Reperfusion injury after detorsion of unilateral ovarian torsion in rabbits Babur Kaleli a,* , Erdal Aktan a , Semra Gezer b , Guldal Kirkali b a Department of Obstetrics and Gynecology, Medical Faculty, Pamukkale University, Denizli, Turkey b Department of Biochemistry, Medical Faculty, Dokuz Eylu ¨l University, Izmir, Turkey Received 10 June 2002; received in revised form 28 November 2002; accepted 8 January 2003 Abstract Objective: To determine if reperfusion injury takes place in ovarian tissue following the detorsion of the torsioned ovary. Study design: Fifty-four New Zealand mature nonpregnant female rabbits were divided into six groups. One group served to determine the basal values of thiobarbituric acid reacting substance (TBARS) and another group was sham. In the third and fourth groups, ovarian torsions and subsequent oophorectomy were performed in 1 and 3 h, respectively. In the fifth and sixth groups, detorsions were carried out after unilateral ovarian torsion lasting 1 and 3 h, respectively, then oophorectomies of the detorsioned ovaries were performed 2 h after detorsion. The level of TBARS in ovarian tissues was determined in all subjects. Statistical analysis was performed using analysis of variance and Duncan’s multiple range test. Differences were considered to be significant if P < 0:05. Results: The levels of TBARS were not different in the basal and sham groups (P > 0:05), while ovarian torsion caused significant increase in TBARS in the ovary (P < 0:05), and detorsion caused a further significant increase in ovarian TBARS (P < 0:05). Conclusion: Reperfusion injury in ovarian tissue, following the detorsion after the torsion of the ovary lasting up to 3 h was demonstrated biochemically in this study. # 2003 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Reperfusion injury; Adnexal torsion; Free radicals 1. Introduction Adnexal torsion is a surgical emergency. Traditionally, the treatment for adnexal torsion has been oophorectomy. Oophorectomy may result in surgical castration in some women. The conservative therapy may be appropriate for young women. The approach seems especially important for women in reproductive age group. Considering the conser- vative therapy in the patients with adnexal torsion, the main problems are the vitality and functional capacity of the detorsioned tissue. It is not well known whether the ischemia due to torsion of adnexa or the reperfusion injury due to detorsion of adnexa which is the mainstay of conservative therapy are real threats to the vitality or to the functional capacity of ovarian tissue. A decrease in blood flow is known how to cause hypoxia which results in elevated levels of lactic acid, hypoxhanthine, and lipid peroxides in the tissues [1]. Reperfusion of the hypoxic tissues may lead to further tissue damage. With the restoration of blood flow to the hypoxic tissues, reoxygenation of the tissues causes the conversion of hypoxhanthine to uric acid in the presence of the enzyme xanthine oxidase. During this conversion large amount of free oxygen radicals is produced. These free radicals react with lipids in membranes of cell and cause lipid peroxidation. The process of lipid peroxidation com- prises a set of chain reactions which is initiated by the abstraction of a hydrogen atom in an unsaturated fatty acyl chain. Oxygen adds to the fatty acid at the carbon-centered lipid radical to give rise to a lipid peroxyl radical. Once initiated, lipid peroxyl radical can further propagate the peroxidation chain. Peroxidized membranes become rigid, lose selective permeability and, under extreme conditions, can lose their integrity [2,3]. This cascade of events is known as reperfusion injury [2]. Reperfusion injury in some tissues such as brain [4], heart [5], stomach [6], intestine [7], testis [1], liver [8] and skin [9] is well known through several studies. But, there is so little information about reperfusion injury in ovarian tissue. So, we decided to perform an experimental study to determine if reperfusion injury occurs in ovarian tissue after adnexal torsion and detorsion. European Journal of Obstetrics & Gynecology and Reproductive Biology 110 (2003) 99–101 * Corresponding author. Tel.: þ90-258-2410038; fax: þ90-258-2410040. E-mail address: bkaleli@netscape.net (B. Kaleli). 0301-2115/$ – see front matter # 2003 Elsevier Science Ireland Ltd. All rights reserved. doi:10.1016/S0301-2115(03)00116-7