KARACİĞER HEMOSTAZINDA YENİ BİR BİTKİSEL İLAÇ: DENEYSEL BİR HAYVAN ÇALIŞMASI

Year 2019, , 156 - 161, 16.07.2019

Enver Kunduz , Zeyneb Afra Dinçer Büşra Şeker , Hatice Kübra Saylak Okan Demir Hüseyin Akbulut Erhan Ayşan

https://doi.org/10.26650/IUITFD.2019.0014

Abstract

Amaç: Kanama, cerrahi işlemlerin ana komplikasyonlarından biridir. Karaciğer hasarı sonrası ciddi kanamalar görülebilir. Literatürde kompresyon, Pringle manevrası ve diğer hemostatik ajanlar gibi karaciğer kanamasını durdurmak için çeşitli yöntemler tanımlanmıştır. Bu çalışmada, literatürde anti-enflamatuar, antioksidan, antimikrobiyal, analjezik ve antikoagülan etkileri gösterilmiş ajanların kullanımının, karaciğer yaralanmalarında hemostatik etkinlikleri değerlendirildi. Gereç ve Yöntem: Bu çalışmada 28 adet Wistar albino dişi / erkek sıçan kullanıldı. Hayvanlar 4 gruba ayrıldı. Karaciğer hasarı modeli oluşturulduktan sonra, karaciğere çeşitli bitkisel karışımlar uygulandı. Hematokrit ve trombosit sayıları ölçüldü. Ayrıca karaciğer parankimindeki histopatolojik değişiklikler için, sıçanlar sakrifiye edilerek karaciğer rezeke edildi. Bulgular: Kanama miktarı (p:0,001) ve preoperatif ve postoperatif hematokrit değişiklikleri (p:0,009) gruplar arasında istatistiksel olarak anlamlıydı. Bağ dokusu büyümesinde (p:0,065) ve nekrozda anlamlı bir fark yoktu (p:0,062). Karyorreksis olmadan iltihaplanmada anlamlı fark vardı (p:0,003). Tartışma: Histopatolojik incelemeler aktif ajan kullanan grupların daha fazla bağ dokusu ve karyorreksi, kanamayı durdurmaya yardım edebilmektedir.

Keywords

Karaciğer kanaması, Bitkisel ilaç, hemostatik ajan

A NOVEL HERBAL EXTRACT MEDICINE FOR LIVER HEMOSTASIS: AN EXPERIMENTAL ANIMAL STUDY

Abstract

Objective: Bleeding is one of the major complications of surgical procedures. Severe bleeding can be seen after liver injury. Various methods have been described in the literature for stopping liver bleeding such as compression, Pringle maneuver, and other hemostatic agents have been used. In this study, the use of anti-inflammatory, antioxidant, antimicrobial, analgesic, and anticoagulant agents described in the literature were evaluated for hemostatic efficacy following liver injuries. Materials and Methods: In this study 28 Wistar albino female / male rats from out-bred production were used. Animals were divided in 4 groups. After liver damage model creation, various herbal substances were applied to the liver. Hematocrit and platelet counts were measured. In addition, for histopathologic changes in the liver parenchyma, the rats were sacrificed, and the liver was resected. Results: The amount of bleeding (p:0.001) and the preoperative and postoperative hematocrit changes (p:0.009) were statistically significant between the groups. There was no significant difference in connective tissue growth (p:0.065) and necrosis (p:0.062). There were significant differences in inflammation and without karyorrhexis (p:0.003). Discussion: Histopathological examinations showed that the groups using active agents had more connective tissue and karyorrhexis. Therefore these tissues could help to stop bleeding.

Keywords

Liver bleeding, Herbal medicine, hemostatic agent

References

• 1. Karkouti K, Dattilo KM. Perioperative hemostasis and thrombosis. Can J Anaesth. 2006;53(12):1260-2.
• 2. Clark WR Jr, Leather RP. Hemostasis during liver resections. Surgery 1970;67:556-7.
• 3. Saifi J, Fortune J, Graca L, Shah D. Benefits of intraabdominal pack placement for the management of nonmechanical hemorrhage. Arch Surg 1990;125:119-22.
• 4. Beal S. Fatal hepatic hemorrhage: an unresolved problem in the management of complex liver injuries. J Trauma 1990;30:163-9.
• 5. Pringle JG. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 1908;48:541-9.
• 6. Carmona RH, Peck DZ, Lim RC Jr. The role of packing and reoperation in severe hepatic trauma. J Trauma 1984;24:77984.
• 7. Raccuia JS, Simonian G, Dardik M, et al. Comparative efficacy of topical hemostatic agents in a rat kidney model Am J Surg 1992;163:234-8.
• 8. Cobden RH, Thrasher EL, Harris WH. Topical hemostatic agents to reduce bleeding from cancellous bone: a comparison of microcrystalline collagen, thrombin, and thrombin-soaked gelatin foam. J Bone Joint Surg Am 1976;58:70-3.
• 9. Fonouni H, Kashfi A, Majlesara A, Stahlheber O, Konstantinidis L, Gharabaghi N, Kraus TW, Mehrabi A, Oweira H. Hemostatic efficiency of modern topical sealants: Comparative evaluation after liver resection and splenic laceration in a swine model. J Biomed Mater Res B Appl Biomater. 2017 Jun 23. doi: 10.1002/jbm.b.33937. [Epub ahead of print]
• 10. Aleinik A, Baikov A, Dambaev G, Semichev E, Bushlanov P. Liver Hemostasis by Using Cold Plasma. Surg Innov 2017;24(3):253-8.
• 11. Jiang X, Williams KM, Liauw WS, Ammit AJ, Roufogalis BD, Duke CC, Day RO, McLachlan AJ. Effect of St John’s wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2004;57(5):592-9.
• 12. Kandis H, Karapolat S, Yildirim U, Saritas A, Gezer S, Memisogullari R. Effects of Urtica dioica on hepatic ischemia-reperfusion injury in rats. Clinics (Sao Paulo) 2010;65(12):1357-61.
• 13. Silva RR, Oliveira e Silva D, Fontes HR, Alviano CS, Fernandes PD, Alviano DS. Anti-inflammatory, antioxidant, and antimicrobial activities of Cocos nucifera var. typica. BMC Complement Altern Med 2013;13:107.
• 14. Chen SP, Lo SF, Wang YC, Chou TY, Chang KM, Chou LW. Validating Efficacy of Shea Nut Oil Extract in Knee Osteoarthritis Patients. Evid Based Complement Alternat Med 2013;2013:147163.
• 15. Lansdown AB, Mirastschijski U, Stubbs N, Scanlon E, Agren MS. Zinc in wound healing: theoretical, experimental, and clinical aspects. Wound Repair Regen 200;15(1):2-
• 16. Basch E, Ulbricht C, Hammerness P, Blevins A, Sollars D. Thyme (Thymus vulgaris L.), thymol. J. Herb. Pharmacother. 2004:4:49-67.
• 18. Klemow KM, Bartlow A, Crawford J, Kocher N, Shah J, Ritsick M. Medical Attributes of St. John’s Wort (Hypericum perforatum) in Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Benzie IFF, Wachtel-Galor S, editors. Boca Raton (FL): CRC Press/Taylor & Francis; 2011.
• 19. Lieberman S. Evidence-based natural medicine: Nutriceutical review of St. John’s wort (Hypericum perforatum) for the treatment of depression. J Women’s Health 1998;7:177-82.
• 20. Schempp CM, Pelz K, Wittmer A, Schopf E, Simon JC. Antibacterial activity of hyperforin from St. John’s wort, against multiresistant Staphylococcus aureus and grampositive bacteria. Lancet 1999;353:2129.
• 21. Mishenkova EL, Derbentseva NA, Garagulya AD, Litvin LN. Antiviral properties of St. John’s wort and preparations produced from it. Transactions of the Congress of Microbiologists of the Ukraine 1975;4:222-322.
• 22. Schempp C. M, Kirkin V, Simon-Haarhaus B. et al. Inhibition of tumour cell growth by hyperforin, a novel anticancer drug from St. John’s wort that acts by induction of apoptosis. Oncogene 2002;21:1242-50.
• 23. Sosa S, Pace R, Bornancin A, et al. Topical anti-inflammatory activity of extracts and compounds from Hypericum perforatum L. J Pharm Pharmacol 2007;59(5):703-9.
• 24. Ozturk N, Korkmaz S, Ozturk Y. Wound-healing activity of St. John’s Wort (Hypericum perforatum L.) on chicken embryonic fibroblasts. J Ethnopharmacol 2007;111(1):33-9.
• 25. Francišković M, Gonzalez-Pérez R, Orčić D, Sánchez de Medina F, Martínez-Augustin O, Svirčev E, Simin N, MimicaDukić N. Chemical Composition and Immuno-Modulatory Effects of Urtica dioica L. (Stinging Nettle) Extracts. Phytother Res 2017;31(8):1183-91.
• 26. Kavalali GM. Urtica: therapeutic and nutritional aspects of stinging nettles (volume 37). In Medicinal and Aromatic Plants—Industrial Profiles, Hardman R (ed). 2003. Taylor & Francis: New York.
• 27. Chrubasik J, Roufogalis B, Wagner H, Chrubasik S. A comprehensive review on the stinging nettle effect and efficacy profiles. Part II: Urticae radix Phytomed 2007;14:56879.
• 28. Beyazit Y, Kurt M, Kekilli M, Goker H, Haznedaroglu IC. Evaluation of hemostatic effects of Ankaferd as an alternative medicine. Altern Med Rev 2010;15(4):329-36. 17. Aysan E, Bektas H, Ersoz F, Sari S, Kaygusuz A, Huq GE. Ability of the ankaferd blood stopper® to prevent parenchymal bleeding in an experimental hepatic trauma model. Int J Clin Exp Med 2010;3(3):186-91.
• 29. Jones PW, Williams DR. The use and role of zinc and its compounds in wound healing. Met Ions Biol Syst 2004;41:139-83.
• 30. Vallee BL, Falchuk KH. The biochemical basis of zinc physiology. Physiol Rev 1993;73:79-118.
• 31. O’Dell BL. Zinc plays both structural and catalytic roles in metalloproteins. Nutr Rev 1992;50:48-50.
• 32. Lansdown ABG, Sampson B, Rowe A. Sequential changes in trace metal, metallothionein and calmodulin concentrations in healing skin wounds. J Anat 1999;195(3):375-86.
• 33. Zorrilla P, Gomez LA, Salido JA, Silva A, Lopez-Alonso A. Low serum zinc level as a predictive factor of delayed wound healing in total hip replacement. Wound Repair Regen 2006;14:119-22.
• 34. Faure H, Peyrin JC, Richard MJ, Favier A. Parenteral supplementation with zinc in surgical patients corrects postoperative serum-zinc drop. Biol Trace Elem Res 1991;30:37-45.
• 35. Braga PC, Dal Sasso M, Culici M, Galastri L, Marceca MT, Guffanti EE: Antioxidant potential of thymol determined by chemiluminescence inhibition in human neutrophils and cell-free systems. Pharmacology 2006;76:61-8.