Alterations in thyroid hormones due to increased intraabdominal pressure in rats

Purpose: Although the effects of increased intraabdominal pressure on the abdominal organs are well known, there is a limited data regarding its effects on the thyroid hormones. The aim of this study is to investigate the changes in thyroid hormone profiles during stress endocrine response induced by increased intraabdominal pressure, which was obtained by pneumoperitoneum in rats. Materials and Methods: A hundred-fifty female wistar albino rats were divided into three main groups, according to intraabdominal pressure applied; Control (Group 1), (n:30), low pressure, 15 mmHg, (Groups 2 and 3), (n:60), and high intraabdominal pressure, 25 mmHg, (Groups 4 and 5), (n:60) groups. Groups 2, 3, 4, 5 were divided into three subgroups separately, according to duration of intraabdominal pressure. Rats in Groups 3 and 5 were decompressed at the end of times indicated (15th, 30th, and 45th min) and blood samples were obtained. Whereas blood samples from Groups 2 and 4 were drawn without decompression at the end of times indicated. Measurements included thyroid stimulating hormone, cortisole, vasopressin, adrenocorticotropic hormone, triiodotronin and thyroxin. Result: Our study revealed that blood TSH levels reduce and free T3 and T4 levels increase in case of prolonged intraabdominal pressure increase that cause abdominal compartment syndrome. The change in blood thyroid hormone levels are encountered prominently on 30th and 45th min. Conclusion: Secretion of vasopressin, adrenocorticotropic Hormone and cortisol increases with increasing intraabdominal pressure. At high pressures, thyroid stimulating hormone secretion decreases while the secretion of triiodotronin increases. The effect of this case on the clinical findings has not been fully clarified yet and it needs further studies to clarify underlying mechanism. In this perspective, the findings of this study may be used in further clinical and experimental studies

Our experience on feeding ostomies

Purpose: The aim of the present study is to assess patient's profiles and complications related to the tube placement in patients undergoing Percutaneous Endoscopic Gastrostomy and surgical feeding ostomies.Materials and Methods: The retrospective data of 114 consecutive hospitalized patients who underwent enteral feeding ostomy procedures was evaluated by dividing patients into two separate groups as Percutaneous Endoscopic Gastrostomy Group and Surgery Group.Results: Of the 114 patients, 57 patients underwent surgical feeding ostomy procedures, and other 57 underwent Percutaneous Endoscopic Gastrostomy. The mean age of the patients requiring surgical ostomy was greater than that of the patients with Percutaneous Endoscopic Gastrostomy. All procedures in the surgical group were performed in the operating theater, but procedures in the endoscopy group were performed in intensive care unit (61.5 %), endoscopy suit (34.6 %), or patient wards (3.8 %). The number of patients having cancer in the surgical ostomy group was higher than the Endoscopy group significantly, p<0.001. On the contrary, 93 % of the patients in the Endoscopy group had neurologic problems. Total complication rates in PEG group, surgical gastrostomy and jejunostomy groups were 26.3 %, 25 % and 24.3 %, respectively.Conclusion: In conclusion, PEG procedure has some advantages such as simplicity, low complication rates, lower cost, long term enteral nutrition. For that reason, recently, there is an increase in use of PEG procedure. However, the situation in which the use of PEG is impossible, surgical enteral tube placement techniques are still valid alternatives