alternatives to enlarge "organ pool" with properly selected cases.

THE PROGNOSTIC VALUE OF TISSUE EXPRESSION OF BETA-HCG IN COLORECTAL CANCER

2002-09-01

The value of the b-HCG expression in biologic behavior of colorectal tumors is unclear. In this study, we aimed to evaluate the effect of expression of b-HCG on local tumor behavior and survival in the patients with colorectal cancer. Between 1989 and 1998, the medical record of the sixty colorectal carcinoma patients (35 male and 25 female) who underwent operation was reviewed. 21 pts (35%) were b-HCG positive, while 39 (65%) were negative according to established scoring system. c2 or Fisher exact test was used in comparision of pathologic data. The differences of survival analysis calculated by using log-rank and cox-regression test. There was no correlation between b-HCG expression and tumor grade, stage, invasion (lymphatic, peri-neural and venous) and differentiation rate (p >0.05). Disease free survival (DFS) and overall survival (OS) were 65 � 11 months and 81 � 11 months in b-HCG expression (+) group, respectively. DFS and OS were 78 � 11 months and 85 ( 9 months in b-HCG expression group, respectively. Also in the same manner, DFS and OS were 45%, 55% in b-HCG expression (+) group, where as 54.55% in b-HCG expression (-) group for five years. There was no survival difference between b-HCG expression (+) and (-) group according to Cox regression analysis (p >0.05). According to our analysis, b-HCG expression was not significant for the definition of the local tumor behavior and survival in colorectal cancer patients.

SURGICAL MANAGEMENT OF ACUTE-BOWEL OBSTRUCTIONS CAUSED BY LEFT COLON TUMOR

2002-09-01

Surgical management of left-sided colorectal obstruction is associated with higher morbidity and mortality compared with elective colorectal surgery and the choice of operation is controversial. The aim of this study was to evaluate the results of management of malignant left colon obstruction by emergency resection with immediate anastomosis (RPA) or Hartmann's procedure during a 10 year period. Twenty-two patients were treated by RPA and 23 patients were treated by Hartmann's procedure. American Society of Anesthesiologists (ASA) grade and associated major medical problems were higher in the patients who undergone Hartmann's procedure. There were no statistical difference among the groups according to the mean operating time, operative blood loss and length of hospital stay. Only two patients (9 %) developed a leak at the anastomotic site. Operative mortality was 14% and 22% in patients underwent RPA and Hartmann 's procedure, respectively. Most common tumor histologic type was moderately differentiated adenocarcinoma and most common tumor grade according to modified Dukes clinicopathologic classification was stage B for the both groups. The overall 5-year survivall rates were 27% and 22% in patients undergoing RPA and Hartmann's procedure, respectively. As a result, a single stage resection and anastomosis of acute malignant left colon obstruction can be preferred in the patients with low operative risks.