A review on the role of laparoscopy in pancreatic cancer.

BACKGROUD: Pancreatic cancer is the fourth leading cause of cancer death in the United States and leads to an estimated 227,000 deaths per year worldwide. Palliative and curative treatments are used for pancreatic cancer by laparoscopic or open techniques. The role of laparoscopy in pancreatic cancer is evaluated in this study. MATERIAL AND METHODS: Electronic databases, such as PubMed/MEDLINE and Google Scholar were searched to identify reports of trials for laparoscopic pancreatic surgery. Articles written in English including the maximum number of patients published -between 2010 and 2014 were included. RESULTS: Recent reports on laparoscopic surgery of the pancreas are encouraging and support the advantages of laparoscopy. Although large series have been reported for benign pancreatic -tumors treated with laparoscopic procedures, only limited data are available for malignant lesions. Most of these studies are retrospective, but the results encourage laparoscopic procedures. CONCLUSION: Over the last decade laparoscopic pancreatic surgery has emerged as an alternative to open surgery with many advantages. There are limited data on about laparoscopic approach for the treatment of malignant lesions. The results are in favor of laparoscopy.

Asymmetric transmission in prisms using structures and materials with isotropic-type dispersion.

It is demonstrated that strong asymmetry in transmission can be obtained at the Gaussian beam illumination for a single prism based on a photonic crystal (PhC) with isotropic-type dispersion, as well as for its analog made of a homogeneous material. Asymmetric transmission can be realized with the aid of refraction at a proper orientation of the interfaces and wedges of the prism, whereas neither contribution of higher diffraction orders nor anisotropic-type dispersion is required. Furthermore, incidence toward a prism wedge can be used for one of two opposite directions in order to obtain asymmetry. Thus, asymmetric transmission is a general property of the prism configurations, which can be obtained by using simple geometries and quite conventional materials. The obtained results show that strong asymmetry can be achieved in PhC prisms with (nearly) circular shape of equifrequency dispersion contours, in both cases associated with the index of refraction 01. For the comparison purposes, results are also presented for solid uniform non-magnetic prisms made of a material with the same value of n. It is shown in zero-loss approximation that the PhC prism and the ultralow-index material prism (01. Possible contributions of scattering on the individual rods and diffraction on the wedge to the resulting mechanism are discussed. Analogs of unidirectional splitting and unidirectional deflection regimes, which are known from the studies of PhC gratings, are obtained in PhC prisms and solid uniform prisms, i.e. without higher diffraction orders.

Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements.

Central-line-associated bloodstream infection (CLABSI) is one of the most important problems in intensive care units (ICUs) worldwide. A bundle of CLABSI care measures was introduced at a 13-bed medical/surgical ICU in Kocaeli, Turkey in January 2010. Compliance rates with the bundle were measured at the beginning of the third quarter of 2010 until June 2013 and compared with CLABSI rates. During the post-intervention period, of 2196 ICU patients, 732 lines placed for 4366 line-days were monitored. Feedback to staff reinforced a culture of patient safety in the ICU. Infection rates remained zero for 38 months after the implementation. There was a strong negative correlation between bundle compliance rate and CLABSI rates. With the implementation of the central-line bundle of care, together with emphasis on high compliance with all its components and a culture of patient safety, it was possible to achieve and maintain a zero rate of CLABSI in this ICU.

Prevalence of IgE mediated cow's milk and egg allergy in children under 2 years of age in Sanliurfa, Turkey: the city that isn't almost allergic to cow's milk.

AIM: Food allergy is a common problem in children and adults. The aim of this study was to determine the frequency of cow's milk and egg allergy based on skin prick test and oral food challenge results METHODS: We recruited 614 children aged 1 month-2 years in from different areas of Sanliurfa. An interview was conducted with each parents and family demographic, and prenatal-antenatal-postnatal information was recorded, then skin prick test was applied to the children for egg white, egg yolk and cow's milk. Cases that are required, sIgE levels for cow's milk, egg white and egg yolk were measured and food challenge tests were applied. RESULTS: Cow's milk and egg allergy was determined in 1 case (0.16%) and 8 cases (1.30%) respectively from the results of the tests applied. Six cases (0.97%) were accepted as sensitive to egg white and egg yolk. Within the factors which were questioned, (only the egg allergy evaluation was made without the cow's milk allergy case) of those with parental consanguinity was determined at a statistically significantly high level (OR=5.8, 95% CI: 1.2-27.2, P=0.01). CONCLUSION: The prevalence of cow's milk allergy in Sanliurfa is the lowest reported prevalence rate to date in children under 2 years of age. When infants develop a food allergy, this takes the form of egg allergy. Within the several factors evaluated to explain this situation, a significant relationship was determined only with parental consanguinity. However, as reported above, to date there is no genetic or epidemiological study to explain this situation.

Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements

Central-line-associated bloodstream infection (CLABSI) is one of the most important problems in intensive care units (ICUs) worldwide. A bundle of CLABSI care measures was introduced at a 13-bed medical/surgical ICU in Kocaeli, Turkey in January 2010. Compliance rates with the bundle were measured at the beginningof the third quarter of 2010 until June 2013 and compared with CLABSI rates. During the post-intervention period, of 2196 ICU patients, 732 lines placed for 4366 line-days were monitored. Feedback to staff reinforced a culture of patient safety in the ICU. Infection rates remained zero for 38 months after the implementation. There was a strong negative correlation between bundle compliance rate and CLABSI rates. With the implementation of the central-line bundle of care, together with emphasis on high compliance with all its components and a culture of patient safety, it was possible to achieve and maintain a zero rate of CLABSI in this ICU.

Les infections sur cathéter central sont l'un des problèmes les plus importants dans les unités de soins intensifs au niveau mondial. Un ensemble de soins dispensés en cas d'infections sur cathéter central a été introduit dans une unité de soins intensifs médicaux et chirurgicaux de 13 lits à Kocaeli (Turquie) en janvier 2010. Le degré d'application de l'ensemble de soins a été évalué du début du troisième trimestre 2010 jusqu'à juin 2013 et comparé aux taux d'infections sur cathéter central. Au cours de la période suivant l'intervention, parmi les 2196 patients ayant séjourné dans l'Unité des soins intensifs, 732 cathéters centraux posés pendant 4366 jours cumulés ont été soumis à observation. Le retour d'information fourni au personnel a permis de renforcer la culture de la sécurité du patient en unité de soins intensifs.Les taux d'infections sont restés nuls pendant les 38 mois ayant suivi la mise en oeuvre. Il existait une forte corrélation négative entre le degré d'application de l'ensemble de soins et les taux d'infections sur cathéter central. La mise en oeuvrede cet ensemble de soins concernant les cathéters centraux, associée à l’accent mis sur le degré d'application de toutes ses composantes et une culture de la sécurité du patient, a permis d'atteindre et de maintenir un taux zéro d'infection sur cathéter central dans cette unité de soins intensifs.

Multiple slow waves and relevant transverse transmission and confinement in chirped photonic crystals.

The dispersion properties of rod-type chirped photonic crystals (PhCs) and non-channeled transmission in the direction of the variation of structural parameters from one cell of such a PhC to another are studied. Two types of configurations that enable multiple slow waves but differ in the utilized chirping scheme are compared. It is demonstrated that the multiple, nearly flat bands with a group index of refraction exceeding 180 can be obtained. For these bands, transmission is characterized by multiple narrow peaks of perfect transmission, strong field enhancement inside the slab, and large values of the Q-factor. Among the bands, there are some that show negative phase velocity. Symmetry with respect to the slab mid-plane must be kept in order to obtain constructive interferences that are necessary for reflection-free transmission. It is shown that 15 and more slow wave bands can be obtained in one configuration. The corresponding transmission peaks are well separated from each other, being the only significant feature of the transmission spectrum, while the Q-factor can exceed 105. The observed features are preserved in a wide range of the incidence angle variation. They can be used for tuning the locations and spectral widths of the transmission peaks. Some comparisons with the chirped multilayer structures have been carried out.

Pancreas transplantation: experience of single center.

BACKGROUND: Diabetes is the most common cause of renal failure. In patients with type I diabetes and renal failure,dialysis and insulin therapy can prevent a clinical context that causes rapid death, but they are insufficient to prevent longterm complications. Pancreas and islet cell transplantation inpatients with type I diabetes are the only curative treatment and have recently become more common. METHODS: Between December 2006 and August 2010 a total of 10 patients underwent pancreas transplantation. The patient's data were analysed retrospectively. RESULTS: 10 patients and their data were included in this study. Six patients were male and 4 patients were female. All patients are still alive, with functional grafts. CONCLUSIONS: Pancreas transplantation is the most effective treatment for patients with type I DM. This paper discusses the feasibility of this process and presents the experience of Ankara University in pancreas transplantation.

Single-port laparoscopic surgery by use of a surgical glove port: initial experience with 25 cases.

BACKGROUND: single-port laparoscopic surgery has gained popularity over the last decade. This technique is used for several surgical procedures. This paper documents a new and cheaper access method known as "surgical glove port" or "homemade single-port", and describes our initial experience with 25 cases. METHOD: Eleven cholecystectomies, eight totally extraperitoneal inguinal hernia repairs, three splenectomies, two gastric wedge resections, and one anti-reflux procedure were performed. RESULTS: Twenty-four procedures out of twenty-five were completed without conversion to open or multiple port techniques. An individual patient who had both cholelithiasis and gastrointestinal stromal tumor underwent both cholecystectomy and gastric wedge resection in the same session with surgical glove port technique. In another case two additional 5-mm incisions were made for hemostasis. The additional operation was required and performed by using surgical glove port for a hiatal hernia repair case, because of postoperative hemorrhage. CONCLUSION: Single-port laparoscopic surgery is an applicable technique for plenty of surgical procedures. Also, surgical glove port is a newer technique and some initial experience shave already published all over the world. Surgical glove port has advantages such as cost-effectiveness, easy and safe port implantation and specimen extraction. SGP can also be used for treating post-operative complications.

An evaluation of neuropeptide Y status in subacute sclerosing panencephalitis patients.

AIM: This study aimed to evaluate the neuropeptide Y values of patients with subacute sclerosing panencephalitis. MATERIALS AND METHODS: The study comprised 38 patients diagnosed with subacute sclerosing panencephalitis at our clinic, who were being routinely followed-up, together with a control group of 36. Using the Risk and Haddad classification for clinical staging, 16 patients were determined as Stage II and 22 patients as Stage III. Neuropeptide Y values were measured by Enzyme Immunoassay methods. RESULTS: The neuropeptide Y values of the all patients with subacute sclerosing panencephalitis were found to be significantly high compared to the control group (p<0.01). The neuropeptide Y values of the Stage III group were found to be significantly high compared to the Stage II and control groups (p<0.05). The neuropeptide Y values of the Stage II group were not determined to be significant compared to the control group (p≤0.05). CONCLUSIONS: Neuropeptide Y can be considered a useful parameter to confirm diagnosis at advanced stages and to establish differences between stages in patients with subacute sclerosing panencephalitis.

Comparison between the intraoperative use of polyvinyl chloride cover and surgical compresses for preventing postoperative adhesions.

BACKGROUND/PURPOSE: Surgical compresses used for retraction during major abdominal and pelvic procedures lead to postoperative adhesion formation resulting from damage to the visceral peritoneum. This study investigates whether polyvinyl chloride (PVC) covers cause less postsurgical adhesion and inflammation than surgical compresses in an animal model. METHODS: Female Wistar albino rats (n = 160) were divided into three groups (compress, PVC cover and control), which were then divided into 16 subgroups (n = 10/group). All animals underwent midline laparotomy and cecal abrasion. A metal retractor, which applies a constant force, was then placed on the small intestine for 2 h. In the control group, no material was placed under the retractor, whereas a surgical compress or PVC cover was placed in the experimental animals. Full-thickness small intestinal biopsies were obtained and examined by light and electron microscopy. The following parameters were evaluated: congestion, mesothelial proliferation, leukocyte migration and collagenization. Adhesions were scored according to the Nair, Knightly and Mazuji scoring systems. RESULTS: All inflammation scores were significantly higher in the compress group than in the other two groups. However, no significant difference was observed between the PVC cover and control groups. Adhesions were more frequent in the compress group than in the other two groups, regardless of the scoring system used. CONCLUSIONS: Surgical compresses used in abdominal and pelvic surgeries cause inflammation and adhesion. Contrary to surgical compresses, PVC covers do not cause inflammation and adhesion, which may considerably reduce adhesion-related complications in abdominopelvic surgeries.

Dispersion irrelevant wideband asymmetric transmission in dielectric photonic crystal gratings.

Wideband suppression of zero order and relevant strongly asymmetric transmission can be obtained in photonic crystal gratings that are made of linear isotropic materials and show the broken structural (axial) symmetry, even if zero diffraction order may be coupled to a Floquet-Bloch (FB) wave at the incidence and exit interfaces. The studied mechanism requires that the peculiar diffractions at the corrugated exit interface inspire strong energy transfer to higher orders, including those not coupled to an FB wave. At the opposite direction of incidence, transmission due to zero and some higher orders that may be coupled at the corrugated input interface can vanish. This leads to the alternative scenario of wideband unidirectional transmission, which itself does not need but can coexist with the other scenario based on the merging of asymmetric diffraction and dispersion of the FB mode.

Multichannel optical diode with unidirectional diffraction relevant total transmission.

We will show that broadband unidirectional optical transmission with a total transmission maximum inside the band can be obtained for linearly polarized incident waves in the nonsymmetric photonic crystal gratings made of isotropic linear materials at a fixed nonzero or zero angle of incidence. Being based on the merging of diffraction and dispersion effects, the basic physical mechanism studied exploits the transmission channels associated with higher orders, for which asymmetry in the coupling conditions at the two grating interfaces appears when spatial inversion symmetry is broken. Total transmission in one direction and zero transmission in the opposite direction can be obtained due to hybridization of Fabry-Perot type resonances with a diffraction anomaly that yields a diode-like operation regime. Single-beam deflection and two-beam splitting can be obtained, for which transmission can be (nearly) total, if the corrugated side is illuminated. In contrast to the previous studies, it is also shown that unidirectional transmission can appear only at a fixed frequency and only due to diffractions, when total transmission occurs at the noncorrugated-side illumination, being in agreement with the Lorentz Lemma.

Pancreatic cancer complicated by splenic infarction and abscess.

Pancreatic tail adenocarcinoma is both a diagnostic and therapeutic challenge. Despite technical and therapeutic advances, the prognosis remains dismal; the average survival time after diagnosis is characteristically only five to eight months. Both splenic infarction and abscess are very rare complications of pancreatic cancer. In this case of splenic infarction, the possible source of emboli should be carefully investigated. In addition, splenic abscess must be suspected in patients with splenic infarction, especially if the infectious signs persist despite appropriate treatment. Rapid diagnosis and treatment are essential as its course can prove fatal. The patient presented herein had a splenic infarct and abscess as complications of pancreatic tail carcinoma. The treatment of choice was splenectomy and distal pancreatectomy with resection of involved organs. The variability in clinical presentation and imaging studies warrants consideration of this entity in the differential diagnosis of many splenic and pancreatic lesions.

Single stapler technique in laparoscopic donor nephrectomy.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) is usually performed with at least 2 separate vascular staplers for division of the renal artery and vein. However, we used a single stapler regardless of the number of renal arteries and veins. Furthermore, the graft was quickly retrieved by hand without using an extraction bag using our technique. Herein we have presented our experience with LDN of grafts with single or multiple renal arteries and/or veins using a single stapler and hand removal. METHODS: We reviewed demographic data, operative and warm ischemia times, postoperative complications, and graft function. RESULTS: Between December 2005 and September 2009, we performed 85 cases with 1 renal artery (group LDN-1), 8 cases with two renal arteries (group LDN-2), and 5 cases with 3 or more renal arteries (group LDN-3). The demographic data among the groups were similar. The mean operative time was significantly longer among groups LDN-2 (100.3 ± 9.5 minutes) and LDN-3 (120.6 ± 10.3 minutes) compared with LDN-1 (76.1 ± 9.3 minutes; P < .001). Similar results were observed with respect to warm ischemia times. There were no significant differences related to graft function and outcomes among these groups. CONCLUSION: The single stapler and hand removal technique was safe, technically feasible, and cost effective regardless of the number of renal arteries and veins. This technique removes the necessity of additional staplers and extraction bags, lowers the operative and warm ischemia times, and thus decreases the cost.

Pure laparoscopic versus open live donor nephrectomy: evaluation of health survey and graft functions.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) has become the gold standard in many kidney transplantation centers seeking to increase the number of potential live donors. This study was designed to compare the health surveys and graft functions between LDN and open donor nephrectomy (ODN). METHODS: We retrospectively analyzed all patients who underwent donor nephrectomy between December 2005 and September 2009 who had at least 1 year of follow-up. We reviewed demographic data, operative time, warm ischemia period, graft function, and quality of life. RESULTS: Among the 132 cases, 98 were pure LDN and 34 were ODN. Demographic data were similar in both groups. Operative times were significantly longer in the ODN group but warm ischemia times significantly longer in the LDN group. However, graft functions were similar in both groups. There was 1 graft loss due to arterial thrombosis of the transplanted kidney among the LDN group. Short-Form 36 health survey scores were similar except for the role-physical subscale. CONCLUSION: Although we failed to observe a significant difference between ODN and LDN as far as the quality of life and graft functions were concerned, the previously documented advantages of laparoscopy with similar operative results suggest? LDN to be the gold standard for this procedure in our institution.

Living-donor hepatectomy.

BACKGROUND: Organ transplantation from deceased donors is still far below the need. Because of this deficiency, liver transplantations are performed mostly from live donors in many transplant centers in our country. Living-donor liver transplantation (LDLT) has evolved dramatically over the past decade. The aim of this study was to present our clinical experience with living-donor hepatectomy. METHODS: We retrospectively analyzed all patients who underwent donor hepatectomy between March 2000 and September 2010. We reviewed demographic data, operation type, operation and cold ischemia times, duration of hospital stay, and postoperative complications. RESULTS: During the study period, 140 living donors underwent operations for liver transplantation. We performed 108 right hepatectomies, 17 left hepatectomies, and 15 left lateral hepatectomies. The mean age of the donors was 30.8 years. There was no operative or postoperative mortality. Overall morbidity rate was 13.57% (n = 19). Nine patients had biliary leakages, 4 biliomas; 2 urinary tract infections, and 1 each inferior vena caval injury, pneumonia, portal vein thrombosis, and acute tubular necrosis. Reoperation was not required in any of these patients. CONCLUSIONS: Living-donor liver transplantation is a valuable alternative for patients awaiting a cadaver organ. Live-donor hepatectomy can be performed with low morbidity. The greatest disadvantage of this procedure is the risk of the surgical operation for the individual who will experience no medical benefit from this procedure.

Treatment of congenital ichthyosis with acitretin: a case report.

The authors assessed the clinical efficacy, tolerability and safety of acitretin in a patient with ichthyosis. A newborn infant with ichthyosis who presented at birth with collodion baby appearance, was treated with acitretin. A moderate response to acitretin therapy (1 mg/kg/day) administered for 6 months was observed, with improvement in cutaneous lesions. Clinical improvement was achieved shortly after treatment. The treatment resulted in a satisfactory improvement in the skin condition of the case. The tolerance to the drug was good. Side effects were not observed. The oral acitretin treatment is efficient in severe congenital ichthyosis.

The effects of polypropylene mesh on femoral artery and femoral vein in mesh repair.

PURPOSE: Since the first description, the use of polypropylene mesh in hernia repair has gained wide acceptance. The aim of this study was to assess whether polypropylene mesh implantation has any effects on femoral blood vessels. METHODS: A 0.5 × 1.0 cm polypropylene mesh was inserted into the rat femoral artery and vein on the right side. After 14, 28 and 90 days, the rats were reoperated. The meshes were excised for histological processing. Blood flow in the dorsum of the foot skin, femoral artery and vein were measured in all groups before mesh implantation and at 14, 28, and 90 days after mesh implantation. RESULTS: Following placement of mesh graft on vascular structures, inflammation and fibrosis developed to a varying degree depending on the time elapsed. On the other hand, fibrosis did not change the histological structure of vessels. There was a decrease in both arterial and venous circulation due to the pressure of the graft. CONCLUSIONS: These data suggest that fibrosis due to mesh graft can negatively affect blood flow in vessels due to mechanical pressure.

Primary biliary cystadenocarcinoma mimicking a complicated hydatid cyst.

Cystadenocarcinoma of the liver is a rare neoplasm that originates from hepatobiliary epithelium. Primary location of this tumor is generally intrahepatic and most cases are in the right hepatic lobe. Herein we present a case of intrahepatic cystadenocarcinoma in a 53-year-old man who had been followed up for 8 years as hydatic cyst disease of the liver. He was admitted to our hospital with jaundice and loss of appetite. Ultrasound and computed tomography showed a cystic lesion that looked like type II cyst hidatic. Thereafter magnetic resonance imaging revealed a cystic lesion associated with biliary tree. On diagnostic laparotomy peritoneal infiltrations were observed and pathologic examination revealed a biliary cystadenocarcinoma and peritonitis carcinomatosa was diagnosed. Unfortunately correct diagnosis was extremely late and no curative management was possible.

Effects of N-butyl-2-cyanoacrylate on high-level jejunojejunostomy.

BACKGROUND: Morbidity and mortality due to anastomotic complications in gastrointestinal surgery remain important problems. The tissue adhesive N-butyl-2-cyanoacrylate (NB2CA) is used in many fields of surgery. This study was designed to assess the effects of NB2CA on high-level jejunojejunostomy. MATERIALS AND METHODS: Forty male albino Wistar rats were divided into 4 groups of 10 each. The groups were treated as follows: group 1 underwent only a jejunojejunostomy, group 2 underwent jejunojejunostomy followed by NB2CA application around the anastomosis, group 3 underwent jejunojejunostomy after a 60-min ischemia and a 60-min reperfusion, and group 4 underwent jejunojejunostomy after a 60-min ischemia and a 60-min reperfusion followed by NB2CA application around the anastomosis. At postoperative day 7, the subjects in all groups were sacrificed. Intra-abdominal adhesions, anastomotic complications and anastomotic burst pressures (ABP) were recorded. RESULTS: The analysis of all the groups for adhesion scores and ABP showed statistical significance (p < 0.001). CONCLUSIONS: The use of NB2CA had positive effects in terms of increasing ABP both with and without the initial ischemia- reperfusion insult. However, it had the adverse effect of significantly increasing the number of intra-abdominal adhesions.