Efficacy of preoperative albendazole use according to months in hydatid cyst of the liver.

PURPOSE: Hydatid cyst is still a significant health and economical problem due to insufficient preventive measures. Infestation by hydatid disease in humans most commonly occurs in the liver and causes complications unless treated properly. Therefore, hepatic hydatid cyst should immediately be treated when diagnosed. Today, the treatment of hydatid cysts is principally surgical. To avoid recurrence, viable scoleces in the hydatid cyst should be eliminated before emptying surgically. Length of Albendazole therapy, a drug effective on scoleces in the cyst, is still controversial. METHODS: In this study, there was a significant difference in the rate of viable scoleces when group III receiving albendazole for 3 months preoperatively was compared with group I, group II, and the control group. We do think 3-month preoperative abendazole treatment is effective in reducing the rate of recurrence and if still viable scoleces are observed in the surgery, albendazole treatment should be continued for 1 month postoperatively. RESULTS: After the therapy, in group I 10 (47.6%), in group II 7 (33.3%), and in group III 2 (0.9%) patient's scoleces were alive. In the control group (group IV) 17 (80%) patients' scoleces were intact. When group III is compared with the control group, a significant difference was observed (P<0.05). Yet again, there was a significant difference between the groups when groups I and II were compared with group III. CONCLUSIONS: We concluded that in treatment of hydatid cyst, albendazole should be continued at least for 3 months preoperatively and if still viable scoleces are identified, medical treatment should follow the surgical intervention at least for 1 month to decrease the possibility of residual cysts and recurrence.

Effect of peritoneal lavage with taurolidine on primary colonic anastomosis in a rat model of secondary peritonitis.

PURPOSE: The reported antibacterial, antiendotoxic, and antiadhesive effects of taurolidine prompted us to study the benefits of intraperitoneal lavage with taurolidine on primary colonic anastomosis in a rat model of secondary peritonitis. METHODS: We induced peritonitis in 40 rats by injecting Escherichia coli isolate intraperitoneally. We performed colonic resection and primary anastomosis 5 h later, after lavage with either taurolidine or saline solution. After the rats were killed, on postoperative day (POD) 3 (n = 10) or 7 (n = 10), we measured the bursting pressures and hydroxyproline levels, then examined the resected specimens histologically. RESULTS: Bursting pressures and tissue hydroxyproline levels were significantly higher in the taurolidine group than in the control group on PODs 3 and 7 (P < 0.05). Histopathological examination revealed significantly higher fibroblastic activity in the taurolidine group. CONCLUSIONS: The higher bursting pressures and tissue hydroxyproline levels in the rats given taurolidine showed the positive effect of taurolidine on anastomotic strength in secondary peritonitis. Taurolidine is a novel antibiotic with both antibacterial and antiendotoxic effects. Intraperitoneal lavage with taurolidine solution may reduce the risks associated with performing primary colonic anastomosis in patients with secondary peritonitis.

Major retroperitoneal vascular injuries during laparoscopic cholecystectomy and appendectomy.

BACKGROUND: Serious complications may occur during laparoscopic surgery, as in any surgical procedure. Injuries of major retroperitoneal vascular structures are uncommon but important complications of laparoscopy. METHODS: We report on 9 major vascular injuries in 8 patients in the course of 8 laparoscopic procedures between 1994 and 2002. RESULTS: The primary operations were cholecystectomy in 7 patients and appendectomy in one patient. Six vascular injuries occurred during placement of the first umbilical trocar, two in the course of the insertion of a Veress needle, and one during the insertion of the second trocar. A laparotomy was performed immediately in all cases. Left common iliac arteries were injured in two patients, aorta in three patients, right common iliac vein in one patient, both right common iliac artery and vein in one patient, and inferior vena cava in one patient. Polytetrafluoroethylene (PTFE) graft interposition was employed in two common iliac arteries and a tubular PTFE graft in one aortic injury, and Dacron patchplasty in one common iliac artery injury. Two aortic, two common iliac vein, and an inferior vena cava injury were repaired primarily. There were also four visceral organ injuries, which were repaired primarily. The major retroperitoneal vascular complication rate was 0.07%. An average of 3.5 units of whole blood were transfused in each case and the average stay in hospital was 6.8 days. There was no mortality. CONCLUSIONS: The surgeon's experience and knowledge are the essential factors for prevention of major vascular injuries during laparoscopic procedures. In case of an injury, immediate laparotomy must be performed to achieve hemostasis and a surgeon who is familiar with vascular surgery should employ the definitive treatment.

[Traumatic diaphragmatic rupture: analysis of 48 cases]. / Travmatik diyafragma rüptürleri: 48 olgunun analizi.

BACKGROUND: Our aim is to investigate treatment modalities and the results of traumatic diaphragmatic rupture in our trauma patients. METHODS: In this retrospective study, 48 patients admitted to our hospital between 1997-2000 with diaphragmatic injury were evaluated according to the type of injury, diagnostic methods, associated organ injury, treatment modality, morbidity and mortality. Injury severity score (ISS) was used in patients with associated organ injury to assess the effect on mortality. RESULTS: There was penetrating injury in 69% and blunt injury in 31% of patients. Physical examination and X-ray films were enough in the diagnosis of 66.6% of patients. There was associated organ injury in 83.3% and isolated diaphragm injury in 16.6% of patients. The morbidity and mortality ratio were 8.3% and 10.4% respectively. There was no difference between mortality ratio of penetrating and blunt trauma statistically (p > 0.05). On the other hand, in regard with morbidity and mortality; the injury severity score was higher in patients with associated organ injury (p < 0.0001). CONCLUSION: Traumatic diaphragmatic rupture is usually seen with associated organ injury and mortality and morbidity are higher in this case.

[The effects of abdominal compartment syndrome on the serum urea and creatinine levels]. / Abdominal kompartman sendromunun serum üre ve kreatinin üzerine etkisi.

BACKGROUND: The purpose of this study was to assess the effects of abdominal compartment syndrome (ACS) on the kidneys. METHODS: Intra abdominal pressures (IAP) were indirectly measured through urinary bladder. The patients were categorised into four groups according to IAP levels. Serum urea and creatinine levels and IAP were measured once a day. Abdominal decompression was planned according to IAP as well as clinical assessment. RESULTS: The number of patients in this study was 25. Serum urea and creatinine levels were highest in the group IV (group in which abdominal pressure was above 31 cmH2O) (t > 0.05). Five of the 25 patients were died and anuria developed in these five patients before death. In three of five patients abdominal decompression operations were performed. CONCLUSION: ACS is an unusual and often lethal syndrome. The most important treatment is abdominal decompression and we conclude that it should be done in patients with IAP 30 cmH2O or above to protect renal function.