title: Effect of topical N-acetylcysteine in the prevention of postoperative pericardial adhesion formation in a rabbit model.
abstract: BACKGROUND
  N-acetylcysteine (NAC), a precursor of reduced glutathione, has been in clinical use primarily as a mucolytic. In addition, NAC is well known for their free radical scavenging and antioxidant properties. Increasing of reactive oxygen products occurring during cardiac surgery can play an important role in postoperative adhesion formation. We investigated to the efficacy of the NAC for postoperative pericardial adhesions.
  
  
  METHODS
  Sixteen New Zealand white rabbits (2.5-3 kg) were used and categorized into two groups including study (use of NAC) and control groups. In both groups, the pericardium was opened longitudinally, and the exposed epicardial surfaces were abraded with dry gauze. The rabbits were divided into two groups: Group 1 was treated with the sponge, which impregnated with NAC solution, (10%, 300 mg/3 ml) and applied over the abraded epicardium for 5 min (n=8). Group 2 was the control, and the sponge, which was impregnated with 3-ml isotonic NaCl solution (0.9%), was applied onto the surface of the abraded epicardium for 5 min (n=8). After a period of 2 weeks, the animals were sacrificed. The scores of adhesion were graded by macroscopic examination, and the pericardial tissues were analyzed microscopically in point of inflammation and fibrosis.
  
  
  RESULTS
  In Group 1, the adhesion scores were significantly lower compared with the control group [Group 1 vs. 2; 1 (1-2) vs. 3 (2-3), P<.001]. No significant difference was found between the groups in terms of the severity of inflammation [Group 1 vs. 2; 1.5 (1-3) vs. 2.5 (1-3), P=.083]. There was a difference between groups in terms of the degree of fibrosis [Group 1 vs. 2; 2 (1-2) vs. 3 (2-3), P=.007].
  
  
  CONCLUSIONS
  The use of NAC for preventing postoperative pericardial adhesions was reduced to adhesion and fibrosis scores in an experimental rabbit model. There was no statistically significant difference between groups in terms of inflammatory scores. The NAC effectively prevented the formation of pericardial adhesion.
authors.affiliation: Department of Cardiovascular Surgery, University of Fatih, Faculty of Medicine, Ankara, Turkey. Electronic address: ncolak44@gmail.com.
authors.forename: Necmettin
authors.initials: N
authors.lastname: Colak
authors.forename: Yunus
authors.initials: Y
authors.lastname: Nazli
authors.forename: Mehmet Fatih
authors.initials: MF
authors.lastname: Alpay
authors.forename: Omer Nuri
authors.initials: ON
authors.lastname: Aksoy
authors.forename: Ismail Olgun
authors.initials: IO
authors.lastname: Akkaya
authors.forename: Reyhan
authors.initials: R
authors.lastname: Bayrak
authors.forename: Omer
authors.initials: O
authors.lastname: Cakir
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D000287:Administration, Topical; D000818:Animals; D004195:Disease Models, Animal; D005355:Fibrosis; D010496:Pericardium / Q000187:drug effects* / Q000473:pathology* / Q000601:surgery; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control*; D011817:Rabbits; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control*
chemical_list: D000111:Acetylcysteine
keywords: Cardiac operation; N-acetylcysteine; Pericardial adhesion