The Feasibility and Safety of Laparoscopic Cholecystectomy Approach without the Intraopertative Cholangiography Use: A Retrospective Study on 750 Consecutive Patients.

BACKGROUND: We have retrospectively reviewed the results of all common bile duct (CBD)-stone preoperative asymptomatic patients operated on our unit to point out the feasibility and safety of the laparoscopic cholecystectomy approach without the IOC use. METHODS: From January 2004 and June 2008 we analyzed all the data from hospital records and follow up results of all the patients who underwent LC. The indications for performing preoperative endoscopic retrograde cholangiopancreatography (ERCP) or selective IOC were abnormal liver function tests, history of jaundice, cholangitis or pancreatitis, and ultrasonographic evidence of CBD stone or dilation (≥ 10 mm). These patients were excluded from study. The follow up of the all patients were done by liver function tests and abdominal ultrasonography when needed at the time of the visit. RESULTS: Between January 2006 and June 2010, 750 patients were operated in our clinic. In 34 patients, operations were converted to open cholecystectomy (OC). Of these 750 patients, 98 of them had one or more exclusion criteria and were excluded from the further analyzes. We did not perform any IOC during LC. Regular follow up of at least two years was obtained in 618 (618/657, 94.0%) patients. No operative mortality was encountered among the patients. Postoperative morbidity was detected in 15 of the patients (2.5%). In one patient, CBD injury was detected (0.017%). The mean follow up was 35 (24 - 74) months. Retained stone was detected in three patients (3/577, 0.5%) during the follow up. CONCLUSION: This approach allows to omit routine IOC and to perform LC safely in selected patients group given the low percentage of both CBD injuries and symptomatic retained stones observed in the late follow up period in our 618 operated patients, we consider our approach a feasible and safe approach to manage patients with gallbladder stones re-confirming the results of other studies.

Sarcomatoid chromophobe renal cell carcinoma with osteosarcoma-like differentiation which presented as a retroperitoneal mass: a case report.

Sarcomatoid component can occur in all histological subtypes of renal cell carcinoma but most commonly accompanies chromophobe renal cell carcinoma. The majority of the sarcomatoid components consist of malignant fibrous histiocytoma, fibrosarcoma or undifferentiated sarcoma areas. Heterologous differentiation in the form of osteosarcoma or rhabdomyosarcoma is very rarely encountered. We report a very rare case of a chromophobe renal cell carcinoma with osteosarcomatous differentiation that presented as a retroperitoneal mass. Renal cell carcinoma with sarcomatoid change should be always kept in mind when a retroperitoneal mass with sarcomatoid differentiation is encountered.

Can occult cystobiliary fistulas in hepatic hydatid disease be predicted before surgery?

BACKGROUND: Biliary fistulas because of the cystobiliary communication is the most frequent and undesirable postoperative complication of hepatic hydatid surgery. We aimed to identify the predicting factors of the occult cystobiliary communication in this study. METHODS: The patients who underwent surgical treatment for hepatic hydatid disease between 2003 and 2008 were reviewed retrospectively. The patients who had jaundice history, preoperative high total bilirubin and direct bilirubin levels, dilated bile duct in preoperative radiologic imagings were not included the study. Patients were divided into two groups: group A; without postoperative biliary fistula, group B; with biliary fistula. The two groups were compared according to preoperative descriptive findings, cystic specialties, and laboratory findings. RESULTS: There were 53 patients and 15 patients in groupA and groupB, respectively. The 20 (37.7%) of 53 patients were male in group A and the 10 (66.7%) patients were male in group B (p<0.05). The age, number of cysts, Garbi scores of cysts, the rate of recurrent cysts, the level of preoperative bilirubin, alkalene phosphatase, and transaminases were similar in both groups (p>0.05). GGT was significantly different between two groups (p<0.05). The cystotomy + drainage, cystotomy + omentopexy, and intracystic biliary suture rates were similar in both groups. Postoperative non biliary complications were determined in 4 (7.5%) patients in group A and 7 patients (46.7%) in group B (p<0.05). Hospital stay was longer in group B significantly (p<0.05). CONCLUSIONS: In conclusion, GGT as a laboratory [corrected] test for predicting occult CBC preoperatively have been shown to be useful in the clinical practice. However, larger prospective studies are needed on this subject. Occult cysto-biliary fistulas can only be exposed during surgery when suspected by a surgeon. If occult CBC is found, the opening in the biliary system should be sutured with absorbable material, with or without cystic duct drainage. If no biliary opening is found, cystic duct drainage may be performed if preoperative factors predict the presence of CBC. As the development of external biliary fistulas increases the morbidity and the hospitalization period, novel surgical methods to prevent the development of bile fistulas are required in such patients.

The value of serum biomarkers (Bc1, Bc2, Bc3) in the diagnosis of early breast cancer.

BACKGROUND: Surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF) is an approach to biomarker discovery that combines chromatography and mass spectrometry. We aimed to consider the efficacy of Bc1, Bc2, and Bc3 serum biomarkers on early detection of breast cancer (BC) in this study. STUDY DESIGN: In this prospective study, 91 patients who were admitted to our hospital between January 2007 and July 2008 were included. Serum samples from 91 women were stored at -80 °C until use. The cancer group included 27 cases of BC. The benign breast disease group included 24 women with benign breast diseases and control group 37 age-matched apparently healthy women. The data obtained for these three groups of patients was worked out for each serum biomarker (Bc1, Bc2, and Bc3) by using SELDI-TOF individually and compared with each other separately and evaluated statistically. RESULTS: Bc2 possesses the highest individual diagnostic power. Bc2 was statistically significant in comparison between the malignant disease group, control group and benign disease group. Bc1 was statistically significant in the malignant disease group compared to control group as well as in the benign disease group compared to control group. Thus Bc1, rather than showing malignant progression, it shows tumoral progression or inflammatory process. Bc3 was found upregulated in all malignant cases; however, it was not statistically significant compared to the benign disease group or the control group. CONCLUSIONS: It has been shown that Bc2 profiles might be useful in clinical practice to improve BC diagnosis. However none of the proteomics reach reasonable AUC values for the discrimination of the BC. Additional confirmation in larger and similarly-designed prospective studies is needed to consider of the efficacy of Bc1 and Bc2 in early diagnosis of the BC.

Melanoma arising in a hairy nevus spilus.

Cutaneous melanoma may develop de novo on normal skin or in contiguity with a potential melanocytic precursor. We report a 45-year-old man who presented with a recently developed nodule in a previously stable congenital nevus. Physical examination revealed a 10x18-cm lesion with speckled lentiginous pigmentation and terminal hairs on the lower back. A 2x2-cm suspicious nodule in the lesion was noted by the patient 2 months earlier. Histopathological evaluation of the nevus and the suspicious nodule revealed the characteristics of a melanocytic nevus and melanoma, respectively. It was interesting for the authors to observe terminal hairs in a lesion that was clinically 'speckled lentiginous' in appearance. This case report is a reminder that there may be great variation in the clinical appearance of nevus spilus, and thus dermatologists must be aware of these lesions as potential precursors of malignant melanoma.

The effect of tegafur and uracil combination on colonic anastomotic strength: an experimental study on rats.

BACKGROUND/AIMS: Some patients are candidates for neo-adjuvant use of Tegafur, a prodrug of 5-fluorouracil, and Uracil combination (UFT). The purpose of this study is to assess the effect of preoperative UFT use on the strength of colonic anastomosis. METHODOLOGY: Forty Wistar albino rats were randomly divided into a control (group 1, n=10) and three study (Group 2, 3 and 4, 10 animals in each group) groups. Animals in control and study groups were given saline or UFT which included 50 mg/kg of Tegafur via an oral-gastric tube for 28 days. A segmental colonic resection and end-to-end anastomosis was performed on all animals 1, 1, 7 and 14 days after the treatments had ended in groups 1, 2, 3 and 4, respectively. On postoperative day 7 the animals were killed and bursting pressure and breaking strength were measured. RESULTS: Three animals in the treatment groups died during the preoperative period, and one in the control group died after surgery. The animals in groups 2 and 3 had lesser bursting pressures than the control group (p<0.001), but no statistical difference was observed in bursting pressures of the control group and group 4 (p>0.05). The breaking strengths of each group were statistically different from the other groups (p<0.001 for each comparison). CONCLUSIONS: UFT use during the preoperative period affected the anastomosis strength in this animal experiment. Current study suggests that an operation should not be performed during the 14 days after UFT use has ended.

Surgical treatment of liver trauma (analysis of 244 patients).

BACKGROUND/AIMS: The liver is the most common injured intraabdominal organ after trauma. This retrospective study was designed to analyze the results of the surgical treatment of 244 cases of liver trauma operated between 1973 and 2001. METHODOLOGY: Two hundred and seventeen of the cases were male and 27 were female. Mean age of the patients was 29.6. Blunt injuries were responsible for liver trauma in 53.6% of the patients. According to the American Association for the Surgery of Trauma classification we evaluated the patients to two groups. The first one was Group A, minor hepatic injuries, which consisted of grade I, grade II and grade III injuries, and the second one was Group B, major hepatic injuries, which consisted of grade IV, grade V and grade VI injuries. There were 238 cases in Group A and 6 cases in Group B. Primary suturing of the hepatic rupture was performed in 187 of 238 cases in group A. Liver injuries of the other 50 cases did not require suturing so that we drained the suprahepatic and infrahepatic spaces during laparotomy. The remaining case in group A had resectional debridement and hemostasis. On the other hand we performed regular or irregular hepatic resection in all group B patients. RESULTS: Overall mortality rate was 16.3%. The mortality rate was higher in group B than group A (66.6% and 15.1%, respectively). The mortality rate was also higher in the blunt abdominal trauma cases than penetrating injuries (25.9% and 5.3% consecutively). CONCLUSIONS: We concluded that the injury grade and the type of trauma influence the mortality rate. Careful clinical assessment and close radiological monitoring of the patients with minor hepatic injuries, may prevent unnecessary laparotomies.

Long-term albendazole treatment in one case of alveolar echinococcosis. Case report.

AIMS: Curative therapy of alveolar echinococcosis is total surgical removal of the infected tissue and concomitant chemotherapy. However, this curative resection can be done on a limited number of patients, for the remaining ones various palliative procedures can be performed. METHOD: In this article it is aimed to present the result of long-term albendazole treatment in patient who had a palliative hepatojejunostomy for obstructive jaundice due to unresectable alveolar echinococcosis. RESULTS: Systemic albendazole treatment was initiated in this patient after palliative hepatojejunostomy procedure. During follow up there was no abnormality in blood chemistry and a considerable regression in size of the lesion was found in postoperative month 24. Residual hepatic lesion was histopathologically documented and showed apparently non-viable parasitic cysts by biopsy. These findings suggest the long-term albendazole therapy being parasitocidal. CONCLUSIONS: Palliative or mass reduction surgery combined with long-term albendazole therapy is the standard therapy for advanced disease, especially when curative resection might result in significant morbidity and mortality.

Effect of transdermal glyceryl trinitrate and anti-inflammatory gel in infusion phlebitis.

BACKGROUND: Phlebitis is the commonest complication of intravenous infusion. It has been suggested that it is initiated by venoconstriction at the infusion site, hence treatment with a vasodilator may reduce its incidence. METHODS: A prospective controlled study was carried out on the effect of transdermal glyceryl trinitrate (GTN) and topical anti-inflammatory gel (non-steroidal anti-inflammatory drug; NSAID) on the survival of peripheral intravenous infusion in 386 patients. RESULTS: A total of 34.9% (43 out of 123) of the infusions failed in the control group compared with 14.1% (18 out of 127) in the NSAID group (P < 0.05) and 30.8% (43 out of 136) in the GTN group (P < 0.05). In the control group 31 positive cultures were obtained. Twenty-one positive cultures were obtained in the GTN group and four cases of bacterial proliferation were observed in the NSAID group. CONCLUSIONS: Infusion phlebitis is a common problem in hospitalized patients and its incidence can be effectively reduced by NSAI gel and GTN but NSAI gel is more effective than GTN.