Role of thiol-disulfide hemostasis in early diagnosis of acute mesentery ischemia: An experimental study.

BACKGROUND: Acute mesenteric ischemia (AMI) is a rarely observed acute abdominal disease that may be mortal and is difficult to diagnose early. The aim of our study is to assess the role of Thiol-Disulphide Haemostasis (TDH), a new method for AMI which still has no specific biochemical markers for early diagnosis, and to assess it together with Ischemia-Modified Albumin (IMA) which has previously proven reliability for AMI. METHODS: The study included 32 Wistar albino rats in four groups. The 1st group (n=8) was the control group, 2nd group (n=8) was the sham group, 3rd group (n=8) had 3 h of arterial mesentery ischemia and the 4th group (n=8) had 6 h of arterial mesentery ischemia. TDH, IMA, and serum lactate values were measured at h 0, 1, 3, and 6. RESULTS: In the 3rd and 6th h, serum total thiol and native thiol values significantly reduced (p<0.001), while serum disulfide, IMA, and lactate values clearly increased (p<0.001). Serum thiol values were observed to reduce from the 1st h. CONCLUSION: TDH changes in the early period of AMI. The TDH parameters can be used with IMA as diagnostic parameters for patients with suspected AMI in the early period.

New surgical technique applied with urological instruments in bilobar multiple hepatolithiasis: Ultra-mini percutaneous hepatolithotomy.

Intrahepatic bile duct stones may emerge with manifestations as chronic stomach ache, cholestasis, cholangitis, abscess, post-obstructive atrophy and liver cirrhosis presentation may occur. Thus the treatment of symptomatic hepatolithiasis patients should be provided. Different methods such as biliary decompression, endoscopic, percutaneous or open surgery are recommended for the treatment of patients with intrahepatic gallstones. The aim of the treatment is to extract the stones and regain biliary drainage. But the treatment regimen to be applied should be determined after examining the age, performance condition, general condition of the patient and location of the stone carefully. In this case, we presented a young female patient who had many unsuccessful surgical interventions due to coledochal cyst and congenital malformation in bile ducts, had large stones in right and left intrahepatic bile ducts and in whom we provided complete stone-free condition through Ultra-Mini Percutaneous Hepatolithotomy (UM-PHL) using urological instruments.

Effectiveness of collagenase in preventing postoperative intra-abdominal adhesions.

INTRODUCTION: The purpose of this study is to investigate the effectiveness of Collagenase clastridiopeptidase an enzyme preparation used in enzymatic debridement in preventing adhesions brought about by peritoneal damage. METHODS: The study covers a total of 40 rats in 4 groups each having 10 rats. Group 1: The control group. Group 2: Normal saline group. Group 3: Sterile Novuxol group. Group 4: The group where the intraperitoneal and systemic effects of sterile Novuxol were investigated. Adhesion frequency and grades were scored on the post-op 11th day according to Granat. Blood work including hemoglobin, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, and albumin level measurements were performed. Toxicity was investigated histopathologically through samples taken from the liver and the peritoneum from Group 4. RESULTS: Adhesion frequency was found to be 80% on the right and 90% on the left for Group 1, while it was 50% on both left and right for Group 2, and 30% on the right and 10% on the left for Group 3. Adhesion stages were found to be 1: 2.35 ± 1.42 for Group 1, 0.31 ± 1.15 for Group 2, and 0.20 ± 0.41 for Group 3. Adhesion stage of the Sterile Novuxol Group was lower than all the other groups (p < 0.05). Biochemical and hematological parameters were similar in all groups (p > 0.05). Histopathological analysis revealed no hepatotoxicity. CONCLUSIONS: According to the results of our study, we believe that Sterile Novuxol can be a good anti-adhesive agent considering its ease of use, non-toxicity, and effectiveness.

Intussusception: as the cause of mechanical bowel obstruction in adults.

BACKGROUND/AIMS: Intussusception in adults is rarely seen and causes misdiagnosis due to its appearance with various clinical findings. The cause of intussusception in adults is frequently organic lesions. In this study, the underlying etiologic factors, diagnostic methods and alternative methods of treatment are discussed in the light of the literature. METHODS: In this study, a retrospective evaluation was performed on 47 cases with the diagnoses of intussusception, who were operated on for bowel obstruction between 1990-2011 in Department of Surgery of Necmettin Erbakan University Meram Medical Faculty. Data related to presentation, diagnosis, treatment and pathology were analyzed. RESULTS: Twenty-four of the patients (51%) were female, and 23 were male (49%). Mean age (year) was 49 (range: 23-78) in female group, and 50 (range: 17-72) in male group. All patients presented mechanical bowel obstruction findings and underwent operation. Intussusception was caused by benign and malignant tumors in 38 patients, and other reasons in 3 cases. No reason could be determined in the other 6 cases. Only small intestine resection was applied in 29 cases, and large intestine resection was also applied in 17 cases. Reduction and fixation surgery was performed in one patient. No postoperative mortality was observed. CONCLUSIONS: Adult intussusception remains a rare cause of abdominal pain. Diagnosis of intussusception in adults is still difficult. Main treatment was surgical in most cases.

[Early laparoscopic cholecystectomy for acute cholecystitis]. / Akut kolesistit için erken laparoskopik kolesistektomi.

BACKGROUND: The aim of this study was to assess the clinical results of treatment by laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. METHODS: Between 1994 and 2006, LC was performed in 3876 patients in Selcuk University Meram Medicine Faculty. The clinical, biochemical, radiologic, and operative data of 182 (101 F, 81 M) consecutive patients with acute cholecystitis operated 3 days after the onset of symptoms were analyzed retrospectively to determine the complications and morbidity after operation. RESULTS: The conversion rate was 31 (17.03%) in acute cholecystitis. Postoperative length of stay was found as 4 days in the successful LC group and 7 days in the conversion group. For acute cholecystitis, we found a statistical difference between the successful LC group and the conversion group in terms of length of postoperative hospitalization time and gallbladder wall thickness. We identified the following factors as associated with conversion: male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. CONCLUSION: LC is a safe approach in selected patients with acute cholecystitis. Male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.

Penis replantation after self-mutilation.

In this case report, the procedure of penis replanting and its complications after genital self-mutilation in a male adult are explained.

Long-term results utilizing the unroofing technique in treating hydatid cysts of the liver.

PURPOSE: The aim of this study was to present the long-term follow-up results of liver hydatid cysts treated with unroofing, together with a review of the related literature data. METHODS: Of 700 liver hydatid cyst patients examined and treated at Selcuk University Meram Medical Faculty, General Surgery Department, between 1985 and 2007, 650 had accessible data and the unroofing method had been applied in 189 of them. The clinical and laboratory findings, stages, operations, and complications of patients treated with unroofing were reviewed. In particular, the resolution of residual cyst cavities over time after the application of this method was evaluated using computed tomography. RESULTS: Four hundred and thirty-six (67.07%) of the cases were female [mean age: 35 (range: 10-73) years] and 214 (32.9%) were male [mean age: 46 (range: 12-76) years]. Of the 189 cases treated with unroofing and followed by tomography, the data of 144 were documented. Cavities were classified into five groups (A-E) according to their postoperative appearance. CONCLUSIONS: Unroofing is an easy approach and it does not require extensive experience. This technique is recommended for peripherally localized cysts but may also be applied to those more deeply situated. Unroofing should be applied as deeply as possible and the residual cavity should also be as shallow as possible.

Internal herniation as a major cause of intestinal obstruction.

OBJECTIVES: To evaluate internal herniation as a rare cause of intestinal obstruction. MATERIALS AND METHODS: Files of 18 cases, operated due to internal herniation between 2000 and 2006 at Selcuk University, Meram School of Medicine, General Surgery Department, were reviewed retrospectively. Sixteen patients (88.8%) were male (mean age: 58.2 years; range: 42-67) and 2 were female (mean age: 56.5 years; range: 52-61).Cases were grouped according to the location of internal herniation, and the clinical findings and applied treatment strategies were evaluated. RESULTS: All patients were taken into surgical operation after preoperative preparations were completed. Findings were as follows: 6 cases of paraduodenal internal herniation, 4 of internal herniation through a defect in the terminal mesoileum, 2 of herniation through a defect in the falciform ligament, 2 of herniation through a defect in the omentum majus, 1 of herniation to the recessus over the bladder, 2 of herniation through a defect in the transverse mesocolon and 1 iatrogenically caused internal herniation through a defect in the mesojejunum. CONCLUSION: In an adult patient with findings of intestinal obstruction, diagnosis is difficult. Most cases presented to date are incidental findings during laparotomy, and surgical treatment is necessary.

Clinical and surgical profile and follow up of patients with liver hydatid cyst from an endemic region.

AIM: The aim of this study is to present the changes in the treatment of liver hydatid cyst during the last 20 years in our clinic according to literature data. MATERIAL AND METHODS: Clinical, laboratory and operational findings and pre- and postoperative complications of 650 from 700 patients with liver hydatid cysts, examined and treated at Selcuk University Meram Medicine Faculty, General Surgery Department, between 1985-2005, were evaluated in two groups: 1st period (1985-1995) and 2nd period (1995-2005). RESULTS: 436 of the cases were females (67.1%) and 214 (32.9%) males. The mean age of the females was 35 years (ranges 10-73) and of the males 46 years (ranges 12-76). Surgical treatment comprised radical and obliterative conservative techniques in the first period, while non-obliterative conservative techniques and percutaneous puncture and aspiration of the cyst, injection of scolex eliminating substance and reaspiration (PAIR) were preferred in the second period. During the follow-up (498 cases were followed for a mean period of 32 [12-72] months), recurrence occurred in 12 in the first period and in 9 in the second period, a total of 21 patients (4.21%). CONCLUSION: We consider that regardless of the surgical treatment used in liver hydatid cyst cases, combination with chemotherapy is the safest and most effective approach.

Gastric heterotopia together with intestinal metaplasia in the gallbladder: case report and review of literature.

Heterotopic gastric mucosa in the gallbladder is extremely unusual. In this study, we aimed to report a case of gastric heterotopia together with intestinal metaplasia in the gallbladder of a 16-year-old male patient who experienced a sudden onset of epigastric pain with nausea. He was admitted to the hospital with a prediagnosis of mild degree obstructive jaundice. Cholecystectomy and hepaticoduodenostomy were carried out. In the microscopical examination of the gallbladder, an antral and pyloric type gastric mucosa together with intestinal metaplasia were clearly evident in the gallbladder submucosa, and the adjacent gallbladder mucosa showed typical features of chronic cholecystitis.

[Diaphragmatic rupture in abdominal trauma]. / Karin Travmasinda Diyfragma Rüptürü.

BACKGROUND: The aim of the study is to evaluate the patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma. METHODS: Thirty-eight patients with diaphragmatic rupture due to penetrating or blunt abdominal trauma were investigated retrospectively. RESULTS: The average age was 41,72 and there were 31 male and seven female patients. The injury forms were penetrating trauma in 22 (58%) and blunt trauma in 16 (42%) cases. Associated abdominal organ injuries were found in 27 (71%) cases. Among 47 diaphragmatic ruptures, 27 (57%) were on the left and 20 (43%) were on the right side. The average diameter of the rupture was 5,45 (1-20) cm. Management of the diaphragmatic rupture and other associated organ injuries were accomplished through laparotomy. Morbidity was developed in 18 cases and mortality in four cases with associated abdominal organ injuries. CONCLUSION: Diaphragmatic rupture results in high morbidity and mortality due to associated organ injuries.

Diphenhydramine and hyaluronic acid derivatives reduce adnexal adhesions and prevent tubal obstructions in rats.

OBJECTIVE: The purpose of this study is to investigate the effects of diphenhydramine-HCl and Na-hyaluronate derivatives on the development of postoperative peritoneal adhesion and tubal obstruction. STUDY DESIGN: Forty female rats of Sprague-Dawley type were used in the study. The rats were divided into four groups, each comprising 10 subjects. After all the rats were anaesthetized with 50mg/kg ketamine HCl, their abdomens were opened with a lower midline incision. Injury was induced on the right pelvic peritoneum and on the peritoneal surface of left uterine tube. No additional procedure was applied to the first group. 10 mg/kg diphenhydramine-HCl was given to the second group intravenously. In the third group, 0.25 mg/kg Orthovisc, a Na-hyaluronate derivative was diluted with 2 ml physiological saline and poured into the abdomen. For the fourth group, Seprafilm, a Na-hyaluronate derivative was covered in a layer of 0.7 cm x 3 cm over the left uterine tube. After 14 days, the rats were anaesthetized with ketamine HCl again, and 5 cm(3) blood sample was taken with cardiac puncture. The abdomen was opened with an incision transverse to the upper end of the midline incision, and the presence of adhesions was investigated. Detected adhesions were staged according to the Mazuji classification. Tubal patencies were inspected by injecting methylene blue from the uterine corpus into the lumen using an injector. A piece of abdominal wall of 4 cm x 4 cm was removed by extending the incision in the reverse U shape. The tensile strength and bursting pressure of the suture line were determined using the Peacock method. One gram of tissue was taken from the incision line, and hydroxyproline levels were determined by the Bergman-Loxley method. Aspartate aminotransferase (AST) levels were measured. RESULTS: All of the rats completed the study. AST levels, tissue hydroxyproline levels and tensile strength and bursting pressure test results were found to be similar in all groups. While adhesion rates in the groups were 100, 40, 40 and 30%, respectively, adhesion stages were found to be, respectively as 2.1+/-1.7, 0.6+/-0.67, 0.6+/-0.67 and 0.5+/-0.85. Adhesion stages in the study groups were significantly lower (P<0.05). Tubal obstruction rates were found to be 70, 30, 30 and 20%, respectively. CONCLUSION: Diphenhydramine, Orthovisc and Seprafilm significantly reduce postoperative peritoneal adhesion development, and they allow the uterine tubes to remain open.

The effects of different hernia repair methods on postoperative pain medication and CRP levels.

Although tension-free techniques of hernia repair using synthetic meshes have yielded encouraging results, the best method of inguinal hernia repair is still unclear. The aim of this study was to compare the responses of inflammatory mediators and postoperative pain relief following laparoscopic total extraperitoneal (TEP) hernioplasty, open tension-free mesh hernioplasty (Lichtenstein), posterior preperitoneal mesh hernioplasty (Nyhus procedure), and Bassini procedure. Patients with primary inguinal hernia were randomized in the operating room to undergo one of these repair techniques. Group I comprised 24 patients treated by Lichtenstein procedure; Group II comprised 21 patients treated by Nyhus procedure; Group III comprised 19 patients treated by Bassini procedure; and Group IV comprised 20 patients treated by laparoscopic TEP mesh hernioplasty. Postoperative pain levels following hernia repair were compared by measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery. Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content. Patient characteristics, operating time, and operative and early complications were noted. Serum CRP levels rose markedly following Nyhus (184.5 +/- 41.6 mg/L), Lichtenstein (138.4 +/- 72.5 mg/L), and Bassini repair (137.2 +/- 55.9 mg/L) compared with that of patients who underwent TEP mesh hernioplasty (55.5 +/- 41.2 mg/L). There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (382.9 +/- 189.1 mg), Bassini (303.2 +/- 173.7 mg), and Lichtenstein (253.9 +/- 129.3) procedures compared with 196.6 +/- 148.8 mg for the TEP mesh hernioplasty group. Patients in the Lichtenstein group also had significantly less need of analgesics than those in the Nyhus and Bassini groups. In conclusion, TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures.