Turkish Journal of Surgery - 2001; 17(4)

EFFECT OF NITRIC OXIDE ON BACTERIAL TRANSLOCATION IN EXPERIMENTAL INTESTINAL OBSTRUCTION

2001-09-01

Bacterial translocation is defined as the passage of endogenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs that suggested to be the cause of sepsis in patient with multiple organ failure. The aim of this study was to investigate the antibacterial effect of nitricoxide by using nitric oxidesynthetase enzyme inhibitors such as L-NAME and aminoguanidin in the obstructive intestinal rat model. Fourty rats were divided into four groups. The first one was control group and had only laparatomy. Intestinal obstruction was performed to second group, intestinal obstruction + L-NAME (L-NG-nitro-L-arginine methyl ester) were applied to third group. Fourth group had intestinal obstruction and aminoguanidin was injected to them. According to the histopothological study of the intestine, group III demonstrated less ulceration than groups II and IV (p<0.05). Mucosal damage and bacterial translocation showed no correlation according to the results. The incidence of bacterial translocation was 46.6% in group II, 73.3% in group III and 90% in group IV. Eighty two percent of isolated bacteria was typical enteric Gram negative organisms. Bacterial translocation was not observed in control group. Plasma nitricoxide levels of groups were 14.0 � 3.3, 31.2 � 7.6, 12.2 � 2.5, and 10.5 � 1.8 (mol/L, respectively. As a conclusion; nitric oxide can damage mucosal integrity that may increase bacterial translocation but the antibacterial effect of nitric oxide may be more effective and nitric oxide can decrease the translocation of bacteria from gut.

EVALUATION OF INTRAABDOMINAL ADHESIONS OF PROSTHETIC MATERIALS USED FOR ABDOMINAL WALL REPAIRING AND THE EFFECT OF CARBOXYMETHYL CELLULOSE AND HYALURONIC ACID

G�REL NE��AR, AL� EBA DEM�RBA�, NESR�N TURHAN, C�NEYT KAYAALP, MUSA AKO�LU — 2001-09-01

Prevention of intraabdominal adhesions is one of the major concerns of general surgery. The present study investigated postoperative adhesions and the effect of carboxymethylcellulose and hyaluronic acid (Seprafilm), when prosthetic materials are used for abdominal wall repairing. For this purpose, 30 rats were allocated into three groups. In each group, 2x3cm abdominal wall defect was created and repaired with prolen emesh, prolene mesh+Seprafilm and polytetrafluoroethylen emesh, respectively. All animals were sacrificed at postoperative day 7. Dense introabdominal adhesions were observed in the first and third group. In the second group, which Seprafilm is used, adhesions were significantly lower (p<0.05) than the other groups.

THE EFFECT OF L-GLUTAMINE ON INTESTINAL ADAPTATION IN THE RATS AFTER SIALOADENECTOMY AND SMALL BOWEL RESECTION

2001-09-01

Luminal foods, endogenous secretions and hormones are effective in the process of intestinal adaptation after intestinal resection. Submandibulary gland is the main source or EGF(Epidermal Growth Factor) in rats. Removal of the glands(Sialoadenectomy) will cause depletion of EGF in rats. The aim of this study was to investigate the effect of L-glutamine to compensate the effect of sialoadenectomy during massive intestinal resection in rats. This study was performed in the Medical Research Center Of xx. Forty five rats were fed by mouth with TPN solution before 48 hours and for seven days after the operation. The rats were divided into 3 groups each of which included 15 rats. Group 1: Sham sialoadenectomy + small bowel resection + oral TPN solution. Group II: Sialoadenectomy + small bowel resection + oral TPN solution. Group III: Sialoadenectomy + small bowel resection + oral TPN solution + L-Glutamine. All rats were sacrificed at 7th day of the operation for the evaluation of intestinal adaptation. There was a significant increase in villous length and crypt depth, in group III when compared to Group I and II (p=0.0001). There was also a meaningful decrease in villous length and crypt depth in Group II compared to Group I (p=0.0001 ). There was no significant changes in goblet cell proliferation between the groups(p>0.05). L-glutamine can prevent mucosal atrophy like EGF in rats with sialoadenectomy and small bowel resection.

THE EFFECT OF ANTITHROMBIN-III ON THE NITRIC OXIDE LEVELS IN EXPERIMENTAL OBSTRUCTIVE JAUNDICE

2001-09-01

There is a very high incidence of morbidity and mortality in patients with obstructive jaundice. The absence of bile in the gastrointestinal tract stimulates bacterial overgrowth and bacterial translocation. The increased concentrations of bacteria and endotoxin in the portal blood leads to systemic endotoxemia. In response to endotoxin or in LPS-induced endotoxemia TNF-alpha, NO and other mediators were released from endothelial and Kupffer cells. We investigated the effect of Antithrombin-III that is a physiological inhibitor of thrombin and other proteases of the clotting cascade. AT-III prevents vascular injury by inhibiting leukocyte activotion in LPS-induced endotoxemia. Forty male Wistar-Albino rats weighing 200-250 gr. were divided into four groups. Controls (not operated on, n=10); Control+AT-III (AT-III was given 250 IU/kg for 5 days, n=10); Bile duet ligation alone (for 5 days, n=10); Bile duet ligation+AT-III (5 days after bile duet ligation AT-III was given 250 IU/kg for 5 days, n=10). At the end of tenth day, rats were sacrified under Ketamine anesthesia and the serum samples were obtained from whole bloods. Nitricoxide levels were measured by Nitricoxide colorometric Assay (Boehringer Mannheim, Cat. No. 1756281. Mannheim, Germany). NO level was found 33.99(mol/L in Group A, 32.26 (mol/L in Group B, 46.33 (mol/L in Group C, 34.71 (mol/L in Group D. As a conclusion, in our experimental study the increased level of NO in rats with induced obstructive jaundice is thought to be related to endotoxemia and a decrease in the level of NO was detected following AT-III application.

VENOUS THROMBOEMBOLISM PROPHYLAXIS WITH LOW MOLECULAR WEIGHT HEPARINS IN POLYTRAUMATIZED PATIENTS IN INTENSIVE CARE UNIT

MEHMET KURTO�LU, C D�N�AY B�Y�KKURT, A CEM DURAL, MET�N KURTO�LU, RECEP G�LO�LU — 2001-09-01

Pulmonary Embolism is a major cause of death in trauma patients in ICU. Without prophylaxis the incidence of PE has been found as 50-60% depending on the severity of trauma. The use of LMWH has gained popularity for reducing the risk of VTE over the last 10 years. In trauma patients, LMWH has better efficiency than unfractionned heparin and similar efficiency to sequential compression, with similar bleeding risk when used for VTE prophyloxis. Alternative prophylaxis methods or no application of prophylaxis, in such a high risk group, as ICU patients were considered unethical, therefore there was no control group. In our study we aimed to evaluate, retrospectively, the bleeding and the VTE complications intrauma patients in ICU under the prophylaxis of enoxaparin sodium. The results will guide us to establish a protocol for the use of enoxaporin sodium in trauma patients, 397 polytraumatized patients treated in ICU are included to the study group. All patients received 40 mg/day of enoxaparin sodium. Severity of trauma was guantified with Apache II Scoring System and the diagnosis of bleeding was made by observing a sudden drop of 2g/dl in hemoglobin concentration whereas pulmonary embolism was diagnosed with a sudden change in blood gases and deterioration of the clinical outlook which was confirmed by a spiral CT scan. Spiral CT scan or radionucleotide ventilation perfusion scan could not be performed in all cases due to difficulities confronted in the application of these procedures in ICU patients. Statistical correlation was made by Pearson's correlation test. Mean Apache II score was 13.8 with a total mortality of 41%. 40 patients (10%) had bleeding due to enoxiparine prophylaxis. 11 patients (2.8%) had pulmonary embolism and 7 of them (63 %) had died, in conclusion polytraumatized patients need prophylaxis since as approved by the literature LMWH significantly reduces PE incidence in polytraumatized patients. On the other hand, the bleeding risk has slightiy increased without showing any significance (p>0.05). Prophylaxis with 40mg/day Enoxaparin sodium is safe and efficient.

EFFECT OF NASOGASTRIC TUBES ON THE MAXILLARY SINUS IN PATIENTS UNDERGONE ABDOMINAL SURGERY

MUSTAFA ALDEM�R, G�LSEN YILMAZ, MURAT ACAR, MUHAMMED TEK�N, B�LSEL BA� — 2001-09-01

The effects of nasogastric tube (NGT) on the maxillary sinusitis in patients undergone abdominal surgery was investigated. NGT is routinely used by many surgeons to decompress the stomach for preventing acute gastric dilatation, treating ileus, monitoring upper gastrointestinal haemorrhage, acting as a guide to start oral feeding, and reducing tension on suture lines in order to reduce the risk of anastomotic dehiscence, after both elective and emergency abdominal surgery. A prospective cohort study was performed in 73 patients who undergone abdominal operation. Patients were divided two groups. Group 1 included the patients (n=35) in whom NGT was retained for > 48 hrs, while in group 2 there were patients (n=38) in whom NGT was retained for > 48hrs. Clinical and radiological examinations of patients were evaluated in preoperotive and postoperative periods. NGT periods (hrs) in group 1 and group 2 were 18.8 � 13.5 hours and 124.6 � 38.7 hours, respectively. There was no difference between two groups about age, sex and way of operation whether urgent or elective, statistically (p>0.05). It was determined both clinically and radiologically that the rate of maxillary sinusitis in group 2 was significantly higher than group l, statistically (p<0.0001). Relative risk was 4.8 and confidence interval was 1.9-12.2. In our study, we determined both clinically and radiologically that, the risk of maxillary sinusitis was seen 4.8 times frequently, in the patients who had NGT been applied more than 48 hour. The major factor for developing sinusitis is the presence of nasal tubes which are responsible for mechanical obstruction of the sinus ostia. For this reason, NGT should be applied as short as possible, the nares and oropharyngeal region should be irrigated with various antiseptic solutions to avoid bacteriel colonization.

DOES SPHINCTER SAVING SURGICAL PROCEDURES EFFECT SURVIVAL IN RECTUM CANCER?

SERDAR KA�AR, ALP G�RKAN, CAN VARILS�HA, MURAT DO�AN, MEHMET KAHYA, CEZM� KARACA — 2001-09-01

Rectal cancer is the most frequent tumor among colorectal tumors. Between 1992-1999, 62 patients had undergone surgical treatment for low and mid rectal cancer. Low anterior resection (LAR) or abdomino-perineal resection (APR) were performed in 27 and 35 of the cases, respectively. Age, sex and stages were equal in both groups. But poorly-differentiated tumors were significantly more frequent in the APR group. Local recurrence was seen in 40% of the cases with APR, and in 14.8% of the patients with LAR (p<0.05).The disease-free and total survival periods in the APR patients were 30.1 and 34.9 months and in the LAR cases were 31.1 and 35.9 months, respectively. According to Kaplan-Meier survival estimation method, disease-free and total survival rates, in the patients with APR were 44 and 53 percent, and in the patients with LAR were 51 and 50 percent, respectively. These parameters were found to be statistically insignificant. LAR found to be comparable to APR according their disease-free and total survival periods.