Differences in egg nutrient availability and embryo development in white layer breeder genotypes.

Because of consumers' preferences and also due to changes in production systems, the importance of pure breeds has increased again. There are a lot of differences among breeds which have been studied extensively, however, the differences during the incubation period are not yet fully known. Therefore, the present study was conducted to evaluate the composition of the egg parts, absorption of nutrients, and development of embryos from different genotypes. A total of 354 fresh hatching eggs were obtained from one hybrid (Lohman White, LW) and two pure breeds (Denizli and Gerze). Hatching eggs from each genotype were examined on the day of setting for egg analysis and then at the beginning of the embryonic d 19 (E19) and embryonic d 21 (E21) for egg, embryo, jejunum, and tibia analysis. On d 21 of incubation, the healthy chicks were removed and weighed. Egg weight, shell thickness, percentages of albumen, and some parameters of albumen composition (dry matter, water, ash, protein, energy, Na, Ca, K, and Mg) were higher in fresh eggs obtained from LW hens. Furthermore, the relative yolk sac and embryo weight, some yolk parameters (dry matter, water, protein, fat, and energy) and some shell parameters (dry matter, ash, Na, Ca, and K) were also higher in eggs obtained from LW hens during incubation. However, tibia deformation and villus width were lower in LW embryos than the other genotypes. Relative chick weights were 68.9, 72.0, and 68.0% in LW, Denizli, and Gerze genotypes, respectively. During incubation, differences in all examined parameters were significant except thickness and weight of shell, tibia deformation, and crypt depth. Yolk sac weight, some yolk composition parameters, K level in the shell, Cu level in the tibia, and villus height were also affected by genotype and period interaction. Based on these results, LW was found advantageous in terms of egg composition, however, regarding villus development and tibia deformation in embryos during incubation, pure breeds showed better results.

Intensive pulmonary care after liver surgery: a retrospective survey from a single center.

BACKGROUND: Prevention from postoperative pulmonary complications (PPCs) has been an important topic. The aims of this study were to determine the risk factors for PPC after liver surgery and to analyze the efficacy of postoperative pulmonary care on PPC prevention. MATERIALS AND METHODS: We retrospectively analyzed variables of 81 patients who underwent hepatectomy and 4 transplantations between January 2007 and March 2012. RESULTS: Nineteen patients suffered PPCs (22.4%). Bivariate analysis identified four risk factors: preoperative anemia (odds ratio [OR] = 5.69), the American Society of Anesthesiologists (ASA) score of 3 or 4 (OR = 5.36), blood transfusion (OR = 2.81), and prolonged operative time (OR = 1.01). Upon multivariate analysis, only prolonged operative time was an independent risk factor for PPC (OR = 1.01). Pulmonary function test (PFT) was performed for 22 of 41 patients with an ASA score ≥ 2 (53.7%); there was no significant relationship between abnormal PFTs (n = 13) and the development of PPCs (P = .12). CONCLUSIONS: The elimination of risk factors may reduce the incidence of PPCs. Postoperative intensive pulmonary care should be given to all patients after liver surgery but particularly to patients with high ASA scores and those with abnormal PFTs irrespective of age.

Hepatic microcirculation in inflow and inflow-outflow occlusion of the liver.

BACKGROUND: Total vascular exclusion (TVE) causes warm liver ischemia. The aim of this study was to investigate the patterns of injury caused by inflow-outflow obstruction in the rat liver. MATERIALS AND METHODS: Twenty-four Wistar-Albino rats were divided into three groups: liver inflow occlusion (Group A), inflow-outflow occlusion (Group B) and intermittent inflow-outflow occlusion applied for 15 minutes. Microcirculation was measured with laser Doppler flowmetry during the procedure. Samples for biochemical and histopathological analyses were collected at the end of the ischemia period. RESULTS: Significant alterations in microcirculation were determined by application of vascular control maneuvers. Microcirculation in the central and dome segments were affected adversely compared with the dome segments in all experimental groups. TVE induced severe disturbances in hepatic microcirculation with more prominent hepatocellular damage. Damage to central segments of the rat liver was more prominent with inflow occlusion; whereas inflow-outflow occlusion produced more prominent damage to dome segments. Intermittent application of TVE clamping was associated with more hepatocellular damage compared with continuous TVE. CONCLUSION: Our mapping methodology within the liver parenchyma suggested that hepatovenous back-perfusion is a principle source of continuity of microcirculation in the rat liver during inflow occlusion. Inflow-outflow occlusion caused more tissue damage compared with inflow occlusion. Ischemic preconditioning during TVE did not increase the tolerance of the liver against ischemia.

Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy.

BACKGROUND: Technical modifications and methods for gallbladder dissection to minimize the risk of gallbladder perforation during laparoscopic cholecystectomy (LC) are described. The authors aimed to investigate the effects of gallbladder aspiration during LC on the operative and postoperative course of patients. METHODS: For this study, 200 patients undergoing LC for symptomatic cholelithiasis were randomly divided into two groups. Gallbladders were aspirated before dissection in group A (n = 100), and they were not aspirated in group B (n = 100). Operative and postoperative data on the patients were collected. RESULTS: The rate of gallbladder perforation was significantly lower in group A than in group B (p = 0.0003). The operative time was significantly shorter in group A (46.70 +/- 15.93 min) than in group B (60.75 +/- 22.09 min) (p = 0.047). Postoperative complications were more numerous in group B. The hospital stay was significantly longer in group B (1.55 +/- 0.81 days) than in group A (1.3 +/- 0.5 days; p = 0.004). CONCLUSION: The findings demonstrate the advantages of gallbladder aspiration in elective cases.

Pheochromocytoma combined with pre-clinical Cushing's syndrome in the same adrenal gland.

Pheochromocytoma (PHEO) occasionally associates with pathological lesions of the adrenal cortex. In most of them, ectopic adrenocorticotropic hormone (ACTH) produced by PHEO resulted in bilateral adrenocortical hyperplasia. The coexistence of PHEO and pre-clinical Cushing's syndrome (PCS) of the same adrenal gland has rarely been reported. We report on a patient and discuss the peculiar diagnostic aspects of this entity. A 52-yr-old Turkish woman was hospitalized at Farabi Hospital for further examinations of a right adrenal mass that was incidentally discovered by abdominal ultrasonography during examinations for abdominal bloating and "gas" in other hospital. The patient had a history of palpitations, nervousness, sweating and heat intolerance. On admission, her blood pressure was 140/90 mmHg. A physical examination revealed no signs of an excessive production of adrenocortical steroids such as in CS. Tension Holter monitoring revealed paroximal hypertension attacks (183/105 mmHg). Urinary catecholamines were markedly increased. Her serum cortisol concentrations ranged from 5 to 17 microg/dl, whereas ACTH levels were undetectable. Cortisol was not suppressed on the overnight 1 mg oral dexamethasone suppression test (DST), 2-day low-dose dexamethasone suppression test (DST). Abdominal computed tomography and magnetic resonance imaging studies revealed a solid round tumor approximately 4 cm in diameter, located in the right adrenal gland. A 131 lodine-metaiodobenzylguanidine (131 I-MIBG) scan revealed uptake within tumor in the right adrenal gland. Right adrenalectomy was performed; the surgical specimen revealed PHEO and adrenocortical hyperplasia. To our knowledge, the present report is a rare case of PHEO combined with PCS in the same adrenal gland.

Effects of octreotide on acute pancreatitis of varying severity in rats.

OBJECTIVE: To find out the effects of the octreotide on the course of acute pancreatitis in rats. DESIGN: Prospective laboratory study. SETTING: Medical school, Turkey ANIMALS: 184 Sprague-Dawley rats, 120 of which were randomly allocated into 8 groups of 15 each for the survival study, and the remainder of which were randomly allocated into 8 groups of 8 rats each for assessment of biochemical variables and histological score. INTERVENTIONS: The same 8 groups were used for the two parts of the study: saline alone (control), octreotide alone (control), oedematous pancreatitis induced by cerulein with and without octreotide, moderate pancreatitis induced by low-dose glycodeoxycholic acid and cerulein with and without octreotide, and severe pancreatitis induced by high-dose glycodeoxycholic acid and cerulein with and without octreotide. MAIN OUTCOME MEASURES: Mortality, results of biochemical tests, and histological score. RESULTS: No rats in the control groups died. Of those with oedematous pancreatitis 1 died that had not been given octreotide (7%) and 2 that had (13%). In the moderate pancreatitis groups 4 that had not been given octreotide died (27%) compared with one that had (7%). In the severe pancreatitis group 7 that had not had octreotide died (46%) compared with 6 that had (40%). Octreotide caused a reduction in serum amylase and lactate dehydrogenase activity in all groups, but reduced aspartate aminotransferase only in those rats with moderate pancreatitis. It prevented hypocalcaemia in rats with severe pancreatitis, but had no effect on serum electrolyte concentrations, alkaline phosphatase activity, or blood gas analyses. Rats with moderate pancreatitis that had been given octreotide had less tissue oedema, acinar necrosis, and inflammatory cell infiltration. In those with severe pancreatitis there was less tissue oedema but more acinar necrosis. CONCLUSION: If octreotide is given early in the course of the disease it may result in improved outcome, but it seems to be ineffective in severe pancreatitis in which acinar necrosis is already established.

Laparoscopic abdominal observation method without anesthesia for preventing unnecessary second-look procedures: short report.

Second-look operations after massive intestinal resections secondary to mesenterovascular occlusion are a frequent practice. In about one half of patients who undergo second-look procedures, no intraabdominal intervention is necessary. We present a laparoscopic abdominal observation method to prevent unnecessary laparotomies. In the first operation, two laparoscopic trocars, 5 and 10 mm in diameter, were left in the abdominal wall. After an appropriate time interval, the abdomen was explored laparoscopically through these trocars without anesthesia. If obvious intestinal gangrene and anastomotic leaks were observed laparoscopically, the patients were reoperated on while under general anesthesia; otherwise, the procedure was terminated with removal of the trocars. This method was performed on six patients. Unnecessary relaparotomies were prevented in four patients; intestinal gangrene and anastomotic leaks were not missed in the remaining two patients. A larger patient sample is needed to assess the advantages of this method in preventing unnecessary laparotomies.

Effects of total parenteral nutrition using a solution enriched with branched-chain amino acids on experimental pancreatitis in rats.

The main purpose of this study was to investigate the influence of total parenteral nutrition enriched with branched-chain amino acids (BCAA) on acute pancreatitis (AP) induced by sodium taurocholate in rats. Total parenteral nutrition (TPN) increased the survival rate and serum calcium, and reduced serum urea, liver transaminase, acid phosphatase and lactate dehydrogenase levels, but it did not change the degree of pancreatic damage or serum amylase. Total plasma amino acid concentration and the concentrations of glutamate, glycine, alanine, taurine, valine, leucine, isoleucine, phenylalarine increased significantly after the induction of AP, but there was no difference between the control and therapy groups. Hyperglycemia occurred during the use of TPN. BCAA-enriched TPN can be used in the treatment of AP with few side effects.

Complications of 867 thyroidectomies performed in a region of endemic goiter in Turkey.

This article aims to define the incidence of complications in 867 thyroidectomies performed by residents with attending surgeons' supervision as part of a training programme, in a region of endemic goiter. Seven hundred and nine patients were female and 158 were male. The age of the patients ranged between 6 and 76 and mean age was 32.5. Cases were divided into two groups according to their disease nature. Group 1 included 805 patients with nodular colloidal goiter (NCG) and adenomas. The remaining 62 cases, 25 with recurrence of goiter (RG), 21 with thyroid malignancy (TM) and 16 with thyroiditis formed group 2. While the overall complication rate was 11.3% (93 cases) in group 1, it was 20.9% (13 cases) in group 2. The mortality rate was zero in both groups. The incidence of complications of 867 thyroidectomies performed by residents with the attending surgeons' supervision was within acceptable limits especially as far as group 1 was concerned. However we suggested that attending surgeons themselves, disregarding residents training, should perform the operation in special cases such as recurrent goiters, thyroid carcinomas with positive regional lymph nodes and thyroiditis with regional adhesions.

Intestinal obstruction caused by splenic volvulus: report of a case.

Torsion of a wandering spleen is rare, usually presenting as acute abdomen, and is commonly misdiagnosed. In special cases, ultrasonography, arteriography, and additional scintigraphy are extremely valuable in the preoperative diagnostic management. We herein present an unusual case of torsion of a wandering spleen in a 19-year-old female. The presenting symptom was acute gastrointestinal obstruction due to pressure of the enlarged and ptotic spleen in the pelvis. The intestinal obstruction with signs of peritonitis made a laparatomy with removal of the infarcted spleen imperative. After the operation, the patient made a complete recovery.

Effect of sucralfate on gastric emptying and mucus under stress in rats.

The effect of sucralfate on gastric emptying, gastric mucus production, and ulcer formation in cold-restraint rats was studied. The rats were treated with sucralfate in doses of 100 mg/kg, 250 mg/kg and 500 mg/kg. Sucralfate prevented ulcer formation dose dependently. This effect was maximum at doses of 500 mg/kg (P < 0.001). Administration of sucralfate lowered the increased gastric emptying rate and increased gastric mucus production. This effect was not dose dependent. It was found that the ulcer-preventive effect of sucralfate was due to a lowered gastric emptying rate and increased mucus production in addition to other mechanisms.

Solitary extramedullary plasmocytoma of the breast with kappa monoclonal gammopathy.

We report a case of solitary extramedullary plasmocytoma of the breast in a 85 year old woman. This is the third case of solitary breast plasmocytoma in the world's literature. This disorder is very rare and it was associated with a serum monoclonal protein. A similar case is presented and its clinical presentation and pathology discussed.

Influence of thyrotropin-releasing hormone on experimental pancreatitis in rats.

The main purpose of this study was to investigate the influence of thyroid releasing hormone on acute sodium-taurocholate-induced pancreatitis in rats. Thyroid-releasing hormone did not change the survival rate, serum amylase, glucose calcium, liver transaminases levels or the degree of pancreatic damage, but reduced lactate dehydrogenase. Our findings suggest that the use of thyroid-releasing hormone has no beneficial effect on the course of acute experimental pancreatitis.

Complicated marginal ulcers after surgery for duodenal ulcer.

During a period of 10 years, 10 cases of marginal ulcer (MU) after surgery for duodenal ulcer were evaluated retrospectively. The most common cause of MU was inadequate gastric resection plus incomplete vagotomy; the second common cause was incomplete vagotomy. In one case, the MU could be ascribed to malignant gastrinoma. In eight of the ten cases epigastric pain was a major symptom. MU was complicated with perforation, massive bleeding, gastrojejunocolic fistula and afferent loop obstruction in 2, 2, 2, and 1 cases, respectively. Gastroscopy was very useful for the diagnosis except in emergency cases. Hollander test was used in six of the 10 patients to evaluate if the vagotomy had been complete. The mean acid output by insulin induction was found 32 meq/h. As a surgical therapy, total gastrectomy (2 cases), truncal vagotomy (2 cases), truncal vagotomy plus 60% gastric resection or reresection and Roux Y gastrojejunostomy were performed. Postoperative complications (enterocutaneous fistula, intraabdominal abscess and delayed gastric emptying) occurred in 33 patients. One patient was lost after total gastrectomy in the malignant gastrinoma and gastrojejunocolic fistula case, due to sepsis. The patients were followed up for 4.4 years on the average. No recurrence was seen.

The effects of variously performed vagotomies on gastric secretion and gastric emptying in rats.

The main purpose of this study was to investigate the effects of (i) truncal vagotomy + pyloroplasty, (ii) proximal cell vagotomy and (iii) anterior proximal cell vagotomy + posterior truncal vagotomy on the gastric secretion and gastric emptying in rats. After vagotomy basal and 2-deoxy-glucose stimulated gastric secretion decreased significantly in all three vagotomy groups. Gastric secretion on the other hand was significantly higher in the proximal cell vagotomy group than on the other vagotomy groups. The rate of gastric emptying in proximal cell vagotomy and anterior proximal cell vagotomy + posterior truncal vagotomy groups was delayed. The best results were found in the truncal vagotomy + pyloroplasty group when the gastric secretion and the rats of gastric emptying are concerned.

The intrabiliary rupture of hydatid cyst of the liver.

The intrabiliary rupture of hydatid cyst of the liver is a severe and relatively frequent complication. In this study six similar cases are presented. 4 of the cases had hydatid cyst surgery before the admission. The obstructive jaundice, cholangitis and unclosed bile fistula are the most frequent clinical findings. Ultrasound is very useful for the diagnosis. In the cases of space occupying lesions of the liver with wide choledochus (1.1 cm >) the intrabiliary rupture of hydatid cyst can be suspected by ultrasonographic examinations. Surgical therapy as the capitonnage combined with the resection of the projecting dome of the cyst and T tube application remains a method which gives good results and has low mortality and morbidity.

A modified technique for performing anterior gastropexy in Stamm gastrostomies.

We describe herein a new modified technique for performing the anterior gastropexy step of the Stamm gastrostomy procedure. In this method, anterior gastropexy was carried out with four 2-0 silk or propylene sutures. These sutures were secured through the whole layer of the abdominal wall from out to within. Then, after passing the seromuscular layer of stomach, they return to skin through the abdominal wall from within to out and tied over the skin surface. This modified technique which provided better exposure and an excellent seal of the stomach and parietal peritoneum, was successfully performed on 23 patients, none of whom developed any peritoneal leakage and peritonitis. The only complications that arose were wound infection in one case and skin excoriation in two others, and these were easily managed.

The management of enterocutaneous fistulas with parenteral hyperalimentation.

During a period of nine years, all patients with enterocutaneous fistula who received parenteral nutrition as part of therapy were evaluated retrospectively. Twenty-three patients were studied. Peptic ulcer was the most common primary disease, with the fistula arising in 78 percent of the cases from the breakdown of an anastomosis and in the remainder from a direct trauma to the bowel. The most common site of the fistulas was the ileum followed by the duodenum. All the patients were treated conservatively with total bowel rest and parenteral nutrition, and in 56.5 percent of the cases spontaneous closure occurred within an average of 29.6 days. In five patients, the fistula failed to close, and surgery was performed. The mean surgical closure time overall 36.4 days, but this varied from 20.8 days for the duodenum to 39 days for the jejunum and ileum, and 19.7 days for the large intestine. Five patients (22.7%) died, four from sepsis, the fifth from systemic malignancy. Mortality was related to the location and output of the fistula, with jejuno-ileal high-output fistulas in particular figuring prominently in the mortality.