title: Effect of growth hormone, hyperbaric oxygen and combined therapy on the gastric serosa.
abstract: OBJECTIVE
  To investigate the role of growth hormone (GH), hyperbaric oxygen therapy (HBOT) and combined therapy on the intestinal neomucosa formation of the gastric serosa.
  
  
  METHODS
  Forty-eight male Wistar-albino rats, weighing 250-280 g, were used in this study. The rats were divided into four groups (n = 12): Group 1, control, gastric serosal patch; Group 2, gastric serosal patch + GH; Group 3, gastric serosal patch + HBOT; and Group 4, gastric serosal patch + GH + HBOT. Abdominal access was achieved through a midline incision, and after the 1-cm-long defect was created in the jejunum, a 1 cm × 1 cm patch of the gastric corpus was anastomosed to the jejunal defect. Venous blood samples were taken to determine the insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) basal levels. HBOT was performed in Groups 3 and 4. In Groups 2 and 4, human GH was given subcutaneously at a dose of 2 mg per kg/d for 28 d, beginning on the operation day. All animals were sacrificed 60 d after surgery. The jejunal segment and the gastric anastomotic area were excised for histological examination. The inflammatory process, granulation, collagen deposition and fibroblast activity at the neomucosa formation were studied and scored. Additionally, the villus density, villus height, and crypt depth were counted and recorded. The measurements of villus height and crypt depth were calculated with an ocular micrometer. New vessel growth was determined by calculatingeach new vessel in a 1 mm(2) area.
  
  
  RESULTS
  In the histological comparison of groups, no significant differences were observed between the control group and Groups 2 and 3 with respect to epithelialization, granulation, fibroblastic activity and the inflammatory process, but significant differences were present between the control group and all others groups (Groups 2-4) with respect to angiogenesis (P < 0.01) and collagen deposition (P < 0.05, P < 0.01). Significant differences between the control group and Group 4 were also observed with respect to epithelialization and fibroblastic activity (P < 0.01 and P < 0.05, respectively). There were significant differences in villus density in all of groups compared with the control group (P < 0.05). Crypt depth was significantly greater in Group 4 than in the control group (P < 0.05), but no other groups had deeper crypts. However, villus height was significantly longer in Groups 2 and 4 than in the control group (P < 0.05). The comparison of groups revealed, significant difference between control group and Groups 2 and 4) with respect to the levels of IGF-1 and IGFBP-3 (P < 0.01) 3 wk after the operation.
  
  
  CONCLUSIONS
  HBOT or GH and combined therapy augmented on neomucosal formation. The use of combined therapy produced a synergistic effect on the histological, morphological and functional parameters.
authors.affiliation: Department of Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, 34147 Istanbul, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Adas
authors.forename: Mine
authors.initials: M
authors.lastname: Adas
authors.forename: Soykan
authors.initials: S
authors.lastname: Arikan
authors.forename: Ahu Kemik
authors.initials: AK
authors.lastname: Sarvan
authors.forename: Akin Savas
authors.initials: AS
authors.lastname: Toklu
authors.forename: Selva
authors.initials: S
authors.lastname: Mert
authors.forename: Gul
authors.initials: G
authors.lastname: Barut
authors.forename: Sedat
authors.initials: S
authors.lastname: Kamali
authors.forename: Bora
authors.initials: B
authors.lastname: Koc
authors.forename: Firat
authors.initials: F
authors.lastname: Tutal
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D005753:Gastric Mucosa / Q000378:metabolism; D019382:Human Growth Hormone / Q000494:pharmacology*; D006931:Hyperbaric Oxygenation; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D007583:Jejunum / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D012038:Regeneration / Q000187:drug effects; D012704:Serous Membrane / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D012778:Short Bowel Syndrome / Q000209:etiology / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D013270:Stomach / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D013997:Time Factors
chemical_list: D018972:Insulin-Like Growth Factor Binding Protein 3; C548904:insulin-like growth factor-1, rat; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I
keywords: Growth hormone; Hyperbaric oxygen; Hypoxia; Neomucosa; Short bowel syndrome