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The Effect of Fluconasole Prophylaxis on Lipid Peroxidation and Nitric Oxide, In Patients Operated For Mechanical Intestinal Obstruction

Year 2006, Volume: 13 Issue: 2, 71 - 76, 01.04.2006

Abstract

Objectives: Candida albicans is being isolated with increasing frequency during intraabdominal infection in patients who are operated for mechanical intestinal obstruction (MIO). The value of fluconazole prophylaxis and documented altered patterns of nitric oxide (NO) and (thiobarbituric acid-reactive substances) TBARS production in response to Candida albicans is a subject of discussion. Material and Methods: Between June 2003 and December 2004, 52 patients with MIO requiring a surgical treatment were included in this study. In this prospective, randomized (placebo-controlled), and double-blind clinical trial, we investigated the frequency and clinical significance of fungal translocation and the effect of a single dose of fluconazole (400 mg) prophylaxis administered with routine antibacterial therapy. NO and TBARS levels were determined in blood samples spectrophotometrically preoperatively; on postoperative 2nd, 6th and 24th hours in order to investigate their roles in fungal translocation. Results: NO levels were significantly high in patients with MIO due to malignant causes who received a single dose of fluconazole, two hours after the operation (p<0.003). In patients with positive gram negative bacteria cultures in the tissue and blood samples obtained preoperatively, NO levels were significantly increased 24 hours after the operation (p<0.05). On the other hand, in patients with positive gram negative bacteria cultures postoperatively, NO levels in samples obtained six hours after the operation were lower than the levels obtained after two hours (p<0,05). Conclusions: Fluconazole with protective effect against candidial translocation had influence on metabolism of NO in patients with MIO due to malign causes and more comprehensive studies should be designed and attention should be paid to the cases with positive gram negative bacteria cultures. Key words: Mechanical intestinal obstruction, Fluconazole, Nitric oxide, TBARS

References

  • Dean DA, Burchard KW. Fungal infection in surgical patients. Am J Surg 1996; 171: 374-82.
  • Whang EE, Ashley SW, Zinner MJ. Small intestine. Brunicardi FC (ed). In Principles of Surgery. New York. McGraw-Hill, 2005:pp1030
  • Evers BM. Small bowel. Townsend CM (ed(. In Textbook of surgery, Philadelphia, WB Saunders Company, 2001: pp 886
  • de Winter BY, van Nassauw L, de Man JG, de Jonge F, Bredenoord AJ, Seerden TC, Herman AG, Timmermans JP, Pelckmans PA.. Role of oxidative stress in the pathogenesis of septic ileus in mice. Neurogastroenterol Motil. 2005;17(2):251-61.
  • Mirza MH, Seahorn TL, Oliver JL, Hosgood G, Moore RM. Detection and comparison of nitric oxide in clinically healthy horses and those with naturally acquired strangulating large colon volvulus. Can J Vet Res. 2005;69(2):106-15.
  • Baltch AL, Smith RP, Franke MA, Ritz WJ, Michelsen PB, Bopp LH. Effects of cytokines and fluconazole on the activity of human monocytes against Candida albicans. Antimicrob Agents Chemother. 2001;45(1):96-104.
  • Mihara M, Uchiyama M..Determination of malonaldehyde precursor in tissues by thiobarbituric acid test. Anal Biochem. 1978; 86:271-8.
  • Cortas, NK, Wakid NW. Determination of inorganic nitrate in serum and urine by a kinetic cadmium-reduction method. Clin Chem. 1990; 36(8 Pt 1):1440-3.
  • Wang ZQ, Watanabe Y, Toki A, Kohno S, Hasegawa S, Hamazaki M. Involvement of endogenous nitric oxide and c-kit-expressing cells in chronic intestinal pseudo- obstruction. J Pediatr Surg. 2000;35(4):539-44.
  • Moojen TM, Van Gulik TM, Hoek FJ, Gouma DJ, Tytgat GN, Boeckxstaens GE. Possible role of nitric oxide in postoperative ileus: a comparative study. Neurogastroenterol Motil. 1999;11(5):403-8.
  • Xilong L, Lei S. Changes of tissue endothelin-1 and nitric oxide synthase in a sheep model of large intestinal obstruction. Vet Res Commun. 2004;28(8):719-25.
  • Turkyilmaz Z, Karabulut R, Gulen S, Demirogullari B, Ozen IO, Sonmez K, Basaklar AC, Kale N. Role of nitric oxide and cyclooxygenase pathway in lipopolysaccharide- induced intussusception. Pediatr Surg Int. 2004;20(8):598-601. Epub 2004 Aug 26.
  • Clary EM, Bruch SM, Lau CL, Ali A, Chekan EG, Garcia-Oria MJ. Eubanks S. Effects of pneumoperitoneum on hemodynamic and systemic immunologic responses to peritonitis in pigs. J Surg Res. 2002 Nov;108(1):32-8.
  • Ivanov A, Khinev S, Koinova G, Dafinova K. The determination of plasma malondialdehyde in patients with obstruction of the small intestine] [Article in Bulgarian]. Khirurgiia (Sofiia). 1995;48(4):38-40. (abstract)
  • Otamiri TA, Tagesson C, Sjodahl R. Increased plasma malondialdehyde in patients with small intestinal strangulation obstruction. Acta Chir Scand. 1988;154(4):283-5 (abstract).
  • Fedorov VI. The indices of lipid metabolism and of lipid peroxidation in acute intestinal obstruction and the administration of plasma substitute solutions. Fiziol Zh. 1997;43(5-6):84-8. Ukrainian. (abstract)
  • Colak O, Sahin A, Alatas O, Inal M, Yasar B, Kiper H. The effect of Ginkgo biloba on the activity of catalase and lipid peroxidation in experimental strangulation ileus. Int J Clin Lab Res. 1998;28(1):69-71. (abstract)

Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+

Year 2006, Volume: 13 Issue: 2, 71 - 76, 01.04.2006

Abstract

Amaç: Mekanik barsak obstrüksiyonu nedeni ile opere edilen hastalarda ortaya çıkan enfeksiyonlarda, giderek artan sıklıkta Candida albicans izole edilmektedir. Bu çalışmada, kandidial enfeksiyonlar, nitrik oksit (NO) ve tiobarbiturik asit türevi aktif ürünlerin (TBARS) yapım cevabı üzerine flukonazol profilaksisin, etkisini incelemek için yapıldı. Gereç ve Yöntem: Temmuz 2003 ile Aralık 2004 tarihleri arasında mekanik barsak obstrüksiyonu nedeniyle laparotomi yapılan 52 hasta çalışmaya alındı. Bu randomize (plasebo- kontrol), çift-kör klinik çalışmada, belirtilen hasta grubunda kandidial translokasyon sıklığı ve bu durumun klinik bulgulara etkisi ile rutin antibakteriyel tedavi ile birlikte preopertaif tek doz flukonazol (400 mg) proflaksisinn etkisi araştırıldı. Aynı zamanda, flukonazol proflaksisinin preoperatif, postoperatif 2., 6. ve 24. saatlerde alınan kan örneklerinde kandidial translokasyonda NO ve TBARS düzeyleri üzerine etkisi spektrofotometrik yöntem ile ölçüldü. Sonuçlar: Malign nedenlerden mekanik barsak tıkanması olan hastalarda ameliyat öncesi tek doz flukonazol verildiğinde, postoperatif 2'inci saat plazma NO düzeyinde artış (p<0.003), ameliyat anında alınan kan ve doku kültürlerinde gram negatif üreme gösteren hastaların postoperatif 24'üncü saatinde plazma NO düzeylerinde istatistiksel olarak artış bulundu (p<0.05). Fakat NO plazma seviyesi, postoperatif kültüründe gram negatif üremesi olan hastalarda 6'ıncı. saatte 2'ıncı saatte ki düzeye göre azalma saptandı (p<0,05). Çıkarımlar: Malign nedenlerden dolayı barsak tıkanması olanlarda, fungal translokasyonu engelleme özelliği gösteren flukonazol, aynı zamanda NO metabolizmasını etkiler. Kültürlerinde gram negatif üremesi olan olgularda ise NO metabolizmasının daha geniş kapsamlı araştırılması gerekmektedir. Anahtar kelimeler: Mekanik barsak obstruksiyonu, Flukonazol, Nitrik oksit, TBARS

References

  • Dean DA, Burchard KW. Fungal infection in surgical patients. Am J Surg 1996; 171: 374-82.
  • Whang EE, Ashley SW, Zinner MJ. Small intestine. Brunicardi FC (ed). In Principles of Surgery. New York. McGraw-Hill, 2005:pp1030
  • Evers BM. Small bowel. Townsend CM (ed(. In Textbook of surgery, Philadelphia, WB Saunders Company, 2001: pp 886
  • de Winter BY, van Nassauw L, de Man JG, de Jonge F, Bredenoord AJ, Seerden TC, Herman AG, Timmermans JP, Pelckmans PA.. Role of oxidative stress in the pathogenesis of septic ileus in mice. Neurogastroenterol Motil. 2005;17(2):251-61.
  • Mirza MH, Seahorn TL, Oliver JL, Hosgood G, Moore RM. Detection and comparison of nitric oxide in clinically healthy horses and those with naturally acquired strangulating large colon volvulus. Can J Vet Res. 2005;69(2):106-15.
  • Baltch AL, Smith RP, Franke MA, Ritz WJ, Michelsen PB, Bopp LH. Effects of cytokines and fluconazole on the activity of human monocytes against Candida albicans. Antimicrob Agents Chemother. 2001;45(1):96-104.
  • Mihara M, Uchiyama M..Determination of malonaldehyde precursor in tissues by thiobarbituric acid test. Anal Biochem. 1978; 86:271-8.
  • Cortas, NK, Wakid NW. Determination of inorganic nitrate in serum and urine by a kinetic cadmium-reduction method. Clin Chem. 1990; 36(8 Pt 1):1440-3.
  • Wang ZQ, Watanabe Y, Toki A, Kohno S, Hasegawa S, Hamazaki M. Involvement of endogenous nitric oxide and c-kit-expressing cells in chronic intestinal pseudo- obstruction. J Pediatr Surg. 2000;35(4):539-44.
  • Moojen TM, Van Gulik TM, Hoek FJ, Gouma DJ, Tytgat GN, Boeckxstaens GE. Possible role of nitric oxide in postoperative ileus: a comparative study. Neurogastroenterol Motil. 1999;11(5):403-8.
  • Xilong L, Lei S. Changes of tissue endothelin-1 and nitric oxide synthase in a sheep model of large intestinal obstruction. Vet Res Commun. 2004;28(8):719-25.
  • Turkyilmaz Z, Karabulut R, Gulen S, Demirogullari B, Ozen IO, Sonmez K, Basaklar AC, Kale N. Role of nitric oxide and cyclooxygenase pathway in lipopolysaccharide- induced intussusception. Pediatr Surg Int. 2004;20(8):598-601. Epub 2004 Aug 26.
  • Clary EM, Bruch SM, Lau CL, Ali A, Chekan EG, Garcia-Oria MJ. Eubanks S. Effects of pneumoperitoneum on hemodynamic and systemic immunologic responses to peritonitis in pigs. J Surg Res. 2002 Nov;108(1):32-8.
  • Ivanov A, Khinev S, Koinova G, Dafinova K. The determination of plasma malondialdehyde in patients with obstruction of the small intestine] [Article in Bulgarian]. Khirurgiia (Sofiia). 1995;48(4):38-40. (abstract)
  • Otamiri TA, Tagesson C, Sjodahl R. Increased plasma malondialdehyde in patients with small intestinal strangulation obstruction. Acta Chir Scand. 1988;154(4):283-5 (abstract).
  • Fedorov VI. The indices of lipid metabolism and of lipid peroxidation in acute intestinal obstruction and the administration of plasma substitute solutions. Fiziol Zh. 1997;43(5-6):84-8. Ukrainian. (abstract)
  • Colak O, Sahin A, Alatas O, Inal M, Yasar B, Kiper H. The effect of Ginkgo biloba on the activity of catalase and lipid peroxidation in experimental strangulation ileus. Int J Clin Lab Res. 1998;28(1):69-71. (abstract)
There are 17 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Halil Düzova This is me

Burak Işık This is me

Dinçer Özgör This is me

Yaşar Bayındır This is me

M.sait Tekerekoğlu This is me

Sezai Yılmaz This is me

Publication Date April 1, 2006
Published in Issue Year 2006 Volume: 13 Issue: 2

Cite

APA Düzova, H., Işık, B., Özgör, D., Bayındır, Y., et al. (2006). Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+. Journal of Turgut Ozal Medical Center, 13(2), 71-76.
AMA Düzova H, Işık B, Özgör D, Bayındır Y, Tekerekoğlu M, Yılmaz S. Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+. J Turgut Ozal Med Cent. April 2006;13(2):71-76.
Chicago Düzova, Halil, Burak Işık, Dinçer Özgör, Yaşar Bayındır, M.sait Tekerekoğlu, and Sezai Yılmaz. “Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+”. Journal of Turgut Ozal Medical Center 13, no. 2 (April 2006): 71-76.
EndNote Düzova H, Işık B, Özgör D, Bayındır Y, Tekerekoğlu M, Yılmaz S (April 1, 2006) Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+. Journal of Turgut Ozal Medical Center 13 2 71–76.
IEEE H. Düzova, B. Işık, D. Özgör, Y. Bayındır, M. Tekerekoğlu, and S. Yılmaz, “Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+”, J Turgut Ozal Med Cent, vol. 13, no. 2, pp. 71–76, 2006.
ISNAD Düzova, Halil et al. “Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+”. Journal of Turgut Ozal Medical Center 13/2 (April 2006), 71-76.
JAMA Düzova H, Işık B, Özgör D, Bayındır Y, Tekerekoğlu M, Yılmaz S. Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+. J Turgut Ozal Med Cent. 2006;13:71–76.
MLA Düzova, Halil et al. “Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+”. Journal of Turgut Ozal Medical Center, vol. 13, no. 2, 2006, pp. 71-76.
Vancouver Düzova H, Işık B, Özgör D, Bayındır Y, Tekerekoğlu M, Yılmaz S. Mekanik Barsak Obstrüksiyonu Nedeniyle Laparotomi Yapılan Hastalarda Flukonazol Proflaksisinin Lipid Peroksidasyonu Ve Nitrik Oksit Üzerine Etkisi+. J Turgut Ozal Med Cent. 2006;13(2):71-6.