Aşkın Ender TOPAL, Ayşe YILDIRIM, Özlem PAMUKÇU, Gönül ÖLMEZ

Aort cerrahisinde fenitoin spinal kord korunması

Bu çalışmada aort cerrahisi sırasında spinal kord iskemisi sonucu gelişen komplikasyonlara engel olabilmek için, cerrahi sırasında inferiyor vena kavadan retrograd yolla fenitoin vermenin yararlılığı araştırıldı. 14 adet kangal kırması köpek üzerinde yapılan çalışmada, birinci grupta hiçbir koruyucu yöntem kullanılmadı, ikinci grupta ise inferiyor vena kavadan retrograd yolla fenitoin verildi ve her iki gruptada aortaya 75 dakika süreyle kros-klemp konularak spinal kord iskemisi yaratıldı. Süre sonunda operasyon sonlandırılıp deneklere Tarlov skorlaması uygulandı. 1 gün sonra aynı denekler reoperasyona alınarak spinal kordları çıkarılıp bcl-2 onkoproteini ile immünohistokimyasal çalışma yapıldı. Çalışma sonunda Tarlov skorlaması kontrol grubunda 0.28 ± 0.49, fenitoin grubunda ise 3.71 ± 0.49 olarak tespit edildi. Bcl-2 ile boyanma sonunda kontrol grubunda korunma görünmezken, fenitoin grubunda % 90 korunma gözlendi. Çalışma sonuçlarına göre inferiyor vena kavadan fenitoin vermenin spinal kord iskemisi üzerine koruyucu etkisi olduğu sonucuna varıldı.

Anahtar Kelimeler:

İmmünohistokimya, Vena kava, inferior, Omurilik iskemisi, Proto-onkojen proteinler c-bcl-2, Fenitoin

Spinal cord protection with phenitoin in aortic surgery

In this experimental study, we examined the advantage of the retrograde phenitoin appliement through the inferior vena cava during aortic surgery to prevent the complications of spinal cord ischemia. This study was examined on 14 kangal dogs. In the first (control) group, no preventive method was used. In the second (phenitoin) group, phenitoin was delivered by retrograde way through the inferior vena cava. Aorts were cross-clamped for 75 minutes in the both groups to create spinal cord ischemia. At the end of this period, the operations were finished and Tarlov score was applied to dogs. After 1 day, the dogs were taken to reoperation and the spinal cords of the dogs were taken out to make the immunohistochemical study with bcl-2 oncoprotein. At the end of this study, Tarlov scores were established 0.28 ± 0.49 in the first group and 3.71 ± 0.49 in the second group. The immunohistochemical study with bcl-2 oncoprotein demonstrated no cell prevention in the first group and 90 % cell prevention in the second group, respectively. According to this experimental study, phenitoin appliement through the inferior vena cava has a preventive effect on the spinal cord ischemia.

Keywords:

Immunohistochemistry, Vena Cava, Inferior, Spinal Cord Ischemia, Proto-Oncogene Proteins c-bcl-2, Phenytoin,

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