Risk factors for postoperative ileus / 대한외과학회지

PURPOSE: This study aimed to examine extended postoperative ileus and its risk factors in patients who have undergone abdominal surgery, and discuss the techniques of prevention and management thereof the light of related risk factors connected with our study. METHODS: This prospective study involved 103 patients who had undergone abdominal surgery. The effects of age, gender, diagnosis, surgical operation conducted, excessive small intestine manipulation, opioid analgesic usage time, and systemic inflammation on the time required for the restoration of intestinal motility were investigated. The parameters were investigated prospectively. RESULTS: Regarding the factors that affected the restoration of gastrointestinal motility, resection operation type, longer operation period, longer opioid analgesics use period, longer nasogastric catheter use period, and the presence of systemic inflammation were shown to retard bowel motility for 3 days or more. CONCLUSION: Our study confirmed that unnecessary analgesics use in patients with pain tolerance with non-steroid anti-inflammatory drugs, excessive small bowel manipulation, prolonged nasogastric catheter use have a direct negative effect on gastrointestinal motility. Considering that an exact treatment for postoperative ileus has not yet been established, and in light of the risk factors mentioned above, we regard that prevention of postoperative ileus is the most effective way of coping with intestinal dysmotility.

Unusual Combination of Tracheobronchopathia Osteochondroplastica and AA Amyloidosis

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown cause characterized by the presence of multiple submucosal osseous and/or cartilaginous nodules that protrude into the lumen of the trachea and large bronchi. A simultaneous diagnosis of TO and amyloidosis is rarely reported. In this report, a case initially suspected to be asthma bronchiole that could not be treated, was radiologically diagnosed as TO, and also secondary amyloidosis is presented. A 53 years, man patient reported a 3 years history of dyspnea. Pulmonary function tests (PFTs) showed an obstructive pattern. Chest X-rays revealed right middle lobe atelectasis. FOB and CT detected nodular lesions in the trachea and in the anterior and lateral walls of the main bronchi. AA amyloidosis was confirmed by endobronchial biopsy. In the abdominal fat pad biopsy, amyloidosis was not detected. Asthma bronchiole was excluded by PFTs. This case illustrates that it is possible for TO and amyloidosis to masquerade as asthma. TO and amyloidosis should be suspected in patients of older ages with asthma and especially with poorly treated asthmatic patients. Although nodular lesions in the anterior and lateral tracheobronchial walls are typical for TO, a biopsy should be obtained to exclude amyloidosis.

Effects of octreotide on healing of mechanical ileus in rats

To investigate the effects of octreotide on mechanical ileus without surgical intervention. This study was organized to investigate the effects of octreotide [Sandostatine one microgram/ml-Sandoz], a long acting analogue of somatostatin, in a mechanical ileus model in Sprague-Dowley rats. The study was performed at Ankara Oncology Hospital, Ankara, Turkey in April 2005. The animals were randomly separated into 3 groups. 1] control group [n:10] 2] ileus group [n:12], and 3] ileus + octreotide group [n:13]. Intraluminal liquid volume, as well as concentrations of sodium, chlorine, calcium, and phosphorous were measured in systemic circulation, proximal, and middle bowel segments. We also evaluated the leukocyte count, and hematocrit levels in all animals. There was no difference in leukocyte count and hematocrit levels. The effects of octreotide in decreasing intestinal liquid volume, and electrolytes were significant. However, these effects were not beneficial on the mortality rates, and intestinal edema [p>0.05]. We believe additional animal studies, and subsequently controlled clinical trials are necessary before using octreotide as a clinical adjunct in the treatment of small bowel obstruction

Computed tomography in detecting bone metastases of breast carcinoma. Is it better than plain X-ray?

To compare 5mm slice computerized tomography [CT] and conventional x-ray [XR] in the detection of bone metastases in breast carcinoma patients. Ninety-eight female breast cancer patients treated in Ankara Oncology Hospital, Ankara, Turkey between September 1997 and March 2002 were assigned into 3 groups with respect to their Tc bone scan [Sc] results. Group 1 included patients with overt bone metastases, group 2 included patients with suspicious of metastases and group 3 were those patients with normal Sc results with back pain complaint. All patients underwent XR, and 5mm contiguous slice CT imaging for the related metastatic sites. For the third group, lumbosacral region was examined. A total 33 bone metastases have been diagnosed out of 98 patients. The Sc result showed 26/33 metastatic cases, XR 19/33 and CT 22/33 cases. There were no false positive results for CT and XR. Results of CT have 11 and XR has 14 false negatives out of 33 metastases. For XR the calculated sensitivity was 65.6, specificity was 100, diagnostic accuracy was 88.7, whereas for CT, sensitivity was 71.8, specificity was 100 and diagnostic accuracy was 90.8. When CT and XR were compared to detect bone metastases, results were not statistically significant [p>0.05]. Our results suggest that 5mm slice CT is not superior than XR to detect metastatic bone lesions. Larger series comparing different slice thickness of CT are needed to clarify the issue