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A bizonyítékalapú orvoslás világában egy innováció elfogadtatásához a randomizált, kontrollált vizsgálatok elengedhetetlenek. A farmakológiai vizsgálatok gyakorlatával ellentétben azonban a sebészi innováció számos buktatót rejt: kontrollcsoport felállítása sokszor nem egyszerű, a placebo fogalma sem könnyen definiálható, az álműtétek alkalmazása sem jogi, sem etikai formában nincs kellően szabályozva, ugyanakkor esetleges szakmai előnyei is kétségesek. A tanulási folyamatból eredő, időben és térben változó kockázat is a sebészeti kutatások sajátos velejárója. Igény mutatkozik tehát olyan vizsgálati módszertan keresésére, amely az előbb említett nehézségeket áthidalja, klinikailag mégis releváns és széles körben elfogadtatható eredménnyel járhat. A nemzetközi irodalomban egyre többször találkozhatunk a problem-based evidence kifejezéssel, amely az evidenciákat konkrét gyakorlati problémákból kiindulva, a felhalmozódó szakmai tudásból és tapasztalatokból nyeri, ezért a manuális szakmák kutatásait illetően számos előnyt jelenthet a randomizált vizsgálatokkal szemben. Ilyen vizsgálati metodikákkal a jelenleginél jóval szélesebb körben nyílhat lehetőség sebészi kutatások indítására és nemzetközi elfogadtatására.

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2005 Limits of evidence-based surgery Worl J Surg 29 606 9 . 4. http://www.clinicaltrials.gov/ct2/results?term=sham+operation

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Acta Biologica Hungarica
Authors: Elza Azmaiparashvili, Ekaterine Berishvili, Z. Kakabadze, O. Pilishvili, Ekaterine Mikautadze, R. Solomonia, M. Jangavadze and D. Kordzaia

Ductular reaction (DR) in bile duct ligated rats generally appears from 2nd day after biliary obstruction (BO). However, we show that increased amount of ductular profiles is evident already in 6 hours after BDL. The study aims to explain the origin of such an early DR in response to BO. Male Lewis rats were subjected to common bile duct ligation (CBDL) for 3, 6, 12 and 24 hours and sham operation. Liver samples were studied histologically, immunohistochemically (Ki67, pan-Cytokeratin /AE1 + AE3/ and OV-6) and by immunoblotting analyses. It appeared that number of ductular profiles increase in timerelated manner after BO. These ductular profiles are formed by biliary epitheliocyte-like cells; No mitotic activity was revealed. Part of hepatocytes reveals pan-Cytokeratin positivity on 12 and 24 hours after BO. Total cytokeratins content at 24 hours after CBDL was 37% higher in comparison with control data. The significant increase was observed for the cytokeratins with molecular weights: 61, 56 and 40 KDa. Thus, early DR after BDL is mediated by widening of the existed finest biliary ramifications and is not associated with proliferation activities. This DR is accompanied by differentiation of hepatocytes toward bile duct-like cells.

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The present study investigates the role of leukocyte transfer in the induction of kidney damage from mice that have undergone a severe renal ischemia-reperfusion insult into the intact recipient mice. First, Balb/c (inbred) mice were subjected to either sham operation (Sham donors) or bilateral renal IR injury (60 min ischemia-3 h reperfusion, IR donors). Leukocytes were isolated from blood and were transferred to two recipient groups: intact recipient mice received leukocytes from Sham donor group (Sham recipient) or from IR donor group (IR recipient). After 24 h, recipient mice were anesthetized for sample collections. Renal malondialdehyde increased and total glutathione concentration and superoxide dismutase activity decreased significantly in the IR recipient group compared to the Sham recipient group. BUN and plasma creatinine were significantly different between donor groups, but these parameters were not significantly different in the two recipient groups. In the IR donor group, there have been extensive changes in renal tissues comparing to Sham including severe destruction of the tubules, necrosis and tubular obstruction plus tubular flattening. IR recipient kidneys showed significant differences from their corresponding Sham group, demonstrating some degrees of injury including loss of brush borders from proximal tubules, cellular vacuolation and flattening of the tubules. However, less tissue damage was seen in this group comparing to IR donor kidneys. These findings showed that leucocytes transferred from post-ischemic mice induced oxidative stress and consequent damage to native kidneys, suggesting a role of leucocytes in the oxidative processes of reperfusion injury.

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The aim of this study was to assess the effect of melatonin and acetylsalicylic acid (ASA) on hepatic damage induced by bile duct ligation (BDL) Material and methods : Male Sprague-Dawley rats were subjected to either sham operation or common BDL before treatment with ASA, melatonin or vehicle. Hepatic superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) enzyme activities and reduced glutathione (GSH), malondialdehyde (MDA) and nitric oxide (NO) levels were evaluated. Results : Our results have indicated that BDL caused a significant increase in lipid peroxidation whereas a statistically insignificant decrease in GSH level and some of the antioxidant enzyme activities. Both MEL and ASA administrations, either separately or together, decreased MDA whereas co-administration of MEL with ASA increased GSH levels in BDL rats. Conclusions : CAT activity and MEL level decreased in the liver tissues of rats with BDL after administration of either melatonin alone or with ASA. However, melatonin and ASA administration increases liver tissue GSH levels in BDL ligated rats

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Interventional Medicine and Applied Science
Authors: Szaniszló Z. Jávor, K. Shanava, E. Hocsák, M. Kürthy, J. Lantos, B. Borsiczky, I. Takács, Sz. Horváth, B. Balatonyi, S. Ferencz, A. Ferencz, E. Rőth and Gy. Wéber

Abstract

Increased intra-abdominal pressure during laparoscopy leads to hypoxia due to reduced blood flow. Aim of our study was to investigate whether preconditioning can reduce this negative effect of the pneumoperitoneum. Fifty female Wistar rats were used, divided into 5 groups. I: Sham operation (Sham), II: conventional pneumoperitoneum (PP), III: transvaginal pneumoperitoneum (TV), IV: preconditioning for 2.5 minutes in two cycles (Pre 2.5), V: preconditioning for 5 minutes (Pre 5). Malondialdehyde (MDA), reduced glutathione (GSH), sulfhydrylgroup (SH-) concentrations, superoxide-dismutase (SOD) and mieloperoxidase (MPO) activity, and anti-apoptotic pathway marker p-AKT level and inflammatory cytokine TNF-α were measured. SOD activity and GSH concentration were decreased in PP and TV groups comparing to Sham and preconditioning groups. MPO activity was decreased also in PP and TV groups comparing to the Sham group but in the preconditioning groups it has remained high. MDA concentration in plasma was increased in PP and TV groups comparing to Sham and preconditioning groups. There was no difference in the case of blood MDA and SH-concentrations between groups. Anti-apoptotic pathway marker p-AKT level was decreased in the TV group comparing to the sham and preconditioning groups. TNF-α level was increased in TV and preconditioning groups compared to the sham group. According to the results preconditioning can reduce negative effects of pneumoperitoneum.

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Magyar Sebészet
Authors: Bettina Zsikai, Lajos Bizánc, Péter Sztányi, Gergely Vida, Enikő Nagy, Lucian Jiga, Mihai Ionac, Dániel Érces, Mihály Boros and József Kaszaki

Absztrakt

Bevezetés: A sepsis és a septicus shock megoldatlan terápiájának egyik fő oka, hogy a komplex patológia megfigyelésére alkalmazott állatkísérletek és a klinikai valóság között jelentős az eltérés. Célunk olyan kísérletes modell kialakítása volt, ami megfelelően leképezi a humán intraabdominalis sepsis jól ismert klinikai lefolyását. Anyag és módszerek: Törpesertésekben 0,5 gr/kg autofaeces intraperitonealis injektálásával peritonitist indukáltunk (n = 9), majd a beavatkozást követő 16. órától elkezdtük a ketamin-propofollal altatott állatok invazív haemodynamicai monitorozását (PiCCO monitor, pulmonalis katéter). A megfigyeléseket további 8 órán keresztül folytattuk, artériás és vénás vérgázanalízis mellett regisztráltuk az extravascularis tüdővíz (EVLWI) változását. A sublingualis régió mikrokeringését orthogonalis polarizációs spektrális képalkotó módszerrel vizsgáltuk, a microperfusiót a vörösvértestek áramlási sebességével és a kapillárisok perfusiós arányával jellemeztük. Plazmamintákból big-endothelin (big-ET) és high-mobility group box protein-1 (HMGB1) szinteket határoztunk meg ELISA módszerrel. Az eredményeket álműtött kontrollcsoport (n = 6) párhuzamos adataihoz hasonlítottuk. Eredmények: A septicus csoportban az artériás középnyomás fokozatosan 70 Hgmm alá csökkent, miközben a perctérfogat szignifikánsan emelkedett. A hyperdynamiás makrokeringés ellenére az EVLWI, a big-ET és a HMGB1 plazmaszintek jelentős növekedését és a sublingualis microperfusio szignifikáns csökkenését detektáltuk a kontrollcsoport adataihoz képest. Következtetés: A törpesertésmodell jól tükrözi a humán sepsis kóros keringési és biokémiai jellegzetességeit, így alkalmas lehet új terápiás eljárások vizsgálatára.

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into four groups, each group contains five animals. Sham operations, orchidectomies, and ovariectomies were performed at 8 weeks of age. All surgeries were performed under sterile conditions. A group of ovariectomized female rats were implanted with

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before statistical analysis ( 32 ). Animals were randomly allocated to nine treatment groups ( n  = 7): group 1, sham operation group (Sham): the operated diabetic rats received placebo; group 2, diabetic group (Dia): diabetic rats receiving placebo

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: Group C This is the control group. Rats in Group C were allocated to sham operation. Group C was not subjected to I/R, but EDL muscles of the individuals were also used for recordings of electrical activity and contractility

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