A Novel Technique for the Management of Persistent Biliary Fistulas Developing After Liver Hydatid Cyst Surgeries: Drain Clamping Technique.

BACKGROUND: External biliary fistula, where the residual cyst is associated with the biliary tree, is one of the most common complications after liver hydatid cyst surgery. Surgical procedures become a consideration for patients in whom the biliary fistula persists despite all endoscopic procedures. However, reoperation for biliary fistula after hydatid cyst surgery leads to additional complications and increases morbidity and mortality. AIM: This study aims to treat persistent biliary fistulas that develop after liver hydatid cyst surgery using a simple noninvasive technique. MATERIALS AND METHODS: External drainage surgery was performed on 295 patients with liver hydatid cysts. Endoscopic treatment methods were used in patients who developed biliary fistula after surgery. Despite all endoscopic treatment methods, 14 patients developed persistent biliary fistulas. These patients were subsequently treated using the drain clamping technique. FINDINGS: All persistent fistulas occluded in 11.86 days (with a range of 8-20 days). No complications were observed in the one-year follow-up visits. CONCLUSION: Drain clamping, a novel approach to the treatment of persistent biliary fistulas developed despite all available endoscopic methods, can be safely used. This technique resulted in a complete recovery in patients without the need for surgical procedures.

Small bowel perforation after drawing a blood sample in the femoral artery: a case report.

Small bowel perforation is a rare complication of femoral artery access in cases of femoral hernia. A 48-year-old woman was admitted to the intensive care unit due to pulmonary insufficiency. After a routine femoral arterial blood gas analysis, severe abdominal pain and nausea began. She underwent emergency laparotomy due to acute abdomen. Laparotomy revealed small bowel perforation. Segmental resection and end-to-end anastomosis were performed. The femoral canal was closed using plaque mesh. Special attention is needed during femoral artery access to avoid accidental small bowel perforation. As seen in this case, a careful examination should be done in cases of femoral hernia.

Tandir burns in and around Diyarbakir, Turkey.

BACKGROUND: Tandir is the name given to a special oven used for baking bread in the eastern and southeastern part of Anatolia. Tandir burn is a unique trauma in that it involves primarily women and young children falling into the in-ground ovens and suffering deep extensive burns. In this study, we aimed to evaluate the tandir burns occurring in the Diyarbakir region. METHODS: The records of 21 patients with tandir burn who were treated in our Burn Center between May 2003 and February 2006 were reviewed. Patients with tandir burns accounted for 2.14% of all burned patients. The mean age was 10.7 years (1hyphen;47 years). Of the patients, 71.43% were female, and 61.90% were under six years old. The mean total body surface area (TBSA) burned was 22.33% (8-75), and 71.43% of the patients had third-degree burns. RESULTS: Three patients required amputation of an extremity. Eight patients had fasciotomies, 16 eschar excision, and 5 partial thickness skin grafts. The mean hospitalization period was 16.90 days (5-34 days). Five patients (23.81%) died. CONCLUSION: Tandir burn is a severe burn with a higher morbidity and mortality.

The effect of caffeic acid phenethyl ester (CAPE) against cholestatic liver injury in rats.

OBJECTIVES: Caffeic acid phenethyl ester (CAPE) has been subjected to considerable investigations that have revealed its antioxidant and anti-inflammatory activities in different conditions. But there is not a previous investigation about its effect on cholestatic liver injury. The aim of this study was to investigate the effect of CAPE in rat liver against cholestatic liver injury induced by bile duct ligation. METHODS: Swiss-albino rats were recruited in the study as follows; Group 1 rats subjected to simple laparotomy known as the sham group; Group 2 rats subjected to bile duct ligation (BDL); Group 3 bile duct ligated rats treated with CAPE. The third group received CAPE (10 micromol/kg) intraperitoneally daily throughout 14 d. RESULTS: Data showed a decrease in gamma glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase levels (ALT) of the CAPE treated rats, compared with BDL group (P < 0.001, P < 0.01, and P < 0.02, respectively). In the CAPE treated rats, tissue levels of malondialdehyde (MDA) and myeloperoxidase (MPO) were significantly lower than that of the BDL group (P < 0.001). The levels of glutathione (GSH) in CAPE treated rats were significantly higher than that of BDL group (P < 0.001). In CAPE treated group, the levels of interleukin-1alpha (IL-1alpha) and interleukin-6 (IL-6) were significantly lower than that of BDL group (P < 0.03, P < 0.02, respectively). Administration of CAPE in the rats with biliary obstruction resulted in inhibition of necro-inflammation. CONCLUSION: These results suggest that treatment of CAPE maintains antioxidant defenses, reduces oxidative liver injury, cytokine damage, and necro-inflammation in bile duct ligated rats. Thus, CAPE seems to be a promising agent for the attenuation of cholestatic liver injury.

The effects of Nigella sativa on bile duct ligation induced-liver injury in rats.

Nigella sativa (NS) has been shown to have antioxidant and antiinflammatory activities in different conditions. The goal of this study was to evaluate the effects of NS on cholestatic liver injury in rats. Thirty rats were recruited in the study as follows: Group 1, Bile duct ligation (BDL) (n = 10); Group 2, BDL plus NS (n = 10); and Group 3, Sham (n = 10). Bile duct ligated group received 0.2 mL kg(-1) dose of NS intraperitoneally daily throughout 14 days. Liver damage and cholestasis were determined by the biochemical and the pathologic examination. Data showed a decrease in gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) activities of the NS treated rats when compared with BDL group (p < 0.001 for GGT and p < 0.05 for others). The NS treated rats' tissue levels of total oxidant status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) were significantly lower than that of the BDL group (p < 0.01 for all). Increases in total antioxidant capacity (TAC) and catalase (CAT) levels were statistically significant in the NS treated rats compared to BDL group (p < 0.01 for both). On the other hand, administration of NS in the rats with biliary obstruction resulted in inhibition of necro-inflammation. These results indicate that NS exerts a therapeutic effect on cholestatic liver injury in bile duct ligated rats possibly through attenuation of enhanced neutrophil infiltration and oxidative stress in the liver tissue.

Protective effects of resveratrol on small intestines against intestinal ischemia-reperfusion injury in rats.

BACKGROUND AND AIM: The aim of this study was to determine whether resveratrol could prevent intestinal tissue injury induced by ischemia-reperfusion (I/R). METHODS: Intestinal I/R was induced in rats' intestines by 60-min occlusion of the superior mesenteric artery, followed by a 60-min reperfusion. Thirty rats were divided into three groups as follows: sham (group 1), control (group 2), and the treatment groups (group 3). The rats in the treatment group received resveratrol both before ischemia and before reperfusion. In all groups, serum aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels were determined. Total antioxidant capacity (TAC), catalase, total oxidative status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) in the intestinal tissue were measured. Intestinal tissue histopathology was also evaluated by light microscopy. RESULTS: The levels of liver enzymes in group 3 were significantly lower than those in group 2 (P < 0.05). TAC in the intestinal tissue was significantly higher in group 3 than in group 2 (P < 0.05). TOS, OSI, and MPO in the intestinal tissue were significantly lower in group 3 than in group 2 (P < 0.05 for all). Histological tissue damage was milder in the resveratrol treatment group than in the control group. CONCLUSIONS: The results of this study indicated that resveratrol treatment limits the oxidative injury of the small intestine induced by I/R in rats. However, more precise investigations are required to evaluate the antioxidative effect of resveratrol on small intestine tissue damage in clinical and experimental models.

Falls from heights in and around the city of Batman.

BACKGROUND: We evaluated the demographic data, mortality rates, fall causes, and post-mortem findings of individuals who fell from heights. METHODS: Five hundred thirty-eight patients who sustained injuries after an accidental fall from heights were entered into the study. Our cases were collected prospectively in Batman over a seven- month period. RESULTS: The mean age was 12.4+/-3.22 years (3 months-98 years); 56.5% of patients were under 6 years old and 83.5% were under 20 years old. The mean fall height was 3.2+/-2.4 m. The mortality rate was 2.2%, and was highest among the patients who fell from flat-roofed houses. The most common injuries were to the head, and 100% of those who died had a head injury. Six patients were followed because of abdominal bleeding and 141 patients due to extremity fractures; 6.7% of patients were operated on and 83.8% of patients were treated in the emergency department. CONCLUSION: The results of this study were at variance with literature data with respect to the following: falls from heights were most common in the 0-5 years of age group. Craniocerebral trauma is the most common injury in fatal falls. Males had a higher rate of falls from height than females.

The handmade endoloop technique. A simple and cheap technique for laparoscopic appendectomy.

OBJECTIVE: To compare 2 laparoscopic appendectomy techniques. METHODS: We describe a modified technique, the handmade endoloop technique, for closing the base of the appendix. This prospective study was carried out at Harran University Medical Faculty, Sanliurfa, and Gulhane Military Medical Academy, Ankara, Turkey from September 2006 to February 2008. We evaluated the safety and efficacy of the procedure in 98 acute appendicitis cases: 57 patients handmade endoloop patients, and 41 endoloop technique patients. Operative time, postoperative complications, need for analgesics, and procedure cost were measured for both groups. The endoloops and sutures used to manage appendectomy were listed at current prices, summarized as number consumed per case, and compared. Data were analyzed by appropriate test. RESULTS: The average price of material used for closing the base of appendix was 81 American Dollars (USD) for laparoscopic appendectomy with endoloop, and 8 USD for the technique described by this article. Overall, postoperative complications, operative time, and the need for analgesia did not show a statistical difference in comparing both groups. CONCLUSION: This procedure is simple, safe, and cheap.

Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid volvulus.

AIM: To evaluate the efficacy of resection and primary anastomosis (RPA) and RPA with modified blow-hole colostomy for sigmoid volvulus. METHODS: From March 2000 to September 2007, 77 patients with acute sigmoid volvulus were treated. A total of 47 patients underwent RPA or RPA with modified blow-hole colostomy. Twenty-five patients received RPA (Group A), and the remaining 22 patients had RPA with modified blow-hole colostomy (Group B). The clinical course and postoperative complications of the two groups were compared. RESULTS: The mean hospital stay, wound infection and mortality did not differ significantly between the groups. Superficial wound infection rate was higher in group A (32% vs 9.1%). Anastomotic leakage was observed only in group A, with a rate of 6.3%. The difference was numerically impressive but was statistically not significant. CONCLUSION: RPA with modified blow-hole colostomy provides satisfactory results. It is easy to perform and may become a method of choice in patients with sigmoid volvulus. Further studies are required to further establish its role in the treatment of sigmoid volvulus.

Spontaneous intestinal perforation due to non-Hodgkin's lymphoma: evaluation of eight cases.

Primary intestinal lymphoma with spontaneous perforation and after systemic chemotherapy is rare. The present study summarizes retrospectively the outcome of eight free intestinal perforated patients diagnosed with intestinal non-Hodgkin's lymphoma. Two patients had a history of systemic chemotherapy before perforation. The most common symptoms of the patients were abdominal pain, nausea, vomiting, weight loss, and fever. Sites of perforation were ileum in four, jejunum in two, cecum in one, and sigmoid colon in one patient. Synchronous lymphoma was present in three patients. The perforation was closed by primary closure in three patients. Resection/anastomosis was performed in four patients and sigmoid colostomy was performed in one patient. Three patients were lost due to leakage or septicemia. Intestinal lymphoma might be kept in mind as a cause in free intestinal perforations. Because of the high mortality rate early diagnosis and treatment are important to improve the prognosis of bowel perforation in patients with non-Hodgkin's lymphoma.