Assessment of Optic Nerve Sheath Diameter in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: A Prospective, Randomized, Controlled Double-Blinded Comparison of Propofol and Ketofol Anesthesia.

BACKGROUND: ERCP is an endoscopic procedure for the diagnosis and treatment of biliopancreatic system diseases. An increase in intra-abdominal pressure due to the insufflation of air to the intestinal lumen may be transmitted to ICP through the course of ERCP. In this prospective, randomized, controlled double-blinded study, we aimed to assess the ICP change using ultrasonography measurement of ONSD in patients undergoing ERCP comparing the effects of propofol and ketofol anesthesia. MATERIAL/METHODS: One hundred and nine patients undergoing ERCP under propofol or ketofol anesthesia were enrolled in the study. Ultrasonography measurement of ONSD was performed before (T0) and immediately after induction of anesthesia (T1), during sphincterotomy (T2), at the end of procedure (T3), and after the patient is fully awake (T4). RESULTS: Comparison of ONSD values and ONSD alteration between groups showed no statistically significant difference (P > 0.05). Both groups showed significantly greater changes from T0 to T2 compared with values from T0 to T1, T3, and T4, respectively (P = 0,000). T0 to T3 alteration was also significantly greater than T0 to T1 and T4 change in both groups (P = 0,000). CONCLUSIONS: ERCP procedure increases intracranial pressure most prominently during sphincterotomy both under propofol or ketofol anesthesia. Further studies are needed to investigate the impact of this phenomenon on adverse clinical outcomes.

Ultrasonographic evaluation of the postoperative airway edema after robotic prostatectomy: a single center observational study.

OBJECTIVE: During general anesthesia, different parts of the upper airway can change for various reasons, such as intravenous fluids, airway trauma due to airway devices used, stasis in tissues due to position, reactions to medications used, etc. For many reasons, edema in the airway or the surrounding tissue can narrow the airway. This study compares preoperative and postoperative ultrasound measurements of upper airway anatomy in patients with robotic radical prostatectomy in the Trendelenburg position. PATIENTS AND METHODS: This study was conducted at the Health Sciences University Ankara City Hospital between May and December 2022. The preoperative and postoperative measurements of tongue thickness, midsagittal tongue cross-sectional area, tongue width, lateral pharyngeal wall thickness, parapharyngeal region thickness, and submental region thickness were analyzed and compared. RESULTS: There was a difference between the preoperative and postoperative median sagittal tongue cross-sectional area, tongue volume values, LPW values, parapharyngeal region thickness, and neck circumference values. We found that the thickness of the submental region and the thickness of the parapharyngeal region increased as the amount of fluid administered intraoperatively increased. CONCLUSIONS: Upper airway edema is the most challenging problem for anesthetists during extubation due to position and pneumoperitoneum. Restrictive fluid management may have beneficial effects in preventing clinically important airway edema.

Reduction of shock wave lithotripsy-induced renal tubular injury by tadalafil.

OBJECTIVES: The aim of the study was to examine whether administration of tadalafil, a phosphodiesterase type 5 inhibitor, has a protective effect in the prevention of renal injury in a rat model after Shock Wave Lithotripsy (SWL), with the assessment based on histopathologic examination and measurement of Heat Shock Protein 70 expression. METHODS: A total of 40 adult, male Sprague-Dawley rats were divided into five groups as follows; control group, group SN3, group SN7, group TSN3, TSN7. Both kidneys were evaluated regarding tubular damage, peritubular fibrosis and glomerular damage using light microscopy. We examined HSP-70 expression, which occurred in response to renal ischemic injury observed after SWL. The groups were compared between each other and with the control group. RESULTS: No statistically significant difference was found when the groups were compared using light microscopy for the changes in glomeruli. Tubular necrosis, loss of microvilli and peritubular fibrosis were less in Group TSN3 and Group TSN7 compared to Group SN3. Similarly, tubular necrosis, loss of microvilli and peritubular fibrosis were less in Group TSN3 and Group TSN7 compared to Group SN7. HSP-70 staining was less in Group TSN3 and Group TSN7 compared to Group SN3 and Group SN7. CONCLUSION: Based on the results of light microscopy and HSP-70 staining, we demonstrated that SWL could cause renal ischemia- reperfusion injury. Our results suggested that Tadalafil administration could prevent this SWL-related renal cell injury (Tab. 2, Fig. 5, Ref. 28).

Treatment for horseshoe fistula with the modified Hanley procedure using a hybrid seton: results of 21 cases.

BACKGROUND: The aim of the present study was to document our recent experience in managing horseshoe fistula of cryptoglandular origin with a modification of the Hanley procedure using a hybrid elastic one-stage cutting seton. METHODS: Surgical outcomes of the modified Hanley procedure for horseshoe fistulae using a seton from 2004 through 2010 were analyzed. The seton fashioned from a surgical glove was tied around the sphincter under less tension than a traditional cutting seton, hence the definition of "hybrid seton". In addition to excision of the superficial segments of the lateral tracts, deeper extensions into the ischiorectal spaces were curetted, and Penrose drains were placed. RESULTS: All of the patients were discharged on the first postoperative day. None required readmission or needed narcotic analgesics after discharge. Complete healing was achieved in all 21 cases at 8.0 ± 3.22 weeks postoperatively. Patients were able to return to regular work activity in 3.5 ± 1 weeks. The postoperative Cleveland Clinic Incontinence Score did not differ significantly from the preoperative score (p = 0.317, Wilcoxon's test). Recurrent fistula was noted in a single patient (4.8 %) after a mean follow-up of 20.9-months. CONCLUSIONS: The use of the hybrid elastic seton is a useful and safe additional modification for the treatment of horseshoe fistulae with the Hanley technique.

Integration of GARD Turkey national program with other non-communicable diseases plans in Turkey.

For the prevention and control of non-communicable diseases (NCD), an action plan on NCDs is intended to support coordinated, comprehensive and integrated implementation of strategies and evidence-based interventions across individual diseases and risk factors, especially at the national and regional levels by World Health Organization (WHO). The Global Alliance against Chronic Respiratory Diseases (GARD) is making every attempt to align with WHO's non-communicable diseases action plan. GARD activities have been commenced in over 40 countries and in 11 countries an integrated NCD action plan is being prepared or has already been initiated. This integrated approach of GARD has also targeted to GARD Turkey project. The Turkish Ministry of Health has decided to apply this national control program in conformity with other NCD action plans. This article is intended to summarize these integration efforts of GARD Turkey (the National Control Program on Chronic Airway Diseases) with other NCD national programs.

Significance of nm23 immunoexpression in the prognosis of renal cell carcinoma.

Non-metastatic gene 23 (nm23) is a metastasis suppressor gene that is expressed in all tissues and decreased nm23 expression may be linked to poor prognosis. By immunohistochemical staining of nm23 protein antibodies this study examined the prognostic value of nm23 protein expression in 54 renal cell carcinoma (RCC) patients and analysed its relationship with tumour, node, metastases (TNM) surgical stage, Fuhrman nuclear grade, lymph node involvement and survival. Of the 54 RCC cases studied, 11 (20.4%) showed positive lymph node involvement while 43 (79.6%) were lymph node negative. There was no difference in nm23 protein expression between cases with and without lymph node involvement. In addition, nm23 protein expression was not related to TNM stage, Fuhrman nuclear grade or survival. More extensive studies are required to understand the effect of nm23 protein expression on the biological behaviour of RCC.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey).

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

Gastrocolic fistula as a complication after gastrojejunostomy.

Gastrocolic fistula formation is an extremely rare complication of gastric ulcer disease. We report a case of a 55-year-old man who presented with a two-month history of abdominal discomfort, postprandial diarrhea, nausea and faecal vomiting. Upper gastrointestinal endoscopy showed an ulcer in the greater curvature of the stomach. Barium enema examination revealed an obvious gastrocolic fistula between the greater curvature of the stomach and the transverse colon. The involved segment of the colon was excised and truncal vagotomy and antrectomy was performed. The patient was discharged on the 7th postoperative day. It is concluded that cases with postprandial diarrhea and nutritional disturbances after gastric surgery should remind us of the probability of gastrocolic fistula formation.

A small bowel fistula extending into a metastatic tumour due to lung carcinoma.

We report the case of a 63-year-old man who presented with an abdominal mass that was subsequently found to be a metastasis of small cell lung carcinoma into which the small bowel had fistulized. After a detailed diagnostic workup, the involved segment of the small bowel was resected along with the mass. The patient is alive and well six months after surgery. Lung carcinoma metastases to the bowel and mesentery are rare. Resection of the metastatic mass gives the best palliation and improves short-term survival.

Posterior tibial nerve stimulation for faecal incontinence after partial spinal injury: preliminary report.

BACKGROUND: This study evaluated the possible effects of posterior tibial nerve stimulation in two patients with faecal incontinence due to partial spinal cord injury. METHODS: Posterior tibial nerve stimulation was performed for 30 min, every other day for 4 weeks, and was then repeated every 2 months for three months. Clinical examination, anorectal physiological work-up, faecal incontinence severity index, and quality of life assessments were performed before and after the treatment. RESULTS: After posterior tibial nerve stimulation, patients showed improvement in rectal sensory threshold, pudendal nerve terminal motor latency, Wexner faecal incontinence score, faecal incontinence severity index, faecal incontinence quality of life scales, resting pressure, and maximum squeeze pressure measurements. CONCLUSIONS: Posterior tibial nerve stimulation can be an effective method for the treatment of faecal incontinence caused by partial spinal cord injury.

Comparison of Shouldice and Lichtenstein repair for treatment of primary inguinal hernia.

PURPOSE: The purpose of this study was to compare the outcome following Lichtenstein open mesh repair or Shouldice repair for the surgical treatment of primary unilateral inguinal hernias. PATIENTS AND METHODS: Patients with primary unilateral inguinal hernia who underwent a Shouldice repair (n: 120) and a Lichtenstein open mesh techniques (n: 121) between 1994 and 1998 were evaluated retrospectively. Operation time, hospital stay, postoperative analgesic consumption and complications, return to work and recurrence after surgery were assessed and compared. RESULTS: The two groups were comparable regarding age, types of hernia and the follow-up interval. There were no significant differences in hospital stay and postoperative complications. The number of recurrences differed significantly between the groups with five in the Shouldice group (4.1%) and one in the Lichtenstein group (0.8%) (p < 0.05). The need of analgesic medication after mesh repair was significantly lower than the Shouldice group (3.9+/-1.4 vs. 4.9+/-1.6 gr. p < 0.05). The operation time was 36+/-14 min. for Lichtenstein repair and 61+/-12 min. for Shouldice repair (p < 0.05). The time for return to work was shorter in Lichtenstein group (17+/-4 days) compared to Shouldice group (25+/-5 days) (p < 0.05). CONCLUSION: Shorter operation time, faster return to work, less need to analgesia and lower recurrence rate, shows the superiority of Lichtenstein repair against Shouldice repair in the surgical repair of primary unilateral inguinal hernia.

Anal canal pressure in anal fissure before and after internal sphincterotomy.

PURPOSE: To assess whether the anal canal pressure is increased in patients with a chronic anal fissure and to examine the effects of internal anal sphincterotomy (IASy) on this pressure. MATERIALS AND METHOD: Anorectal manometry was performed in 28 patients in whom an anal fissure had been diagnosed by means of physical examination and anuscopy. After IASy the manometric measurement was repeated on the 15th postoperative day and compared with the value obtained in twelve healthy volunteers. RESULTS: In patients with chronic anal fissure, the mean maximal resting pressure (MRP) was found to be 112.38 +/- 8.35 cm H2O pre-operatively and 66.23 +/- 8.44 cm H2O postoperatively, with a significant drop after IASy (p < 0.001). The MRP value was found as 75.16 +/- 10.22 cm H2O in the control group. The pre-operative MRP values in patient group was found to be higher than in the control group (p < 0.001). CONCLUSIONS: In patients with chronic anal fissure, the anal canal MRP pressures decreased significantly following IASy and complete clinical recovery was attained.

The outcome of gallbladder perforation during laparoscopic cholecystectomy.

PURPOSE: Laparoscopic cholecystectomy (LC) has become the standard treatment for symptomatic cholelithiasis. The perforation of gallbladder, bile and stone spillage, trauma to bile duct are the most common complications of LC. This study was carried out to assess the outcome of gallbladder perforation (GBP) during LC. MATERIAL AND METHODS: Between 1991 and 2001, intraoperative GBP occurred in 48 patients during LC among 336 patients who were operated on for acute cholecystitis in 14, and for chronic cholecystitis in 322. RESULTS: Perforation was observed in 48 patients (14%). Perforation occurred during traction and grasping in 36 patients (75%), dissection of gallbladder in 8 patients (16%), and removal of the gallbladder in 4 patients (8%). Bile spillage occurred in 40 patients (83%) while bile and stone spillage was present in 8 patients (16%). During the follow-up period, a patient was diagnosed with a subhepatic abscess on the 15th postoperative day and percutaneous drainage was performed. CONCLUSIONS: During LC careful attention must be taken in order to prevent perforation, and the procedure must be performed by experienced surgeons with adequate instrumentations. If perforation occurs, extensive prompt retrieval of the bile and stone spillage must be done along with abundant irrigation. In case of inadequate aspiration and irrigation, the patients must be closely followed.

Bezoar: an uncommon cause of intestinal obstruction.

Bezoars or undigested food concretions in the gastrointestinal tract are mostly due to ingestion of a stringent immature fruits following gastric surgery and can lead to the serious complication of acute small bowel obstructions. We are reporting a case of complete jejunal obstruction in a 60 year old female, 15 years following bilateral vagotomy and gastrojejunostomy for pyloric obstruction. Important clinical and pathological features are emphasised to increase the awareness of this rather uncommon cause of intestinal obstruction.

Clam ileocystoplasty in adult nocturnal enuresis.

OBJECTIVE: We investigated the effect of clam ileocystoplasty in patients with nocturnal enuresis with urodynamically proven detrusor instability which was recalcitrant to conservative therapy. MATERIAL AND METHODS: Twelve patients (10 males, 2 females) with ages ranging between 22 and 44 years (mean 32) underwent clam ileocystoplasty. In addition to cystometry all patients underwent pressure flow evaluation. Patients with obstruction; poor contractility and poor compliance that was diagnosed by pressure flow studies were not operated. RESULTS: In a mean 38 months of follow-up all patients were cured symptomatically and urodynamically except one. In this patient, symptomatic improvement was observed despite the persistence of detrusor instability. No patient needed intermittent self catheterization. There were no postoperative complications except an incisional hernia diagnosed after two years postoperatively and corrected surgically. CONCLUSION: Clam procedure could be the best treatment for patients with life long nocturnal enuresis recalcitrant to conservative therapy with coexistence of proven detrusor instability.