Long term results of minimally invasive treatment of pilonidal disease by platelet rich plasma.

BACKGROUND: Although, there are several treatment options for treatment of pilonidal disease, nowadays minimally invasive modalities are becoming more common. The aim of this study is to evaluate the results of platelet rich plasma application for pilonidal disease. METHODS: For this prospective cohort study, cases with pilonidal disease were evaluated. All cases that are eligible and accepted to be involved were included in the study. Platelet rich plasma was applied into the pilonidal sinus under local infiltration anesthesia. Healing of the disease and recurrence rates were recorded. RESULTS: The success rate of the application was 97.1% at the first month. With a median follow up of 60.2 months the recurrence rate was 8.2%. CONCLUSION: Platelet rich plasma can be safely used for treatment of pilonidal disease with high success and low recurrence rate.

The effect of fundus resection on weight loss and ghrelin levels in rats.

BACKGROUND: Ghrelin is a 28-amino acid peptide that is isolated mainly from the oxyntic glands of the stomach, especially fundus. Ghrelin administration, either centrally or peripherally, increases food intake and body weight in both rodents and humans. This study evaluates the effects of fundus resection and sclerosing agent injection on ghrelin level and weight loss. MATERIAL AND METHODS: Thirty rats were divided into three groups. In group 1, NaCl was injected into the submucosal space at the gastric fundus while in Group 2, a sclerosing agent was injected into the latter site. In group 3, gastric fundus was resected. Ghrelin levels and weight were recorded. RESULTS: In group 1, rats continued gaining weight and ghrelin levels stayed stable. In group 2, rats' weight and ghrelin levels stayed stable and in group 3, while weight stayed stable, ghrelin levels decreased significantly. CONCLUSION: In rats, the resection of fundus stabilizes weight gain and decreases ghrelin levels. However, in sclerotherapy, although weight gain was stabilized, there was no decrease in ghrelin levels. In humans, the effect of fundus resection on weight gain can usher in a new era of investigation (Tab. 2, Ref. 16).

Serum estradiol/free testosterone ratio can be important predictor for varicose vein recurrence in men.

AIM: Recurrent varicose veins are a frustration for both the patient and the surgeon. More investigation of the exact diagnosis, proper practice, and causes for the recurrence of varicose veins is needed. METHODS: We investigated a total number of 187 patients in a five year period with an estradiol-2/free testosterone (E2/fT) ratio relationship on recurrent varicose veins in men between the ages of 20-50. Fifity years was the maximum age due to the age dependent sex steroid hormone regression that occurs after this age, which may interefere with the assessment. Fifty three men with an elevated E2/fT ratio (group A), and 143 men with no endocrinologic problems (group B) were enrolled in the study and had surgery for varicose veins. After 5 years follow up (mean 3 years), Group A (N.=29) and group B (N.=43) had recurrent varicose veins by clinical and radiologic findings. Venous blood samples were driven from all patients of both groups in the morning to detect the levels of serum E2 and fT levels. Patient history of surgery for varicose veins, physical examination, color duplex ultrasound of both limbs, and classification of CEAP were performed in both groups. RESULTS: The serum E2/fT ratio was significantly higher in Group A (5.21 ± 0.56) compared to group B (2.54±0.27) in the recurrent varicose vein groups (p ≤ 0.05). Moreover, there was a high correlation between serum E2/fT ratio and the CEAP clinical classification in group A (5) compared to group B (2) (P≤0.05). Also, recurrence rate was higher in group A (54%) compared to group B (32%)(P≤0.05). CONCLUSION: Elevated serum E2/fT ratio is a precipitating factor for recurrent varicose veins in male patients.

Three complications of Pair (puncture, aspiration, injection, reaspiration) in one case: Recurrent hemobilia, cyst infection and pneumonia.

INTRODUCTION: With the appropriate indications, puncture, aspiration, injection and reaspiration (PAIR) is the most effective minimal invasive method used in the treatment of hydatic cysts. Hemobilia is the hemorrhagia in bile ducts in consequence of any reason. In literature there is no case with hemobilia because of PAIR. This is the first case with recurrent hemobilia, infection in cyst cavity and pneumonia because of PAIR. CASE: A 66 years old female patient was admitted to hospital with complaints of abdominal pain, hematemesis and melaena. She gave the history of PAIR for two hydatic cysts. At physical examination, there were jaundice, tenderness at right subcostal area and melaena at rectal digital examination. Hemobilia was detected by abdominal ultrasonography and magnetic resonance cholangiopancreaticography (MRCP). An endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy were performed. The patient was discharged after 6 days hospital stay. One day after the discharge the patient was admitted to hospital with the same complaints again. Performing ERCP and balloon extraction, the hematoma filling the common bile duct was removed. After the patient was hemodynamically stable for 3 days, she was discharged from the hospital. A week after that the patient was admitted to hospital with the clinical findings of infected hydatic cyst and pneumonia. The patient was treated medically with mechanical ventilation support for 8 days. CONCLUSION: It should not be underestimated that, there can be serious complications of PAIR like hemobilia. Therefore, PAIR should be performed only in centers having appropriate medical and surgical facilities.

Using oxidant and antioxidant levels to predict the duration of both acute peripheral and mesenteric ischemia.

OBJECTIVE: The aim of this study was to determine the relationship between oxidative stress markers and the duration of ischemia in rat mesenteric and peripheral ischemia models. METHODS: Forty rats were divided into five equal groups, as follows: rats in Group I (control group) were sacrificed to determine the baseline characteristics of the serum markers; the superior mesenteric artery was clamped via a simple laparotomy to induce mesenteric ischemia in Groups II and III; the right common femoral artery was clamped to induce peripheral ischemia in Groups IV and V. Blood samples were taken at 2 (Groups II and IV) and 6 (Groups III and V) hours after these procedures. The serum total oxidative status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and paraoxonase-1 (PON-1) enzyme activities were evaluated in the samples obtained from each group. RESULTS: The OSI level of the control group was 91.00±5.46 (mean ± SD). The OSI levels taken 2 hours after the induction of mesenteric ischemia and peripheral ischemia were significantly higher (194.50±11.16 and 301.75±19.98, respectively (p<0.05)). However, these levels decreased to 151.88±17.02 (mesenteric ischemia) and 108.88±9.46 (peripheral ischemia) after 6 hours. The PON-1 levels of Group III (mesenteric ischemia at 6 hours) (99.75±7.26), Group IV (peripheral ischemia at 2 hours) (96.88±4.09), and Group V (peripheral ischemia at 6 hours) (111.25±10.33) were slightly elevated over that of the control group (87.38±5.31). However, the PON-1 level of Group II (mesenteric ischemia at 2 hours) (42.88±3.14) was lower than that of the other groups (p<0.05). CONCLUSION: Despite the increment of oxidative markers in early periods of ischemia (2(nd) hour), which was a hypoxic response of ischemic cells, they have decreased markedly in prolonged ischemia. This might have been caused by the opening of some collateral circulation or the destruction of the ischemic cells.

Serum ischaemia-modified albumin level is an irrelevant predictive factor for ischaemic duration in mesenteric ischaemia.

BACKGROUND: Acute mesenteric ischaemia is an emergency condition that requires urgent and expeditious diagnosis and immediate surgical or medical intervention. The initial hours are critical for the recovery of the affected bowel segment. Thus, its clinic diagnostic biomarkers are important when it comes to reducing mortality and morbidity rates. METHODS: Twenty-four male Sprague-Dawley rats were included in the study. The rats were divided into three equal groups. Those in Group I were sacrificed to determine the basal serum values of ischaemia-modified albumin (IMA) after a simple laparotomy. The superior mesenteric artery (SMA) was clamped in a simple laparotomy in Groups II and III; blood samples were taken at 120 minutes in Group II and 360 minutes in Group III. The serum IMA levels were identified from the blood samples and the results obtained were compared statistically. RESULTS: The serum IMA levels were determined to be 22±6 (22) µ/L, 34±7 (34) µ/L and 36±4 (37) µ/L in Groups I, II and III, respectively. The differences between the groups were not statistically significant. CONCLUSION: Our results showed that the serum IMA level is not an appropriate biomarker for acute mesenteric ischaemia. Additionally, the IMA level is not an appropriate biomarker for the detection of ischaemia duration. However, future studies should be conducted to clarify the efficacy of serum IMA levels under different ischaemic conditions.

Iloprost reduces myocardial edema in a rat model of myocardial ischemia reperfusion.

OBJECTIVE: Myocardial ischemia severely reduces myocyte longevity and function. Extensive interstitial edema and cell damage occur as a result of myocardial reperfusion injury. Current therapies are directed at prevention of ischemia-induced damage to cardiac tissue. Iloprost is a novel pharmaceutical agent for the treatment of ischemia. METHODS: Twenty rats were segregated into four experimental groups. The procedure control group consisted of four rats undergoing a sham operation. The remaining 16 rats were divided into two equal groups. The first group (control group) received a continuous intravenous infusion of physiological serum immediately prior to the procedure. Iloprost was administered by a continuous intravenous infusion into the right jugular vein at an infusion rate of 100 ng/kg/min for 30 minutes prior to reperfusion in the experimental group (study group). Following the infusion treatments, ligation of the left coronary artery was conducted for 30 minutes to induce myocardial ischemia. The rats were euthanized 24 hours after reperfusion and cardiac tissue was harvested from all specimens for analysis. RESULTS: Histological examination revealed three myocardial tissue specimens with grade II damage and five myocardial tissue specimens with grade III reperfusion injury in the control group. However, the study group consisted of two grade III myocardial tissue specimens, five grade II myocardial tissue specimens and one grade I myocardial tissue specimen. Moreover, a statistically significant reduction in myocardial edema was observed in the study group (p=0.022). CONCLUSION: Our results support the hypothesis that iloprost enhances protection against cardiac ischemia reperfusion injury. This protective effect may be associated with vasodilation, antioxidant or anti-edema mechanisms.

A high oxidative stress index predicts endothelial dysfunction in young male smokers.

Experimental studies have shown that smoking was related to endothelial dysfunction via oxidative stress. However, the degree of oxidative stress to be associated with endothelial dysfunction is unknown. Oxidative stress index (OSI) might be a useful and easy way of determining the endothelial dysfunction. Hence, we aimed to evaluate the relationship between OSI and flow mediated dilatation (FMD) in smoking healthy male volunteers. Eighty smoking healthy male volunteers were enrolled in the study. Participants were classified as having normal and abnormal FMD response. In an univariate analysis; systolic and diastolic blood pressures, C-reactive protein (CRP), low-density lipoprotein cholesterol, OSI and lipid peroxidation (LPO) levels were predictive for abnormal FMD response. In a multivariable logistic regression analysis with forward stepwise method, OSI (OR: 3.194, 95% CI: 1.710-5.966, p<0.001) and CRP (OR: 2.082, 95% CI: 1.101-3.939, p 0.024) were found to be independent parameters for predicting abnormal FMD response in young male smokers. The optimal cut-off value of OSI for detecting abnormal FMD response was found to be >3.35, with 100 % sensitivity and 84.1 % specificity. We have shown that critical endothelial dysfunction can easily be detected by OSI in individuals, at risk for developing coronary artery disease, such as smokers (Tab. 3, Fig. 3, Ref. 30). Text in PDF www.elis.sk.

Evaluating the effectiveness of spleen autotransplantation into the liver and the omentum.

BACKGROUND: Experimental research into the viability and functionality of splenic tissue placed in the liver and the omentum. METHODS: There were 4 groups in this study. First group: sham laparotomy, 2nd group: splenectomy, 3rd group: splenectomy and splenic autotransplantation into the greater omentum and 4th group: splenectomy and splenic autotransplantation into the liver. Blood levels of haemoglobin, leukocytes, thrombocytes, immunoglobulin G (IgG), immunoglobulin M (IgM) and complement protein 3 (C3) were studied 1 day before and 6 weeks after the procedure. At the end of 6 weeks, scintigraphy was performed. Splenic tissue in the liver and the omentum were subjected to macroscopic and histopathologically. RESULTS: Pre- and postoperatively, no significant differences were found in terms of haematological and immunological measurements of groups I, III and IV. An increase in the numbers of thrombocytes and leukocytes and a decrease in the levels of IgG, IgM and C3 were observed in the postoperatively in group II.When the postoperative hematological and immunological values of the second group are compared to those of groups III and IV, the difference was significant in terms of levels of thrombocyte, leukocyte and IgM; insignificant in terms of levels of IgG and C3. In the microscopic and scintigraphic analyses the spleen tissue was found to be viable in all of the six rabbits in groups III and IV. CONCLUSIONS: The liver is a suitable organ for splenic autotransplantation (Tab. 6, Fig. 2, Ref. 17).

Minimally invasive parathyroidectomy under local anesthesia.

BACKGROUND: More than 85% of primary hyperparathyroidism (PHPT) cases are due to solitary, benign parathyroid adenomas. Recently, the success rate of Tc99m sestamibi scintigraphy in localization has made minimally invasive parathyroidectomy (MIP) more prominent. MIP is as effective as conventional bilateral neck exploration. Moreover, it offers lower morbidity, cost effectiveness, and better cosmetics effects. AIM: We aimed to evaluate the success of MIP, which happens only under local anesthesia, in this study. MATERIALS AND METHODS: Total of 63 patients were operated for PHPT, of which 54 had solitary adenoma. Five patients underwent bilateral neck exploration under general anesthesia for thyroid nodules or unlocalizated adenomas. A total of 49 patients underwent MIP under local anesthesia without any sedation. During MIP, gamma probe was used for all patients. The patients were followed for parathyroid functions. RESULTS: The mean age of 49 patients with MIP (5 male, 44 female) was 59 years. The mean follow-up time was 16.4 (±10.1) months (range: 2-36 months). Of the 49 patients, 47 (96%) were totally cured. In 2 patients, the procedure was switched to conventional bilateral neck exploration. Temporary hypocalcaemia was noted in 4 patients. CONCLUSIONS: If the adenoma is localizated, MIP under only local anesthesia can be performed with a high success rate. Gamma probe-guided MIP under local anesthesia is an effective and safe method. It has the advantage of being minimally invasive and, therefore, it should be preferred over the conventional method.

A comparison of sutureless and antibacterial suture abdomen closure.

PURPOSE: This experimental study aimed at comparing the cyanoacrylate abdomen closure to the effectiveness of triclosan coated polidioxanone abdomen closure. METHODS: The abdomen layers were closed with 3/0 polidioxanone suture in the first group. In the second group, the layers were closed with triclosan coated polidioxanone suture in a single layer. The abdomen layers of rats in the third group were attached with cyanoacrylates without sutures. The rats were sacrificed on the 14th day and the adhesive level was recorded. The incision resistance strength was measured. The tissue was examined blindly in the terms of inflammatory cell infiltration, capillary proliferation, fibrosis and micro-abscess by the pathologist. RESULTS: No significant difference was determined between the 1st and 2nd groups in the terms of inflammatory cell infiltration, capillary proliferation, collagen deposition, fibroblast activity, adhesive and tissue distension strength. The fibrosis and adhesive rate of the 3rd group was significantly higher than the 1st and 2nd groups statistically. The tissue distension strength was lower than in the other groups and the differences between the groups were found to be significant (p < 0.05). No significant difference was determined between the groups in the term of micro-abscess. CONCLUSIONS: Antibacterial suture is not superior to the conventional suture. It is concluded that cyanoacrylate is not an appropriate molecule for abdomen closure (Tab. 1, Fig. 3, Ref. 17).

Hartmann colostomy with LigaSure.

PURPOSE: While LigaSure is commonly used for blood vessel closure, our aim was to research the effectiveness of using the latter tool for the purpose of closing intestines in rats. METHODS: Twenty Wistar albino rats were divided into two groups per 10 each. In Group 1, the sigmoid colon was cut from its middle and its distal was closed with 4/0 silk. In Group 2, on the other hand, the sigmoid colon was divided from the middle with LigaSure LS1200 probe and its distal was closed with LigaSure. In both groups, the proximal sigmoid colon was entered by means of colostomy with 4/0 silk to the left part of the abdomen. Operation durations, adhesion levels and explosion pressures were recorded. Tissue samples were taken for tissue hydroxyproline level. RESULTS: While the average duration of the operation was 25.7 minutes in Group 1, it was 18.8 minutes in Group 2 and the difference between them was significant in favour of LigaSure. (p<0.001). Stump explosion pressure was 181.4 (160-190) mmHg in average in the suture group (Group 1), and 173.3 (150-190) mmHg in the LigaSure group (Group 2) and the difference between them was not statistically significant. Tissue hydroxyproline level was 123.6 (13-232) in Group 1, and 123.3 (32-216) in Group 2 and no significant difference was determined between the groups. Adhesion level between the groups was also similar. CONCLUSIONS: This study experimentally shows that the duration of effective stump closure as part of Hartman colonostomy can be shortened with LigaSure (Tab. 1, Fig. 4, Ref. 12).

Diagnosis and follow up of patients with primary cardiac tumours: a single-centre experience of myxomas.

OBJECTIVE: In this study, 12 patients who were diagnosed as having cardiac tumours and were operated on in the Department of Cardiovascular Surgery following referral from the Department of Cardiology were enrolled between January 1995 and October 2007. METHODS: The symptoms, clinical findings, diagnostic methods, localisation of masses and surgical applications were recorded retrospectively. RESULTS: There were 10 female (83%) and two (17%) male patients; their ages ranged from 35 to 70 years (mean 68.7 years). Twelve patients were diagnosed with myxomas, nine of which were located within the left atrium and three in the right atrium. The most common symptoms at clinical presentation were those associated with heart failure or embolisation. Diagnosis of the tumours was made by echocardiography in all patients. The masses were completely resected in eight patients and the interatrial septae were partially excised with mass resection in two patients. The defect was reconstructed with a pericardial patch in one of the patients, and primarily reconstructed in the other. We carried out debridement with mass resection in another case. Femoro-popliteal aorto-iliac thrombo-endarterectomy was performed with mass resection in a further case. CONCLUSION: Atrial myxomas are the most common primary cardiac tumours. They can cause valvular or inflow-outflow tract obstruction, thrombo-embolism, arrhythmias, or pericardial disorders. Most atrial myxomas are benign but due to non-specific symptoms, early diagnosis may be a challenge and they must be removed by surgical resection. Diagnosis and follow up with the collaboration of cardiology and cardiovascular surgery departments is important for meticulous care of these patients.

Is the naphthalene sulfonate H-acid biodegradable in mixed microbial cultures under aerobic conditions?

Synthetically prepared wastewater originating from the H-acid (4-Amino-5-hydroxy-2,7-naphthalene disulfonic acid) manufacturing process was subjected to respirometric analysis for evaluating the level of achievable biodegradation in the presence of this commercially important azo dye precursor. For this purpose, H-acid was mixed with synthetic substrate having the same characteristics as sewage at a concentration and composition being typical for H-acid manufacturing wastewater. Experimental results indicated that H-acid was not biodegradable under activated sludge treatment conditions even after prolonged acclimation periods. The results were also confirmed by model evaluation of oxygen uptake rate profiles. H-acid also did not inhibit the biodegradation of synthetic sewage but accumulated as soluble inert COD in the treated wastewater.

Type I plasminogen activator inhibitor 4G allele frequency is associated with chronic venous insufficiency.

Chronic venous insufficiency (CVI) is a common disease associated with poor quality of life. Genetic polymorphisms causing coagulation abnormalities may account for some of the CVI pathogenesis. Type I plasminogen activator inhibitor (PAI-1) is responsible for fibrinolytic system regulation, and plasma levels of PAI-1 are strongly correlated with PAI-1 4G/5G gene polymorphism. The association between PAI-1 4G/5G gene polymorphism and CVI was investigated. In 34 consecutive patients with clinically overt CVI, the PAI-1 4G/4G polymorphism was detected in three cases (8.8%); the 4G/5G polymorphism was detected in 28 (82.4%). In 34 age- and sex-matched controls, the PAI-1 4G/4G polymorphism was detected in one case (2.9%) and the 4G/5G polymorphism was detected in 14 cases (41.2%). The PAI-1 4G allele was found significantly more frequently in CVI patients than in controls. The 4G allele was associated with a 3.25-fold increase in CVI risk. Thus, a relationship between CVI and the PAI-1 4G allele is apparent.

COD fractionation of tannery wastewaters--particle size distribution, biodegradability and modeling.

This study aims to establish the scientific link between particle size distribution (PSD) and biodegradability of different COD fractions of tannery wastewater, by means of sequential filtration/ultrafiltration, respirometric analysis and model evaluation. PSD profiles were determined in physical segregation experiments, using eight membrane discs, each with different pore sizes between 2 and 1600 nm. Biodegradability-related COD fractionation was determined at each size interval by model simulation and calibration of the corresponding oxygen uptake rate (OUR) profiles. Activated Sludge Model No. 3 (ASM3), modified for direct growth on hydrolysis products, was adopted for evaluation. PSD analyses defined a COD fingerprint with two significant portions at the two ends of size distribution, with 60% of the total COD at the particulate range, 25% at the soluble range and the remaining 15% well distributed among the colloidal range. Comparative evaluation of the sequence of OUR profiles yielded values of applicable model coefficients. It also enabled the assessment of size distribution for each major COD fraction, as an original tool for better interpretation of specific biodegradation characteristics of the selected tannery wastewater. Results also revealed a very slowly biodegradable/residual particulate COD component with a significant inhibitory effect. Model-based evaluation of the OUR profiles enabled quantifying the impact of inhibition in terms of changes in rate coefficients for growth, hydrolysis of soluble COD and endogenous decay.

Respirometric assessment of biodegradation characteristics of the scientific pitfalls of wastewaters.

This paper provides an overview of common problems encountered when using oxygen uptake rate (OUR) measurements for the assessment of wastewater characteristics and process kinetics. Emphasis is placed upon pitfalls that would lead to significant errors. It covers model dependency of the OUR measurements and the need to select appropriate models; interpretation of OUR perturbations as a way to identify new model components and processes; the need for simultaneous observation of relevant model components and multicomponent modelling for appropriate evaluation of OUR measurements; parameter identifiability problems and the effect of active biomass concentration and the endogenous decay rate on model simulation and calibration. Relevant experimental OUR data from previous studies are presented to illustrate and underline common scientific pitfalls.

Effect of biochemical storage on the denitrification potential of acetate in sequencing batch reactors.

This study evaluates the effect biochemical storage on the denitrification potential (N(DP)) of acetate. The fate of bacterial storage is evaluated in a sequencing batch reactor system operated in a sequence of anoxic/aerobic phases, fed with acetate as a pulse and continuously under anoxic conditions. N(DP) is defined based on system stoichiometry both for direct growth and storage on acetate. Experimental results do not support conceptual calculations based on system stoichiometry, yielding a higher denitrification potential, N(DP), for continuous feeding than the N(DP) obtained with pulse feeding, due to partial utilisation of the stored PHB within the anoxic phase. The nitrate, acetate and poly-beta-hydroxybutyrate (PHB) profiles obtained in the experimental studies were used in model calibrations for two different feeding patterns. Results of model simulations confirm the experimental results and evaluate the effects imposed on the denitrification potential by sludge age and the anoxic volume ratio.