THE EFFECT OF PIROXICAM AND DISODIUM CROMOGLYCATE ON INTRAABDOMINAL ADHESIONS IN AN EXPERIMENTAL MODEL OF PERITONITIS

In spite of the various drugs and methods that have been used, adhesions are still among the most common causes of morbidity and mortality in postoperative period. In our study, the effects of proxicam and disodium cromoglycate on adhesion formation were observed in an experimental model of peritonitis. Thirty Sprague-Dawley rats were divided into 3 groups as proxicam, disodium cromoglycate and control. After peritonitis was made, abdominal incision was closed. Twenty-four hours later, the abdominal cavity was evaluated macroscopically about the peritonitis. Specimens for culture and histopathological examination were obtained and existence of peritonitis was shown by those examinations. Piroxicam 0.250 mg/kg and, disodium cromoglycate 10 mg/kg were applied by intraperitoneal injection at the end of the operation and then by intramuscular injection. Duration of the treatment was 5 days. At control group peritoneal exudate was swept by gauze pads and abdominal cavity was closed. On postoperative 15th day adhesions were observed along the left lateral incision of laparatomy. The localizations and severity of adhesions were identified. The parts of periton, viscus and/or fibrotic band where the adhesion was dens, were obtained for histopathological examination. The microscopic examination was based on the evaluation of infectious infiltration, fibroblast activation, vascularization and foreign body giant cells reaction. As a result, piroxicam that is a non steroidal anti inflammatory drug was found to be effective on prevention of adhesions (p<0.001). Proxicam could be used in the case of preventing adhesion formation, if its effects on immune response was clearly shown.

DENEYSEL PERÝTONÝT MODELÝNDE DÝSODYUM KROMOGLÝKAT VE PÝROKSÝKAMIN KARIN ÝÇÝ YAPIÞIKLIKLARA ETKÝSÝ

Ameliyat sonrasý erken ve geç dönemde görülen karýn içi yapýþýklýklar, kullanýlan çok sayýda ilaç ve yönteme raðmen büyük sorunlar yaratmakta, morbidite ve mortalitenin artmasýna yol açmaktadýr. Çalýþmamýz, sýçanlarda geliþtirilen peritonit modelinde Piroksikam (Piroxicam) ve Disodyum kromoglikatýn (Disodium cromoglycate)yapýþýklýk oluþumu üzerine olan etkilerini araþtýrmak amacý ile planlandý. Spraque-Dawley cinsi 30 adet sýçan Piroksikam, Disodyum kromoglikat ve kontrol grubu olmak üzere üç gruba ayrýldý. Peritonit oluþturulduktan sonra karýn katlarý kapatýldý. 24 saat sonra karýn peritonit yönünden makroskopik olarak deðerlendirildi, mikrobiyolojik inceleme için kültür alýndý ve karýn sað ön-yan duvarýndan parietal periton ve kas tabakasýný içeren 1 cm2 'lik biopsi alýnarak peritonit oluþtuðu histopatolojik incelemelerle doðrulandý.Piroksikam 0.250 mg/kg, Disodyum kromoglikat 10 mgr/kg, birinci doz intraperitoneal, sonraki dozlar intramuskuler olarak toplam 5 gün uygulandý. Kontrol grubunda ise sadece peritoneal eksuda kuru tamponla silindi ve karýn kapatýldý. Ameliyat sonrasý 15. gün karýn sol kadrandan laparotomi yapýldý ve yapýþýklýklar gözlendi. Yapýþýklýklarýn yerleri ve þiddeti tespit edildi. Yapýþýklýðýn en yoðun olduðu yerdeki periton, visseral organ, ve/veya fibröz bantlar biopsi için alýndý. Mikroskobide iltihabi infiltrasyon, fibroblast aktivasyonu, damarlanma ve yabancý cisim dev hücresi reaksiyonu yönünden deðerlendirildi. Sonuç olarak çalýþmamýzda bir nonsteroid-antiinflamatuar ilaç olan Piroksikam'ýn yapýþýklýklarý önlemedeki etkisi olumlu yönde bulunmuþtur (p<0.001). Piroksikam'ýn immun yanýtý ne ölçüde etkilediði açýk olarak ortaya konulabilirse yapýþýklýk oluþumunun önlenmesinde kullanýlabilmesi mümkün olacaktýr.