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Öğe The effects of serum estrogen levels on hypoxemia and blood nitric oxide levels in experimental hepatopulmonary syndrome(WILEY, 2005) Yol, S; Erikoglu, M; Toprak, SS; Tavli, S; Tavli, LBackground: Hepatopulmonary syndrome (HPS) is a well-defined cause of hypoxemia in patients who have liver disease due to abnormal intrapulmonary vascular dilatation. The pulmonary symptoms of HPS are the result of oxygenation defects that occur as a result of acquired dilatations of the pulmonary blood vessels. In this study, we investigated the effects of estrogen and nitric oxide (NO) in experimental HPS, especially in intrapulmonary vascular dilatation. Methods: Fifty female Sprague-Dawley rats were used in this study. The animals were divided into five groups of 10. Group I (the control group): the common bile duct (CBD) was dissected but not ligated. Group 2 (the cirrhosis group): the CBD was ligated. Group 3 (the cirrhosis + oophorectornized group): the CBD was ligated and a bilateral oophorectomy performed. Group 4 (the cirrhosis + estrogen group): the CBD was ligated and exogenous estrogen (5000 U/kg) given. Group 5 (the control+ estrogen group): the CBD was dissected, but not ligated and exogenous estrogen (5000 U/kg) given. A 5-week waiting period was observed for the development of cirrhosis and the rats' lungs and liver were taken for histopathological examination. Pulmonary vessel diameters were measured. The total bifirubin, direct bilirubin, alkaline phosphatase (ALP), estrogen and serum nitric oxide (NO) levels were measured. Results: The mean perialveolar vessel diameters were significantly higher in the cirrhotic rats (Groups 2, 3, and 4) than the control and control + estrogen administered groups. Again, when we compared the cirrhosis + oophorectornized group and the cirrhosis + estrogen group, the mean perialveolar vessel diameter was significantly lower in the cirrhosis + oophorectornized group than the cirrhosis + estrogen administered group (p = 0.001). The mean perialveolar vessel diameter in the cirrhosis + oophorectornized group was significantly lower than the cirrhosis group (p = 0.01). When we compared the cirrhotic rats (Groups 2, 3, and 4) and the control group, the plasma NO levels were significantly higher in the cirrhotic rats than the control group (p < 0.001). Among the cirrhotic rats, the plasma NO levels were 47.2 +/- 0.7 and 70.9 +/- 1.5 mu mol/l in the cirrhosis + oophorectomized group and the cirrhosis + estrogen administered group, respectively (P = 0.004). Conclusions: We consider that raised levels of estrogen have a potential role in intrapulmonary vascular dilatation and hypoxemia in HPS. Also, we consider that this effect of estrogen is due to increased levels of NO. Antiestrogenic surgical therapy may decrease the serum estrogen and NO levels, and may decrease the diameter of perialveolar vessels in order to relieve hypoxia in cirrhotic cases. (c) 2005 Elsevier B.V. All rights reserved.Öğe Electron-microscopic alterations of the peritoneum after both cold and heated carbon dioxide pneumoperitoneum(ACADEMIC PRESS INC ELSEVIER SCIENCE, 2005) Erikoglu, M; Yol, S; Avunduk, MC; Erdemli, E; Can, ABackground. Carbon-dioxide (CO2) is used universally as an insufflation agent to create a laparoscopic pneumoperitoneum. In this study, we aimed to examine the electron and light microscopic alterations of the peritoneum after both cold-dry and heated-humidified CO, pneumoperitoneum. Materials and methods. Thirty male Sprague-Dawley rats were used in this study. The rats were separated into three groups each comprising 10 rats. Group-I: (Control group): Gas insufflation was not applied to these animals. Group-II: These animals received standard cold-dry (21 degrees C, 2% relative humidity) CO2. Group-III: These animals received heated-humidified (40 degrees C, 98% relative humidity) CO2. In groups II and III, peritoneal gas was emptied 2 h after pneumoperitoneum. application. All rats were killed after 12 h. Peritoneal samples were examined both by scanning electron and light microscopy by two different pathologists who were not aware of the groups. Results. According to light microscopic examination; in group II and III, cellular response (increased lymphocyte) was significantly higher than the control group (P < 0.01). Similarly, in group II cellular response was significantly higher than group Ill. (P < 0.01). There was no difference in increased capillarity among all groups. (P > 0.05). According to scanning electron microscopic examination, in group I, normal peritoneum was covered by a sheet of flat mesothelial cells densely covered with microvilli. No intercellulary clefts and no free basal lamina were detected. In group II, drastic alterations of the surface layer were seen. The mesothelial cells had extreme desquamation, and the basal membrane was clearly visible. In group III, the mesothelial cells had bulged up to the surface layer and retracted. Intercellulary clefts become visible, but the basal lamina was not seen. Conclusions. Electron and light microscopic examination revealed that heated-humidified CO results in less peritoneal alteration than cold-dry CO2. Accordingly, we believe that heated-humidified CO2 is more suitable for pneumoperitoneum. application in laparoscopic surgery especially in selected cases. (c) 2005 EIsevier Inc. All rights reserved.Öğe The Management of Hepatic Hydatid Cyst Cavity by Overlapping(K FAISAL SPEC HOSP RES CENTRE, 1998) Kartal, A; Şahin, M; Yol, S; Belviranlı, M; Karahan, O; Vatansev, C; Açıkgözoğlu, Saim[Abstract not Available]Öğe Open drainage versus overlapping method in the treatment of hepatic hydatid cyst cavities(INT COLLEGE OF SURGEONS, 1999) Yol, S; Kartal, A; Tavli, S; Sahin, M; Vatansev, C; Karahan, O; Belviranli, MIn order to compare the results of open drainage and overlapping methods, 58 consecutive patients with uncomplicated hepatic hydatid disease were investigated between January 1990 and January 1997. The cavities were obliterated by overlapping method in 26 patients and were left open into the peritoneal cavity following partial pericystectomy in 32 patients. Postoperative complications and follow-up results of ultrasonography (US) and computed tomography (CT) were compared between the two groups. In total, there were 56 cysts in the obliterated group and 83 cysts in the open drainage group. There was no significant difference in age, sex, mean diameter of the cysts, US features:of the cysts according to the Gharbi classification, and median followup. Mean hospital stay was 10 days in the overlapping group and 7.5 days in the open drainage group (P = 0.033). No postoperative complication was observed in the obliterated group and nearly half of the cyst cavities could not be detected in the early postoperative period by US and CT. Pleural effusion (n = 1) and biliary fistula (n = 1) were detected in the open drainage group which disappeared spontaneously. In the open drainage group, US and CT surveillance revealed that the cyst cavities were reduced in size and the echo pattern was changed in the early postoperative period, whereas the appearance changed into pseudotumor view in the late postoperative period. In conclusion, the cyst cavities disappear perfectly in the overlapping group. Treating the cyst cavity by open drainage is an easy, effective and safe technique. Open drainage can be a 'method of choice' for patients with multiple hydatid cysts and for cysts where management is difficult or unamenable to other methods, but the residual cyst cavities may be misinterpreted as a new cyst by an inexperienced radiologist.Öğe Transanal electrovaporisation of rectal tumours(SCANDINAVIAN UNIVERSITY PRESS, 1999) Yol, S; Kartal, A; Kilinc, M; Tavli, S; Karahan, O; Tatkan, YObjective: To present our early results with endoscopic transanal electrovaporization of rectal tumours. Design: Retrospective study. Setting: Department of Surgery, Faculty of Medicine, University of Selcuk. Subjects: 10 patients, 4 with malignant and 6 with benign lesions. Interventions: Vaporization of the tumour using a new ridged roller electrode, the VaporTrode, and a standard 24F urological resectoscope. Main outcome measures: Morbidity and recurrence. Results: There were no complications and all adenomas were vaporized completely. 2 patients with obstruction required a further treatment 3 and 5 months later because of recurrence. Median duration of operation was 22.5 minutes (range 10-38) and median duration of hospital stay was 3 days (range 1-4). Conclusion: The VaporTrode is a safe and potentially useful tool for transanal excision of rectal tumours, the long term efficacy of which should be tested in larger series of patients.
