Yasar, Hasan; Ersoy, Alevtina; Yazici, Gulce Naz; Suleyman, Halis; Özgeris, Fatma Betul; Arslan, Yusuf Kemal; Sunar, Mukadder

Background: Paclitaxel is a drug used to treat cancer, but it causes neuropathic pain and peripheral neuropathy. One of the causes of these effects of paclitaxel on nerve tissue is oxidative damage. Lutein has antioxidant effects. In this study, it was investigated the influence of lutein whether decrease oxidative damage of paclitaxel on nerve tissue or not. Methods: Pain threshold (PT) in paw of paclitaxel-only group (PC), paclitaxel+lutein group (PL), and control group (CG) rats were measured using a Basile algesimeter. The sciatic nerve tissue of experimental animals was used to conduct biochemical analyses. Analyses of malondialdehyde (MAD), total glutathione (GT), myeloperoxidase (MP), interleukin 1 beta (IL-1 beta) were performed. Histopathologic examination was performed in all groups. The CG and the other groups were compared. Results: PT was lowest in the PC group. However considerable increase in pain threshold in paw was observed in the PL group with respect to the PC group. As a result, the usage of lutein increased PT in paw. The PC group had signs of oxidative damage. With the use of lutein, paclitaxel was prevented from causing oxidative damage. Histopathological examination revealed that paclitaxel caused damage to myelin sheath and axon of sciatic nerve tissue. However, lutein was found to prevent this damage to the myelin sheath and axon. Paclitaxel causes neuropathic pain and peripheral neuropathy. One of the causes is the oxidative damage of paclitaxel in nerve tissue. Conclusion: Lutein, which has an antioxidant effect, prevents the damage of paclitaxel on nerve tissue.

Cimen, Ferda Keskin; Kockara, Nizamettin; Turkoglu, Murat; Dundar, Cihat; Cetin, Nihal; Suleyman, Bahadir; Coban, Abdulkadir; Yarali, Oguzhan; Malkoc, Ismail; Suleyman, Halis

Background: The effect of sheep tail fat (STF) on the damage induced in the knee articular joint with formalin was investigated and evaluated from the biochemical, gene expression, histopathological aspects in comparison with an extract consisting of glucosamine hydrochloride, chondroitin sulfate, methylsulfonylmethane, Harpagophytum procumbens and bromelain (GCMHB). Material and methods: The animals were divided into four groups: The first group received formalin injection to the knee joint as FCG control. The second group received 500 mg/kg STF + formalin (STFF). The third group was given 500 mg/kg GCMHB + formalin (GCMHBF). The fourth group was the healthy group (HG). The STF and GCMHBF were administered at 500 mg/kg dose. After 1 h of the STF and GCMHB administration 0.2 ml 1% formalin was injected into the knee joints of all rats except the HG group. The STF and GCMHB were given once a day at the specified doses over 30 days. Results: It was observed that, STF and GCMHB prevented the increase of IL-1β, TNF-α and COX-2 gene expressions in the cartilage tissue after formalin damage. In addition, STF and GCMHB improved the histopathological disturbances in the cartilage tissue caused by formalin. Conclusion: Since it is an inexpensive and easily available natural product, Sheep Tail Fat could be used in clinical practice along with the other medicines to prevent cartilage damage.

Deger, Ayse Nur; Deger, Hakki; Tayfur, Mahir; Balci, Mecdi Gurhan; Aksoy, Asude; Ekici, Mehmet Fatih; Moray, Melike Nalbant

Background: Carpal Tunnel Syndrome (CTS) is a trap neuropathy which occurs when Nervous Medianus gets compressed in the carpal tunnel. Fibrosis of subsynovial connective tissue in etiopathogenesis of CTS occupies an important place. Systemic factors facilitate the formation of the syndrome. In this study, collagen structure and fibrosis of subsynovial connective tissue in patients with diabetic and idiopathic CTS cases were evaluated. Methods: Subsynovial connective tissue samples of 30 diabetes mellitus patients with CTS and 30 subsynovial connective tissue samples of idiopathic CTS cases were used in the study. Antibodies of Collagen Type I, Collagen Type II, Collagen Type III and Collagen Type VI were used to evaluate the collagen structure. Expression of Transforming Growth Factor-beta (TGF-beta), an important molecule held responsible of non-inflammatory fibrosis, was evaluated by comparison in both patient groups. Results: Specific staining was not observed in subsynovial connective tissue with Collagen Type I and Collagen Type II. Collagen Type III and Collagen Type VI were positive in subsynovial connective tissue and a significant difference in staining intensity was not observed in diabetic and idiopathic CTS group (P>0.01). Expression of Collagen Type III was seen as more intense in the vessel wall in the diabetic CTS group. (P<0.01). It was observed that TGF-beta expression in the diabetic group was weaker than the idiopathic CTS group. (P<0.01). Conclusion: Collagen Type VI is seen as the major component of the subsynovial connective tissue. Decrease in TGF-beta expression in subsynovial connective tissue was observed in diabetic CTS cases similar to the healing model of wounds in diabetic patients. We believe that microvascular changes and metabolic factors are effective more than TGF-beta expression in subsynovial connective tissue changes in diabetic patients with CTS. As a result, diabetic patients with CTS consisting the majority of CTS cases must be evaluated as a separate group of patients while histomorphological changes in CTS are evaluated.

Bicer, Senol; Gursul, Cebrail; Demiryilmaz, Ilhan; Demiryilmaz, Ismail; Peker, Necla Aydin; Eken, Huseyin; Cimen, Orhan; Demirtas, Levent; Cakarli, Secil

We evaluated the effects of a panel of pharmaceutical interventions in an experimental model of gastric ulcer. The aim of this study is to investigate the protective effect of ozone therapy in an experimental rat model of acute gastric ulcer induced by indomethacin. Twenty-eight Wistar-albino male rats were used in this study. The rats were divided into four groups of seven animals in group as follows: Group 1 (control), Group 2 (sham), Group 3 (ozone), and Group 4 (lansoprazole). After 24 hours of fasting, 5 ml ozone-oxygen mixture was administered to Group 3, 30 mg/kg lansoprazole-5 ml distilled water mixture was administered to Group 4, and 5 ml distilled water was administered to Group 2 by gavage. Five minutes later, 25 mg/kg of indomethacin was administered to stomachs of all rats by gavage except for the control group. After six hours, all animals were anesthetized and stomach tissue was extracted. Ulcers on the gastric surface were measured at the time of collection. Myeloperoxidase (MPO), malondialdehyde (MDA), catalase (CAT), total glutathione (tGSH), superoxide dismutase (SOD), and 8-hydroxy-deoxyguanosine (8-OHdG) were measured in the stomach tissue. Administration of ozone and lansoprazole led to decreased macroscopic gastric ulcer size induced by indomethacin. Ulcer area was elevated in the sham group (71.47 ± 17.08 mm2) relative to the treatment groups. Ulcer area was 20.79 ± 12.88 mm2 in ozone group, significantly lower than sham group but significantly greater than the lansoprazole group. MPO, MDA, CAT, and 8-OHdG levels after ozone administration were significantly reduced and tGSH and SOD levels were higher relative to the lansoprazole group (P<0.01). Ozone therapy has a protective effect on acute gastric ulcer induced by non-steroidal anti-inflammatory drugs through an antioxidative mechanism.

Başol, Ömer; Pülat, Hüseyin; Zihni, İsmail; Damar, Sedat; Özçelik, Kazım Çağlar; Eken, Hüseyin; Karaköse, Oktay; Çalta, Alpaslan Fedai; Duran, Ali; Arikanoğlu, Zülfü

Aim: The present study was aimed to analyze the predictive factors for the mortality of relaparatomies. Materials and method: The retrospective study included 236 patients who underwent abdominal surgery and at least one subsequent relaparatomy at Dicle University School of Medicine Department of General Surgery between January 2000 and December 2011. The evaluations included age, gender, accompanying systemic diseases, procedure used in the primary surgery and its condition (emergency/elective), total amount of blood transfusion since the primary surgery, length of time between the primary surgery and relaparatomy, date of the primary surgery, preoperative parameters (albumin, platelet, hemoglobin, leukocyte, and MPV), Glasgow coma score, length of hospital stay, length of stay in intensive care unit, and presence of shock. Results: The patients comprised 165 (69.9%) men and 71 (30.1%) women. The mean age was 55.5±17.22 years (15-89). Early stage relaparatomy (i.e. within the 21 days following the primary surgery) was performed in 231 (97.8%) patients while 5 (2.2%) patients received it in the late stage (i.e. after the 21st day). Mortality rate was 13.8% (32/231) in the early stage and 80.0% (4/5) in the late stage. The patients over 50 years old had a mortality rate of 66.6% (24/36) and the ones below 50 years old had 6.0% (12/200). It can be concluded that the need for a relaparatomy and the risk of mortality could be reduced by a well-arranged primary surgery and efficient time management in handling the postoperative complications. Nevertheless, if needed, relaparatomy could be life-saving when performed at the correct time. Conclusion: The decision whether and when to perform a relaparatomy, preoperative preparation, number of laparatomies, amount of blood transfusion, and the length of period since the primary surgery are important factors for the mortality.

Torun, Mümtaz Taner; Kanmaz, Lutfi; Yalçın, Yusuf; Özkan, Özalkan; Seçkin, Ender; Tuncel, Ümit

Background: Tinnitus is a common otological symptom that affects quality of life seriously. Several factors involved in the etiology of tinnitus have been investigated. However, some independent main risk factors affecting subjective tinnitus are still unclear in the current literature. The purpose of this study was to evaluate body mass index (BMI) and other demographic data and to determine their effects on patients with tinnitus. Materials and methods: This retrospective study was performed at our clinic and involved 100 patients with subjective tinnitus and 113 control patients without tinnitus. Patients’ age, gender, BMI, side of tinnitus involvement and place of residence (city, town or village) were investigated. Then these data were analyzed statistically. Results: BMI values of patients with tinnitus were significantly higher than those of the control group. However, no statistical significant difference was observed in other demographic data. Conclusion: Tinnitus is a common subjective symptom. Various studies have investigated the risk factors. However, the number of studies assessing BMI and the place that the patients’ live is limited. Our results suggest that tinnitus may be associated with modifiable risk factors, such as BMI. Further research is needed to evaluate the relationship between these factors and tinnitus.

Pülat, Hüseyin; Karaköse, Oktay; Zihni, İsmail; Özçelik, Kazım Çağlar; Eken, Hüseyin; Çalta, Alpaslan Fedai; Benzin, Mehmet Fatih; İbiş, Abdil Cem

Background: Mannheim Peritonitis Index, that has been evaluated to calculate the prognosis of the peritonitis patients, is a simple and predictive scoring test. The disadvantage is that some of the parameters must be calculated peroperatively. In our studies, in order to by-pass this disadvantage, by modificating the test by the bladder pressure parameters thus creating a new scoring system that’s called Modificated Mannheim Peritonitis Index. Material and method: Seventy-five patients, between the age of 15-89, diagnosed as surgical acute abdominal syndrome and planned to have an emergency operation has been included in the study. Results: It has been found out that the Mannheim Peritonitis Index score of the patients, increases with the length of hospitalitisation. If the test cut-off value is set to 26, the scores above this level shows increased the postoperative complications and mortality rates. Mannheim Peritonitis Index score above 30 are calculated to have a sensitivity of 57%, specificity of 82%, positive predictive value of 25% and negative predictive value of 95% and a 80% accuracy rate for predicting the mortality. We also found that the bladder pressure on admission is irrevelant on mortality and complication rates. The prognosis of the patients has a statistically significant relationship with the parameters: Age above 50, organ failure, malignancy, sepsis and exudate with feces. Conclusions: As an addition the goal as changing some of the parameters of Mannheim Peritonitis Index with bladder pressure values and creating a new scoring system with similar predictive abilities has been failed.

Demirtas, Levent; Degirmenci, Husnu; Akbas, Emin Murat; Ozcicek, Adalet; Timuroglu, Aysu; Gurel, Ali; Ozcicek, Fatih

In recent years, there has been renewed interest in hematological parameters as predictors of endothelial dysfunction and inflammation. The aim of our study is to evaluate the relationship between HbA1c and hematological indices, and to evaluate the relationship between these parameters and microvascular complications of diabetes. Three hundred and seven diabetic patients (124 male, 183 female; mean age 50.8±8.5), and 187 controls (76 male, 111 female; mean age 51.1±10.1) were included in the study. In the diabetic group, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), white blood cell count (WBC), platelet count, platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) were significantly higher than the control group (P<0.05). Diabetic patients were divided into two group according to their HbA1c levels (Group 1; HbA1c <7 (n=82) and group 2; HbA1c ≥7 (n=225)). Mean platelet volume, PCT and PDW levels were significantly increased in group 2. Mean platelet volume was significantly increased in diabetic patients with retinopathy compared to those without retinopathy (P=0.006). The neutrophil to lymphocyte ratio and PLR levels were significantly higher in patients with nephropathy (P=0.004, P=0.004 respectively). There was statistically significant difference of lymphocyte count between patients with and without neuropathy. In correlation analysis, positive correlation between HbA1c and PCT (rs=0.192, P<0.001), HbA1c and PDW (rs=0.305, P<0.001), HbA1c and MPV (rs=0.352, P<0.001) were determined. In binary logistic regression analysis; WBC, PDW and PLR levels were found to be independently associated with diagnosis of diabetes while WBC, MPV, PLR and NLR levels were found to be independently associated with impaired glucose regulation. This study demonstrates that altered hematological indices are closely associated with HbA1c levels in individuals with and without diabetes and some of these parameters are associated with diabetic microvascular complications. These associations may be explained by connection between these easy accessible and inexpensive hematological indices and inflammation, tendency to coagulation and thrombosis in patients with diabetes.

Cetin, Nihal; Suleyman, Bahadir; Altuner, Durdu; Kuyrukluyildiz, Ufuk; Ozcicek, Fatih; Coskun, Resit; Kurt, Nazahat; Suleyman, Halis

It is known that ketamine increases the production of catecholamines, causing oxidative damage to the heart. Suppression of the production of catecholamines by disulfiram, a drug with antioxidant properties, indicates that disulfiram may decrease ketamine-induced cardiotoxicity. The objective of the present study was to investigate the effect of disulfiram on ketamine-induced cardiotoxicity in rats. Disulfiram was administered by oral gavage in doses of 25 mg/kg to rats in the DK-25 group and 50 mg/kg to rats in the DK-50 group. Distilled water was applied in the ketamine control (KC) and healthy (HG) rat groups. At one hour after drug administration and subsequently at ten-minute intervals, a 60 mg/kg dose of ketamine was intraperitoneally injected in the rats in all groups other than HG, and anesthesia was maintained for three hours. Disulfiram prevented both increase in the levels of parameters indicating oxidative and myocardial damage and decrease of antioxidant levels in the heart tissue with ketamine in a dose-dependent manner. Disulfiram better prevented occurrence of cardiotoxicity with ketamine in the 50 mg/kg dose than in the 25 mg/kg dose. It is concluded that disulfiram may usefully be applied in clinical practice in the prevention of cardiotoxicity as observed during anesthesia with ketamine.

Kuyrukluyıldız, Ufuk; Binici, Orhan; Onk, Didem; Celik, Serap Ayhan; Torun, Mumtaz Taner; Unver, Edhem; Ozcicek, Adalet; Alagol, Aysin

Backround: Surgical operations are alternative treatments in persons with Obstructive Sleep Apnea Syndrome who cannot tolerate continuous positive airway pressure therapy. Drug-Induced Sleep Endoscopy is a method with which somnolence is pharmacologically induced and collapse is evaluated through nasal endoscopy in patients with Obstructive Sleep Apnea Syndrome. Aims: We aimed to evaluate efficiency of dexmedetomidine or propofol used for sedation in patients undergoing drug-induced sleep endoscopy. Methods: A total of 40 patients aged between 18 and 65 years old in the ASA STATUS I-II group were included in the study. After premedicatıon wıth midazolam 0.05 mg/kg intravenously, patients were randomly divided into two groups and administered intravenous (iv) propofol with the loading dose of 0.7 mg/kg for 10 minutes, followed 0.5 mg/kg/h infusion (Group P); or dexmedetomidine with the loading dose of 1 mcg/kg for 10 minutes, followed by 0.3 mcg/kg/h infusion (Group D). Haemodynamic and respiratuary parameters, Bispectral index score, Ramsey sedation score, time to achieve sufficient sedation, surgeon’s and patients’ satisfaction, postoperative Aldrete score and side effects were recorded. Results: Time to achieve sufficient sedation, Bispectral index scores at 5, 10 and 15th. minutes intraoperatively, first Aldrete score in the recovery room, SpO2 values and respiratory rates all over the surgical procedure and in the recovery room were found lower in Group P (P<0.05). Bispectral index scores, mean arterial pressure and heart rate in the recovery room were significantly lower in Group D (P<0.05). Conclusion: Dexmedetomidine may be preferred as a safer agent with respecting to respiratory function compared with propofol in obstructive sleep apnea patients who known to be susceptible to hypoxia and hypercarbia.