Husnu
Celik,1
Ahmet Ayar,2
Niyazi Tug,1
Mehmet Simsek,1
Ibrahim Ozercan,3
Gürkan Cikim, 4
Ibrahim Bildirici, 5
Firat
University, Faculty of Medicine, Departments of
1. Obstetrics and Gynecology, 2. Pharmacology, 3. Pathology,
4. Biochemistry, Elazig-TURKEY. Hacettepe
University, Faculty of Medicine,
5. Department of Obstetrics and Gynecology, Ankara-TURKEY.
Submitted:
September 29, 2002
Accepted: February 1, 2002
Key words:
melatonin, ischemia-reperfusion, pulmonary edema, guinea
pig
Abstract
OBJECTIVES:
Pulmonary edema has been shown to occur following ischemia-reperfusion
injury in a variety of organs and effects of several pharmacological
agents on ischemia-reperfusion-induced damage has been investigated
previously. However, there are only a few studies in the literature
about pulmonary injury following adnexial ischemia-reperfusion.
In this study we aimed at investigating pulmonary changes
following adnexial ischemia-reperfusion and the effects of
melatonin on noncardiogenic pulmonary edema secondary to adnexial
ischemia-reperfusion.
METHODS:
A total of 32 Dunkin-Harley guinea pigs were randomly divided
into four groups. In group I, oopherectomy was performed following
adnexial torsion of three hours (ischemia). Adnexial torsion
of three hours followed by a 3 hours detorsion period (reperfusion)
and then oopherectomy was performed in remaining three groups.
No therapy was given in group one and two while isotonic saline
and melatonin was applied intraperitoneally in groups three
and four, respectively. Serum malondialdehyde (MDA) levels
of operated ovaries and lungs and polimorphonuclear leucocyte
infiltration of lungs were determined.
RESULTS:
MDA levels in serum, ovary and lungs were higher in detorsion
groups (groups II, III) than torsion group (group I) (p<0.01).
Melatonin administration significantly decreased the polimorphonuclear
leukocytes infiltration of lung parenchime and MDA levels
in serum, ovaries and lungs (groups II and IV; groups III
and IV; p<0.01, p<0.01). MDA levels and lung tissue
PNL infiltration levels of melatonin administered detorsioned
group was similar to those levels of only salphingo-oopherectomy
performed group (Group I and IV, p>0.05).
CONCLUSION:
Pathophysiology of ischemia-reperfusion must be considered
in the cases of adnexial torsion where detorsion is thought.
As an antioxidant, melatonin administration might be helpfull
in decreasing post-operative morbidity by decreasing reperfusion
injury of lungs.
Introduction
Reperfusion
injury develops as a result of reperfusion of tissues following
a certain period of ischemia [1]. Free radicals are released
into systemic circulation which gives harm to the other parts
of body as well as the reperfused tissue. Lungs may also be
affected. Non-cardiogenic pulmonary edema was shown to occur
following ischemia-reperfusion of gut and extremities [2-6].
Free radical scavengers had been proposed to lessen pulmonary
injury secondary to ischemia-reperfusion of tissues [3].
Adnexial torsion is a serious gynecologic problem where conservative
management include detorsion of the involved segments. Detorsion
of torsioned ovaries was shown to cause reperfusion injury
histopathologically in our previous study performed in ra
[7].
In this study, effect of an antioxidant, melatonin (N-Acetyl-5-methoxytryptamine)
[8, 9] on pulmonary injury secondary to adnexial ischemia-reperfusion
was investigated.
Material,
Methods
... ...
Results
... ...
Discussion
... ...
Acknowledgement
Supported
by grant CNS LN00B12 MSMT CR and by grant IGA: 870-2.
REFERENCES
1 Zimmerman BJ, Granger DN. Reperfusion injury. Surg Clin
North Am 1992; 72:65-83.
2 Koike K, Yamamoto Y, Hori Y, Ono T. Group IIA phospholipase
A2 mediates lung injury in intestinal ischemia-reperfusion.
Ann Surg 2000; 232:90-7.
3 Galili Y, Ben-Abraham R, Weinbroum A, Marmur S, Iaina A,
Volman Y, Peer G, Szold O, Soffer D, Klausner J, Rabau M,
Kluger Y. Methylene blue prevents pulmonary injury after intestinal
ischemia-reperfusion. J Trauma 1998; 45:222-5.
4 Koksoy C, Kuzu MA, Kuzu I, Ergun H, Gurhan I. Role of tumour
necrosis factor in lung injury caused by intestinal ischaemia-reperfusion.
Br J Surg 2001; 88:464-89.
5 Schmeling DJ, Caty MG, Oldham KT, Guice KS, Hinshaw DB.
Evidence for neutrophil-related acute lung injury after intestinal
ischemia-reperfusion. Surgery 1989; 106:195-201.
6 Nielsen VG, Tan S, Weinbroum A, McCammon AT, Samuelson PN,
Gelman S, Parks DA. Lung injury after hepatoenteric ischemia-reperfusion:
role of xanthine oxidase. Am J Respir Crit Care Med 1996;
154:1364-9.
7 Sapmaz E, Celik H, Ozercan I, Mogulkoc R. Comparision of
the effect of salpingo-oopherectomy and detorsion of the lung
in adnexial torsions. Selcuk Journal of Medicine 2000; 16:261-266.
8 Pierrefiche G, Laborit H. Oxygen free radicals, melatonin
and aging. Exp Gerantol 1995; 30:213-27.
9 Czyrko C, Steigman C, Turley DL, Drott HR, Ziegler MM.The
role of reperfusion injury in occlusive intestinal ischemia
of the neonate: malonaldehyde-derived fluorescent products
and correlation of histology. J Surg Res 1991; 51:1-4.
10 Rahman A, Ustundag B, Burma O, Ozercan IH, Cekirdekci A,
Bayar MK. Does aprotinin reduce lung reperfusion damage after
cardiopulmonary bypass? Eur J Cardiothorac Surg 200; 18:583-8.
11 Hibbart LT, Adnexal torsion. Am J Obstet Gynecol 1985;
152:456-61.
12 Kampdenekh S, Possover M, Merker A, Bechler J, Krause N,
Schneider A Laparoscopic adnexal preservation in a patient
with complete torsion - a case report Eur J Obstet Gynecol
Reprod Biol 1998; 78:113-5.
13 Shalev E, Bustan M, Yarom I, Peleg D Recovery of ovarian
function after laparoscopic detorsion Hum Reprod 1995; 10:2965-6.
14 Oelsner G, Bider D, Goldenberg M, Admon D, Mashiach. Long-term
follow-up of the twisted ischemic adnexa managed by detorsion.
Fertil Steril 1993; 60:976-9.
15 Nichols D,Julianp.Torsion of the adnexa. Clin Obstet Gynecol
1985; 28:375-80.
16 Lynda L, Burt Mc Hutchison, MD, Paul PD, Koonings,MD, Charles
A,Ballard MD, and Gerrit D’Ablaing III, MD. Preservation
of ovarian tissue in adnexal torsion with fluorescein. Am
J Obstet Gynecol 1993; 168:1386-8.
18 Wellman JJ, Smith BA. Respidenekory complications of surgery.
In Lubin MR, ed. Medical management of the surgical patient.
Boston: Butterworth,1988:9-10.
19 Hotchkiss RS, Perioperative management of patient with
chronic obstructive pulmonary disease. Int Anesthesiol Clin
1988; 26:134-41.
20 Colletti LM, Burtch GD, Remick DG, Kunkel SL, Strieter
RM, Guice KS, Oldham KT, Campbell DA Jr. The production of
tumor necrosis factor alpha and the development of a pulmonary
capillary injury following hepatic ischemia/reperfusion. Transplantation
1990; 49:268-72.
21 Grace PA. Ischemia-reperfusion injury. Br J Surg 1994;
81:637-647.
22 Pablos MI, Reiter RJ, Chuang JI, Ortiz GG, Guerrero JM,
Sewerynek E, Agapito MT, Melchiorri D, Lawrence R, Deneke
SM. Acutely administered melatonin reduces oxidative damage
in lung and brain induced by hyperbaric oxygen. J Appl Physiol
1997; 83:354-8.
23 Yamamoto H, Tang H.Melatonin attenuates L-cysteine-induced
seizures and lipid peroxidation in the brain of mice. J Pineal
Res 1996; 21:108-13.
24 Guerrero JM, Reiter RJ, Ortiz GG, Pablos MI, Sewerynek
E, Chuang JI. Melatonin prevents increases in neural nitric
oxide and cyclic GMP production after transient brain ischemia
and reperfusion in the Mongolian gerbil (Meriones unguiculatus).
J Pineal Res 1997; 23:24-31.
25 Smith G. Management of postopedenekive pain. Can J Anaesth
1989; 36:1-10.
