Retrospective analysis of open preperitoneal mesh repair of complex inguinal hernias.

PURPOSE: The open posterior approach in the form of either a Stoppa or Wantz operation may be a good alternative technique particularly in the repair of complex inguinal hernias. The term "complex inguinal hernia" designates hernias with a combination of arduous features including large hernia defects, large to giant hernia sacs, multiple recurrences, and bilaterality. In this retrospective analysis, we investigated our results of open posterior repair in view of its feasibility in patients with complex inguinoscrotal hernias. METHODS: From a series of 845 inguinal hernia patients, we retrospectively reviewed the records of 60 patients with complex inguinal hernias whom were directed to open preperitoneal repair by either a Stoppa or Wantz procedure. RESULTS: More than 80% of cases were males with large to giant inguinoscrotal hernias. One half of patients had bilateral hernias, and one fourth had recurrent hernias. Early postoperative complications occurred in almost half of patients; however, most of them were minor. The most important early complication in this series was the full recurrences we encountered in the very next morning in two patients. Eighty-three percent of patients left hospital in the first 2 days averaging 1.8 days of hospital stay. The mesh:defect area ratio is < 7 in recurrent hernias while it is > 9 in nonrecurrent cases. CONCLUSION: The open posterior approach to complex inguinal hernias facilitated both handling and repair of difficult hernias. It was very well tolerated by the patients, and yielded favorable postoperative results. We think the open posterior repair may be a method of choice in the repair of complex inguinal hernias.

The effect of helicobacter pylori eradication on atrophic gastritis and intestinal metaplasia : a retrospective single center research.

BACKGROUND AND STUDY AIMS: Gastric cancer (GC) is one of the major causes of cancer-related deaths worldwide. Helicobacter pylori (Hp) plays an important role in gastric carcinogenesis by inducing precancerous changes such as atrophic gastritis (AG) and intestinal metaplasia (IM). In our study, we aim to compare the grade of AG and IM before and after Hp eradication in patients who underwent esophagogastroduodenoscopy (EGD) in our center. PATIENTS AND METHODS: The data of 40.060 patients who underwent EGD for various reasons in our Endoscopy Unit between June 2011 and November 2017 were retrospectively evaluated. The grade of AG and IM before and after Hp eradication of patients meeting the study criteria were compared with each other. In addition, these findings were compared using OLGA and OLGIM staging systems. RESULTS: A total of 175 patients, 89 (50.9%) women and 86 (49.1%) men, were included in the study. The mean age was 55±12 years. The mean time between two EGD examinations was 38±14 months. Significant improvement was observed in the grade of AG on corpus and antrum after Hp eradication (P=0.000, P=0.008). In the corpus and antrum, the grade of IM was regressed but this was not significant (P=0.80 and P=0.370 respectively). There was a decrease in OLGA stages after Hp eradication (P=0.000). There was also a reduction in the OLGIM stages, but this was not significant(P=0.341). CONCLUSION: Our study demonstrates that Hp eradication may reduce the risk of developing GC by providing an improvement in AG and IM which are precancerous changes in GC.

[Preoperative cognitive function in very old patients : Influence on the complication rate and length of hospitalization]. / Präoperative kognitive Funktion hochbetagter Patienten : Einfluss auf die Komplikationsrate und die Krankenhausverweildauer.

BACKGROUND: Gastrointestinal cancer is a frequent diagnosis in older patients. A curative resection, possibly in combination with radiotherapy and/or chemotherapy, is the standard therapy. The advanced age of the patients with an increasing number of comorbidities and often the presence of cognitive impairment represents a high risk for perioperative complications and a longer stay in hospital. The challenge in the clinical routine is to recognize a cognitive impairment in older patients and to prepare these patients for the operative intervention in the best possible way. OBJECTIVE: This retrospective analysis was carried out to find out whether preoperative cognitive impairment is a prognostic factor for the postoperative outcome. METHODS: In patients over the age of 75 years who were prepared for abdominal surgery of gastrointestinal cancer in the preoperative consultation, the mini mental state examination (MMSE) and the clock test were carried out. The results of the tests were retrospectively compared with the complication rate and the duration of hospital stay. RESULTS: Low MMSE values were significantly associated with the complication rate and the development of a severe complication (Clavien-Dindo grade ≥ 3a). A cut-off value of 24 points in the MMSE was predictive for the development of complications and a longer hospital stay. The age of the patients was not associated with the MMSE. CONCLUSION: Cognitive impairment is an important prognostic factor for the development of perioperative complications and the duration of the hospital stay in patients undergoing extensive abdominal surgery for gastrointestinal cancer. Therefore, a preoperative assessment, for example with the MMSE, is recommended in order to identify high-risk patients.

Effects of penile fracture and its surgical treatment on psychosocial and sexual function.

The current therapy for penile fracture is immediate surgical repair, but sexual and psychosocial effects of the repair have been poorly investigated. We aimed to assess the impact of surgical correction of penile fracture on psychosocial status, sexual function, and erectile quality. Sixty-four patients classified into two subgroups according to follow-up: 2-24 months (Group 1), and longer than 24 months (Group 2), and 28 healthy men (Control group). The mean overall follow-up period was 39.1±32.7 months. The number of sexual intercourse origin was 44 (68.8%), the mean time interval from incident-to-surgery was 13.6±9.3 h. The mean sexual relationship score decreased during first year (P=0.001), and significant recovery was observed over 12-24 months. The mean overall relationship scores and the mean self-esteem scores of the study groups decreased until the end of the 24 months (P<0.05). The mean erectile function domains remained stable in all groups (P>0.05). The mean EHS scores were lower but the difference was not significant in the study groups (P>0.05). Penile fracture repair have no detrimental effect on sexual function, but psychogenic aspect may be adversely affected. This article concludes lower complication rates can be reached with immediate surgical correction of the penile fracture whereas psychogenic recovery might prolonged.

Association between seroprevalence of measles and various social determinants in the year following a measles outbreak in Turkey.

OBJECTIVES: Despite an ongoing measles elimination programme, a measles outbreak occurred in 2013 in Turkey. Population-based seroprevalence studies are needed to determine seronegativity and explore the reasons for this outbreak. This study aimed to explore the seroprevalence of measles and its association with various social determinants in a provincial population in Turkey in the year following a measles outbreak. STUDY DESIGN: Cross-sectional study. METHODS: This study was conducted in Manisa Province in 2014 in a sample of 1740 people aged >2 years. The dependent variable was the seroprevalence of measles. Independent variables were sex, age, migration, household size, household density, income, education level, existence of chronic disease and occupational class. Blood samples were collected from participants at family health centres. The presence of specific measles antibodies in serum samples was determined using an anti-measles virus IgG enzyme-linked immunosorbent assay test. Chi-squared test and logistic regression analysis were performed. RESULTS: Overall, data from 1250 people were analysed. The seroprevalence of measles in the whole study population was 82.2% (95% confidence interval 80.0-84.2). Seroprevalence was 55.4% among subjects aged 2-9 years, 48.7% among subjects aged 10-19 years, 74.1% among subjects aged 20-29 years and 93.6% among subjects aged 30-39 years (P < 0.01). Seroprevalence in subjects aged >40 years was >95%. The lowest seroprevalence was found in primary school children (40.2%), followed by those below the age for primary education (69.8%) and secondary school graduates (75.1%). The prevalence of measles seronegativity was not associated with any of the social determinants when adjusted for age. CONCLUSIONS: The seroprevalence of measles was lower than expected in the study population and was particularly low in subjects aged <30 years of age despite previous vaccination. Seroprevalence was not associated with social determinants of health that confirmed either an even distribution of virus exposure or fair access to vaccination services. However, the current seroprevalence cannot be sufficiently effective to reach the measles elimination targets, suggesting that it may be necessary to re-evaluate the need for an extra dose of measles vaccine.

Can preoperative neutrophil to lymphocyte and platelet to lymphocyte ratios predict cervical stromal involvement in endometrioid endometrial adenocarcinoma?

PURPOSE: To evaluate the possible relationships between preoperative inflammatory markers [neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)] and cervical stromal involvement in endometrioid endometrial adenocarcinoma. MATERIALS AND METHODS: Charts and pathology results of 639 women who were operated on for endometrioid endometrial adenocarcinoma between 2000 and 2013 in the present clinic were retrospectively reviewed. Demographic, laboratory, and clinical parameters were evaluated. RESULTS: 118 women (18.4%) had cervical stromal involvement. Lymph node positivity was significantly more frequent in the cervical stromal involvement group (p < 0.001). A threshold value of 2.41 for NLR had a sensitivity of 62.7%, specificity of 60.1%, PPV of 61.1%, and NPV of 61.8% for the presence of cervical stromal involvement. In multivariate analysis, increased NLR had a significant predictive value for cervical stromal involvement (p = 0.006, OR = 2.03), although PLR remained non-significant (p = 0.77, OR = 1.08). CONCLUSIONS: The preoperative NLR assessment is a significant predictor for cervical stromal involvement in endometrioid endometrial adenocarcinoma.

Determining and Managing Fetal Radiation Dose from Diagnostic Radiology Procedures in Turkey.

OBJECTIVE: We intended to calculate approximate fetal doses in pregnant women who underwent diagnostic radiology procedures and to evaluate the safety of their pregnancies. MATERIALS AND METHODS: We contacted hospitals in different cities in Turkey where requests for fetal dose calculation are usually sent. Fetal radiation exposure was calculated for 304 cases in 218 pregnant women with gestational ages ranging from 5 days to 19 weeks, 2 days. FetDose software (ver. 4.0) was used in fetal dose calculations for radiographic and computed tomography (CT) procedures. The body was divided into three zones according to distance from the fetus. The first zone consisted of the head area, the lower extremities below the knee, and the upper extremities; the second consisted of the cervicothoracic region and upper thighs; and the third consisted of the abdominopelvic area. Fetal doses from radiologic procedures between zones were compared using the Kruskal-Wallis test and a Bonferroni-corrected Mann-Whitney U-test. RESULTS: The average fetal doses from radiography and CT in the first zone were 0.05 ± 0.01 mGy and 0.81 ± 0.04 mGy, respectively; 0.21 ± 0.05 mGy and 1.77 ± 0.22 mGy, respectively, in the second zone; and 6.42 ± 0.82 mGy and 22.94 ± 1.28 mGy, respectively, in the third zone (p < 0.001). Our results showed that fetal radiation exposures in our group of pregnant women did not reach the level (50 mGy) that is known to increase risk for congenital anomalies. CONCLUSION: Fetal radiation exposure in the diagnostic radiology procedures in our study did not reach risk levels that might have indicated abortion.

Traditional practices used by Turkish mothers in the care of their babies.

This descriptive study was conducted to determine the traditional practices used by 1410 mothers in the care of their babies in Eskisehir, Turkey. The results of the present study suggest that traditional practices, which sometimes may be hazardous or beneficial, are widely used by Turkish mothers. We recommend that families should be informed about the possible hazardous effects of some traditional practices, however the non-hazardous and beneficial practices providing spiritual well-being may be supported. The optimal strategy is to teach mothers this information during the pregnancy period.

The importance of anatomical region of local anesthesia for prostate biopsy; a randomized clinical trial.

INTRODUCTION: In our study, the efficiency and reliability of lidocaine (1 cc/1%) application during transrectal ultrasound-guided (TRUS) prostate biopsy to levatores prostate was studied. Levatores prostate was visualized on a cadaver dissection previously. PATIENTS AND METHODS: Eighty outpatients with lower urinary tract complaints or were suspected clinically to have prostate cancer were submitted to TRUS-guided prostate biopsy. The ages of outpatients were ranging from 45 to 81. Patients were randomized in 2 groups: Group-I, with 40 patients submitted to local anesthesia by periprostatic injection of 1 cc 1% lidocaine before biopsy; and group-II, with 40 controls the biopsy was performed without local anesthesia. The anatomical region for anesthesia was determined via dissection. The name of this anatomical region is levatores prostatae and it has got high nerve density. The process was explained to the patients and their approvals were obtained. Levatores prostatae was detected with TRUS before biopsy. Pain; related to digital rectal examination (DRE), probe insertion or biopsy, was scored via visual analog scale (VAS). The patients were evaluated about side effects of lidocaine and early and late complications of biopsy as well. RESULTS: Both groups were similar in terms of mean age, PSA levels, prostate volume and VAS scores (p > 0.05). As for VAS score, on the group submitted to anesthesia was determined 2.34 ± 1.08, while for VAS score on the group submitted conventional biopsy was determined 5.8 ± 1.6. Between two groups, there was a statistical difference in terms of VSA score (p < 0.05); but there was no statistical difference about early and late complications of biopsy. CONCLUSIONS: The periprostatic blockage use is clearly associated with more tolerance and patient comfort during TRUS-guided biopsy. Owing to the local anesthesia introduced to the periprostatic nerve bundle localization in levatores prostate area, the patients could tolerate the pain better.

Relationship between penile fracture and Peyronie's disease: a prospective study.

Peyronie's disease is postulated to be initiated by repetitive minor traumas to the fully or partially erect penis. We investigated Peyronie's disease prospectively in cases treated for penile fracture (PF) within the last 20 years. Medical records of 63 cases treated for PFs were reviewed. Subjects were required to self-assess their current penile morphologies and sexual functions. Penile nodules and Peyronie's plaques were also evaluated with physical examination, ultrasonography and magnetic resonance imaging (MRI), and penile curvatures with auto-photography, and sexual function with international erectile function index (IIEF). Of the 63 cases (mean age 37 years), 46 who had mean follow-up of 63 months were re-evaluated. The mean IIEF-5 score was 23.2±3.1. Painful erections (n=5), penile nodules (n=5) and also penile curvatures <20° (n=2) were investigated. No Peyronie's plaque was palpated in any of the cases. Ultrasound and MRI showed fibrotic nodules of 5 mm in diameter, which extended into the subtunical area in the rupture site in 54% of the cases, although any thickening and Peyronie's plaque were not found in the tunica albuginea and intracavernosal septum of the cases examined. In PF patients treated surgically, the erectile function and penile morphology were preserved. In our cases PFs did not induce the development of Peyronie's disease.

The influence of medium composition and matrix on long-term cultivation of primary porcine and human hepatocytes.

The differentiated hepatocyte phenotype remains difficult to maintain in culture. The duration over which phenotypically stable hepatocytes can be cultured ranges from a couple of days to a few weeks. Shortcomings in medium formulation may be a factor in this lack of success. We have investigated effects of medium formulation on primary porcine and human hepatocyte cultures. We tested seven culture medium compositions (DMEM, ExCell 400, HepatoZYME-SFM, L-15 Leibovitz, SF-3, Waymouth, and Williams' E) and the effects of serum, fibronectin and biomatrix in a sandwich culture configuration. Albumin, urea, cholesterol, GOT, GPT, LDH and triglyceride concentrations were measured over 14 days. For both human and porcine cultures, the best results were obtained with SF-3 medium. Cells cultivated with Williams' E medium and FCS had good morphology and synthetic function during the first days of culture. However, continued addition of serum, was associated with a subsequent loss of differentiated phenotype. Addition of fibronectin was associated with improved function in cultures maintained in SF-3 medium whilst biomatrix had no effect. In contrast, addition of fibronectin did not influence cultures maintained in Williams' E medium, but cultures with biomatrix were associated with improved function at longer time points.

Bilateral bifid mandibular condyle: a case report.

Bilateral bifid mandibular condyle is a rarely seen malformation. The aetiology of bifid condyle is not completely understood, although developmental anomaly, traumas, condylar fracture, teratogenic embryopathy and surgical condylectomy may all be causative factors. Although a few studies on human dried skulls tried to shed light on this entity it remains obscure. As most bifid condyle subjects have no complaint related to temporamandibular joint(TMJ), the cases are generally diagnosed through incidental radiographic findings. The case of a 54-year-old female is presented. In a panoramic radiograph obtained after a clinical examination, bilateral bifid mandibular condyle was observed. The open-closed lateral radiograph of the TMJ (obtained using the TMJ-specific program of the panoramic device) demonstrated duplication of the right and left condyles. In order to better evaluate the TMJ morphology and to eliminate pathologies such as fractures that might be missed with conventional radiographs, a computed tomography scan was also obtained. The joint head orientation was observed in the mediolateral direction. The case is discussed in the context of the relevant literature. Until large population-based studies are undertaken and further experimental studies are performed, bifid condyle will remain an incidental finding of anatomic variation rather than a clinically informative observation.

Digital panoramic radiography: a reliable method to diagnose carotid artery atheromas?

OBJECTIVES: The aim of the present study is to evaluate the panoramic radiographs of 4106 patients for carotid artery atheromas (CAAs) and to correlate our findings with the literature. MATERIALS AND METHODS: The digital panoramic radiographs of 4106 dental patients (2428 female, 1678 male) were evaluated. Radiographs of patients 40 years of age or older were randomly chosen from a computer database. CAA findings were defined as radiopaque masses adjacent to the cervical vertebrae at or below the intervertebral space between C3 and C4 on the panoramic radiograph. The patients who had CAA findings were contacted by telephone, and some of them agreed to further evaluation. Evaluation included carotid ultrasound, ECG, echocardiography and treadmill exercise testing at the Department of Cardiology. RESULTS: Of 4106 patients, 88 patients (2.1%; 70 female, 18 male) had one or more radiopaque mass detected on digital images. All 88 patients with CAA findings were contacted by telephone and 23 agreed to further evaluation at the university hospital. Of these 23 patients, 8 (34.7%) had CAAs on carotid ultrasound and 15 (65.3%) had normal carotid arteries. From these eight patients with CAAs on Doppler ultrasound, 7 (30.4%) had plaques that were not haemodynamically significant and only one (4.3%) had significant plaque. The patient with severe carotid artery stenosis consequently underwent endarterectomy operation. There were no statistically significant differences between male and female in CAAs (P>0.05). CONCLUSION: Digital panoramic images may have some diagnostic value for detecting CAAs and this early diagnosis could potentially increase the length and quality of life for people with CAAs.

Characteristics and prevalence of non-syndrome multiple supernumerary teeth: a retrospective study.

OBJECTIVE: The goal of this study was to evaluate the radiological and clinical findings of non-syndromic multiple (five or more) supernumerary teeth in patients radiographically examined between 1999 and 2004. METHODS: Among 9550 patients, 251 cases of supernumerary teeth were found, including six cases of multiple supernumerary teeth. Patients with multiple supernumerary teeth were evaluated for age, sex, unilateral or bilateral distribution of the teeth, localization, morphology and complications or associated pathologies such as dentigerous cysts, eruption anomalies, resorption of adjacent teeth, displacement of tooth germ, malformation, migration, neurological symptoms, and secondary and periapical infections. RESULTS: All patients were male and most of the multiple supernumerary teeth were seen in the premolar region. The prevalence of multiple supernumerary teeth was 0.06%. Out of 37 multiple supernumerary teeth examined, 30 were impacted. Various associated anomalies were seen in 21.6% of cases. Although the mean age was high (23.1 years), no pathologies such as root resorption on adjacent teeth or cystic formation were observed, in contradiction of previous studies. CONCLUSION: In agreement with previous studies, the majority of supernumerary teeth were seen in the lower premolar region. That all patients with multiple supernumerary teeth were male and that most of these teeth were impacted was also in agreement with previous studies. The order of location frequency in previous studies has been premolar-molar-anterior; we found the order to be premolar-anterior with no supernumerary molar teeth observed. It was also interesting that no serious pathological findings were recorded.

Rare benign tumours of oral cavity--capillary haemangioma of palatal mucosa: a case report.

Haemangiomas are benign tumours composed of blood vessels, they are probably developmental rather than neoplastic in origin. Haemangiomas are often present at birth but may become more apparent during life. The tumours appear as a flat or raised reddish-blue lesions and are generally solitary. They are occasionally seen on the palatal mucosa. Haemangiomas are classified on the basis of their histological appearance as capillary, mixed, cavernous or a sclerosing variety that tends to undergo fibrosis. Their differential clinical diagnosis is based on appearance. The tumours may be slowly progressive, involving extensive portions of the superficial and deep blood vessels. Function may be affected where development of the lesion is extra-invasive. Colour change on pressure is a common finding with return to the original colour on withdrawal of pressure. The case presented here was referred because of swelling and recurrent periodontal bleeding. The lesion was diagnosed as a capillary haemangioma through histopathology. Although different therapeutic procedures have been reported, in this case surgical excision was carried out under general anaesthesia following hospitalization. Despite their benign origins and behaviour, haemangiomas in the region of oral cavity are always of clinical importance to the dental profession and require appropriate clinical management. Dental practitioners and oral surgeons need to be aware of these lesions because they may pose serious bleeding risks.

Sinus polyp-associated soft tissue lesion and unilateral blindness: complications of extraction in leukemic patient.

A case of an inflammatory polyp-associated lesion extending through an extraction socket appearing as an intraoral nodular lesion and unilateral blindness secondary to leukemic optic nerve head infiltration is reported. The patient was a 28-year-old male whose his upper first molar had been extracted fifteen days previously. The lesion was an asymptomatic soft tissue mass, red in color and hot tender to palpation, involving the alveolar ridge in the maxillary molar area. Although this is apparently a rare occurrence, the nature of the lesion was suggested by the history, clinical appearance, and radiographic findings. Excision of the inflammatory lesion was followed by complete healing with closure of the lesion. Unfortunately, the blindness was irreversible. The patient is still under leukemia therapy. Review of the literature did not yield any other such cases. The role of oral lesions as a diagnostic indicator and the importance of dental surgeons in the diagnosis of leukemic patients are discussed. It is concluded that proper precautions and meticulous early diagnosis are required in these patients and that dental practitioners should be aware of the diagnostic features and possibilities of oral complications associated with leukemia.

CT display of multiple dentigerous cysts of the mandible: a case report.

Computerized tomographic (CT) display of a case with multiple dentigerous cysts in the mandible is presented and benefits of the CT in such cases are discussed. CT images provides 3 dimensional accurate details of the cystic lesions without any distortion and superposition. It shows the exact size, location and possible origin of the cysts as well as the extent of the bone destruction. It is considered that CT could be used as a guide in presurgical evaluation of the complex cystic lesions of the jaws.