[Late-onset traumatic rupture of the diaphragm: two case reports]. / Geç dönem saptanan travmatik diyafram yirtigi: Iki olgu sunumu.

Ruptured diaphragm as a result of blunt thorax or abdominal trauma can present acutely or late in the disease. Symptoms may be nonspecific and diagnosis can easily be missed. Patients may present with dyspnea, chest pain or cough. Chest radiograph, CT scan, and MRI are the primary diagnostic tools. Clinicians must have a high index of suspicion for prompt diagnosis, especially in patients with a history of trauma to the abdomen or thorax. The only treatment in diaphragm rupture is surgery. We report two cases of traumatic diaphragm ruptures presenting years after the trauma.

Comparison of recovery characteristics, postoperative nausea and vomiting, and gastrointestinal motility with total intravenous anesthesia with propofol versus inhalation anesthesia with desflurane for laparoscopic cholecystectomy: A randomized controlled study.

BACKGROUND: Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy. OBJECTIVE: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility. METHODS: Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2-2.5 mg/kg) and alfentanil (20 µg/kg) or desflurane (4%-6%) and alfentanil (20 µg/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale. RESULTS: Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter in the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements in a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03). CONCLUSION: Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study.

Effect of propolis on healing in experimental colon anastomosis in rats.

INTRODUCTION: Propolis is the generic name for the resinous substance collected by honeybees, which is known to have antioxidant, anti-inflammatory, apoptosis-inducible effects. Anastomotic dehiscence after colorectal surgery is an important cause of morbidity and mortality. We aimed to assess the effect of propolis on healing in an experimental colon anastomosis in rats. METHODS: Forty adult male Wistar albino rats were randomly assigned into 5 treatment groups with 8 rats in each: Group I, anastomosis+no treatment; Group II, anastomosis+oral propolis (600 mg/kg/d); Group III, anastomosis+oral ethyl alcohol (1 cc/d); Group IV, anastomosis+rectal propolis (600 mg/kg/d); Group V, anastomosis+rectal ethyl alcohol (1 cc/d). The bursting pressures, hydroxiproline levels and histopathological changes in each group were measured. RESULTS: When bursting pressures were compared between groups, we observed that they were increased in the groups treated with propolis in contrast to all other groups. Hydroxiproline levels in the propolis groups were also significantly increased in contrast to the other groups. There was also a statistically significant difference in histopathological changes between the treatment types. When propolis administration methods were compared, we did not observe a statistically significant difference. CONCLUSION: Propolis has a significantly favourable effect on healing in experimental colon anastomosis, independent from the method of administration.

Effect of mesalamine on healing in experimental colon anastomosis: a randomised experimental study.

OBJECTIVE: We aimed to investigate the effect of mesalamine on healing of experimental colon anastomosis model. MATERIAL/METHODS: Forty adult male Wistar albino rats were performed segmentary colonic resection and end-to-end anastomosis. Animals were randomly divided into four groups: group I, anastomosis group, received no treatment (GI, n=8); group II, anastomosis+oral mesalamine group (100mg/kg/day); group III, anastomosis+rectal mesalamine (2mL) group, (GIII, n=8); group IV, anastomosis+oral mesalamine+rectal mesalamine (GIV, n=8) group. A sham group (n=8) was constituted and was performed laparotomy. Bursting pressure, hydroxyproline levels and histopathological characteristics of the anastomosis were analyzed. RESULTS: Although it was not statistically significant, there was an increase in the burst pressure of the mesalamine group. When hydroxyproline measurements were compared there were statistically significant difference between the non-treated colon and all groups. There were significant differences between GI and GIII-GIV, GII and GIV. The differences between group I and II and group II and III were not statistically significant. When we compared the median amount of the histopathological changes, we found significant difference between the anastomosis and the mesalamine groups (P<0.05). But when mesalamine groups were compared with each other we did not observe a significant difference. CONCLUSION: Mesalamine had positive effects which were not statistically significant on bursting pressure and statistically different significant effects on hydroxyproline (HP) levels based on the way of administration and statistically significant positive effects on histopathologic anastomotic healing in experimental anastomosis model.