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Öğe Effect of abdominal insufflation on bacterial growth in experimental peritonitis(Mary Ann Liebert Inc Publ, 2001) Sare, M; Demirkiran, AE; Alibey, E; Durmaz, BBackground: Perforated appendicitis can be treated laparoscopically, but this approach is associated with a higher rate of intra-abdominal abscess. Pneumoperitoneum impairs the clearance of bacteria from the peritoneal cavity in experimental models of peritonitis. The aim of this study was to investigate the effects of intra-abdominal gas insufflation on bacterial growth in a rat model. Materials and Methods: The effects of intraperitoneal insufflation with different gases and a gasless model on bacterial proliferation in a setting of Escherichia coli-induced experimental peritonitis were studied in a rat model. Saline (0.25 mL) was given intraperitoneally to six Wistar male rats as the sham group. Escherichia coli (1.5 x 10(9) cfu/mL per kilogram) was injected intraperitoneally into to 24 rats. Microorganism counts were taken after 8 hours, and rats were divided into three groups: group 1, CO2 insufflation; group 2, N2O insufflation; and group 3, no insufflation. Microorganism counts were repeated 8 hours after the procedure (at 16 hours postinjection). Results: The difference in microorganism counts between 8 and 16 hours were significant in the CO2 and N2O insufflation groups (P < 0.05) but not in the group without pneumoperitoneum. Conclusions: Abdominal insufflation may promote intra-abdominal bacterial growth or decrease intra-abdominal bacterial clearance.Öğe The effect of carbon dioxide pneumoperitoneum on free radicals(Springer, 2000) Sare, M; Yilmaz, I; Hamamci, D; Birincioglu, M; Özmen, M; Yesilada, ÖBackground: Carbon dioxide is usually preferred as the insufflating agent for laparoscopic surgery because it is readily available, noncombustible, and chemically stable. It is still questionable, however, if CO2 pneumoperitoneum has any effect on free radicals and lipid peroxidation. The purpose of this study was to investigate the possible effects of CO2 pneumoperitoneum on free radicals and lipid peroxidation in the erythrocytes of rats. Methods: Fifty male Sprague-Dawley rats were divided into five equal,groups: controls, a sham-operation group, and three groups of 5, 10, or 15 mmHg pneumoperitoneum with CO2. At the end of the procedure, blood was collected and the erythrocytes were separated from the plasma. The resultant supernatant fractions of erythrocytes were assayed For superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA). Results: SOD activities of the 5 and 10 mmHg pneumoperitoneum groups were significantly lower than those of the sham operation group. SOD activity was greater in the 15 mmHg pneumoperitoneum group than in any of the other groups, and this activity was significantly different from that seen in the 5 and 10 mmHg pneumoperitoneum groups (p < 0.05). No significant changes were observed in the CAT activities of the study,groups (p > 0.05). MDA level was increased in the 5 mmHg pneumoperitoneum group; this result was statistically different from the control and 15 mmHg pneumoperitoneum groups (p < 0.05). No significant differences were found in the CAT activities for the study groups. On the other hand, the SOD activities of the 5 and 10 mmHg pneumoperitoneum groups were significantly lower than those of the sham and the 15 mmHg pneumoperitoneum group (p < 0.05 for all comparisons). Conclusions: These results indicate that CO2 pneumoperitoneum applied with 5-10 mmHg pressure increases the formation of free oxygen radicals by inhibiting SOD activity and that the accumulation of free radicals elevates the level of MDA, a metabolite of Lipid peroxidation. The effect of CO2 pneumoperitoneum on free radicals and lipid peroxidation is pressure-dependent in rats. The mechanism underlying this pressure dependency is still under investigation.Öğe The effect of dividing the sphincter of oddi at endoscopic sphincterotomy on the filling and emptying aspects of function of the gallbladder(Lippincott Williams & Wilkins, 1999) Taskin, V; Ozyilkan, E; Sare, M; Hilmioglu, FThe effect of dividing the sphincter of Oddi at endoscopic sphincteretomy (EST) on the filling and emptying aspects of gallbladder function has not been definitely established in humans. This prospective study is designed to examine the effects of EST on gallbladder emptying. In 13 patients (8 men and 5 women; mean age, 60.54 years +/- 2.14: range, 45-75 years), postprandial gallbladder emptying was measured ultrasonographically before and after EST (within 1-4 days). The fasting volumes after 8 hours of fasting, at times 0 min and before the test meal was given, residual volume (the smallest postprandial volume), gallbladder ejection fraction (EF), and total ejection volume, at 10, 20, 30, 40, 50, 60, 70, 80, and 90 min after the test meal, were studied. The fasting gallbladder volume and the residual volume tended to decrease after EST, but the differences were not significant (40.21 +/- 10.79 mt and 35.48 +/- 11.21 mt, 17.79 +/- 4.83 mt, and 13.10 +/- 4.83 mt, respectively; p > 0.05). Maximum EF was found to be 19.72% at 40 min and increased to 28.62% at 70 min after EST. Although the difference was not statistically relevant, a trend of improvement was evident after EST. The ejected volumes after EST have depicted a trend toward increase, without reaching to any statistical significance (p > 0.05). Our results demonstrate at least no adverse effects of EST and further support some positive effects on gallbladder kinetics.Öğe Effect of Helicobacter pylori eradication on peptic ulcer disease complicated with outlet obstruction(Blackwell Science Inc, 2000) Taskin, V; Gurer, I; Ozyilkan, E; Sare, M; Hilmioglu, FBackground. At present, the prevalence of Helicobacter pylori (H. pylori) in complicated peptic ulcer and the effect of H. pylori eradication on complicated peptic ulcer have not been fully established. In this study, we report the prevalence of H. pylori in peptic ulcer patients complicated with gastric outlet obstruction, effectiveness of oral eradication therapy on these patients, and their long-term follow up. Patients and Methods. Ten consecutive patients presenting with clinically and endoscopically significant obstructed peptic ulcers were included in this study. During each endoscopy, seven gastric biopsy specimens were obtained and analyzed for H. pylori colonization. Results. The antral mucosal biopsy specimens were positive for H. pylori in nine patients. H. pylori infection was eradicated and complete ulcer healing was observed in all patients. The mean follow-up period was 14 (7-24) months. One patient had duodenal perforation and underwent surgical intervention following medical treatment, despite the eradication of H. pylori. Ulcer recurrence was noted in two (22.2%) of nine patients, and in one of them the recurrent ulcer was complicated with obstruction (11.1%). The mean time to ulcer recurrence was 17 months (range, 10-24 months). The biopsies and CLOtests were H. pylori negative at the time of ulcer or erosion recurrence in two patients. Conclusion. We suggest that H. pylori eradication may improve the resolution in obstructive ulcer cases with colonization.Öğe Effects of carbon dioxide pneumoperitoneum on free radical formation in lung and liver tissues(Springer, 2002) Sare, M; Hamamci, D; Yilmaz, I; Birincioglu, M; Mentes, BB; Özmen, M; Yesilada, ÖBackground: The purpose of this study was to investigate the possible effects of carbon dioxide (CO2) pneumoperitoneum on free radical formation and lipid peroxidation in the lung and liver tissues of rats. Methods: For this study, 50 male Sprague-Dawley rats were divided into five equal groups: control (group 1); sham operation (group 2): 5, 10, or 15 mmHg (group 3, 4, or 5) pneumoperitoneum with CO2 groups. At the end of the procedures, the rats were killed, and perfusion was performed via vena jugularis with cold Ringer's lactate. After the perfusion procedure, the lung and liver were harvested, and the supernatant fractions of the lungs and livers were assayed for superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA). Results: Both the lung and liver CAT activities were elevated consistently and significantly in the order of the study groups. as compared with the previous groups (p < 0.01 for all comparisons). The lung and liver SOD levels were elevated in groups 4 and 5, as compared with the other groups (p < 0.05). The lung MDA was significantly higher in groups 3 and 4, but not in group 5. Significant elevation in liver MDA was noted only in the 5-mmHg pneumoperitoneum group (p < 0.05). Conclusions: These results indicate that CO2 pneumoperitoneum applied with 5, 10, or 15 mmHg pressure increases the formation of free oxygen radicals, which is counterbalanced by increased SOD and CAT activities of the lung and liver tissues. This effect of CO2 pneumoperitoneum on free radicals and lipid peroxidation appears to be pressure dependent in rats. The mechanism underlying this pressure dependency is still under investigation.Öğe Effects of CO2 insufflation on bacterial growth in rats with Escherichia coli-induced experimental peritonitis(Lippincott-Raven Publ, 1997) Sare, M; Yesilada, O; Gurel, M; Balkaya, M; Yologlu, S; Fiskin, KThe effects of i.p. CO2 insufflation on bacterial proliferation in a setting of Escherichia coli-induced experimental peritonitis was studied in a rat model. Six male Wistar rats were given 0.25 ml of i.p. saline and formed the sham operation group. Twenty-four rats were divided into three groups, and all had i.p. E, coli injections. Microorganism counts were taken after 8 h in ail groups. Group I was used as the control group. Group 2 (laparoscopy) was insufflated with CO2, and group 3 (laparotomy) had a midline laparotomy. Microorganism counts were repeated 8 h after the procedures (16 h after i.p. E. coli inoculation). Postoperative microorganism counts were significantly higher in the CO2 insufflation group (p < 0.05) compared with the control and laparotomy groups and showed an increase, whereas they decreased in the other two groups.Öğe The effects of indomethacin, NDGA, allopurinol and superoxide dismutase on prostaglandin E(2) and leukotriene C-4 levels after mesenteric ischemia-reperfusion injury(Churchill Livingstone, 1996) Sare, M; Bozkurt, S; Onuk, E; Oguz, M; Gurel, M; Ercan, SIn this study, the changes of arachidonic acid metabolites after an ischemia-reperfusion (I/R) period are investigated. The cyclooxygenase and lipoxygenase metabolites were found to be significantly increased after a 45 min period of ischemia followed by 5 min of reperfusion. Prostaglandin E(2) (PGE(2))- and leukotriene C-4 (LTC(4))-like activities did not change in the ischemic period, but they both increased after reperfusion. A cyclooxygenase inhibitor indomethacin and lipoxygenase inhibitor nordehydroguaretic acid (NDGA) decreased PGE(2)- and LTC(4)-like activities, respectively, while allopurinol and superoxide dismutase (SOD) decreased both activities. According to our results, it can be assumed that free oxygen radicals are responsible for the elevation of PGE(2)- and LTC(4)-like activities and both of these arachidonic acid metabolites and free oxygen radicals are the main necrotizing agents in ischemia-reperfusion induced damage.Öğe Effects of laparoscopic models on anaerobic bacterial growth with Bacteroides fragilis in experimentally induced peritonitis(Mary Ann Liebert Inc Publ, 2003) Sare, M; Demirkiran, AE; Tastekin, N; Durmaz, BBackground: Previous reports of recurrent intra-abdominal abcess formation after the laparoscopic treatment of perforated acute appendicitis led us to investigate the possible effects of gas insufflation on the spread of infection. We previously showed that Escherichia coli counts were significantly higher in a laparoscopy group that underwent carbon dioxide (CO2) insufflation than in control and laparotomy groups. The aim of this study is to investigate the effects of intra-abdominal CO2 and nitrous oxide (N2O) insufflation on anaerobic bacterial growth in a rat model. Methods: A standard strain of Bacteroides fragilis (ATCC 25285) was injected intraperitoneally (1 x 10(6) cfu/mL per kilogram) in 40 Wistar rats under sterile conditions. Forty rats with induced peritonitis were randomly divided into five groups: control, laparotomy, CO2 insufflation, N2O insufflation, and one group without pneumoperitoneum. Eight hours after the intraperitoneal injection of B. fragilis, peritoneal aspirates were obtained and inoculated onto Brucella agar. At the sixteenth hour of induced peritoneal infection (corresponding to hour 8 in the laparoscopy groups) all animals underwent laparotomy; peritoneal aspirates were obtained and inoculated into Brucella agar for bacterial counts. The colonies of B. fragilis were counted manually, and the results were expressed as the mean number of colony-forming units per milliliter. Results: No significant differences in microorganism counts were noted between the study groups before the procedure (p >.05 for all comparisons). We observed a significant increase in the number of bacteria (mean +/- SD) in the CO2 insufflation group between hour 8 and hour 16 of peritoneal contamination. Conclusion: The results suggest that CO2 insufflation may promote the growth of intra-abdominal anaerobic bacteria. Such bacterial growth may lead to intra-abdominal abcess formation or cause localized peritonitis to develop into generalized peritonitis. We suggest that laparoscopy without pneumoperitonemn may be preferred in patients with peritonitis.Öğe Mirizzi syndrome: Choice of surgical procedure in the laparoscopic era(Lippincott Williams & Wilkins, 1998) Sare, M; Gurer, S; Taskin, V; Aladag, M; Hilmioglu, F; Gurel, MImpaction of a calculus in gallbladder neck or cystic duct or even in its remnant may produce common hepatic duct stricture by direct mechanical impression or associated inflammation. This clinical entity is referred to as Mirizzi syndrome. Four patients were operated on for Mirizzi syndrome. This represents 0.9% of the 444 patients who underwent laparoscopic cholecystectomy in our clinic. Two cases with Mirizzi syndrome type I, one of which had a stone in a gallbladder remnant, were successfully treated by laparoscopic cholecystectomy without any complications, One patient developed a bile leakage; fistulography via a sump drain revealed bile leakage from the laceration site of the stone, and: the patient was reoperated on to perform a Roux-en-Y hepaticojejunostomy. The patient was lost due to cardiopulmonary arrest originating from septic shock. In another case diagnosed as Mirizzi type Il, the operation was converted to an open procedure due to intense inflammation and fibrosis around the area of the Calot's triangle. Subtotal cholecystectomy was done and the defect on the common hepatic duct repaired by means of a gallbladder flap over the T tube.
