Effect of Tramadol Hydrochloride on Healing of Ischemic Colon Anastomosis

In patients who are operated under emergency or elective conditions after reasons such as ileus, bleeding, colorectal malignancy or trauma, anastomosis can be performed together with segmental bowel resection, and separation or separation of this anastomosis in the postoperative period is one of the important complications with high mortality and morbidity. The minimal level of ischemia / reperfusion damage occurring in the postoperative period will have a positive effect on the healing process of the anastomosis. Studies on factors contributing to wound healing have increased in order to prevent complications that we may encounter in the postoperative period in colon anastomoses. Tramadol hydrochloride is considered a weak opioid analgesic and has serotonin and noradrenaline reuptake inhibition. It is a drug used to treat moderate to severe pain, usually in the postoperative period. Our aim in this study is to show the effect of tramadol hydrochloride, an opioid analgesic drug, on inflammation and colon anastomosis healing in a reperfused rat model after distant ischemia / reperfusion injury. Method: 24 Winstar Albino rats will be included in the study, and the rats will be divided into two groups. Group 1: Intraperitoneal normal saline will be administered daily for 5 days postoperatively. Group 2: Tramadol hydrochloride 30 mg/kg will be administered intraperitoneally every day for 5 days postoperatively. In our study, according to the experimental model plan prepared according to the experimental model used in the study Effects of montelukast on the healing of ischemic colon anastomoses, Atilla Celik, American Journal of Surgery, 2013 Oct;206(4):502-8, 24 rats with the same characteristics were swam from the 14th day before the study. From the beginning to the end of the work, it will be subjected to a 12-hour day-night cycle at 21±3º C room temperature, 60% ideal humidity. After completing the feeding under the specified conditions for 14 days, two groups of 12 will be formed from the rats, with an equal number of controls and experiments (the group to which Tramadol hydrochloride will be administered) by simple random sampling method. Intramuscular dissociative anesthesia will be created with 50 mg/kg ketamine hydrochloride for all rats. After shaving the skin of the rats in the supine position, antisepsis will be provided with 10% povidone iodine. Sterility conditions will be ensured throughout the surgery and spontaneous respiration of the rats will be allowed. All rats will be subjected to a 5 cm midline incision by laparotomy and the superior mesenteric artery and collateral vessels will be clamped from the distal aorta with the help of a microvascular clamp for 45 minutes, then the clamps will be released and 45 minutes will be allowed for reperfusion. After reperfusion, a full-thickness incision will be made in the left colon segment 3 cm proximal to the peritoneal reflection of all animals and anastomosis will be made one by one with 6/0 monofilament propylene sutures. In the postoperative period after left colon anastomosis, rats in the first group will receive 1 cc intraperitoneal saline once a day, and 30 mg/kg 1 cc intraperitoneal Tramadol hydrochloride will be administered to the rats in the second group once a day for 5 days. The anastomosis line in the left colon segment will be resected together with the proximal and distal regions of two centimeters each, by entering the abdomen through the incision on the 6th postoperative day before. All rats will be sacrificed by intracardiac blood puncture. Burst pressures will be measured to determine clinical recovery from the removed anastomosis intestinal segment. After the fecal content in the left colon intestinal segment lumen is washed with physiological saline, the distal end of the anastomosis will be tied, the proximal part will be integrated into the catheter tip, infusion pump, pressure manometer, monitor system and burst pressures will be recorded. As a biochemical examination from blood samples taken by intracardiac puncture during the sacrification of rats according to the experimental model plan; catalase, nitric oxide, glutathione, reductase, Superoxide Dismutase, TNFα, IL-6, AST, ALT, Hydroxyproline, Myeloperoxidase, Malondialdehyde, Caspase-3 will be checked and their effectiveness will be measured. In the statistical evaluation, the data obtained after the study will be used using the SPSS 21.0 (SPSS Inc., Chicago, IL, USA) package program and the mean, median, standard deviation, minimum, maximum, percentage values ​​of all data will be calculated. Normality tests of the subjects' data will be done with the Kolmogorov-Smirnov test, and Mann Whitney U test will be used to evaluate the difference between the groups of non-parametric data of the subjects (p<0.05). Parametric data will be analyzed with Independent Samples t test (p<0.05)

Role of Platelet to Lymphocyte Ratio as a Biomedical Marker for the Pre-Operative Diagnosis of Acute Appendicitis

Aydin, Oktay/0000-0001-5728-0128WOS: 000496634600007PubMed: 31120412Background: Recently, the possible use of laboratory parameters such as full blood count, neutrophil count, neutrophil to lymphocyte ratio (NLR), thrombocyte count (PLT), and mean thrombocyte volume (MPV) have been investigated in diagnosis of acute appendicitis and the prediction of complications. The aim of this study was to investigate the utility of the platelet to lymphocyte ratio (PLR) value as a biomedical marker in the prediction of acute appendicitis and perforated appendix. Patients and Methods: The data were retrieved from the hospital records related to age, gender, length of stay in hospital, MPV, leukocyte, neutrophil, lymphocyte, and thrombocyte counts measured in the peripheral venous blood sample on presentation, NLR and PLR values, and the pathology results. The patients were grouped according to the pathology results as follows: group 1 (normal appendix, n = 86); group 2 (acute appendicitis, n = 458); group 3 (perforated appendicitis, n = 14). Results: The study included a total of 558 patients (308 males; 250 females) with a mean age of 34.24 +/- 14.27 years. The mean length of stay in hospital was 2.12 days. The leukocyte and neutrophil count values of group 1 were lower than group 2 and group 3 values (p < 0.001). The lymphocyte count values of group 1 were higher than those of the other groups (p < 0.001). The NLR and PLR values of group 1 were lower than group 2 and group 3 values (p < 0.001). The length of stay in hospital was shorter in group 1 than in group 2 and group 3 (p = 0.42). The receiver operating characteristic (ROC) curve test results showed that PLR and NLR values were sensitive and specific to differentiate normal appendix, acute appendicitis, and perforated appendicitis. Conclusion: The results of this study demonstrated that PLR value, such as NLR, could be evaluated as a new biomarker that could be valuable in the differentiation of normal appendix from acute appendicitis and in the differentiation of acute appendicitis from perforated appendicitis

Factors Affecting Mortality in Fournier Gangrene: A Single Center Experience

Aydin, Oktay/0000-0001-5728-0128WOS: 000449392600001PubMed: 30403562Background: The objective of this study was to determine the clinical and laboratory features affecting mortality in Fournier gangrene. Patients and Methods: This retrospective case control study was designed to evaluate patients treated for Fournier gangrene in our center between 2010 and 2018. Those patients were divided into two groups: discharged patients (group 1) and deceased patients (group 2). Comparisons were made regarding clinical and demographic features; leukocyte, neutrophil and lymphocyte count results; neutrophil to lymphocyte ratio (NLR); Fournier's Gangrene Severity Index (FGSI) scores; number of debridements; complications; and mortality rates. Results: Twenty-three patients (19 males, 4 females) were evaluated; mean age was 65.9116.34 years. The most common cause of the disease and comorbidity were perianal abscess (n=14; 60.9%) and type 1 diabetes mellitus (n=11; 47.8%), respectively. Escherichia coli was the pathogen identified most often (n=17; 73.9%). The total mortality rate was 21.7% (n=5). Neutrophil to lymphocyte ratio, FGSI, number of debridements, and complication rates were higher in group 2 (p<0.05). There was a substantial difference between the groups regarding perianal abscess in group 1 and rectum cancer in group 2 (p<0.05). Conclusion: In conclusion, it was believed that the mortality rate could be predicted by combining the NLR value with the FGSI score

Is the Platelet to Lymphocyte Ratio a Potential Biomarker for Predicting Mortality in Peptic Ulcer Perforation?

Aydin, Oktay/0000-0001-5728-0128WOS: 000467443800011PubMed: 30735093Background: Despite surgical treatment of peptic ulcer perforation (PUP), the high rates of morbidity and mortality have motivated researchers to search for new laboratory markers to predict morbidity and mortality. The aim of this study was to investigate the relation between pre-operative laboratory values and demographic factors and post-operative mortality in patients undergoing surgery for PUP. Patients and Methods: A retrospective study was made of the clinical findings and laboratory data of patients operated on for a diagnosis of PUP in the general surgery clinic between 2014 and 2018. The patients were separated into two groups according to survival (PUP-S) or mortality (PUP-M) and the differences between the groups were evaluated. Result: In the analysis of the patient data, age (p = 0.014), female gender (p = 0.005), length of stay in hospital (p = 0.009), platelet to lymphocyte ratio (PLR) (p = 0.09), and neutrophil to lymphocyte ratio (NLR) (p = 0.010) values were determined to be high and lymphocyte count was low (p = 0.046) in the PUP-M group. A positive correlation was determined between mortality and age, length of stay in hospital, PLR, and NLR (p < 0.05). A substantial negative correlation was determined between mortality and gender and lymphocyte count (p < 0.05). As a result of the receiver operating characteristic (ROC) curve analysis, it was determined that a PLR value <322.22 (p = 0.009) and lymphocyte count <0.67 x 10(3) microliter (p = 0.035) could have diagnostic value in the prediction of the possibility of mortality in patients operated on because of PUP. Conclusion: This study results suggested that PLR, NLR, and lymphocyte count values could be used as new biomarkers to identify the mortality risk in patients operated on for peptic ulcer perforation

Suprapubic Midline Extraperitoneal Approach for Widespread Retroperitoneal Abscess Originating from Anorectal Abscess

Aydin, Oktay/0000-0001-5728-0128WOS: 000425926200007